Sinusitis: Symptoms and Treatment of Sinusitis in Adults
- Causes of sinusitis
- The mechanism of development of sinusitis in adults
- Classification of sinusitis
- Symptoms of sinusitis in adults
- Complications of sinusitis
- Diagnosis of sinusitis
- Adult sinusitis treatment
- Prevention of sinusitis
Sinusitis (sinusitis) is an acute or chronic infectious-inflammatory disease of the paranasal nasal cavities of an allergic, viral, bacterial or fungal nature. The inflammatory process can affect the epithelium of the mucous membrane of one, two or more of any paranasal sinuses on one side and simultaneously on both sides of the nose.
Sinuses are called accessory, or okolonosovy, sinuses, representing a pneumatic cavity of small size, located in the bones of the cerebral and facial parts of the skull. Each sinus communicates with the nasal cavity. With sinusitis, the epithelium lining one or several 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 depending on their location: the frontal, maxillary (maxillary) and the ethmoid labyrinth, which are paired, as well as the unpaired wedge-shaped sinus. In children older than 7–10 years old and adults, more often the lesion of the maxillary sinuses is diagnosed, in the second place is the ethmoid, then the frontal. The sphenoid sinus is inflamed much less frequently. According to statistics, up to 10% of the total population of the planet suffers from this or that type of sinusitis. The disease is detected in 0.2% of adults and approximately 0.5% of children of different ages.
Causes of sinusitis
The leading role in the development of sinusitis is given to the Pfeiffer stick (Haemophilus influenzae) and pneumococcus (Streptococcus pneumoniae), which are the causative agents of the disease in more than 50% of cases. Less commonly, hemolytic streptococcus (Streptococcus pyogenes), moraxella (Moraxella catarrhalis), golden aureus (Staphylococcus aureus), various viruses, fungi and anaerobes are sown.
Causes of inflammation of the sinuses and blocking their fistula:
- congenital anomalies of the nasal concha and lattice labyrinth;
- deformations of the structures of the nose acquired in the process of life, which have arisen after unsuccessful surgical intervention, various injuries, chronic inflammation of the nasal mucosa, for example due to hypertrophic rhinitis;
- acute viral infections;
- therapeutic and diagnostic nosocomial manipulations: nasotracheal intubation, nasogastric intubation, nasal tamponade;
- a consequence of sensitization of the body, manifested in the form of allergic vasomatous rhinitis or seasonal rhinoconjunctivitis (pollinosis);
- nasal polyposis, adenoids ;
- poor-quality extraction of the teeth of the upper jaw, after which a bacterial infection joins, in an ascending way that reaches the mucous membrane of the maxillary sinuses;
- mycotic infection, which develops as a result of a long and unjustified administration of antibiotics and a decrease in immunity against this background;
- frequent hypothermia;
- forced inhalation of aggressive chemicals, for example, while working in hazardous factories.
- diseases of the dental system;
- cystic fibrosis or other genetic diseases caused by increased viscosity of the secretion;
- immunodeficiency diseases;
- allergic diathesis;
- hypothyroidism ;
- Cartagener syndrome;
- use of steroids, etc.
The mechanism of development of sinusitis in adults
Inflammation of the sinus mucosa, 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 a narrowing of the fistula of the paranasal cavities, is condensed. Sinuses cease to be fully cleansed. As a result of stagnation of the secret, impaired natural ventilation and oxygen deficiency in the tissues of the sinuses, favorable conditions are created for the vital activity of the conditionally pathogenic flora, which causes a chronic infection process.
At the onset of the disease, nasal discharge is serous, and as inflammation develops, it is transformed into mucous-serous. Purulent exudate, which includes a large number of detritus and leukocytes, is observed when a bacterial infection is added. In this case, severe swelling 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 transition to the chronic form, in which there is a persistent change in the membranes of the sinuses mucous membrane. This increases the patient's tendency to frequent sinus infections.
Classification of sinusitis
Types of sinusitis regarding the location of the inflammatory process:
- Sinusitis - inflammation of both or only one maxillary adnexal (maxillary) cavity.
- Etmoiditis is a pathological process in the cells of the ethmoid bone.
- Frontal infection - infection of the mucous membrane of the frontal sinus.
- Sphenoiditis is an inflammatory lesion of the sphenoid sinus.
