鼻竇炎
楊惟婷整理
過敏性鼻炎、感冒、鼻竇炎，有很多症狀都很類似，要如何分辨？如果不理它，會演變為慢性鼻竇炎，甚至引發嚴重的併發症，如腦膜炎嗎？
一、鼻竇是什麼？
鼻竇 (paranasal sinuses) 位於顱骨，人體擁有額竇 (frontal sinus)、蝶竇 (sphenoid sinus)、篩竇 (ethmoid sinus)、上頜竇 (maxillary sinus) 等四對鼻竇。
鼻竇內充滿空氣，鼻竇內的粘膜由一種有分黏液功能的上皮細胞，以及成千上萬的纖毛所構成。上皮細胞分泌的黏液可吸附外來的髒污物質，並藉由纖毛的擺動，將這些黏液往外排出。
鼻竇的功能包括減輕頭部重量、改善吸入空氣的品質（滋潤、加熱空氣等）、提升發聲共鳴、減緩外來力量對臉部造成的傷害等等。
二、鼻竇炎的成因和症狀
鼻竇炎的成因有可能是因為過敏、發炎、感染造成鼻竇開口阻塞，分泌的黏液無法排出，導致細菌在鼻竇中繁殖。
其中最常見的是感冒所引起的鼻竇炎，其他如鼻中膈彎曲、鼻息肉、化學物質的刺激及牙齒感染都有可能引發鼻竇炎。
若罹患鼻竇炎，患者可能會有以下幾種症狀：
- 鼻塞
- 流出黃膿鼻涕，或倒流至喉嚨
- 臉部疼痛、感到腫脹
- 嗅覺減退
- 聞到不明異味
其他症狀還有可能引起發燒、頭痛、疲倦、牙痛、咳嗽。
約有三成的急性鼻竇炎患者會自行痊癒，九成以上的急性鼻竇炎在治療後會痊癒，然而有部分的鼻竇炎會進展為慢性鼻竇炎，甚至進而引發嚴重的併發症。
慢性鼻竇炎 (chronic rhinosinusitis) 意味著病程較久，擁有兩種以上鼻竇炎症狀，且時間達三個月以上，常見已長出鼻息肉等組織增生，造成鼻竇開口阻塞。相較之下，一般的鼻竇炎持續時間通常小於四週。
有別於急性鼻竇炎，慢性鼻竇炎的致病因子較為多元，細菌只是導致發炎的元素之一，而急性鼻竇炎若未經妥善治療，也可能演變成慢性鼻竇炎。
三、鼻竇炎4招改善方法
- 喝熱飲或補充水分可舒緩症狀
- 吸入熱蒸氣，可以嘗試泡熱水澡，或放置溫而濕的毛巾在鼻子上
- 戒菸、拒吸二手煙
- 戴上口罩，隔絕髒空氣與過敏原
還有，患者擤鼻涕時不可過度用力，且一次擤一邊，避免內耳壓改變，使細菌等異物更加深入體內。
若經由醫師指導，患者也可在家自行操作鼻腔沖洗術，這是種利用微溫生理食鹽水沖洗鼻腔，去除過多黏液與過敏物質的方法，可舒緩鼻竇炎症狀。
四、鼻竇炎的藥物治療
急性鼻竇炎通常以藥物治療為主，常見的藥物有以下幾種。
◆抗生素
鼻竇炎最常見的原因為病毒感染引起的上呼吸道感染 (感冒)，稱為病毒性鼻竇炎，單純病毒性感染的鼻竇炎不需用抗生素治療，因為抗生素主要作用是針對細菌。但有部分患者會續發細菌性鼻竇炎，醫師也會根據臨床症狀判斷是否為細菌性鼻竇炎而給予抗生素治療。口服抗生素需服用至少十天，醫師會根據病程調整，需遵照醫師的指示連續服藥，以避免產生抗藥性。
◆抗組織胺
抗組織胺常用於緩解流鼻水的症狀，但是也會使得黏液、鼻涕更為濃稠而不易排出。
◆化痰劑
