Hyperplastic sinusitis

Types of genyantritis: viral, parietal, unilateral

Sinusitis is an inflammatory process in the maxillary sinuses.

The disease can have a different nature, differ in symptoms and differ in the nature of its course.

There are several types of sinusitis:

• acute;
• sluggish;
• viral;
• allergic;
• odontogenic;
• purulent sinusitis;
• hyperplastic sinusitis.

To have an idea of ​​the types of sinusitis is not only the otolaryngologist, but also the person who suffers from this ailment. This is necessary because further treatment is dependent on the type of maxillary sinusitis.

Types of sinusitis are classified according to the following features:

1. due to the onset of the disease;
2. localization of the inflammatory process;
3. by the nature of the current;
4. on the basis of changes in the mucous membrane.

Now in detail for each item.

Group of sinusitis due to origin

Inflammation of the maxillary sinuses can develop for several reasons, knowing which ones can be predicted:

• further course of the disease;
• its symptoms;
• method of correct treatment;
• the required approach to the problem.

This division (meaning the classification of sinusitis) can be a good basis for prevention.

Since the ability to exclude the pathogenic factor gives a chance to avoid the disease and its complications.

So, the types of genyantritis due to the occurrence of the following:

1. viral sinusitis;
2. bacterial;
3. odontogenic;
4. fungal;
5. traumatic;
6. allergic.

Disease-causing viruses are microorganisms that can cause various pathologies. Under the abbreviation of ARVI, for example, everyone is familiar with a well-known respiratory-viral infection.

Viral genyantritis often goes in parallel with ARVI or develops against the background of this disease. Symptoms of such a genyantritis:

• shortness of nasal breathing;
• inflammation is bilateral;
• congestion of mucus;
• edema of the mucosa, which is clearly visible on the X-ray.

This inflammation often passes in three to four weeks. Treatment is based only on antiviral drugs. Complications of viral sinusitis develop rarely, nevertheless, they are possible. To avoid them, the patient is recommended to do the following:

1. use as much liquid as possible;
2. Bury in the nose drops, narrowing vessels;
3. often wash the nasal passages;
4. apply inhalation.

The next kind of genyantritis is bacterial. Natural microflora is necessary for man, but pathogenic microorganisms give him a lot of trouble, one of which is inflammation of the paranasal sinuses.

In fact, bacterial sinusitis is a complication of untreated rhinitis caused by viruses, and it manifests itself about ten days after the onset of the disease. Symptoms of bacterial sinusitis are carried by patients quite hard:

• a stiff cough;
• fever;
• purulent green discharge from the nose;
• facial pain.

All these manifestations reduce the quality of life of the patient. Diagnosis of bacterial inflammation of the symptoms, the results of X-rays and computed tomography. To determine what kind of bacteria caused inflammation, do the sowing of mucus.

Treatment of bacterial sinusitis requires the appointment of antibiotics, the course of which the doctor determines depending on the type of pathogen and the stage of the disease.

Odontogenic sinusitis - a fairly common phenomenon. This inflammation develops as a result of ingestion of food particles through the fistula formed after removal of the tooth.

The roots of the posterior upper teeth are too close to the maxillary sinuses, and sometimes they are simply located in them. But while the tooth is standing still, there's nothing to worry about. The fistula that appears after removal is the direct route for the penetration of pathogens into the maxillary sinus.

If a doctor suspects odontogenic sinusitis, the patient is referred to the x-ray of the jaw and a dental treatment is prescribed, without which the problem can not be eliminated.

The development of fungal sinusitis can provoke antibiotics. This side effect, like superinfection, is indicated in almost all accompanying instructions for antibacterial drugs. Therefore, you need to take antibiotics with extreme caution. Often fungal sinusitis is observed in people suffering:

1. AIDS;
2. diabetes mellitus;
3. leukemia.

Treatment with antibiotics can not get rid of the genyantritis of the fungal etiology and eliminate its symptoms. Therefore, if the disease does not respond to these drugs, most likely it is a fungal inflammation. Other signs of the disease:

• facial pains in the region of the maxillary sinuses;
• Change in color of nasal secretion from green to black.

The fungal lesion is treated for a long time, as the disease usually has a chronic form (parietal sinusitis). In addition to special antifungal drugs, surgical intervention (drainage and pumping of mucus) is required in some cases. For the development of fungal inflammation is typically aggressive impact of antibacterial agents and a general decrease in immunity.

Traumatic sinusitis is a consequence of a nose injury (bruise, fracture). The consequence of such damage is the accumulation of blood clots in the maxillary sinuses, which in itself is not physiological. With this development of events, the slightest infection can provoke the most severe inflammation, called sinusitis.

Another cause of traumatic sinusitis is an unsuccessful operation, which resulted in the displacement of individual parts of the bone into the maxillary cavity. The sinus tissue becomes inflamed and becomes completely unprotected from any infection.

The development of traumatic sinusitis accompanies the symptoms typical of any trauma (pain, swelling, bruising). In this case, the treatment should be surgical, it is aimed at eliminating the consequences of trauma.

The causative agents of allergic sinusitis are allergens that persecute a person at every step. Usually, these are factors of natural or chemical origin. It can be:

1. pollen of flowering plants;
2. wool of domestic animals;
3. household or industrial chemistry.

Prolonged swelling of the nasal mucosa, which provokes allergens, ends with a sinusitis. Symptoms of allergic sinusitis are as follows:

• copious watery discharge from the nose;
• compulsive sneezing;
• itching in the nose;
• The feeling of heaviness in the nose and cheeks.

Antibiotic allergic inflammation is not treated. First of all, it is necessary to eliminate the irritant (if possible), rinse the nose and start taking antiallergic medicines.

Other types of genyantritis

The maxillary sinuses are two and are located symmetrically on both sides of the nose. If the inflammation affects one sinus - this is a one-sided sinusitis (left-sided, right-sided). When both sinuses are affected, they speak of a bilateral inflammatory process.

