Hildenbrand Tanja, Milger-Kneidinger Katrin, Baumann Ingo, Weber Rainer
Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center - University of Freiburg, Freiburg, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Medical Clinic V - Pneumology, Munich, Germany; Department of Otorhinolaryngology, Heidelberg University Hospital, Heidelberg, Germany; Division of Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Hospital Karlsruhe, Karlsruhe, Germany; Sinus Academy, Karlsruhe, Germany.
Dtsch Arztebl Int. 2024 Sep 20;121(19):643-653. doi: 10.3238/arztebl.m2024.0167.
Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by local chronic inflammation of the mucous membranes of the nose and paranasal sinuses. It affects approximately 5% of the population.
This review is based on relevant publications retrieved by a selective search of the literature, with particular attention to current national and international guidelines.
CRS is defined by, and diagnosed on the basis of, a combination of symptoms and objective findings of nasal endoscopy and imaging studies. It markedly impairs quality of life and gives rise to both direct and indirect health care costs. In 20-45% of cases, CRS is associated with comorbid bronchial asthma and a significantly elevated risk of further diseases (e.g., COPD, OR 1.73; depression, HR 1.50; obstructive sleep apnea, OR 1.91; carcinoma, OR 1.14-5.30). CRS is primarily treated medically with topical steroids (standardized mean difference of nasal symptoms, -0.63 (95% confidence interval [-0.89; -0.37]; standardized mean difference of quality of life as measured by SNOT -22, -5.46 [-8.08; -2.84]), as well as with nasal lavage and, as an option, systemic steroids (and antibiotics where appropriate). If appropriate medical treatment fails to bring about adequate and sustained improvement, endoscopic sinus surgery is indicated. This improves the individual symptoms, the overall symptom score, and patients' quality of life. Severe refractory CRS with nasal polyposis can be treated with biological agents.
CRS calls for individually adapted medical and/or surgical treatment.
慢性鼻-鼻窦炎（CRS）是一种异质性疾病，其特征为鼻腔和鼻窦黏膜的局部慢性炎症。它影响着约5%的人口。
本综述基于通过选择性文献检索获取的相关出版物，特别关注当前的国家和国际指南。
CRS通过症状以及鼻内镜检查和影像学研究的客观结果相结合来定义和诊断。它显著损害生活质量，并产生直接和间接的医疗保健费用。在20%至45%的病例中，CRS与合并支气管哮喘相关，且进一步患其他疾病的风险显著升高（例如，慢性阻塞性肺疾病，比值比1.73；抑郁症，风险比1.50；阻塞性睡眠呼吸暂停，比值比1.91；癌症，比值比1.14 - 5.30）。CRS主要采用局部类固醇药物进行药物治疗（鼻部症状的标准化平均差为 -0.63（95%置信区间[-0.89；-0.37]）；用SNOT -22量表测量的生活质量标准化平均差为 -5.46[-8.08；-2.84]），同时进行鼻腔冲洗，也可选择全身用类固醇药物（以及在适当情况下使用抗生素）。如果适当的药物治疗未能带来充分且持续的改善，则需进行鼻内镜鼻窦手术。这可改善个体症状、总体症状评分以及患者的生活质量。伴有鼻息肉的重度难治性CRS可用生物制剂治疗。
CRS需要个体化的药物和/或手术治疗。