Forms of the disease regarding the severity of symptoms:
- mild form;
- moderately severe;
The nature of the flow can be:
Graduation of sinusitis depending on the etiological factor:
Forms of the disease regarding the nature of the inflammation:
- Exudative sinusitis:
- serous form;
- Productive sinusitis:
- parietal hyperplastic form;
- Alternative sinusitis:
- choleastomy form;
- Mixed sinusitis.
Depending on the prevalence of the process, sinusitis can be:
- unilateral - can be right or left;
- bilateral - simultaneous defeat of paired sinuses on both sides of the nose;
- polysinusitis is an inflammatory process of several accessory cavities;
- monosinusitis is a lesion of the mucous membrane of one sinus;
- hemisinusitis - the simultaneous involvement in the process of all the paranasal cavities located on one half 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 symptoms depends on the type, form and prevalence of the disease. Manifestations of sinusitis are local and common.
- weakness, weakness, fatigue;
- fever: febrile temperature is observed in acute sinusitis (up to 38.9 0 С and higher), in chronic - low-grade fever, which does not rise above 37.5 0 С, or normal;
- loss of appetite;
- cephalgia - headache;
- sleep disturbance.
Local signs characteristic of any type of sinusitis:
- runny nose with nasal congestion and secretions of a different nature;
- difficulty in nasal breathing;
- coughing, sneezing, other manifestations of infection;
- loss of smell;
- dryness of the epithelium of the nasal cavity.
Symptoms of sinusitis
In acute sinus symptoms are expressed. In addition to the general signs of intoxication, the patient is worried about pain in the zone of the affected maxillary sinus and cheekbones, radiating to the corresponding half of the face, temple, upper jaw, forehead. Palpation of the maxillary sinuses painful. With bilateral antritis, breathing through the nose becomes almost impossible. As a result, blockage of the lacrimal canal begins tearing. Liquid, serous discharge from the nasal passages become turbid and viscous, and then purulent with an unpleasant odor.
In chronic sinusitis, which is the outcome of acute, the manifestations are more smoothed. Temperature is normal or slightly elevated. Bursting or pressing pains in the head appear due to a violation of the outflow of discharge from the maxillary sinuses. According to the patient, pain is often located “behind the eyes.” It decreases in the supine position due to the partial recovery of the discharge of pus from their sinuses, it increases with pressure on the area under the eyes, lifting the eyelids.
Often the patient is worried about the night cough, the cause of which becomes pus flowing down the back of the pharynx from the maxillary sinus. Possible swelling, maceration, cracks detected in the run-up of the nose.
Signs of ethmoiditis
The temperature is usually elevated. The patient complains of pressure in the nose, in the area of the root of the nose, head and eyes, the insensitivity of odors. Nasal breathing is difficult due to edema, first discharge serous, then purulent. The acute process often affects the orbit, causing the development of swelling of the eyelids and protrusion of the eyeball. Children often have reddened conjunctiva, swelling of both the upper and lower eyelids.
Etmoiditis posterior labyrinth in most cases accompanied by sphenoiditis. Inflammatory damage to the epithelium of the anterior sections of the ethmoid labyrinth is accompanied by sinusitis and frontal sinusitis.
Signs of frontalitis
The lesion of the frontal sinus is more severe than the other sinusitis. The patient suffers because of intense, sometimes unbearable pains in the projection of the frontal sinuses and in the whole head, increasing in the morning hours. The pains become stronger with the accumulation of pus in the frontal sinuses, weakening after their emptying. Characterized by: high temperature, marked swelling of the mucous membrane, difficulty with nasal breathing, heavy discharge from the nasal passage from the side of the lesion.
Some have pain in the eyes, swelling of the upper eyelid and brow area on the side of the inflamed sinus, and a change in skin pigmentation on the forehead. Photophobia develops, sense of smell decreases.
For chronic frontal sinusitis is characterized by hypertrophy of the epithelium of the middle nasal passage. Sometimes the process moves to the bone structure, resulting in fistulas and areas of necrosis.
Signs of sphenoiditis
Inflammation of the wedge-shaped cavity is usually accompanied by the defeat of the cribrious sinuses. Patients are disturbed by pains in a nape, parietal area, depth of the head, and also in an orbit. Despite the wear and tear of the symptoms of chronic sphenoiditis, inflammation can affect the optic nerves, causing a progressive decrease in vision.
Complications of sinusitis
The most commonly diagnosed complications are:
- Meningitis The most common consequence of acute sphenoiditis and ethmoiditis.
- Osteomyelitis . Occurs with the defeat of the bones, when the inflammatory process goes deeper into the tissue.
