home Audience 4 Rhinosinusitis does not go away. Rhinosinusitis. Auxiliary treatment includes a complex of means

Rhinosinusitis does not go away. Rhinosinusitis. Auxiliary treatment includes a complex of means

Rhinosinusitis - what is it? The disease occurs as a result of damage to the mucous membranes of the nose and paranasal sinuses by infections or viruses. If signs of illness appear, you should immediately consult a doctor. Treatment must begin in a timely manner, otherwise the disease will move to a severe stage..

Reasons for the development of the disease

In most cases, the disease becomes a consequence of the course of acute respiratory viral infections or the common cold, in which there was no treatment or therapy was not completed to the end. The presence of inflammation in the mucous membrane is a concomitant factor, so the disease has many manifestations.

A significant place is occupied by the deformation of the side wall of the nose. These can be anomalies of the nasal concha, which manifests itself in the form of polyps in the nose, curvature of the septum and adenoids. The hypertrophic form of rhinitis leads to stagnation of the secret and a violation of the cleaning of the sinuses.

Many viral infections lead to the development of edema in the mucosa, which leads to increased secretion of the glands. There is a blockage of the sinus openings due to the large amount of mucus. The edematous state of the membrane also matters, which also contributes to clogging. Violations can occur with improper blowing of the nose. The ingress of purulent secret into the sinuses leads to increased blocking of fistulas and an increase in the viscosity of the contents.

With bacterial and fungal infections, the patient's situation is also aggravated. In the first case, the appearance of bacteria is a consequence of mucus stagnation and outflow failure. The fungal form of rhinosinusitis is a complication that occurs when antibiotics are used improperly.

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Contribute to the occurrence of the disease and the following factors:

development of bronchial asthma;
the presence of an allergic type of rhinitis;
unfavorable ecological situation;
weakened immune system;
the development of chronic inflammatory processes in the sinuses of the nose - vasomotor rhinitis.

Signs of illness

With rhinosinusitis, the symptoms are mixed. Therefore, there is a need for differentiation of features. The presence of manifestations similar to other diseases can confuse the patient, therefore, with the development of symptoms, it is necessary to visit a doctor.

Most patients develop the following symptoms:

the general nature of the malaise;
edematous condition of the paranasal sinuses and mucous membrane;
high body temperature;
headache;
a feeling of congestion in the ears;
cough may be present;
mucus is formed;
the work of smell is disturbed, and breathing is difficult.

Symptoms of pathology differ from each other due to the development of certain forms. The main feature of this factor is the duration of manifestations. The following stages of the development of the disease are distinguished:

acute rhinosinusitis, which lasts up to 1 month;
subacute type develops no more than 3 months;
the recurrent form may occur several times a year;
chronic rhinosinusitis has been observed in a patient for more than 3 months.

Types of pathology and their characteristics

Types of diseases differ in causes, stages of development and duration. There are some features in the manifestations of diseases. Acute rhinosinusitis is more common, in which the inflammatory process occurs in the nasal mucosa. However, there is a possibility of transition of the pathology to the region of the paranasal sinuses. Acute rhinosinusitis is more often a complication that occurs after colds. The following signs appear:

lack of smell and appetite;
nasality occurs;
body temperature rises;
nose is constantly stuffed up;
a headache develops;
discharge from the nose has a different color and structure.

It is necessary to take into account the typical symptoms of pathology. Often an acute type of sinusitis is formed. There is severe pain in the cheek area. Pain may be aggravated if the patient turns his head. Similar manifestations have an acute form of frontal sinusitis, however, painful signs are localized in the forehead. Another typical manifestation is acute sphenoiditis. The disease affects the sphenoid sinuses and is accompanied by constant pain in the head.

The acute type is divided into several stages of development. With a mild form, the signs are poorly expressed. The temperature is slightly elevated, and there is no fluid in the sinuses, which is clearly visible during the diagnosis. In the middle stage, the temperature rises, the patient has an increase in headache. When pressing on the forehead and cheeks, the patient will experience pain that can spread to the teeth. In severe form, the temperature exceeds 38, pain occurs when you press on the sinuses. The patient's face swells, and complications can be detected during x-rays.

In the chronic type, there is also a headache and discharge that becomes purulent. The patient has a nasal and unpleasant symptoms in the face. The temperature rises, the sense of smell decreases, congestion is observed constantly. The following factors exacerbate the situation:

improper elimination of the acute type of rhinosinusitis;
dental diseases;
drinking and smoking;
bad ecology;
allergic reaction;
changes in the shape of the nasal septum.

The polyposis form is more common in patients who have a weakened immune system. The following factors also influence:

viruses;
swelling of the mucosa;
exposure to allergens;
exposure to chemicals.

The development of pathology is influenced by concomitant diseases. This applies to allergic rhinitis, obstructive bronchitis and asthma. Treatment is complicated by the occurrence of the aspirin triad, which is characterized by the formation of nasal polyps, the appearance of aspirin intolerance, and the development of bronchial asthma. The intervention of the surgeon can lead to suffocation and exacerbation of the pathology. However, endoscopic surgery is often used as the most effective tactic for eliminating an allergic focus.

Purulent rhinosinusitis occurs as a result of penetration of a bacterial infection. In some cases, this leads to the development of allergies and changes in the nasal septum. To eliminate the disease, doctors prescribe antibiotics. The disease can appear with the following types:

sinusitis;
frontitis;
sphenoiditis;
ethmoiditis.

The allergic form is formed when exposed to irritating factors in the form of allergens. They may be:

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During the development of the pathology, the patient has a variety of manifestations, which are represented by reddening of the eyes and the development of a rash on the skin. In addition, clear mucus is secreted from the nasal cavity. Treatment is represented by the elimination of the focus of an allergic reaction and the use of antihistamines.

