home Audience 3 How to treat acute rhinosinusitis. Symptoms and treatment of chronic rhinosinusitis. Antibacterial therapy for exacerbations of chronic rhinosinusitis

How to treat acute rhinosinusitis. Symptoms and treatment of chronic rhinosinusitis. Antibacterial therapy for exacerbations of chronic rhinosinusitis

Rhinosinusitis is a rather serious disease, during which the nasal mucosa becomes very inflamed. The most common is acute rhinosinusitis, which in most cases appears already in mature people. However, sometimes this disease can be found in children.

With the appearance of rhinosinusitis, the mucous membrane thickens and seriously swells. Because of this, the fistulas begin to gradually overlap and purulent mucus accumulates in the nasal cavity. To get rid of rhinosinusitis in adults, you need to understand what rhinosinusitis is and how to treat it.

Types of disease

Spicy

The most dangerous form of the disease is acute rhinosinusitis. It is accompanied by pronounced symptoms that develop quite quickly. Literally a few days after the onset of the disease, patients develop a severe headache and the upper half of the face swells.

The most common acute symptoms include:

Intoxication. It is accompanied by pressure in the ears, great fatigue and fever.
Pain sensations. Acute rhinosinusitis is often accompanied by pain and discomfort around the nose.
Breathing problems. Difficulties in nasal breathing appear due to severe nasal congestion. It can also lead to a partial loss of smell and the appearance of copious nasal discharge.

Sometimes acute rhinosinusitis is accompanied by serious complications:

vision problems;
swelling of the entire face;
increased irritability.

Chronic

Chronic rhinosinusitis is accompanied by narrowing and swelling of the anastomosis located between the sinus and nose. This form of the disease is characterized by a decrease in incoming oxygen.

The main reason why chronic rhinosinusitis appears is the improper treatment of the acute form of the disease.
However, there are other factors that contribute to its occurrence:
curvature of the nasopharynx;
allergy;
head injury;
bad habits;
frequent inhalation of dusty air;
intoxication.

Chronic rhinosinusitis lasts much longer than acute. However, his symptoms are not as severe. On average, the chronic form can last about 8-9 months. At the same time, the disease does not manifest itself in the first months. The first symptoms begin to appear after 3-4 months. At first, a person is worried about weakness and irritability, mucus from the nose gradually begins to stand out. Over time, the disease worsens, and the following symptoms appear:
deterioration of smell and hearing;
pain sensations;
increased discharge from the nose;
labored breathing.

If you do not treat the symptoms of rhinosinusitis in adults, then serious complications will appear over time.
Allergic
Allergic rhinosinusitis appears only if a person is allergic to various irritants. There are many symptoms of allergic rhinosinusitis. The main features include:
increased tearing;
nasal discharge;
constant sneezing;
itching in the nose;
redness of the eyes.

Most often, chronic allergic rhinosinusitis appears after the use of certain drugs and contact with wool or plants.
To cure allergic rhinosinusitis, it is necessary to identify the irritant and get rid of it immediately. During treatment, only antihistamines are used.
catarrhal
Acute catarrhal rhinosinusitis differs from other forms in that it is not accompanied by nasal discharge. Many doctors call this disease a viral rhinitis, since most often it appears with SARS. During the disease, the following symptoms of rhinosinusitis appear:
sleep problems;
severe intoxication;
complete loss of smell;
increased tearing;
dryness and severe burning in the nose;
hyperthermia;
swelling of the paranasal sinuses.

Treatment of acute catarrhal rhinosinusitis should be carried out immediately after the onset of the above symptoms. Late treatment can lead to complications such as brain abscess and meningitis.
Bacterial
Bacterial rhinosinusitis in adults appears due to the appearance of a bacterial infection. This form of the disease is accompanied by fever and other vivid symptoms:
insomnia;
acute toothache;
poor appetite;
swelling of the nose;
copious purulent discharge.

At the first appearance of symptoms, the patient should be examined by the attending physician. The treatment of the bacterial form of the disease should only be done in a hospital, so that doctors have the opportunity to regularly monitor the patient. During treatment, antihistamines and antibacterial agents are used.
Vasomotor
Vasomotor rhinosinusitis appears due to problems with the blood vessels located in the paranasal sinuses and nasal cavity. In the early stages of the disease, small swelling of the nasal mucosa and vasodilation appear.
Vasomotor rhinosinusitis often becomes chronic and is accompanied by such complications as the appearance of polyps in the nose and otitis media.

How to treat rhinosinusitis
Rhinosinusitis is treated in a variety of ways. Therefore, before dealing with sinusitis, you should familiarize yourself with the main means and methods of its treatment.
Medication use
Quite often, during the treatment of bilateral rhinosinusitis, antibiotics and other medications are used.
Amoxicillin
This drug is recommended for the treatment of the bacterial form of the disease, since with the help of Amoxicillin you can get rid of all harmful bacteria. The main advantage of the product is that it is acid-resistant. This allows you to accelerate and improve its absorption in the intestine.
Before treating bilateral sinusitis, it is necessary to determine the dosage. Children should take the drug three times a day, 0.2 grams. For adults, the dosage increases slightly and is 0.5 grams three times a day.
Azithromycin
Azithromycin allows not only to get rid of the disease, but also to increase immunity. After taking the drug quickly enters the respiratory tract, soft tissues and skin. With its help, the inflammation of the nasal cavity is eliminated and the amount of pus released gradually decreases.
Isofra
Topical drug, which is often used for rhinosinusitis. The active component of this remedy is framycetin, which copes well with inflammatory processes in the nasal cavity and helps to boost immunity.
The drug is sold in the form of a spray, so you can use it immediately after purchase. Before the first use, it is recommended to spray it a little. This is done to achieve correct dosing. During the injection of Isofra into the nose, you should slightly tilt your head forward. It should be injected three times a day for 2-3 weeks. To determine the exact course of treatment, it is recommended to consult with your doctor in advance.
Nazivin
Many use Nazivin to treat acute purulent rhinosinusitis. This drug is sold as a spray and nasal drops. It allows you to slightly narrow the vessels and get rid of swelling of the nose, thereby increasing the supply of oxygen.
Dosages of use depend on the form in which the drug will be used. If a spray is used for treatment, then 1-2 injections three times a day will be enough per day. Nazivin in drops is applied three times a day before meals, two drops.
Folk remedies
To cure the disease at home, you need to familiarize yourself with folk remedies that can be used for this.
Drops
If thick mucus is actively secreted from the nasal cavity, then you can get rid of it with the help of drops. For their preparation, you can use fresh juice from Kalanchoe or aloe. To prepare such drops, you need to mix 50 ml of fresh juice with 100 ml of water. You need to use the created mixture about 5-6 times a day. For each dose, with the help of a pipette in the nose, two drops are instilled.
Beetroot juice is also used to make drops. It is diluted with water in equal proportions, after which they can be instilled into the nose. Beetroot juice drops do not have any side effects and can therefore be taken by pregnant girls and young children.