One-sided sinusitis is diagnosed with allocation of mucous contents and concentration of painful sensations on one side. If the symptoms of sinusitis are accompanied by swelling of the eyelids, under the eyes you can observe bags, the location of which can be judged on unilateral or bilateral sinusitis.

Based on the nature of the course of the disease, sinusitis is divided into acute and chronic form. These two types of inflammation differ from each other in duration, symptoms and consequences for the patient.

Acute sinusitis develops as a result of a complication of cold or infectious disease. Usually the disease lasts no more than one month and has the following symptoms:

1. general weakness;
2. heat;
3. chills;
4. headache;
5. labored breathing;
6. abundant discharge of mucus and pus;
7. swelling of the cheeks and eyelids;
8. absence of smell.

Pain can increase with tilting the head forward.

This effect is due to increased pressure of the affected sinus on the front wall. Additionally, lacrimation and photophobia may join.

Treatment of acute sinusitis consists in conservative measures:

• taking anti-inflammatory drugs;
• application of nontraditional methods of treatment;
• washing procedures;
• burial of the nose.

Any warming up in this stage is contraindicated.

Chronic inflammation of the maxillary sinuses is called "parietal chronic sinusitis" in another way. The following symptoms are typical for this form of the disease:

1. constant fatigue;
2. general weakness;
3. nasal congestion;
4. in the evening hours the patient has attacks of headache.

Chronic sinusitis can provoke serious complications, among which:

• serous or purulent meningitis;
• edema of meninges;
• swelling of the oropharynx;
• vascular thrombosis;
• brain abscess.

The video in this article tells what the genyantritis is, and what kinds of it occur.

stopgripp.ru

Chronic sinusitis in children and adults

Chronic sinusitis, the symptoms and treatment of which are discussed in this article, belongs to the group diseases of the paranasal sinuses (sinusitis) and, in particular, is an inflammation of the maxillary sinus.

In its prevalence, this form of pathology occupies one of the first places among ENT diseases.

Causes of purulent, hyperplastic and other chronic sinusitis

The most widely known is catarrhal, chronic purulent maxillary sinusitis, and also a mixed form of the disease. In addition, the classification of the disease can be identified chronic hyperplastic maxillary sinusitis, polyposis and atrophic variants of the disease.

The immediate cause of the development in the sinuses of the pathological process, which later turns into a chronic form, most often become streptococci, less often viruses, anaerobic microbes and fungi.

However, the causes of chronic maxillary sinusitis can be seen from the other side: not from the position of the causative agent of the infectious process, but from the point of chronicization of the formed inflammation.

First of all, the transition to a chronic form is promoted by illiterate therapy of acute sinusitis.The non-observance of the therapeutic scheme is important:a violation of the dosage and timing of taking medications and other inconsistencies to the prescribed measures.

The chronicity of the described disease is also caused by the constant presence of foci of chronic infection in the nasopharynx: rhinitis, tonsillitis, etc.

Chronic sinusitis can form and against the background of the curvature of the septum of the nose, and with such formations as polyps and cysts, which naturally disrupt the normal movement of air in the sinuses, while stimulating the stagnation of mucus and breaking it Departure.

The development of the disease is influenced by the environment:the more gassed and dusty the higher the risk of getting sick.

Their role in the development of the described ailment is also played by bad habits, allergy and immunity.

Symptoms of chronic sinusitis in children and adults

SymptomsChronic sinusitis in adults and children are often erased or mild. This fact causes difficulties in the diagnosis and treatment of the described ailment.

The main manifestation of the disease is a chronic runny nose, not amenable to traditional therapy. Runny nose is accompanied by nasal congestion (more often one-sided) and other characteristic symptoms.

Often patients have complaints of pain localized in the head and depth of the orbit, passing in the prone position and intensifying with blinking. Dull pain can occur in the infraorbital area.

SymptomsChronic sinusitis include the morning swelling of the eyelids and chronic inflammation of the conjunctiva of the eyes. This characterizes the spread of the process from the maxillary sinus to the orbital walls.

A significant manifestation of the described disease is also considered to be a symptom such as a chronic dry cough. Moreover, this cough does not respond to therapy with the use of antitussive and expectorant drugs. The appearance of a cough for a given disease can be explained by an irritating effect on the pharyngeal region, which pus flows from its affected sinus.

Characteristic for the diagnosis of chronic sinusitis symptoms also include dulling of the olfactory function of the nose.

And the course and prognosis for this disease depend on the quality of the treatment used, as well as on the presence of structural changes in the sinus.

Exacerbations and complications of chronic sinusitis

Exacerbation of the chronic form of sinusitis, as a rule, happens after an infectious disease, for example, scarlet fever, measles, influenza, etc.

If the body is weakened by a factor that provokes an exacerbation, even the slightest hypothermia can occur.

In patients with a diagnosis of chronic sinusitis, exacerbation may be accompanied by the appearance of a rather intense pain in the area of ​​the affected sinus. When you click on this area, the pain intensifies. Such a painful sensation is often accompanied by bursting when tilted or abruptly moving the head, which can be, for example, by sneezing or coughing.

Often, the ill begin to tear from the bright light of the eye, due to which there is some photophobia.

The main danger of the described illness comes from the structure and location of the maxillary sinus. Thin walls of this anatomical formation participate in the formation, as well as contact with the membranes of the brain. Given this fact, patients with this disease always have the risk of spreading infection into the cranial cavity with the development of meningitis.

However, with the diagnosis of chronic sinusitis complications of this nature are extremely rare. Bole is likely to transfer infection from the affected maxillary sinus to the orbit, the fiber that fills the orbit, and also to the eye membranes.

This swelling of the process is evidenced by puffiness of the eyelids and a certain bulge of the eye on the background of severe pain.

