鼻炎怎么治？慢性鼻炎-鼻窦炎的防治
慢性鼻-鼻窦炎(chronic rhinosinusitis，CRS)：是指鼻腔和鼻窦粘膜的慢性炎症，临床表现为粘脓性前鼻涕和（或）后鼻涕，鼻塞，面部疼痛（可为压迫感或胀满感）和嗅觉减退等，症状持续时间在12周以上。由急性鼻窦炎或鼻腔粘膜的炎症反复发作，未能彻底治愈而迁延所致。CRS病因复杂，但就目前的研究发现有：（1）感染因素；（2）解剖因素，如粘膜的纤毛受损，解剖的异常等；（3）变应性的反应或其他的免疫疾病；（4）环境因素（微生物、化学物、药物、外伤和外科手术）；（5）代谢因素，如阿司匹林耐受不良；（6）医源性因素等。CRS的诊断依据包括：（1）具有粘脓性前鼻漏和（或）后鼻漏，鼻塞，头面部疼痛（可为压迫感或胀满感）和嗅觉减退等，症状持续时间在12周以上，其中有2个或2个以上的临床症状（2）鼻内镜检查见鼻道粘膜水肿，有粘脓性分泌物，伴或不伴有息肉；（3）CT检查示窦口鼻道复合体（OMC）和（或）鼻窦粘膜的炎症性改变。
病因治疗：找出全身和局部病史，及时治疗慢性疾病，改善生活和工作环境，锻炼身体提高机体抵抗力。
一、局部用药
（1）鼻内糖皮质激素：如雷诺考特（布地奈德鼻喷雾剂），伯克纳（丙酸倍氯米松鼻喷雾剂），辅舒良（丙酸氟替卡松鼻喷雾剂），内舒拿（糠酸莫米松鼻喷雾剂），急性鼻窦炎至少3个月，慢性鼻-鼻窦炎应用至少6个月，但注意应用于6岁以上儿童及成人。
（2）鼻内减充血剂：短期应用利于窦口开放引流，如0.5%-1%麻黄碱生理盐水或达芬霖（盐酸羟甲唑林鼻腔喷雾剂）。按照目前的观点，应当减少或限制减充血剂的应用。因为常规口服减充血剂有造成全身血管收缩的危险，长时间鼻腔局部应用可能引起药物性鼻炎，加重鼻塞。最近，国内专家有关限制滥用麻黄素类鼻腔减充血剂的建议，一般连续应用不超过7天。
（3）生理盐水冲洗鼻腔：应用高渗盐水（2%）冲洗鼻腔，增强粘液纤毛传输功能、减轻粘膜水肿、减少炎性介质、有效地清除鼻腔细菌、机械性清理鼻腔浓缩的粘液，故对缓解CRS的症状有良好的辅助作用。
（4）鼻腔局部应用抗组胺药物：不少学者认为变应性鼻窦炎与CRS有相关性。大约53%的变应性鼻炎患者同时有CRS，故鼻腔可用爱塞平鼻喷剂（氮卓斯汀），但不作为常规使用。
二、全身用药
（1）抗生素：对于CRS推荐使用的抗生素包括：阿莫西林+克拉维酸、克林霉素，氯霉素、甲硝唑+大环内脂类药物，以及新一代喹诺酮类药物，建议用药时间至少21天，可以延长到6-10周。
（2）粘膜促排剂：吉诺通，沐舒坦，仙璐贝，建议用1-3月。
（3）组胺药：若鼻塞、喷嚏、流清涕症状明显可适量用抗组胺药，第一代抗组胺药，如扑尔敏，大多有中枢抑制作用，因此从事精密机械操作和司乘人员应慎用，其次第一代抗组胺药多具有抗胆碱能作用，可导致口干，视力模糊，尿潴留，便秘等；第二代抗组胺药，克服了传统抗组胺药的中枢抑制作用，但同时也带来了一些新问题，如严重的甚至是致命的心脏并发症等；第三代抗组胺药，如西替利嗪，开瑞坦，相对安全，但仍有较小的副作用，都不作为常规用药。
上颌窦穿刺冲洗、置换法，规范的保守治疗无效方可接受手术治疗。
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