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Sinusitis is an inflammation of the paranasal sinuses. Viruses, mycotic microorganisms, bacteria and allergens provoke sinusitis. General otolaryngologists deal with sinusitis more often than with other diseases, since inflammation of the sinuses is very widespread.
Sinusitis can be acute or chronic. Acute inflammation is said to occur when the disease lasts less than 2 months. A chronic infection is indicated by a long course of inflammation, or frequent recurrences of sinusitis (from four or more per year).
Any paranasal sinus can be infected. However, in children after seven years of age and in adults, the following sequence is most often observed: inflammation of the maxillary paranasal sinus, then the ethmoid and frontal sinuses. Sometimes the sphenoid sinus is involved in the infection process. Possible manifestation of the disease in two or more cavities at the same time. In this case, they speak of polysinusitis (pansinusitis, hemisinusitis, maxillary etmoiditis).
The term “acute sinusitis” doctors most often use to refer to bacterial inflammation. However, recent studies indicate that 87% of sinusitis cases are viral and tend to resolve without any antibiotic treatment. Although up to 2% of viral sinusitis can be complicated by a bacterial infection, antibiotics cannot be dispensed with in this case.
Causes of Acute Sinusitis
The causes of acute sinusitis lie in the development of inflammation caused by a variety of infectious agents. Among them are:
Haemophiliusinfluenzaeи Streptococcus pneumoniaare sown from a smear in 50% of cases or more;
Less common pathogens are moraxella, hemolytic streptococci, Staphylococcus aureus, anaerobic bacteria and viruses;
Enterobacteria, anaerobic bacteria, Staphylococcus aureus and mycotic microorganisms are the main pathogens that cause nosocomial acute sinusitis.
If community-acquired forms of the disease develop mainly against the background of ARVI, then nosocomial sinusitis manifests itself with prolonged nasal tamponade in a hospital setting, as well as after nasogastric intubation or nasotracheal intubation.
Other causes of acute sinusitis are:
Various infectious diseases;
allergic rhinitis;
There may be a violation of the drainage of the sinuses against the background of the formation of polyps in them and with hypertrophy of the nasal mucosa;
The cause of impaired aeration and drainage is often the curvature of the nasal septum as a result of an injury;
Diseases of the dentition can cause acute sinusitis, manifesting in the maxillary sinus;
Pathogenic role is played by endo- and exotoxins, which have a toxic effect on the body as a whole.
If the anastomoses, through which the nasal sinuses communicate with the nose, are blocked, then negative pressure arises in their cavity. This leads to excessive formation of mucus, to its stagnation. As a result, the acidity of the nasal flora changes, the function of the ciliated epithelium is disturbed. Cilia begin to move either very slowly, or completely stop their work, being shrouded in mucus. This contributes to the multiplication of bacteria in the nasal cavity, their penetration into the cells of the mucous membrane, the destruction of their membrane and the formation of colonies.
What happens during acute sinusitis?
Discharge from the nasal passages at the initial stage of development of sinusitis has the character of a serous exudate. As inflammation increases, it becomes muco-serous, and subsequently purulent, as the bacterial flora begins to prevail. In the discharged contents, an increased number of leukocytes are found, which were abandoned by the body to fight the infection, as well as detritus. Mucosal edema increases due to increased capillary permeability.
There are two types of sinusitis:
Acute, which develops quickly, and chronic, which has a long course. Most often, this disease is a consequence of viral penetration into the nasal cavities. Therefore, sinusitis is able to be eliminated independently, by the body’s own forces.
When a bacterial infection is attached, edema increases, mucus increases, blockage of the nasal passages and reproduction of pathogenic flora occur.
Both viral and bacterial sinusitis can last up to 2 months or more. With chronicization of the process, an irreversible change in the nasal mucosa is not excluded, which leads to an increase in cases of acute respiratory viral infections.
Such a complication of sinusitis as osteomyelitis is considered quite rare. However, all complications of inflammation of the paranasal sinuses are dangerous to human health and threaten his life.
Symptoms of acute sinusitis
Symptoms of acute sinusitis are expressed in headaches, an increase in body temperature to high levels, in general weakness. The process of inflammation will also be reflected in the results of a blood test. However, a general disturbance of the condition can occur with other diseases, and they are not characteristic only for sinusitis. Therefore, local symptoms are of particular importance.
Local symptoms of acute sinusitis are as follows:
Violation of nasal breathing against the background of severe headaches;
Increased nasal discharge. In addition, mucus will drain down the back of the nasopharynx;
Violation of the olfactory function occurs due to swelling of the mucous membrane of the nasal passages, or due to their overlap with a thick secret;
Headaches with localization in the temples and forehead. The pain tends to increase with head tilt;
During a night’s rest, pain may occur in the center of the head and in the back of the head. This indicates involvement in the pathological process of the sphenoid sinus;
With an undisturbed outflow of exudate from the sinuses, headaches may not occur.
