Code of ileal sinusitis

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.

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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, it has a large number of dehydration, through which the vessels and nerves of the mucous membrane communicate with similar formations of the orbit. 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 a mesomorphic type of facial skeleton structure, the main role belongs to one degree or another obstruction of the natural opening of the maxillary sinus, which causes a violation of drainage and aeration of its mucosa. 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 of the sinus 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 mucous membrane of the cavity nose extend to the structure of the ostiomeatal complex, especially when there is a pathology of the structure of its constituent 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, applied to chronic sinusitis, which, although not different in principle, from the classification of BS Peremogensky, allows you to look at the problem from the point of view of concepts and interpretations adopted abroad. The author distinguishes the following pathomorphological forms:

chronic catarrhal maxillary sinusitis vacuo (closed form), in which the sinus drainage function is absent or reduced to a level not providing a normal ventilation; at this form the mucous membrane of the sinus is diffusely hyperemic, thickened, in the sinus there is a serous transudate; differs frequent exacerbations;
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, the gelatinous type, gray color, sometimes fleshy-red, with ulceration areas, extensive zones of necrobiosis, at the level of which areas of naked bone with elements of osteitis and osteomyelitis are found;
chronic polynomial maxillary sinusitis, in which various types of natomorphological changes can occur in the mucosa; the most typical of which is proliferation epithelium, which most often retains the multilayered cylindrical structure of the ciliated epithelium and the ability to secrete mucous glands; this kind of proliferation of multilayer cylindrical epithelium was called "tooth saw" and, given the abundant secretion of goblet cells and mucous glands, it is the basis of the formation of polypous masses;
chronic cystic maxillary sinusitis, the occurrence of which is due to retention of the secretion of the mucous glands; The resulting 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 mucous membrane of the sinus;
chronic hyperplastic maxillary sinus is characterized by thickening and hyalinization of vascular plexuses, combined with fibrosis of the mucosa;
chronic caseous maxillary sinusitis is characterized by filling with fetid caseous masses of the entire maxillary sinus, which, exerting pressure on 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 a latticed labyrinth and frontal sinus;
chronic cholesteatomous maxillary sinusitis occurs when penetrated into the sinus cavity of the epidermis, which forms a unique shell of white with pearlescent an outflow (matrix) consisting of the smallest epithelial scales, inside of which is a paste-like fat-like mass, which has an extremely unpleasant odor.

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,

In 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:

on etiology and pathogenesis - rhinopathy and odontogenic sinusitis;
on pathomorphological signs - catarrhal, purulent, polypous, hyperplastic, osteomyelitic, infectious-allergic, etc .;
on the microbiological basis - banal microbiota, influenza, specific, mycotic, viral, etc.;
on the basis of a dominant symptom - secretory, obstructive, cephalic, anosmic, etc .;
on the basis of clinical severity - latent, often exacerbated and persistent forms;
on the basis of prevalence - monosynusitis, hemisinusitis, polygamisinusitis, pansinusitis;
on the basis of complication - simple uncomplicated and complicated forms;
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 various aspects of a single pathogenetic process, the development of which there are all or most of these features, and the appearance of certain features may be consistent, or may occur 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 sinus. 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, at times a 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 puffiness of the outer shells of the eye and the mucous membrane of the lacrimal ways, phenomena chronic dermatitis in the area of the anterior 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 of the 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 of cells a one-sided, less often bilateral hypo- or anosmia is observed in the latticed labyrinth and the formation of the olfactory slit that surrounds the polyps. 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 is defined, often with an admixture of caseous masses, dirty-yellow color, drying up in the crust that is difficult to separate from the mucous membrane. 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 infundibulum, prolabs from the upper part of the middle nasal passage to the common nasal passage (Kaufmann's cushion). The average nasal shell often has a bullous appearance, is hyperemic and thickened.

