Acute sinusitis - how and with what to treat?
Sinusitis is an inflammation of the paranasal sinuses. Sinusitis is provoked by viruses, mycotic microorganisms, bacteria and allergens. General practitioners otolaryngologists experience sinusitis more often than other diseases, since sinus inflammation is very widespread.
Sinusitis can be acute or chronic. Acute inflammation is referred to when the illness lasts less than 2 months. A chronic infection is indicated by a prolonged course of inflammation, or frequent relapses of sinusitis (from four or more per year).
Any paranasal sinus can be infected. Nevertheless, in children after seven years 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. The manifestation of the disease in two or more cavities at the same time is possible. In this case, they talk about polysinusitis (pansinusitis, hemisinusitis, maxillary ethmoiditis).
The term "acute sinusitis" is most often used by doctors to refer to bacterial inflammation. However, recent studies indicate that in 87% of cases, sinusitis is viral in nature and has the ability to resolve without any antibiotic treatment. Although up to 2% of viral sinusitis can be complicated by a bacterial infection, antibiotics cannot be avoided in this case.
Content:
- Causes of Acute Sinusitis
- What Happens During Acute Sinusitis?
- Symptoms of Acute Sinusitis
- Diagnostics of the acute sinusitis
- Treatment of acute sinusitis
- Prevention of acute sinusitis
- Which doctor treats sinusitis?
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:
- Haemophilius influenzae and Streptococcus pneumoiae are sown from a smear in 50% of cases or more;
- Less common pathogens are moraxella, hemolytic streptococci, Staphylococcus aureus, anaerobic bacteria and viruses;
- Enterobacteriaceae, anaerobic bacteria, Staphylococcus aureus and mycotic organisms are the main causative agents of nosocomial acute sinusitis.
If community-acquired forms of the disease develop mainly against the background of acute respiratory viral infections, 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 of the nose 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 the injury;
- Diseases of the dentoalveolar system can cause acute sinusitis, manifesting in the maxillary sinus;
- The pathogenic role is played by endo- and exotoxins, which have a toxic effect on the body as a whole.
If the fistulas, with the help of which the nasal sinuses communicate with the nose, are closed, then negative pressure arises in their cavity. This leads to excessive mucus production, to its stagnation. As a result, the acidity of the nasal flora changes, the function of the ciliated epithelium is impaired. The cilia begin to move either very slowly, or completely stop their work, being shrouded in mucus. This promotes 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 the development of sinusitis has the character of serous exudate. As the inflammation grows, it becomes muco-serous, and subsequently purulent, since the bacterial flora begins to prevail. The separated contents show an increased number of leukocytes, which were thrown by the body to fight infection, as well as detritus. Edema of the mucous membrane increases due to increased capillary permeability.
There are two types of sinusitis:
- Acute, which develops rapidly, and chronic, with a long course. Most often, this disease is a consequence of viral penetration into the nasal cavities. Therefore, sinusitis can 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 the reproduction of pathogenic flora are observed.
Both viral and bacterial sinusitis can last up to 2 months or more. With chronicity of the process, irreversible changes in the nasal mucosa are not excluded, which leads to an increase in cases of ARVI.
A complication of sinusitis, 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 inflammation process will also be reflected in the blood test results. However, a general disorder of the condition can occur with other diseases, and they are not characteristic exclusively for sinusitis. Therefore, local symptoms are of particular importance.
The local symptoms of acute sinusitis are as follows:
- Violation of nasal breathing against a 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 edema of the mucous membrane of the nasal passages, or because of their overlap with thick secretions;
- Headaches localized in the temples and forehead. The pain tends to get worse when the head bends;
- During a night's rest, painful sensations may occur in the center of the head and in the back of the head. This indicates the involvement of the sphenoid sinus in the pathological process;
- With an undisturbed outflow of exudate from the nasal 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 only experiences local symptoms. After the x-ray is taken, the doctor does not detect any signs of sinusitis on the images. If they are still there, then they are expressed slightly. Headaches and sinus pains may occur. The patient's body temperature remains within normal limits, or rises to subfebrile levels;
- Sinusitis of moderate severity. 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 are possible such as swelling of the eyelid and soft tissues surrounding the paranasal sinuses;
- Severe sinusitis. A person suffers from serious intoxication of the body, headaches and other pains are very intense, the body temperature exceeds 38.5. The severe form of the disease most often leads to the development of complications.