Catarrhal rhinosinusitis is formed when an infection or SARS is attached. The patient has increased lacrimation and impaired sense of smell. Appetite is absent, sleep disturbances occur. There is burning and dryness in the nasal cavity. There are manifestations of general intoxication of the body.

Therapeutic measures

Treat the disease in adults as soon as possible. Lack of intervention can lead to the development of complications or the transition of the disease to the next stage, which will be much more difficult to get rid of. It is important to find the source of the disease and eliminate it. For this purpose, diagnostic measures are carried out, which are represented by the following methods:

x-ray, which is used to determine the degree of the inflammatory process;
rhinoscopy;
ultrasonic examination to determine the level of liquid;
with the help of an endoscope, it is possible to identify all violations that are associated with the nasal septum;
CT scan;
at an exacerbation apply a puncture.

Symptoms and treatment are interconnected with each other, since the treatment tactics will depend on the manifestations of the pathology and its form. Antibiotics and local therapy are used. The task of using antibiotics is related to the need to eliminate pathogens. There are no universal means. Therefore, the choice of the drug should be carried out with the help of a specialist. It is forbidden to take medicines on your own.

To eliminate rhinosinusitis, the following groups of drugs are used:

tetracyclines;
macrolides;
cephalosporins.

The duration of medication is 5-7 days. However, the duration of therapy may vary, due to the peculiarities of the course of rhinosinusitis. This process is affected by the development of complications, the form of the disease and the stage. The dosage of the drug is prescribed by the attending physician after the diagnosis and determination of the type of pathogenic microorganisms.

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If symptoms are detected and treatment has already been started, then topical agents are used. It is necessary to clean the nasal cavity and paranasal sinuses from purulent and mucous contents. Antibiotics and other drugs cannot accomplish their task if foci for the development of bacteria and viruses remain. Therefore, the following groups of funds are assigned:

nasal drops of antibacterial action;
nasal sprays and vasoconstrictor drops;
solutions for washing the nasal cavity with antiseptic properties.

Acute, purulent, chronic and other types of inflammation require special attention to this problem. Your doctor may recommend certain medications, but you should never use medications on your own. Before using each drug, you should consult your doctor.

Preventive measures

Prevention is essential for healthy people and patients struggling with rhinosinusitis. For patients, preventive measures are needed, as they will avoid further development of the disease and deterioration of well-being. For healthy people, such activities help to avoid the formation of the disease.

It is necessary to strengthen the immune system. To this end, you should include in the diet foods that are rich in vitamins, minerals and nutrients. Drinking alcoholic beverages should be avoided, as alcoholic beverages significantly undermine health. Smoking, which acts as a provoking factor, has a negative effect.

You need to exercise and lead an active lifestyle. It is useful to harden your body with various procedures: air, water and solar. A walk in the fresh air away from the tracks is not only a pleasant pastime, but also hardens the body. For the same reason, you should regularly ventilate the room and carry out regular cleaning. It is especially important to eliminate dust and objects that can accumulate it. If you have a predisposition to allergies, you should not have pets.

An important component of prevention in adults is represented by rest. During this process, the body restores its strength. Improper rest can disrupt human health, so you need to be careful about such activities too.

The resulting diseases associated with the nasal cavity and respiratory tract must be eliminated in a timely manner. Rhinosinusitis often occurs as a result of untreated common cold, so you should be careful about your health.

Thus, the development of rhinosinusitis must be stopped at an early stage of formation.

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The presence of symptoms is a reason to seek help from a doctor

It is not recommended to use a variety of means for self-treatment, since a lack of knowledge about the characteristics of drugs can lead to a negative result.

Nasal congestion.
Periodic purulent discharge from the nose.
Decreased sense of smell.
Drainage of mucus down the back of the throat.
Nasty voice.
There may be a feeling of heaviness in the face, headache, in most cases not intense, periodic, sometimes with a feeling of pulsation. Headache medications provide temporary partial relief.
Lachrymation.

Symptoms of exacerbation of chronic rhinosinusitis are similar to those of acute rhinosinusitis (acute inflammation of the paranasal sinuses):

nasal congestion intensifies;
viscous thick discharge from the nose appears (white, yellow, green, brownish);
there is a pronounced headache or facial pain;
body temperature rises, usually not higher than 37.5 ° C.

Forms

By localization distinguish the following forms of the disease.

Chronic maxillary sinusitis (sinusitis) is an inflammation of the maxillary (maxillary) sinuses, which is characterized by a feeling of heaviness, pressure in the cheek area.
Chronic frontal (frontal) sinusitis (frontal sinusitis) is an inflammation of the frontal sinuses, which is characterized by periodic pain in the forehead, above the eyebrows.
Chronic ethmoid sinusitis (ethmoiditis) is an inflammation of the ethmoid sinuses, which:
- characterized by nasality, runoff of mucus and pus along the back of the throat, an unpleasant taste in the mouth;
- may be accompanied by swelling and redness of the inner corner of the eye;
- occurs more often in combination with inflammation of other paranasal sinuses.
Chronic sphenoidal sinusitis (sphenoiditis) is an inflammation of the sphenoid sinuses, which manifests itself:
- constant dull headache in the occipital or parietal region, radiating to the eyes, aggravated by the sun or in a hot room, as well as at night;
- runoff of viscous mucus along the back wall of the pharynx;
- an unpleasant odor from the nose.

Often chronic inflammation develops in several paranasal sinuses at once:

chronic maxillary etmoiditis (inflammation of the maxillary and ethmoid sinuses);
chronic hemisinusitis (inflammation of all sinuses on one side);
chronic polysinusitis (inflammation of several different sinuses from different sides, for example, the right maxillary, left maxillary and frontal);
chronic pansinusitis (inflammation of all paranasal sinuses).

All forms of chronic rhinosinusitis can be unilateral (inflammation in the sinuses on one side) or bilateral (inflammation on both sides).

