Treatment of bilateral sinusitis in children and adults
The content of the article:
- Types of sinusitis
-
Development reasons
Risk factors
- Symptoms
- Diagnostics
-
Treatment of bilateral sinusitis
- Should I settle for a puncture, and what is a cuckoo?
- Treatment of bilateral sinusitis at home
- Possible complications
- Video
Bilateral sinusitis is an inflammation of the mucous membrane of both maxillary sinuses.
Sinusitis is one of the most common diseases and is the leading pathology in otorhinolaryngology. The bilateral process of inflammation is much more difficult than the unilateral process, characterized by more vivid clinical manifestations and a protracted course.
Most often, sinusitis develops as a complication against the background of ARVI (acute respiratory viral infection), ARI (acute respiratory disease), so the incidence rate remains high and is 5-10% in adults and 5% in children.
In the development of acute or chronic bilateral sinusitis, in addition to viruses, bacteria play an important role: staphylococci, streptococci, Haemophilus influenzae, chlamydia, mycoplasma, anaerobes. The infection can get into the upper respiratory tract primarily with the inhaled air, as well as with the blood flow from chronic foci of infections, for example, in chronic tonsillitis, osteomyelitis. The presence of carious teeth in the upper jaw, trauma or surgery near the maxillary sinuses can also cause infection.
For bilateral sinusitis, more severe symptoms and a protracted course are characteristic
Types of sinusitis
Depending on the duration of the course, the following types of sinusitis are distinguished:
- acute (less than 3 months);
- recurrent (2-4 episodes of acute sinusitis per year);
- chronic (more than 3 months).
According to the etiological factor, sinusitis can be:
- viral;
- bacterial;
- fungal;
- allergic;
- mixed;
- traumatic;
- endogenous: odontogenic, otogenic, vasomotor;
- iatrogenic;
- perforated.
According to the form of the disease, sinusitis is distinguished:
- exudative or catarrhal, accompanied by the active production of inflammatory fluid, depending on which they are distinguished: serous, mucous or purulent sinusitis;
- productive, accompanied by the growth of the mucous membrane of the sinuses. Depending on the nature of growth, it is divided into: parietal-hyperplastic (characterized by thickening of the mucous membrane without purulent discharge), polyposis (characterized by the formation of polyps in the nose and sinuses).
ICD-10 code: J01 (acute sinusitis), J32 (chronic sinusitis).
Development reasons
A decrease in the general resistance of the body against the background of hypothermia, overwork, hypovitaminosis leads to susceptibility to viruses, bacteria, fungi that enter the nasopharynx.
The inflammatory process is usually caused by viruses, fungi or bacteria.
Most often, one sinus is affected first. Inserting itself into the mucous membrane, the infection causes severe swelling. As a result, it thickens 20–100 times, filling almost the entire lumen of the cavity. Since all the sinuses communicate with each other, the inflammation spreads quickly enough to the second cavity. In conditions of pronounced edema, blockade of the natural anastomosis occurs, hypersecretion and stagnation of secretions, the partial pressure of oxygen in the sinus cavity decreases, which creates favorable conditions for further multiplication of bacteria and the progression of inflammation.
In the early stages of the disease, the exudate is serous, then muco-serous, and when a bacterial infection is attached, it becomes purulent, with a large amount of detritus and leukocytes. Prolonged violation of the outflow of secretion from the sinus leads to a decrease in the oxygen content in it and, accordingly, an increase in the carbon dioxide content. This contributes to the development of a chronic process with the reproduction of anaerobic infection.
Risk factors
The development of bilateral inflammation in the maxillary sinuses is facilitated by general and local predisposing factors:
- congenital narrowness of the nasal passages;
- curvature of the nasal septum;
- the presence of adenoids, polyps, cysts in the nose;
- allergic rhinitis;
- congenital or hereditary diseases characterized by damage to the glands of external secretion, pathology of the respiratory and gastrointestinal tract, for example, cystic fibrosis;
- excessive use of nasal drops, leading to atrophy of the nasal mucosa and unhindered entry and reproduction of viruses, bacteria and fungi;
- a general decrease in immunity;
- the presence of concomitant diseases;
- air pollution with industrial gases;
- occupational hazards: working with toxic or chemical substances, in a dusty, hot room.
Symptoms
Symptoms of acute bilateral sinusitis include:
- nasal congestion;
- profuse, mucopurulent discharge from the nose;
- an increase in body temperature up to 38.5 ° C and above;
- general weakness, fatigue, drowsiness, sweating, chills, aching muscles and joints, nausea and vomiting;
- bad breath and nose;
- pressing pain in the area of the nose, eye sockets and cheeks, aggravated by pressure on the bridge of the nose, in the center of the cheeks, when turning and tilting the head forward;
- headaches and throbbing in the temporal region;
- loss of ability to recognize smells and tastes;
- ear congestion;
- sore throat or sore throat in the morning;
- changing the timbre of the voice;
- night or morning cough due to the fact that pus from the cavities flows down the back of the pharynx.
