Acute sinusitis is a form of the disease based on a prolonged inflammatory process in the maxillary sinuses, when the mucous membranes swell and provoke copious discharge. The disease is characterized by a runny nose with an unpleasant odor, swelling of the face and elevated body temperature.
An x-ray of the maxillary sinuses shows accumulation of fluid in the form of darkening.
The disease occurs due to a cold or flu “carried on the legs”, the cause is the presence of a virus in the body that could not suppress the immune system. In the process of weakening the immune function, the work of the local microflora is disrupted and bacteria develop on the nasal mucosa, which enter the sinuses, where the development of acute sinusitis begins.
Development of exudative acute sinusitis from catarrhal form to advanced
When a disease enters the body, 3 main protective functions are activated to eliminate it: lymphatic, cardiovascular and immune. They increase blood flow to the affected area (in this case, the nasal mucosa) and provoke the production of “main defenders” - leukocytes.
This leads to the fact that a large number of antibodies accumulate in one place, swelling of the mucous membrane develops, which disrupts the natural circulation of air and the outflow of secretions. They accumulate in the maxillary sinuses (rhinosinusitis begins to develop), the patient experiences headaches and discomfort in the cheek area due to the pressure exerted by the exudate inside the sinuses.
How to breathe properly over potatoes when you have a runny nose is described here.
And then, along the “well-trodden path”, depending on the degree of ignoring the disease, the development of the following stages is observed:
- Catarrhal form - discharge from the nasal cavity of liquid mixed with exudate.
- Serous is characterized by swelling of the nasal mucosa and difficulty breathing.
- The purulent form is characterized by the release of pus from the nasal sinuses (in a significant volume).
- Mixed includes symptoms of the three previous forms.
Causes of the disease
According to the ICD 10 reference book, sinusitis in its various forms is the most common infectious disease of the ENT organs. Its complications still lead to various pathologies and a high mortality rate among children and adults in many countries of the world.
Inflammation of the maxillary sinus or sinuses is very common. There are many reasons why inflammatory processes begin to develop in the maxillary sinuses. There is a predisposition to this disease if a person has:
- chronic inflammation of the nasal cavity in the form of allergic rhinitis, nasal polyps, chronic runny nose.
- chronic inflammation of the teeth or upper jaw. The close proximity of the roots of the teeth of the upper jaw determines the penetration of infections into the sinuses from diseased roots or canals of destroyed teeth.
- chronic infections of the tonsils and adenoids. The close location of the adenoids and frequent inflammatory diseases in them cause inflammation of the nasal cavity and sinuses.
- curvature of the nasal septum, deformation of the nasal turbinates and passages. These features may be congenital or acquired as a result of injuries and the development of purulent processes in the nose.
The danger of infection lies in the fact that the sinus is a closed, limited cavity. Once inside, a bacterial or viral infection finds itself in ideal conditions and begins to develop rapidly. High temperature, humidity, and poor drainage from the sinuses create excellent conditions for the proliferation of pathogenic microorganisms.
At the first stage, when the process of sinus inflammation begins, mucus is formed, making breathing difficult. It is an excellent environment for the development of pathogens.
Characteristic symptoms and signs
The characteristic clinical signs and symptoms of acute sinusitis (mild course of the disease) are:
- nasal congestion, difficulty breathing;
- the appearance of nasal discharge (sometimes mixed with pus);
- weaker sense of smell;
- pain in the forehead and cheeks.
Symptoms of acute sinusitis: purulent discharge, nasal congestion, swelling, unpleasant odor, polyps, bloody discharge.
With moderate and severe severity of acute sinusitis, the following signs are included:
- dehydration of the body;
- increased body temperature (over 38 degrees);
- worsening headache radiating to the temples and back of the head.
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Types in adults and children
This classification is based on the analysis of nasal discharge and, depending on the definition of the type, appropriate treatment is prescribed.
Catarrhal
This type occurs in a mild form with slight swelling of the sinus. Nasal discharge is colorless and odorless – hence the name “catarrhal”. However, catarrhal sinusitis is very similar to ARVI and is not detected in a timely manner. As a result, the disease may go unnoticed and progress to an advanced stage. Inflammatory mucus accumulates in the exudate void and gradually turns into pus. At this stage, symptoms of bilateral purulent sinusitis begin to appear.
