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Sinusitis in adults: symptoms, signs, treatment


Sinusitis is one of the types of inflammation of the paranasal sinuses, or rather, inflammation of the maxillary sinus, often the result of inadequate treatment of colds and infectious diseases.

What is the maxillary sinus?

Sinusitis in adults The maxillary sinus is a paired adnexal cavity located on both sides of the nose in the body of the maxillary bone, which is the largest in terms of the nasal sinus.

With age, the size and shape of the maxillary sinus increases significantly. This cavity is a four-sided pyramid of irregular shape, bounded by the front, orbital, inner and rear wall. The bottom of the maxillary sinus is the base of this pyramid, and its volume depends on the wall thickness (in the large maxillary sinus, the walls are rather thin, and in the small sinus, on the contrary, they are very thick). It should be noted that sometimes paired accessory cavities are asymmetrical.

Normally, the maxillary sinus communicates with the nasal cavity, takes part in the formation of nasal breathing, smell and voice (its resonance).

How does sinusitis develop?

In the case when acute respiratory diseases, dental diseases or allergic reactions involve the maxillary sinus in the inflammatory process, this can lead to the development of sinusitis. This condition arises due to the characteristic anatomical structure, or rather, the connection of the maxillary sinus with the nasal cavity by means of fistulas (small holes that contribute to the continuous circulation of air inside the paranasal sinuses). The mucosa of the fistula due to the development of the inflammatory process swells and begins to produce an increased amount of secretion (this is a kind of protective reaction), which clogs the exits from the nasal sinuses and disrupts the normal process of nasal breathing.

Classification of sinusitis in adults

Inflammation of the maxillary sinuses in adults can have an acute and chronic course. At the same time, sinusitis, depending on the extent of the spread of the pathological process, can be one- and two-sided, and the nature of inflammation - purulent or catarrhal.

Acute sinusitis is a disease whose average duration is 2-4 weeks. According to the form of the flow, it can be catarrhal (edematous), purulent and necrotic (the most severe form with an aggressive course).

Chronic sinusitis is diagnosed if the duration of the disease is more than 4 weeks.

Inflammation of the maxillary sinuses, as a rule, occurs not in isolation, but in combination with other sinuses, but signs of the lesion of the maxillary cavities predominate. In the mild form of the disease, the mucous membrane of the sinus is involved in the inflammatory process, and with the development of complications, the inflammation can go to the periosteum and bone.

What is odontogenic sinusitis?

If the infection penetrates the maxillary cavity from the carious teeth located in the upper jaw, the patient is diagnosed with odontogenic sinusitis. This condition, provoked by conditionally pathogenic microflora living in the oral cavity, occurs in case of development of periodontitis or osteomyelitis of the upper jaw, with unsuccessful extraction of a diseased tooth, suppuration of cysts, and also with very deep damage to the canals of the dental roots. For this form of pathology, proceeding as an acute or chronic process, the stages of exacerbation and remission are characteristic.

What is purulent sinusitis?

In the event that the maxillary sinus is inflamed and purulent contents accumulate in it, it is a purulent sinus. In this situation, due to a strong edema of the tissues, the outflow of pus from the maxillary cavity is hampered, which leads to a sharp deterioration in the patient's condition. This is a very dangerous condition in which pus can break into the region of the brain cranial region or into the cavity of the eye orbit with subsequent formation of sepsis, intracerebral abscesses, inflammation of the periosteum and bones.

Symptoms of acute sinusitis in adults

The most characteristic signs of acute inflammation of the maxillary sinuses are:

  • Constant nasal congestion;
  • The development of edema and redness in the eyelids;
  • Bursting or pressing facial pain in the upper jaw, radiating to the forehead, teeth and root of the nose. Sometimes they are confused with toothache;
  • Severity in the region of the maxillary sinus;
  • Difficult to separate mucopurulent discharge from the nose with an unpleasant odor;
  • Symptoms of general intoxication, fever and toxicosis;
  • Increased pain when pressing on the upper jaw or when bending the head.
  • Unproductive cough.

Symptoms of chronic sinusitis in adults

With inadequate or completely absent treatment of acute sinusitis in adults develops a chronic form of the pathological process. The presence of infection in the region of the nasopharynx, as well as various anomalies of nasal development can contribute to the formation of this condition. The most characteristic symptoms of chronic sinusitis include:

  • Frequent headaches of oppressive nature;
  • Constant nasal congestion, which is practically not relieved by vasoconstrictor preparations;
  • Mucopurulent nasal discharge with an unpleasant odor;
  • Disturbance or complete loss of smell.

