Knutson J W, Slavin R G
St. Louis University School of Medicine, Missouri, USA.
Drugs Aging. 1995 Oct;7(4):310-6. doi: 10.2165/00002512-199507040-00006.
Sinusitis is a common medical condition in the elderly; however, the clinical presentation is often subtle and the condition may not be readily diagnosed. The most important clinical clue to the diagnosis of acute sinusitis is the continuation of symptoms after a typical cold has subsided. In chronic sinusitis there is often a distinct lack of symptoms, although most patients will have nasal obstruction and purulent post-nasal drip. On physical examination, the patient with sinusitis will have thick, purulent, green or deep yellow secretions in the nasal passages. The use of radiographic imaging, such as sinus roentgenograms or CT scans, will help confirm the diagnosis. The goal of treatment of sinusitis is eradication of infection with clearance of the infected material from the sinuses. While the use of an appropriate antibiotic is necessary, the use of ancillary therapy is also of utmost importance. Steam and nasal saline, decongestants, topical corticosteroids and mucoevacuants are given in an attempt to reduce nasal obstruction, increase sinus ostia size, promote improved mucociliary function, decrease mucosal inflammation and thin secretions. In selected patients who fail to respond to aggressive medical therapy, functional endoscopic surgery can often provide relief. In patients with poorly controlled asthma, treatment of underlying sinusitis has been shown to dramatically improve the asthmatic state.
鼻窦炎在老年人中是一种常见的病症；然而，其临床表现往往较为隐匿，病情可能不易被诊断出来。诊断急性鼻窦炎最重要的临床线索是在典型感冒症状消退后症状仍持续存在。在慢性鼻窦炎中，通常明显缺乏症状，尽管大多数患者会有鼻塞和脓性鼻后滴漏。体格检查时，鼻窦炎患者的鼻腔内会有浓稠、脓性、绿色或深黄色分泌物。使用鼻窦X光片或CT扫描等影像学检查有助于确诊。鼻窦炎的治疗目标是根除感染并清除鼻窦内的感染物质。虽然使用适当的抗生素是必要的，但辅助治疗也至关重要。给予蒸汽和鼻腔生理盐水、减充血剂、局部皮质类固醇和黏液促排剂，试图减轻鼻塞、增大鼻窦开口大小、促进改善黏液纤毛功能、减轻黏膜炎症并使分泌物变稀薄。在一些对积极药物治疗无反应的特定患者中，功能性内窥镜手术通常可以缓解症状。在哮喘控制不佳的患者中，治疗潜在的鼻窦炎已被证明能显著改善哮喘状态。