Sometimes instillations are made from garlic juice. To prepare garlic drops, you need to mix 10 drops of garlic with 30 grams of olive oil. During treatment, at least two drops are instilled into each nostril.
Ointments
When treating rhinosinusitis with folk remedies, you can use homemade ointments that are placed in the nostrils. They help prevent rhinosinusitis. Most often they are made from juice made from onions, alcohol, honey and vegetable oil. All these ingredients in equal proportions are added to a small container and mixed thoroughly. After that, they are boiled over low heat for 20-30 minutes. You can use the ointment only after it has completely cooled.
A small piece of cotton is soaked in the prepared liquid and placed in the nostrils. It will be possible to take them out of the nose only after 10-20 minutes. The procedure is carried out twice a day for a week. The course of treatment can be increased if it is not possible to get rid of the inflammation in the nasal cavity in a week.
Conclusion
Rhinosinusitis is a fairly common disease that many people experience. To get rid of it, you need to familiarize yourself with the main causes of rhinosinusitis and the features of its treatment.

Types of rhinosinusitis

Acute (disease duration less than 12 weeks and complete disappearance of symptoms after recovery).
Recurrent (from 1 to 4 episodes of acute rhinosinusitis per year, the periods between exacerbations (when there are no symptoms of the disease and treatment is not carried out) last at least 8 weeks).
Chronic (presence of symptoms for more than 12 weeks).

Localization

maxillary sinus (sinusitis),
sphenoid sinus (sphenoiditis),
frontal sinus (frontitis),
in the cells of the ethmoid bone (ethmoiditis).

Depending on the etiological factors, acute and recurrent rhinosinusitis are divided into:

viral,
bacterial,
fungal.

Chronic are divided into:

bacterial,
fungal,
mixed.

Taking into account the peculiarities of pathogenesis:

nosocomial,
odontogenic,
polyposis,
developed against the background of immunodeficiency states of rhinosinusitis,
acute (lightning) form of mycosis of the paranasal sinuses.

Chronic fungal rhinosinusitis subdivided into:

allergic (eosinophilic) fungal sinusitis,
mushroom ball,
superficial sinonasal mycosis,
chronic invasive form of mycosis.

Factors predisposing to the development of rhinosinusitis

Rhinitis.
Intolerance to non-steroidal anti-inflammatory drugs.
Anomalies in the structure of the nasal cavity and paranasal sinuses (curvature of the nasal septum; bulla of the middle nasal concha; additional fistula of the maxillary sinus, etc.).
Immunodeficiency states (X-linked agammaglobulinemia; common variable immunological deficiency; IgG subclass deficiency; selective IgA deficiency; hyper-IgM syndrome; HIV).
Diseases accompanied by a slowdown in the MCT (Kartagener's syndrome; Young's syndrome; cystic fibrosis).
Wegener's granulomatosis.
Hyperplasia of the pharyngeal tonsil, adenoiditis.
Gastroesophageal reflux disease.
Fistula between the oral cavity and the maxillary sinus.

Reasons for the development of rhinosinusitis

The main causative agents of acute bacterial rhinosinusitis are Streptococcus pneumoniae And haemophilus influenzae. Among other causative agents are Moraxellacatarrhalis, Staphylococcusaureus, Streptococcuspyogenes, Streptococcusviridans etc. The main anaerobic pathogens of rhinosinusitis are anaerobic streptococci. However, the spectrum of causative agents of acute bacterial rhinosinusitis can vary significantly depending on geographic, socioeconomic and other conditions.

The list of causative agents of nosocomial, developed against the background of immunodeficiency states, and odontogenic rhinosinusitis, along with the bacteria mentioned above, includes Staphylococcus epidermidis, Pseudomonasaeruginosa, Proteusspp., and in immunodeficient patients also saprophytic bacteria and fungal microflora. In recent years, the role of chlamydia and other atypical microflora in the etiology of rhinosinusitis has been discussed.

Fungal sinusitis is more commonly caused by fungi Aspergillus(In most cases A. fumigatus), less often Candida, Alternaria, Bipolaris and etc.

The acute invasive form of mycosis of the paranasal sinuses is most often caused by fungi of the family Mucoraceae: Rhizopus, Mucor and Absida.

Development mechanism

Rhinosinusitis almost always develops in violation of mucociliary clearance, when optimal conditions are created for the development of a bacterial infection.

The starting point in the development of acute bacterial rhinosinusitis is usually SARS. It was found that almost 90% of patients with acute respiratory viral infections in the paranasal sinuses revealed changes in the form of mucosal edema and secretion stagnation. However, only 1-2% of these patients develop acute bacterial rhinosinusitis.

In the development of chronic rhinosinusitis, in addition to disorders of mucociliary transport, an important role is played by anomalies in the structure of the intranasal structures and the ethmoid labyrinth, which block the patency of the natural openings of the paranasal sinuses and disrupt the mechanisms of sinus cleansing. The presence of two or more fistulas of the maxillary sinuses also creates conditions for the reflux of mucus that has already been in the nasal cavity and infected back into the sinus. Under conditions of chronic inflammation in the mucosa, focal or diffuse metaplasia of multi-row cylindrical epithelium occurs in a multi-layer, devoid of cilia and has lost the ability to remove bacteria and viruses from its surface by active mucociliary transport.

Hospital-acquired rhinosinusitis is most commonly associated with prolonged nasotracheal intubation.

Odontogenic sinusitis develops against the background of chronic foci of inflammation, cysts or granulomas in the roots of the teeth of the upper jaw, as a result of the ingress of pieces of filling material into the maxillary sinuses, the roots of the teeth, or the formation of a fistula between the oral cavity and the maxillary sinus after tooth extraction.

A key role in the pathogenesis of polyposis rhinosinusitis is played by eosinophils and IL-5, which causes their proliferation, migration into tissues and degranulation.

Mucopurulent discharge from the affected paranasal sinuses can be transported by the ciliated epithelium directly through the mouth of the auditory tube, which is the starting point in the development of an exudative or chronic inflammatory process in the middle ear.

Superficial sinonasal mycosis is caused by the growth of mycelium of the fungus on crusts formed in the cavities of the operated paranasal sinuses, on the surface of neoplasms and on accumulations of antimicrobial drugs or glucocorticosteroids for topical use, which are long-term in the nasal cavity.

Symptoms of rhinosinusitis

The main symptoms of rhinosinusitis are:

difficulty in nasal breathing
headache,
nasal discharge.

Intermittent symptoms:

decreased sense of smell
ear congestion,
increase in body temperature,
general malaise,
cough (more typical for children).

With inflammation in the maxillary and frontal sinuses, the pain is localized in the face, nose and eyebrows. Sphenoiditis is characterized by pain in the center of the head and the back of the head.
The secretions are mucous, purulent, and can be discharged when you blow your nose or drain down the back of the throat. The latter is more typical for lesions of the sphenoid sinus and the posterior ethmoid labyrinth.
Chronic rhinosinusitis is accompanied by the same symptoms as acute, but without exacerbation they are much less pronounced.

Rhinosinusitis is diagnosed based on:

anamnestic data.
clinical manifestations.
Results of laboratory researches.
The results of instrumental methods of examination.

Acute bacterial rhinosinusitis is characterized by a connection with an episode of ARVI transferred 5-10 days ago.

Patients with a history of odontogenic and fungal sinusitis often have previous complex maxillary fillings, as well as a long history of repeated visits to the otorhinolaryngologist and repeated diagnostic punctures of the maxillary sinuses, in which no content was obtained.

Polypous rhinosinusitis is characterized by a gradual progression of the main symptoms: difficulty in nasal breathing and decreased sense of smell. Often, patients are disturbed by the painful sensation of constant flow of a very viscous secret along the back wall of the nasopharynx. In many cases, polypous rhinosinusitis is combined with bronchial asthma, intolerance to non-steroidal anti-inflammatory drugs, and cystic fibrosis.

