Front - What Is It? Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

Frontitis: symptoms and treatment

Frontitis is an inflammation of the mucous membrane that covers the inside of the frontal sinus. This condition is accompanied by a headache that concentrates on the forehead, rhinitis, and a deterioration in well-being. 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.

Content:

• Front - what is it?
• Causes of frontal sinusitis
• Frontitis types
• Frontal sinusitis symptoms
• Complications of frontal sinusitis
• Diagnostics of the frontitis
• Frontitis treatment
• Is it possible to treat frontal sinusitis at home?
• Frontitis in children: features of the course of the disease
• Prevention of frontal sinusitis

Front - what is it?

Frontitis is a type of sinusitis. Sinusitis is a generic name for inflammation of the sinuses. The disease should 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 accumulates in the sinuses, then the pressure in it increases. This can lead to a crack in the thin bone plate. Through it, the inflammatory exudate enters the lining 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 the 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 septum 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.

Up to 6-7 years of age, the frontal sinuses in children are not developed. Therefore, they are not diagnosed with frontal sinusitis. Moreover, in 10% of people, this sinus does not develop during life, which is explained by the peculiarities of genetics.

Causes of frontal sinusitis

Regardless of a person's age, frontal sinusitis will develop due to the effects on the body of the following factors:

• A viral, bacterial, or fungal infection. It should be noted right away that fungi very rarely cause the development of frontal sinusitis. 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 flu. Often, the cause of the development of frontal sinusitis is the bacterial flora (staphylococci, streptococci, hemophilic bacillus, diphtheria bacillus). In childhood, the cause of frontal sinusitis is often Moraxella catarrhalis. Sometimes bacterial frontalitis is a consequence of other diseases (diphtheria, scarlet fever), and sometimes acts as a complication of a viral infection. Pathogenic flora can be introduced into the sinuses during surgery on the nasal cavity, if injured. 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 the blood stream. The source of their spread can be tonsils, aching teeth, lungs.
• Allergy. Frontal sinuses can become inflamed against the background of a runny nose of an allergic nature. At first, such a 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 impaired.
• Ingress of a foreign object into the sinus. Most often, this reason for the development of frontal sinusitis is diagnosed in childhood. Any object is a source of infection, as it cannot be sterile. Moreover, it will disrupt the natural flow of mucus, leading to an inflammatory response.
• Taking some medicines.
• Injuries to the nose and frontal sinus.

The following factors increase the likelihood of developing inflammation:

• Overgrown adenoids.
• Injuries to the nose.
• Nasal septum defect.
• Chronic runny nose.
• The presence of polyps, cysts, tumors in the nasal sinus.
• The presence of pathogenic flora in the nasal sinuses.
• The canal that connects the frontal sinus to the nose is too long.

If a person's immune system is weakened, then frontal sinusitis can develop in him even when exposed to cold, or when inhaling dusty and gassed air.

Frontitis types

The course of frontal sinusitis 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 untreated acute frontal sinusitis. Often, the disease is chronic in people with a deviated nasal septum.

Depending on the etiological factor, such types of frontal sinusitis are distinguished as:

• Viral.
• Mycotic.
• Bacterial.
• Mixed (when the disease is provoked by several representatives of the pathogenic flora at once).
• Allergic.
• Medication.

By the type of inflammatory reaction, the following types of frontalitis are distinguished:

• Exudative frontal sinusitis. The lining of the sinuses becomes inflamed and begins to secrete fluid. Depending on the composition of this fluid, catarrhal frontitis (fluid is represented by mucus) and purulent (fluid contains pus) are distinguished. 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 frontalitis. In this case, the mucous membrane of the nasal sinuses grows. Such frontal sinusitis can be of 3 types: polypous (accompanied by the appearance of polyps), cystic (cysts grow in the nasal cavity) and parietal-hyperplastic (the mucous membrane itself grows).

In addition, a distinction is made between unilateral and bilateral inflammation.

Frontal sinusitis symptoms

If a person develops acute frontal sinusitis, then this is characterized by symptoms such as:

• Pain.
• Mucus flow from the nose. Its nature may vary.
• Deterioration of nasal breathing.
• Hyperthermic reaction of the body.
• Swelling in the upper corner of the eye from the side of the lesion.
• Lachrymation, pain in the eyeballs.
• Weakness.
• Malaise.
• Excretion of sputum in the morning.

If the frontal sinusitis has a chronic course, then the patient develops symptoms such as:

• Pain in the forehead.
• Headache.
• The appearance of nasal discharge that has an unpleasant odor.
• Cough at night.
• Sputum with pus, which appears mainly in the morning.
• Incessant rhinitis.
• Deterioration of olfactory function.

