Sinusitis

The ENT organs, being an outpost of the immune system on the path of infection into the body, are the first to encounter the effects of various pathogens. That is why inflammatory processes often begin in them. Inflammation of the paranasal sinuses is called sinusitis . In total, a person has 4 pairs of paranasal sinuses, these are cavities filled with air. As a result of inflammatory processes, pus is formed in the sinuses, and the person begins to feel weak and unwell.

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Symptoms of sinusitis

There are acute and chronic forms of sinusitis, which differ in their symptoms.

Acute sinusitis. Symptoms:

Runny nose lasting more than 7-10 days, without signs of improvement;
nasal congestion, mucous or purulent discharge from the nose;
mucus running down the back of the throat, copious discharge of purulent sputum in the morning;
headache, heaviness and pain in the inflamed sinus area. Sometimes pain in the teeth, eyes, cheekbones, cheeks;
increased sensitivity of the facial skin in the projection of the affected sinus;
increase in body temperature (up to 38°C and above). As a rule, this symptom is observed in an acute case. In a chronic process, body temperature rarely rises or remains at subfebrile levels (37-37.50°C);
weakness, fatigue, irritability. Photophobia, lacrimation, loss of appetite, sleep disturbance;
weakened or absent sense of smell;
swelling of the cheeks and eyelids.

Chronic sinusitis. Symptoms:

Symptoms of chronic sinusitis depend on the form of the disease. Outside of an exacerbation, symptoms may be very mild or absent. The most common symptoms of concern are:

nasal congestion, difficulty in nasal breathing;
scant mucous or purulent discharge from the nose, may be in the form of drying crusts;
constant leakage from the nose, causing cracks and abrasions at the entrance to the nose;
mucus running down the back of the throat;
dry throat;
headache;
bad breath.

As the disease worsens, symptoms characteristic of acute sinusitis may appear.

Sinusitis in children

Sometimes sinusitis in children is more difficult to see than sinusitis in adults. The disease usually develops after an infection: influenza or sore throat, and is often accompanied by otitis media. The symptoms are somewhat blurred and appear weaker than in adults. Here are the main ones:

purulent or mucous discharge from the nose;
general weakness, malaise;
pungent odor from the mouth.

With sinusitis in children, one side of the face is often inflamed. While sinusitis in adults is often accompanied by headaches, headaches in children are extremely rare.

Types of sinusitis

There are several types of sinusitis:

sinusitis;
frontal sinusitis;
ethmoiditis;
sphenoiditis, but the latter type of sinusitis is extremely rare and almost always together with ethmoiditis.

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2 Examination of the nasal cavity in MedicCity

3 ENT unit Atmos S 31

Sinusitis is one of the most common types of sinusitis. This disease is accompanied by inflammation in the maxillary and maxillary cavities. During inflammation, swelling of the mucous membrane occurs, which blocks the opening from the sinus to the nasal cavity. Mucus begins to accumulate in the sinus space, pathogenic bacteria multiply, and pus appears. Inside the cavity, pressure occurs on the vessels, and the person begins to feel pressing pain at the site of accumulation of pus.

Chronic sinusitis is the result of a long inflammatory process, when a person has had sinusitis for more than 2 months. The patient develops general weakness, nasal discharge has an unpleasant odor, the sense of smell is impaired, and a night cough appears. Chronic sinusitis is characterized by inflammation of only one sinus, right or left. Pressure in the sinus can cause a deviated nasal septum.

Symptoms of sinusitis

The following symptoms are characteristic of sinusitis:

increased body temperature;
copious discharge, nasal congestion;
disturbances of smell;
weakness;
headache radiating to the forehead, bridge of the nose, teeth;
pain that intensifies when tilting the head and pressing on the sinus;
constant, intense pain;
a feeling of fullness in the forehead and cheeks, aggravated by tilting the head, coughing and sneezing;
photophobia and lacrimation.

Signs of sinusitis

If after a flu or cold the temperature rises again, your health worsens, severe pain appears when tilting your head and when pressing on the sinuses, then you need to urgently consult an otolaryngologist. These could be manifestations of sinusitis! Sinusitis in adults is often advanced, since adults are usually in no hurry to see a doctor.

Treatment of sinusitis

Antibiotics for sinusitis are used only after a complete examination of the patient, based on the characteristics of his body and possible allergic reactions.

Antibiotics are not advisable in case of sinusitis of allergic or fungal origin. For mild sinusitis, inhalations, rinses and immunotherapy are also sufficient.

