Chronic sinusitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Chronic sinusitis symptoms
- Features of the course of the disease in children
- Diagnostics
- Chronic sinusitis treatment
- Possible complications and consequences
- Forecast
- Prevention
Chronic sinusitis is a chronic inflammatory disorder of one or more paranasal sinuses. The disease affects people of all age categories, equally, both women and men.
Nasal congestion and mucopurulent discharge are common symptoms of chronic sinusitis during an exacerbation.
Chronic sinusitis accounts for approximately 20% in the total structure of otorhinolaryngological diseases of childhood. Isolated disease is rarely recorded (in 3-5% of cases), much more often children are diagnosed with polysinusitis. At the same time, the most common combined pathology is maxillary ethmoiditis (about 70%), as well as frontal ethmoiditis (14%). Sphenoiditis in childhood is extremely rare.
Causes and risk factors
The main cause of chronic sinusitis is recurrent acute sinusitis, especially in the absence of adequate treatment. The transition to the chronic form of the disease usually occurs against the background of reduced immunity, other chronic pathologies, curvature of the nasal septum, in the presence of polyps or other neoplasms in the nasal cavity.
Risk factors include:
- allergic processes;
- metabolic diseases;
- facial trauma;
- bad habits;
- industrial hazards (regular exposure to industrial toxins, dust, etc.).
When the paranasal sinuses are affected by microscopic fungi and anaerobic microorganisms, forms of the disease resistant to conservative treatment can occur, which are characterized by a long recurrent course.
In children, sinusitis often develops as a complication of acute respiratory viral infections and childhood infectious diseases (measles, scarlet fever).
Forms of the disease
Chronic sinusitis can be unilateral or bilateral.
Depending on the clinical picture and histomorphological signs, the following forms of chronic sinusitis are distinguished:
- exudative (catarrhal, serous, purulent);
- productive (polyposis, parietal-hyperplastic);
- alternative (atrophic, cholesteatomic);
- mixed (polypous-purulent).
Depending on which of the sinuses is involved in the pathological process, there are:
- sinusitis (inflammation of the maxillary sinus);
- frontal sinusitis (inflammation of the frontal sinus);
- ethmoiditis (inflammation of the ethmoid labyrinth);
- sphenoiditis (inflammation of the sphenoid sinus).
Types of chronic sinusitis
Depending on the etiological factor, chronic sinusitis is divided into the following forms:
- viral;
- bacterial;
- mycotic;
- allergic;
- traumatic.
Chronic sinusitis symptoms
Chronic sinusitis lasts a long time, relapses have a seasonality (usually occur in the autumn-winter period), pronounced general symptoms and subjective sensations are absent during remission.
Common symptoms of chronic sinusitis during an exacerbation include nasal congestion, mucopurulent discharge from the nasal cavity, decreased sense of smell, pain and / or discomfort in the area of the affected sinus, headache, and bad breath. These symptoms may be accompanied by cough, toothache, nasal feeling, pressure in the ears, weakness and fatigue.
Symptoms during an exacerbation of chronic sinusitis
The rest of the clinical picture of chronic sinusitis in adults depends on the form of the disease.
Polypoid and polypous-purulent sinusitis usually develop against the background of allergic rhinitis or bronchial asthma and are characterized by a persistent and severe course. Polyps are the result of prolapse through a natural opening into the nasal cavity of the edematous mucous membrane, but they can also form in the nasal cavity, in the upper and middle nasal passages. Polyps have a smooth grayish or yellow-red surface, a gelatinous consistency, are not prone to bleeding. Large polyps that are in the nasal cavity for a long time put pressure on the walls and can cause deformation with the expansion of the nasal dorsum and an increase in the distance between the eyes. In this case, the turbinates atrophy, the nasal septum bends, and in some cases is destroyed.
With polyposis sinusitis, the curvature of the nasal septum is possible and even its destruction
Features of the course of the disease in children
It is possible to diagnose chronic sinusitis in a child from the age of two. The disease in children has age characteristics.
In patients of early and preschool age, in contrast to adults, the general symptoms of chronic sinusitis prevail over local manifestations. Patients have prolonged low-grade fever, decrease in body weight, pallor of the skin, cervical lymphadenitis, mouth breathing (constantly open mouth). Children with chronic sinusitis are irritable, lethargic, have sleep disturbances, and decreased appetite.
In older children, the clinical picture differs little from chronic sinusitis in adults. Patients complain of difficulty or absence of nasal breathing, pathological discharge from the nasal cavity, decreased sense of smell, the temperature rises only during exacerbations.
In children, chronic sinusitis occurs with prolonged low-grade fever, pallor of the skin, lethargy, apathy, and weight loss.
In addition to the general manifestations of the disease, the symptoms of chronic sinusitis in children vary depending on the localization of the pathological process.
