Sinusitis: symptoms and treatment of sinusitis in adults
- Causes of sinusitis
- The mechanism of sinusitis in adults
- Classification of sinusitis
- Symptoms of sinusitis in adults
- Complications of sinusitis
- Diagnosis of sinusitis
- Treatment of sinusitis in adults
- Prophylaxis of sinusitis
Sinusitis (sinusitis) - acute or chronic infectious and inflammatory disease of the adnexal nasal cavity of an allergic, viral, bacterial or fungal nature of the onset. The inflammatory process can affect the mucosal epithelium of one, two or more of any paranasal sinuses from either one or both sides of the nose.
Sinus called accessory, or paranasal, sinuses, which are small air cavity cavities, 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: frontal, maxillary (maxillary) and latticed labyrinth, which are paired, as well as an 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 world's population suffers from one or another type of sinusitis. The disease is detected in 0.2% of adults and about 0.5% of children of different ages.
Causes of sinusitis
The leading role in the development of sinusitis is given to the Pfeiffer rod (Haemophilus influenzae) and pneumococcus (Streptococcus pneumoniae), which are the causative agents of the disease in more than 50% of cases. Less common are hemolytic streptococcus (Streptococcus pyogenes), moraxella (Moraxella catarrhalis), staphylococcus aureus (Staphylococcus aureus), various viruses, fungi and anaerobes.
Causes of sinus inflammation and blockage of their anastomosis:
- Congenital anomalies of the shells of the nose and trellis labyrinth;
- Acquired in the course of life deformations of the structures of the nose that have arisen after unsuccessful surgical intervention, various injuries, chronic inflammation of the nasal mucosa, for example due to hypertrophic rhinitis;
- Acute viral infections;
- Medical and diagnostic intrahospital manipulations: nasotracheal intubation, nasogastric probing, tamponade of the nose;
- The effect of sensitization of the body, manifested in the form of allergic vasomotor rhinitis or seasonal rhinoconjunctivitis (pollinosis);
- Polyposis of the nose, adenoids ;
- Poor-quality extraction of the teeth of the upper jaw, after which a bacterial infection joins, ascending by the mucous membrane of the maxillary sinuses;
- Mycosis infection, which develops as a result of prolonged and unjustified intake of antibiotics and reduced immunity against this background;
- Frequent hypothermia;
- Forced inhalation of aggressive chemicals, for example, during work at harmful enterprises.
- Dentofacial system diseases;
- Cystic fibrosis or other genetic diseases caused by increased secretion viscosity;
- Diseases accompanied by immunodeficiency;
- Allergic diathesis;
- Hypothyroidism ;
- Kartagener's syndrome;
- Use of steroids, etc.
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 the narrowing of the anus of the paranasal cavities, thickens. The sinuses cease to be fully purified. As a result of stagnation of the secret, violation of natural ventilation and oxygen deficiency in the sinus tissues, favorable conditions are created for the vital activity of the opportunistic flora, which 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, resulting in either recovery or 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 either or only one maxillary subclavial (maxillary) cavity.
- Etmoiditis is a pathological process in the cells of the latticed bone.
- Frontitis - infection of the frontal sinus mucosa.
- Sphenoiditis is an inflammatory lesion of the sphenoid sinus.
The 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:
The forms of the disease in relation to the nature of the inflammation:
- Exudative sinusitis:
- Serous form;
- Productive sinusitis:
- Parieto-hyperplastic form;
- Alternative sinusitis:
- Holostomnaya form;
- Mixed sinusitis.
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;
- Temperature increase: with acute sinusitis febrile temperature is noted (up to 38,9 0 С and above), in chronic - subfebrile, not rising above 37,5 0 С, 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 symptoms are expressed. In addition to the general signs of intoxication, the patient is concerned about the pain in the affected area of the maxillary sinus and the cheekbones radiating to 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 violation 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, increases with pressure on the area under the eyes, lifting the eyelids.
Often the patient is disturbed by a night cough, caused by pus that flows 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, in the area of 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
The lesion of the frontal sinus proceeds more severely than the rest of the sinusitis. The patient is suffering because of intense, sometimes unbearable pain in the projection of the frontal sinuses and in the entire head, intensifying in the morning hours. The pain becomes stronger with the accumulation of pus 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 bone structures, 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.
Complications of sinusitis
The most commonly diagnosed complications are:
- Meningitis . The most common consequence of acute sphenoiditis and etmoiditis.
- Osteomyelitis . It occurs when the bones are affected, when the inflammatory process goes deeper into the tissue.
- Epidural or subdural abscess of the brain . A similar complication develops at the front, and the epidural type is diagnosed more often.
Other possible consequences:
- Periostite eye sockets.
- Thrombophlebitis of cavernous or upper longitudinal sinus.
- Cavernous sinus thrombosis.
- Optic neuritis and others.
Diagnosis of sinusitis
The detection of sinusitis is not difficult. The only exceptions are cases with erased symptoms. The characteristic clinical picture, the data of a physical examination with the collection of an anamnesis, the clarification of the causes of the disease and objective medical examination, as well as the results of instrumental and laboratory diagnostics, serve as the basis for the diagnosis.
Invasive and non-invasive methods of research:
- X-ray of accessory sinuses in two projections;
- Ultrasound of the sinuses;
- Nuclear magnetic resonance or computed tomography;
- Diaphanoscopy (transillumination);
- Treatment-diagnostic puncture of the inflamed sinus;
Laboratory diagnostic methods:
- Clinical and biochemical blood tests, confirming inflammation in the body;
- Bacteriological sowing of exudate, taken during puncture, on the microflora with further determination of its sensitivity to antibiotics.
To additional studies, appointed according to the indications in case of complications, include MRI or CT of the brain.
Differential diagnosis is carried out with viral or allergic rhinitis, Wegener's granulomatosis, trigeminal neuralgia, malignant or benign tumorous neoplasms, temporomandibular joint syndrome, possible foreign bodies in the nasal cavity, etc.
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 a specific causative agent that has become the cause of the inflammatory process.
- Bacterial sinusitis is treated with antibiotics. Before the beginning of therapy with the help of bacteriological analysis, the species of the bacterium is detected and to which antibiotic it is sensitive. Assign drugs from the group of semisynthetic penicillins (ampicillin, amoxicillin , ampiox), cephalosporins (cefsol, cephalexin, cefuroxime, ceftibutene), macrolides (roxithromycin), fluoroquinolones (sparfloxacin, levoflox), etc. They are usually used orally, in severe cases, intramuscularly .
- Etiotropic therapy of viral sinusitis is the use of an antiviral agent (neovir, isoprinosine or arbidol).
- The main treatment of sinusitis of the fungal nature is reduced to the use of antimycotics (miconazole, etc.).
- The disease of an allergic nature is stopped by taking antihistamines (tavegil, suprastin).
Complex treatment includes:
- Anti-inflammatory drugs (eryspal);
- Sulfonamides (biseptol, sulfadimethoxin);
- Vasoconstrictor 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 consists in rinsing 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 in 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-Lucas;
- Radical operation on Killian;
- Intervention 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.