Purulent sinusitis: treatment, symptoms, consequences
The content of the article:
- Development reasons
- Symptoms of purulent sinusitis
- Diagnostics
-
Treatment
- Drug therapy
- What to do if pus does not come out on its own?
- Treatment of purulent sinusitis at home
- Possible complications
- Video
Acute or chronic purulent sinusitis is an inflammatory disease of the maxillary sinuses, accompanied by purulent discharge.
For the purulent form of sinusitis, viscous, abundant discharge of yellow and green colors
A decrease in the general resistance of the body against the background of hypovitaminosis, hypothermia, overwork leads to susceptibility to bacteria entering the nasopharynx. Inserting itself into the mucous membrane of the maxillary sinuses, the infection causes its severe swelling by dilating the blood vessels and increasing the permeability of the capillaries, as a result of which the mucous membrane thickens 20–100 times, filling almost the entire lumen of the sinus.
Inflammatory edema makes it difficult for air to pass into the upper respiratory tract. Ventilation of the sinuses is impaired, discharge accumulates in them. In the early stages, the exudate is muco-serous. In conditions of pronounced edema, the natural fistula is blocked, the secret stagnates inside the cavity, which creates conditions for the active reproduction of bacteria.
The discharge becomes purulent, with a large number of leukocytes and detritus. What color the discharge from the nose will be depends on the etiological factor: for purulent maxillary sinusitis, mainly yellow and green discharge is characteristic.
Prolonged violation of the outflow of secretion from the sinus leads to a decrease in the oxygen content in it and an increase in carbon dioxide. This contributes to the development of a chronic process with the reproduction of anaerobic infection.
Depending on the spread of the process, purulent sinusitis can be unilateral or bilateral. ICD-10 code: J01.0 (acute maxillary sinusitis), J32.0 (chronic maxillary sinusitis).
Development reasons
The main causative agents of the purulent form of sinusitis are bacteria: streptococci, staphylococci, hemophilus influenzae, anaerobes.
The development of a purulent form of the disease is most often caused by bacteria
Sinusitis can occur in the presence of carious molars adjacent to the lower wall of the sinus, after operations in the nasal cavity or on the upper jaw. Also, a significant role is played by chronic foci of infections, from which bacteria can be spread by the hematogenous route.
For the occurrence of sinusitis, general and local predisposing factors are of great importance:
- the presence of cysts, adenoids or polyps in the nose (polyposis sinusitis);
- curvature of the nasal septum;
- congenital narrowness of the nasal passages;
- allergic rhinitis;
- regular and prolonged use of nasal drops, leading to atrophy of the nasal mucosa;
- concomitant chronic diseases;
- a general decrease in immunity.
Also, an important role in the development of acute and chronic sinusitis is played by the disruption of the normal function of the mucociliary apparatus of the mucous membrane, caused by unfavorable environmental factors, for example, cold air, atmospheric pollution with industrial gases.
Symptoms of purulent sinusitis
The symptoms of the disease in an adult and a child do not differ from each other.
Sinusitis in acute form proceeds with an increase in body temperature and signs of general intoxication
A characteristic sign of acute purulent sinusitis is abundant, viscous discharge of yellow and green color. In addition, it is noted:
- increased body temperature;
- signs of intoxication of the body: general weakness, rapid fatigue, sweating, chills, aching muscles and joints, nausea and vomiting;
- pressing pain in the area of the nose, eye sockets and cheeks, aggravated by pressure on the bridge of the nose, turning and tilting the head forward;
- nasal congestion;
- headaches and throbbing in the temporal region;
- inability to recognize smells and tastes;
- ear congestion;
- sore throat or sore throat in the morning;
- night or morning cough due to the discharge from the sinuses flowing down the back of the pharynx;
- changing the timbre of the voice;
- bad breath and nose.
The symptoms of chronic sinusitis are:
- persistent moderate headache;
- malaise and lethargy;
- periodic profuse mucopurulent discharge from the nose;
- persistent nasal congestion and nasal breathing difficulties.
