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Frontitis is an inflammation of the mucous membrane that covers the frontal sinus from the inside. This condition is accompanied by headache, which is concentrated in the forehead, rhinitis and deterioration of health. Otolaryngologists are engaged in the diagnosis and treatment of frontal sinusitis. Sometimes the disease has a severe course, and it is possible to cope with it only with the help of an operation.
Frontal – what is it?
Frontit is a type of sinusitis. Sinusitis is the general term for inflammation of the sinuses. The disease must be taken very seriously, since the frontal sinus is separated from the brain only by a thin bone. If a lot of mucus and pus accumulate in the sinuses, then the pressure in it rises. This can cause a crack to appear in the thin bone plate. Through it, the inflammatory exudate penetrates the membranes of the brain and leads to their inflammation.
From below, the frontal sinus is bounded from the orbit by a thin plate, and behind by a bone. It is she who separates the sinus and frontal lobes of the brain. The front wall of the sinus is covered with skin and is located slightly above the eyebrow. Its inner wall is represented by a partition between the frontal sinuses. Such a partition appears only by the age of 15. In 15% of people, it never forms. Their frontal sinus will be represented by a single space.
Until 6-7 years of age, the frontal sinuses in children are not developed. Therefore, frontitis is not diagnosed in them. Moreover, in 10% of people, this sinus never develops during life, which is explained by the peculiarities of genetics.
Causes of frontitis
Regardless of the age of a person, frontal sinusitis will develop due to the impact on the body of the following factors:
Viral, bacterial or fungal infection. It should be noted right away that fungi cause the development of frontitis very rarely. Viruses enter the frontal sinus from the nasal cavity, as they communicate with each other through a narrow channel. Most often this happens against the background of an acute viral infection or influenza. Often the cause of the development of frontal sinusitis is the bacterial flora (staphylococci, streptococci, Haemophilus influenzae, diphtheria bacillus). In childhood, the cause of frontal sinusitis often becomes Moraxella catarrhalis. Sometimes bacterial frontal sinusitis is a consequence of other diseases (diphtheria, scarlet fever), and sometimes acts as a complication of a viral infection. Pathogenic flora can be brought into the sinuses during surgery on the nasal cavity, in case of injury. If the wound is not penetrating, then at first the inflammation will be aseptic. In the future, it is complicated by suppuration. Another way for bacteria to enter the frontal sinuses is hematogenous. In this case, the causative agents of inflammation enter them with a blood stream. The source of their distribution can be tonsils, bad teeth, lungs.
Allergy. The frontal sinuses can become inflamed against the background of a runny nose of an allergic nature. At first, such frontal sinusitis will have an aseptic course, and in the future it can turn into a bacterial infection. Microbes begin to multiply in the sinuses due to the fact that their normal drainage is disturbed.
The ingress of a foreign object into the sinus of the nose. Most often, this cause of frontal sinusitis is diagnosed in childhood. Any object is a source of infection, since it cannot be sterile. In addition, it will disrupt the natural outflow of mucus, which will lead to an inflammatory reaction.
Taking certain medicines.
Injuries of the nose and frontal sinus.
The following factors increase the likelihood of developing inflammation:
Enlarged adenoids.
Injuries to the nose.
Nasal septum defect.
Chronic runny nose.
The presence of polyps, cysts, tumors in the nasal sinus.
The presence in the sinuses of pathogenic flora.
Too long canal that connects the frontal sinus and nose.
If the human immune system is weakened, then frontal sinusitis can develop even when the body is exposed to cold, or when inhaling dusty and polluted air.
Frontite types
The course of frontitis can be acute and chronic. Acute inflammation is most often caused by viruses, bacteria, allergens, or trauma. Chronic inflammation develops mainly against the background of undertreated acute frontal sinusitis. Often the disease is chronicized in people with a deviated nasal septum.
Depending on the etiological factor, there are such types of frontal sinusitis as:
Viral.
Mycotic.
Bacterial.
Mixed (when the disease is provoked by several representatives of the pathogenic flora at once).
Allergic.
Medication.
According to the type of inflammatory reaction, the following types of frontitis are distinguished:
Exudative frontitis. The mucous membrane of the sinuses becomes inflamed and begins to secrete fluid. Depending on the composition of this fluid, catarrhal frontitis is distinguished (the fluid is represented by mucus) and purulent (the fluid contains pus). Catarrhal inflammation is characteristic of the onset of the disease, and the appearance of pus in the exudate indicates the development of complications and the multiplication of bacterial flora.
Productive front. In this case, the mucous membrane of the nasal sinuses grows. Such frontitis can be of 3 types: polyposis (accompanied by the appearance of polyps), cystic (cysts grow in the nasal cavity) and parietal-hyperplastic (the mucous membrane itself grows).
In addition, inflammation is unilateral and bilateral.
