Sinusitis is an acute or chronic infectious and inflammatory disease of the accessory nasal cavity of the allergic, viral, bacterial or fungal nature of the onset. The inflammatory process can affect the epithelium of the mucosa of one, two or more of any paranasal sinuses from one or both sides of the nose.
Sinus called accessory, or paranasal, sinuses, which are air cavities of small sizes, located in the bones of the brain and facial parts of the skull. Each sinus communicates with the nasal cavity. With sinusitis, the epithelium lining one or more cavities becomes inflamed, which leads to characteristic clinical manifestations. Such a process can be independent, for example, with allergies, or proceed as a complication of acute viral or bacterial infections.
There are four groups of sinuses, named according to their location: the frontal, maxillary and latticework maze, which are paired, as well as the unpaired sphenoid sinus. Children older than 7-10 years and adults are diagnosed more often with damage to the maxillary sinuses, in the second place – latticed, then frontal. The sphenoid sinus inflames much less often. According to statistics, up to 10% of the total population of the world suffers from one type of sinusitis. The disease is detected in 0.2% of adults and about 0.5% of children of different ages.
The mechanism of sinusitis in adults
Inflammation of the mucous sinus, caused by infection or other etiological factors, is accompanied by edema. The glands begin to actively produce a large amount of mucus, which, accumulating in the sinuses due to narrowing of the anus of the paranasal cavities, thickens. The sinuses cease to be fully purified. As a result of stagnation of secret, violation of natural ventilation and oxygen deficiency in the sinus tissues, favorable conditions are created for the vital activity of the opportunistic flora that causes a chronic infectious process.
At the beginning of the disease, the discharge from the nose is serous, and as the inflammation develops, they become mucus-serous. Purulent exudate, which includes a large amount of detritus and leukocytes, is observed when an infection of a bacterial nature is attached. In this case, pronounced puffiness is accompanied by a violation of the permeability of the capillary walls.
Acute sinusitis can last up to 2 months. And longer, ending either with recovery, or with a transition to a chronic form, in which there is a persistent change in the membranes of the mucosa. This increases the patient’s tendency to frequent sinus infections.
Classification of sinusitis
Types of sinusitis relative to the location of the inflammatory process:
- Sinusitis is an inflammation of both or only one maxillary subclavial cavity.
- Etmoiditis is a pathological process in the cells of the latticed bone.
- Frontite – infection of the frontal sinus mucosa.
- Sphenoiditis is an inflammatory lesion of the sphenoid sinus.
Forms of the disease relative to the severity of the symptoms:
- Light form;
- Of medium gravity;
The nature of the current can be:
The gradation of sinusitis, depending on the etiologic factor:
Forms of the disease regarding the nature of inflammation.
- Serous form;
- Parieto-hyperplastic form;
- Holostomnaya form;
Depending on the prevalence of the process, sinusitis occurs:
- One-sided – can be right-sided or left-sided;
- Bilateral – simultaneous defeat of paired sinuses on both sides of the nose;
- Polysynusitis – an inflammatory process of several accessory cavities;
- Monosynusitis – a lesion of the mucosa of one sinus;
- Gemisinusit – simultaneous involvement in the process of all paranasal cavities located on one side of the face;
- Pansinusitis is the most severe form of the disease, characterized by the defeat of all sinuses.
Symptoms of sinusitis in adults
The severity of the symptoms depends on the type, form and extent of the disease. Manifestations of sinusitis are local and common.
- weakness, weakness, fatigue;
- increase in temperature: with an acute sinusitis febrile temperature is noted (up to 38.9 ° C and above), with chronic – subfebrile, not rising above 37.5 ° C, or normal;
- loss of appetite;
- cephalgia – pain in the head;
- sleep disturbance.
Local signs, characteristic of any type of sinusitis:
- A runny nose with stuffy nose and secretions of a different nature;
- Obstruction of nasal breathing;
- Coughing, sneezing, other manifestations of infection;
- Loss of smell;
- Dry epithelium of the nasal cavity.
Signs of genyantritis
In acute maxillary sinusitis, the symptomatology is expressed. In addition to the general signs of the patient’s intoxication, the pain in the affected area of the maxillary sinus and the cheekbones, irradiating into the corresponding half of the face, the temple, the upper jaw, and the forehead. Palpation of the maxillary sinuses is painful. With bilateral sinusitis, breathing through the nose becomes almost impossible. As a result of blockage of the lacrimal canal, tearing begins. Liquid, serous discharge from the nasal passages becomes turbid and viscous, and then purulent with an unpleasant odor.
In chronic sinusitis, which is the outcome of acute, manifestations are more flattened. The temperature is normal or slightly increased. Spreading or pressing pains in the head appear due to a disturbance of the outflow from the maxillary sinus. According to the patient, the pain is often “behind the eyes”. It decreases in the supine position due to a partial restoration of the escape of the pus of their sinuses, is strengthened by pressing on the area under the eyes, lifting the eyelids.
Often, the patient is disturbed by a night cough, caused by pus flowing down the posterior wall of the pharynx from the maxillary sinus. Possible swelling, maceration, cracks, revealed on the eve of the nose.