There are three forms of acute sinusitis, depending on the severity of the symptoms of the disease:
Mild sinusitis. In this case, the patient experiences only local symptoms. After taking x-rays, the doctor does not detect signs of sinusitis in the pictures. If they do exist, then they are insignificant. Headaches and pain in the sinuses may occur. The patient’s body temperature remains within the normal range, or rises to subfebrile levels;
moderate sinusitis. In this case, the pain is moderate, there are signs of intoxication of the body. Body temperature can reach 38,5 °C. In addition, local symptoms such as swelling of the eyelid and soft tissues surrounding the paranasal sinuses are possible;
Severe sinusitis. A person suffers from serious intoxication of the body, headaches and other pains are very intense, body temperature exceeds 38,5. A severe form of the disease most often leads to the development of complications.
Diagnosis of acute sinusitis
Diagnosis of acute sinusitis includes rhinoscopy. In this case, the doctor visualizes a pronounced swelling of the nasal mucosa on the side where there is inflammation. Nasal fistulas are narrowed, breathing is difficult, the sense of smell is disturbed. Purulent discharge is found in all nasal passages (in the middle, general, lower and upper).
When the sphenoid sinus and the ethmoid labyrinth are involved in the pathological process, purulent mucous masses flow down the back of the pharynx and are visible during the examination. However, even if there is no purulent content in the nasal cavity, this does not exclude acute sinusitis. It is possible that the pathological mucus is very thick, or the fistulas are completely blocked.
In addition to rhinoscopy, otolaryngologists use in their practice methods such as radiography (possibly with the use of a dye), computed tomography. If necessary, a puncture of the paranasal sinuses is performed.
X-ray sign of acute sinusitis there is a violation of the pneumatization of the sinuses. If the patient was x-rayed in a sitting position, then the contents of the sinus will have a horizontal level. The study is carried out in two projections – in the nasolabial and naso-chin.
Computed tomography makes it possible to diagnose not only the inflammatory process in the sinuses, but also to determine the presence of complications of the disease (intracranial and orbital).
Diagnostic puncture taken from the maxillary sinus. Its intake is carried out through the lower nasal passage. It is also possible to perform trepanopuncture through the orbital or anterior wall of the sinus. This method was proposed by M. E. Antonyuk. The resulting contents of the sinuses are examined for the detection of bacterial microflora and its sensitivity to antibacterial drugs.
Treatment of acute sinusitis
Treatment of acute sinusitis is based on general or local therapy with antibacterial drugs. In parallel, the sinuses are drained and the immune forces of the body are strengthened.
The need for hospitalization is determined by the severity of acute sinusitis. If the disease is mild or has an average severity, then outpatient treatment is possible under the supervision of a local ENT doctor. The severe course of the disease, and sometimes the moderate severity, requires hospitalization of the patient in the otolaryngological department of the hospital.
Medication Therapy
The primary goal of drug therapy is the complete elimination of the pathogenic microorganism and the normalization of the microflora of the sinuses. In order for the treatment to be as effective as possible, you need to know which pathogen provoked the inflammation. Despite the wide possibilities that modern medicine has, it seems possible to accurately identify an infectious agent only 5-7 days after sending the material for research. Even if there is data regarding which pathogen provoked the disease, it is impossible to accurately predict whether it has sensitivity to a particular drug. This also requires additional testing.
In order not to delay treatment, specialists use those drugs, the resistance to which bacteria have is minimal. It remains for the doctor to choose the medicine that, in his opinion, (based on the clinical picture of the disease and the alleged pathogen) will be the most effective.
Other criteria for choosing one or another antibacterial agent are:
The severity of the disease;
The safety of the drug for the patient’s condition;
No toxic effect for the body;
The minimum set of side effects.
With mild flow sinusitis is prescribed oral antibiotics. Antibiotics and a course of treatment are prescribed by a doctor.
For moderate flow prescribe cephalosporins of the second and third generation, b-lactam penicillins, and it is also possible to use drugs from the group of fluoroquinolones.
For severe sinusitis (or with the development of complications), intravenous and intramuscular administration of antibacterial drugs in a hospital setting is indicated.
In addition to antibiotics, complex therapy involves the appointment of mucolytics, anti-inflammatory and anti-allergic drugs.
Stationary methods for removing pus from the sinuses
The “cuckoo” method or the “movement” method according to Proetz is a non-puncture method for the treatment of inflammation of the sinuses. With the help of surgical suction, purulent contents from the sinuses are removed, and medicinal solutions take its place.
Also, to remove the pathological secretion, the YAMIK sinus catheter, which was developed by V. S. Kozlov and G. I. Markov, can be used. Thanks to this method, the pathological contents of the sinuses can be aspirated and disinfected with medicines. A sinus catheter is recommended for use in the treatment of exudative forms of sinusitis, or if several sinuses are affected simultaneously. In order to achieve maximum sterility in the sinus of the nose after its cleansing by any available method, it is necessary to introduce a solution of Gepon, which allows you to enhance local protection.
Prevention of acute sinusitis
Prevention of recurrence of acute sinusitis requires the following preventive measures:
Elimination of any existing anatomical defects in the event that they interfere with the natural passage of air through the nasal passages;
Dental treatment of the roots of teeth adjacent to the bottom of the maxillary sinus;
Strengthening local and general immunity of the body.
Also effective is the introduction of bacterial vaccines that allow the population to be immunized.
Which doctor treats sinusitis?
Sinusitis is treated by an otolaryngologist (ENT).