Frontitis symptoms
If a person develops acute frontal sinusitis, then this is characterized by symptoms such as:
Pain.
Flow of mucus from the nose. Her character may vary.
Deterioration of nasal breathing.
Hyperthermic reaction of the body.
Edema in the upper corner of the eye from the side of the lesion.
Lachrymation, pain in the eyeballs.
Weakness.
Malaise.
Sputum production in the morning.
If the sinusitis has a chronic course, then the patient develops symptoms such as:
Pain concentrated in forehead.
Headache.
The appearance of discharge from the nose, which have an unpleasant odor.
Cough at night.
Sputum with pus, which appears mainly in the morning.
Persistent rhinitis.
Deterioration of olfactory function.
Painful sensations are concentrated above the bridge of the nose, or somewhat away from it. The pains become stronger in the morning, as the outflow from the sinuses weakens at night. It also increases when turning the head, during vibration, shaking, driving. The pains radiate to the eyes, to the temples. If the disease is acute, then the pain is intense, and if the inflammation is chronic, then the pain is aching and pressing.
How to distinguish frontitis from sinusitis?
It is important to be able to distinguish between the symptoms that are characteristic of frontal sinusitis and sinusitis, since their clinic has similar manifestations.
Symptom | Sinusitis | Frontit |
Where is the pain located? | It is concentrated on both sides of the nose, it gives off to the whiskey, to the teeth, to the cheekbones. The pain becomes more intense if the person tilts his head down. | The pain is localized 2 cm above the bridge of the nose, or to the side of it. It radiates to the eyes, becomes stronger during the vibration of the body, with the movement of the head. |
Edema | Edema intensifies in the area of the lower eyelid, bags appear under the eyes. | Edema is concentrated in the upper inner corner of the eye. |
Features of rhinitis | At first, the exudate is mucous, and then becomes purulent. | First, the nose is stuffed up, and then mucus begins to stand out from it. There is not much of it, it can be transparent, or it will contain pus. |
Complications of frontitis
Frontitis can cause complications such as:
Phlegmon of the orbit with inflammation of its adipose tissue.
Inflammation of other sinuses.
Osteomyelitis with damage to bone tissue.
Abscess of the eyelid and frontal lobes of the brain.
Meningitis.
Sepsis.
Diagnosis of frontal sinusitis
If you suspect a frontal sinusitis, a person needs to go to an appointment with an otolaryngologist. The doctor will examine the patient’s sinuses with the help of mirrors, listen to his complaints.
To clarify the diagnosis, a person will be sent to undergo one or more studies:
X-ray of the nasal sinuses. The picture will show how filled they are with liquid. In this case, it will not be possible to determine the nature of the liquid.
CT This method allows you to perform layered images of the bone tissue of the skull.
Endoscopic examination of the nasal sinus. In this case, a flexible tube with a camera and illumination is inserted into the patient’s nose. The doctor sees the image on the screen. However, based on the results of this study, it will not be possible to make a diagnosis.
LHC seeding of nasal mucus. This study allows you to identify the bacterium that led to the development of the infection.
Treatment of frontitis
If the sinusitis has an uncomplicated course, then it is possible to cope with it with drugs and physiotherapy. It is important to remove inflammatory exudate from the sinus and normalize its ventilation. If a positive trend cannot be achieved, then a sinus puncture is performed, which allows its contents to be drained. When it is too thick and viscous, the patient is referred for surgery.
The main stages of treatment:
Adults with frontal sinusitis are prescribed vasoconstrictor drops, which can reduce swelling of the nasal mucosa and fistula that connects its cavity with the frontal sinuses. Examples of such medicines are Naphthyzin and Galazolin drops (preparations of the last century), Sanorin, Tizin, Lazolvan Rino (modern drops). To achieve maximum effect, you need to make drops into the nasal passages correctly. For this, the head is tilted to the right and up, after which the agent is instilled into the right nasal passage. You should stay in this position for about 10 minutes. This will allow the fistula to fully open. Then a similar procedure is carried out with the left nostril.
To reduce the intensity of the inflammatory reaction, nasal sprays based on corticosteroid hormones (Avamys, Baconase, Flix, etc.) are used. For more than 5 days, such drugs are not used. Irrigate their nasal passages no more than 2 times a day.
Since frontitis is most often provoked by bacterial flora, patients are prescribed antibiotics. If the course of the disease is uncomplicated, then local therapy is enough. For this purpose, antibacterial drops Tsiprolet, Normaks, etc. can be used. You can independently prepare a complex antibacterial composition for nasal administration. At the same time, a Lincomycin capsule is added to the Tsiprolet vial.
If a person has a severe headache, the body temperature rises, then it will not be possible to do without the systemic intake of antibacterial drugs. In this case, the patient is prescribed such drugs as: Lincomycin, Ceftriaxone, Cefotaxime, Augmentin, Ciprofloxacin. Some of them can be taken in tablets, and some drugs are available only in the form of injections.
