Aero sinusitis — the acute inflammatory disease of additional bosoms of a nose arising in a consequence of their traumatizing at sharp change of pressure of atmospheric air. Aero sinusitis can be observed at pilots, scuba divers, participants of lacunar works or experiments in a pressure chamber. The clinical picture of aero sinusitis includes a congestion of a nose, pain and a raspiraniye in the field of the inflamed sine, headaches, existence separated from a nose. Diagnosis of aero sinusitis is carried out by means of a rinoskopiya, a X-ray analysis of additional bosoms of a nose, a bacteriological research. Medical actions at aero sinusitis include an instillation of vasoconstrictive drops, washing and drainage of okolonosovy bosoms, sanitation of a nasopharynx. At existence of indications surgical treatment (a gaymorotomiya, a frontotomiya) is performed.
Sharp pressure difference of the air environment in which there is a person is capable to cause a barotrauma of the structures of its organism filled with air. Except aero sinusitis at the same time there can be an injury of a drum cavity (aero otitis) and lungs (pheumothorax, emphysema). On occurrence frequency among these diseases aero sinusitis is in the second place after aero otitis. Most often the pilots testing considerable pressure differences at sharp ascent or decrease in the plane, divers at deep immersions, workers in a caisson and also the persons passing tests in a pressure chamber suffer from it.
Mechanism of developing of aero sinusitis
Emergence of aero sinusitis is connected with violation of balance of pressure of air in an okolonosovy bosom and in the external environment. At increase in atmospheric pressure pressure in a sine turns out rather low what promotes a congestion in a bosom of exudate and blood. At decrease in external pressure pressure in a sine is superfluous and can injure its walls. In both options noncompensated pressure difference negatively affects a state and blood supply of a mucous okolonosovy bosom that can lead to emergence of inflammatory changes with development of aero sinusitis. There is a puffiness mucous, submucous hemorrhages, ventilation of a bosom is broken. In such conditions easily there is an infection of a bosom and aero sinusitis is complicated by purulent sinusitis.
The modern otolaryngology considers that developing of aero sinusitis is promoted considerably by the pathological changes complicating ventilation of sine and breaking passability of the openings reporting them with a nose cavity. So, aero sinusitis develops at persons with a curvature of a nasal partition and violation of an anatomic structure of a nasal cavity as a result of congenital anomalies or injuries of a nose more often. Inflammatory processes of a nasopharynx (rhinitis, adenoides) and the allergic diseases which are followed by puffiness mucous a nose (, allergic rhinitis), also favor to development of aero sinusitis.
Aero sinusitis symptoms
Aero sinusitis has mainly bilateral character. It is shown by an intensive headache and face pain, is frequent in the field of localization of the affected okolonosovy bosoms. Pains at aero sinusitis can irradiate in a temple or have diffusion character. As a rule, they are followed by feeling of excessive pressure, a raspiraniye or weight in the inflamed sine. Patients with aero sinusitis complain of a congestion of a nose and the expressed difficulty of nasal breath. Nasal bleedings are in some cases noted.
Accession of a secondary infection at aero sinusitis is characterized by temperature increase of a body, emergence of the general symptoms (an indisposition, weakness, fatigue) and the dense allocations from a nose having yellow or chartreuse color. Most often aero sinusitis develops with damage of a frontal bosom and is followed by symptoms of a frontit. Less often the maxillary aero sinusitis which is shown characteristic symptoms of antritis meets.
Diagnosis of aero sinusitis
In diagnosis of aero sinusitis inquiry of the patient concerning his profession and identification in the anamnesis of the fact of a barotrauma is important. At survey of the patient with aero sinusitis the otolaryngologist can reveal expansion of skin capillaries in the affected additional bosoms of a nose. Also breath of the patient through a mouth attracts attention.
Inspection of a nasal cavity — a rinoskopiya is performed. It allows to diagnose pathological conditions of a nasopharynx which promoted emergence of aero sinusitis and are capable to aggravate its current. At a rinoskopiya puffiness and hyperaemia mucous, an effluence separated from openings of the affected okolonosovy bosoms is observed. The X-ray analysis of okolonosovy bosoms at aero sinusitis reveals blackout in them, sometimes on the roentgenogram liquid level is noted. The bacteriological research of dab from a nasopharynx and separated from a nose is made for definition of a species of pathogenic microflora and its sensitivity to antibacterial medicines.
At suspicion on an aero sinusitis combination to aero otitis the hearing research (audiometriya) and an otoskopiya, for diagnostics of damages of pulmonary fabric — a X-ray analysis of lungs is conducted.
Treatment of aero sinusitis
For the period of treatment patients with aero sinusitis are exempted from the works connected with flights by plane, caissons, pressures chamber and divings. The main objectives of treatment of aero sinusitis are: removal of puffiness mucous, restoration of passability and normal drainage of the affected additional bosoms. For this purpose carry out an instillation to a nose of vasoconstrictive medicines (, , naphazoline and so forth), drainage and washing of okolonosovy bosoms by means of a suction by the cuckoos method or way a sine evacuation with use a sine catheter. At an intensive pain syndrome purpose of analgetic and anti-inflammatory medicines is shown.
Treatment of the associated diseases of a nasopharynx aggravating the course of aero sinusitis is important. The aero sinusitis complicated by a secondary infection demands performing system antibiotic treatment which is appointed on result of an antibiotikogramma. Application of physical therapy is effective: UVCh, diadynamic currents, , , inhalations. However its carrying out is possible only at the normal body temperature of the patient.
In most cases aero sinusitis conservative therapy is rather productive and leads to recovery of the patient. At impossibility of adequate drainage of a bosom the threat of development of purulent complications arises by conservative methods and a congestion of a large amount of purulent exudate in a cavity of a sine: abscess of a brain, purulent meningitis, osteomyelitis. In such situations surgical treatment of aero sinusitis is shown. Operation of a gaymorotomiya or frontotomiya which consists in opening according to maxillary or a frontal bosom, removal from it of pus and nekrotizirovanny fabrics, creation of conditions for normal drainage is performed.