With anemia of the mucosa in the region of the middle nasal passage, a sign of profuse discharge of purulent discharge from the maxillary sinuses, which, when the head tilts forward, continuously flow down the inferior nasal concha and accumulate at the bottom of the nasal cavity. 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 that occur during periods of exacerbations, most often in cold weather of the year; general physical and intellectual fatigue; signs of a chronic foci of 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, the nasal breathing, general weakness increases, body temperature rises, signs of a common infectious disease appear in the blood.

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 1-, mi of 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 you can see a rounded shadow in the area of the alveolar process, evidence of the presence of a cyst, or a symptom of "denticles", indicating the presence of polyps in the lumen of the sinus.

With the help of CT it is possible to obtain more accurate data on the nature of destruction in the walls of the maxillary sinus, 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, it is necessary to differentiate the disease from trigeminal neuralgia, in which the pains are "burning" in nature, suddenly, their appearance can provoke a stressful situation or transition from a warm room to a street where the temperature is lower. 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 a local headache predominates in clinical symptoms, and nasal discharge is absent, the crucial element of differential diagnosis is mucosal anemia of the middle nasal passage, after which an exudate or "a strip of pus" appears in the nasal cavity, indicating a block of the natural opening of the maxillary sinus.

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 on the background of hyperthermia, confirmed radiographic signs of the disease, as well as the lack of the effect of conservative treatment for 2-3 days, the appearance of clinical signs of 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 to ultrasonic or ultrahigh frequencies to the sinus area, radiation from a therapeutic helium-neon laser, intraspecific phonophoresis, or irradiation with a helium-neon laser.

With "fresh" forms of chronic sinusitis, which are characterized by involvement in the pathological process of the mucous membrane of the sinus and limited of the cure period can be achieved by non-operative methods (as in acute maxillary sinusitis), including puncture, drainage, the introduction into the sinus of proteolytic enzymes with subsequent washing of the sinus, removal of lysed 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, with the use of medication effects on the endonasal structures, as well as the removal of polypous lesions from the nasal cavity to improve the drainage function of the remaining 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 point out antibiotics, corticosteroids and enzymes, and as a polymeric carrier can Cellulose derivatives (methylcellulose, sodium CMC, hydroxypropylmethylcellulose and polyvinyl alcohol) are used.

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

Thus, despite the continuing improvement of the methods of non-surgical treatment of inflammatory diseases paranasal sinuses, recently their number does not decrease, 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 use of biological antibacterial drugs, as well as general changes in the body towards the weakening of systemic and local homeostasis with the use of chemotherapeutic means, the effects of adverse environmental household and production conditions, other risk factors. 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 agents of influence on the reactivity of the organism as a whole and on local reparative-regenerative wound processes, it is impossible to say with certainty about the existence of a scientifically tested system of a complex, effectively "working" in this 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 a systemic increase in immunity and nonspecific resistance are resorted only when traditional treatment does not produce 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 onset of allergic and toxic reactions and as a consequence - to the development of significant violations of the natural mechanisms of specific and nonspecific defense of the organism.

These provisions encourage scientists to find new, sometimes non-traditional means of treating inflammatory diseases bacterial genesis of various organs and systems, including ENT organs and the maxillofacial system. Morphogenetic, innervation, adaptation-trophic, blood, etc. the unity of the last two organ systems allows us to talk about the commonality and the possibility of applying 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, when local application is detrimental to bacteria (especially effective on anaerobes), viruses and fungi. Studies have shown that the systemic effect of ozone is aimed at optimizing metabolic processes with respect to protein-lipid complexes of cellular membranes, the increase in their plasma concentrations of oxygen, 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 concentrations - 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 sluggishly current inflammatory processes, including purulent diseases and insufficient effectiveness of antibiotic 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 in otorhinolaryngology the experience of using medical ozone in the maxillofacial and plastic surgery, you can achieve significant success in the complex treatment of many ENT diseases, in which the effectiveness of treatment in many ways can be determined precisely by the properties of medical ozone. These diseases include ozona, chronic purulent sinusitis and otitis in pre- and postoperative period, abscesses, phlegmon, osteomyelitis, wound oncological processes in the ENT organs, etc.

