The problem of diagnosis needs an objective and dialectical understanding, that is, from a big perspective, it is not difficult to distinguish whether it is diagnosed as chronic rhinitis and its main types. If there are problems at this level, most of them are the social attributes of doctors, and a small part are professional and technical problems; What specific types of chronic rhinitis can be subdivided after diagnosis (at present, chronic rhinitis can even be subdivided into more than 50 specific types in the world) is more to test the knowledge level of doctors, but fortunately, there are not many patients with special types of chronic rhinitis.
So how to correctly understand and treat the most common refractory chronic simple rhinitis? First of all, we should correct our mentality, build up confidence, and overcome impetuousness and quick success, because this is the premise and guarantee to persist in correct treatment and avoid being cheated. Abandoning the unrealistic thinking mode of "going with children" and "radical cure", it is best to learn some relevant medical knowledge, understand nasal physiology such as nasal concha, and know that rhinitis is not only related to local factors of nasal cavity, but also closely related to systemic factors. The advantage of this is that it can avoid more passive outcomes such as drug-induced rhinitis caused by wrong treatment and over-treatment. We should learn to accept the idea that transient nasal congestion, runny nose and other symptoms that occur under certain conditions or time periods such as cold (also known as acute rhinitis), cold stimulation and pregnancy are normal physiological reactions rather than chronic rhinitis. At this point, no treatment or short-term symptomatic treatment can be given. Excessive attention and long-term overdose will lead to more and more serious symptoms and even separation. In addition, for chronic rhinitis caused by similar systemic factors such as heart, liver, kidney and thyroid dysfunction, the treatment should also focus on the primary disease. It is not satisfactory to make a fuss about the nasal cavity. If the primary disease is controlled, the nasal symptoms will naturally be alleviated.
At present, studies at home and abroad show that chronic rhinitis is ultimately related to allergic reaction, which is often called allergic reaction. Therefore, unless complicated by bacterial and viral infections, the routine use of antibiotics (so-called anti-inflammatory drugs) is unreasonable and ineffective. At present, the main drugs are nasal corticosteroids and antihistamines. Here, we need to overcome the popular thinking cycle of fear of hormones and antibiotics. When it comes to hormones, it is associated with obesity and femoral head necrosis, but it does not hesitate to abuse antibiotics. The standard usage of nasal spray hormone is to spray it twice every nostril every morning, preferably to the upper part of the nasal cavity. Note that this medicine is not a magic medicine, and it can be effective after it cannot be used. 4-6 hours at the earliest, lasting more than half a month. It is best to use 1-2 months, and one of budesonide, mometasone furoate and fluticasone propionate can be selected. For critically ill patients, short-term systemic corticosteroids can also be used to strengthen treatment. Attention should be paid to the use under the guidance of a doctor. Generally, it can be taken orally. Prednisone tablet is 0.5mg/kg body weight, taken once in the morning for 5 ~ 7 days. The second generation of antiallergic drugs, such as levocetirizine hydrochloride, desloratadine, ebastine, etc. , can be taken orally before going to bed, 1 ~ 2 weeks is 1 course of treatment.
For mild nasal congestion, just drip or spray normal saline or hypertonic saline (2% ~ 3%) into the nasal cavity, and the treatment effect is good. Because it does not contain pharmaceutical ingredients, it is also suitable for infants, pregnant women, lactating women, the elderly and other people with weak physique. Even for severe or surgical patients, it is a good auxiliary treatment and nursing method, which is worthy of praise.
For severe nasal congestion, decongestants (nasal ventilators) such as oxymetazoline hydrochloride can be used as short-term alternative treatment in the initial treatment of drug-induced rhinitis, but the instructions must be read, and the use should be controlled, and gradually transition from less use to no use. When using, you should also pay attention to it. If you can use it through one nostril, don't use it at both sides at the same time. As long as ventilation is acceptable, don't pursue excessive ventilation. Children generally can't use it, and individual children can only use low-concentration dosage forms under the guidance of doctors. We should be fully aware of the dangers of drug-induced rhinitis caused by the abuse of decongestants, and be alert to the dangers of banned decongestants such as naphazoline and ephedrine, as well as counterfeit drugs that actually add the above ingredients without labeling under the banner of pure Chinese medicine. The characteristic of this kind of drugs is that they can greatly improve nasal ventilation in a few minutes, but after long-term use, the effect of these drugs will become worse and worse, or it will become a so-called dependence and rebound phenomenon. Long-term addictive use will not only not cure chronic rhinitis, but will disturb the normal physiological cycle of turbinate and excessive proliferation of turbinate, make the condition worse and irreversible, and turn ordinary chronic rhinitis into drug rhinitis that is more difficult to treat.
In the treatment, some details should also be paid attention to. Often see the same method, the same drug treatment, the same disease can not get the same effect. The reason may be specific details. As the saying goes, details determine success or failure.
First of all, we must establish good compliance. Studies have confirmed that trust between doctors and patients can determine the curative effect of 10%. If you think that long-term nasal spray of hormones has no feeling, fishing for three days and drying the net for two days, or if you don't use it often, such as decongestant, you will use it for a while, and the effect will naturally be unsatisfactory. In addition, the order of medication is also very important. Usually, when the nasal congestion is serious, spray decongestant into the nasal cavity to open the nasal door, then rinse the nasal cavity with normal saline, and then spray nasal hormone after washing the nasal secretions, so as to remove the side effects of the drugs to the maximum extent and retain the positive effects of the drugs. It seems that mentality, knowledge and learning ability also play an important role in the treatment.
Finally, talk about the surgical treatment of chronic rhinitis. The best operation is better than no operation, because the operation itself can not eliminate inflammation, and can only be used for some cases of chronic hypertrophic rhinitis that cannot be improved by drug treatment. Most patients will get better and more stable curative effect than surgery after long-term standardized treatment. To overcome the misunderstanding that surgery is the best treatment, don't be superstitious about the so-called no hospitalization, no bleeding, no pain and one-time radical cure. Any treatment, including medication, is not without side effects. As a simple criterion for patients with chronic rhinitis to measure whether they should be operated, it is whether the nasal congestion is persistent, including even if decongestants are used. As long as the drug can relieve, there is generally no hurry for surgery. Teenagers and children are highly sensitive to drug treatment, and the operation is difficult and the mucosal damage is great, which may lead to long-term loss of nasal function. They should be extremely cautious in sinus surgery, especially children should consider whether there is adenoidal hypertrophy. At present, the operation is usually performed under nasal endoscope. During the operation, the normal structure should not be destroyed as much as possible, only some irreversible hyperplasia lesions should be treated under the mucosa, and the mucosa and its function on the surface of the turbinate should be strictly preserved to achieve the ideal curative effect of less trauma. It is more important to standardize medication before and after operation. Standardized drug preparation before operation is helpful to correctly evaluate the necessity and scope of operation, reduce intraoperative bleeding and collateral damage, and relieve postoperative symptoms. Both doctors and patients should resolutely oppose the wrong behavior of performing surgery without any preparation for treatment, because some operations can be completely replaced by drug treatment, so we might as well try drug treatment for one month first, and the damage to the physiological function of the nasal cavity may be irreversible for life.