In clinical practice, there are several types of chronic antritis:

  1. Hyperplastic sinusitis is a pathological condition in which there is a thickening of the mucous membrane of the maxillary sinus. As a result, the lumens of the paranasal sinus narrow, and the passage of air through these natural airways is impeded.
  2. Atrophic sinusitis is a disease in which the mucous membrane of the maxillary cavity atrophies and stops functioning normally.
  3. Polypous sinusitis is a condition that develops as a result of the formation of grape-like soft growths on the maxillary sinuses, which completely fill their cavity. In clinical practice, these tumors are called polyps.
  4. Mixed antritis is a pathology in which areas with various types of inflammation are found on the mucous membrane of the maxillary sinuses.

Sinusitis during pregnancy

The development of sinusitis during pregnancy is a very dangerous condition. Therefore, in order to prevent complications and not harm the unborn child, it should be treated at the first signs of inflammation of the maxillary sinuses.

It should be emphasized that in pregnant women, the disease can sometimes occur without characteristic symptoms. However, sinusitis often makes itself felt by fever, severe headaches, sore cheeks, nasal congestion, and symptoms of general intoxication.

In order to diagnose the nature of the pathological process in pregnant women, they are assigned to an ultrasound of the paranasal sinuses or radiography through them (X-rays and MRI are contraindicated in this situation). However, these diagnostic methods, unfortunately, are not 100% effective. Therefore, most often for the detection of sinusitis, pregnant women under local anesthesia are punctured the maxillary sinus. Also, a relatively good new diagnostic technique, nasal endoscopy, which is performed in specialized hospitals, has also proved itself well.

Diagnosis of sinusitis in adults

  1. Consultative examination by an otolaryngologist, which includes examination of the nasal passages using special mirrors (rhinoscopy).
  2. X-ray of the paranasal nasal cavities.
  3. Computed tomography of the paranasal sinuses (in particularly difficult cases that are not amenable to diagnosis).
  4. Blood test for analysis.
  5. Puncture of the maxillary sinuses followed by examination of the resulting contents.
  6. MRI, thermal imaging and thermography are used as additional diagnostic methods in clinical practice.

Conservative treatment of sinusitis in adults

It should be noted that each specific case of sinusitis requires a complex of specific therapeutic measures. Very often, in acute inflammation, it is quite enough to prescribe a patient for bed rest, regularly clean the nasal cavity from mucous secretions, use antiviral agents, and use local vasodilators for a few days in the form of nasal sprays or drops.

However, if the patient's condition does not improve within 1-2 weeks, and pus begins to mix with the mucous discharge from the nose, pains occur in the upper jaw, the nasal congestion does not pass, and the body temperature rises, then it is mandatory for him to prescribe antibiotic therapy , puncture of the maxillary sinus with its subsequent washing and anti-inflammatory agents. For washing the maxillary sinus, a physiological solution or solution of furacillin, boric acid, etc. is used. Antibacterial preparations are then injected into the inflamed sinuses.

With the development of chronic antritis, the patient is given a course of enhanced antibiotic therapy. In parallel, the treatment should be used sulfonamide and vasoconstrictor drugs, as well as physiotherapy procedures (inhalation, UHF, Solux lamp, etc.).

In the case when chronic sinusitis cannot be cured by conservative methods, the patient is prescribed a surgical operation involving the removal of purulent contents or polyps.

Surgical treatment of sinusitis

According to specialists and patients, a surgical method for the treatment of sinusitis is a very effective technique. Currently, the most popular endoscopic method, in which access to the maxillary sinus is carried out directly through the nasal cavity using special endoscopic equipment.

During the operation, the airway is improved, the outflow of mucus and pus is simplified, the nasal congestion is eliminated, the patient's breathing is facilitated and his overall condition and quality of life is significantly improved. It must be emphasized that during endoscopic surgery the maxillary sinus is not subjected to special damage, and therefore it is very quickly restored in the usual way.

After a thorough examination of the condition of the paranasal sinuses, special microtools and a microscopic video camera are introduced into the nasal cavity, which makes it possible to keep the entire process under control and to carry out the most careful surgical intervention. The specialist can observe the entire course of the operation in real time on the monitor screen, and information from the infrared emitter and computer tomograph is also displayed there.

During the operation, infected, swollen and damaged tissues or polyps that have formed inside the maxillary sinuses are removed. However, if it is necessary to create a more wide passage for the outflow of mucus, bone fragments or foreign bodies can be removed to block the nasal passage.

Possible complications of sinusitis

Sinusitis is a very insidious disease that can cause the development of some complications. They develop in the event that the inflammatory process spreads from the maxillary sinus to nearby organs and formations.

If the inflammation touches the brain part of the skull, then this condition can cause the development of encephalitis or meningitis. With the penetration of infection into the cavity of the orbit, ophthalmitis may develop (inflammation of the eye and eye membranes). Also, in some cases, a neglected form of sinusitis can cause the development of sepsis (blood poisoning).

As a rule, complications of the disease occur with inadequate therapy or complete refusal of treatment.

| 22 June 2015 | | 1,338 | ENT diseases
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