Since taking antibacterial drugs negatively affects the intestinal microflora, it is necessary to take funds to normalize it: Hilak forte, Lineks, Laktomun, etc.
On the 5th day after the start of antibiotic treatment, the patient is offered Fluconazole at a dosage of 200 mg. This is necessary to prevent fungal infection. If a woman has already begun to develop thrush, then the dose is increased to 300 mg.
Since any inflammation is accompanied by increased production of histamine in the body, which affects the severity of edema of the mucous membranes, it is necessary to take antihistamines (Loratadin, Diazolin). If the sinusitis is at all allergic in nature, then a combination of these 2 drugs is required. Also, patients with allergic frontal sinusitis are prescribed several injections of glucocorticosteroids.
You can relieve inflammation and reduce body temperature with the help of drugs from the NSAID group (Ibuprofen, Nimesil, etc.).
Sometimes the treatment is supplemented with homeopathic remedies (Sinupret, Cinnabsin).
Washing the sinuses
Washing the sinuses with a vacuum method is called the “cuckoo”. During its implementation, the patient is injected into one nostril with saline, supplemented with an antiseptic or anti-inflammatory component. After that, the solution is pulled out of the other nostril using a vacuum pump. So that the composition for washing the sinuses does not get into the respiratory system, the person will need to repeat “coo-coo”. During the articulation of these sounds, the soft palate is pressed against the back wall of the pharynx, which allows it to overlap. Hence the “strange” name for an effective treatment procedure.
When the soft palate is blocked, and a solution is poured into the nasal passages, negative pressure is created in the sinuses, which helps to remove pus to the outside. After the procedure is completed, the person feels nasal congestion, he may sneeze, complain of a headache. Sometimes a small amount of blood comes out of the nose.
PIT method
This method resembles the “cuckoo” described above. However, the procedure can be carried out as early as the age of five.
For treatment, a Yamik catheter is required. Inside it are 2 channels that have different outputs. Also, the tube is equipped with two cylinders.
The catheter is inserted into the patient’s nasopharynx, after which I begin to inflate the balloons with syringes, creating negative pressure in the nasopharynx. Its strength contributes to the fact that inflammatory exudate comes out of the sinuses. When the pressure is changed to positive, the doctor gets the opportunity to spray medicines into the affected sinus.
The procedure is carried out in a sitting position. Before it is performed, the nasal passages are treated with Lidocaine and adrenaline to achieve an analgesic and vasodilating effect.
It is forbidden to carry out therapy with the YAMIK method for people with disorders in the blood coagulation system, with polyps in the nose.
More: YAMIK catheter: treatment without puncture
Physiotherapy
Physiotherapeutic techniques are an excellent addition to the conservative treatment of frontal sinusitis.
The patient may be prescribed procedures such as:
Electrophoresis.
Quartzation of the nasal cavity.
Laser treatment.
UHF therapy.
Sollux.
Operative intervention
Surgical care is required for patients with chronic frontal sinusitis, as well as in cases where drug therapy does not achieve the desired effect.
In this case, such operational methods can be applied, such as:
Puncture of the nasal sinuses. It is performed in close proximity to the fistula. The patient is given local anesthesia, after which a needle is inserted, the end of which remains outside. Inflammatory exudate flows from the sinus along it. Then, antiseptic solutions are fed through the same needle. When a lot of pus accumulates in the sinuses, a catheter is inserted through the needle into the nose, which is left there for a while. It is necessary for the outflow of pathological contents. Antiseptic compounds are delivered through this catheter into the sinuses.
Balloon sinusoplasty. During the operation, an endoscope is inserted into the nasal cavity, which allows you to display an image on the screen. Under his control, a balloon is inserted into the sinus, after which it is inflated. This contributes to the expansion of the anastomosis. Through the enlarged passage, all the contents of the sinuses come out (Read more: balloon sinusoplasty: non-puncture treatment).
Operations of open type. Such an intervention is rarely prescribed to patients, since it injures the anastomosis and the sinuses themselves.
There can be several operations:
According to Jansen-Jacques. The patient’s skin is cut, after which a hole is made in the bone, in the region of the lower wall of the frontal sinus. A cannula is inserted into it for a week, through which the inflamed sinus is washed.
According to Ogston-Luke. An incision is made above the bridge of the nose, after which a bone is drilled or pierced in this area. Through this hole, the doctor examines the internal structure of the sinus, can remove overgrown neoplasms. After that, a cannula is inserted into the channel for the outflow of fluid and for the introduction of drugs. The procedure is indicated exclusively for adult patients. It is performed under local anesthesia with blockade of nerve fibers. If the disease has an acute course, then the procedure is contraindicated for the patient.