In addition, chronic sinusitis in adults and children plays the role of a source of infection. Because of this, the described disease becomes the cause of frequent recurrences of angina, pharyngitis, and also can lead to the occurrence of diseases of the teeth or maxillary osteomyelitis.

With genyantritis, neuritis of the trigeminal nerve can form, which will be indicated by strong attacks of pain in the face area. Chronic rhinitis, which has appeared as a result of inflammation of the maxillary sinus, can cause atrophy of the mucous membrane and loss of smell. The disease can be complicated by the formation of an abscess.

Patients with chronic sinusitis, as a rule, are treated long and unsuccessfully for chronic bronchitis and other possible causes of chronic cough.

Treatment of chronic sinusitis at home with drugs

Chronic sinusitis in children and adults requires compulsory treatment, while it is very important that the appointment of therapy carried out by an experienced specialist.

Treatment of this disease should be complex. As a rule, physicians prescribe local or common glucocorticoids, antibiotics and saline solutions for rinsing.

Of all these groups of drugs, antibiotics are considered to be the most important, although the role of bacteria in the development of this ailment remains controversial.

Treatment in a hospital is shown primarily to patients with developed orbital and intracranial complications. In addition, patients with immunodeficiency and children need hospital treatment.

In deciding the question of how to treat chronic sinusitis, one should be guided by drugs that affect the various links of the pathological process. One of these means are decongestants. They cause narrowing of the vessels of the mucous membrane and thereby contribute to the elimination of edema, the reduction of local inflammation and the normalization of outflow from the sinuses.

The most popular drugs in this group are drugs that include oxymetazoline (for example, Nasivin or Nasol), phenylephrine (in particular, Vibrocil), naphazoline (all known as Naphthysin), xylometazoline (these are familiar to many Otrivin and Galazolin).

Care should be taken when using drugs of this group in patients diagnosed with chronic sinusitis. You can not tolerate treatment with these drugs for more than 5-7 days, otherwise there is a risk of addiction and drug rhinitis.

After the doctor has determined the symptoms of chronic maxillary sinusitis and treatment in adults, and the children are selected appropriate. And it is quite possible that to obtain the best result the patient will need to prescribe corticosteroids.

Such means for direct introduction into the nose (sprays, drops) are especially effective in the combination of sinusitis with polyps, a medicamentous variant of rhinitis and an allergic rhinitis.

Along with antibiotics, these drugs are key components of the therapy of this ailment.

The most well-known of this group of drugs are fluticasone-based drugs (eg, Fliksonase), beclomethasone (Aldecin) and mometasone (Nazonex).

In the question of how to cure chronic sinusitis, not the last role of the physician is assigned to the lavage of the nose. Used for this, saline solutions, moisturizing the mucous membrane, reducing edema and mucus viscosity.

Solutions may include a solution of sodium chloride or sea water. Most often in pharmacies there are Aqua Maris, Dolphin and Marimer.

The pharmaceutical industry also produces combined preparations, which, in addition to sea water, also contain vasoconstrictor substances. An example of such drugs is Snoop, which is a combination of sea water with xylometazoline.

How to treat chronic sinusitis with antibiotics?

Antibiotics for chronic sinusitis can be used only when there are signs of bacterial infection in the clinical picture of the disease. If this ailment has developed for some other reason, then the use of antibacterial medicines will not yield any results.

As a rule, such drugs as Doxycycline and Amoxicillin are used as antibacterial therapy for patients with sinusitis. Trimethoprim or Sulfamethoxazole is also used. If such treatment of chronic sinusitis does not have an effect, then the drugs should be replaced by others.

In the treatment of antimicrobial medicines, it is extremely important to follow the prescribed course of treatment. In most cases this is 10-14 days, but a longer period of therapy may well be required. It all depends on how soon the patient's condition will improve.

If you stop taking medication after a few days, then the manifestations of the illness come back and quickly enough.

How to cure chronic sinusitis at home using folk methods?

Helps with the diagnosis of chronic sinusitis and treatment at home using folk methods.

It should be remembered that a good help in the fight against the disease rest. And to dilute the secretions and improve the patency of the nasal passages, you need to drink plenty of fluids. It is better to avoid drinks with caffeine and alcohol, tk. they lead to dehydration, and alcohol also worsens the swelling of the mucous sinuses.

Sleep with this disease is recommended in a position with a slightly raised head. Due to this, it is possible to reduce congestion in the sinuses of the nose.

In patients with a diagnosis of sinusitis, chronic home treatment should include moistening of the sinuses. To do this, you can inhale the steam from the hot water tank while holding the towel over your head and trying not to direct the steam into your face. In addition, you can inhale warm moist air by taking a hot shower. Such procedures facilitate pain and help in the mucus.

Pain can also be reduced with a warm compress:for example, put a warm towel on the cheek area of ​​the nose.

Solving the question of how to cure chronic sinusitis at home, do not forget about washing.

Usually, for this disease, special devices are used to rinse the nasal passages:in particular, a syringe with a flexible tube or syringing. Used for washing, usually salt water. You can also rinse your nose with propolis.

Surgical treatment of chronic sinusitis

If even after adequate, properly prescribed therapy the disease continues to develop, then the treatment of chronic sinusitis in adults and children should be performed surgically.

Nowadays there is endoscopic surgery. Doctors using an endoscope first examine the paranasal sinuses, and then remove polyps and tissues that cause nasal congestion with a special tool.

NasmorkuNet.ru

Chronic sinusitis

Chronic sinusitis is a chronic inflammation of the maxillary sinus, chronic maxillary sinusitis (sinusitis maxillam chronica, highmoritis chronica).

A method of mass non-invasive examination of a large contingent of people could be diaphanoscopy of the maxillary sinuses or fluorography of the paranasal sinuses.