化痰劑可以使濃稠的黏液、鼻涕變稀，以利於排出。
◆鼻用類固醇噴劑
主要用來緩解流鼻水、鼻塞、鼻子癢等症狀。藥效作用比較慢，通常需要3-5小時候症狀才會緩解，因此需要規律、持續性地使用，效果才會好。鼻用類固醇噴劑副作用小，且能有效消炎。
◆口服去充血劑
鼻竇炎會造成粘膜腫脹，導致鼻竇開口阻塞，引起鼻塞及臉部脹痛感。口服去充血劑可以改善黏膜腫脹的問題，但長期使用會造成依賴性，造成停藥時更為嚴重的粘膜腫脹。
五、鼻竇炎檢查
◆內視鏡檢查
內視鏡是一條具有攝影功能的軟管，醫生會將它從鼻孔放入患者鼻竇內，觀察發炎情形，也可收集鼻竇黏液做進一步的分析。
◆X光檢查
觀察鼻竇內的積液狀況，以及鼻腔結構是否正常。
◆電腦斷層掃描
醫生可藉此得知患者鼻竇內是否有鼻息肉，以及黏液分泌程度、發炎情況等細節。
六、慢性鼻竇炎是什麼？
（一）慢性鼻竇炎成因
除了鼻息肉以及未經治療的急性鼻竇炎，慢性鼻竇炎的危險因子還包括：
◆過敏
不只黴菌可能造成過敏，舉凡塵蟎、動物毛髮、蟑螂等都是典型的過敏原。
◆菸害、空氣汙染
長期吸菸或暴露於二手菸環境、吸入空氣中的有害物質（如二氧化硫、甲醛等），皆會提升罹患慢性鼻竇炎的風險。
◆免疫系統異常
如果患者體內的免疫系統異常，身體無法製造足夠的抗體，容易有反覆的感染現象，若感染部位為鼻腔，就有可能導致慢性鼻竇炎。
（二）慢性鼻竇炎併發症
由於鼻竇位於鼻腔，且分別靠近腦部與眼部，若發炎症狀嚴重，將可能連帶影響上述部位，形成嚴重併發症。
慢性鼻竇炎的併發症包含：
◆腦膜炎
◆部分或完全喪失嗅覺
◆視力受損
（三）慢性鼻竇炎的治療方法
慢性鼻竇炎常見治療方法如下：
1、藥物治療
◆類固醇藥物﹕
類固醇藥物能治療發炎現象，包含慢性鼻竇炎，常見噴劑或口服藥物。
◆抗生素﹕
細菌與黴菌是造成慢性鼻竇炎的原因之一，抗生素可以減少或抑制慢性鼻竇炎致病原。
2、手術治療﹕
藥物是控制病情的第一線治療方法，但有些情況手術治療才能有效改善病情，如長出鼻息肉、鼻竇開口阻塞，這時候藥物通常無法根治，而施行手術可以恢復鼻竇的暢通，讓鼻竇內的黏膜纖毛可以正常通氣、慢慢恢復正常功能。手術後仍須配合醫師的指示服用藥物和其他治療，並且避免菸害和其他的致病因子，才能達到最好手術的效果。
常見的手術方式為「內視鏡鼻竇手術」，目的是以內視鏡移除阻塞鼻竇開口的多餘黏液或鼻息肉，讓鼻竇開口擴大，清除病變組織，恢復鼻竇通道暢通。目前的內視鏡鼻竇手術傷口小、手術時間短、安全性高，患者如需接受手術，可以不用太擔心。
七、學會區別鼻竇炎、過敏性鼻炎及感冒
（一）鼻竇炎
鼻竇炎是因為鼻竇受外來刺激時，鼻竇內的黏膜特別容易充血腫脹，阻塞通往鼻腔的開口，鼻黏膜與纖毛的功能受損而無法將分泌物排出。這些黏液、灰塵累積在鼻竇內，容易引起細菌感染而發炎。
這些外來的刺激，最常見的就是上呼吸道感染所引起的感冒、粉塵、吸菸、乾燥的空氣、與過敏體質者的過敏原。
（二）慢性鼻竇炎
除了本身體質與鼻生理結構的因素之外，有一些情況也可能引起慢性鼻竇炎：