Laboratory research methods

Bacteriological research

This study is designed to isolate bacteria and study their properties in order to make a microbiological diagnosis. The material for the study can be obtained from the nasal cavity or from the affected sinus during its puncture. When taking the material, there is a high probability of getting "travel" microflora.

mucociliary transport study

Allows you to assess the state of the mucociliary apparatus of the mucous membrane, that is, to identify one of the most important pathogenetic disorders in rhinosinusitis.

In clinical practice, the measurement of transport time is most widely used. One of the varieties of this method is the measurement of the time during which the marker (charcoal, carmine, ink, polystyrene, etc.) moves from the anterior parts of the nasal cavity to the nasopharynx. Due to its simplicity, the saccharin test has become more widespread.

Its principle is to measure the time it takes for a particle to travel a conventional distance - from the anterior parts of the nasal cavity to the taste buds in the throat. Indicators of saccharin time in healthy people can range from 1 to 20 minutes, averaging 6 minutes. However, these indicators are very conditional.

Instrumental research methods

To assess the patency of the anastomosis of the punctured sinus, a simple scheme is used that takes into account 3 degrees of impaired patency of the anastomosis (see table). To do this, with a syringe connected to a needle or a drainage tube, the contents are first aspirated, and then the sinus is washed.

Evaluation of the patency of the natural fistula of the paranasal sinuses

Normal fistula patency	When aspirating, air or liquid contents of the sinus enter the syringe, when washing, the liquid freely flows into the nasal cavity
Violation patency I degree	When aspiration creates a negative pressure, when washing, the liquid freely enters the nasal cavity (valve mechanism and negative pressure in the sinus)
Violation patency II degree	Aspiration from the sinus is not possible, flushing is possible only with increased pressure on the syringe plunger
Violation patency III degree	Neither aspiration nor washing of the sinus is possible: there is a complete blockade of the anastomosis

Differential Diagnosis

For viral and bacterial MS more characteristic is the simultaneous defeat of several sinuses ( polysinusitis).

Isolated lesion of one sinus ( monosinusitis) typically for fungal and odontogenic rhinosinusitis.

Signs of rhinosinusitis caused by typical pathogens ( S. pneumoniae And H. influenzae), are a decrease in smell, the presence of a liquid level on the RG, and the effectiveness of traditional therapy.

Distinctive features of rhinosinusitis caused by other microorganisms are fetid discharge from the nose, a total decrease in the pneumatization of the paranasal sinuses on RG, a slower positive dynamics of the x-ray picture during the treatment.

Allergic (or eosinophilic) fungal rhinosinusitis characterized by the detection of multiple polyps during endoscopy, as well as a very characteristic detachable yellow, green or brown color of a very viscous rubber-like consistency. A similar discharge - allergic mucin - is found in all affected sinuses during surgery.

Odontogenic sinusitis usually acquires a primary chronic course, accompanied by the formation of polyps, granulations or fungal calculi in the sinus.

Chronic invasive form of mycosis accompanied by the formation of fungal granulomas with their invasion into the bone structures and soft tissues of the face.

Polypous rhinosinusitis characterized by the formation and recurrent growth of polyps, consisting mainly of edematous tissue infiltrated by eosinophils.

General principles of treatment

The main goals of rhinosinusitis treatment are:

Reducing the duration of the disease.
Prevention of the development of orbital and intracranial complications.
pathogen eradication.

From these positions, the basic method of treating acute bacterial rhinosinusitis (moderate and severe forms) and exacerbation of chronic rhinosinusitis is empiric antibiotic therapy.

The main indications for the appointment of antimicrobial drugs include:

A characteristic history of rhinosinusitis.
The severity of clinical manifestations.
The presence of purulent discharge in the nasal passages.

Antibacterial therapy, taking into account the type and sensitivity of a specific pathogen identified during bacteriological examination, does not at all guarantee success due to the high probability that "travel" microflora will enter the test material during material sampling. In addition, the results of an in vitro susceptibility study of a detected microorganism do not always correlate with the clinical efficacy of individual antibacterial drugs. The reasons for this may be a significant increase in antibacterial activity as a result of the unidirectional effect of the antibiotic and its metabolite and the ability to purposefully achieve bactericidal concentrations in the focus of infection.

Antibacterial therapy for acute bacterial rhinosinusitis

On an outpatient basis, oral antimicrobial drugs are predominantly prescribed.

Taking into account the spectrum of typical pathogens and Russian data on their antibiotic resistance, amoxicillin is the drug of first choice for acute bacterial rhinosinusitis.

In the absence of a noticeable clinical effect after three days, the drug should be replaced with an antibiotic active against penicillin-resistant S. pneumonia and H. influenzae producing β-lactamase. In this case, III-IV generation cephalosparins or new fluoroquinolones are prescribed.

In case of intolerance to penicillin drugs (and due to possible cross-allergic reactions, cephalosporins should also not be prescribed), the drugs of choice are macrolides.

In the case of hospitalization of the patient, the parenteral route of administration of antimicrobial drugs is preferred.

Antibacterial therapy for exacerbations of chronic rhinosinusitis

In the treatment of exacerbations of chronic rhinosinusitis, oral amoxicillin/clavulanate is the drug of choice.

Alternative drugs (prescribed in case of ineffectiveness of antimicrobial drugs of choice) currently include III-IV generation fluoroquinolones. In patients younger than 16 years, macrolides are classified as alternative drugs.

Given the significant role of obstruction of the natural openings of the paranasal sinuses in the pathogenesis of rhinosinusitis, vasoconstrictor drugs, which are prescribed either locally or orally, are of great importance in its treatment.

In the treatment of acute and chronic rhinosinusitis, herbal medicines are also used, which have anti-inflammatory and mucolytic effects.

Punctures and probing of the paranasal sinuses

These methods allow you to wash the affected sinus with an antiseptic solution, remove a pathological secret from it, and administer a drug (antiseptics, proteolytic enzymes, glucocorticosteroids). In some cases, puncture and washing of the paranasal sinuses can eliminate the blockade of its natural anastomosis. It is believed that regular removal of exudate in purulent rhinosinusitis protects local immunity factors from proteolysis and increases the content of Ig and complement in the affected sinus by 2-3 times, stimulating local antibacterial defense mechanisms. The most common and easier to perform is the maxillary sinus puncture. It is most often used in the treatment of rhinosinusitis.

Forced drainage method

The method has certain advantages over treatment with repeated punctures. The presence of a catheter creates an additional way for the evacuation of the secret from the affected sinus, increases air exchange, eliminates negative pressure when the natural fistula is blocked or works like a valve.

Other Methods

Nasal douches, rinsing of the nasal cavity with warm isotonic solution and physiotherapy (ultra-high frequency currents, microwave therapy, ultrasound).

Surgery

Indications for surgical treatment for bacterial rhinosinusitis occur when antibiotic therapy is ineffective and orbital or intracranial complications develop.

In surgical treatment, the trend towards minimal invasiveness prevails. Less traumatic functional endoscopic interventions give better results, are accompanied by fewer complications, less likely to contribute to the progression of the disease and the development of bronchial asthma than classical operations with radical removal of the mucous membrane and turbinates.

