What is cystic polyposis sinusitis?

Factors influencing the development of pathology

Polypous sinusitis appears under the influence of biological and external factors on the human body.

Biological effects include:

• disorders of the nervous system;
• decreased protective functions of the immune system;
• hypersensitivity of the nasal mucosa;
• hereditary factors.

Among the external factors, experts highlight:

• exposure to natural allergens;
• infectious diseases;
• sudden change in climatic conditions;
• mechanical effect on the mucous membrane.

The combined effects of external and biological factors provoke increased mucus production, which leads to inflammation of the nasopharynx.

Causes, symptoms and treatment of polyposis and cystic sinusitis

Polypous sinusitis is an inflammatory disease of the paranasal sinuses.
It develops due to blockage of the ducts connecting the sinuses to the nasal cavity by polyps. Polyps, in turn, are overgrown mucous membranes that have lost the ability to secrete mucus and accumulate it in themselves. The most common case is the formation of a polyp in the maxillary sinus. Allergic rhinitis or asthma.

The main predisposing factor to the growth of polyps is the presence of chronic allergic edema; such diseases include allergic rhinitis or bronchial asthma.

Viral infection or injury to the nose.

If, in addition, there are foci of chronic infection in the body, it can aggravate the development of polypous sinusitis. Also, various disorders in the structure of the nose, be it a deviated nasal septum or hypertrophy of the nasal turbinates, will contribute to the general complication of the disease.

Constant nasal congestion.

When the presence of a polyp growing in the nasal cavity and a deviated nasal septum are combined, one of the nasal passages may be completely blocked by the polyp, which will lead to a complete cessation of breathing on one side.

In turn, the cessation of adequate ventilation will increase the development of the inflammatory process in the paranasal sinus, thus forming a kind of vicious circle - inflammation promotes the growth of polyps, and polyps, preventing breathing, increase inflammation.

Since polyposis sinusitis, as a rule, is a complication of existing chronic rhinosinusitis, it does not cause any symptoms that force a person to urgently seek medical help.

Clinical picture of manifestation

The classic symptoms of the disease are difficult to go unnoticed. They are directly related to impaired nasal breathing and deterioration of well-being.

Polypous sinusitis is characterized by:

• violation of nasal breathing;
• swelling of the mucous membrane;
• active production of clear or yellowish mucus;
• blockage of the nasal passages with accumulation of mucous exudate;
• headache;
• deterioration of sense of smell;
• the presence of rounded formations in the nasal passages;
• feeling of a foreign object in the nose;
• voice change;
• feeling of fullness in the ears;
• increased body temperature;
• decreased appetite;
• general deterioration of health.

An increase in body temperature and a serious deterioration in well-being occurs in the later stages of the disease, when the sinuses, both or one of them, are completely blocked, and purulent exudate has accumulated in the cavities.

Types of polyps in the maxillary sinuses

Classification of polypous structures in the maxillary sinuses allows us to assess the nature of the neoplasms and the degree of potential risks.
Classification helps to draw up treatment tactics. There are three main criteria :

1. Localization;
2. Prevalence;
3. Types by morphology.

By localization

According to their location, polyps can be:

• Ethmoidal . The stroma is formed from the ethmoid epithelium of the mucous membranes. The polypous lesion affects the septa of the ethmoid tissue, forming a bilateral pathological process. Ethmoid polyps occur only in adults.
• Antrochoanal . The base of the growths consists of the mucous membranes of the maxillary sinuses. Neoplasms appear mainly on one side. Antrochoanal polyp in the nose is more common in childhood. How to find out if a child has polyps in the nose, read more here.
• Choanal . Stromal tissue is formed from a retention cyst located in the maxillary sinuses. A fairly voluminous neoplasm that requires surgical removal.

Polypous lesions at the stage of their formation resemble cysts with serous exudate.

By prevalence

When developing polypous sinusitis, the volume and prevalence of neoplasms is taken into account:

• neoplasms concern the ethmoid labyrinth;
• growths completely fill the lumen of the nasopharynx and paranasal sinuses;
• polyps grow on a large scale and are visible to the naked eye.

