Sinusitis – the infectious and inflammatory process affecting a mucous membrane of okolonosovy bosoms. Can have the virus, bacterial, fungal or allergic nature. Temperature increase of a body, pain in projections of additional bosoms, difficulty of nasal breath, serous and purulent separated from a nose belong to the general symptoms characterizing the course of sinusitis. Sinusitis is distinguished on the basis of given to a X-ray analysis, ultrasonography, KT and MPT of okolonosovy bosoms, a diagnostic puncture. At sinusitis antibiotic treatment, physical therapy, medical washings, punctures and drainage, traditional and endoscopic operations on additional bosoms of a nose is carried out.
Sinusitis – inflammatory process in one or several additional bosoms of a nose. Sinusitis is diagnosed for 0,02% of adult population; at children of an upper respiratory tract infection are complicated by development of sinusitis in 0,5% of cases. In otolaryngology inflammations belong to sinusitis: a maxillary bosom – antritis, frontal bosoms – plays the dandy, a wedge-shaped bosom – sfenoidit, a labyrinth of a trellised bone – etmoidit. On a current allocate sharp and chronic sinusitis. The increased temperature, a headache, a congestion and purulent allocations from a nose, a face edema in a zone of the inflamed bosom is noted. In the absence of treatment serious complications develop: inflammation of an optic nerve and covers of an eye, osteomyelitis, brain abscess, meningitis.
Reasons of development of sinusitis
The nasal cavity is reported with seven additional (paranasal) bosoms: two frontal, two maxillary, two trellised and one wedge-shaped. Bosoms are connected to a nasal cavity the narrow courses. Through these courses constant drainage (clarification) of bosoms is carried out. If bosoms for any reason cease to be cleared, in them the secret stands and favorable conditions for development of sinusitis are created.
nasal bosoms can be blocked at various deformations of intra nasal structures (hypertrophic rhinitises, a curvature of a nasal partition, anomaly of a structure of a trellised labyrinth and nasal sinks). The viral infection is one more risk factor of developing of sinusitis. As a result of an inflammation the mucous membrane of additional bosoms and a nasal cavity swells. Mucous glands begin to develop a large number of a secret. paranasal bosoms are even more narrowed because of hypostasis of mucous and are hammered with a dense pathological secret.
Ventilation violation, stagnation separated and deficiency of oxygen in tissues of bosoms become a push for intensive development of opportunistic flora. Bacterial joins a viral infection. Degree of expressiveness of displays of sinusitis depends on virulence of the microbes causing an inflammation. Broad application of antibiotics leads to the fact that the bacterial flora which became the reason of development of sinusitis quite often differs in the increased resistance (resistance) to the majority of antibiotics.
In recent years sinusitis even more often is caused by fungi. The reason of this tendency is also covered in unjustified use of antibiotic treatment which negatively influences a condition of immune system, breaks normal structure of microflora and creates favorable conditions for development of a mycotic infection. Sinusitis at an initial stage is not necessarily provoked by microbes. The hypostasis of a mucous membrane leading to closing of soustiya of paranasal bosoms can be caused by inhalation of cold air and a number of chemicals.
However, immunodeficiency and allergic reactions are the most frequent reason of development of sinusitis. The allergy causes vasomotorial rhinitis, one of manifestations of which is hypostasis of a mucous nasal cavity. Process repeatedly repeats. As a result chronic sinusitis develops approximately at 80% of patients with vasomotorial rhinitis.
Classification of sinusitis
Depending on localization of process allocate the following types of sinusitis:
- Antritis. Inflammatory process strikes a gaymorova (maxillary) bosom.
- Etmoidit. The inflammation develops in a trellised labyrinth.
- Plays the dandy. Pathological process covers a frontal bosom.
- Sfenoidit. The inflammation arises in a wedge-shaped bosom.
First place on prevalence is won by antritis, the second – etmoidit, the third – plays the dandy also the fourth – sfenoidit. One is possible - or bilateral defeat. One or several bosoms can be involved in process. If the inflammation covers all additional bosoms, the disease is called pan-sinusitis.
All sinusitis can sharply proceed, or chronically. Sharp sinusitis is, as a rule, provoked by cold, flu, scarlet fever, measles and other infectious diseases. The disease proceeds 2-4 weeks. Subsharp sinusitis most often is a consequence of the wrong or insufficient treatment of sharp sinusitis. Disease symptoms at the subsharp course of sinusitis remain from 4 to 12 weeks. Chronic sinusitis becomes an outcome of repeated sharp sinusitis of an infectious etiology or develops as a complication of allergic rhinitis. Criterion of synchronization of process is existence of symptoms of sinusitis within 12 and more weeks.
Depending on character of an inflammation allocate three forms of sinusitis:
- edematous and catarrhal. Are surprised only a mucous membrane of paranasal bosoms. Process is followed by allocation of serous separated;
- purulent. The inflammation extends to deep layers of tissues of additional bosoms. Separated gains purulent character;
- mixed. There are symptoms of edematous and catarrhal and purulent sinusitis.
