Chronic and acute maxillary sinusitis: what it is, symptoms and treatment
The content of the article:
- Types and causes of the development of sinusitis
- Symptoms
- Diagnostics
- Maxillary sinusitis treatment
- Prevention
- Video
Maxillary sinusitis, or sinusitis, is an inflammatory lesion of the mucous membrane of the maxillary sinus, is one of the most common and often recurrent diseases of the ENT organs.
The severity of the symptoms of sinusitis is determined by the severity of its course
The maxillary sinus, or the maxillary sinus, is a paired paranasal sinus that occupies most of the body of the maxillary bone. Its size and shape differ in individual and age-related variability. The mucous membrane of this cavity is a continuation of the nasal mucosa. It is represented by ciliated epithelium and includes many mucous glands.
The incidence of sinusitis varies from 5 to 50% of all diseases of the paranasal sinuses.
Types and causes of the development of sinusitis
By localization, sinusitis can be:
- unilateral: right-sided or left-sided;
- double-sided.
Depending on the process of inflammation in the maxillary sinus, sinusitis is distinguished:
- acute;
- chronic.
ICD-10 code (international classification of diseases of the 10th revision): J01.0 (acute maxillary sinusitis); J32.0 (chronic maxillary sinusitis).
Sinusitis often has odontogenic etiology
Depending on the etiology of the disease, the following types of sinusitis are distinguished: rhinogenic, odontogenic, traumatic and allergic. But the cause of the inflammatory process can be several factors. So, sinusitis of rhinogenic etiology, developed against the background of acute respiratory disease (ARI), can lead to an exacerbation of the periapical focus of chronic odontogenic infection and Tuesday infection of the sinus mucosa.
The presence of a chronic focus of infection in the oral cavity or in the area of the apex of the roots of the teeth of the upper jaw is a predisposing factor for weakening local tissue immunity or direct infection through the blood stream. The leading infectious agents in odontogenic and rhinogenic sinusitis include staphylococci (including Staphylococcus aureus), streptococci, corynebacteria, anaerobes.
Corynebacteria are one of the leading infectious agents.
It is also possible to perforate the wall of the maxillary sinus when removing the upper teeth or surgery on the alveolar ridge of the upper jaw.
In the pathogenesis of the development of inflammation in the maxillary sinus, a local dysfunction of the ciliated epithelium of the sinus due to the resulting inflammatory and toxic tissue reaction plays an important role.
As a result of exposure to an infectious agent (first, as a rule, a viral one, then the bacterial flora joins) and the development of an inflammatory process, the properties of the secretion secreted by the mucous membrane of the sinus change and mucociliary transport is disrupted. The discharge stagnates in the sinus cavity, which creates conditions for the active reproduction of bacteria and the formation of pus. The pressure in the sinus begins to rise, tissue swelling increases.
Symptoms
The most common one-sided localization of the inflammatory process.
The characteristic symptoms of the acute course of the disease are:
- pain and heaviness in the upper jaw;
- increased pain when tilting the head;
- purulent or serous nasal discharge;
- change in the timbre of the voice, rhinolalia (defect in sound pronunciation);
- bad breath and nose;
- disorder of smell.
The general reaction of the body to inflammation in the sinus is manifested by malaise, weakness, headache, and fever.
In the chronic course of the disease, symptoms may be less severe, but they also reduce the patient's quality of life. The most frequently reported complaints are:
- pain or discomfort in the nose bridge, infraorbital area on the affected side;
- persistent headaches;
- periodic or persistent nasal congestion;
- mucous or purulent nasal discharge;
- general weakness, fatigue, apathy.
In some cases, sinusitis may be asymptomatic.
Diagnostics
During the examination, pain and sensitivity are revealed on palpation of the anterior walls of the paranasal sinuses, the region of the bridge of the nose, and local pain in the cheek area above the affected sinus. Rhinoscopy determines edema and hyperemia of the mucous membrane, mucous or purulent discharge in the middle nasal passage on the side of the sinus lesion.
If symptoms of sinusitis appear, you should contact the ENT
CBC data can reflect the viral, bacterial, or allergic nature of the disease.
Bacteriological culture of nasal discharge is carried out with determination of sensitivity to antibiotics.
On the plain radiograph, in most cases, there is an intense homogeneous or parietal darkening. With a purulent form of the disease, a homogeneous darkening or fluid level in the sinus is revealed.
To clarify the diagnosis, magnetic resonance imaging of the maxillary sinuses can be prescribed
Endoscopic examination of the sinus, as well as CT and MRI (computed and magnetic resonance imaging) are of particular information value in recognizing the pathology of sinusitis. With the help of CT, it is possible to accurately determine the nature and prevalence of the pathological process, the degree of involvement of the bone and soft tissues of the border areas.
Endoscopic examination allows assessing the condition of the mucous membrane, revealing edema, cicatricial and polyposis changes, and resolving the need for surgical treatment.
Maxillary sinusitis treatment
It is possible to achieve good results, shorten the duration of the disease and prevent the development of complications thanks to an integrated approach.
First of all, antibacterial drugs are selected. Broad spectrum antibiotics are preferred:
- protected penicillins (Flemoklav Solutab);
- macrolides (Azithromycin);
- cephalosporins (cephalexin).
One of the most important aspects of the pathogenetic therapy of sinusitis is the appointment of agents that affect the production and properties of sputum - mucoregulators (Myrtol, Bromhexin), which contribute to the dilution and elimination of secretions. They also have antimicrobial and anti-inflammatory effects.
Reducing tissue edema is achieved by systematic anemization of the nasal mucosa with vasoconstrictor solutions (Naphthyzin, Xymelin). At the same time, the mode of blood circulation in the nasal cavity and paranasal sinuses changes, the swelling of the mucous membrane decreases, the outlet opening of the cavity expands and the outflow of discharge from the sinus improves.
Antiseptic solutions such as Chlorhexidine are often used to rinse the nose.
The active excretion of sinus contents is facilitated by washing the nasal cavity and sinus with antiseptic (Chlorhexidine, Miramistin) and hypertonic solutions.
At home and in stationary conditions, the Cuckoo nose rinsing method (the method of moving liquid according to Proetz) is often used. An automatic suction tip or a rubber bulb is inserted into one half of the nose, the other nostril is clamped with fingers after the drug is injected. During suction, the child screams, the soft palate is pressed against the back of the pharynx, which creates favorable conditions for sucking out the contents not only from the nasal cavity, but also from the paranasal sinuses and nasopharynx. Older children and adults pronounce during the procedure "cuckoo", which prevents the solution from entering the oropharynx.
If the filling material enters the maxillary sinus, surgical intervention is indicated
According to the indications, surgical treatment is carried out aimed at sanitizing and restoring ventilation of the sinus, if necessary, to remove foreign objects: filling material, implants, cysts, areas of altered mucous membrane. In the postoperative period, in addition to broad-spectrum antibacterial therapy, steroid drugs are prescribed to reduce postoperative edema and restore sinus aeration.
Prevention
To minimize the likelihood of developing sinusitis, it is recommended to observe the following preventive measures:
- treatment of carious teeth;
- remediation of chronic foci of infection;
- timely diagnosis and treatment of acute viral diseases;
- increased immunity.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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