Acute sinusitis
The content of the article:
- Causes and risk factors
- Forms of the disease
-
Symptoms of Acute Sinusitis
- Acute sinusitis
- Acute ethmoiditis
- Acute sphenoiditis
- Acute frontal sinusitis
- Features of the course of the disease in children
- Diagnostics
- Treatment of acute sinusitis
- Possible complications and consequences
- Forecast
- Prevention
Acute sinusitis is an infectious and inflammatory disease in which the mucous membrane of one or more paranasal sinuses is affected.
In adults, sinusitis occurs in about 0.02% of cases. In children, about 0.5% of the total number of respiratory diseases of infectious etiology are complicated by the development of acute sinusitis. In the general structure of pediatric ENT pathology, sinusitis is approximately 32%.
There are 4 pairs of paranasal sinuses, which are associated with the nasal passages: maxillary (maxillary), frontal, sphenoid sinus and ethmoid labyrinth.
With the development of sinusitis, the inflammatory process spreads to the mucous membrane of the paranasal sinuses, the submucous layer, and in severe cases affects the periosteum and bone walls.
Acute sinusitis is the general name for a group of inflammation of the paranasal sinuses.
Causes and risk factors
The main reasons for the development of acute sinusitis include:
- anatomical defects of the nasal cavity, ethmoid labyrinth and / or turbinates;
- acute and chronic infectious processes in the body, especially in the upper respiratory tract;
- immunodeficiency states;
- allergy;
- injuries to the nose and paranasal sinuses;
- surgical interventions requiring prolonged tamponade of the nasal passages.
Forms of the disease
Depending on the localization of the pathological process (damage to a particular sinus), acute sinusitis is divided into:
- sinusitis - inflammation of the maxillary sinus;
- frontal sinusitis - inflammation of the frontal sinus;
- sphenoiditis - inflammation of the sphenoid sinus;
- ethmoiditis is an inflammation of the ethmoid labyrinth.
The disease can be unilateral or bilateral, complicated and uncomplicated, one (monosinusitis), several (polysinusitis) or all (pansinusitis) of the paranasal sinuses can be affected.
Types of sinusitis
Depending on the nature of the inflammation, acute sinusitis is classified into catarrhal (serous), purulent, hemorrhagic, necrotic.
Depending on the severity of clinical manifestations, the course of the disease can be mild, moderate and severe.
Symptoms of Acute Sinusitis
Acute sinusitis, regardless of the localization of inflammation, is characterized by the following symptoms:
- feeling of pressure in the face area;
- disorders of taste and smell;
- bad breath;
- nasal voice;
- reflex cough caused by the flow of inflammatory exudate along the back of the pharynx.
In addition, an acute inflammatory process is manifested by general intoxication: weakness, a decrease in general well-being, an increase in body temperature, and sleep disturbance.
Other symptoms of acute sinusitis depend on its form.
Acute sinusitis
Acute sinusitis begins suddenly. The temperature rises to 38-39 ˚С (less often it can be subfebrile or remain within the normal range). Patients complain of pain in the area of the affected sinus, which sometimes spreads to the cheekbone, root of the nose, forehead, temple or the entire half of the face from the side of the lesion. Soreness increases with palpation and tilting the head. Nasal breathing from the side of the affected sinus is difficult or absent. Discharge from the nasal cavity at the beginning of the disease is serous, then becomes cloudy and becomes more viscous. If sinusitis is bilateral, patients are forced to breathe through the mouth. When the lacrimal canal is blocked by edema, tearing is observed.
Symptoms of Acute Sinusitis (Sinusitis)
Acute ethmoiditis
The development of acute ethmoiditis is often preceded by sinusitis and frontal sinusitis. The inflammation usually begins in the posterior ethmoid labyrinth. Signs of acute ethmoiditis are intense headaches, pressing pain in the bridge of the nose and root of the nose, difficulty in nasal breathing, and a sharply reduced sense of smell. Discharge from the nose is at first serous, then becomes purulent. In some cases, the orbit may be involved in the pathological process, which leads to edema of the eyelids and protrusion of the eyeball.
Acute sphenoiditis
Acute sphenoiditis is usually associated with ethmoiditis. In isolation, this form of the disease is extremely rare. Inflammation is manifested by pain localized in the orbit, crown and occiput.
Acute frontal sinusitis
Acute frontal sinusitis is more severe than other forms of acute sinusitis. Against the background of a high temperature, nasal breathing becomes difficult, nasal discharge from the side of the lesion appears, pain in the forehead. These signs are more pronounced in the morning. In addition, eye pain and photophobia are noted. Often, in patients with acute frontal sinusitis, the color of the forehead skin changes (hyperemia), the upper eyelid and the brow region on the affected side swell. With the spread of the inflammatory process to bone structures, their necrosis is possible with the formation of fistulas.
