Sinusitis how to treat? Causes and symptoms
Sinusitis is an inflammatory process of an infectious nature that affects the mucous membrane of the paranasal sinuses. Viruses, bacteria, mycotic organisms, and allergens can cause sinusitis.
This disease is quite common and is diagnosed in 0.02% of adults. In 0.5% of cases, sinusitis is a complication of acute respiratory viral infections in childhood. Otolaryngologists include diseases such as sinusitis:
- Sphenoiditis (inflammation of the sphenoid sinus);
- Frontitis (inflammation of the frontal sinuses);
- Sinusitis (inflammation of the maxillary sinuses);
- Ethmoiditis (inflammation of the ethmoid bone of the labyrinth).
Sinusitis can be acute or chronic. If there is no treatment, serious complications may develop that threaten not only the health, but also the patient's life.
- Sinusitis causes
- Sinusitis symptoms
- Sinusitis diagnosis
- Complications of sinusitis
Answers to popular questions
- Can I warm my nose with sinusitis?
- Can I do inhalations with sinusitis?
- Is it possible to go to the bathhouse for sinusitis?
- How is sinusitis treated?
The causes of sinusitis are almost always inextricably linked with the stagnation of secretions in the paranasal sinuses, impaired aeration and subsequent infection. There are 8 sinuses in total. With each of them, the nasal cavity communicates due to the presence of narrow passages. If this regular drainage is disturbed, conditions are favorable for the development of sinusitis.
Worsening sinus cleansing can occur for the following reasons:
- Violation of the intranasal structures as a result of their deformation. This is often due to hypertrophic rhinitis, which is a chronic sinus disease associated with overgrowth of bone and mucous membranes. Also, the curvature of the nasal septum, resulting from mechanical damage to the plate dividing the nasal cavity into two parts, can disrupt normal drainage. The third cause of deformation of the intranasal structures is congenital anomalies in the structure of the turbinates and ethmoid labyrinth.
The penetration of a viral infection into the body often causes the development of sinusitis. The mucous membrane lining the sinuses reacts to the introduction of a pathogenic agent with inflammation and swelling. The glands located in the nasal mucosa begin to work in an enhanced mode and secrete an increased amount of secretion. As a result, the passages between the sinuses and the nasal cavity are narrowed even more, clogged with thick contents. The ventilation of the sinuses is completely impaired, resulting in sinusitis.
- The bacterial flora can also cause the development of inflammation of the paranasal sinuses. Most often, bacterial infection occurs against the background of a viral infection. Stagnant mucus, lack of oxygen, lack of adequate ventilation - all this leads to the creation of favorable conditions for the growth of bacteria. The more often a person uses antibacterial drugs to treat viral rhinitis, the higher the risk that the bacterial flora will become resistant to them. This, in turn, will complicate the treatment process, make it time-consuming and laborious.
- The fungal nature of sinusitis in recent years has been increasingly traced. This is also explained by the irrational use of antibiotics. They negatively affect the state of human immune defense, disrupt the natural microflora of the nasal sinuses, create favorable conditions for the reproduction of mycotic microorganisms in them.
Sinusitis does not always have a microbial etiology. The development of inflammation is also possible due to exposure to cold, for example, when inhaling cold air.
- Exposure to the mucous membrane of chemicals becomes a predisposing factor for the development of sinusitis in the future.
- Vasomotor rhinitis, which is provoked by allergic reactions of the body, causes sinusitis in 80% of cases. Therefore, allergies are the most common cause of sinus inflammation. The mechanism of development of the disease is explained by the constant, multiple edema of the mucous membrane of the respiratory tract, which leads to the chronicity of the process.
- Another reason that can provoke the development of sinusitis is the pathology of the roots of the teeth (oroantral fistula, chronic periodontitis). After tooth extraction, or due to infection of the maxillary sinus, sinusitis may develop. Filling the root canal can also lead to the development of sinusitis, especially when the filling material gets into the maxillary sinus. In this case, mainly mycotic sinusitis develops.