Local application of medical ozone is to introduce peripheral inflammatory infiltrates of ozonized isotonic solution sodium chloride, washing of purulent wounds and cavities (for example, paranasal sinuses, cavities of an open peritonsillar abscess or cavity of the otogenic or rhinogenic cerebral abscess after surgery, etc.) ozonized with 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 obtained, antibiotics of a wide range actions - amoxicillin, including in combination with clavulanic acid, cefotaxime, cefazolin, roxithromycin, etc. 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 taking drops or a spray, you can use a gel), in the absence of effect for 6-7 days are treated with imidazole drugs (nafazoline, xylometazoline, oxymetazoline, etc.).

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 the introduction into the sinuses of mixtures medicines, including broad-spectrum antibiotics and hydrocortisone suspensions. 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 by soft palate when pronouncing a vowel to a patient (for example, "y") and negative pressure in the nasal cavity created by the electro-aspirator.

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

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 colored masses can be suspected fungal infection, 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 bacteriological examination 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 minutes.

In case of necessity of long drainage of the sinus and introduction of medicines into its lumen 2-3 times in day, a special synthetic drainage from the thermoplastic mass is installed through the lower nasal passage. 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 functioning a natural outlet, and the restoration of full drainage and aeration of the sinus. 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.

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Sinusitis: features, symptoms, treatment methods

Sinusitis (code on mb 10 - j32) - an acute inflammatory process, localized in the maxillary sinuses. In these sinuses, mucus is formed, which quickly becomes purulent. Infection affects the inner epithelium of the sinuses themselves, which quickly leads to sinusitis. Very rarely the disease appears immediately. Therefore, most often sinusitis - the result of carelessness rights.

The first phases of the disease are diagnosed as rhinitis or common sinusitis. These are not such complex processes, often do not require cardinal treatment.If the runny nose in the initial stage or there is a risk of its appearance, then the sinusitis can be stopped even by folk remedies.

Usually, the patient has about 5-7 days in order to localize the process and prevent the transition to sinusitis. The exception is only those people who have a history of chronic disease. In this case, it proceeds differently.

Forms and types

Sinusitis is classified according to the form of the course, signs and pathogens. There are two forms: chronic and acute. In acute sinusitis, the causative agent is a sudden viral infection that has become a complication after such diseases:

measles;
scarlet fever;
rhinitis;
ARVI;
ARI; from this article you can find out what to do when there is no cough after ARI.
cold (flu).

The acute form passes aggressively, almost uniquely involving the ears of the patient. In general, sinusitis is dangerous precisely by a close ligament with the ear. Such a chain is dangerous for those who have a predas
the condition for otitis.

The chronic form is not so active even at the time of exacerbations. Here the character is more often sluggish, in which exacerbations are replaced by temporary remissions. Inflammation is almost constant, the symptoms are more even with the preservation of the main signs.

Infection often affects both sides, but its type may be different: infectious or bacterial.Viral sinusitis, in which a malignant agent is "implanted" by a primary disease. Cause of bacterial type - hit

bacteria from the cocci class.

Sinusitis is also divided according to the severity of the flow and manifestation:

catarrhal form.Sudden and acute form caused by the virus, but without complications;
purulent form.To the attack of the virus joined the bacterium, eventually mucous edema;
traumatic.After injury, the blood remained in the sinuses, which caused infection.

Two additional forms appear as chronic: fungal type and polyposis. Develop slowly, without bursts. Rarely identified immediately, usually it is a random finding during routine inspections.