By type of inflammation distinguish:

chronic catarrhal sinusitis - there is swelling of the mucous membrane of the nasal sinuses;
chronic purulent sinusitis - manifested by periodic exacerbations with the release of pus from the nose, the accumulation of pus in the paranasal sinuses;
chronic polypous sinusitis - characterized by the growth of polyps (pale edematous tissue) in the paranasal sinuses;
chronic cystic sinusitis - formation in the paranasal sinuses, more often in the maxillary (maxillary), cavity filled with fluid;
mixed forms (for example, chronic polyposis-purulent sinusitis).

Depending on the causative agent distinguish:

bacterial sinusitis - caused by bacteria, usually several at once;
fungal sinusitis - the causative agents are fungi, most often with fungal sinusitis a dense fungal body - mycetoma is formed in the sinus.

Causes

Untreated or undertreated acute rhinosinusitis (inflammation of the paranasal sinuses).
Anatomical features of the nasal cavity that prevent normal ventilation of the paranasal sinuses (for example, curvature of the nasal septum). They can be congenital and acquired (as a result of trauma to the nose, face).
The cause of chronic maxillary sinusitis (sinusitis) can be diseases of the teeth of the upper jaw or dental interventions on them.
Allergy.
Adverse environmental factors (inhalation of dusty, polluted air, toxic substances).
Smoking, alcohol abuse.

Diagnostics

Treatment of chronic rhinosinusitis

Treatment of an exacerbation of chronic rhinosinusitis is the same as the treatment of acute rhinosinusitis (acute inflammation of the paranasal sinuses).

Outside of exacerbation, for the treatment of chronic sinusitis, the following are used:

rinsing the nose with saline solutions;
nasal sprays with steroid hormones. The drugs have proven their effectiveness and safety in numerous studies around the world: they are practically not absorbed into the blood and do not affect the hormonal background, many of them are approved for use in young children;
long courses of macrolide antibiotics in low doses;
allergy treatment;
treatment in the presence of diseases of the teeth of the upper jaw;
with the ineffectiveness of conservative therapy, and in the presence of anatomical defects in the nasal cavity, surgical treatment is always performed. The "gold" standard is functional endoscopic surgery of the paranasal sinuses under endotracheal (general) anesthesia (ETN). This restores the aeration of the sinuses (access to oxygen). In the presence of anatomical defects (curvature of the nasal septum, anomalies of the nasal structures), they are immediately corrected - this eliminates the cause of chronic sinusitis and prevents relapses (repeated episodes of the disease);
until now, in some institutions for the treatment of chronic rhinosinusitis, radical operations on the paranasal sinuses are performed with the removal of the entire mucous membrane lining the sinus. Such operations are currently considered crippling, since after them the operated sinus completely loses its functions; in addition, the frequency of recurrent diseases after such operations is high. The list of indications for radical sinus surgery is rather narrow and does not include chronic uncomplicated rhinosinusitis.

Complications and consequences

With untimely and inadequate treatment of exacerbations, it is possible:

the transition of inflammation to the soft tissues of the face;
the spread of inflammation to the respiratory tract - bronchi (bronchitis) and lungs (pneumonia), as well as ears (otitis media);
orbital (eye) complications: the purulent process spreads to the tissues of the orbit, which leads to its purulent inflammation, the formation of abscesses in it. May cause permanent vision loss;
intracranial complications: abscess (a cavity filled with pus) of the brain, meningitis (inflammation of the meninges), osteomyelitis (inflammation of the bones of the skull), encephalitis (inflammation of the brain tissue);
thrombosis of the cavernous sinus (a cavity in the dura mater in which venous blood collects). In this case, there is a severe headache, exophthalmos (bulging eyes), convulsions, coma (lack of consciousness) and other severe disorders of the nervous system;
sepsis - the spread of infection throughout the body through the bloodstream;
risk of death.

In addition, chronic rhinosinusitis can lead to:

chronic pharyngitis (inflammation of the mucous membrane of the pharynx), tonsillitis (inflammation of the palatine tonsils), laryngitis (inflammation of the larynx);
inflammation of the nasolacrimal canal (takes tears from the eye into the nasal cavity) - dacryocystitis.

Difficulty in nasal breathing leads to chronic hypoxia (lack of oxygen), which negatively affects all organs and systems, including mental activity - attention and memory suffer.

Violation of nasal breathing during sleep can lead to the development of obstructive sleep apnea syndrome (OSAS) - respiratory arrest during sleep, which is also dangerous for cardiovascular and other complications due to the constant lack of oxygen. These patients have increased daytime sleepiness.

Correction of nasal breathing.
Allergy treatment.
- sports;
- hardening.
To give up smoking.

Prevention of chronic rhinosinusitis

Timely and adequate treatment of acute rhinosinusitis (inflammation of the paranasal sinuses).
Timely treatment of dental diseases.
Correction of nasal breathing.
Allergy treatment.
Prevention of colds and strengthening of immunity:
- avoid hypothermia, drafts;
- a healthy lifestyle (walking in the fresh air, physical activity, etc.);
- sports;
- hardening.

Additionally

The paranasal sinuses are air-filled cavities in the bones of the skull, lined with a mucous membrane and communicating with the nasal cavity through small openings - anastomoses. The following pairs (right and left) of the paranasal sinuses are distinguished:

maxillary (maxillary) - located in the maxillary bones. Their front wall corresponds to the upper part of the cheek;
frontal (frontal) - located in the frontal bone, in the central part of the forehead, above the bridge of the nose;
ethmoid (ethmoid) - consist of separate air cells connected to each other, which are divided into anterior ethmoid and posterior ethmoid cells, and are located deep in the nose;
sphenoid (sphenoid) - located in the sphenoid bone, the deepest paranasal sinuses, the back wall of which borders the cranial cavity and the brain.