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Causes

There are three reasons for the appearance of pathology. They usually cause disease in the presence of provoking factors, which lead to a drop in immunity and a weakening of the body's natural defenses. In individuals who suffer from a constant decrease in immunity, the likelihood of pathology occurring is especially high. The following reasons provoke the development of the disease:

penetration of infection into the nasal sinuses - the problem is most often caused by bacteria and somewhat less frequently by viruses. Exceptional cases would be fungal sinusitis. Penetration of bacteria can occur from the pharynx, nasal passages, or the infection enters the sinuses with air;
an allergic reaction also often provokes the appearance of pathology. Due to allergies, swelling of the mucous membrane develops, which disrupts the outflow of the contents of the paranasal sinuses. As a result of this, stagnation develops in them, which becomes the cause of further formation of sinusitis, which in most cases is bilateral;
mechanical blocking of the sinus lumen - various polyps in the nasal cavity are often bilateral, which is why the ventilation of the paired sinuses is impaired. This cause of pathology is not common, but it can occur.

Doctors identify the following types of effects on the body as factors that lead to a drop in local immunity and allow the problem to begin to develop:

smoking in active and passive forms;
severe general hypothermia;
the presence of chronic inflammatory pathologies of the pharynx;
chronic inflammatory diseases of the nasal cavity;
proliferation of adenoids;
the presence of carious teeth in the upper jaw that are left without treatment;
chronic lack of sleep;
chronic fatigue - not only physical, but also emotional;
severe stress;
monotonous diet, in which the body does not receive enough vitamins and minerals.

If there are predisposing factors that significantly increase the likelihood of developing sinusitis, special attention to your health is required. In such a situation, any runny nose that persists for more than 7 days requires a mandatory visit to an otolaryngologist. It is unacceptable to refuse professional treatment in such cases.

Frontit

Frontal sinusitis (frontal sinusitis) is an inflammatory disease of the frontal paranasal sinus. This type of sinusitis is the most severe. There are forms of acute and chronic frontal sinusitis.

Symptoms of sinusitis

Acute frontal sinusitis, symptoms:

pain and swelling around the nose and eyes;
increased pain when tapping in the projection area of the inflamed sinuses;
heavy breathing due to inflammation of the nasal passages;
runny nose with thick yellow or green mucus;
increase in body temperature to 38-39 degrees;
severe headache (minor relief occurs when lying down);
pain radiating to the ears and teeth;
fear of light;
severe weakness;
sometimes sore throat, difficulty identifying odors, decreased pungency of taste.

Chronic frontal sinusitis, symptoms:

aching headache;
purulent, unpleasant-smelling nasal discharge in the morning;
slight increase in temperature;
difficulty breathing through the nose;
sputum discharge in the morning.

Causes of frontal sinusitis

The following reasons for the development of frontal sinusitis are distinguished:

viral, bacterial or fungal infection;
complication after influenza, ARVI, etc.;
getting foreign objects into the nose;
long-term infectious or allergic rhinitis (rhinitis);
deviated nasal septum;
adenoids;
allergy;
nasal polyps.

Treatment of frontal sinusitis

How to treat frontal sinusitis? Definitely under the supervision of an otolaryngologist! The disease is not only difficult for many patients to tolerate, but also has dangerous complications, including orbital abscess, meningitis, sepsis, etc.

Treatment of sinusitis is aimed at eliminating infection in the sinuses and stopping inflammation. Medicines will help relieve swelling, improve ventilation of the sinuses and lead to the discharge of contents from them. If the disease is viral in nature, then antibiotics for frontal sinusitis are mandatory!

The following antibiotics are used to treat sinusitis:

penicillin antibiotics (semi-synthetic or synthetic amoxicillin preparations);
cephalosporin antibiotics;
macrolide antibiotics (they do not affect the intestinal microflora);
local antibiotics in the form of nasal drops, nasal spray, aerosol;
homeopathic medicines;
symptomatic remedies for frontal sinusitis in the form of vasoconstrictor nasal drops, antipyretics and anti-inflammatory drugs.

In case of severe frontal sinusitis and insufficient effectiveness of conservative treatment, sinus lavage using the method of displacement and puncture is prescribed.

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Prevention of frontal sinusitis

To prevent frontal sinusitis, you need to monitor the state of your immune system, promptly eliminate foci of inflammation in the ENT organs, harden your body, and lead a healthy lifestyle.

Forecast

If a person seeks medical help at the first symptoms of double sinusitis, the prognosis for him is favorable. The pathology will be completely eliminated at the initial stage and using the most gentle method. In such a situation, no complications arise, and the risk of an early relapse is minimal.

With advanced disease, depending on the patient’s condition and the presence or absence of complications, the prognosis varies from unfavorable to poor. In some cases, with severe complications, even in a modern clinic, it is impossible to save a person. Because of this, postponing therapy or carrying it out on your own is highly not recommended.

Ethmoiditis

Ethmoiditis is an acute or chronic inflammation of the mucous membrane of the cells of the ethmoid labyrinth (anatomical labyrinth in the bridge of the nose). Ethmoiditis is bacterial or viral in nature.