- The development of sinusitis against the background of immunodeficiency is possible.
Violation of the microflora of the sinuses
American scientists note that one of the reasons why sinusitis develops is a violation of the normal microflora in the nasal sinuses. The number of those bacteria that inhibit the growth of conditionally pathogenic flora begins to fall, as a result of which inflammation develops.
According to various sources, about 15% of the world's population suffers from sinusitis. The main cause of the development of bacterial inflammation is staphylococci and streptococci. However, it is known that these microorganisms can be present in a person's nasopharynx, but not provoke the development of the disease in him. Therefore, the mere fact of their presence in the nasal cavity does not mean the development of sinusitis.
Scientists at the University of California at San Francisco conducted a laboratory study of the microflora of the nasal sinuses in people with chronic sinusitis and in healthy people. The results of the study are such that in patients with sinusitis, Corynebacterium predominates in the nasal mucosa, which occurs in the nome on the skin, in the respiratory tract, and in the digestive tract. In healthy people, the microflora of the mucous membrane of the nasal sinuses is represented mainly by Lactobacilli.
As for Corynebacterium tuberculostearicum, it is not absolutely pathogenic for the human body, however, in large quantities it can lead to the development of inflammatory processes. So, when these bacteria were introduced into the nasal sinuses of mice, the animals developed sinusitis. When the sinuses were colonized with Lactobacilli, inflammation did not occur, just as with the simultaneous administration of Lactobacilli with Corinebacteria.
The scientists who conducted the experiment came to the conclusion that Lactobacilli are capable of controlling the growth of other opportunistic microorganisms. However, experts are not yet able to explain the mechanisms of this process. Nevertheless, it is possible that in the near future, to get rid of a person from sinusitis, it will be possible to inject not an antibiotic into the nose, but beneficial bacteria.
The balance of bacterial microflora is important for the nose, mouth, intestines, and vagina. If it is violated, the disease develops. Although research is still pending, the results are very encouraging. It is believed that many bacterial infections will soon be treated without antibiotics.
Depending on which sinus is inflamed, the symptoms of sinusitis will differ:
Symptoms of sinusitis:
- Acute onset with an increase in body temperature to 38 ° C and above.
- Symptoms of body intoxication.
- Pain in the region of the maxillary sinus, in the frontal zone, near the root of the nose and along the zygomatic bone.
- Increased pain on pressure, its return to the temples.
Headaches of varying severity.
- Deterioration of nasal breathing on the side that was involved in the pathological process. Breathing is done through the mouth.
- Lacrimation may occur.
- The discharge from the nasal passages is at first serous and liquid, and as the disease progresses, it becomes green and cloudy.
If the disease becomes chronic, then during the period of remission it reminds of itself with rare headaches, which are expressed in a feeling of pressure behind the eyes. Perhaps the addition of a cough at night, conjunctivitis, keratitis. Discharge from the nose is insignificant, their volume increases during an exacerbation of the disease.
Symptoms of ethmoiditis:
- A person experiences painful sensations in the region of the bridge of the nose and the root of the nose.
- In childhood, redness of the conjunctiva, swelling of the upper and lower eyelids is possible.
- Headaches and pains of a neurological nature are not excluded.
- The body temperature rises.
- The olfactory function is impaired, nasal breathing is difficult.
- If ethmoiditis is acute, it is possible that the eyeball is involved in the pathological process with its protrusion, as well as severe swelling of the eyelids.
With sinusitis of the frontal sections of the ethmoid labyrinth, parallel development of sinusitis and frontal sinusitis is likely. With inflammation of the posterior regions of the ethmoid labyrinth, sphenoiditis may develop.
Frontal sinusitis symptoms:
- Nasal breathing is extremely difficult.
- The body temperature is increased to high levels.
- From the side of the inflamed sinus, the serous contents are separated.
- The pains are very intense, the place of their localization is the forehead. Increased pain occurs in the morning.
- Photophobia with pain in the eye sockets is possible.
- After the inflamed sinus is emptied, the intensity of painful sensations decreases.