Diagnostics of the acute sinusitis
Diagnosis of acute sinusitis includes rhinoscopy. In this case, the doctor visualizes pronounced swelling of the nasal mucosa on the side where there is inflammation. The nasal fistulas are narrowed, breathing is difficult, the sense of smell is impaired. Purulent discharge is found in all nasal passages (in the middle, common, lower and upper).
When the sphenoid sinus and ethmoid labyrinth are involved in the pathological process, purulent mucous masses flow down the back of the pharynx and are visible during 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 such methods as radiography (possibly with the use of a dye), computed tomography. If necessary, puncture of the paranasal sinuses is performed.
A radiological sign of acute sinusitis is a violation of the pneumatization of the sinuses. If the X-ray patient took place 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 nasal-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 is taken from the maxillary sinus. It is taken 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 for 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 body's immune forces are strengthened.
The need for hospitalization is determined by the severity of the acute sinusitis. If the disease is mild or moderate, outpatient treatment is possible under the supervision of a local ENT doctor. The severe course of the disease, and sometimes the moderate degree of severity, requires hospitalization of the patient in the otolaryngology department of the hospital.
Drug therapy
The primary goal of drug therapy is the complete elimination of the pathogenic microorganism and the normalization of the microflora of the sinuses. 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 is possible to accurately establish an infectious agent only 5-7 days after sending the material for research. Even if there is data as to what kind of pathogen provoked the disease, it is impossible to accurately predict whether it has sensitivity to a particular drug. This also requires additional tests.
In order not to postpone treatment, experts use those drugs that bacteria have minimal resistance to. The doctor is left with the choice of the drug, which, in his opinion, (based on the clinical picture of the disease and the alleged pathogen) will be the most effective.
There is evidence that pneumococci and Haemophilus influenzae, which cause acute sinusitis in Russia, are sensitive to drugs of the penicillin group. These are drugs such as Ampicillin, Amoxiclav, Panklav, Amoxicillin. Also effective for eliminating these bacteria are drugs from the group of second and third generation cephalosporins. Moreover, 40% of pneumococci and 22% of Haemophilus influenzae have high resistance to co-trimoxazole.
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 on the body;
- The minimum set of side effects.
For mild sinusitis, oral antibacterial agents are prescribed. In this case, it is possible to use Cefuroxime, Spiramycin, Ampicillin, Roxithromycin, Doxycycline, Phenoxylmethylpenicillin, Fusafungin. Treatment is carried out for a week, sometimes the course can be extended up to 10 days.
With a moderate course, cephalosporins of the second and third generation, b-lactam penicillins are prescribed, and it is also possible to use drugs from the group of fluoroquinolones. These are antibiotics such as Ciprofloxacin, Levofloxacin, Sparfloxacin. High efficiency and low toxic properties for the human body of drugs from the group of cephalosporins and penicillins make them the leaders among other antibacterial agents.
Amoxicillin in combination with clavulanic acid (Panklav drug) is able to eliminate the causative agent of the infection and is well tolerated by both adults and children. This fact has been proven by numerous studies. The absorption of the drug is not affected by food intake. Both components are quickly absorbed by the body, well distributed in tissue cells and penetrate into the paranasal sinuses, as well as into the secretion they produce. A single dose for an adult is one 250 mg / 125 mg tablet. The antibacterial drug is taken up to 3 times per day.
Only the effectiveness of a drug such as Cefuroxime depends on food intake. It must be taken with meals. Most often, all of the listed medicines are used twice every 24 hours, and the course of administration is designed for 10-12 days.