Causes and predisposing factors

The three main causes of sinusitis

Genyantritis is a whimsical disease, its character depends on the timeliness of the treatment. It is important to pay attention to its provocateurs, especially if the anamnesis is predisposition to ENT diseases. To cause infection and create the ideal soil for the disease can:

ARVI and ARI;
rotten teeth;
bacteria of the cocci class;
allergy;
cold;
flu;
anomalies in the structure.

What is the treatment of thick nozzles in a child, is indicated in this article.

The adult snot has a brown color, what can be done with this in this article.

The child's snot flows like water, which is indicated here: http://prolor.ru/n/lechenie-n/sopli-kak-voda-u-rebenka-chem-lechit.html

In these cases, sinusitis is secondary and takes the form of complication.But he is dangerous because he always starts a fatal bundle: sinusitis - otitis.It is extremely important to protect yourself from any hypothermia, especially the legs. The first reaction of the body to cold is a runny nose. And then the infection went "walk" through the body. If there is such a threat, you should immediately stop the probability of consequences. This is especially critical in the off-season, when the immune system weakens and diseases cease to obey protective barriers.

First signs

The first sign of genyantritis- duration of the common cold.If the body is able to cope with the virus or bacterium itself, the cure will take place within a week with the minimum of your participation. But if the runny nose lasts two weeks or more, this is already an excuse to talk about sinusitis. Yes, often by this time the patient is changing the color of mucus. It becomes thick, viscous, changes color to yellow or green.

However, there is also a catarrhal form of the disease, in which mucus can remain transparent. To a genyantritis necessarily accompany a few constant signs:

headache;
hum in the head;
morbidity in the region of the frontal lobes;
permanent stuffiness;
a bad condition is common.

If the process is purulent, it can cause a different temperature, worsening the condition. The hearing can decrease, the sense of smell disappears, the taste sensations change.

Diagnostics

In general, the diagnosis of sinusitis includes three components:

a swab from the sinus;
Rhinoscopy;
X-ray.

But experts rarely observe this procedure. Only x-rays of the sinuses are necessarily prescribed. This is a necessary step to determine the state of neglect. Then the sinus is inspected, and the complaints are the addition to the general picture.

Treatment of genyantritis

Medicines

Almost 95% of the treatment of sinusitis starts with a procedure like a sinus puncture.Extremely unpleasant procedure, but almost painless. The patient is given a local anesthetic and then the surgeon starts the puncture. During the operation, a person will feel a strong pressure on the head and inside the nose. This is because the doctor presses one hand on his head, and the second hand makes efforts to break through the septum. The whole process takes about 10 minutes.

The danger of sinusitis is so great and fraught with complications that even with complaints about the otitis, the patient first check the condition of the sinuses.

At the slightest suspicion of sinusitis, a puncture is prescribed. This method allows you to completely remove the mucus. If necessary, put a catheter for further washing. Usually a catheter is placed for 5 days, but puncture can be performed repeatedly. While the doctor does not see the dynamics of improvement, the patient lies in the clinic.

At the same time, powerful modern antibiotics are prescribed for sinusitis, usually Cefotaxime.The drug group of third-generation antibiotics, well tolerated and has a huge spectrum of action. It is possible that an antibiotic will not be absorbed by the body and there will be no improvement. Normally, this doctor and he can see by the growing indicators of leukocytes. But there are predisposing forms of sinusitis and otitis, which are extremely difficult to treat.

If you have had or have severe medical history problems, tell your doctor. Pay attention to the poor assimilation of antibiotics, if it already was. Then the drug will be administered intravenously, which will make the result extremely effective.

Antiviral drugs are also prescribed: Arbidol, Sinupret. More often it is Sinupret, since its direction is the relief of sinusitis and sinusitis. If we are talking about the treatment of the chronicle, Sinupret-Fort is appointed. It has a longer duration and does not require reception by the clock.

The composition of therapy necessarily includes antihistamines: Suprastin, Diazolin. They help to cope with swelling and prevent the allergic reaction of the body to other drugs.