Therapy of fungal forms of rhinosinusitis

With a fungal ball, the appointment of antifungal drugs is not done. Treatment is surgical (endoscopic). Complete removal of fungal masses from the paranasal sinuses guarantees recovery.
Treatment of allergic fungal rhinosinusitis is surgical (in the presence of large polyps). votes)

Content

Watery or mucous discharge from the nasal passages is not always a symptom of a cold: they can also accompany rhinosinusitis - what it is and what drugs it eliminates is unknown to most people. However, doctors advise taking therapeutic measures already at the first symptoms in order to prevent serious complications. What are the consequences of this disease and how can it manifest itself?

What is rhinosinusitis

If the inflammatory process in the respiratory system simultaneously affects the nasal cavity and sinuses (the number does not play a role), the doctor diagnoses "rhinosinusitis" or "sinusitis". Both words refer to the same disease. Inflammation of the mucosa can either happen due to mechanical damage, or be a complication of acute respiratory viral infections, acute rhinitis, other infectious-viral or bacterial diseases. Treatment for rhinosinusitis depends on the cause. Already at the first symptoms, a visit to the otolaryngologist is needed, since the patient can get as a complication:

bronchial asthma;
abscesses in the soft tissues of the face;
intracranial changes (in rare cases, sinusitis leads to brain abscess, meningitis);
visual impairment due to damage to the optic nerves;
purulent inflammation of the middle ear;
damage to the nervous system.

Rhinosinusitis can be triggered by trauma, which will lead to a deviated septum or narrowing of the sinuses, or be the result of physiological pathologies in the structure of the face and respiratory organs, but most cases of this disease are associated with the activity of pathogenic microorganisms. It may be due to:

viruses;
bacteria;
mushrooms.

Causes

Such a complex problem as rhinosinusitis does not arise from scratch, even if a person has become infected with the influenza virus. In addition to a general decrease in the protection of the immune system and colds, predisposing factors play a role, and the more of them, the higher the likelihood of getting rhinosinusitis. These include:

polyps in the nasal cavity;
pathology of the endocrine system;
curvature of the nasal septum;
allergic rhinitis;
problems with the development of the anatomical structures of the nasal cavity (impaired patency of the natural fistulas of the sinuses, which prevents the timely removal of bacteria by active mucociliary transport);
immunodeficiency states;
pathology of nearby organs.

Species

This disease can have several forms, which are determined by the pathogen, symptoms, rate of development. Based on these differences, doctors have developed 4 main classifications, and in order to understand how to treat rhinosinusitis at home, you need to correctly and fully determine its type. The division can be done:

By etiology:
- Viral - rhinoviruses, influenza and parainfluenza viruses, adenoviruses are involved here, and sinusitis of viral etiology always occurs in an acute form
- Bacterial - pathogens are pneumonia and pyogenic streptococci, hemophilus, Pseudomonas aeruginosa and Escherichia coli, moraxella, Staphylococcus aureus, enterobacteria.
- Fungal - the disease is provoked by aspergillus, Alternaria, culvularia, mainly it is a superinfection (co-infection of an infected cell with another strain or microorganism).
- Mixed - inflammation is of a bacterial nature, and then it gets a viral or fungal complication, or it all starts with the flu, and then a bacterial disease is added.
According to the localization of the inflammatory process:
- maxillary - classic sinusitis;
- frontal - affects the frontal sinuses;
- ethmoidal - inflammation of the ethmoid sinuses;
- sphenoidal - an inflammatory process in the sphenoid sinuses.
According to the severity of the flow:
- Light form.
- Average.
- Heavy.
According to the nature of the manifestation:
- Spicy.
- Subacute.
- Chronic.
- Recurrent.

General symptoms of the disease

The main manifestation of rhinosinusitis in any localization of inflammation is a violation of nasal breathing, to which mucous secretions can be added (at the last stage - with pus), which are absent if the nose is blocked. Common symptoms of rhinosinusitis in people of all ages include:

an increase in body temperature to 38-39 degrees (absent in the chronic nature of the disease);
runny nose;
weakness;
loss of appetite;
headaches (towards the end of the day);
difficulty breathing;
nasal voice;
smell disorder.

Frontit

When the inflammatory process affects the frontal lobe, rhinosinusitis immediately passes to a severe stage - the natural outflow of mucus from this zone is reduced, and if abnormalities in the structure of the bones are added to this, frontal sinusitis can become chronic. The main symptoms include pain in the forehead in the morning (due to stagnation of the secretion in the sinuses), which can be aggravated by the same sensations in the eyes, photophobia and loss of smell. As complications arise, add:

change in skin color;
swelling of the forehead;
collateral edema of the upper eyelid.

Ethmoiditis

The ethmoidal labyrinth of the sinuses is located at the very base of the nose, therefore, with an inflammatory process in this area, pain affecting the bones of the orbit becomes the main symptom. Additionally, ethmoiditis will be characterized by a decrease in the sense of smell or its complete loss, nasal congestion, the appearance of purulent or mucopurulent discharge. Children have a fever. If the disease has passed into a severe stage, bone destruction will begin, so there will be:

hyperemia and swelling of the inner corner of the eye;
swelling of the medial zone of the eyelid;
exophthalmos;
impaired visual acuity.

Sinusitis

The most common form of rhinosinusitis is sinusitis - an inflammatory process in the maxillary sinuses, which is considered a complication of influenza, measles, acute rhinitis and a consequence of the curvature of the nasal septum. It is characterized by pulling pain, aggravated by tilting the head forward and localized in the nose and bridge of the nose. Additional symptoms:

difficulty in nasal breathing along with the appearance of nasality in the voice;
headache (toward evening);
discharge from the nose is green (purulent) or yellow, if there is no congestion;
permanent runny nose;
sleep disturbance.

Sphenoiditis

If acute rhinosinusitis that has affected the ethmoid sinuses has not been cured, the process can reach the posterior regions and develop in the sphenoid sinuses, which will be the beginning of sphenoiditis. It is always acute and is considered the most dangerous, as it easily provokes complications in the eyes and brain. In the initial stages, the course of the disease may be asymptomatic, and later acute sphenoiditis will manifest itself:

pain in the temporal zone, forehead and eyes;
insomnia;
decrease in working capacity;
constant aching pain in the back of the head;
dizziness;
copious thick discharge from the nasal passages.

Features

The symptoms of sinusitis should be analyzed not only by the localization of the inflammatory process - it is important to take into account the severity of the disease, its etiology and the nature of the manifestation. So acute is necessarily manifested by pronounced pain, but always has a short duration, subacute will be sluggish, lasting up to 3 months. Chronic symptoms persist for longer than 12 weeks, and with recurrent symptoms, up to 4 exacerbations can occur in a year, the periods between them are longer than 2 months.

catarrhal

An acute inflammatory process of the nasal mucosa lasts 2-3 weeks and may affect the right or left side, or both. The main manifestation is an increase in body temperature and mucous discharge from the nose, which gradually thicken. If there is swelling of the affected area (often catarrhal rhinosinusitis affects several sinuses), the discharge stops, and the nose is blocked completely. Gradually, there is an accumulation of mucus in the nasopharynx, an inflammatory process begins on the conjunctiva.

Acute purulent

With proper treatment, the duration of the acute form, even complicated by purulent discharge, does not exceed 4 weeks, while all the symptoms are pronounced - especially for pain. In such a situation, there are several affected sinuses with purulent contents, so the pain can affect half of the face or the entire surface. Thick green discharge from the nose, fever, symptoms of severe intoxication and swelling are the main manifestations of the acute phase.