Filling of the segments of the nasal passages and cavities leads to stagnation of mucus, its infection, and disruption of nasal breathing.

Symptoms of growing polyps are always noticeable.

According to morphological features

Classification by morphology allows you to assess the degree of potential cancer risks.

The following types are distinguished:

• Hyperplastic - typical proliferation of mucous membranes due to impaired cell division;
• Inflammatory , when the growth of mucous membranes is based on inflammation and swelling;
• Neoplastic , which appeared from initially atypical tissues with high oncological risks.

Polyps in the maxillary sinuses against the background of chronic inflammation contribute to the duration of the active phase of the disease. Surgery is usually required to restore normal breathing.

What is the threat?

The danger of the disease is to a lesser extent due to the oncological transformation of tissues.

Against the background of active growth of the polypous unit:

• nasal breathing is impaired;
• the risk of developing acute sinusitis, ethmoiditis, frontal sinusitis, and sphenoiditis increases.

Polyps can form in any cavity of the facial bone. In young children, signs of chronic hypoxia increase due to a lack of oxygen supply to the brain. If you want to know about the causes of nasal polyps, go here.

Effective treatments

Treatment of polyposis sinusitis is carried out in two main ways: conservative and surgical. The purpose of conservative therapy is to exclude the factors that caused the disease. The operation involves direct removal of the polyp. How to treat the disease is determined by an ENT doctor.

Conservative therapy

Conservative therapy involves an integrated approach to solving the problem, including drugs in several areas.

1. Antibiotics. Antibacterial drugs are necessary to treat the complicated form. Depending on the complexity, systemic and local antibiotics are prescribed. Systemic antibiotics are prescribed for the treatment of chronic polypous sinusitis or sinusitis. The most effective antibiotics include Amoxiclav, Ecositrin, Sumamed, Suprax. Local medications are presented in the form of nasal drops or sprays. They are designed to irrigate the nasal mucosa and eliminate bacterial background. Most often, adults and children are prescribed Isofra, Polydex, Bioparox.
2. Antihistamines. The action of antihistamines is aimed at relieving swelling, normalizing mucus production, and preventing the growth of polyps. New generation drugs are considered the most effective. These include Zyrtec, Zodak, Claritin, Fenistil.
3. Vasoconstrictor drugs. The use of vasoconstrictor drugs is necessary for short-term removal of swelling from the mucous membrane in order to increase the effectiveness of therapeutic drops. They allow you to normalize nasal breathing for a short period of time.
4. Glucocorticosteroid sprays. Sprays are designed to provide an anti-inflammatory effect and reduce the size of existing polyps.
5. Compositions for washing. In addition to the main drugs, saline solutions are used to cleanse the nasal cavity. The most effective is saline solution or compositions with sea salt. Cleansing solutions are used after vasoconstrictor drops, before using the main medication.

See also

Causes, symptoms and treatment of sinusitis in children

Read

In cases where polypous sinusitis cannot be treated with conservative methods, surgery may be prescribed.

Surgical intervention

Surgery is one of the most effective treatment methods. Its main disadvantage is the possible relapse of the disease.

Experts distinguish two removal methods.

1. Endoscopic removal. An endoscope is used for the operation. The method is low-traumatic. The main advantage of removal with an endoscope is the ability to observe all actions on the monitor. This minimizes the risk of complications.
2. Maxillary sinusotomy. The method is effective for the treatment of polypous sinusitis and complicated forms of sinusitis. Its peculiarity is to create an incision and create open access to the sinuses. Maxillary sinusotomy shows good results when it is necessary to remove purulent formations.

Most often, experts recommend using a combined method. It consists of surgical intervention and subsequent drug treatment.

In uncomplicated cases, sinusitis is treated with folk remedies. The use of medicinal herbs and natural products requires consultation with specialists and increased caution due to the risk of developing an allergic reaction.

Treatment options for polypous sinusitis

The treatment regimen for polypous sinusitis is selected by the ENT doctor individually for each patient by comparing:

• The nature of the complaints;
• Anamnesis data;
• Results of instrumental research;
• The probable cause of the development of the disease;
• The presence of other somatic pathologies in the patient;
• Patient preferences and wishes;
• Individual tolerability of pharmacological agents and their compatibility with other medications taken by the individual;
• Predicted effect and existing risks.

