Chronic sinusitis
The content of the article:
- Causes and risk factors for chronic sinusitis
- Forms of chronic sinusitis
- Symptoms of chronic sinusitis
- Features of chronic sinusitis in children
- Diagnostics of the chronic sinusitis
- Treatment of chronic sinusitis
- Possible complications and consequences of chronic sinusitis
- Forecast
- Prevention
Chronic sinusitis is a disease of the paranasal (maxillary) sinuses (sinuses) located in the thickness of the upper jaw, which is long-term, recurrent in nature with periods of exacerbation and remission.
Symptoms and types of chronic sinusitis
The human nasal cavity has a complex of paranasal air sinuses located in the nearby bones of the skull: paired maxillary (maxillary) sinuses, paired frontal (frontal) sinuses, paired ethmoid and unpaired sphenoid sinuses.
The full functioning of the paranasal sinuses is necessary for normal sound production, warming, humidifying and disinfecting the inhaled air, isolating sensitive structures of the facial skull (for example, the roots of the teeth) from a sharp temperature drop during the act of breathing. In addition to the above, these structures, normally filled with air, lighten the weight of the cranial bones and perform a shock-absorbing function in case of maxillofacial injuries.
The maxillary sinuses have a peculiar structure that makes them especially vulnerable to aggressive influences. The mucous membrane of the maxillary sinus is poorly supplied and innervated, which creates the preconditions for the formation of chronic sinusitis, the lower wall of the sinus is thin and easily injured during an acute inflammatory process or dental manipulations, which is a risk factor for the occurrence of acute, and subsequently chronic sinusitis.
Inflammation of the maxillary sinuses accounts for more than 70% of all diseases of the air sinuses - sinusitis, and there is a clear tendency to an increase in the frequency of this pathology: over the past few years, sinusitis has become registered twice as often. Chronic sinusitis is diagnosed equally often in both men and women in all age categories.
Synonyms: chronic maxillary sinusitis, rhinosinusitis, maxillitis.
Causes and risk factors for chronic sinusitis
Chronic sinusitis in the overwhelming majority of cases is a consequence of acute inflammation of the maxillary sinuses or (much less often) other organs. In this case, pathogenic microorganisms can enter the sinus cavity in several ways:
- hematogenous - the ingress of pathogenic agents through the systemic circulation from the main focus;
- rhinogenic - the spread of the inflammatory process from the middle nasal passage through the communicating opening into the sinus cavity;
- odontogenic - infection of the sinus in inflammatory diseases of the dentoalveolar system, dental procedures.
In addition, chronic sinusitis can transform from an acute traumatic one (which is a consequence of trauma to the facial skull), have an allergic or vasomotor nature.
Polyps in the nasal cavity can cause chronic sinusitis
Chronization of acute sinusitis is facilitated by:
- incompetent therapy of acute sinusitis with the preservation of residual effects after the completion of the main treatment cycle;
- anatomical features [congenital narrowness of the nasal passages or the outlet of the maxillary sinus, bending (congenital or post-traumatic) of the nasal septum, proliferation of tissues that form the turbinates], which impede the outflow of mucus in acute inflammation and provoke its stagnation;
- polyps, cystic formations in the nasal cavity;
- chronic inflammatory diseases of the ENT organs;
- the presence of an unresolved chronic focus of inflammation in the oral cavity;
- unfavorable ecological or microclimatic conditions in the area of residence (gas pollution, increased dust levels, dampness, etc.).
For chronic sinusitis, cyclic exacerbations are characteristic, provoked by a wide range of external and internal factors:
- spring-autumn period (wet, cold weather);
- state of immunosuppression;
- general hypothermia;
- exacerbation of other chronic diseases, leading to a decrease in the reactivity of the body;
- acute stressful effects;
- physical stress; and etc.
Forms of chronic sinusitis
Depending on the root cause, the disease can be of several types:
- allergic;
- odontogenic (a consequence of diseases of the dentition);
- hematogenous;
- rhinogenic;
- vasomotor;
- cystic (polyposis).