Chronic

If rhinosinusitis is observed for 12 weeks or longer, the severity of symptoms is smoothed out, apart from periods of exacerbation, we are talking about a chronic form. The structure of the mucous membrane changes, with any hypothermia or a decrease in immunity, especially complicated by an infectious disease, the acute stage returns again. Often, chronic rhinosinusitis in children and adults affects individual sinuses. Nasal congestion, weakness and decreased sense of smell are constant companions of this disease.

Polyposis sinusitis

Against the background of the chronic form, to which therapeutic measures have not been applied, polyps may begin to appear - a formation from hypertrophied tissue filled with infiltrate. The more they become, the more difficult nasal breathing, so the patient is forced to breathe through the nose. There may be complaints about a foreign body in the nasal passages, pain, stuffy ears, and difficulty swallowing food.

Allergic

Against the background of prolonged rhinitis, provoked by seasonal allergies, a person may develop allergic sinusitis. It passes even without the use of antihistamines and is characterized by sneezing, constant itching in the nasopharynx, and redness of the eyes. There may be watery discharge from the nose, swelling that causes difficulty in breathing, and skin rashes.

Diagnosis of rhinosinusitis

When the first symptoms appear, you need to contact an ENT doctor who will analyze the patient's complaints and conduct a general examination. If the clinical manifestations of the disease are identical to those characteristic of rhinosinusitis, the doctor will prescribe additional examinations:

Anterior rhinoscopy (posterior - less often).
Endoscopy.
X-ray of the paranasal sinuses - to examine the sphenoid and frontal sinuses.
Ultrasound - for the diagnosis of cysts, inflammation of the frontal sinuses.
Computed tomography - to assess the anatomical features of the nose.
Laboratory identification of the pathogen - the most reliable is the diagnostic puncture of the maxillary sinus, but it may be necessary to culture the contents of the exudate, a blood test, a smear for eosinophils.

How to treat

Therapeutic measures should be aimed at eliminating the pathogens that provoked sinusitis (if it is not caused by trauma) and affect the symptoms. For this purpose, sinus drainage is carried out - conservative or surgical, depending on the severity of the disease, and antiviral or antibacterial drugs are necessarily used. Additionally, immunomodulators are needed. To symptomatic therapy, you can add:

regular ventilation of the room;
maintaining optimal humidity;
plentiful drink (there is an intoxication of the body).

Medical therapy

If rhinosinusitis is not complicated by a bacterial infection or pus, there is no need for antibiotics: they are mainly recommended at a severe stage, especially if the inflammation has gone to the frontal sinuses to prevent brain damage. Often, a penicillin and cephalosporin series, or macrolides are prescribed here, which destroy protein synthesis in the cell of a pathogenic bacterium. In other cases, complex drug treatment of rhinosinusitis consists of:

Mucolytics - to thin the contents of the sinuses.
Hormonal drugs (topical steroids) - for 3 weeks.
Antiviral drugs - Anaferon, Amantadine, etc.
Vasoconstrictor drops - for a short time to restore the outflow of sinus contents, eliminate edema.

Surgical methods

The most common method of surgical treatment of rhinosinusitis is a puncture (puncture) of the maxillary sinuses. It is performed under local anesthesia, it is prescribed mainly for sinusitis with severe pain and a large accumulation of fluid. The procedure consists of washing the maxillary sinuses with an antiseptic and the subsequent administration of the drug. The patient's condition improves rapidly, the inflammation is eliminated, but several procedures are needed for a complete cure, and the atypical structure of the sinuses can provoke complications. They may also be assigned:

YAMIK catheter is an alternative to puncture for sinusitis and ethmoiditis, non-invasive intervention. The antiseptic substance is fed into the sinus through a probe, after which the medicine is injected there. So you can clear all the sinuses, but you also need several procedures to achieve a complete cure for sinusitis.
Removal of polyps:
- Endoscopy - the introduction of a surgical instrument into the sinus through the nasal passage, healthy tissues are not damaged, the risk of recurrence is reduced by 50%.
- Sinusotomy - through opening the facial bone and removing part of it. The downside is a long rehabilitation, the presence of a large number of contraindications. Recurrence of sinusitis is not ruled out.

Non-drug methods

Nasal rinsing is the main procedure that helps fight rhinosinusitis, which is carried out using saline or sea water on a schedule with an interval of 1-2 hours. It helps to remove leakage, affect inflammation. If sinusitis was preceded by odontogenic sinusitis, mouth rinses will be required. In addition to saline, decoctions of herbs are used for this purpose. Additionally, the doctor may prescribe physiotherapy:

electrophoresis;
laser treatment;
exposure to diadynamic currents.

Treatment of sinusitis in children

Pediatric sinusitis therapy implies an emphasis on topical drugs, even if they are antibiotics. It is advisable to use vasoconstrictor agents (Otrivin, Nazivin) only at bedtime, 1-2 drops in the nasal passage. Doctors try not to use steroids and NSAIDs in children. Mostly babies from 2.5 years old are prescribed:

Bioparox - 1 press for each nasal passage 4 r / day.
Polydex - 1 injection into the nostril 3 r / day, the course of treatment is 5 days.
Protargol is a local antiseptic, 3 drops are injected into each nasal passage up to 3 times a day.

How to treat rhinosinusitis in adults

Washing the nasal passages can be done with a simple saline solution or take a spray of Aqualor, Aquamaris (they are also recommended for children). Vasoconstrictor drugs are selected on phenylephrine, naphazoline, tetrizoline - these are Sanorin, Vibracil, Otrivin. However, the basis of drug therapy is:

Antibiotics for bacterial infection - Erythromycin, Augmentin, Ceftriaxone.
Antipyretic at temperature - Paracetamol, Nurofen.
Topical corticosteroids to relieve inflammation and swelling - Baconase, Altsedim.
Mucolytics - Fluditec, Fluimucil.

Folk methods

In addition to drug treatment, you can use traditional medicine procedures: the main one is steam inhalation. They are carried out in chronic sinusitis without fever. You need to breathe hot steam for 10-15 minutes, using a decoction of sage, chamomile or calendula. A couple more recipes for folk treatment:

After washing, instill thuja oil (1 drop in each passage) 2 times a day, especially if you need to cure rhinosinusitis in a child.
Mix 1 tsp. honey, baking soda and vegetable oil, warm and soak with a mixture of turunda, which must be inserted into the nose for 20-25 minutes. 3 times a day.
Bury Kalanchoe juice daily, 2 drops in each nasal passage.

Disease prevention

In view of the infectious etiology of sinusitis, strengthening the immune system remains the most reliable way of protection: regular intake of immunostimulants, normalization of work and rest schedules, prevention of beriberi, moderate physical activity. A few more points:

stop smoking;
treat colds in time, especially for children;
control indoor humidity.

Discuss

Rhinosinusitis - what is it in children and adults, signs and treatment of the disease

Rhinosinusitis is a disease that affects the nasal mucosa and paranasal sinuses. Often the pathological process occurs in adults aged from forty to seventy years. Also, rhinosinusitis can be detected in childhood.

With the progression of the inflammatory process, the mucous membranes in the nose swell and thicken greatly. As a result, the fistulas between the tissues overlap and a closed cavity is formed. And purulent contents accumulate in it. The duration of this disease in the acute period is about four weeks. In a chronic course, the disease does not leave the patient for three months.

Acute rhinosinusitis can result from several causes.