- If frontal sinusitis develops against the background of influenza, then the patient may have a change in the skin of the forehead with swelling of the areas above the eyebrows and swelling of the upper eyelid.
Frontitis is more severely tolerated by patients than other sinusitis. With chronicity of the process, it is possible to grow polyps in the nasal cavity, necrosis of bone tissue, and the formation of fistulas.
- The pains are localized in the orbit, in the parietal zone and in the back of the head.
- The patient may complain of painful sensations in the depths of the head.
- The chronic course of the disease can provoke visual impairment, since the optic nerves are involved in the pathological process.
- Often the symptoms of sphenoiditis are blurred and the disease is hidden.
- The ethmoid sinus is often involved in the inflammatory process, so isolated sphenoiditis is rarely diagnosed.
There are three forms of sinusitis, which differ depending on the nature of the discharge from the nose:
- Edematous catarrhal form - serous discharge, transparent.
- Purulent form - purulent discharge, yellow or green, with an unpleasant odor.
- Mixed form - serous discharge with impurities of pus.
Diagnosis of sinusitis is usually not difficult. A specialist is able to suspect inflammation of the nasal sinuses only on the basis of the clinical picture of the disease, after examining the patient.
To confirm sinusitis, additional studies will be required, including:
- X-ray examination of the paranasal sinuses, a picture must be taken in two projections (the disadvantage of this research method is that the fluid level in the sinuses cannot be visualized, as well as the condition of the ethmoid sinuses);
- Ultrasound, used as a screening test;
- CT scan of the paranasal sinuses is the most informative test.
Depending on the indications, it is possible to prescribe CT and MRI of the brain.
Complications of sinusitis
Complications of sinusitis can pose a serious threat to human health.
Among the negative consequences that the disease can cause:
- The spread of the pathological process deep into the tissues with damage to the bones and the formation of osteomyelitis.
- Orbital complications, accompanied by pain in the orbit, impaired mobility of the eye, development of exophthalmos, loss of vision. Treatment is carried out with the obligatory participation of an ophthalmologist.
- Development of otitis media is possible.
- Meningitis, arachnoiditis. This complication occurs mainly with the defeat of the ethmoid bone and sphenoid sinus.
- Frontitis is dangerous with epidural or subdural brain abscess.
In the most severe cases, in the absence of adequate care, a lethal outcome is possible, since any intracranial complications have a poor prognosis.
Treatment of complications of sinusitis should be carried out strictly in a hospital setting. Helping the patient is reduced to mandatory surgical intervention with drainage of the focus of infection after its opening. However, even against the background of powerful antibiotic therapy, the prognosis of intracranial complications is poor.
Answers to popular questions
- Can I warm my nose with sinusitis? With sinusitis, you should not warm your nose. This is a direct contraindication in the acute stage of the inflammatory process. Warming up not only can save a person from the disease, but can also lead to a worsening of the patient's condition, with the spread of infection into the deep structures of the skull.
- Can I do inhalations with sinusitis? Inhalation with sinusitis can be done if this method of treatment was recommended by the otolaryngologist after examining the patient.
- Is it possible to go to the bathhouse for sinusitis? Going to the bathhouse is contraindicated in acute sinusitis, since there is a threat of breakthrough of the contents of the nasal sinus into the bloodstream. In addition, the bath is prohibited against the background of high body temperature, which almost always accompanies the development of sinusitis.
How is sinusitis treated?
You should not make your own decisions about how to treat sinusitis. Therapy of this disease is in the competence of the otolaryngologist. The sooner inflammation is diagnosed, the more effective the treatment will be.
Taking antibacterial drugs. Current recommendations for the treatment of bacterial sinusitis suggest antibiotics. These can be the following groups of drugs:
- Penicillins: Amoxicillin, Amoxiclav, Sulbactam. Acute bacterial rhinosinusitis suggests the appointment of Amoxicillin.
- 2nd generation cephalosporins: Cefuroxime Axetil, Cefaclor.
- Macrolides: Azithromycin, Clarithromycin.
