Sinusitis Treatment In Adults: Drugs, How To Treat, Nose Drops

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Sinusitis treatment in adults: drugs and features of their use

The content of the article:

Causes and features of the development of sinusitis
Clinical manifestations
Diagnostics
How to treat sinusitis in adults?

Surgery
Possible complications
Prevention
Video

Sinusitis is an inflammatory lesion of the lining of the paranasal sinuses. The most commonly diagnosed inflammation of the maxillary sinus is sinusitis, in second place is ethmoiditis - a lesion of the ethmoid labyrinth, then frontal sinusitis and sphenoiditis - the process takes place in the frontal and sphenoid sinuses, respectively.

Sinusitis is a common ENT disease requiring complex treatment

Acute and chronic sinusitis occupies a leading position among infectious and inflammatory diseases of the ENT organs and account for up to 60% in the structure of otorhinolaryngological morbidity.

Causes and features of the development of sinusitis

The appearance of inflammation in the sinus is influenced by:

anatomical features (ridges, spines or deformities of the nasal septum);
a decrease in the protective mechanisms of the mucociliary system of the nasal cavity and paranasal sinuses as a result of too frequent use of nasal drops;
prevalence in the environment of viruses, pathogenic microbial flora, protozoa;
adverse environmental and social factors;
the presence of chronic foci of infection;
concomitant chronic diseases;
lack of vitamins and minerals in the diet;
frequent psycho-emotional stress;
a general decrease in immunity.

One of the risk factors for developing sinusitis is a deviated septum.

The etiological factors in the development of sinusitis are viruses or mixed viral-bacterial infection. The most common viruses include influenza, parainfluenza, entero- and adenoviruses. Among bacterial pathogens, streptococci, staphylococci, haemophilus influenzae are detected. The increasing role of gram-negative bacteria is noted, as well as protozoa: mycoplasma, ureaplasma, chlamydia, etc.

The main cause of sinusitis is viruses or mixed viral-bacterial infection

As a result of primary damage by a viral agent, the mucous membrane of the nose and sinuses swells, and begins to actively produce a large amount of secretion. Further, due to a decrease in the diameter of the outlet, mucus stagnates in the sinus cavity. The exudate irritates the surrounding tissues and leads to an even greater increase in edema. The pressure in the sinus cavity increases. The bacterial flora joins, aggravating congestion and edema.

The process of remodeling or altering the mucous membrane of the sinus in chronic sinusitis creates conditions for the weakening of defense mechanisms and leads to even greater susceptibility to the effects of various types of microorganisms.

Clinical manifestations

The main symptoms of sinusitis are:

intoxication syndrome: fever, headache, general weakness;
a feeling of heaviness, distention in the projection of the sinus;
serous or purulent discharge from one or both halves of the nose;
decreased sense of smell (hyposmia);
watery eyes and sneezing.

Discharge can drain down the back of the throat, causing a cough. Swelling of the face, cheeks over the affected sinus or orbit is possible.

Acute purulent sinusitis is characterized by: rapid development of fever, symptoms of intoxication, runny nose, hyperemia and edema of tissues in the orbit and cheek region.

The disease can be one- or two-sided, involving one sinus in the process or affecting all paranasal cavities on one side (hemisinusitis) or both sides (pansinusitis).

By the nature of the course, acute and chronic sinusitis are distinguished; by the origin, sinusitis can be rhinogenic, odontogenic, nosocomial (nosocomial), bacterial, fungal, allergic.

Diagnostics

To make a diagnosis, a specialist performs an examination and a traditional or endoscopic rhinoscopy. At the same time, pus is detected in the general and middle nasal passages, catarrhal changes are noted: hyperemia and swelling of the mucous membrane.

Diagnosis and treatment of sinusitis is carried out by an ENT doctor

The discharge from the sinuses and nose is sent for bacteriological culture with determination of sensitivity to antibiotics and phages. The flora allocated in this case in most cases is represented by staphylococci, streptococci, enterobacteria, Haemophilus influenzae or mixed flora.

A clinical blood test is also prescribed, which provides additional information about the severity of the condition and the nature of the inflammatory process.

An important role is played by X-ray examination of the paranasal sinuses. On the roentgenogram, parietal edema of the sinus mucosa, homogeneous darkening or the presence of a fluid level in the sinus cavity during a purulent process is visualized.

In order to clarify the diagnosis, radiography is prescribed

During the diagnosis, it should be borne in mind that three options for the course of the disease are possible:

Easy:

nasal congestion;
mucopurulent discharge from the nose;
low-grade fever (37.1–38 ° C);
headache;
weakness;
hyposmia;
thickening of the sinus mucosa less than 6 mm (on x-ray).

Moderate:

nasal congestion;
profuse purulent discharge from the nasal cavity;
pain on palpation in the projection of the sinus;
aggravation of intoxication syndrome with an increase in body temperature up to 38 ° C;
thickening of the sinus mucosa more than 6 mm (on x-ray);
total sinus darkening or fluid level in one or both sinuses (possibly).