The presence of bronchial asthma.
Decreased immune forces of the body.
A viral or bacterial infection.
Fungal attack.
Long-term use of certain drugs.
hereditary nature of the disease.
Nose injury.
Nasal polyposis in adults.
Deformation of the side wall at the nose.
Enlargement of the adenoids or the formation of polyps.
Allergic reactions.
Unfavorable working and living conditions.

One of the above reasons can be the start for the development of rhinosinusitis. If the disease is not treated for a long time or the wrong drugs are taken, then the disease becomes chronic.

Symptoms of rhinosinusitis

The inflammatory process in the form of rhinosinusitis is a common disease. Often the main factor is a viral infection. Occurs as a result of hypothermia in the cold season.

The main symptoms include the following.

The presence of mucous secretions that flow down the back wall into the pharynx.
Swelling of the mucous membrane.
Pain in the paranasal sinuses.
Pain in the head.
General malaise.
Congestion of the nasal passages and ears.
Increase in body temperature.
Manifestation of cough.

Concomitant symptoms directly depend on what form of the disease is observed in the patient.

Acute rhinosinusitis

Acute rhinosinusitis is commonly referred to as an inflammatory process that occurs in the mucous membranes with further spread to the paranasal sinuses. This ailment manifests itself as a complication after a cold or flu in seven to ten days.

The main features include the following.

The presence of secretions of a thick consistency and brownish, yellowish or greenish color.
Pain in the head.
Nasal congestion.
Increase in body temperature up to 38 degrees.
Nasal.

Acute rhinosinusitis in children is characterized by the following factors.

Increased capriciousness.
Bad sleep.
An increase in body temperature up to 39 degrees.
Cough resulting in expectoration of sputum.
Drainage of mucus on the back wall.
Lethargy and general malaise.

Also in medicine it is customary to distinguish two stages of the disease.

catarrhal rhinosinusitis. It is characterized by a slight increase in body temperature up to 37.5 degrees and a runny nose, which after two or three days passes into the paranasal sinuses. There is swelling of the mucous membrane, and the patient feels heaviness in the facial area. If acute catarrhal sinusitis is not treated, then it passes into another form.
Purulent sinusitis. In such a situation, a bacterial infection joins, as a result of which the fistulas in the nasal cavity overlap with purulent contents. There is an increase in body temperature up to 38 degrees, pain is given to the ears and teeth. In this case, pain can be given to the back of the head or eyes when leaning forward. Acute purulent rhinosinusitis quickly turns into a severe form, which leads to the development of complications. The development of pathology can be determined using an X-ray examination.

Acute purulent sinusitis is usually divided into several types.

Sinusitis. Pain occurs in the maxillary sinuses.
Frontit. Purulent contents accumulate in the frontal part, as a result of which pain can radiate to the eye sockets.
Etmoiditis. The inflammatory process develops in the ethmoid sinuses, resulting in a nasal sound.
Sphenoiditis. The disease occurs in the sphenoid sinuses, while the disease is characterized by a dull pain sensation in the head.

Chronic rhinosinusitis

Chronic rhinosinusitis refers to an inflammatory process that periodically makes itself felt. In this case, the duration of one relapse can be about three months. The disease affects the nasal cavity and paranasal sinuses, resulting in severe swelling and lack of oxygen.

Chronic rhinosinusitis is manifested by the following symptoms.

The presence of purulent discharge.
Nasal congestion.
Decreased olfactory function.
The appearance of nasality in the voice.
Heaviness in the facial region and throbbing.
Pain in the head.
Increased tearing.
Rise in body temperature.

The pathological process can affect several sinuses at once and have several forms.

catarrhal sinusitis. This is a type of disease that is characterized by the formation of an inflammatory process in the nasal and paranasal sinuses, while there is no separation of mucus. The disease occurs as a result of a viral infection. The main symptoms of the disease are commonly referred to as:
loss of smell;
tearing;
general intoxication of the body;
swelling of the paranasal sinuses;
burning sensation and dryness in the nasal cavity;
insomnia;
rise in body temperature;
pain in the head;
loss of appetite.
Catarrhal rhinosinusitis can cause a number of complications in the form of meningitis, abscess, respiratory diseases and pharyngitis.
Purulent sinusitis. The main cause of this type of disease is considered to be a bacterial infection, which is located in epithelial tissues. In some situations, purulent sinusitis can occur due to trauma, a deviated septum, or allergies. At the same time, bacterial rhinosinusitis is diagnosed in only ten percent of all cases. Despite this, doctors prescribe antibacterial drugs to all their patients. To make an accurate diagnosis, it is necessary to take a swab from the nasal cavity for analysis. Another main criterion in determining the type of disease is the duration of the disease. It should be noted that chronic purulent rhinosinusitis lasts more than ten days.
Chronic polyposis rhinosinusitis. This type of disease is most common in those people who have severely reduced immune function. When exposed to viruses, allergens and chemicals, the mucous membrane begins to swell. As a result of this, the formation of thickening and the growth of polyps occurs. The main role in the development of this disease is played by allergic rhinosinusitis, obstructive bronchitis and asthma. If such rhinosinusitis occurs, treatment is greatly complicated, since the patient develops intolerance to analgin and aspirin. Surgery may cause suffocation. Therefore, the elimination of polyps occurs only after the cause is found and eliminated.

Other possible types of rhinosinusitis

In medicine, it is customary to distinguish several more types of rhinosinusitis. This is referred to.

Allergic rhinosinusitis. This type of disease occurs due to exposure to irritants in the form of dust, pollen from flowering plants, drugs, pet hair.
Allergic rhinosinusitis is manifested by symptoms in the form of:
the appearance of a rash on the skin;
the presence of clear discharge in the nasal passages;
redness of the eyes.
The first step is to correctly differentiate acute catarrhal rhinosinusitis from allergic rhinitis. For this, an examination is carried out, which includes skin tests.
Vasomotor rhinosinusitis. The main cause of this type of disease is a cold. The patient has a runny nose with the release of mucus of a liquid consistency. After a few days, they begin to thicken, acquire a yellowish or greenish color and an unpleasant odor. Often this type of rhinosinusitis occurs in childhood due to frequent colds. The child has a fever, general weakness and sleep disturbance. With a greatly weakened immune function, vasomotor rhinosinusitis becomes chronic and sinusitis.

If a patient has rhinosnusitis, symptoms and treatment should be determined as soon as possible. Such a disease quickly flows from one form to another, so the consultation of an experienced specialist is required.

Rhinosinusitis treatment process

Many patients ask how to treat rhinosinusitis. The first thing to do is to visit a doctor. He will examine and listen to the patient's complaints. Based on this, he makes a diagnosis. If the patient has acute purulent sinusitis, then an additional examination is prescribed to exclude complications and determine the pathogen. If purulent sinusitis is confirmed, then treatment includes surgical intervention in the form of a puncture. The patient's sinuses are pierced and the purulent contents are pumped out.

After that, drug therapy and physiotherapy are prescribed.

Taking broad-spectrum antibiotics.
Washing the nasal passages with saline or furatsilin solution.
Use of vasoconstrictor drops.
The use of immunostimulating agents.
Carrying out UV or UHF.

If rhinosinusitis occurs in children, treatment includes the following steps.

Taking probiotics to normalize the functioning of the digestive system.
Carrying out the "cuckoo" procedure with the addition of saline.
Carrying out the procedure for suctioning mucus with a special apparatus.
Inhalation with a nebulizer.
Reception of vitaminized complexes.
The use of antihistamines.