With chronic sinusitis, patients have heaviness in the head, stuffing of one half of the nose, purulent discharge from the nasal cavity, which, flowing down the back wall of the pharynx, can cause a reflex cough. Isolated sinusitis in children is observed less often than combined damage to the maxillary sinus and ethmoid labyrinth, and sinusitis in young children does not happen at all due to the anatomical features of the maxillary sinuses.
Chronic frontal sinusitis in children accounts for 15-40% of all chronic sinusitis. This form of the disease is characterized by increased fatigue and subfebrile body temperature. The headache is not too intense, but almost constant, aggravated in the morning, as well as with eye movement.
Diagnostics
For the diagnosis of chronic sinusitis, data from the collection of anamnesis and complaints, an objective examination, as well as a number of additional studies are used, which are selected depending on the form of the disease.
The condition of the paranasal sinuses is assessed using diaphanoscopy (scanning the sinuses in a dark room with a lamp inserted into the mouth) and sinusoscopy (examining the upper sinus with an endoscope). Endoscopic diagnostics makes it possible to detect changes in the posterior parts of the nasal cavity, which are difficult to view using traditional methods. Endoscopy also allows for targeted biopsy.
Diagnostics of the chronic sinusitis
The most common and informative diagnostic method in this case is radiography of the paranasal sinuses in three projections - lateral, frontal-nasal, nasal-chin. For the purpose of clarification, the following may be applied:
- computed or magnetic resonance imaging in axial and frontal projections;
- thermal imaging diagnostics (assessment of vegetative homeostasis by changes in the temperature of the skin of the face in the area of the studied sinuses);
- rhinopneumometry (assessment of the patency of the nasal passages);
- assessment of the motor function of the ciliated epithelium of the mucous membrane;
- high-quality olfactometry;
- determination of the pH of the detachable nasal cavity;
- bacteriological examination of discharge from the nasal cavity and paranasal sinuses.
Chronic sinusitis treatment
The condition for the successful treatment of chronic sinusitis is the elimination of unfavorable factors that contribute to its development.
Catarrhal and purulent forms of chronic sinusitis, as a rule, are successfully treated with conservative methods. Drug therapy consists in the use of antibacterial drugs, selected taking into account the sensitivity of the pathogen, non-steroidal anti-inflammatory drugs (in difficult cases, steroid anti-inflammatory drugs can be prescribed).
Physiotherapy is effective in this case: ultrahigh-frequency therapy, electro- and phonophoresis of drugs, magnetotherapy, KUV-irradiation of the nasal mucosa, local darsonvalization, etc.
With the development of exudative forms of chronic sinusitis, they resort to puncture of the affected sinus with evacuation of the contents and subsequent washing with solutions of antiseptics, antibacterial, anti-inflammatory drugs. In addition to therapeutic, puncture also plays a diagnostic role, helping to determine the volume of the sinus and the nature of the exudate.
With exudative form of chronic sinusitis, a puncture of the paranasal sinus is performed
Puncture of the maxillary sinus is performed under local anesthesia through the lower nasal passage. If it is necessary to repeat the procedure, as well as to create an outflow path for exudate, it is advisable to drain the sinus. The drainage tube is passed into the affected sinus through a mandrel, the protruding (outer) end of the tube is fixed to the cheek. Daily washings are carried out through the tube, followed by the introduction of drugs into the cavity.
With the localization of the pathological process in the frontal sinus, the outflow of the contents is carried out through the frontal-nasal canal by means of puncture, probing or trepanopuncture.
With the defeat of the sphenoid sinus, direct endonasal intubation is usually performed through the natural anastomosis, washing the sinus and injecting drugs into it. This manipulation is carried out under local anesthesia.
In the presence of contraindications to puncture, they resort to surgical intervention. Its purpose is to eliminate the factors that prevent the normal drainage of the affected paranasal sinuses. The operation is performed using a traditional or endoscopic method.
The absolute indications for surgical intervention include intracranial and orbital complications, relative indications are polyposis and polyposis-purulent forms of chronic sinusitis, the presence of neoplasms (both benign and malignant), as well as the absence of a positive effect from conservative treatment. Endonasal polypotomy can be performed with a nasal loop, as well as by laser or cryodestruction methods. Surgical treatment is required to correct a deviated nasal septum (septoplasty). The choice of the method of surgical intervention depends on the form of the disease, as well as on the patient's individual indications.
With polyposis form of chronic sinusitis, polypotomy is indicated
Possible complications and consequences
Against the background of chronic sinusitis, meningitis, osteomyelitis, epidural or subdural abscess may develop. In advanced cases, intracranial complications of chronic sinusitis can be fatal.
Forecast
With timely started and correctly selected treatment, the prognosis is favorable.
Prevention
In order to prevent the development of chronic sinusitis, it is recommended:
- timely treatment of pathologies that contribute to the maintenance of chronic inflammation in the paranasal sinuses;
- strengthening immunity;
- avoiding hypothermia of the body;
- compliance with the rules of personal hygiene;
- rejection of bad habits.
YouTube video related to the article:
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!