Symptoms of sinusitis
Clinical displays of antritis are in detail described in the article "Antritis".
Symptoms of an etmoidit
As a rule, inflammatory process in forward departments of a trellised labyrinth develops along with frontity or antritis. Quite often accompanies an inflammation of back departments of a trellised labyrinth sfenoidit.
The patient etmoidity shows complaints to headaches, the pressing pain in a nose bridge and a root of a nose. At children of pain often are followed by conjunctiva hyperaemia, hypostasis of internal departments of the lower and upper eyelid. Some patients have pains of neurologic character.
Body temperature usually increases. Separated in the first days of a disease serous, then becomes purulent. Sense of smell is sharply reduced, nasal breath is complicated. At a rapid current of sinusitis the inflammation can extend to an eye-socket, causing protrusion of an eyeball and the expressed hypostasis a century.
Symptoms of a frontit
Plays the dandy, as a rule, proceeds heavier than other sinusitis. The hyperthermia, a zatrudnennost of nasal breath, allocation from a half of a nose on the party of defeat is characteristic. Patients are disturbed by the intensive pains of area of a forehead more expressed in the mornings. At some patients decrease in sense of smell and a photophobia develops, eye pain develops.
Intensity of headaches decreases after depletion of the affected bosom and increases at difficulty of outflow of contents. In some cases (usually – at influenzal you play the dandy) change of skin color in a forehead, hypostasis of nadbrovny area and an upper eyelid on the party of defeat comes to light.
Chronic plays the dandy often is followed by a hypertrophy of a mucous membrane of the average nasal course. Emergence of polyps is possible. Sometimes the inflammation extends to bone structures, leading to their necrosis and formation of fistulas.
Symptoms of a sfenoidit
Sfenoidit seldom proceeds separately. Usually develops along with an inflammation of a trellised bosom. Patients complain of a headache in an eye-socket, areas of a darkness and a nape or head depth. At a chronic sfenoidit the inflammation sometimes extends to an optic chiasm, leading to the progressing decrease in sight. Quite often chronic sfenoidit is followed by the erased clinical symptomatology.
At sinusitis the eye-socket and intra cranial structures can be involved in pathological process. Distribution of an inflammation deep into can lead to damage of bones and development of osteomyelitis. The most widespread complication of sinusitis is meningitis. The disease arises at an inflammation of a trellised labyrinth and a wedge-shaped bosom more often. At you play the dandy epiduralny abscess or subduralny (more rare) brain abscess can develop.
Timely diagnostics of complications at sinusitis is sometimes complicated because of poorly expressed clinical symptomatology. The started intra cranial complications of sinusitis predictively are adverse and can become the reason of a lethal outcome.
Diagnosis of sinusitis
The diagnosis of sinusitis is exposed on the basis of a characteristic clinical picture, objective survey and these additional researches. In the course of diagnostics the X-ray analysis of okolonosovy bosoms in two projections, ultrasonography, a nuclear magnetic resonance and KT of okolonosovy bosoms is used. According to indications for an exception of complications it is carried out by brain KT or MPT.
Treatment of sinusitis
Therapy of sharp sinusitis is directed to knocking over of a pain syndrome, elimination of the reason of inflammatory process and restoration of drainage of bosoms. For outflow normalization otolaryngologists use the vasoconstrictive medicines (naphazoline, , etc.) eliminating hypostasis of a mucous nasal cavity and cavity of bosoms.
Practical application at sinusitis is found a method by a sine evacuation. The procedure is carried out as follows: enter two catheters into the different nasal courses. Antiseptics moves in one catheter and it is sucked away through another. Together with an anti-septic tank from a nasal cavity and a cavity of bosoms pus and slime is removed.
At sinusitis of the bacterial nature apply antibiotics. For release of a bosom from pus carry out its opening (a gaymorotomiya, etc.). At viral sinusitis antibiotic treatment is not shown as antibiotics in this case are inefficient, can aggravate violation of the immune status, break normal structure of microflora in ENT organs and to become the process synchronization reason.
To patients with sharp sinusitis appoint antihistamines and rassasyvayushchy medicines (to prevent formation of solderings in the inflamed bosoms). Antiallergic therapy is shown to patients with sinusitis of an allergic etiology. Treatment of an exacerbation of chronic sinusitis is carried out by the principles similar to therapy of an acute inflammation. In the course of treatment physiotherapeutic procedures (diadynamic currents, UVCh etc.) are used.
At inefficiency of conservative therapy of chronic sinusitis surgical treatment is recommended. The operations performed to patients with chronic sinusitis are directed to removal of obstacles for normal drainage of paranasal bosoms. Removal of polyps in a nose by the laser, elimination of a curvature of a nasal partition, etc. is carried out. Bosom operations are performed both by a traditional technique, and with use of the endoscopic equipment.