Home Treatment

For the treatment of sinusitis, nebulizer inhalations are especially suitable

Genyantritis is allowed to treat at home only after a doctor's examination:

with mild forms;
when combined with a main therapy regimen;
in rehabilitation after severe form.

To facilitate breathing and stopping the remnants of inflammation, inhalations are suitable for sinusitis on the basis of propolis.For 3 liters add 30% of the tincture and actively breathe the healing steam. What drops to treat sinusitis? You can prepare drops: in equal parts, take aloe, honey and celandine. Everything is mixed, diluted with water.Important: be careful with celandine!The herb is extremely poisonous and can lead to allergies and signs of intoxication when over-saturated. Drops are effective, but first make sure of the tolerance of the herb: take more portions of honey and aloe, and cleanse a pinch. So you will not suffer and maximum (with allergies) will be covered with urticaria.

Ideal sea-buckthorn in its pure form as a drop. She will remove swelling, protect against epithelium drying and stimulates immunity.

Effects

The genyantritis is terrible "in anger", its minimal complication is otitis. But this is only one of the possible options. Complications of the whole spectrum:

purulent, serous meningitis;
brain abscess;
damage to the shell and its swelling;
reactive edema of the brain or retina.

After some sinusitis, people go blind, go dead forever. Therefore, when treating a disease, it is better to raise an alarm in vain than to leave it on its own. And also do not forget about the prevention of sinusitis in the common cold.

Video

More information about sinusitis - in this video:

Sinusitis can leave a terrible imprint, especially neglected. Mortality increases by 3% every year. Only earlier treatment can save you from such an "acquaintance".

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Features of treatment of bilateral sinusitis

bilateral sinusitis should call a doctor

Bilateral sinusitis is one of the most common and serious diseases.Wrong treatment of this disease can lead to the fact that it will flow into a chronic form.This disease can also overtake children. In order to correctly diagnose, correctly appoint a treatment, you need to see a doctor. What are the symptoms accompanied by bilateral sinusitis?

Symptoms

If the sinusitis begins its development immediately in two sinuses, then the disease is quite hard.

Body temperature rises above 38 degrees.
The nose is permanently embedded.
There is an unpleasant smell from the mouth.
First there are small purulent discharge from the nose, then these discharge become thick and yellow.

Depending on which forms of sinusitis arise, the symptoms also depend.If the inflammation is catarrhal or serous, then all manifestations will not be very disturbing.Usually, breathing is difficult, there is pain in the nose and forehead. From a nose there are plentiful allocation. With the development of purulent bilateral sinusitis, the nose is clogged with mucus, so the bacteria develop very rapidly, pus is formed. During this time period the following symptoms appear:

chills, fever, fever;
weakness, loss of strength;
headache.

How to treat a cold in a newborn is indicated in this article.

How to cure a runny nose folk remedies quickly, is indicated in the article.

How is the treatment of the common cold with pregnancy folk remedies, you can find here: http://prolor.ru/n/lechenie-n/lechim-nasmork-pri-beremennosti-narodnye-sredstva.html

On the video - bilateral sinusitis:

If there was a purulent process, the patient's lack of normal breathing does not bother so much. More serious processes will begin, if this type of sinusitis is not treated. Otitis, meningitis, and a number of other diseases may appear.

A person with a chronic sinusitis will not feel any very strong changes. Disturb will be a stuffy nose and a fairly tight discharge. Also, the sense of smell disappears, and this, in turn, complicates the work of the brain. As a result, a person quickly gets tired.

It is worth noting that preschool children practically do not suffer from such a disease. Sinusitis occurs often after 10 years. If at this age it is not good to cure inflammation, it will lead to negative consequences.

Kinds

Acute form- is manifested as a result of the penetration of bacteria or infections into the sinuses of the nose, the ducts of the maxillary sinuses are clogged.
Chronic form- Usually occurs if the acute form is not treated. But it can also occur if there are still some foci of infection nearby, for example, in the oral cavity.