Code for ICD-10 J32 Chronic sinusitis J32.0 Chronic maxillary sinusitis

Epidemiology

Epidemiology of the disease is not associated with living in a particular region of the world. In various regions of Ukraine and in a number of other countries, the microbial flora in chronic paranasal sinusitis is often close in composition. Regularly recurring epidemics of influenza and respiratory viral infections cause a decrease in all factors of protection of the nasal cavity and paranasal sinuses. In recent years, the relationship between the occurrence of sinusitis and unfavorable environmental factors: dust, smoke, gas, toxic emissions into the atmosphere began to be traced.

Causes of chronic sinusitis

The causative agents of the disease are often representatives of the coccal microflora, in particular streptococci. In recent years, reports have emerged that three opportunistic pathogens, Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catharrhalis, have been identified as pathogens. Often began to sow mushrooms, anaerobes, viruses. They also note the formation of various types of aggressive associations that increase the virulence of pathogens.

Pathogenesis

The lower wall of the sinus is formed by the alveolar process: a significant number of people in the lumen of the sinus are the roots of 4 or 5 teeth, which in some of them are not even covered by the mucous membrane. In this regard, the inflammatory process from the oral cavity often extends into the lumen of the maxillary sinus. When developing a granuloma of the tooth, it can be hidden for a long time and can be detected accidentally.

The upper sinus wall, which is the bottom wall of the orbit, is very thin, there is a large number dehydration, through which the vessels and nerves of the mucous membrane communicate with similar formations eye sockets. With increasing pressure in the lumen of the sinus, the pathological discharge can spread into the orbit.

It is proved that the disease often develops in people with mesomorphic type of facial skeleton structure, the main role belongs to one or another the degree of obstruction of the natural opening of the maxillary sinus, which causes a violation of drainage and aeration of its mucosa shell. Important is the violation of nasal breathing, associated with deformities of the septum of the nose, synechiae, adenoids, etc. The development of the disease is promoted by an increase in the aggressiveness of pathogenic microorganisms, the formation of their associations (bacterial-bacterial, bacterial-viral, viral-viral), a decrease in the rate of mucociliary transport in the lumen sinuses and in the nasal cavity. In addition, the incomplete cure for acute rhinitis is considered as a predisposing factor, when the inflammatory phenomena of the mucosa the nasal cavities extend to the structures of the ostiomeatal complex, especially if there is a pathology of the structure of its components structures. This disrupts the movement of air and fly-transport transport, contributes to the formation of sinusitis. Sinusitis is often accompanied by the involvement of nearby paranasal sinuses (latticular and frontal) in the inflammatory process. Currently, it is believed that in the development of sinusitis, including the maxillary, the role of allergy factors, the state of general and local immunity, disorders of microcirculation of the mucous membrane, vasomotor and secretory components, a significant violation of vascular and tissue permeability.

Pathological anatomy. Of definite clinical interest is the classification of M.Lazeanu mentioned above, as applied to chronic sinusitis, which, although not differs in principle from the classification of BS Preobrazhensky, allows you to look at the problem from the point of view of concepts and interpretations adopted for abroad. The author distinguishes the following pathomorphological forms:

1. chronic catarrhal maxillary sinusitis vacuo (closed form), in which the sinus drainage function is absent or reduced to a level not providing normal ventilation; at this form the mucous membrane of the sinus is diffusely hyperemic, thickened, in the sinus there is a serous transudate; characterized by frequent exacerbations;
2. chronic purulent maxillary sinusitis; characterized by the presence in the sinus of the "old" thick pus with caseous masses, extremely offensive; the mucosa is productively thickened, gelatinous, gray, sometimes fleshy-red, with ulceration, extensive areas of necrobiosis, at the level of which areas of exposed bone with osteitis elements and osteomyelitis;
3. chronic polynomial maxillary sinusitis, in which various types of natomorphological changes can occur in the mucosa; the most typical of them - proliferation of the epithelium, which most often preserves the multilayered cylindrical structure of the ciliary epithelium and the ability to secrete mucous glands; this kind of proliferation multilayered cylindrical epithelium was called the "saw tooth" and, taking into account the abundant secretion of goblet cells and mucous glands, it is the basis of the formation polypous masses;
4. chronic cystic maxillary sinusitis, the occurrence of which is due to retention of the secretion of the mucous glands; emerging micro-cysts can be thin-walled, lying in the surface layer of the mucous membrane and thick-walled, lying in the deep layers of the mucosa sinuses;
5. chronic hyperplastic maxillary sinus is characterized by thickening and hyalinization of vascular plexuses, combined with fibrosis of the mucosa;
6. chronic caseous maxillary sinusitis is characterized by filling with fetid caseous masses of the entire maxillary sinus, which, exerting pressure on the surrounding tissues, destroy them and spread into the nasal cavity, forming extensive messages of the latter not only with the maxillary sinus, but also with the latticed labyrinth and frontal Sinus;
7. chronic cholesteatomous maxillary sinusitis occurs when penetrated into the sinus cavity of the epidermis, which forms a unique shell of white color with mother-of-pearl (matrix), consisting of the smallest epithelial scales, inside which is a paste-like fat-like mass, which is extremely unpleasant smell.

Such is the pathoanatomical picture of chronic suppurative maxillary sinusitis. Their various forms can occur in various combinations, but always progress in the sequence indicated above.

Symptoms of chronic sinusitis

Quite often, the only complaint of patients without exacerbation is the difficulty of nasal breathing, expressed in varying degrees, right up to his absence. Discharge from the nose with acute sinusitis profuse, their nature slimy, mucopurulent, often purulent, especially during periods of exacerbation. Pathognomonic sign is the highest number of excretions in the morning,

With genyantritis, there are often complaints of a feeling of "pressure" or "heaviness" and the area of ​​the fangs and the root of the nose on the side of the inflammation, and the pain can irradiate into the brow or temporal region. In a chronic process, especially during periods of exacerbations, the nature of pain is diffuse, the clinical picture is similar to trigeminal neuralgia.

