Obvious pain, diffuse redness and swelling in the nasal vestibule, and may have cracks and superficial erosion

Fever, dryness and itching in the nasal vestibule; sparse nasal hair in the nasal vestibule, local skin thickening, and scab formation.

The most common one is the nasal vestibule; it manifests as red, swollen, hot and painful nodules, usually limited to one side, which may be accompanied by low-grade fever and general malaise, followed by spontaneous progressive pain; when mature, a yellow pus head can be seen on the top, and may appear after ulceration The pus drains out, after which the inflammation gradually subsides

Chondritis of the nose and tip, cellulitis of the upper lip and cheek, orbital cellulitis, intracranial infection

Thrombophlebitis of the cavernous sinus: When the nasal boil is squeezed, the infection can reach the cavernous sinus retrogradely through the small veins without valves, facial veins, and superior/inferior ophthalmic veins; clinical manifestations include chills and high fever, Severe headache, eyelid/conjunctival edema on the affected side, fixed proptosis, and papilledema, which can be life-threatening in severe cases

Immature boils: anti-inflammatory and analgesic (local hot compress, physical therapy, antibiotic ointment, fish stone ointment)

The boil is mature: wait for it to ulcerate naturally or cut it to drain the pus (do not cut the surrounding infiltrated parts and do not squeeze it)

Boil ulceration: local cleaning and disinfection, drainage promotion, antibiotics

Pay appropriate attention to rest, use antibiotics and analgesics, and traditional Chinese medicine treatment as appropriate

Cavernous sinus thrombophlebitis: hospitalization; adequate, effective antibiotics

The incubation period is 1 to 4 days; early manifestations include nasal itching, irritation, burning sensation (acute nasal sympathetic irritation syndrome), and dry nasal cavity; later, systemic symptoms (such as fatigue, headache, chills, loss of appetite) appear, followed by nasal congestion. Sexual aggravation, sneezing, and increased nasal discharge (watery → mucopurulent)

Symptoms usually subside and disappear after 1 to 2 weeks; however, purulent discharge may occur when combined with bacterial infection, and the condition may be delayed.

Initially, the nasal mucosa is widely congested and dry. Later, the nasal mucosa becomes swollen and produces watery/mucoid/mucopurulent secretions. There is also often congestion in the pharynx.

The essential

Topical corticosteroid nasal spray (first-line drug), decongestants (only used when accompanied by acute infection), nasal saline irrigation; systemic antibiotics can be considered if the inflammation is obvious and accompanied by a large amount of secretion reflux.

Indications: significant persistent nasal obstruction symptoms that are ineffective with drugs and other treatments

Surgical procedure: resection of the inferior turbinate bone with preservation of the inferior turbinate mucosa or removal of the entire inferior turbinate fracture; methods of resection of the inferior turbinate or damage to the inferior turbinate mucosa and submucosal drug injection into the inferior turbinate are not recommended

Dry nose/nasopharynx, nasal congestion, loss of sense of smell, headache and dizziness, foul-smelling breath (late and severe cases; deformed rod

Bacterial fermentation produces indole, also known as "ozena"), tinnitus and hearing loss, dry throat/hoarseness/irritating dry cough

The nasal cavity is wide (the nasopharynx can be seen directly from the front nostril), the nasal mucosa is obviously dry, there are scabs in the nasal cavity, the scabs are green and have a foul smell, and the turbinates are obviously atrophied; in severe cases, the external nose may be deformed.

The original upper respiratory tract symptoms worsened, including irritability, chills, fever, headache, listlessness, and drowsiness.

Nasal congestion: one of the most common symptoms

Runny nose: mostly purulent; often with a rancid smell in cases of odontogenic maxillary sinusitis

Olfactory disorders: mostly temporary

local pain

Physical examination: turbinate swelling, purulent discharge, local tenderness/percussion pain in the affected sinus wall

sinus imaging

Antibiotics (but not irrigation with topical antibiotics), topical corticosteroids, mucus inducing agents

Negative pressure replacement therapy, sinus puncture and irrigation (maxillary sinus), nasal lavage

Four major symptoms: main symptoms (nasal congestion, mucopurulent nasal discharge); secondary symptoms (loss of sense of smell, fullness and heaviness in head and face)