Rhinosinusitis is a complex disease in which the paranasal sinuses and, in fact, the nasal mucosa, are simultaneously affected by an infection or viruses. As a rule, the inflammatory process starts in the maxillary sinus and later passes to the main mucous protective structures.

Signs and symptoms

The main symptoms of rhinosinusitis usually include significant difficulty in breathing. Regardless of the degree and severity of the disease, the patient is also observed with localization at the base of the nose, a constant release of purulent secretion with its regular entry into the nasopharynx, as well as a general swelling of the nasal mucosa.

The remaining symptoms determine the main type of this disease and its specific form.

The main types and forms of rhinosinusitis

The course and clinical pictures for different types of the above disease differ in particular cases:

Acute rhinosinusitis

The acute form of this type of disease is characterized by severe intoxication of the body, a rapid and vivid manifestation of the above symptoms. Within five to seven days after the onset of inflammatory processes, a person cannot lead a full life, his performance is significantly reduced, pain syndromes in the head become paroxysmal.

At the same time, body temperature almost always rises, often overcoming the mark of 39 degrees Celsius. Puffiness of the mucous membranes can go beyond the organ, and spread to the eyelids and upper facial tissues. Pathogenic microflora actively reproduces and captures more and more spaces, affecting neighboring sinuses and provoking complications.

Chronic rhinosinusitis

The inflammatory process of this kind is less pronounced when compared with the previous form of rhinosinusitis, but it is longer and can often proceed in a sluggish form from twelve to thirty weeks. The main symptoms of this condition are normal temperature, a significant weakening of hearing and smell, constant moderate swelling of the mucous membranes with a strong blockade of the nasal passages, as well as a nasal voice and a mucopurulent secret released from the nose.

Pain syndromes in this case appear much less frequently, they are “smeared” and, if they occur regularly, cause a feeling of weakness and irritation.

In the chronic form of rhinosinusitis, the likelihood of getting a complication is much higher than in the case of an acute course of the disease.

Polypous rhinosinusitis

Further progression of chronic rhinosinusitis usually leads to the formation of polyps - active growth and thickening of the walls of the mucous membranes, as a result of which the swelling increases significantly in size, and vasoconstrictor drugs do not help temporarily restore normal breathing. This condition is quite often accompanied by stagnation in the sinuses, a large amount of purulent masses, which further activate inflammatory processes in the body and form the basis for the development of concomitant complications, in particular deadly meningitis and tissue damage / eyeballs.

This type of rhinosinusitis can only be cured with the help of surgical methods, mechanically removing the polyps.

Allergic rhinosinusitis

The main cause of allergic rhinosinusitis and catarrhal purulent course of the disease is the effect of allergens on the body. Such allergens can be plant pollen, wool, body reactions to certain drugs, fungal spores, car smog and dust, etc.

The main symptom, directly indicating an allergic type of disease, is considered to be side rashes on the skin, significant redness of the membranes of the eyeball, itching in the nasopharynx, and abundant clear discharge from the nose. Fighting allergic rhinosinusitis with antibiotics is useless; antihistamines and isolating the person/environment from the allergen are used to effectively get rid of the problem.

Treatment of rhinosinusitis

The treatment of rhinosinusitis in adults is a complex process, which includes the elimination of the cause that caused the reaction, the elimination of the focus of inflammation, the reduction of symptoms, and the restoration of natural immune defenses.

Antibacterial therapy with broad-spectrum antibiotics is drugs or alternative Augmentin. The duration of such a course does not exceed ten days.
Maximum removal from the nose and sinuses, pathogenic secretions. For this, (Naphthyzinum), moisturizing and mucolytic drugs (Aquamaris), as well as means for (saline) are used.
Reducing inflammation. For this, the ENT doctor may advise corticosteroids (hydrocortisone) and antihistamines (Loratadine).
Strengthening immunity. It can be carried out both at the local level with the help of special homeopathic sprays (IRS 19), and general procedures, including normalization of nutrition, taking interferon, and regular exercise.

Treatment of the disease in children

Rhinosinusitis in children is treated in a more gentle way, excluding the use of broad-spectrum antibiotics and glucocorticosteroids. In this case, it is rational to use local steroids / antibiotics (Isofra, Bioparox, Protargol), rinse the sinuses more often with saline solutions, use Borjomi, and strengthen the child's immunity.

Only in the most extreme case, with a severely advanced form of the disease and in the event of a direct danger to the life of the baby, is it necessary to use classic "adult" drugs that have strong side effects and cause serious harm to the liver, kidneys and heart of your child.

Folk remedies

Folk remedies against rhinosinusitis, of course, are not a panacea for this disease, but they can really help you recover faster in the case of complex therapy with medications.

The most popular methods “of the people” are considered to be heating the nasal septum with hot salt in a bag, inhalation and instillation into the nose with herbal preparations based on calendula, valerian, chamomile, eucalyptus and sage, as well as compresses based on tinctures from the same herbs. It should be understood that the above methods must be agreed with your doctor in order to prevent deterioration and the occurrence of concomitant diseases.

Useful video

Get well soon!

Sinusitis ("sinus" - meaning paranasal sinus) is an inflammatory disease of the mucous membrane of the sinuses of the nose (maxillary, frontal, sphenoid or ethmoid). Sinusitis is almost always accompanied by simultaneous inflammation of the nasal airways and often precedes the symptoms of rhinitis, so the term "" was introduced to more accurately describe this condition.

Rhinosinusitis can be acute (lasting from 2 to 12 weeks, depending on the severity of the disease) and chronic, lasting more than 12 weeks. Chronic rhinosinusitis often develops against the background of allergies. Prolonged inflammation and accumulation of mucus in the sinuses contributes to the attachment of a secondary infection (various bacteria and fungi).