Painful sensations are concentrated above the bridge of the nose, or somewhat away from it. The pain becomes worse in the morning, as the outflow from the sinuses decreases at night. It also grows when turning the head, 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 frontal sinusitis from sinusitis?

It is important to be able to distinguish between symptoms that are characteristic of frontal sinusitis and sinusitis, since their clinic has similar manifestations.

Symptom	Sinusitis	Frontit
Where the pain is concentrated	It is concentrated on both sides of the nose, gives off to the temples, teeth, cheekbones. The pain becomes more intense if the person tilts their head down.	The pain is localized 2 cm above the bridge of the nose, or to the side of it. It radiates into the eyes, becomes stronger during vibration of the body, when moving the head.
Edema	The swelling increases in the lower eyelid area, bags appear under the eyes.	The edema is concentrated in the upper inner corner of the eye.
Features of rhinitis	At first, the exudate is mucous, and then it becomes purulent.	At first, the nose is stuffy, 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 frontal sinusitis

Frontitis can cause complications such as:

• Orbital cellulitis 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.

Diagnostics of the frontitis

If you suspect 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 sinuses. The picture will show how filled they are with liquid. In this case, it will not be possible to clarify the nature of the liquid.
• CT. This method allows you to perform layer-by-layer 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.
• TANK seeding of nasal mucus. This test allows you to identify the bacteria that led to the development of the infection.

Frontitis treatment

If the frontal sinusitis has an uncomplicated course, then it is possible to cope with it with drugs and physiotherapy. It is important to remove the inflammatory exudate from the sinus and normalize its ventilation. If it is not possible to achieve a positive trend, then a sinus puncture is performed, which allows its contents to drain. 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 the swelling of the nasal mucosa and the anastomosis connecting its cavity with the frontal sinuses. Examples of such medicines are drops Naftizin and Galazolin (drugs of the last century), Sanorin, Tizin, Lazolvan Rino (modern drops). To achieve the maximum effect, you need to make the drops into the nasal passages correctly. To do 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 anastomosis to fully unfold. Then a similar procedure is performed on the left nostril.
• To reduce the intensity of the inflammatory reaction, nasal sprays based on corticosteroid hormones (Avamis, Beconase, Flix, etc.) are used. Such drugs are not used for more than 5 days. They irrigate the nasal passages with them no more than 2 times a day.
• Since frontal sinusitis is most often provoked by bacterial flora, antibiotics are prescribed to patients. If the course of the disease is uncomplicated, then local therapy is enough. For this purpose, antibacterial drops Tsiprolet, Normax, 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 bottle.
• If a person has a severe headache, 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 as pills, and some are available only as injections.
• Since taking antibacterial drugs negatively affects the intestinal microflora, it is necessary to take means to normalize it: Hilak forte, Linex, Lactomun, etc.
• On the 5th day after starting antibiotic treatment, the patient is offered Fluconazole at a dosage of 200 mg. This is necessary to prevent fungal infections. If a woman has already begun to develop thrush, then the dose is increased to 300 mg.
• Since any inflammation is accompanied by an 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 frontal sinusitis is of an allergic nature, then a combination of these 2 drugs is required. Also, patients with allergic frontalitis are prescribed several injections of glucocorticosteroids.
• It is possible to 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).

Lavage of the sinuses

Washing the sinuses with the vacuum method is called "cuckoo". During its implementation, the patient is injected into one nostril with a saline solution supplemented with an antiseptic or anti-inflammatory component. Thereafter, the solution is drawn out from 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 the "cuckoo". When these sounds are articulated, the soft palate is pressed against the back of the pharynx, which allows it to be blocked. 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 out. After the procedure is completed, the person feels a stuffy nose, he can sneeze, complain of a headache. Sometimes a small amount of blood comes out of the nose.

YAMIK method

This method resembles the "cuckoo" described above. However, the procedure can be carried out already from the age of five.

You will need a YAMIK catheter for treatment. There are 2 channels inside it, which have different outputs. The tube is also equipped with two cylinders.

The catheter is inserted into the patient's nasopharynx, after which I begin to pump 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 is able to spray medications into the affected sinus.

The procedure is carried out in a sitting position. Before its implementation, the nasal passages are treated with lidocaine and adrenaline in order to achieve an analgesic and vasodilating effect.

It is forbidden to carry out YAMIK therapy for people with disorders in the blood coagulation system, with polyps in the nose.

