1) Disease Description (Causes and Symptoms)
- Definition: Chronic rhinosinusitis (CRS) is a condition in which inflammation of the mucous membranes of the sinuses (air-filled spaces beside the nose) and retention of secretions persist for 3 months or longer.
- Pathophysiology (brief): Mucosal swelling and blockage of the drainage openings → reduced ciliary movement and retention of secretions → persistent bacterial, viral, or hypersensitivity reactions lead to chronic inflammation. When nasal polyps are present, breathing difficulty and impaired sense of smell may become more severe.
- Main causes and risk factors: Allergic rhinitis, recurrent upper respiratory tract infections, asthma, anatomical obstruction (such as a deviated nasal septum), smoking, odontogenic infection, and immunodeficiency.
- Typical symptoms: Malaise, nasal congestion (nasal obstruction), purulent nasal discharge (pus-like nasal mucus), postnasal drip (secretions passing down the back of the throat), facial pain or pressure, and reduced sense of smell (decreased or lost sense of smell).
- Relevant departments: Otorhinolaryngology, allergy and immunology.
2) Treatment Methods (Including Standard Treatment, Medication, Procedures/Surgery, Lifestyle Management) and Precautions
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Conservative and medication treatment (first-line)
- Saline nasal irrigation (normal saline irrigation): Fundamental for daily management and symptom relief.
- Topical corticosteroid preparations (nasal sprays: fluticasone, mometasone, etc.): Essential for suppressing chronic inflammation.
- Oral corticosteroids: May be used for a short period (e.g., 1–3 weeks) for severe nasal polyps or acute exacerbations; caution is needed with long-term use because of side effects.
- Antibiotics: Administered selectively when a bacterial acute exacerbation is suspected (in cases of purulent nasal discharge, fever, and severe pain). Generally, first-line drugs according to local guidelines (e.g., amoxicillin-clavulanate) are selected. For recurrent or refractory cases, culture-based treatment is recommended.
- Long-term low-dose macrolides (selective use): May be considered in some patients when an anti-inflammatory or immunomodulatory effect is expected, but their indications and supporting evidence are limited.
- Biologics: Used when chronic rhinosinusitis with nasal polyps recurs despite medical treatment and surgery (e.g., dupilumab), after considering the indications, cost, and side effects.
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Procedures and surgery
- Functional endoscopic sinus surgery (ESS): Performed when symptoms do not improve despite appropriate medical treatment, when acute exacerbations recur, when complications occur (spread to the orbit or intracranial spread), or when anatomical obstruction is the cause.
- Balloon sinus dilation: May be used in selected situations to improve mild obstruction.
- Postoperative management: Active saline irrigation, continued use of topical corticosteroids, and, when necessary, consideration of endoscopic removal or revision surgery.
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Lifestyle management and prevention
- Avoid smoking, prevent indoor air from becoming dry (humidification), avoid allergens (when allergies are present), and treat oral and dental infections.
- Regular saline irrigation and continued use of topical corticosteroids are recommended.
- Long-term use of nasal decongestants (fast-acting nasal sprays or nasal drops), usually for more than 3–5 days, may instead worsen symptoms (rhinitis medicamentosa), so caution is needed.
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Precautions and complications
- Emergency signs: Immediate emergency medical care is needed if there are vision changes, severe swelling or pain around the eyes, altered consciousness, high fever, or severe headache (possible orbital infection or intracranial complications).
- Surgery-related complications: Bleeding, Eustachian tube injury, CSF leakage (extremely rare), and possible recurrence.
- Long-term complications: Rare but severe complications such as orbital infection, osteomyelitis, and meningitis may occur.
3) Outpatient Visit Checkpoints (Items to Bring · Examples of Key Information to Report During the Visit)
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Items to bring
- A list of currently used medications (including prescription, nonprescription, and sprays), with dosages and duration of use.
- Copies of previous test results (such as sinus CT scans and endoscopic images) and surgical records, if available.
- Symptom diary: When symptoms began, patterns of worsening or improvement, color and amount of nasal discharge, changes in the sense of smell, presence of fever, and effects on sleep and daily life.
- Information about coexisting conditions: Asthma, allergies, diabetes, immunodeficiency, and other conditions, as well as records of recent dental treatment.
- Allergy test results, if available.
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What healthcare professionals will mainly ask about during the visit (examples)
- When symptoms first began and whether they have persisted for 3 months or longer.
- Medications used previously (antibiotics and corticosteroids) and whether they were effective.
- Whether there is breathing difficulty or worsening asthma, whether there is fever, and whether there are vision changes or orbital symptoms.
4) Examples of General Questions to Ask the Doctor
- What are the expected effects and side effects of this medication (nasal corticosteroid／antibiotic／oral corticosteroid)?
- When do you recommend surgery (endoscopic sinus surgery)? What are the prognosis and recovery period?
- What lifestyle habits should I change in daily life to help improve my symptoms?
- What should I do to reduce the risk of recurrence?
5) Examples of Condition-Specific Questions (1–2)
- Do I have nasal polyps in my case? If I have polyps, is it likely that they can be adequately controlled with medication, or are surgery or biologics (e.g., dupilumab) needed?
- I have used antibiotics several times before, but they were not effective. Do I need a culture test or personalized (precision) treatment? Are there many cases that can be resolved with surgery?