As a result, the mucociliary function of the nose is disturbed, changes occur in the mucous membrane and polyps begin to grow. The condition of the nasal passages and sinuses worsens even more, new infections join, new polyps grow, the cycle repeats, and it is difficult to break it.

Features of the disease in children and pregnant women

Chronic rhinosinusitis is a common condition in children, but it can be underestimated because it is very difficult to suspect. Symptoms in toddlers are limited and can be very similar to the common cold or allergies. Cough and nasal discharge are often the only manifestations of rhinosinusitis. Also, in childhood, the sinonasal complex is not fully developed and immunity is not strengthened, so there is a higher risk of complications.

In pregnant women, the development of the disease is associated with a decrease in immunity and hormonal changes in the body. Treatment in such circumstances becomes more difficult, as strong drugs must be avoided.

Classification of chronic rhinosinusitis

There are 3 forms of chronic rhinosinusitis:

without nasal polyps (common inflammation);
polyposis (with nasal polyps);
allergic rhinosinusitis.

By origin, it can be infectious (viral, bacterial and fungal) and non-infectious (caused by allergies, deviated septum, immunodeficiency diseases, etc.).

This classification is of great therapeutic value, since each type of rhinosinusitis has its own manifestations and is treated differently.

What causes chronic rhinosinusitis?

Most cases of chronic sinusitis are associated with acute sinusitis that either goes untreated or does not respond to treatment. Chronicization of the disease occurs under the influence of many factors at once, leading to a violation of the patency of the mouth of the sinuses and ciliary function, a decrease in the level of oxygen in the sinus, and an increase in the viscosity of the mucous secretion.

These include:

allergy;
asthma;
cystic fibrosis;
allergic and non-allergic rhinitis;
anatomical deviations in the structure of the nose and paranasal sinuses;
immunological disorders;
inhalation of polluted air and cigarette smoke;
dental diseases;
hormonal changes (puberty, pregnancy, oral contraception);
tumors;
repeated viral infections of the upper respiratory tract.

With sinusitis, the sinuses create a favorable environment for the growth of bacteria, which, in turn, further contributes to increased inflammation of the mucous membrane.

The bacteria thought to be involved in chronic inflammation are different from the bacteria that cause acute rhinosinusitis. And often the carrier has several types of microbes.

Scientists have compiled the following list of common bacterial infections that occur in chronic rhinosinusitis:

Staphylococcus aureus (Staphylococcus aureus);
hemophilic bacillus;
M catarrhalis (moraxella catarrhalis);
Pneumococcus;
Streptococcus intermedius;
Pseudomonas aeruginosa;
anaerobic bacteria (Peptostreptococcus, Prevotella, Porphyromonas, Bacteroides, Fusobacterium species).

Also, a theory has recently been put forward that fungi can become the cause of chronic rhinosinusitis. Since fungal spores are present in the air, they can be found in the respiratory tract even in healthy people. Under the influence of certain factors (listed above), mushrooms lead to inflammation, and in some people they can cause an allergic reaction. The most common types of fungal infection that cause chronic rhinosinusitis are Aspergillus, Candida, Cryptococcus, Sporothrix.

Symptoms and signs of chronic rhinosinusitis

Most cases of chronic rhinosinusitis are a continuation of unresolved acute sinusitis, but the chronic form of the disease presents differently than the acute form.

Primary symptoms of chronic rhinosinusitis include:

nasal congestion;
not abundant runny nose (may be mucous or purulent), with a characteristic runoff of mucus into the throat, or purulent discharge during rhinoscopy;
pressure in the face, pain;
decreased sense of smell.

Minor signs of chronic rhinosinusitis include:

These manifestations are hardly noticeable, not the same as in acute rhinosinusitis, so they are often ignored. As a rule, when a secondary infection is attached, the patient's condition worsens.

Diagnosis of the disease

Diagnosis of chronic rhinosinusitis consists of successive steps:

It begins with a thorough and detailed history taking. The clinician should be able to gather information about the timing and severity of symptoms associated with the disease. There are certain criteria (signs and symptoms of chronic rhinosinusitis) that help establish the correct diagnosis. The disease is suspected if the patient has 2 or more major symptoms, or 1 major and 2 or more minor symptoms that persist for more than 12 weeks.

Interesting! When diagnosing, doctors determine the severity of the patient's condition and the impact of the disease on his quality of life. To assess these parameters, a severity scoring system was developed. Clarification of the impact of chronic rhinosinusitis on the functions of the patient's body is necessary to establish future treatment outcomes.

In addition to the medical history, physical signs are important criteria in the diagnosis of ENT diseases. The simplest method of examining the nasal mucosa is rhinoscopy, but it does not allow you to see distant parts of the nasal passages. Nasal endoscopy, although more invasive, is the examination of choice. With its help, an enlarged image of the nasal mucosa, turbinates and the inside of the nasal airways is obtained.

Endoscopy helps in assessing the integrity of the mucosa, and also directly shows changes in it, polyps, crusts or discharge. Also, with the help of endoscopy, tissue samples and secretions can be taken for further laboratory research.

Finally, an X-ray or CT scan is performed, which gives a clear picture of the state of the bone structures and the nasal mucosa. CT helps to identify various abnormalities, confirm the diagnosis and choose the right treatment option, and in candidates for surgery, clearly determine the anatomy and extent of the disease.

Magnetic resonance imaging (MRI) is not recommended for diagnosing chronic rhinosinusitis, but it is superior to CT for differentiating infectious (bacterial or viral) inflammation from fungal infections, and for detecting malignancies. In addition, MRI helps to detect orbital and intracranial complications.

Laboratory studies such as nasal cytology, mucosal biopsy, and blood tests are not needed for a clinical diagnosis. They only help determine whether a bacterial infection or allergy is present, or more serious conditions such as cystic fibrosis, ciliary dysfunction, or various immune deficiencies.