By the nature of inflammation, chronic sinusitis is classified as follows:
- catarrhal - the exudate accumulated in the sinus cavity has a serous or mucous character;
- purulent - the stagnant content of the maxillary sinus is represented by purulent discharge;
- mixed.
Depending on the morphological changes in the mucous membrane of the maxillary sinuses and nasal passages, chronic sinusitis is divided into:
- atrophic - the mucous membrane is thinned, the number of mucous cells in it is sharply reduced, a small amount of discharge from the inflamed cavity is purulent;
- hyperplastic - characterized by thickening of the mucous membrane, its proliferation with the formation of polyps, cysts, and abundant discharge from the nose.
Depending on the side of the lesion, chronic sinusitis can be left-, right- or bilateral.
Symptoms of chronic sinusitis
The manifestations of chronic sinusitis in adult patients are very characteristic:
- feeling of tension, pressure in the area of the affected sinus;
- runny nose;
- headache;
- low-grade fever (optional symptom);
- difficulty breathing;
- change in voice (nasal);
- cough that gets worse at night;
- general malaise.
Manifestations of chronic sinusitis
The main symptom of chronic sinusitis is pain in the area of the inflamed sinus (symmetrically on both sides on the side of the wings of the nose up towards the lower edge of the orbit), in the forehead, bridge of the nose, sometimes the entire half of the face on the side of inflammation, behind the eyeballs. Initially, in these areas there is discomfort, a feeling of pressure, which changes as the disease progresses with a feeling of bloating and dull aching pain. Soreness increases in the evening, with the head tilted forward, chewing, with pressure in the projection of the affected sinus, it can become permanent.
A runny nose at the initial stage is slimy, then the discharge becomes purulent, fetid. In the case of significant nasal congestion with severe difficulty in nasal breathing, a runny nose may be absent due to a violation of the drainage of the contents of the maxillary sinus.
Dry cough with sinusitis is caused by irritation of the posterior pharyngeal wall by the flowing inflammatory contents of the maxillary sinuses. The cough is persistent and does not respond to standard antitussive therapy.
In addition to specific complaints, patients are worried about unmotivated weakness, disorder of sleep and wakefulness, decreased performance, irritability.
The signs of chronic sinusitis are most pronounced during the exacerbation period; during remission, as a rule, patients do not present active complaints. Sometimes chronic sinusitis in adults is asymptomatic, diagnosed solely on the basis of instrumental research data.
Features of chronic sinusitis in children
Chronic sinusitis in children develops for the same reasons as in adult patients, but quite often it is provoked by an additional factor - the presence of adenoid vegetations (growths) in the nasopharynx, which are the focus of chronic ENT infection.
In pediatric patients, chronic sinusitis can occur as an isolated ENT pathology, but quite often it is accompanied by inflammation of the cells of the ethmoid labyrinth (ethmoiditis) and proceeds in a polypous-purulent form.
The specificity of the clinical manifestations of chronic sinusitis in children lies in the blurred symptoms: complaints of pain in the projection of the sinuses are often absent, discharge from the nose is serous for a long time, the disease is often manifested by cough or pain in the ear on the side of sinusitis. The latter is associated with the flow of inflammatory discharge along the posterior and posterior-lateral walls of the pharynx, secondary involvement of the structures of the respiratory tree or middle ear in the inflammatory process, followed by the development of tracheitis, bronchitis, otitis media.
In a child, chronic sinusitis is often manifested by pain in the ear.
In some cases, the inflammatory process from the maxillary sinus in children spreads to the soft tissues of the eye, the conjunctiva, provoking the development of keratitis, conjunctivitis.
The final formation of the maxillary sinuses occurs by 18-20 years. During the first years of life, the maxillary sinus is anatomically defective: it is represented by a narrow slit, its bottom is much higher than that of an adult, which is due to the structural features of the child's skull. In view of these specific characteristics, the development of chronic sinusitis in children up to 3-4 years of age is practically impossible and occurs in extremely rare cases.