According to Galle-Dana. The doctor accesses the frontal sinuses through the nose by inserting a probe into it. The bones in front of the probe are then removed. This allows you to create a wide opening that does not close. The internal contents of the sinuses flow out under the pressure of their own gravity.
Also, the operation can be aimed at removing polyps, adenoids, deviated as a result of trauma to the nasal septum.
Rehabilitation. It is not enough to perform the operation and forget about the frontal forever. After it is carried out, it will be necessary to wash the frontal sinus with antiseptic solutions.
If the disease was accompanied by the development of complications with damage to bone tissue or eye structures, it is necessary to use solutions with antibiotics.
Until the treatment is completed, the doctor will ensure that there is no fusion of the tissues of the artificially made hole. To do this, it is expanded using a special probe, or cauterized with silver nitrate. Sometimes a stent is inserted into the passage.
Is it possible to treat frontitis at home?
Hospitalization is not always required for frontitis. Sometimes the patient is left at home.
This is possible in the following cases:
Uncomplicated course of the disease.
Preliminary examination of the patient by an otolaryngologist.
It is important that the patient strictly follows all medical recommendations and does not independently carry out any medical procedures. At home, it is necessary to direct efforts to ensure that outflow is carried out from the affected sinus.
This can be achieved if the following algorithm of actions is performed:
The first step – washing the nose with saline solutions (Dolphin, Aqua-Maris, saline). You can prepare such a tool yourself. An alcohol solution of Chlorophyllipt (dessert spoon) is added to 0,2 ml of physiological solution and mixed thoroughly.
The second step – expansion of the passage that connects the sinuses and nasal cavities. To do this, 10 minutes after washing, you need to drip into the nose either Lazolvan Rino or Nazol.
The third step – Antibiotic use. To do this, use nasal drops with an antibacterial component. You can add an ampoule of Lincomycin to Tsiprolet and make a few drops into the nasal passages.
If the doctor prescribes an antibiotic inside, then it must be taken strictly according to the schedule. It is also allowed to use Sinupret in the form of an alcohol solution. Before taking the drops, dilute in a small amount of water.
Solutions for washing the nose at home
Salt based solution. To prepare it, dissolve a teaspoon of salt in a glass of warm water, add a pinch of soda, 2 drops of iodine and the same amount of tea tree oil. Rinse the nose with the resulting composition at least 2 times a day.
Chlorophyllipt solution for nasal treatment. These procedures complement the washing of the sinuses with a saline composition.
Decoction of herbs. It is best to use chamomile. To prepare the composition, pour 3 tablespoons of dry raw materials with boiling water (0,45 ml of water is required for this volume), after which it is kept in a water bath for a quarter of an hour. Rinse the nose with the finished composition after it has cooled.
A solution of onion and honey. To prepare it, grind 1 onion into a pulp on a blender and pour a glass of boiling water. When the solution has cooled, a teaspoon of honey is added to it and used to rinse the nose.
Frontitis in children: features of the course of the disease
Frontitis can be diagnosed in children only after they turn 6 years old. Prior to this, the child’s frontal sinuses are not yet fully formed, so pus cannot accumulate in them. Most often, the disease develops against the background of a viral infection, acting as its complication. In childhood, the disease is more severe than in adults, since many young patients have overgrown adenoid tissue. In addition, the immunity of a child is not as perfect as the immunity of an adult.
Symptoms of frontal sinusitis in children can be identified as follows:
Severe headaches that increase in intensity in the morning.
Sleep deterioration.
Decreased appetite.
Lachrymation.
Photophobia.
These symptoms do not necessarily indicate frontal sinusitis, but they can lead to the thought of it.
Only after some time, the child develops pus in the discharge from the nose, the upper eyelid swells, and there is pain in the bridge of the nose. The disease is often complicated by otitis media.
Therapeutic measures aimed at the treatment of frontal sinusitis in children:
Washing the nasal cavity.
Cuckoo treatment.
Reception or local use of antibacterial drugs.
Removal of edema with vasoconstrictor sprays or drops.
The use of sprays containing a hormonal component, for example, Baconase or Flix.
Taking medications that contain beneficial bacteria.
It is recommended that all young patients with frontal sinusitis be hospitalized. If the child is under medical supervision, the likelihood of developing complications of the disease is minimized.
Prevention of frontitis
In order to prevent the development of frontal sinusitis, it is necessary to direct efforts to increase immunity, as well as to minimize the likelihood of infection with viral and colds.
To do this, you should follow such recommendations as:
Lead a healthy lifestyle.
They will be hardened.
Eat right.
Watch your weight, give up mono-diets.
Dress according to the season and weather conditions.
Avoid overheating and hypothermia of the body.
Start the treatment of any diseases in time.
Annually undergo preventive examinations at the dentist, do fluorography.