Symptoms of chronic bilateral inflammation of the maxillary sinuses are:
- persistent nasal congestion and nasal breathing difficulties;
- malaise and lethargy;
- moderate headache that goes away only after using pain relievers;
- memory impairment;
- periodic profuse mucous or mucopurulent discharge from the nose.
Chronic sinusitis has a negative impact on the quality of life, professional activity. Due to constant breathing problems, bilateral sinusitis in a child can lead to a delay in physical and mental development.
Diagnostics
When making a diagnosis, the otolaryngologist is based on an analysis of the history data, clinical manifestations, the results of laboratory and diagnostic studies. The ENT performs examination, palpation of the nasal region, cheeks, rhinoscopy and prescribes a clinical blood test, bacteriological culture of nasal discharge, X-ray examination of the paranasal sinuses.
X-ray examination of the paranasal sinuses may be prescribed to make a diagnosis.
X-ray shows homogeneous darkening of the sinuses, thickening of the mucous membrane due to edema. When taken in an upright position, the pus looks like a liquid level.
Treatment of bilateral sinusitis
How to treat bilateral sinusitis, the doctor decides. Therapy has the following goals:
- sanitation of the focus of inflammation;
- improving the outflow of secretions from the sinuses;
- elimination of edema of the mucous membranes of the maxillary sinus and nasal cavity.
Also, measures should be taken to prevent the occurrence of orbital and intracranial complications.
In the treatment of sinusitis, penicillin antibiotics are most often prescribed
Due to the large volume of the lesion, antibiotic therapy plays a leading role in treatment. In most cases, broad-spectrum antibiotics are prescribed:
- Amoxicillin, Amoxiclav (penicillins);
- Cefuroxime, Cefixime (cephalosporins);
- Azithromycin, Clarithromycin (macrolides).
The dosage of antibacterial agents is selected by the doctor individually, it depends on the age, weight, severity of the disease.
To eliminate edema of the nasal mucosa and paranasal sinuses, vasoconstrictor drops (Xylometazoline, Oxymetazoline) and antihistamines (Loratadin, Cetirizine) are used. When the body temperature rises, antipyretic drugs are used.
Should I settle for a puncture, and what is a cuckoo?
If the effectiveness of drug treatment is insufficient, a puncture (puncture) of the maxillary sinuses is prescribed. The doctor decides whether it is necessary after assessing the ratio of the expected benefit with the possible risk.
In case of ineffectiveness of drug treatment, a puncture of the maxillary sinuses can be prescribed
In some cases, it is possible to avoid surgery by using minimally invasive methods. In order to facilitate the release of pus from the affected cavity and normalize breathing, the method of washing the paranasal sinuses, the cuckoo, is actively used. For the procedure, the following solutions are used: Dekasan, Furacilin, Dioxidin, Chlorhexidine, Octenisept, Miramistin, Physiological solution (0.9% NaCl).
The liquid, circulating from one half of the nose to the other, helps to flush out stagnant pus and mucus from the maxillary sinuses, while disinfecting the mucous membranes of the nasal cavity.
In addition to drug treatment and washing, physiotherapeutic methods are used: electrophoresis, UFO (ultraviolet irradiation), UHF (ultra-high-frequency therapy). Speleotherapy is highly effective. When a patient is in a salt mine or karst cave, the body is favorably influenced by clean, ionized, cool air with low humidity.
Treatment of bilateral sinusitis at home
Antibiotic therapy and outpatient treatment can be complemented by home therapy. You can ask the doctor to explain in detail and show how to do the lavage of the nasal cavity, like a cuckoo, and carry it out yourself, using a syringe with a soft catheter and a rubber bulb for suction of fluid.
At home, you can use decoctions of medicinal herbs
Also, a nasal wash - nasal shower can be used as an adjunct treatment. To carry it out, you need a special device or a small kettle. In this case, various means can be used:
- A solution of sea or table salt. For its preparation, 1/3 teaspoon of salt is dissolved in 200 ml of warm boiled water. Washing can be replaced by the use of pharmaceutical preparations - sprays with sea water, for example Humer, Physiomer, Marimer, Aqualor, Aqua Maris and others.
- Herbal solutions. For the treatment of sinusitis, decoctions and infusions of chamomile, string, calendula, St. John's wort, sage, eucalyptus are used. You can supplement the therapy with folk remedies: instilling aloe juice into the nose, using drops with cyclamen.
- Furacilin solution. For rinsing, a ready-made solution can be used. You can also prepare it yourself by dissolving 1–2 tablets in 200 ml of water.
Possible complications
If diagnosed and treated late, the disease can progress and lead to damage to internal organs, orbital and intracranial complications.
The likely consequences of the disease include:
- bacterial damage to the myocardium and kidneys;
- otitis;
- osteomyelitis;
- phlegmon of the orbit;
- meningitis;
- encephalitis.
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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