Ferguson B J
Department of Otolaryngology, Eye and Ear Institute, Pittsburgh, PA 15213, USA.
Postgrad Med. 1995 May;97(5):45-8, 51-2, 55-7.
Patients with acute sinusitis often have purulent nasal discharge, facial pain, and congestion, whereas those with chronic sinusitis have more subtle signs. Infection, hyperreactivity reactions, anatomic obstruction, and underlying disease are among the causes and must be differentiated before appropriate care can be offered. Plain films and sinus transillumination may provide clues in adults but are of little value in young children. Computed tomography is much more sensitive but should be reserved for patients in whom maximal medical therapy has failed, who have a confusing presentation, or who are being considered for endoscopic surgery. Antibiotic therapy is still effective for bacterial infections, but penicillin-resistant organisms are on the increase. If there is no clinical improvement in 3 days, an agent with a broader spectrum of activity should be considered. A combination of agents and prolonged administration may be required for chronic sinusitis, and patients with recurrent symptoms may need endoscopic surgery. Such adjunctive agents as decongestants and saline or steroid nasal sprays may promote drainage. Antihistamines have no role in the treatment of sinusitis.
急性鼻窦炎患者通常有脓性鼻涕、面部疼痛和鼻塞，而慢性鼻窦炎患者的症状则较为隐匿。感染、高反应性反应、解剖学阻塞及基础疾病都是病因，在提供恰当治疗前必须加以区分。成人的鼻窦平片和透照检查可能提供线索，但对幼儿价值不大。计算机断层扫描更为敏感，但应仅用于接受最大程度药物治疗失败、临床表现不明确或考虑接受内镜手术的患者。抗生素治疗对细菌感染仍然有效，但耐青霉素的病原体在增加。如果3天内无临床改善，应考虑使用活性谱更广的药物。慢性鼻窦炎可能需要联合用药及延长给药时间，症状反复的患者可能需要内镜手术。减充血剂、盐水或类固醇鼻喷雾剂等辅助药物可能促进引流。抗组胺药在鼻窦炎治疗中不起作用。
