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医生坐门诊时，经常遇见这样的病人
病人经常头痛
在内科做了头颅CT后
没有发现脑部任何异常
却被内科医师告知来看耳鼻喉科
这时耳鼻喉科医生已经怀疑病人患上鼻窦炎
这是怎么回事呢？
因为头痛是急性鼻窦炎最常见的表现之一，也是临床常见的症状。部分鼻窦炎病人，往往以头痛为单一的临床表现，常常首诊于神经内科。
01 | 什么是鼻窦炎？
鼻窦包括上颌窦、筛窦、额窦和蝶窦，这些鼻窦黏膜发炎统称为鼻窦炎。鼻窦炎可分为急性和慢性两种，急性鼻窦炎多由急性鼻炎发展而来，患者主要以鼻塞、多脓涕、头痛为临床表现；慢性鼻窦炎常继发于急性鼻窦炎，主要表现为流脓涕，可伴有轻重不等的鼻塞、头痛及嗅觉障碍。鼻窦炎是由病毒、细菌或真菌引起的鼻窦感染。
02 | 不同部位鼻窦炎头痛表现？
1.急性上颌窦炎：发病时患者常会有患侧面颊部、前额部疼痛，在站立或午后头痛加重，平卧位时头痛可减轻。
2.急性筛窦炎：窦位于眼内眦两侧，头痛程度一般较轻，位置多在内眦间及眶内上角，有反射痛。
3.急性额窦炎：引起的头痛特点较为明显，初期可表现为全头痛，之后逐渐局限于前额部，并有明显的时间规律，晨起后开始头痛，近中午时头痛达高峰，程度十分剧烈。
4.急性蝶窦炎：急性蝶窦炎的疼痛位于眼球深部，可反射至头顶中央和后枕部，严重者可伴有头昏和眩晕。
03 | 如何诊断鼻窦炎？
主要根据典型的症状（如鼻塞、流脓涕、头痛等）以及副鼻窦CT、鼻内镜等检查。
鼻窦炎中医称为鼻渊，一般分三型：
第1型 肝胆郁热型
这种孩子的鼻涕是黄脓稠的，一般伴随扁桃体肿大，平素打呼噜，口臭，大便干结，性格急燥，不怕冷，手足心热。
第2型 脾胃痰湿型
鼻涕白黄少，然后肌肉偏软，乏力，舌苔偏厚，大便溏，小便清长。
第3型 肺脾气虚
这一型病程往往比较迁延，鼻涕清多黄少，乏力怕冷，喜静不爱动，平素懒洋洋，注意力不集中。
04 | 鼻窦炎的治疗
（1）短期全身使用抗生素推荐用于慢性鼻窦炎急性加重期。中医中药治疗以散风清热、芳香通窍为主，以解毒去瘀为辅。
（2）改善鼻窦引流常用含1%麻黄素的药物滴鼻，收缩鼻腔，改善引流。急性鼻窦炎还可以通过体位改变进而改善鼻窦的通气引流而减轻头痛。
（3）鼻腔冲洗可以清除鼻腔分泌物。
（4）病因治疗如为牙源性上颌窦炎应同时治疗牙病。
（5）黏液促排剂治疗可以使用黏液促排剂，改善分泌物性状并易于排出。
如果保守治疗效果欠佳的患者，可考虑鼻内镜下手术治疗。
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