Read more: YAMIK catheter: treatment without puncture

Physiotherapy

Physiotherapy techniques are an excellent complement to the conservative therapy of frontal sinusitis.

The patient may be assigned procedures such as:

• Electrophoresis.
• Quartzization 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 allow achieving the desired effect.

In this case, such operational techniques can be applied as:

• Puncture of the 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. An inflammatory exudate flows out of 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 fed through this catheter to the sinuses.
• Balloon sinusoplasty. During the operation, an endoscope is inserted into the nasal cavity, which allows you to display an image on a screen. Under his control, a balloon is inserted into the sinus, after which it is inflated. This promotes the expansion of the anastomosis. Through the enlarged passage, the entire contents of the sinuses exit (more: balloon sinusoplasty: treatment without puncture).
• Open type operations. Such an intervention is rarely prescribed to patients, since it injures the anastomosis and the sinuses themselves.

There can be several operations:

1. 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.
2. According to Ogston-Luke. An incision is made over 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 administration of drugs. The procedure is indicated exclusively for adult patients. It is performed under local anesthesia with nerve blockade. If the disease has an acute course, then the procedure is contraindicated for the patient.
3. According to Galle Dani. 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, curved as a result of trauma to the nasal septum.

Rehabilitation. It is not enough to perform an operation and forget about the front forever. After it is carried out, you will need to rinse the frontal sinus with antiseptic solutions.

If the disease was accompanied by the development of complications with damage to bone tissue or ocular structures, it is necessary to use solutions with antibiotics.

Until the treatment is completed, the doctor will make sure that the tissues of the artificially made hole do not fuse. To do this, it is expanded using a special probe, or burned with silver nitrate. Sometimes a stent is inserted into the passageway.

Is it possible to treat frontal sinusitis at home?

Hospitalization is not always required at the front. 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 carry out any medical procedures on his own. 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:

1. The first step is rinsing the nose with saline solutions (Dolphin, Aqua-Maris, saline). You can prepare such a remedy yourself. Chlorophyllipt alcohol solution (dessert spoon) is added to 0.2 ml of physiological solution and mixed thoroughly.
2. The second step is to widen the passage that connects the sinuses and nasal cavities. To do this, 10 minutes after washing, you need to drip into the nose either Lasolvan Rino or Nazol.
3. The third step is using an antibiotic. To do this, use nasal drops with an antibacterial component. You can add an ampoule of Lincomycin to Tsiprolet and add a few drops to the nasal passages.

If the doctor prescribes an antibiotic by mouth, then it must be taken strictly on schedule. It is also allowed to use Sinupret in the form of an alcohol solution. Before taking, the drops are diluted in a small amount of water.

Solutions for rinsing 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. The nose is washed with the resulting composition at least 2 times a day.
• Chlorophyllipt solution for nasal treatment. These procedures complement the saline flushing of the sinuses.
• Decoction of herbs. It is best to use chamomile. To prepare the composition, 3 tablespoons of dry raw materials are poured with boiling water (this volume will require 0.45 ml of water), after which it is kept in a water bath for a quarter of an hour. Rinse the nose with the ready-made composition after it has cooled down.
• A solution of onions and honey. For its preparation, 1 onion is ground into gruel on a blender and poured with 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 only be diagnosed in children after they turn 6. 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 that of an adult.

The symptoms of frontal sinusitis in children are as follows:

• Severe headaches that increase in intensity in the morning.
• Worsening sleep.
• Decreased appetite.
• Lachrymation.
• Photophobia.

These symptoms do not necessarily indicate frontal sinusitis, but can prompt the thought of it.

Only after a while, the child develops pus in the discharge from the nose, the upper eyelid swells, and pain occurs in the bridge of the nose. The disease is often complicated by otitis media.

Therapeutic measures aimed at treating frontal sinusitis in children:

• Rinsing 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, Beconase or Flix.
• Taking medications that contain beneficial bacteria.

It is recommended to hospitalize all young patients with frontal sinusitis. If the child is under medical supervision, the likelihood of developing complications of the disease is minimized.

Prevention of frontal sinusitis

In order to prevent the development of frontal sinusitis, efforts should be made to increase immunity, as well as to minimize the likelihood of infection with viral and colds.

To do this, you should adhere to such recommendations as:

• Lead a healthy lifestyle.
• Get hardened.
• Eat properly.
• Monitor your weight, give up mono-diets.
• Dress appropriately for the season and weather conditions.
• Avoid overheating and hypothermia of the body.
• Start the treatment of any disease on time.
• Annually undergo preventive examinations at the dentist, do fluorography.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".