Depending on what form of inflammation occurs, the following types are distinguished:

Catarrhal viewIs the easiest kind of bilateral sinusitis. With this form only the upper layers of the mucosa are affected as a result of the viral infection. Edema occurs, but shows little. From the nose there are secretions that have no odor and color.
Serous or exudative- in this case, the development of a large amount of serous fluid begins, mucus secretions are formed. But as a result of the fact that the outflow of mucus from the nose is disturbed, bacterial infections begin to occur, resulting in ulcers.
Purulent appearanceIs a complicated form of catarrhal or serous process. In this case, the patient suffers from more complicated symptoms. Slime, which stands out from the nose, becomes viscous, and the smell is unpleasant. It is purulent bilateral sinusitis is more common than others. Pain in the bridge of the nose interferes with sleep, discomfort is felt, the temperature can often be increased. The main thing is that the first symptoms are very similar to a cold. In this regard, people do not go to see an otolaryngologist, which leads to serious consequences. About how to treat purulent maxillary sinusitis without a puncture, is specified in the article.

On video - treatment of bilateral sinusitis in a child:

There is an International Classification of Diseases or abbreviated ICD 10. In this document all pathogens of diseases, classification and cause of death are fixed. Each disease carries a certain code of the ICD.Acute sinusitis has the code J01.0. This species refers to acute respiratory diseases.And here the chronic genyantritis has other code - J32.0.

reviews of Albucida in the common cold in children.

In the article references of Albutsida at a cold in children are indicated.

What folk remedies for the common cold with pregnancy are most often used, is indicated in the article.

How the common cold is treated with folk remedies at home, is indicated here: http://prolor.ru/n/lechenie-n/narodnye-recepty-ot-nasmorka.html

It is known that sinusitis can be caused by various pathogens. In this connection, use the additional code. B95 is the causative agent of streptococcus or staphylococcus aureus. B96 - other bacteria, B97 - viruses that provoked the appearance of the disease.

On the photo, a two-sided sinusitis:

Treatment

The most important thing in treatment is to remove the pathogenic microflora.90% of cases are accompanied by the development of the disease against a background of bacterial infection.In order to accurately identify the pathogen, it is necessary to take excreted mucus for research. Drug treatment mainly consists of the use of the following drugs:

Drops, narrowing vessels. Due to their use, the edema of the mucous membrane decreases, and, therefore, the passages stop clogging, a person can breathe. Such drops can be applied no more than 5 days, since in the subsequent they will cause a habit, and then the nose can not breathe without their help.
Rinsing of the nose- this procedure is quite important. Due to the solutions used, the mucus leaves better, and the pathogenic microflora is destroyed. Washing can be done both in a polyclinic and at home. At home, you can use saline, decoction of herbs, drugs that are sold in a pharmacy such as Rotokan, Chlorophyllipt. Washings are often done, at least 4 procedures must be done per day.
Use of anti-inflammatory drugs. The composition of these drugs include antibacterial components. Such drops include Pinosol, Sinuforte. A Sinupret can be used inside.
Antibiotics. In the treatment of sinusitis without them, it is very difficult to manage. Cephalexin, Macroben is prescribed for various forms of sinusitis. The most important thing is to drink antibiotics courses. It is necessary to finish them up to the end, otherwise you can not achieve complete cure.
Antihistamines. Such drugs are usually prescribed to children. The puffiness is removed, the respiration is adjusted. You can drink such drugs in case of an allergy.
Warming up. It is used in the case when pus accumulations have been removed.

It is worth considering that it can be used in the event that when pressing on certain areas on the face there are no strong pain sensations, the body temperature is not increased. How does heating occur with sinusitis with salt, indicated in the article.