How and how to treat chronic rhinosinusitis in adults and children?

Treatment of chronic rhinosinusitis in adults and children is aimed at:

decrease in edema of sinus tissues;
facilitating mucus drainage;
elimination of associated infections.

In addition, in order to cure rhinosinusitis, it is necessary to eliminate such predisposing factors as allergies, deviated nasal septum, polyps, etc. Immunocompromised patients should be given intravenous immunoglobulin therapy.

A clear principle for the treatment of chronic rhinosinusitis has not been fully established, for the most part due to the fact that doctors cannot determine the exact causes of its origin.

In different cases, the following methods are used:

Therapy is continued until remission occurs, but after some time an exacerbation may occur. Exacerbation of chronic rhinosinusitis is treated again according to the same scheme or, if necessary, other options are considered.

Treatment of catarrhal rhinosinusitis at home

Below are folk methods for the treatment of chronic rhinosinusitis. They should be used after consulting a doctor and only in combination with traditional medicines.

Heating with dry heat. To alleviate the symptoms of pain and speed up the healing process, it is recommended to warm the sinus and nose areas with a bag of heated salt (another bulk material is possible) or a boiled egg. Warming up lasts 15-20 minutes. You can do it 1-2 times a day. Please note that during the procedure you should not experience discomfort, so the salt should not be hot, and you can additionally apply a towel to your face. With purulent inflammation, warming up is strictly prohibited!
Washing the nose. Make your saline solution by mixing 0.5 tsp in 0.5 l of boiled warm water. salt. Bend over the sink and, turning your head to the side, pour the solution into the upper nostril through a syringe or bulb. Do the same with the other nostril. Such procedures are very useful both for the treatment of rhinosinusitis and for prevention. They can be done every day.
Steam inhalation. At home, you can do them with a special inhaler or in another convenient way. You need to breathe over the steam for about 10 minutes 2-3 times a day. Inhalations help soften mucus, steam and moisturize the nasal mucosa. If decoctions of herbs, essential oils or bee products are added to the water for inhalation, then an anti-inflammatory effect is additionally obtained.
homemade drops. As drops from sinusitis, you can use beet juice, carrots, aloe. Onion is also an effective antimicrobial agent. Its juice must be mixed with water in a ratio of 1:5, so as not to burn the mucous membrane.

Why is chronic rhinosinusitis dangerous?

Chronic rhinosinusitis is rarely life-threatening, although serious complications may occur due to proximity to the orbit and cranial cavity. Approximately 75% of all cases of orbital infections are directly related to sinusitis. Intracranial complications of chronic rhinosinusitis (meningitis, brain abscess) remain relatively rare, but they are the most dangerous and can be fatal.

In most cases, the disease leads to such consequences as a persistent decrease in the sense of smell, a deterioration in the quality of life and working capacity.

Disease prevention

The best prevention of chronic rhinosinusitis lies in the proper treatment of acute sinusitis. In addition, you need to eliminate possible irritants (cigarette smoke, dust) and monitor the humidity in the house so that it does not become too dry.

To prevent the recurrence of chronic rhinosinusitis, treatment of related conditions should be carried out: allergies, asthma, adenoids, immunodeficiency, etc.

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Content

The inability to breathe freely, headaches, nasal discharge, require an ENT doctor. A neglected disease causes serious complications. Why does rhinosinusitis occur, what are the symptoms? It is useful to get acquainted with the peculiarities of the course of various types of illness, diagnostic methods, methods of treatment with drugs, surgical intervention, folk remedies.

What is rhinosinusitis

Inflammatory processes in the mucous membranes of the nasal cavity and paranasal sinuses cause infections provoked by bacteria, fungus, viruses. Rhinosinusitis often begins in an acute form. With the development of the disease:

under the influence of infection increases secretion, vascular permeability;
the mucous membranes of the nasal cavity and sinuses swell and thicken;
fistulas between them overlap, forming a closed space;
there is an accumulation of mucous purulent exudate;
there are severe and unpleasant symptoms.

The patient, feeling the signs of the disease, should consult a doctor. The disease in acute form lasts up to a month. Untreated rhinosinusitis is dangerous by the transition to the chronic stage, the occurrence of complications such as:

bronchial asthma;
damage to the optic nerves - visual impairment;
abscess of soft tissues of the face;
purulent inflammation of the middle ear;
damage to the nervous system;
brain abscess;
transmission of infection to the lungs;
purulent inflammation of the eye sockets;
thrombosis of the cavernous sinus;
sepsis - infection through the bloodstream;
meningitis;
risk of death.

Reasons for the development of rhinosinusitis

The occurrence of an inflammatory process in the paranasal sinuses causes numerous diseases. The causes of the development of the disease are provoking factors of various etiologies. The reason for the appearance of the disease are:

taking medications for a long time;
defects in the structures of the nose - acquired, congenital;
hereditary factors;
the habit of blowing your nose incorrectly - to clean both nostrils at once;
violation of the patency of the fistulas of the nasal sinuses;
weakening of the immune system;
injury.

The causes of the development of the disease are:

in adults - nasal polyposis;
in children - adenoiditis;
pathology of nearby organs;
allergic rhinitis;
bronchial asthma;
immunodeficiency states;
endocrine diseases;
fungal infections caused by pathogens of the genus Candida, Aspergillus, moldy fungi;
bacterial pathologies provoked by staphylococcus, streptococcus, intestinal, hemophilic, Pseudomonas aeruginosa;
diseases associated with the activity of viral microorganisms - influenza, adenovirus, parainfluenza.

Symptoms of rhinosinusitis

The disease can develop in various forms, each of which has its own characteristics. There are symptoms that are common to all types of ailment. With the appearance of rhinosinusitis, there are:

The disease causes intoxication of the body, which is accompanied by the following symptoms:

severe headaches, with localization near the sinuses;
temperature above 39 degrees;
weakness;
malaise;
runny nose;
loss of appetite;
dizziness;
sore throat;
irritability;
sleep disorders;
cardiopalmus;
increased fatigue.