Allergy is the most common complication from taking drugs from the penicillin and cephalosporin groups. It is also possible suppression of immunity during treatment. Fluoroquinolones do not have such a side effect, which leads to an increase in the frequency of their use for the treatment of sinusitis.
In severe sinusitis (or with the development of complications), intravenous and intramuscular administration of antibacterial drugs is indicated.
In this case, appoint:
- Penicillins (inhibitor-protected);
- Cephalosporins of the third and fourth generation (Cefotaxime, Cefpir, Ceftriaxone, Cefepime);
- Fluoroquinolones (Ciprofloxacin, Levofloxacin, Sparfloxacin);
- Carbapenems (Imipenem).
If a person suffers from an allergic reaction to b-lactam antibacterial agents, then intravenous fluoroquinolones are indicated. However, drugs in this group are not prescribed for children and the elderly, since negative side effects are possible. Fluoroquinolones are prohibited for patients with impaired liver and kidney function in the stage of decompensation.
Drugs such as Meropenem and Imipenem from the carbapenem group have a high degree of activity against various pathogenic agents. These drugs are used extremely rarely, since they are considered stock drugs to which the bacterial flora does not have resistance. Carbapenems are prescribed only for severe infections. With nosocomial sinusitis, drugs from this group are prescribed first.
If there is a suspicion of the presence of anaerobic flora, in addition to the listed antibiotics, Metronidazole is used. This drug has a broad spectrum of action, is active against anaerobic bacteria. The drug belongs to the group of imidazoles.
Sometimes the therapeutic regimen begins with intravenous (intramuscular) drug administration, and after 4 days they switch to oral administration of drugs. This is the so-called stepwise treatment regimen.
In addition to antibiotics, complex therapy involves the appointment of mucolytics, anti-inflammatory and anti-allergenic drugs. To relieve inflammation from the mucous membrane of the nasal sinuses, Fenspiride (NSAID group) is used.
A phytopreparation such as Sinupret has proven itself well in the treatment of the respiratory tract. It is able to relieve inflammation, liquefy a viscous secret, have a muco-regulating effect, and fight viruses. Thus, not a single link in the pathological process is left out. Sinupret is recommended to be taken already at the initial stages of the development of the disease. In this case, it acts as a drug for the prevention of sinusitis.
If patients have contraindications to taking synthetic drugs, then in the early stages of the development of the disease, it is possible to use homeopathic pills.
These can be drugs such as:
- Oscillococcinum;
- Echinacea compositum;
- Apis Mercurius;
- Antigrippin;
- Traumgel;
- Influenza hel;
- Influcid;
- Argentum berberis;
- Doron R;
- Pneumatic line 1P and 2P;
- Edas under the numbers 904, 903, 801, 131, 117, etc.
The use of these drugs in the early stages of the development of the disease makes it possible to reduce the symptoms of incipient ARVI.
Antihistamines
It should be understood that antihistamines are inappropriate to take together with antibiotics and sputum thinners. Antihistamines can make it difficult to drain and clear the lining of your sinuses. These medications should only be used when the swelling and inflammation is of an allergic nature. In this case, antihistamines can relieve the existing obstruction.
It is impossible to consider the complex treatment of sinusitis, excluding local therapy. It, first of all, should be reduced to a direct effect on the sinuses. Reducing edema, normalizing drainage, and restoring the function of aeration allow vasoconstrictor agents. These can be preparations based on Oxymetazoline, Xylometazoline, Naphazoline, etc.
In this case, accurate dosing of the agent is important. Often, patients, in order to enhance the effect, use vasoconstrictor drugs in large volumes and more often than recommended by the instructions. This, in turn, threatens the development of serious side effects. Therefore, doctors recommend using such agents in the form of an aerosol, or using metered-dose drugs, for example, a pump Xymelin.
Also, such a vasoconstrictor, anti-inflammatory and mucolytic drug as Rinofluimucil has found widespread use. In addition to the complex effect on the nasal mucosa, the positive property of the drug is that it does not irritate it. It is advisable to use the combined funds for purulent sinusitis. If the patient suffers from allergies, then the appointment of Polydexa is possible.