Diagnosis: Choose 2 from 4. Lasts >12w, but must have one of the main symptoms

Mucopurulent discharge from middle meatus/olfactory cleft (VS chronic hypertrophic rhinitis)

Sinus X-ray: changes in sinus cavity morphology, varying degrees of thickening of the sinus mucosa, increased sinus cavity density/polyps, and fluid levels can be seen

Sinus CT: It is the most direct and accurate diagnostic method, but it is not a necessary condition for diagnosis; it can show the location and scope of the lesion, and even make a qualitative diagnosis (such as the presence of calcification plaques indicating fungal sinusitis)

CRS-wp requires surgical treatment; CRS-np requires at least 12 weeks of drug treatment first, and surgery is chosen only when it is ineffective.

Dual-path anti-infective treatment: local glucocorticoids and systemic low-dose long-term macrolides for >12w;

CRS-wp requires additional systemic glucocorticoid therapy <2w, >4w systemic antihistamines, mucus excretion promoter: >12w

Decongestants: In principle, their use is not recommended unless acute infection occurs and severe congestion and edema of the nasal mucosa affects breathing. They can be used <1w

Maxillary sinus puncture and irrigation

Traditional sinus surgeries: such as the Ke-Lu operation (radical maxillary sinus surgery), intranasal ethmoidectomy, transmaxillary ethmoid surgery, frontal sinus trephination; no longer used

Functional endoscopic sinus surgery (FESS): mainly to relieve obstruction of the sinus orifice complex

Seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR)

Intermittent (symptoms occur <4d/w or disease duration <4w), persistent (symptoms occur >4d/w or disease duration >4w)

Mild (symptoms are mild and have no impact on quality of life), moderate to severe

Typical symptoms: nasal itching, paroxysmal sneezing, large amounts of watery nasal discharge, nasal congestion (bilateral, varying severity)

Other symptoms: Seasonal allergic rhinitis may cause conjunctival congestion, loss of sense of smell, and lower respiratory tract symptoms; non-seasonal allergic rhinitis usually occurs when cleaning the room, arranging clothes, or coming into contact with pets (related to exposure to dust mites)

General examination: Seasonal allergic rhinitis may have eyelid swelling, conjunctival congestion, nasal mucosa edema/pale, watery/mucoid nasal discharge, and turbinate enlargement; non-seasonal allergic rhinitis may show dark red/pale nasal mucosa. Blue/pale, edema/polypoid change at the front of the middle turbinate, and inferior turbinate hypertrophy; lung wheezing can be heard when accompanied by chest tightness and asthma; more eosinophils can be seen in nasal secretion smears, and hypertrophy can be seen in nasal mucosa scrapings cells, basophils

Specific IgE measurement: positive allergen skin test (more reliable diagnostic basis), positive serum specific IgE measurement

Bronchial Asthma

allergic pharyngitis

secretory otitis media

sleep disordered breathing syndrome

Antihistamines: the first choice for mild intermittent/persistent rhinitis; including oral drugs (cetirizine, loratadine), nasal sprays (levocabastine, azelastine)

Glucocorticoids: the drug of choice for moderate to severe intermittent/persistent rhinitis; intranasal preparations are commonly used, and systemic application is only used for a small number of severe patients with seasonal exacerbations; for those with pollen allergies, preventive use can be started 2 weeks before the onset of illness each year. Antihistamines can be added during the onset of disease

Decongestants: mostly used locally in the nose to treat nasal congestion; but caution is required when using anticholinergics: mostly used in patients with severe runny nose; such as ipratropium bromide

Mast cell membrane stabilizers: such as sodium cromoglycate, nidocorol

Mechanism: Inhibits the transformation of T cells into Th2 cells thereby reducing the production of Th2 type cytokines

Indications: Persistent rhinitis and asthma that are ineffective in conventional drug treatment

Contraindications: ① Combined with persistent asthma or acute asthma exacerbation; ② Patients are taking beta-blockers; ③ Combined with other immune diseases; ④ Children under 5 years old; ⑤ Pregnant women

Reduce sensitivity of nasal mucosa: laser irradiation of turbinate mucosa, chemical cauterization

Reduction of nerve excitability: intranasal selective neurotomy