Often the chronic inflammatory process in the maxillary sinus is accompanied by a violation of the sense of smell in the form of hyposmia, sometimes anosmia. Rarely does it appear tearing due to the closure of the nasal canal.

Sinusitis is often bilateral. The exacerbation is characterized by hyperthermia with febrile digits, malaise and general weakness, while maintaining all the indicated signs of the disease.

Clinical forms of chronic sinusitis are classified by some authors on the following grounds:

1. on etiology and pathogenesis - rhinopathy and odontogenic sinusitis;
2. on pathomorphological signs - catarrhal, purulent, polypous, hyperplastic, osteomyelitic, infectious-allergic, etc .;
3. on the microbiological basis - banal microbiota, influenza, specific, mycotic, viral, etc.;
4. on the basis of a dominant symptom - secretory, obstructive, cephalic, anosmic, etc .;
5. on the basis of clinical severity - latent, often exacerbated and persistent forms;
6. on the basis of prevalence - monosynusitis, hemisinusitis, polygamisinusitis, pansinusitis;
7. on the basis of complication - simple uncomplicated and complicated forms;
8. on the basis of age - sinusitis of children and senile age.

It should be noted, however, that this classification is purely didactic, indicating only the different aspects of a single pathogenetic process, in the development which all or most of these features are present, and the appearance of certain features may be consistent, or may manifest itself Simultaneously.

Symptoms of chronic sinusitis are divided into local subjective, local objective and general.

Subjective local symptoms of chronic sinusitis are reflected in patients' complaints of unilateral purulent discharge from the nose (with monosynusitis), on permanent headaches, which are periodically amplified with the localization of a painful focus in the area of ​​the maxillary sinuses. The painful crisis coincides with the periods of exacerbation of the chronic process, the pain radiates to the temporal and orbital region. In odontogenic chronic sinusitis, the pain is combined with odontalgia at the level of the aching tooth. Patients complain also of a feeling of fullness and bursting in the area of ​​the affected sinus and surrounding tissues, an unpleasant, sometimes putrid odor from the nose (subjective kakosmia), which causes the patient to feel sick and lose appetite. One of the main subjective symptoms is a complaint of difficulty in nasal breathing, nasal congestion, and an olfactory impairment that is obstructive.

Objective local symptoms of chronic sinusitis. When examining the patient, attention is drawn to the diffuse hyperemia and swelling of the outer shells of the eye and the mucous membrane of the lacrimal ways, the phenomena of chronic dermatitis in the area of ​​the anterior of the nose and upper lip, caused by persistent purulent discharge from the corresponding half of the nose (impetigo, eczema, excoriation, cracks, etc.), which sometimes provoke the appearance of sycosis and furuncles of the vestibule nose. With exacerbations of chronic sinusitis, soreness is revealed on palpation of the corresponding points: in the region of the exit of the lower nerve head, in the region of the dog fossa and the inner corner of the eye. A test with a V.Voyachek fluff or rhinomanometry indicates a one-sided incomplete or complete obstruction of nasal breathing. When examining the used handkerchief, yellow spots with dense caseous inclusions and blood veins are found. In wet conditions, these spots produce an extremely unpleasant putrefactive odor, differing, however, from the fetid smell of the lake and the sweetish-sugary smell of the rhinosclerome. In this case, an objective kakosmia is also determined. Usually, with banal chronic sinusitis, the sense of smell is preserved, as evidenced by the subjective kakosmia, but when involved in the process cells of the latticed labyrinth and formation of olfactory slit obturating the polyps, a one-sided, less often bilateral hypo- or anosmia. Objective signs of disturbance of the function of tear-excreting function due to edema of the mucous membrane in the area of ​​the lacrimal point and violations of the pump function of CML are also noted.

With anterior rhinoscopy in the nasal passages of the corresponding side, thick mucopurulent or creamy discharge, often with an admixture of caseous masses, dirty-yellow, drying out in a difficult to separate from the mucous membrane crusts. Often in the middle and common nasal passages polyps of different sizes are found; the middle and lower nasal conchaes are enlarged, hypertrophied and hyperemic. Often there is a picture of a false double middle nasal concha, which is caused by mucosal edema shell infundibulum, prolabs from the upper middle nasal passage to the common nasal passage (pad Kaufmann). The average nasal shell often has a bullous appearance, is hyperemic and thickened.

With anemia of the mucous membrane in the region of the middle nasal passage, a sign of profuse discharge of purulent discharge from maxillary sinus, which, when the head tilts forward, continuously flow down the inferior nasal concha and accumulate at the bottom of the cavity nose. Their removal leads to a new accumulation of pus, which indicates the presence of a bulky reservoir of secretions in the maxillary sinus. With posterior rhinoscopy, there is a presence of purulent masses in the khoans, which stand out from the middle nasal passage to the posterior end of the middle nasal conch in the direction of the nasopharynx. Often, the posterior end of this shell in chronic sinusitis acquires the appearance of a polyp and increases to the size of a choana polyp.

Examination of the teeth of the corresponding half of the alveolar process can reveal their diseases (deep caries, periodontitis, apical granuloma, fistula in the gum area, etc.).

Common symptoms of chronic sinusitis. Headaches that intensify during exacerbations and when the head is tilted, coughing, sneezing, blowing, shaking his head. Cranio-cervico-facial neuralgic crises arising during periods of exacerbations, most often in cold season; general physical and intellectual fatigue; signs of a chronic hearth infection.

The clinical course is characterized by periods of remission and exacerbations. In the warm season may come periods of apparent recovery, but with the onset of cold weather the disease resumes with a new force: there are general and irradiating headaches, mucopurulent, then purulent and putrefactive discharge from the nose, worse nasal breathing, general weakness increases, body temperature rises, signs of a common infectious disease.