Symptoms of ethmoiditis
The temperature is usually increased. The patient complains of pressing pain in the bridge of the nose, near the root of the nose, head and eyes, insensitivity of odors. Nasal breathing is difficult due to edema, first separable serous, then purulent. An acute process often affects the orbit, provoking the development of the edema of the eyelids and protrusion of the eyeball. Children often have reddening of the conjunctiva, swelling of both the upper and lower eyelid.
The etoiditis of the posterior parts of the labyrinth is in most cases accompanied by sphenoiditis. Inflammatory lesion of the epithelium of the anterior parts of the labyrinth of the latticed bone is accompanied by sinusitis and frontalitis.
Signs of the frontitis
Lesion of the frontal sinus is more severe than other sinusitis. The patient is suffering because of intense, sometimes unbearable pain in the projection of the frontal sinuses and throughout the head, intensifying in the morning hours. Pain becomes stronger with pus accumulation in the frontal sinuses, weaken after their emptying. Characteristic: high temperature, pronounced mucosal edema, difficulty with nasal breathing, abundant discharge from the nasal passage from the side of the lesion.
Some have pain in the eyes, swelling of the upper eyelid and the superciliary area on the side of the inflamed sinus, a change in skin pigmentation on the forehead. The photophobia develops, the sense of smell decreases.
For chronic frontitis, hypertrophy of the epithelium of the middle nasal passage is characteristic. Sometimes the process goes to the bone structure, as a result, fistula and necrosis areas are formed.
Symptoms of sphenoiditis
Inflammation of the wedge-shaped cavity is usually accompanied by the defeat of latticed sinuses. Patients are concerned about pain in the nape, parietal region, depth of the head, and also in the orbit. Despite the erasure of the symptoms of chronic sphenoiditis, inflammation can affect the optic nerves, causing a progressive decline in vision.
Treatment of sinusitis in adults
Treatment is mostly conservative, but surgical intervention is not excluded. The main goals of sinusitis treatment:
- Eradication (complete destruction) of the causative agent in the event that the inflammation is caused by an infectious agent;
- Elimination of other provoking factors, for example deformations of the structures of the nose;
- Relief of symptoms of sinusitis;
- Restoration of normal sinus drainage;
- Prevention of complications;
- Prevention of the transition of acute sinusitis into a chronic form.
With a mild to moderate sine syndrome, the patient does not need to be hospitalized, the treatment is performed on an outpatient basis under the supervision of an otorhinolaryngologist. Severe course and some cases of moderate severity with complications require in-patient treatment in the specialized otolaryngology unit.
Etiotropic therapy is the leading in the treatment. It is aimed at eliminating the specific pathogen that caused the inflammatory process.
Bacterial sinusitis is treated with antibiotics. Before the beginning of therapy with the help of bacteriological analysis, the type of bacterium is revealed and to which antibiotic it is sensitive. Assign drugs from the group of semisynthetic penicillins (ampicillin, amoxicillin, ampioks), cephalosporins (cefsol, cephalexin, cefuroxime, ceftibuten), macrolides (roxithromycin), fluoroquinolones (sparfloxacin, levoflox), etc. They are usually used orally, in severe cases, intramuscularly .
Also, a doctor can prescribe antibiotic Avelox 400 mg.
Etiotropic therapy of viral sinusitis consists in the use of an antiviral agent (neovir, isoprinosine or arbidol).
The main treatment of fungal sinusitis is reduced to the use of antimycotics (miconazole, etc.).
Disease of the allergic nature is stopped by taking antihistamines (tavegil, suprastin).
Complex treatment includes:
- Anti-inflammatory drugs (eryspal);
- Sulfonamides (biseptol, sulfadimethoxin);
- Vasoconstrictive drugs (sanorin, naphthysine), saline sprays, corticosteroids used intranasally.
Physiotherapy is prescribed after the acute phase of the illness subsides approximately 6-7 days from the appearance of the first signs. Diadynamic currents, solux, UHF and microwave therapy are effective, ultraphonophoresis, heating of the inflamed sinus area with a blue light lamp, inhalation.
The method of sinus-evacuation is used mainly for the moderate form of sinusitis. The procedure is to wash the sinus with a sinus catheter consisting of two tubes and the same number of small cylinders. Antiseptic is fed into the cavity through a single tube, and sucked along with pus through the other.
The puncture of the maxillary sinus with the installation of drainage is required with a protracted process. Manipulation is necessary for the outflow of pus through the established thin tube, regular rinsing of the cavity and administration of drugs.
Surgical treatment is indicated if the above methods of conservative therapy are ineffective.
Options for surgical intervention:
- Laser destruction of polyps in the nose;
- Operation Caldwell-Luc;
- Radical operation on Killian;
- Interference by the method of Dzerkera-Ivanova;
- Balloon synoplasty.
Prophylaxis of sinusitis
At the heart of prevention is the timely treatment of the underlying disease, leading to the development of sinusitis (acute respiratory viral infection, influenza, allergies, scarlet fever, dental diseases), and elimination of risk factors (atresia of the nasal cavity, curvature of the nasal septum, etc.).
- Hardening of the body;
- Sanitation of the oral cavity;
- Avoidance of hypothermia.