Here the outflow of serous fluid from the sinuses is disrupted. The inflammatory process contributes to the formation of purulent discharge and swelling of the paranasal space. Usually the disease begins against the background of a bacterial infection or reduced immunity. The discharge has a thick consistency with an unpleasant odor and bloody spots. Untimely identification of the exudative type leads to serious complications, such as polypous growths or cystic neoplasms
In this case, the anastomosis swells, the drainage of the mucous membranes is disrupted, and the sinuses quickly become clogged. Good conditions arise for the growth of bacteria. This leads to the acute stage of the disease, which develops into chronic. The parietal type of bilateral sinusitis causes thickening of the mucosa and disruption of the natural outflow of mucus. Doctors often use only conservative therapy.
Sinusitis of this form is dangerous due to complications, since the purulent fluid, penetrating into the surrounding cells, destroys bones and soft tissue. The cause of the disease can be the presence in the body of:
- streptococci;
- chlamydia;
- Haemophilus influenzae;
- Staphylococcus aureus;
- mycoplasma.
The symptoms of this sinusitis are similar to a common cold or rhinitis. Therefore, if the disease is incorrectly identified, the problem may worsen, which will lead to atrophy of the mucous and bone tissues of the nasopharynx. In children, the pharyngeal and palatine tonsils enlarge, which provokes the development of adenoiditis and tonsillitis.
With this type, thickening of the mucous membrane and narrowing of the openings of the nasal sinuses occurs, and hypertrophic sinusitis is observed. Breathing through the nose is impaired. The disease is difficult, since it is difficult to choose the right treatment, and it is not always possible to be cured with therapeutic methods in the form of tablets and sprays. The mucous membranes of the sinuses grow, which disrupts the process of natural secretion.
The disease occurs due to the presence of a staphylococcal or streptococcal infection in the body. Improper nose blowing provokes the growth of pathogenic bacteria in the oral and nasal cavities, causing a pathological process. On an x-ray, hyperplastic sinusitis appears as a dark stripe with clear outlines.
Find out how to quickly cure a runny nose by following this link.
Polyposis
This type is characterized by the growth of the mucous membrane of the maxillary sinuses in the form of polyps and is formed over several years against the background of a chronic form. Polyps are benign growths whose nature is unknown. The secreted mucus contains many harmful bacteria that can cause infection in the oral cavity.
The disease polypous sinusitis requires immediate medical intervention, as it threatens the health and life of the patient. Headache, long runny nose, sinus congestion, as well as the sensation of a foreign body in the nasal passages indicate a polypous form of the disease.
Atrophic
Here, atrophy of the glands and weakening of the epithelial cells located in the mucosa occurs. The discharge is scanty with an unpleasant pungent odor. The disease is caused by various reasons:
- colds, acute respiratory infections;
- hypothermia of the body;
- allergic reactions;
- deviated nasal septum;
- polyps, adenoids in the nasal cavity;
- radiation sickness, tuberculosis.
Diagnosis
When visiting a hospital, an otolaryngologist makes a diagnosis based on the following indications:
- Collects anamnesis: when the development of the disease began - the first ailments, how many days lasted, what painful sensations were observed, whether there was a fever.
- Performs rhinoscopy - examines the nasal mucosa with a rhinoscope to assess the stage of swelling.
- Prescribes additional studies - x-rays to determine the degree of filling of the sinuses and the transparency of the discharge.
If the previous methods did not give a clear clinical picture, MRI, CT, or ultrasound of the sinuses may be prescribed, but, as a rule, in most cases, the previous methods are sufficient to determine acute sinusitis.
If it is impossible to determine the degree of development of the disease, sinus puncture may be prescribed, followed by bacteriological culture of the discharge. This is necessary to think through a regimen of medication and physiotherapeutic treatment.
According to ICD-10
In the International Classification of Diseases 10 Rev. (ICD-10), acute sinusitis is defined under the identifier J01.0, where 0 is the definition of the location of the inflammatory process depending on the area of the lesion. For example, frontal sinusitis will have code J01.1, and J01.4 - all sinuses of the upper respiratory tract are affected.