The duration of treatment with antibacterial agents is two weeks. Complete recovery from acute rhinosinusitis occurs in a month.

Treatment of rhinosinusitis with folk methods

Treatment with folk remedies is used as an additional therapy. They can be used both topically in the form of washing the nasal passages or instillation of drops, and taking them orally.

To prepare medicinal drops, you need to take calendula, eucalyptus, valerian, sage in equal proportions. Pour two tablespoons of boiled water and let it brew for thirty minutes. The infusion should be filtered. After that, drops should be instilled into each nasal passage, two or three drops up to three times a day.

Some experts advise preparing oil drops. To prepare them, you will need olive oil and a small piece of propolis. Dissolve the ingredients in a water bath, mix well and let it brew for an hour. You need to dig up to two times a day. The procedure should be carried out after washing the nasal passages or inhalation.

You can use compresses as warming procedures. But this procedure should be carried out only if the patient has a non-purulent form of rhinosinusitis. To carry out the manipulation, you need to finely grate the black radish. Give a little juice and wrap in gauze. Put a compress on the affected sinus, and cover with a warm scarf on top. Leave the remedy for fifteen minutes.

In childhood, the sinuses are often warmed up with a bag of salt. But before the procedure, you need to consult a doctor.
If the child does not have allergic reactions, then two drops of liquid linden honey can be dropped into each nasal passage. Such a tool will remove puffiness and eliminate the inflammatory process.

Inhalations are considered an indispensable and effective means. In childhood, you can use a nebulizer with the addition of saline, herbal decoctions. Adults can carry out steam inhalations with the addition of essential oils.

Chronic rhinosinusitis is a process of inflammation of the nasal mucosa with the spread of the process in the sinuses near the nose. This pathology is chronic.

Due to edema in the sinus as a result of inflammation, the lumen of the anastomosis narrows and hypoxia develops in the sinus - a lack of oxygen supplied during inhalation. Fistula - an opening that connects the nasal cavity with the sinuses. Hypoxia exacerbates swelling and inflammation further. As a result, a vicious circle is formed.

Chronic rhinosinusitis can occur at any age, but adult sinusitis is most commonly diagnosed between 45 and 70 years of age.

When a patient hears a diagnosis of rhinosinusitis, he should know that it is a nasal breathing disorder. They are expressed in the fact that the nose becomes stuffy, and inhalation and exhalation are disturbed. If there is no treatment or it is carried out incorrectly, inflammation from acute becomes chronic. The treatment of rhinosinusitis should be taken seriously, because in the chronic form there is no cure, it is only possible to heal it temporarily.

The mechanism of development of pathology

As a result of inflammation of the mucosa, it swells, the sinus structure thickens. This is more typical for the middle nasal passage. This section is the narrowest, so the risk of rhinosinusitis increases here. A pathological cavity is formed in which mucus accumulates, pus - exudate. The evacuation of mucus from the sinuses is also impaired due to edema and inflammation. The acute process lasts 3-4 weeks; chronic - up to 3 months.

Inflammation can contribute to defects in the nasal structures (congenital or acquired); among them, one can name a deviated nasal septum, anomalies of the shell, etc. These signs are well detected on CT.

Causes of inflammation

Acute rhinosinusitis, which turned out to be untreated or untreated at all;

anomalies of the nasal cavity;
dental diseases in the upper jaw;
allergy;
dirty and dusty air;
bad habits in the form of smoking and alcoholism.

The main pathogens are bacteria, fungi (mold, yeast fungi, etc.). But they can cause inflammation only with a decrease in immunity, which is provoked by: viral and infections in the stage of relapse; the presence of asthma, nasal polyposis, taking certain medications.

Sinus Anatomy

Symmetrical paranasal sinuses:

Maxillary caves or maxillary; they border on the cheeks.
Frontal or frontal sinuses - located above the bridge of the nose in the central region of the forehead;
Ethmoidal or ethmoid sinuses - located deep in the nose and have anterior and posterior sections.
Sphenoidal or sphenoid sinuses - are deeper than others and already border on the cranial cavity.

Classification of pathology

The classification of rhinosinusitis is divided according to the nature of inflammation, etiology, flow rate, localization, etc.

According to the nature of inflammation, chronic rhinosinusitis is:

In the polyposis form, the mucosa is thickened and outgrowths appear in it - polyps. They are to be removed as soon as possible.
Cystic chronic rhinosinusitis - neoplasms in the form of cysts appear in the sinuses of the nose.
Fibrous - connective tissue grows, which clogs passages and openings.
Parietal-hyperplastic - cells of the epithelium of the mucous membrane grow rapidly.
With a mixed form, the purulent process is combined with a polypous or cystic form.

Along the course, rhinosinusitis can be acute and chronic. When the acute process subsides after 3-4 weeks and the pain decreases, the person thinks that he has recovered. In fact, inflammation continues and is chronic in nature. There are no positive dynamics here. The main difference between these 2 forms is the duration of the attacks and their number.

By origin, rhinosinusitis is vasomotor and odontogenic. Vasomotor - nasal conchas are too edematous, yellow snot also becomes too plentiful. Odontogenic - pathogens at the same time penetrate from the oral cavity. With this form, relapses systematically occur.

By type of pathogen: fungal and bacterial rhinosinusitis. With a fungal etiology, a fungal body, a mycetoma, begins to grow in the sinus. Determination of the pathogen is important for the selection of treatment. Mucosal involvement may be unilateral or bilateral.

Also, rhinosinusitis is distinguished by localization: maxillary sinusitis (sinusitis) - symptoms in the form of pain and pressure along the wings of the nose.

Frontitis or frontal sinusitis - algias appear in the nose and forehead; seizures occur. Ethmoiditis or ethmoid sinusitis - a nasal voice is noted; the flow of pus and mucus in the throat continues constantly. An unpleasant taste appears in the mouth. Inflamed and reddened inner corner of the eye. Ethmoiditis is often combined with inflammation of neighboring sinuses.

Sinusitis sphenoidal (sphenoiditis) - inflamed sphenoid sinuses give cephalalgia, a diffuse character that does not go away; they are more localized in the occipital and parietal region; algia can radiate to the eyes. It is aggravated at night, in a hot and stuffy room, in the sun. Breath becomes fetid.

Chronic inflammation is not isolated; it often occurs simultaneously in a number of sinuses. This is chronic sinusitis, hemisinusitis (the sinuses are inflamed on one side); polysinusitis (various damage to the sinuses); pansinusitis (all available sinuses are involved in the process).

Symptomatic manifestations

The symptoms of chronic sinusitis are as follows: nasal congestion is noted, due to which a person sleeps poorly; it is impossible to breathe through the nose, the patient begins to breathe through the mouth; lacrimation; moderate transparent or more often purulent snot; reduction or even complete loss of odor perception; along the back of the throat there is a constant migration of mucus and pus, which gives a taste in the mouth and bad breath.

The voice changes in timbre - it becomes nasal. Pain appears in the area of the affected sinuses. There is a feeling of heaviness of the face and cephalgia; analgesics help temporarily and not completely. With an exacerbation of the process, the main symptom is an increase in all symptoms, as in an acute process.

Nasal congestion intensifies, snot becomes thick, viscous, changes color - more often greenish or yellowish. Facial algia and cephalgia also become stronger.

Fever is not noted, but subfebrile condition is present. Increased swelling is present not only in the cavity of the sinuses and nose, it extends to the skin of the face: eyelids, cheeks.