Where does it hurt?

Headache when tilted

Forms

Distinguish catarrhal, purulent, parieto-hyperplastic, polyposis, fibrous, cystic (mixed forms), complicated and allergic sinusitis.

Diagnosis of chronic sinusitis

At the stage of assessing anamnestic data, it is important to collect information about previous respiratory diseases, including other perinasal sinusitis, ARVI. It is necessary to ask the patient in detail about the presence of pain and the area of ​​the upper jaw, examinations of the dentist, possible manipulations and interventions on the teeth and structures of the alveolar process. It is obligatory to question the preceding exacerbations of the disease, their frequency, the peculiarities of the treatment of surgical interventions on the structures of the nose and paranasal sinuses, the course of the postoperative period,

Physical examination

Palpation in the projection of the anterior wall of the maxillary sinus in a patient with chronic sinusitis causes a slight increase in local pain, which is sometimes absent. Percussion of the anterior wall of the sinus is not sufficiently informative, as it is surrounded by a large array of soft tissues

Analyzes

In the absence of complications of the disease, general blood and urine tests are poorly informative.

Instrumental research

Anterior rhinoscopy reveals flushing and edema of the mucous membrane of the nasal cavity, with this lumen of the middle nasal passage often closed. In these cases, mucosal anemia is produced. Pathognomonic rhinoscopic symptom for sinusitis is a "strip of pus" in the middle nasal passage, ie, from under the middle of the middle nasal concha,

The presence of polyps in the nasal cavity indicates the cause of the violation of the drainage function of the natural outlets of one or more sinuses. The polypous process is rarely isolated and almost always bilateral.

During oropharyngoscopy, attention is drawn to the features of the mucosa of the gums, the state of the teeth from the inflamed maxillary sinus, carious teeth and seals. In the presence of a sealed tooth, percussion of its surface is carried out, in the case of pathological changes in it, it will be painful. In this case, consultation of the dentist is mandatory.

A non-invasive method of diagnosis is diaphanoscopy by Goering's bulb. In a darkened room, it is injected into the mouth of the patient, which then tightly clamps her base with her lips. The transparency of the inflamed maxillary sinus is always reduced. The method is mandatory for use in pregnant women and children. It should be remembered that a decrease in the intensity of luminescence of the maxillary sinus does not always indicate the development of an inflammatory process in it.

The main method of instrumental diagnosis is radiography. If necessary, perform an x-ray about contrasting examination of the sinus during its diagnostic puncture, introducing into its lumen a 1-, mi contrast preparation. It is best to implement it directly in the X-ray room. It is recommended to perform the procedure in the position of the patient lying on the back for shooting in the floor of the axial projection, and then in the lateral, on the side of the inflamed sinus. Sometimes on X-rays with a contrast agent, one can see a rounded shadow in the region of the alveolar an appendage indicating the presence of a cyst, or a symptom of a "denticle," indicating the presence of polyps in the lumen sinuses.

With the help of CT it is possible to obtain more accurate data on the nature of destruction in the walls of the maxillary sinuses, involvement in the inflammatory process of other paranasal sinuses and nearby structures of the facial skeleton. MRI gives more information when there are soft tissue tissues in the lumen of the lumen.

In the absence of clear evidence of the presence of an inflammatory process in the maxillary sinus, but the presence of indirect symptoms, it is possible to conduct a diagnostic puncture using a Kulikovsky needle. The needle is inserted into the arch of the inferior nasal passage, then unfolds the curved part medially and pierces the sinus wall.

Another method of invasive diagnosis has been endoscopy, which allows us to clarify the nature and characteristics of the inflammatory process through direct visual examination. The study is carried out after micro-hemorrhoid with a trocar or cutter by introducing an optical endoscope with a certain angle of view.

What it is necessary to survey?

Gajmorov's sinus

How to inspect?

X-ray of the nasal cavity and paranasal sinuses Studies of the anterior and posterior paranasal sinuses Endoscopy of the maxillary sinus Puncture of the maxillary sinus

Differential diagnostics

First of all, the disease should be differentiated from the trigeminal neuralgia, in which the pains are "burning" in nature, appear suddenly, their appearance can provoke a stressful situation or the transition from a warm room to the street, where the lower temperature. The pains are paroxysmal, expressed by palpation of the scalp, often accompanied by paresthesia and synesthesia of the half of the face. Pressing on the exit points of the branches of the trigeminal nerve causes a sharp pain unlike the patients with sinusitis.

When the clinical symptoms dominate the local headache, and the discharge from the nose is absent, the crucial element of the differential diagnosis is anemia mucosa shell of the middle nasal passage, after which an exudate or "a strip of pus" appears in the nasal cavity, which indicates a block of a natural outlet of the maxillary sinuses.

Indications for consultation of other specialists

The presence of a pathology of the teeth or oral cavity requires consultation of the dentist. If necessary, sanation measures: treatment of carious teeth, extraction of their or their roots, etc. Sometimes it may be necessary to consult a specialist in maxillofacial surgery. With clinical signs of neuralgia of the trigeminal nerve for a thorough differential diagnosis, a consultation of a neurologist is shown.

Who to contact?

ENT - doctor Otolaryngologist

Treatment of chronic sinusitis

The goals of chronic chronic sinusitis: restoration of drainage and aeration of the affected sinus, removal of pathological detachment from its lumen, stimulation of reparative processes.

Indications for hospitalization

The presence of signs of exacerbations of chronic sinusitis: severe local pain, discharge from the nose against the background of hyperthermia, confirmed X-ray signs of the disease, as well as the absence of the effect of conservative treatment for 2-3 days, the appearance of clinical signs complications.