Classification according to ICD 10
According to the International Classification of Diseases, Tenth Revision, acute sinusitis (J01) is divided into:
- J01.1 Front
- J01.2 Ethmoidal
- J01.3 Sphenoidal
- J01.4 Pansinusitis
In turn, chronic sinusitis (J32) is divided into:
- J32.0 Maxillary
- J32.1Front
- J32.2 Ethmoidal
- J32.3 Sphenoidal
- J32.4 Pansinusitis
- J32.8 Other chronic sinusitis
- J32.9 Chronic sinusitis, unspecified
The terminology of the disease depends on the location of sinusitis. Most often, the disease occurs in the maxillary sinuses, which are located in the maxillary part of the head. If the inflammatory process affects only the maxillary sinuses, then this condition is characterized as sinusitis.
Maxillary sinusitis (sinusitis) (ICD10 code J32.0.) – inflammation in the upper paranasal sinuses of the nasal cavity. The disease can occur at any age. Statistics show that every tenth person has suffered from this disease.
It is very important to begin treating the disease at the initial stage of development, otherwise it will turn into a purulent form and subsequently can provoke the development of serious complications.
In most cases, sinusitis (ICD code 10) occurs as a result of repeated incompletely treated colds and rhinitis. But in addition to ARVI and a runny nose, the main cause of the disease is neglected teeth affected by caries, especially in the upper jaw (odontogenic). Diseases that cause disturbances in the immune system (allergies, paritosis and other long-term chronic diseases) can trigger the development of maxillary sinusitis.
Why it’s dangerous: complications and consequences
In the absence of timely and adequate therapy, as well as as a result of a severe weakening of the body’s protective function, various complications and consequences for the body may occur. The most common ones in adults and children are:
- Transition to chronic form. This complication is difficult to distinguish from ordinary sinusitis, a general malaise. The disease occurs with untreated acute sinusitis (becomes chronic). In this form, the disease is practically untreatable and requires surgical intervention, therefore it is considered dangerous, because can provoke inflammation in the internal structures of the head.
- Otitis media As a result of the spread of infection from the maxillary sinus to the middle ear, inflammation begins there, which leads to purulent formation. A characteristic symptom is shooting pain in the neck and a sharp rise in temperature.
- Inflammation of the trigeminal nerve. In this case, pain occurs with lumbago in the face. The disease is very difficult to treat.
- Vision problems: vein thrombosis, retinal edema. The simplest thing is bacterial conjunctivitis.
- Periostitis and osteitis. It is characterized by inflammation in the bone tissue as the infection spreads throughout the body. Requires surgical intervention.
- Meningitis is an inflammatory process that affects the lining of the brain. It is a treatable disease, but can be fatal. Can only be treated under the supervision of a doctor in a hospital.
Diagnostics
DIAGNOSTIC METHODS, APPROACHES AND PROCEDURES
Diagnostic criteria
Complaints: · violation of nasal breathing; · localized pain depending on the damage to the sinuses: - in the infraorbital (sinusitis); - superciliary (frontitis); - occipital (sphenoiditis); - in the area of the bridge of the nose (ethmoiditis); · purulent discharge from the nasal cavity; · nasal congestion; · swelling of soft tissues in the cheek area, at the root of the nose; · malaise.
From the anamnesis: we find out the timing and frequency of the disease.
Physical examination: · Rhinoscopy: hyperemia, swelling of the mucous membrane, purulent discharge from under the middle turbinate, purulent discharge in the posterior parts of the nose, discharge with a fetid odor. Palpation of the projection of the paranasal sinuses: - Frontal; — Lattice; - Maxillary sinuses. NB ! When pressing with the thumbs of both hands on the points of the first and second branches of the trigeminal nerve, their soreness is checked, which should not normally be present. The anterior walls in the area of the canine fossa are palpated using gentle pressure. Signs of involvement of the ethmoidal labyrinth and frontal sinuses in the pathological process may include pain on palpation in the area of the inner surface of the medial and upper orbits. Percussion in the projection of the paranasal sinuses: with the middle finger bent at a right angle, percussion is carried out on the anterior walls of the paranasal sinuses.