- Epidural or subdural abscess of the brain . A similar complication develops with frontal sinusitis, with the epidural type being diagnosed more often.
Other possible consequences:
- Periostitis of the orbit.
- Thrombophlebitis of the cavernous or superior longitudinal sinus.
- Cavernous sinus thrombosis.
- Optic neuritis and others.
Diagnosis of sinusitis
Detection of sinusitis is not difficult. The exception is made only by cases with the erased symptomatology. The characteristic clinical picture, physical examination data with anamnesis collection, elucidation of the causes of the disease and an objective medical examination, as well as the results of instrumental and laboratory diagnostics, serve as the basis for establishing the diagnosis.
Invasive and non-invasive research methods:
- x-ray of the sinuses in two projections;
- Sinus ultrasound;
- nuclear magnetic resonance or computed tomography;
- diaphanoscopy (transillumination);
- therapeutic and diagnostic puncture of the inflamed sinus;
Laboratory diagnostic methods:
- clinical and biochemical blood tests confirming inflammation in the body;
- bacteriological seeding of the exudate, taken during the puncture, on the microflora with further determination of its sensitivity to antibiotics.
MRI or CT of the brain are additional tests that are prescribed for indications in case of complications.
Differential diagnostics is performed with viral or allergic rhinitis, Wegener's granulomatosis, trigeminal neuralgia, malignant or benign tumor neoplasms, temporomandibular joint syndrome, the possible presence of foreign bodies in the nasal cavity, etc.
Adult sinusitis treatment
The treatment is mostly conservative, but surgery is possible. The main objectives of the treatment of sinusitis:
- Eradication (complete destruction) of the pathogen in case inflammation is caused by an infectious agent;
- elimination of other provoking factors, such as deformations of the structures of the nose;
- relief of symptoms of sinusitis;
- restoration of normal drainage of the sinuses;
- prevention of complications;
- preventing the transition of acute sinusitis to the chronic form.
With light and moderate sinusitis, the patient does not need hospitalization, medical measures are carried out on an outpatient basis under the supervision of an otorhinolaryngologist. Severe course and some cases of moderate severity with complications require inpatient treatment in a specialized otolaryngology department.
Etiotropic therapy is leading in treatment. It aims to eliminate the specific pathogen that caused the inflammatory process.
- Bacterial sinusitis is treated with antibiotics. Before starting therapy, bacteriological analysis reveals the type of bacteria and to which antibiotic it is sensitive. Prescribe drugs from the group of semisynthetic penicillins (ampicillin, amoxicillin , ampioks), cephalosporins (kefzol, cephalexin, cefuroxime, ceftibuten), macrolides (roxithromycin), fluoroquinolones (sparfloxacin, levofloks) and t. D. Use them typically 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 fungal nature is reduced to the reception of antimycotics (miconazole, etc.).
- The disease of an allergic nature is stopped by taking antihistamines (tavegil, suprastin).
Comprehensive treatment includes:
- anti-inflammatory drugs (erispal);
- sulfonamides (biseptol, sulfadimethoxin);
- vasoconstrictor drugs (sanorin, naphthyzin), salt sprays, corticosteroids used intranasally.
Physical therapy is prescribed after the acute phase of the disease subsides approximately 6–7 days after the first signs appear. Effective diadynamic currents, Solux, UHF and microwave therapy, phonophoresis, warming the area of the inflamed sinus with a blue light lamp, inhalation.
Sinus evacuation technique is used mainly for moderately severe sinusitis. The procedure consists in washing the sinus with a sinus catheter consisting of two tubes and the same number of small cylinders. Antiseptic is fed into the cavity through one tube, and sucked together with pus through another.
Puncture of the maxillary sinus with the installation of drainage is required during a prolonged process. Manipulation is necessary for the outflow of pus through an established thin tube, regular rinsing of the cavity and the introduction of drugs.
Surgical treatment is indicated for the failure of the above methods of conservative therapy.
- maxillary sinusitis;
- laser destruction of nasal polyps;
- Caldwell – Luke operation;
- radical Killian surgery;
- intervention by the method of Dliker-Ivanov;
- balloon synoplasty.
Prevention of sinusitis
The prevention is based on the timely treatment of the underlying disease leading to the development of sinusitis (ARVI, influenza, allergies, scarlet fever, dental diseases), as well as the elimination of risk factors (nasal atresia, nasal septum curvature, etc.).
- hardening of the body;
- sanitation of the oral cavity;
- avoid hypothermia.