Heavy:

nasal congestion;
often profuse purulent discharge from the nasal cavity;
body temperature above 38 ° C;
severe intoxication syndrome (severe headaches, general weakness, apathy);
total darkening or fluid level in the sinus cavity on an x-ray;
leukocytosis with a shift of the leukocyte formula to the left, increased ESR (erythrocyte sedimentation rate) in the clinical blood test.

With this option, it is necessary to exclude the presence of orbital and intracranial complications.

How to treat sinusitis in adults?

The starting scheme for antibiotic therapy of sinusitis in adults includes broad-spectrum antibiotics: Amoxicillin, Flemoxin Solutab, Cefuroxime, Azithromycin.

Depending on the data obtained from the culture method of research, the ENT can leave or replace the drug with another antibiotic that has a more pronounced activity in relation to the detected flora. So, when enterobacteria are detected, the appointment of IV generation cephalosporins (Cefepim) or respiratory fluoroquinolones (Levofloxacin) is indicated.

Decongestants are also included in the treatment regimen for sinusitis. What it is? Decongestants are intranasal vasoconstrictors that reduce swelling of the mucous membranes, improve nasal breathing, and reduce the risk of complications. Among the vasoconstrictor nasal drops in adults with sinusitis and sinusitis, Naphazoline, Sanorin, Galazolin, Vibrocil are often used.

An important role in the treatment of sinusitis in adults is played by local therapy by inhalation or washing with antiseptic solutions that have antimicrobial and antiviral effects.

Rinsing the nose with antiseptic solutions is an important part of the complex therapy of sinusitis

When using antiseptics during washing, the optimal dose of the active component is delivered directly to the mucous membrane and to the inflammation focus.

Lavages are distinguished by the simplicity and availability of introduction into the zone of pathological changes. They can be done at home. Antiseptic drugs for the treatment of sinusitis in adults (Chlorhexidine, Miramistin) have the following properties:

low toxicity;
bactericidal action with a strong antimicrobial and antiparasitic effect;
high activity;
no damaging effect on tissues and the regeneration process.

Especially important is the fact that, despite the long period of use of antiseptic drugs, therapy does not lead to the appearance of allergic reactions, and the most common pathogens do not acquire resistance to these drugs.

Bacteriophages - highly effective immunobiological antimicrobial drugs used in the development of resistance of the infectious agent to antibiotics

In the case of the development of resistance of the pathogen to antibiotics, bacteriophages are actively used - these are viruses that selectively infect bacteria. These are highly effective immunobiological drugs with antimicrobial action. Their antibacterial effect is based on the introduction of the phage genome into a bacterial cell, followed by its reproduction and destruction of the infected cell.

Phage therapy is especially effective in the treatment of chronic inflammatory conditions against a background of reduced immunity, since the use of bacteriophages stimulates the activation of specific and non-specific immunity factors.

Surgery

In a hospital setting, the treatment of sinusitis by puncture of the maxillary sinus is actively practiced. The procedure is recommended to be carried out daily. The average course of treatment is 3-4 punctures. During it, antiseptic solutions are also used. Simultaneously, the drug Betadine affects the bacterial and viral pathogenic microflora. The maxillary sinus is washed with 0.01% Betadine solution, then 10 ml of 0.1% solution of the drug is injected into the cavity.

For polyposis form of chronic sinusitis, surgical treatment is indicated.

In the treatment of chronic sinusitis, both conservative and invasive methods are used. So, in the treatment of the polyposis form of chronic sinusitis, loop polypotomy or opening of the paranasal sinus with the subsequent removal of polyps, evacuation of pathological contents remains relevant. An alternative modern solution is minimally invasive endoscopic surgery, which shortens the rehabilitation period and reduces the likelihood of postoperative complications. Laser technologies are also used in the treatment of various forms of chronic sinusitis.

Laser technology can be used to treat sinusitis

The criteria for the effectiveness of the treatment of sinusitis in adults are the following:

a significant decrease in clinical manifestations;
improved nasal breathing;
relief of headache;
normalization of body temperature;
reduction of hyperemia and swelling of the nasal mucosa with anterior rhinoscopy;
gradual replacement of purulent discharge from the nose with mucous;
reduction of inflammatory changes in the sinus according to the X-ray examination of the paranasal sinuses.

Possible complications

A predisposing factor in the development of purulent-septic and intracranial complications is the high resistance of microorganisms to the antibacterial drugs most often used in medical practice. To prevent an unfavorable outcome, it is necessary to strictly follow the doctor's recommendations, observe the prescribed antibiotic regimen.

A complication with the involvement of the knee joint, bacterial damage to internal organs (heart, kidneys) is also possible.

Prevention

Sinusitis is often a bacterial complication of ARVI (acute respiratory viral infection), as a result of the activation of opportunistic flora against the background of edema of the nasal mucosa. Therefore, it is very important during cold weather and off-season to carry out vitamin therapy, when the first signs of colds appear, promptly start antiviral and symptomatic treatment to prevent the spread of infection.