Laboratory tests: · complete blood count: leukocytosis, increased ESR; · study of microflora: identification of the pathogen; · cytological examination: neutrophyllosis, desquamated epithelial cells, mucus.
Instrumental studies: · Endoscopy of the nose and paranasal sinuses: using a flexible endoscope, a rigid endoscope 0, 30 and 45 degrees. with a diameter of 4 mm, using a rigid endoscope 0, 30 and 45 degrees. with a diameter of 2.8 mm in children. To identify features of the anatomical structure · X-ray examination of the paranasal sinuses (nasomental, nasofrontal, lateral projections): decreased pneumatization of the paranasal sinuses, sometimes it is possible to determine the horizontal level of fluid in the sinus (if the filming was done in a sitting position). · Contrast radiography: performed to clarify the form of the chronic process in the sinuses. · Fluorography of PPN: changes in the mucosa, presence of exudate. · Puncture of the maxillary sinus: presence of purulent contents.
Indications for specialist consultation: · consultation with an ophthalmologist – if intraorbital complications are suspected; · consultation with a neurologist, neurosurgeon – for intracranial complications; · consultation with a dentist, maxillofacial surgeon – in the presence of dental damage (sinusitis of odontogenic origin).
Diagnostic algorithm:
How to treat yourself quickly at home
Home treatment includes rinsing, inhalation, warming the nose, and using folk remedies. They allow you to quickly get rid of a runny nose only in the initial stages. The methods only complement drug therapy, which is prescribed by a doctor. But you shouldn’t treat yourself without consulting a doctor, because... You can choose the wrong medications and make the situation worse.
Drug treatment
If the acute form has catarrhal discharge, then the doctor will not rush to prescribe antibiotics. Treatment will consist of drugs that support the immune system, vitamins and auxiliary products, such as Sinupret.
This is a drug from the Bionorica company, which has an anti-inflammatory effect and enhances the secretion of the nasal mucosa, which helps remove infection from the sinuses. It relieves swelling, strengthens local immunity, and is often prescribed for the viral form. You need to take it for 7-10 days, 2 tablets 3 times a day.
Antibiotics
For sinusitis, antibiotics are often prescribed. Usually they begin to be used if the disease has become long-lasting and incessant, fever occurs, and the temperature rises. Antibiotics are relevant for exudative form with purulent contents.
Antibiotics are used for moderate and severe forms of acute sinusitis. The course of treatment for any of the medications is determined individually by the attending physician. Antibiotics are also included in nasal drops and sprays. In such forms of funds they have maximum effectiveness.
Some of the effective antibiotics during the treatment of chronic sinusitis are:
- Summed belongs to the group of macrolides of the latest generation. The main active ingredient is azithromycin. Effective against streptococci and staphylococci. It is taken according to the following regimen: 1 tablet 1 time per day for 3 days. If there is no effect, then the course is increased to 5 days of administration.
- Augmetin. Contains synthetic penicillin. Affects gram-positive and gram-negative aerobes and anaerobes (coagulase-negative staphylococci, etc.). Contraindications to the use of the drug include the presence of pathologies in the functioning of the liver and kidneys, age (up to three months is not prescribed), etc. During pregnancy and breastfeeding, consultation with a specialist is necessary. Recommended dosage is up to 40 microns per 1 kg of the patient's body.
- Bioparox. Included in the group of polypeptide antibiotics. Actively affects group A streptococci, pneumococci, staphylococci and other bacteria. Do not prescribe before age 12, if there is a risk of an allergic reaction. It is recommended to take up to 50 microns (1 release of the drug).
- Azithromycin. Belongs to the group of azalide antibiotics. It has a targeted effect on the source of inflammation. If there are contraindications (hypersensitivity, liver and kidney failure, etc.), this medication is not prescribed. The maximum dosage of the drug should not exceed 500 mg of the active substance (corresponds to one tablet).
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Drops and sprays
Sprays that contain antibiotics are the most effective means of treating sinusitis (even compared to drops). With their help, you can be sure of the accuracy of the dosage and they are distributed as evenly as possible throughout the nasal mucosa.