Types of rhinosinusitis

In medicine, it is customary to classify diseases. This helps in the diagnosis, the correct prescription of treatment, the choice of drugs. Rhinosinusitis is systematized according to several parameters. Types of illness by etiology:

	pathogens	Note
Bacterial	enterobacteria staphylococcus aureus Pseudomonas aeruginosa, Escherichia coli streptococcus
Viral	rhinoviruses adenoviruses parainfluenza	passes in an acute form
Fungal	mushrooms of the genus Candida, Aspergillus	the cell is attacked by several microorganisms at once
mixed		starts with a bacterial infection, complicated by other types

Inflammatory disease is classified according to several parameters. According to the nature of the course, an acute, chronic, recurrent form is distinguished. Localization of the process can be one-sided, two-sided. The course of the disease differs in severity - mild, moderate, severe. Classify the types of the disease according to the site of the lesion:

maxillary - sinusitis;
ethmoidal - affected parts of the ethmoid sinuses - ethmoiditis;
frontal - frontal areas are affected - frontal;
sphenoidal - inflamed sphenoid sinuses - sphenoiditis.

Spicy

Diseases in this form begin rapidly, requiring urgent medical attention. The progression of the disease in the patient occurs within a week. Acute rhinosinusitis has a characteristic clinical picture:

intoxication - fever, pressure in the ears, feeling of weakness, weakness, fever;
decreased sense of smell;
swelling of the face;
paroxysmal headaches;
nasality;
labored breathing;
bad breath;
nasal congestion;
mucous secretions;
discomfort, squeezing in the sinuses.

If the symptoms have not changed within a week, a bacterial infection is not excluded. This condition requires hospitalization, antibiotic therapy. This will help to avoid the development of the disease in a chronic form, the appearance of serious complications. The provoking factors for the occurrence of an acute inflammatory process in the sinuses are:

incorrect or incomplete treatment of sinusitis;
violations of the discharge of mucous exudate;
deviated nasal septum.

Chronic

If acute rhinosinusitis is not cured to the end, it leads to the development of chronic pathology. The disease can last up to six months. The provoking factors for the occurrence of this form of pathology are:

allergic reactions;
severe form of intoxication;
facial trauma;
smoking;
constant inhalation of dusty, gassed air;
acquired, congenital defects of the nasopharynx.

Chronic rhinosinusitis is characterized by mild symptoms. This type of disease is dangerous for the development of complications. The narrowing of the anastomosis between the sinus and the nose as a result of edema reduces the supply of oxygen, which increases the inflammatory process. The following clinical picture of the disease is observed:

weakened sense of smell;
hearing impairment;
persistent nasal congestion;
lack of temperature;
nasal voice;
labored breathing;
discharge from the nose of a mucous secretion with pus;
bursting in the sinuses;
irritation;
weakness.

polyposis

Running inflammation of the paranasal sinuses leads to the growth of the mucous membranes. Chronic polypous rhinosinusitis develops against the background of a decrease in the concentration of immunoglobulin G. The provoking factor is exposure to aggressive chemicals, allergens, viruses, and a hereditary predisposition to allergies. The development of the disease occurs according to the following scheme:

there is swelling of the mucous membranes;
the walls thicken, grow;
outgrowths - polyps are formed;
in the sinuses there is a stagnation of purulent contents.

The disease is dangerous for its complications - meningitis, damage to the eyeballs. Requires surgical treatment - removal of polyps. The clinical picture is characterized by symptoms:

nasal congestion;
feeling inside a foreign body;
loss or decrease in taste, smell;
swallowing problems - with a running form;
sleep disturbance;
tachycardia;
stuffy ears;
chronic fatigue;
pain in the head, sinus area.

Purulent

Rhinosinusitis of this type is bacterial in nature. Often, the activation of pathogenic microorganisms on the mucous membranes of the nose and sinuses occurs due to injuries. The disease is dangerous with life-threatening complications - abscesses, empyema of the orbits, brain, meningitis, requires inpatient treatment. Clinical symptoms in this pathology are pronounced:

purulent discharge from the nose;
fever;
toothache, headache;
swelling of the face at the site of the lesion of the sinuses;
sleep disturbance;
lack of appetite;
weakness;
aches in the joints;
muscle pain;
heat.

Allergic

Provoking factors in the development of this type of disease is exposure to allergens. It can be food, medicines, plants, dust, fungal spores, animal hair. Allergic rhinosinusitis requires the exclusion of irritants leading to the disease, the use of antihistamine drugs. The disease is distinguished by clinical symptoms:

catarrhal

A disease that occurs without purulent discharge is also called a viral rhinitis. Catarrhal rhinosinusitis is distinguished by abundant and transparent mucous exudate. The disease is provoked:

fungal, viral infections of the upper respiratory tract;
neoplasms, polyps in the nasal cavity;
weakening of the immune system;
curvature of the nasal septum;
hypothermia;
dental infections;
allergies.

The inflammatory process is dangerous with complications, it requires timely treatment to exclude them. The disease has a clinical picture:

elevated temperature;
swelling of several sinuses;
nasal congestion;
inflammation of the conjunctiva of the eyes;
loss of smell;
dry burning in the nasal cavity;
hypothermia;
headache;
puffiness;
profuse lacrimation;
lack of sleep.