Diagnostics
When making a diagnosis, the doctor fills in the medical history, finding out the main symptoms of the disease, the circumstances and the time of their occurrence, examines, palpates the area of the nose, cheeks, rhinoscopy and prescribes a clinical blood test, bacteriological culture of nasal discharge, X-ray examination of the paranasal sinuses.
To make a diagnosis, the doctor examines
If necessary, it is possible to conduct video endoscopy of the nasal cavity or video rinoscopy, during which a specialist can take a photo or save a video for a visual display of the state of the patient's nasal mucosa when anomalies of the structure, tumors, wounds are detected. Such a record eliminates the need for re-examination during consultation with other doctors in difficult clinical cases.
On the roentgenogram, homogeneous darkening of the sinuses (or sinuses in a one-sided process), thickening of the mucous membrane due to edema is determined. When taken in an upright position, the pus looks like a liquid level.
Treatment
Treatment tactics depend on the prevalence of the process, the general condition of the patient, and the presence of concomitant diseases.
Drug therapy
Therapy should be aimed at solving the following problems:
- elimination of edema of the mucous membrane of the maxillary sinus and nasal cavity;
- restoration of the outflow of secretions from the sinuses;
- sanitation of the focus of infection;
- prevention of the development of orbital and intracranial complications.
As part of complex treatment, vasoconstrictor drugs are usually prescribed.
Given the bacterial nature of the formation of this form of sinusitis, antibiotic therapy plays a leading role. Preference is given to broad-spectrum antibiotics:
- penicillin series: Amoxicillin, Amoxiclav;
- cephalosporins: Cefuroxime, Cefixime;
- macrolides: Azithromycin, Clarithromycin.
The dosage of antibacterial agents depends on the age, weight, severity of the disease and is selected by the doctor individually.
To eliminate edema of the nasal mucosa and paranasal sinuses, vasoconstrictor (Xylometazoline, Oxymetazoline) and antihistamines (Loratadin, Cetirizin) drugs are used, nasal lavages are carried out with hypertonic solutions and antiseptic solutions. Antipyretic drugs are used as needed.
What to do if pus does not come out on its own?
If the drug treatment is ineffective, a sinus puncture (puncture) is prescribed. In order to quickly restore air permeability to the upper respiratory tract without a puncture, the cuckoo washing method (the method of moving fluid according to Proetz) is used, during which various solutions are used that remove pus from the sinuses. The most commonly used are Chlorhexidine, Miramistin, Octenisept, Dekasan, Dioxidin, Furacilin, Physiological solution (0.9% NaCl).
In addition, of non-drug methods of treatment, physiotherapeutic methods are used: electrophoresis, UHF (ultra-high-frequency therapy), UHF (ultraviolet irradiation), speleotherapy (therapeutic stay in a salt mine or karst cave, where the body is favorably affected by clean cool ionized air of low humidity).
Treatment of purulent sinusitis at home
How to treat sinusitis with folk remedies? Most often, herbal preparations are used, which have anti-inflammatory, antibacterial and secretolytic effects, promoting the outflow of exudate from the paranasal sinuses and upper respiratory tract.
One of the effective home remedies is alo juice
Rinsing the nose with broths of sage and chamomile, instilling aloe juice help relieve symptoms. Onion drops, drops with cyclamen, propolis and St. John's wort are also used.
At the same time, it is not recommended to neglect the deterioration of the general condition against the background of home treatment, since there is a risk of spreading the infection. Folk remedies can only be used as an adjunct to the main antibiotic treatment.
Possible complications
Complications of the purulent form of sinusitis are:
- otitis;
- phlegmon of the orbit;
- meningitis;
- encephalitis;
- osteomyelitis;
- bacterial damage to the myocardium and kidneys.
Timely diagnosis and treatment of the disease avoids many consequences.
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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