Possible Complications

Violation of the correctness of treatment can lead to the following complications: inflammation expands with the involvement of the soft tissues of the face, respiratory tract;

otitis;
eye complications (purulent inflammation of the eye sockets, leading to loss of vision in general).
complications from the brain and skull: brain abscesses; inflammation of its membranes; osteomyelitis;
thrombosis of the cavernous sinus (accumulation of blood in the dura); symptoms are cephalgia, bulging eyes, convulsive syndrome, and other disorders of the central nervous system.
sepsis;
cholesteatoma - the appearance of a cavity with dead epithelial cells, surrounded by a connective tissue capsule;
osteomyelitis;
mucocele - the formation of a cyst inside the sinus due to obstruction of the excretory duct;
inflammation of the periosteum (periostitis); pain in the corner of the eye and the root of the nose;
exophthalmos (bulging eyes);
chemosis - the line of the eyelid and the conjunctiva become edematous.

With sufficient treatment, complications of this kind are rare. Also, complications can occur in the form of diseases of the nasopharynx and larynx. These are chronic pharyngitis, laryngitis, tonsillitis, dacryocystitis (inflammation of the nasolacrimal canal); constant lack of oxygen causes a decrease in memory, attention; persistent daytime sleepiness. Due to nasal congestion, air cannot pass into the nasal cavity and apnea can occur - breathing stops during sleep - obstructive sleep apnea syndrome (OSAS).

Diagnostic measures

Diagnostics includes the following activities:

Rhinoscopy - examination of the nose with a rhinoscope: hyperemia and swelling are detected; discharge occurs during exacerbations. The area of fistulas contains pus.
Inspection of the nasal cavity with an endoscope - allows you to examine the farthest corners of the nose and identify violations.
Radiography of the facial part of the skull in 2 projections. The inflammation looks like a dark area in the affected sinus. With different degrees of inflammation, blackouts will be different. The ethmoidal and sphenoidal sinuses are poorly identified by X-ray.
CT is now the main method in the diagnosis of rhinosinusitis. With exacerbations is not carried out. Pictures are obtained in layers, they reveal the prevalence of the process and anatomical features.
With an exacerbation of inflammation for diagnostic purposes, a puncture (puncture) of the maxillary sinus is performed; with its purulent content, the sinus is washed with antiseptics and local antibiotics are introduced into it.
Ultrasound - as an alternative to X-ray;
When exudate is pumped out without a puncture (YAMIK procedure), it is sown on a nutrient medium to determine the type of pathogen and its sensitivity to various antibiotics.

Treatment of chronic rhinosinusitis

Chronic rhinosinusitis: treatment and symptoms - these 2 points are closely interconnected. The first step in treatment is the elimination of inflammatory manifestations. For this, antibiotics are used.

Amoxicillin and Amoxiclav and other penicillins, more synthetic, become the first-line antibiotic. They are used at 1 and 2 degrees of severity.

Antibiotics of the second choice are cephalosporins: Cefurabol, Cefurus, Zinacef, Cefuroxime, etc. They are used for existing allergies to first-line representatives.

Third-line antibiotics - macrolides: Azax, Sumamok, Azimak, Rovamycin, Zatrin, Josamycin. The average course of treatment for an acute process is from 1 to 2 weeks; with chronic rhinosinusitis - 3-6 weeks.

Even if there are no symptoms, treatment continues for another week. In the treatment of chronic rhinosinusitis, loading doses of antibiotics are not prescribed.

The antibiotic may not be effective. The reason may be in the wrong choice; incorrectly administered - antibiotics for rhinosinusitis are taken orally; incorrect dose; low frequency of reception; the time of admission with meals is not taken into account.

With good patency of fistulas, local antimicrobial agents are used: Fusafungin, Bioparox, Octenisept.

It is good to add vasoconstrictors to antibiotics: Xylometazoline, Oxymetazoline, Naphazoline, etc.

Step 2 - cleansing the nose. You can rinse your nose with such nasal solutions with sea salt as Aquamaris, Quicks, Humer, etc .; they not only relieve swelling, but also remove mucus.

Of the drugs, vasoconstrictor drops are immediately prescribed (remove swelling) or nasal sprays for a course of no more than a week. They may contain corticosteroids and antibiotics. With bacterial sinusitis, systemic antibiotic therapy is performed.

Sinus punctures under local anesthesia in the treatment of sinusitis. The sinus is washed with antiseptics and an antibiotic is injected there.

The advantage of this method is the complete evacuation of pus from the sinuses, which greatly facilitates the patient's well-being: the general condition improves and facial and headaches decrease; the drug is administered directly.

The downside is that the piercing procedure has to be repeated several times, which becomes stressful for the patient. This method can be treated only if other sinuses are not inflamed, otherwise it loses its usefulness.

YAMIK procedure is an alternative to punctures. It is carried out without puncture. For it, a special sinus catheter is used, which has 2 cartridges - anterior and posterior; movable cuff on which the working channel is located.

Local anesthesia is administered, then a catheter is inserted. They are inflated and the rear balloon completely blocks the entrance to the pharynx and the front one closes the nasal cavity.

A negative pressure is created and the exudate itself begins to flow out of the sinus, it is sucked off through the working channel, after which the drug is injected.

The advantage is that the method is applicable to all sinuses. Disadvantages include the lack of catheters in some facilities; repetition of procedures and the impossibility of complete pumping. Can be used from 5 years.

The nasal cavity is washed with antiseptics or saline solutions; The advantage of the method is that it can be used at home. Used for flushing a syringe or a special device.

In the clinic at the doctor's office, drugs can be moved during washing - the "cuckoo" method. This name is given because the drug is poured into one nostril, while the contents are sucked out of the other; while the patient is asked to repeat “cuckoo” so that the solutions being driven do not get into the oropharynx.

The process, of course, is painless, but at the same time it has less efficiency than the previous one.

Allergic rhinosinusitis requires the appointment of AGP - Fenistil, Loratadin, Erius, etc. AGP 2 generations are not combined with antimycotics and macrolides - this combination has a toxic effect on the heart muscle. Also, during treatment, mucolytics are prescribed - Rinofluimucil - the drug removes and thins mucus well.

Step 3 - Strengthening the immune system. To do this, prescribe a vaccine with a bacterial lysate. It is usually available in the form of tablets: Ribomunil, IRS-19, Bronchomunal.

IRS-19 helps very well in children's practice of treating infections and colds. They are used after the acute symptoms of edema and inflammation subside. You can also take vitamin and mineral complexes, rose hips, ginseng, etc.

To treat rhinosinusitis, intranasal glucocorticosteroids (InGCS) are used quite widely. They well and quickly relieve inflammation, swelling, act as anti-allergic drugs.

They do not reduce immunity, acting only locally, at the site of application - this is a plus. These include:

Beclomethasone dipropionate (BDP).
Fluticasone furoate (FF).
Mometasone furoate (MF).
Budesonide.
Fluticasone propionate (FP).

Physiotherapy procedures - are prescribed when the inflammation subsides and a good outflow from the sinuses.

Preventive actions

Strengthening the immune system is a top priority. There should be moderate physical activity, swimming, walking, running. It is necessary to carry out hardening and cold rubdowns, regular contrast showers. It is necessary to treat colds and acute respiratory viral infections in a timely manner, to carry out sanitation of the oral cavity. It is necessary to avoid hypothermia and drafts, to correct nasal breathing.