Non-drug treatment of chronic sinusitis

Physiotherapeutic treatment: electrophoresis with antibiotics on the anterior wall of the sinus, phonophoresis of hydrocortisone, including in combination with oxytetracycline, exposure ultrasonic or ultrahigh frequencies to the sinus region, radiation from the therapeutic helium-neon laser, intrasternal phonophoresis, or irradiation with helium-neon laser.

With "fresh" forms of chronic sinusitis, which are characterized by involvement of the sinus mucosa in the pathological process and limited areas of the cure period, can be achieved by non-operative methods (as in acute maxillary sinusitis), including puncture, drainage, insertion of proteolytic enzymes into the sinus with subsequent washing of the sinus, removal of lyseed pus and administration of antibiotics in a mixture with hydrocortisone. Non-surgical treatment gives a quick effect with simultaneous sanation of the causative foci of infection with odontogenic or lymphadenoid localization, when applied medicamentous effect on the endonasal structures, as well as the removal of polypous lesions from the nasal cavity to improve the drainage function of the rest paranasal sinuses. Anti-allergic measures with the use of antihistamines are of great importance in non-operative treatment.

S.Z. Piskunov et al. (1989) proposed an original method for the treatment of chronic sinusitis with the use of drugs on a polymer basis. As drugs, the authors refer to antibiotics, corticosteroids and enzymes, and as a polymeric carrier cellulose derivatives (methylcellulose, sodium CMC, hydroxypropylmethylcellulose and polyvinyl alcohol).

Repeated preventive courses conducted in the cold season, when exacerbations of chronic sinusitis occur particularly often, as a rule, do not always lead to complete recovery even with a number of preventive measures and radical elimination of risk factors for this disease (sanation of foci of infection, strengthening of immunity, elimination of bad habits and other).

Thus, in spite of the ongoing improvement in the methods of non-operative treatment of inflammatory diseases of the paranasal sinuses, recently their number is not decreasing, and according to some data, even increases. This, according to many authors, is due to both a tendency to change the pathomorphism of the microbiota in general, and changes not in the best direction of the body's immune defense. As noted by VS Agapov and co-authors. (2000), immunodeficiency in various indicators is observed in almost 50% of healthy donors, and the degree of it increases with the development of the inflammatory process in the body. This is partly due to the increase in antibiotic-resistant forms of microorganisms as a result of widespread and sometimes irrational application biological antibacterial drugs, as well as general changes in the body towards weakening systemic and local homeostasis use of chemotherapeutic agents, the effects of adverse environmental household and industrial conditions, other factors risk. All this leads to a decrease in the activity of immunological and nonspecific reactivity, the violation of neurotrophic functions both at the level of macrosystems and in the field of cell membranes. Therefore, in the complex treatment of patients with diseases of the paranasal sinuses and ENT organs in general, in addition to the generally accepted symptomatic and antibacterial agents, it is necessary to include immunomodulating and immunocorrecting therapy.

At present, in spite of a rather full arsenal of medicamental means of influence on the reactivity of the organism as a whole and on local reparative-regenerative wound processes, it is impossible to speak with confidence about the existence of a scientifically tested system of a complex, effectively "working" direction. In most cases, the purpose of the respective drugs is empirical in nature and is based mainly on the principle of "trial and error". Preference is given to chemo- and biological medicinal products, but to systemic enhancement immunity and nonspecific resistance are resorted only when traditional treatment does not give the desired result. When using chemotherapy drugs and antibiotics, as rightly noted V.Sagapov et al. (2000), they are invariably included in the metabolism in the macroorganism, which often leads to the emergence of allergic and toxic reactions and as a consequence - to the development of significant violations of the natural mechanisms of specific and non-specific protection organism.

These provisions encourage scientists to find new, sometimes non-traditional means of treating inflammatory diseases of bacterial genesis of various organs and systems, including ENT organs and maxillofacial system. Morphogenetic, innervation, adaptation-trophic, blood, etc. the unity of the last two organ systems allows us to speak about the commonality and the possibility of applying them to them identical principles of therapy and the same remedies for the occurrence of chronic purulent-inflammatory diseases.

Both in stomatology, and in otorhinolaryngology methods of phytotherapy with application of infusions, broths, extracts of a phytogenesis are developed. However, in addition to phytotherapy, there are other possibilities for using so-called non-traditional drugs to treat the pathological condition discussed in this section. So, a new perspective direction in the treatment of chronic purulent processes in dentistry is developed under the guidance of prof. VS Agapova, which probably should be of some interest for ENT specialists. We are talking about the use of ozone in the complex treatment of chronic sluggish purulent infectious and inflammatory diseases of the maxillofacial region. The therapeutic effect of ozone is determined by its high oxidation-reduction properties, which at local application perniciously act on bacteria (especially effectively on anaerobes), viruses and mushrooms. Studies have shown that the systemic effect of ozone is aimed at optimizing metabolic processes with respect to protein-lipid complexes cell membranes, to increase in their plasma oxygen concentrations, the synthesis of biologically active substances, increased activity of immunocompetent cells, neutrophils, improvement of rheological properties and oxygen transport function of blood, as well as stimulating effect on all oxygen-dependent processes.

Medical ozone is an ozone-oxygen mixture obtained from ultrapure medical oxygen. The methods and fields of application of medical ozone, as well as its dosage, depend mainly on its properties, concentration and exposure, established at a particular stage of treatment. At higher concentrations and prolonged action, medical ozone gives a pronounced bactericidal effect, at lower concentration - stimulates the reparative and regenerative processes in damaged tissues, contributing to the restoration of their function and structure. On this basis, medical ozone is often included in the complex treatment of patients with sluggish inflammatory processes, including purulent diseases and insufficient effectiveness antibacterial treatment.

Under low-grade purulent inflammation is meant a pathological process with steady progression under hypoergic flow, which is difficult to give in to traditional non-operative treatment. Using the experience of using medical ozone in the maxillofacial and plastic surgery in otorhinolaryngology, it is possible to achieve significant successes in the complex treatment of many ENT diseases, in which the effectiveness of treatment in many ways can be determined by the properties medical ozone. These diseases include ozona, chronic purulent sinusitis and otitis in pre- and postoperative period, abscesses, phlegmon, osteomyelitis, wound oncological processes in ENT organs and others.