- Fluoroquinolones: Moxifloxacin, Levofloxacin, Gatifloxacin.
If there is no improvement in the condition from the treatment being carried out, then it is necessary to change the antibacterial drug. In addition, the introduction of an antibiotic topically is shown, most often it is the Isofra nasal spray based on Framycitin.
Using drops to relieve nasal breathing and to relieve swelling. Shown is symptomatic treatment aimed at relieving pain, restoring normal drainage of the sinuses. To relieve nasal congestion, to reduce mucosal edema, it is possible to use vasoconstrictor drops: Xylometazoline (Otrivin, Xymelin, Galazolin), Oxymetazoline (Nazol, Nazivin), Naphazoline (Naphtizin, Sanorin). It is also possible to use drops with the addition of essential oils: Pinosol, Sinupret, Sinuforte.
Improves the outflow of mucus, has a vasoconstrictor effect of the drug Rinofluimucil, which consists of two components.
With sinusitis of an allergic nature, it is possible to prescribe drops with an antiallergic component - these are Vibrocil drops, Rinopront.
The drug is in the form of drops containing an antibiotic and a corticosteroid - Polydex.
- Antipyretic drugs for sinusitis. When the body temperature exceeds 38.6 ° C (for adults), it is necessary to bring it down by taking antipyretic drugs. Most often, doctors recommend using NSAIDs - these are Ibuprofen, Paracetamol, Nurofen.
- Antiallergic therapy. Antihistamines are used if sinusitis is allergic in nature. For viral sinusitis, experts do not recommend using antihistamines. A drying effect can be obtained, but there is a risk of worsening the outflow of mucus from the paranasal sinuses.
Antiallergenic drugs are: Loratadin, Cetrin, Zyrtec, Desloratadin, Claritin, Clarisens, Zenerit, etc.
- The use of antiseptics. Antiseptics are used to treat viral sinusitis. They allow you to improve the outflow from the paranasal sinuses and sanitize the nasal cavity. For disinfection, it is possible to use: Dioxidine in 1% concentration, Miramistin, Furacillin in solution, Protorgol. The selection of an antiseptic agent should be carried out by a doctor, since each drug has certain contraindications and can cause side effects.
- Sinus evacuation for sinusitis. The sinus evacuation procedure is indicated for moderate sinusitis. For this, a tube is inserted into the nasal cavity, at the end of which there is a pair of balloons. After insertion into the nasal cavity, the balloons expand and block the entrance to the nose, as well as the junction of the pharynx and nose. The desired solution is injected into the nasal cavity through another tube, after which it is sucked off along with the exudate.
- Rinsing the nose. For uncomplicated sinusitis, a procedure such as rinsing the nose is effective. To do this, you can use both special ready-made solutions (Salin, Aquamaris, Aqualor, Dolphin), and ordinary saline solution.
- Treatment of fungal sinusitis. If the cause of sinusitis is a fungal infection, it is necessary to use antimycotics: Fluconazole (Diflucan), Amphotericin B. The dosage is determined by the attending physician.
- Surgical treatment of sinusitis. Surgical treatment of sinusitis is necessary in the case when conservative treatment has not yielded a positive result, if inflammation develops against the background of abnormalities in the development of the nasal sinuses, and also in the case when there is a threat to the patient's health.
Operations can be both endonasal with access through the nose and exonasal with extra-nasal access to the sinuses.
Endonasal surgery is performed using endoscopic equipment. This allows you to gain access to even the most inaccessible places, to remove during the operation existing polyps, overgrown bone tissue, etc. At the same time, the integrity of the nasal septum is maximally preserved, and the recovery period takes place in a short time.
Surgical intervention according to the method of Ogston-Luke, Calduffla-Luke is also possible. However, minimally invasive surgery using endoscopic equipment is a priority in modern otolaryngological surgery.
Puncture of the sinuses is referred to as minimally invasive surgery. This method allows you to remove purulent contents from them and inject an antibacterial agent directly to the site of inflammation.
The prognosis for sinusitis is usually favorable if therapy is started on time.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)