- Isofra. The spray contains framycetin. The effectiveness is due to the fact that the active substance has a targeted effect on the source of inflammation. At the same time, the sensitivity of other organs (for example, hearing) is not impaired, since this antibiotic has a large number of side effects.
- Polydexa. Includes phenylephrine and vasoconstrictor components.
- Rinofluimucil is a complex drug that can thin mucus and also have an anti-inflammatory effect, gently affecting the vessels of the mucous membrane.
- Nasonex spray. Belongs to the group of glucocorticosteroids, aimed at relieving symptoms - congestion and swelling of the mucous membrane, restoring breathing. Available in the form of a spray suspension. Use no more than 2 times a day, no more than 5 days.
Nasonex is a hormonal drug. Uncontrolled use can lead to disruption of the endocrine system.
Antipyretics and painkillers
The use of drugs that are included in this group can significantly reduce the patient’s body temperature, as well as provide an analgesic effect. Among them are:
- Aspirin;
- Paracetamol;
- Ibuprofen;
- Citramon.
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Traditional recipes for adults
In the treatment of acute sinusitis, traditional medicine recipes are also used. With an integrated approach, you can achieve the best results in a short time.
- Application of drops based on cyclamen root: plant juice is diluted in a ratio of 1:20 with boiled water and dripped into each nostril no more than 3 times a day.
- The use of honey capping is a substance that bees use to “seal” the honeycombs. The bee product must be chewed (1 tsp) for 15 minutes every hour. Take no more than 8 times a day.
- Breathe steam with propolis tincture. Add 1 teaspoon of propolis to boiling water, stir and breathe over the container, covered with a towel, for no more than 20 minutes.
- Experts also recommend using saline solution to rinse the nose.
Inhalations using a nebulizer
Due to the fact that warming the nose during sinusitis is strictly prohibited, you can only use a nebulizer. Essential oils, decoctions of chamomile or St. John's wort are placed in this device. The procedure lasts for 10-20 minutes. After it, it is not advisable to consume food or liquids, or go out into fresh air.
You may also be interested in the Dolphin nasal rinsing device, which you can read about here.
How to treat in hospital
In hospitals, when treating acute sinusitis, the following procedures are used.
Physiotherapy
Prescribed by a doctor as an additional treatment to enhance the effect of drug therapy.
- Tube-quartz. The “Solnyshko” apparatus is used. Result: metabolism accelerates, cell permeability improves. Immunity is also significantly improved.
- UHF. UHF and microwave therapy courses are used. Their essence is related to the impact of devices on the areas of the affected sinus. Recommends at least 15 procedures. The use of vasoconstrictors (Galazolin, Otrivin, etc.) may also be prescribed in parallel. Contraindications: high blood pressure, oncology.
- Laser therapy Its purpose is associated with an analgesic effect, as a result of which blood circulation increases, the concentration of bacteria in the sinuses and allergens decreases, and also helps relieve the inflammatory process.
- Magnetotherapy. When small electrical currents occur, redox reactions are activated and blood circulation is stimulated.
Procedures to cure sinusitis
The following procedures are carried out in medical institutions, which are preferable in the treatment of acute sinusitis.
Also read about how to rinse your nose with hydrogen peroxide in this article.
Puncture
If the problem cannot be eliminated and sinusitis does not respond to drug treatment, then the doctor will prescribe a puncture. The puncture is performed under local anesthesia (using lidocaine), and the cartilage tissue of the sinus is pierced using a special needle. Then an antibacterial or antiseptic agent is injected into the cavity.
YAMIK-catheter
A YAMIK sinus catheter is used. The essence of the procedure is to alternately cleanse the paranasal sinuses (on one side of the nose, then on the other). The advantage of this method is that it does not require a puncture and acts as the most painless and preferable option in the treatment of sinusitis in a hospital setting.
"Cuckoo"
Another name for the method is “proetz drug transfer”. During the procedure, a mixture of antibiotics and hydrocortisone is injected into the sinuses. The solution, penetrating into the maxillary sinus when the patient pronounces the sound “ku-ku,” allows you to create negative pressure (an electric aspirator is used for this) and the mucus begins to come out of the other nostril. Thus, you can easily clear the sinuses of accumulated secretions and pus.