Local application of medical ozone consists in the introduction along the periphery of inflammatory infiltrates of ozonized isotonic solution of sodium chloride, washing of purulent wounds and cavities (for example, paranasal sinuses, the cavity of an open peritonsillar abscess or the cavity of an otogenic or rhinogenic cerebral abscess after surgery, etc.) with an ozonized distilled water. General ozonotherapy includes intravenous infusions of the ozonized isotonic sodium chloride solution and a small autohemozon therapy alternating every other day.

Medical treatment of chronic sinusitis

Before the results of the microbiological examination of the isolate can be used, antibiotics spectrum of action - amoxicillin, including in combination with clavulanic acid, cefotaxime, cefazolin, roxithromycin and others. Based on the results of inoculation, antibiotics of directed action should be prescribed. If the discharge from the sinus is absent or can not be obtained, continue treatment with the same drug. As one of the preparations of anti-inflammatory therapy, fenspiride can be administered. Antihistamine treatment with mebhydroline, chloropyramine, zbastin, etc. is carried out. Assign vasoconstrictive drops in the nose (decongestants), at the beginning of treatment - mild action (a solution of ephedrine, dimethindene with phenylephrine, and instead of night reception drops or spray can be used gel), in the absence of effect for 6-7 days are treated with imidazole drugs (nafazoline, xylometazoline, oxymetazoline and other).

Anemization of the mucous membrane of the anterior part of the middle nasal passage is carried out with the help of vasoconstrictive preparations (solutions of epinephrine, oxymeteolin, naphazoline, xylometazoline, etc.).

The transfer of drugs is carried out after anemia of the mucosa for insertion into the sinuses mixtures of drugs, including broad-spectrum antibiotics and suspensions hydrocortisone. Differential pressure, due to which the mixture moves into the lumen of the sinus is created as a result of the isolation of the nasal cavity and nasopharynx soft palate when pronouncing a vowel to a patient (for example, "y") and negative pressure in the nasal cavity created with an electroaspirator.

With the help of the YAMIK catheter, a negative pressure is created in the nasal cavity, which allows aspirating the pathological the contents of the paranasal sinuses of one half of the nose, and their lumen filled with a drug or a contrasting substance.

Surgical treatment of chronic sinusitis

Puncture treatment of sinusitis in our country is the "gold standard" and is used both for diagnostic and therapeutic purposes - for evacuation of pathological contents from its lumen. When obtaining a washing liquid during a sinus puncture, white, dark brown or black mass colors can be To suspect a fungal defeat, after which it is necessary to cancel antibiotics and to perform antifungal treatment. If the pathogen is assumed to be anaerobes (an unpleasant odor of the discharge, a negative result of the bacteriological research of the contents), it is necessary to carry out oxygenation of the lumen of the sinus after washing its cavity with moistened oxygen for 15-20 min.

In case of necessity of long drainage of the sinus and introduction of medicines into its lumen 2-3 times a day in it through the lower nasal passage set a special synthetic drainage from thermoplastic masses. which can be left for up to 12 days without disrupting trophism of tissues.

Microgeymorotomy is carried out with the help of special trocar (Kozlova - Karl Zeise, Germany, Krasnozhenz - MFS, Russia) in the center of the anterior wall of the sinus over the roots of the 4th tooth. After the introduction of the funnel into the lumen of the sinus, it is inspected by rigid endoscopes with optics of 0 ° and 30 ° and carries out subsequent medical manipulations, carrying out the assigned tasks. An obligatory element of the intervention is the removal of formations that prevent normal the functioning of a natural outlet, and the restoration of full drainage and aeration sinuses. The application of sutures to the wound of soft tissues does not produce. In the postoperative period, usual antibiotic therapy is carried out.

Extranasal opening by Caldwell-Lucas is performed by cutting soft tissue in the area of ​​the transitional fold from the 2nd to 5th teeth through the anterior wall of the sinus. Form a hole, sufficient for inspection and manipulation in its lumen. From the sinus remove pathological formations and detachable, in the region of the inner wall and in the lower nasal passage impose an ankle with the nasal cavity. When removing a significant amount of the altered mucosa to the bottom of the sinus, a U-shaped flap is placed from its unchanged site. Soft fabrics are sewed tight.

Further management

For 4-5 days, soft-acting vasoconstrictors are used. In the postoperative period, sparing care of the wound is necessary - 7-8 days do not use a toothbrush, after a meal rinses are performed on the threshold of the oral cavity with astringent preparations,

Approximate terms of incapacity for exacerbation of chronic sinusitis without signs of complications in the case of conservative treatment with sinus punctures are 8-10 days. The use of extranasal intervention lengthens the time by 2-4 days.

Information for Patient

• Beware of drafts.
• To carry out vaccination with anti-influenza serum in the autumn-winter period.
• At the first sign of acute respiratory viral infection or influenza, consult a specialist.
• At the recommendation of the attending physician to perform a surgical sanation of the nasal cavity for the restoration of nasal breathing and normal architectonics of its structures.

In addition to treatment

Physiotherapy with genyantritis Drops from sinusitis Antibiotics for sinusitis Surgery for chronic sinusitis Than to treat? Tavanik Galazolin

Prevention

Prevention is the preservation of free nasal breathing and normal anatomy of the structures of the nasal cavity, especially the ostiomeatal complex. Prevention of disease - compliance with the correct hygienic regime. To prevent the development of chronic sinusitis, surgical sanation of the nasal cavity structures is necessary to restore nasal breathing.

Forecast

The forecast is favorable if you follow the above tips and rules.

ilive.com.ua

Similar articles