● 拔牙、植牙等手術不小心所引起的感染。
● 因外傷撞及鼻竇，使鼻竇口變形。
若牙齒手術或受傷後的一個月內發現臉部有腫脹、疼痛感或流膿性鼻涕時，應儘速就醫檢查。由於早期植牙手術還不成熟，在植上排牙齒時如果不小心打穿上頷竇，就會造成鼻竇炎。
根據症狀持續時間，1個月內為急性鼻竇炎；1∼3個月以內稱為亞急性鼻竇炎（也有醫師歸類為急性鼻竇炎）；持續超過3個月以上或一年復發4次以上則為慢性鼻竇炎。
不少鼻竇炎患者都會感到臉頰痛或頭痛（靠近前額處），這是因為臉頰的上頷竇及前額的額竇發炎所致，嚴重的話必須動手術將這些發炎的鼻竇腔清洗乾淨，才能緩解這類頭痛。
由於鼻竇與眼、腦距離近，若細菌不慎蔓延，可能會出現眼球蜂窩性組織炎、眼窩膿瘍、腦膜炎等併發症。若發現突然視力變差、眼球紅腫、疼痛、意識不清等症狀，應儘速就醫。
（三）過敏性鼻炎與鼻竇炎
患者常將過敏性鼻炎與鼻竇炎搞混，雖然兩者在症狀上有其重疊的部分，但兩者不是一模一樣的疾病。台南市立醫院耳鼻喉科趙俊智醫師表示，就症狀上來說，過敏性鼻炎常見的症狀有鼻子癢、眼睛癢、打噴嚏、流鼻涕、鼻塞、及鼻塞嚴重時造成的嗅覺減退。而鼻竇炎是細菌或黴菌感染，常見的症狀有黃濃鼻涕、顏面或是面頰疼痛、鼻塞、鼻子內有異味、嗅覺下降或是嗅覺喪失等。
過敏性鼻炎與鼻竇炎兩者在局部構造上也有異。過敏性鼻炎的局部解剖構造呈現潮濕、蒼白及肥厚的下鼻甲(即俗稱的鼻肉) ，而鼻竇炎的局部解剖構造有時可以發現到在中鼻甲及下鼻甲間有黃濃鼻涕流出。此外，鼻竇炎的局部解剖構造有時尚可以發現到有鼻息肉增生(鼻息肉是因慢性發炎增生出來的額外病態組織)。
過敏性鼻炎與鼻竇炎在治療上，也是有所差異。過敏性鼻炎的治療方式，除了避免接觸過敏原、藥物治療及減敏療法等外，亦可以藉由手術方式，以期能減輕患者的症狀。目前針對過敏性鼻炎常用的手術治療方式為鼻部二氧化碳雷射手術、鼻部無線電波射頻手術、鼻部冷觸氣化手術等，如病患尚有嚴重的鼻中膈彎曲，醫師會建議病患採用鼻中隔鼻道成型手術來治療。這些手術在局部麻醉下即可完成，不過要採用何種手術方式，仍需經過詳細的問診及檢查，藉由醫師與病患間的討論，方能擬定適合病患的診療計畫。
（四）過敏性鼻炎和感冒的比較表
| 過敏性鼻炎 | 感冒 | |
| 致病機轉 | 過敏原刺激 | 病毒感染
|
| 症狀 | 流鼻涕、鼻塞、打噴嚏、頭暈、頭痛 | 發燒、流鼻涕、鼻塞、咳嗽、打噴嚏、喉嚨痛、頭暈、倦怠 |
| 治療藥物 | 抗組織胺、類固醇鼻噴劑、血管收縮劑 | 症狀治療藥物
|
| 復原時間 | 依照過敏嚴重程度而定 | 5至7天
|
由於過敏性鼻炎跟一般感冒的症狀很類似，所以出現打噴嚏、流鼻水等症狀時，很多人第一個想到的可能是自己感冒了。
比較容易辨別出的症狀是過敏性鼻炎不會發燒，鼻子相關症狀的持續時間長，鼻子分泌物通常是清稀的水狀。
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