If all these types of conservative treatment did not help ease the condition, then use such a procedure as a puncture. The nose region anesthetize and pierce the place between the sinus and the nasal passage - through the bone septum. The entire area of the puncture is rinsed with an antiseptic, removes excess mucus, and injects the medicine into the sinus area.

Folk remedies

Folk methods are used as additional measures to the main treatment:

Inhalation. This will help potatoes. It is necessary to take 1 kg of potatoes, but do not clean it. When the potatoes are cooked, you need to drain the water, and breathe over the steam. It is necessary to take shelter from above with a towel, so that the pairs of potatoes do not go away quickly. The time of the procedure is unlimited: it all depends on the abilities of the person. After the end of the procedure, you need to lie on the bed without a pillow, and throw your head back. Inoculate the onion with a solution of onions. Cook it as follows: squeeze 15 drops of juice from onions and mix them with 15 drops of alcohol, concentration of 96%. In each nasal passage, drip 2 drops. At first this procedure will cause a strong burning sensation, but after 20 seconds everything will pass. It is best to do this procedure at night. By morning all the symptoms will go away.
Eggs and garlic. It is necessary to weld 1 hard-boiled egg. Now you need to warm up your sinuses. Instead of the egg, you can use salt, heated in a frying pan and wrapped in canvas paper. After warming, rub garlic on the skin above the place where the focus of inflammation. Then you need to rub the mixture of burdock root with birch charcoal. The procedure lasts 30 minutes. Achieve a standing effect can be after 2-3 procedures.
Oil and Grass. You need 100 g of olive oil, you can take and sunflower, 1 tbsp. l. shredded lemon grass. Mixing these ingredients, put them in a dark place for 3 weeks, without forgetting to periodically mix the compound. Then you need to strain the solution, removing it from the impurities of Ledum. This oil can bury your nose. The first time you need to drip 2-3 drops in each passage, the next - 1 drop 4 times a day. The course lasts one week. Acute antritis, or rather a runny nose, for this period of time will pass, and chronic it is necessary to treat 2 weeks.
Plant from a tomato. It is necessary to take the tops of dried tomatoes, pour it with water and boil. Use this solution to do inhalation. Covered with a blanket, you need to inhale the right, left nostril, and the mouth alternately. It is necessary to conduct sessions for 10 days. The effect will not keep you waiting. It is better not to conduct this procedure for younger children.
Balm "star". You need to boil 5 or 6 liters of water, add 1 tbsp. l. soda and a little balsam asterisk. If there is none, then you can buy a liquid for inhalations in the pharmacy. Not superfluous will be added and 2 tbsp. l. vodka or alcohol. These solutions need to breathe for 20 minutes. In the beginning it is better to breathe with your mouth to get used, it will take about 10 minutes.Then you can breathe through your nose, so the nasal passages and nasopharynx warm up.The next stage is washing. It is necessary to prepare the following solution: in 200 ml of boiled water pour 25 drops of pharmacy propolis, ½ h. l. salt and 1 h. l. soda. With this solution you need to wash your nose using a syringe, but without needles, or a special syringe. After these procedures, you need to drip your nose with a solution of oil, which must be prepared 10 days before the procedure. Mix 200 g of olive oil with 1 tbsp. l. dry mint, 20 g propolis. Leave the oil for 10 days, then strain. In each pass you need to drip 1-2 drops. Complete this complex for 10 days.

The video tells you whether to agree to a protocol with bilateral sinusitis:

Features of treatment in children

Children often develop a chronic form of the disease due to the structure of the nose.

In the treatment it is best to use sprays and aerosols, and not drops, because the spray is evenly distributed in the nasal cavity. When using antibiotics, you first need to test for how the child reacts to them.

This will help to avoid side effects and waste time. Of course, this method of treatment, like a puncture, is used only in the most extreme cases. Choosing the traditional methods of treatment, too, pay attention to the composition of funds. Also the child can carry out acupressure and respiratory gymnastics.