Diagnostics of the chronic sinusitis
Diagnosis of chronic sinusitis is based on a comprehensive assessment of the results of a number of studies:
- anamnestic data (the presence of foci of chronic infection, the degree of sanitation of the oral cavity, episodes of acute or chronic sinusitis in the past, etc.);
- objective examination of the patient (soreness on palpation of the face in the projection of the maxillary sinuses, traces of an inflamed sinus discharge on the back of the pharynx);
- complete blood count (leukocytosis with neutrophilic shift to the left, accelerated ESR);
- biochemical blood test (acute phase indicators);
- rhinoscopy (inflammatory changes in the nasal mucosa, the presence of pus in the middle nasal passage);
- diaphanoscopy, or transillumination (the cheek and lower eyelid on the side of the lesion are not translucent, the patient has no sensation of light in the eye);
- X-ray examination of the maxillary sinuses (partial darkening of the affected sinus, in severe cases - total, with a clear horizontal level);
- diagnostic puncture;
- computed tomography - in diagnostically unclear cases.
Chronic sinusitis is characterized by pain on palpation of the face.
Treatment of chronic sinusitis
Treatment of chronic sinusitis is predominantly conservative, carried out on an outpatient basis. Hospitalization is required for patients with complicated maxillary sinusitis or in the presence of violent symptoms (severe intoxication or pain syndrome, significant disturbance of nasal breathing).
For the treatment of chronic sinusitis, the following groups of drugs are used:
- antibacterial agents or synthetic antimicrobial drugs (protected semi-synthetic penicillins, cephalosporins of the 2nd, 3rd generations, fluoroquinolones, macrolides, tetracyclines);
- non-steroidal anti-inflammatory drugs (antipyretic and analgesic effects);
- hyposensitizing agents;
- sedatives;
- fortifying;
- vitamin and mineral complexes;
- mucolytic-antibacterial complexes;
- vasoconstrictor drops, sprays (including those of plant origin) topically;
- other nasal preparations for topical use.
In addition to pharmacotherapy, physiotherapeutic methods of exposure are shown in complex treatment: microwave therapy, electrophoresis of drugs, diadynamic currents, laser exposure, ultrasound therapy, balneotherapy and mud therapy, paraffin applications, inhalations, rinsing of the nasal cavity by the method of fluid movement.
Rinsing the nose with the Cuckoo method for sinusitis
If there is no effect of conservative therapy of chronic sinusitis, puncture of the affected sinus is resorted to. When performing a puncture of the medial wall of the maxillary sinus, exudate is removed from it, after which the cavity is washed with antiseptic solutions, the introduction of antibacterial, glucocorticosteroid drugs, enzymes that promote the resorption of inflammatory contents. If necessary, a catheter is installed, through which the discharge of the maxillary sinus is evacuated, it is washed and the local administration of drugs is performed.
The duration of therapy for exacerbation of chronic sinusitis is 3-4 weeks.
In case of persistent, severe course of chronic sinusitis with frequent relapses and minimal response to the treatment, surgical opening of one or more sinus walls is recommended in order to create an adequate fistula between the sinus and the nasal passage and restore normal mucus passage.
Possible complications and consequences of chronic sinusitis
Chronic sinusitis can have the following complications:
- inflammation of the lining of the brain;
- brain abscess;
- purulent inflammation of the soft tissues of the orbit;
- sepsis.
Forecast
With uncomplicated chronic sinusitis, the prognosis depends on the individual characteristics of the organism, the consistency of the immune response; generally favorable. The prognosis worsens with the addition of complications, the lack of effect from the ongoing conservative therapy.
Prevention
Prevention of chronic sinusitis is reduced to the following activities:
- restorative procedures;
- timely treatment of diseases of the ENT organs;
- regular sanitation of the oral cavity;
- avoiding hypothermia.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
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!