For small polyps, it is recommended to begin therapy by resorting to conservative methods of treating sinusitis, since the huge arsenal of modern pharmacological agents, when properly selected and taken regularly, in most cases allows one to avoid surgical intervention.

In the case of obstructive (closing the lumen) polypous formations, there is every reason for surgical treatment .

On the practical side, when choosing a treatment method, the following subtypes of polypous sinusitis are distinguished according to the factors that provoked the process of tissue proliferation:

• Disorders caused by pathologies in the architectonics (anatomical structure) of the nasal cavities;
• Chronic inflammation of the maxillary sinuses of bacterial or fungal origin;
• Conditions developing against the background of aspirin-induced bronchial asthma - the Fernand-Vidal triad (intolerance to non-steroidal anti-inflammatory drugs).

Corticosteroid sprays.

Patients suffering from proliferating sinusitis are required to undergo a course of corticosteroid therapy aimed at eliminating swelling of the mucous membranes of the nasal cavities, due to which purulent accumulations drain from the maxillary sinuses and natural respiration is restored.

However, pharmacological therapy is not a radical method of combating growths in the nose, but acts as a way to stop their growth and development.

Microdebrider or mini meat grinder.

In the vast majority of cases, it is necessary to resort to surgical interventions performed using modern endoscopic equipment - electromechanical instruments, such as Shaver (microdebrider) .

Features of the cystic form

The difference between cystic polyposis sinusitis is the formation of sacs filled with liquid contents. The formation of a cyst is associated with swelling of the mucous membrane and blockage of the ducts of the gland, which is responsible for the removal of mucus. As a result, mucus production continues, but without being discharged. The walls of the ducts gradually stretch, forming a cyst.

The disease has similar symptoms to the simple form. They can be distinguished by diagnosis from a specialist or an x-ray.

To treat cystic sinusitis, conservative methods or surgery are used. The disease is chronic. It has stages of remission and exacerbation. Even after a successful operation and a course of drug therapy, it is necessary to monitor the condition of the nasopharyngeal mucosa.

Methods for diagnosing polyposis sinusitis

In order to accurately determine how much the polyps have grown and the condition of the patient’s mucosa, two types of examinations are used:

1. Endoscopy.
2. Rhinoscopy.
3. CT scan.

Using the latter method, you can accurately determine the number of polyps, their location, size and shape. Radiography does not provide such a complete picture, but, nevertheless, this method is also used quite often.

Tests for allergic reactions are also carried out to accurately determine the cause of the development of polyposis sinusitis.

Cystic sinusitis

Cystic sinusitis is very similar in nature to polypous sinusitis, the only difference is in the substrate. A cyst is a sac filled with fluid. How is it formed?

The mucous membrane contains a huge number of glands that produce secretions, as already mentioned, to cleanse the nose of incoming dust.

Under the influence of edema or other reasons, the excretory duct of the gland to the surface of the mucous membrane may be blocked. In this case, the fluid secreted by the gland accumulates in the excretory duct, stretching it, sometimes to very impressive sizes, and a cyst is formed.

The symptoms of cystic sinusitis are the same as with the polyposis variant; they can only be distinguished by examining the nasal cavity or by radiographic examination if a pathological formation is found inside the sinus.

Conservative treatment also does not have any fundamental differences and is aimed primarily at relieving edema.

Symptoms

At the initial diagnostic stage, the doctor interviews and examines the patient. Chronic polypous sinusitis occurs in both adults and children. It can be suspected based on a number of signs:

• Nasal congestion.
• Deterioration of nasal breathing.
• Decreased sense of smell.
• Scanty viscous discharge (mucous or mucopurulent).
• Nasal voice.

The severity of clinical signs is determined by the localization of polyps, their size and the prevalence of the inflammatory process. Patients may experience headaches due to hypoxic disorders. During the interview, the doctor takes into account the anamnestic data. Information about bronchial asthma, drug or food allergies, injuries to the nose or operations on it is especially important.