- 期刊
鼻及鼻竇炎治療的流程
The Flowchart for Management of Rhinosinusitis
摘要
鼻及鼻竇炎（簡稱鼻竇炎）依病程長短及型式可區分爲：急性鼻竇炎，亞急性鼻竇炎，復發性急性鼻竇炎，慢性鼻竇炎和慢性鼻竇炎之急性惡化等五大類。若依臨床研究及病人照護觀點則區分爲急性疑細菌性鼻竇炎、慢性鼻竇炎無鼻息肉、慢性鼻竇炎併鼻息肉、過敏型黴菌性鼻竇炎四種主要類型；其他可再細分包括急性疑病毒性鼻竇炎、未緩解亞急性鼻竇炎、復發性急性鼻竇炎、慢性鼻竇炎之急性惡化及嗜酸型黴菌性鼻竇炎。 各類鼻竇炎的臨床症狀相似，主要症狀包括鼻塞、鼻漏、臉部充血、臉部疼痛／腫賬感、嗅覺損失及次要症狀包括頭部疼痛、倦怠感、耳賬、咳嗽、牙痛、口臭、發燒等。鼻竇炎的治療，可分爲內科及外科療法：內科療法(medical management)以選擇適當的抗生素爲主，輔以去充血劑、黏液溶解劑、抗組織胺、抗發炎劑及類固醇等藥物或以生理食鹽水施行鼻沖洗或改善可能致病的環境因素；經過積極的內科療法仍失敗的鼻竇炎患者或是鼻竇炎合併立即危險的併發症，則應考慮採用以鼻竇內視鏡手術爲主的外科療法(surgical management)。
並列摘要
Rhinosinusitis was classified as acute, subacute, recurrent acute, chronic and acute exacerbations of chronic rhinosinusitis according to the persistence of disease. In searching definitions for clinical research and patient care, it was also classified as acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Other classification included acute presumed viral sinusitis, unresolved subacute rhinosinusitis, recurrent acute rhinosinusitis, chronic sinusitis with acute exacerbation and eosinophilic fungal sinusitis etc. Symptoms associated with rhinosinusitis include nasal obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip, facial pressure and pain, alteration in sense of smell, cough, fever, halitosis, fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear fullness and clicking), and headache etc. Treatment modality of rhinosinusitis includes medical and surgical management. Medical management involves choosing optimal antibiotics, decongestants, mucolytics, antihistamine, anti-inflammatory agents, and steroids etc. Nasal irrigation with normal saline solution is also helpful. The indication of surgical management includes medical management failure, complication induced by severe rhinosinusitis etc. Functional Endoscopic Sinus Surgery (FESS) is the mainstay of surgical management at present.