Acute frontitis causes intense forehead pain
Features of the course of the disease in children
The clinical picture of acute sinusitis in children varies depending on age, origin, localization, and the presence of concomitant pathology.
In childhood, ethmoid sinus is affected more often (about 80% of all sinusitis cases) than in adults. The second place in this age group is occupied by inflammation of the maxillary sinus. The presence of a common bone wall and the close location of the excretory orifices causes frequent combined lesions of these sinuses. Frontitis in children over 6-7 years of age occurs less frequently, which is associated with the formation of the frontal sinus. The sphenoid sinus in children is rarely affected.
In newborns, as well as in infants and young children, acute sinusitis is more severe, general symptoms prevail over local ones. In addition, in children of this age group, acute sinusitis can mimic the clinical picture of other pathologies (lower respiratory tract and even the gastrointestinal tract, due to the severity of intoxication).
With a mild form of the disease, the general condition is within normal limits, the temperature rises to subfebrile values or remains within the normal range. The headache is not too intense or constant. Local signs of the inflammatory process are moderately expressed.
With a moderate form, signs of general intoxication of the body, as well as local inflammatory changes, are more pronounced.
A severe course is characteristic of poly- or pansinusitis, especially with the development of orbital and intracranial complications. At the same time, the general condition of the child deteriorates sharply, there is a severe headache, pain in the affected sinus and orbit, photophobia and lacrimation. Temperatures are usually high (38 ° C and above).
Diagnostics
The diagnosis of acute sinusitis is established on the basis of data obtained during the collection of complaints and anamnesis, an objective examination, as well as a number of additional studies. An important role is played by the anterior, middle and posterior rhinoscopy carried out sequentially. In addition, X-ray of the paranasal sinuses in two projections, ultrasound examination, computed or magnetic resonance imaging of the paranasal sinuses are shown.
Rhinoscopy is the main method for diagnosing sinusitis
A general and biochemical blood test, a general urine test is prescribed (nonspecific signs of inflammation are detected). To identify an infectious agent, a microbiological examination of the punctate is carried out to determine the sensitivity of the pathogen to antibiotics. Cytological examination of imprints of the mucous membrane of the turbinates makes it possible to determine the signs of an incipient inflammatory process in the early stages of the development of the disease.
Treatment of acute sinusitis
Treatment of acute sinusitis is usually conservative. The main goals are: elimination of the etiological factor, relief of pain syndrome, restoration of the outflow of the contents of the affected sinus. In severe and sometimes moderate acute sinusitis, the patient must be admitted to a hospital.
Vasoconstrictor drugs, antihistamines, mucolytics are prescribed. In acute sinusitis of bacterial etiology, antibiotic therapy is indicated, in mild and moderate forms, antibiotics are prescribed orally, in case of severe forms of the disease - parenterally (intramuscularly or intravenously).
Vasoconstrictor drops help relieve sinusitis symptoms
Since inflammatory edema often prevents the nasal sinuses from clearing in acute sinusitis, they resort to puncture of the affected sinus, followed by drainage and washing with antiseptic solutions, after which a drug (antibiotic, anti-inflammatory, antiseptic) is injected into the sinus. It is possible to carry out medical and diagnostic punctures for children starting from 10 months.
In severe acute sinusitis, detoxification, hyposensitization, dehydration, immune and symptomatic therapy is indicated. In some cases, it may be necessary to carry out surgery in conjunction with active antibiotic therapy.
Indications for surgical treatment (surgical interventions on the frontal, sphenoid and maxillary sinuses) are:
- severe course of the disease, poor response to ongoing therapy;
- progression of the pathological process during complex treatment;
- development of orbital and / or intracranial complications.
Surgical intervention in newborns and children in the first years of life is carried out with an endonasal approach to avoid deformation of the facial bones and injury to the tooth buds.
Puncture of the maxillary sinus is the easiest method of surgical treatment for acute sinusitis
After the signs of acute inflammation subsided, physiotherapy methods are used: electro- and phonophoresis, ultra-high-frequency therapy, laser therapy, pulse currents, magnetotherapy, and diadynamic therapy.
Possible complications and consequences
In acute sinusitis, intracranial and orbital complications can develop: meningitis, epidural or subdural brain abscess, osteomyelitis, purulent inflammation of the soft tissues of the orbit (phlegmon of the orbit).
Forecast
With timely diagnosis and properly selected treatment, the prognosis is usually favorable. In the absence of adequate treatment, the risk of the pathological process becoming chronic is high. With acute sinusitis in children in the first years of life, the prognosis worsens. The development of intracranial complications of acute sinusitis can be fatal.
Prevention
In order to prevent the development of acute sinusitis, it is recommended:
- timely treatment of acute respiratory diseases;
- correction of anatomical defects of the nasal cavity (hypertrophy of the turbinates, curvature of the nasal septum, etc.);
- rejection of bad habits;
- balanced diet;
- avoiding hypothermia.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
