Contents
Frontal sinusitis (acute frontal sinusitis)
– inflammation of the frontal paranasal sinus. With this disease, the inflammatory process develops in the mucous membrane lining the frontal sinus.
Causes of Frontitis (acute frontal sinusitis):
The cause of acute frontal sinusitis is an infection (bacterial, viral, fungal) that penetrates the sinuses from the nose during acute runny nose (rhinitis). Most often, acute frontal sinusitis develops as a complication against the background of influenza and ARVI, as well as some infectious diseases (scarlet fever, diphtheria, etc.). Other causes include injuries to the nose and paranasal sinuses.
Symptoms of Frontitis (acute frontal sinusitis)
There are acute and chronic sinusitis.
Acute frontal sinusitis often occurs with influenza, rhinitis, measles, and can develop with injury to the frontal bone, especially in the area of the frontonasal canal. Due to the development of edema of the mucous membrane and obstruction of the frontonasal canal, inflammatory phenomena rapidly progress. The transition from an acute to a chronic process is facilitated by insufficient drainage of the frontal sinus, which is often observed with hypertrophy of the anterior end of the middle turbinate and severe curvature of the nasal septum. Reducing the body’s resistance is important.
Chronic frontal sinusitis, as a rule, is accompanied by damage to others near the nasal (paranasal) sinuses.
In acute frontal sinusitis the following are noted:
- sharp pain in the forehead, aggravated by pressing or tapping on the anterior wall of the frontal sinus and the upper wall of the orbit in the medial corner of the eye,
- headache of another localization,
- Pain in the eyes,
- photophobia,
- lacrimation,
- difficulty in nasal breathing,
- copious (initially serous, then serous-purulent), odorless discharge from the corresponding half of the nose.
- Body temperature rises to 38-39°, but may be low-grade.
- Swelling of the soft tissues is often observed, especially at the medial corner of the eye.
Anterior rhinoscopy reveals mucopurulent discharge under the middle concha. The anterior end of the middle concha is swollen, the mucous membrane is hyperemic.
The clinical picture of chronic sinusitis is less pronounced than acute sinusitis.
- The headache is aching or pressing in nature and is most often localized in the area of the affected sinus.
- In case of obstructed outflow of exudate and increased pressure inside the sinus, the pain intensifies, and when pressing on the upper wall of the orbit and at its inner corner, it becomes sharp.
- Purulent nasal discharge is especially abundant in the morning and often has an unpleasant odor; Often during sleep, discharge flows into the nasopharynx, so in the morning the patient coughs up a large amount of sputum.
- During rhinoscopy, discharge from the frontal sinus can best be detected in the morning when the patient moves to an upright position, because The pus that has accumulated in the sinus overnight flows more easily into the middle nasal passage.
- The mucous membrane of the anterior end of the middle turbinate in chronic sinusitis. hyperemic and edematous.
Complications of frontal sinusitis
Frontitis (usually chronic) can be complicated by the transition of the inflammatory process to the anterior bone wall of the frontal sinus, followed by its necrosis, sequestration and fistula formation.
Less commonly, the process spreads to the lower wall of the frontal sinus, causing purulent inflammation of the tissues of the orbit.
Involvement of the posterior wall in the process leads to intracranial complications – extradural abscess, brain abscess or meningitis.
Sepsis may develop.
The inflammatory process can spread to areas adjacent to the maxillary sinus – the orbit and skull, causing intraorbital (edema of the eyelids and orbital tissue, eyelid abscess, orbital phlegmon) and intracranial (meningitis, brain abscesses) complications.
Diagnosis of Frontitis (acute frontal sinusitis)
The diagnosis of frontal sinusitis is relatively easy to establish based on subjective and objective signs. X-ray examination of the frontal sinuses allows one to judge their shape, the presence of exudate in them, and swelling of the mucous membrane. Differential diagnosis is carried out with neuralgia of the first branch of the trigeminal nerve, inflammation of other paranasal sinuses.
Treatment of Frontitis (acute frontal sinusitis)
Treatment of frontal sinusitis: conservative, carried out in an ENT hospital.
To reduce swelling of the nasal mucosa and improve the outflow of pathological contents of the frontal sinus, vasoconstrictor nasal drops are used: Naphthyzin, Galazolin, Oxymetazolin, Sanorin, Tizin, Farmazolin. One of these drugs is instilled 2-3 drops into each half of the nose 3-4 times a day.
After instilling vasoconstrictor drops, you can irrigate the nasal cavity with one of the aerosols: Bioparox, Kameton, Proposol.
In case of acute frontal sinusitis, antibiotics are prescribed for 7-10 days; the choice of drug depends on its tolerability and the severity of the disease. The most commonly used drugs are: Augmentin, Flemoxin Solutab, Sumamed, Sporidex (cephalexin), Rovamycin, Ampiox, Duracef, Cefazolin, ceftriaxone – intramuscularly, Cifran.
In parallel with antibiotics, one of the antihistamines is used: Suprastin, Diphenhydramine, Diazolin, Tavegil – 1 tablet 2 – 3 times a day, for 7-10 days. These drugs reduce swelling of the nasal mucosa.
To liquefy thick purulent secretions, use ACC-long (600 mg) 1 tablet. Once a day, the drug promotes easier release of pus from the sinuses.
Homeopathic drugs (Cinnabsin, Sinupret) are also used in complex treatment; they help reduce inflammation in the sinuses, swelling, and pain. The drugs can be used independently, if you are allergic to other medications, or if the disease is milder.
A good effect is achieved by rinsing the nasal cavity using the “cuckoo” method. For washing, solutions with antimicrobial and anti-inflammatory effects are used – a solution of chlorophyllipt, furacillin, etc.
Surgical intervention – puncture of the frontal sinus, is carried out when conservative treatment is ineffective, as well as in the presence of pus in the sinus and severe headaches, i.e. when the outflow of sinus contents through the natural anastomosis is impaired.
The prognosis in the case of an uncomplicated course with timely and correct treatment is favorable.