Vasomotor

If there is a violation in the paranasal sinuses and the nasal cavity of the tone of the blood vessels, swelling of the mucous membranes occurs. Vasomotor rhinosinusitis begins against the background of colds, SARS. Provoke the development of the disease:

Sudden expansion of blood vessels leads to the appearance of edema, while the clinical picture of the disease is characterized by constant nasal congestion, watery mucous secretions that turn into green exudate with the progression of the disease. Symptoms are observed:

Diagnostics

When symptoms of the disease appear, you can not self-medicate, you need to contact a specialist. The otolaryngologist begins the diagnosis by questioning the patient. During the visit:

the general condition of the patient is assessed;
complaints are heard;
symptoms are cleared up;
palpation of the cheekbones and forehead is carried out in order to determine the zone of soreness, to identify anomalies in the nasal cavity.

To clarify the diagnosis, instrumental studies are carried out:

rhinoscopy - examination of the mucous membranes of the nasal passages;
endoscopy - a violation of the anatomy is revealed in detail, individual areas are studied;
radiography - an examination of the frontal and sphenoid sinus is performed;
computed tomography - a feature of the anatomical structure of the nose is revealed;
Ultrasound - inflammation of the frontal sinuses is diagnosed, cysts, polyps are determined;
magnetic resonance imaging - tumors, inflammations are detected.

Laboratory tests help to determine the diagnosis with high accuracy. According to the appointment of an ENT doctor, the following is carried out:

diagnostic puncture of sinus contents;
smear for eosophils;
microbiological examination of exudate from the sinuses, discharge of the nasopharynx, to identify the causative agent of rhinosinusitis, to determine its sensitivity to antibiotics;
blood analysis.

Treatment of rhinosinusitis

In the complex therapy of the disease, doctors prescribe drugs for topical and oral administration, use sinus lavage, and physiotherapy. In the treatment of rhinosinusitis, it is necessary to solve several problems:

eliminate the cause of the inflammatory process;
eliminate the outbreak;
relieve painful symptoms;
restore the body's defenses.

Antibacterial agents play an important role in this. Depending on the identified pathogen, antibiotics are prescribed - cephalosporins, tetracyclines, macrolides. The duration of the course of treatment is determined by the doctor. For topical application, sprays with antibacterial action are used - Isofra, Polydex. With rhinosinusitis, antibiotics are often used in the form of tablets, injections, suspensions for children:

Clarithromycin;
Augmentin;
Azithromycin;
Amoxicillin.

The course of therapy for the disease includes the use of:

to relieve inflammation - the corticosteroid Hydrocortisone, the antihistamine Loratadine;
in order to increase the protective forces - immunomodulators - Ismigen, Imunorix, Immunal, to strengthen local immunity - IRS-19;
for pain relief, fever relief - Paracetamol, Ibuprofen;
combined topical sprays - Rinofluimucil, Vibracil.

To remove pathogenic contents from their sinuses, otolaryngologists recommend:

mucolytics that contribute to liquefaction of sputum, its normal outflow - Sinupret, ACC;
moisturizing spray Aquamaris;
vasoconstrictor, decongestants in the form of drops - Rinonorm, Tizin, Nazivin;
solutions for washing - Miramistin, Chlorhexidine, Furacilin.

Rhinosinusitis in children, if the disease is not in an advanced form, they try to treat without the use of antibiotics. Doctors prescribe antiseptic drops Protargol, Bioparox, inhalations with a nebulizer using Borjomi mineral water. Complex therapy of the disease in children and adults includes:

washing the sinuses with a solution of sea salt, decoctions of medicinal herbs, saline;
physiotherapy - electrophoresis, UHF, diadynamic currents;
laser treatment;
strengthening immunity;
sanitation of teeth;
application of traditional medicine recipes.

ethnoscience

The use of natural herbal remedies for the treatment should be agreed with the doctor. Recipes of traditional medicine become an addition to complex therapy, but do not replace it. Popular remedies for the treatment of rhinosinusitis:

washing the nasopharynx with diluted and salted lemon juice, beets, sage broth - a spoonful of herbs in a glass of boiling water;
instillation into the nose of a composition of equal parts of liquid honey, onion juice and potatoes;
heating the nasal septum with hot salt in a linen bag - strictly as prescribed by the doctor to avoid the spread of inflammation.

Make compresses, instillations into the nose, inhalations with a decoction of herbs - two tablespoons per half liter of boiling water. The composition of the collection includes equal parts of eucalyptus, sage, valerian, calendula, chamomile.
Perform daily instillation into each nasal passage, 2 drops of Kalanchoe juice.
Put for half an hour three times a day turundas with a warm mixture of equal parts of vegetable oil, baking soda, honey.
Take in the morning on an empty stomach half a teaspoon of a mixture of juice of three lemons with pureed horseradish root.

Surgical intervention

If the conservative treatment of rhinosinusitis has not yielded results, the likelihood of complications is high, doctors prescribe surgery. There are several ways of surgical treatment. One of them is sinus puncture, during which:

make a puncture with a needle in the thinnest place of the maxillary bone;
pus is removed by washing the sinus space with antiseptics;
medications are administered.

An alternative method to puncture is the use of a YAMIK catheter. For a complete cure of rhinosinusitis, several procedures are necessary. During a session:

a catheter with two rubber balloons is inserted into the nose;
they swell and close the nasal cavity;
purulent contents are removed with a syringe;
an antiseptic for washing is fed through the catheter, the medicine is injected.

Surgical methods of treating the disease include the following methods:

Sinusotomy - removal of part of the facial bone by opening it. It is characterized by a long rehabilitation, many contraindications.
Endoscopic removal of polyps. The instrument is inserted into the nasal passage, does not cause damage to healthy tissues, and the risk of re-development of rhinosinusitis is reduced.

The non-invasive cuckoo treatment is carried out separately for each nostril. Features of the procedure:

a syringe is inserted into one nasal passage, and a suction hose is inserted into the other;
physiological saline or antiseptic is supplied under pressure;
fluid passes through all the sinuses into the sinuses;
at the same speed, the contents are sucked out;
the patient during treatment, in order not to choke, constantly says “cuckoo” - the glottis should be open.

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