Isofra in the form of a spray has an antibacterial effect. To increase local immunity, relieve inflammation and eliminate viruses, it is possible to use agents such as Derinat, Gepon, Euphorbium compositum.
Puncture is used to evacuate pathological contents from the nasal sinuses. The puncture method can be used both in an outpatient clinic and during inpatient treatment. During the puncture, the nasal cavity is washed, and then drugs are injected into it: solutions of antibiotics or antiseptics (Dioxidin, Peloidin, Octenisept, etc.).
If the exudate inside the nasal sinus is viscous and contains pus, then proteolytic enzymes are used (Trypsin, Lidase, Chymotrypsin). During local administration, enzymes liquefy the viscous contents of the sinuses, break down necrotic masses, as well as blood clots. Among other things, enzymes can reduce inflammation.
Achieve a mucolytic effect, eliminate the bacterial flora and relieve inflammation by introducing Fluimucil into the sinuses in combination with an antibacterial agent.
As a rule, 5 or 7 punctures are sufficient for the treatment of purulent sinusitis. If with the help of such a number of washings it is not possible to cope with the disease, then surgical intervention is advisable.
The "cuckoo" method or the "movement" method according to Proetz is a non-functional method of therapy for sinus inflammation. With the help of surgical suction, the purulent contents are removed from the sinuses, and medicinal solutions take its place.
Also, to remove pathological secretions, the YAMIK sinus catheter, which was developed by VS Kozlov and GI Markov, can be used. Thanks to this, the method can be used to aspirate the pathological contents of the nasal sinuses and disinfect them with drugs. It is recommended to use a sinus catheter in the treatment of exudative forms of sinusitis, or if several sinuses are simultaneously affected. To achieve maximum sterility in the nasal sinus after cleansing it by any available method, it is necessary to inject Gepon's solution, which enhances local protection.
Physiotherapeutic treatment of sinusitis is possible:
- Laser therapy;
- Magnetotherapy;
- UHF;
- Impulse currents;
- Microwave;
- Magnetic laser therapy.
If the patient suffers from severe pain, then he is recommended to undergo a course of procedures using diadynamic currents or sinusoidally modulated currents. However, before going to any physiotherapy procedure, it is necessary to rid the sinus of the pathological secretions with the help of a puncture.
Prevention of acute sinusitis
Prevention of recurrence of acute sinusitis requires compliance with the following preventive measures:
- Elimination of any existing defects of an anatomical nature in the event that they interfere with the natural passage of air through the nasal passages;
- Dental treatment of the roots of the teeth adjacent to the floor of the maxillary sinus;
- Strengthening local and general immunity of the body.
Also effective is the introduction of bacterial vaccines, which allow the population to be immunized.
Increasingly, modern otolaryngologists use the drug IRS-19. It contains lysates in its composition, which fight against bacterial agents that provoke ARVI. The tool is produced in the form of a spray, aimed at activating the specific and nonspecific immunity of the mucous membrane of the ENT organs. Available clinical studies indicate that the drug reduces the number of recurrences of sinusitis and other respiratory diseases by 2.5-4 times. To achieve the maximum effect, it is advisable to conduct a double immunization with an interval of 4-5 months.
In addition, probiotics, for example, Normoflorin B and L, Lactofiltrum, have a preventive and therapeutic effect. They must be used both during treatment with antibacterial drugs and after a therapeutic course. In parallel, the state of the patient's intestinal microflora should be monitored.
The use of aromatherapy for the prevention of disease is not excluded. The most commonly used aromatic oils of tea tree, mint, lavender, eucalyptus, etc. You can also use mixtures based on oils, for example, Citrosept, Karmolis, Eka, etc. They have a local vasoconstrictor effect, have a positive effect on nerve endings, relieve inflammation and fight with viruses.
Which doctor treats sinusitis?
Sinusitis is treated by an otolaryngologist.
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)