There are acute and chronic ethmoiditis. Acute ethmoiditis accompanies influenza, rhinitis and is complemented by inflammation of the paranasal sinuses.

Ethmoiditis in adults affects both the frontal and maxillary cavities. With weak immunity, the acute form of ethmoiditis turns into long-term chronic ethmoiditis with periods of exacerbation and remission.

Polypous ethmoiditis is characterized by the appearance of polyps in the mucous membrane of the ethmoid labyrinth of the forehead. Polypous ethmoiditis may appear after chronic, allergic rhinitis.

Catarrhal ethmoiditis occurs due to the activity of viruses. It is characterized by increased lacrimation, weakness, nausea, dizziness, swelling in the bridge of the nose, and fever.

Ethmoiditis in children is a very serious disease. The infection spreads very quickly due to the anatomical structure of the ethmoid labyrinth. The development of ethmoiditis in children requires urgent hospitalization.

Symptoms of ethmoiditis

Acute catarrhal ethmoiditis. Symptoms

pain in the bridge of the nose and at the wings of the nose;
heavy breathing through the nose;
loss of smell;
headache, weakness;
profuse nasal discharge, which gradually becomes purulent;
temperature rises to 38 degrees;
In children, the inner corner of the eye socket also swells and turns red.

In the acute form, primary and secondary ethmoiditis are distinguished.

With primary ethmoiditis, anxiety, vomiting, dyspepsia and toxicosis appear, the temperature is 39-40 degrees.

Secondary ethmoiditis is more severe and develops faster. The patient is in extremely serious condition with pronounced septic symptoms. The eyelids become swollen and cyanotic, swelling of the conjunctiva and noticeable protrusion of the eyeball are observed, and nasal breathing becomes difficult.

Chronic ethmoiditis. Symptoms

headaches that are difficult to register by localization;
weakness, rapid fatigue of the patient;
soreness in the bridge of the nose when pressed and painful points at the wings of the nose;
purulent discharge with a nauseating odor;
extensive mucus in the nasopharynx, which is difficult to spit out;
emerging polyps.

Complications after ethmoiditis:

meningitis;
encephalitis,
intraocular and intracranial pressure;
destruction of the ethmoid bone.

Treatment of ethmoiditis

Treatment of ethmoiditis in acute form is predominantly conservative. It is necessary to ensure the outflow of mucus with the help of vasoconstrictors and physiotherapeutic procedures.

Treatment of ethmoiditis in chronic form is predominantly surgical.

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3 Ultrasound examination of the paranasal sinuses in MedicCity

Diagnosis of sinusitis using modern techniques

To confirm the diagnosis of sinusitis, the following types of examination are used:

Video endoscopy of the nasal cavity and nasopharynx to identify features of the anatomical structure and determine predisposing factors for the development of sinusitis;
radiography of the paranasal sinuses;
Ultrasound examination of the paranasal sinuses is a safe method with no contraindications, used to diagnose sinusitis and monitor the treatment process;
CT, MRI - according to indications;
laboratory diagnostics according to indications in full.

Diagnostics

A presumptive diagnosis is made by a specialist at the first appointment. During it, a history of the disease is collected and the patient’s complaints are listened to. Palpation of the sinus areas and rhinoscopy are also performed. To further confirm the diagnosis, an examination is indicated. This makes it possible to accurately determine the degree of damage and diseased sinuses.

1. X-ray of the facial part of the head. It is carried out most often, as it allows you to immediately assess the condition of the sinuses. At the same time, this method also has contraindications. It should not be used during pregnancy or childhood.

2. Magnetic resonance or computed tomography. Allows you to identify the affected sinuses as accurately as possible, as well as immediately assess the general condition of the nasal cavity and detect neoplasms, if any.

3. General blood test. It is not always required, but is usually prescribed only if there is a significant impairment in the patient’s condition.

If the main reason for the appearance of the pathology is an allergic reaction, the patient is referred for an allergy test. This skin procedure identifies the irritant.

Treatment of sinusitis at MedicCity

Conservative methods of treating sinusitis

If you are concerned about how to treat sinusitis in Moscow, be sure to contact the MedicCity specialists! Our clinic provides treatment for sinusitis without puncture and without pain. However, non-surgical treatment of sinusitis is possible only at the initial stage. Don't waste time!

In the vast majority of cases, treatment of sinusitis in our clinic is carried out without a puncture.

Using YAMIK (sinus catheter). The YAMIK method is the use of a device called the “YAMIK sinus catheter.” Using the YAMIK sinus catheter, controlled pressure is created in the nasal cavity and the purulent contents of the sinus are pumped out through the natural anastomosis (openings), and then a medicinal substance (antibiotics, mucolytics) is administered.
Rinsing the nose and paranasal sinuses using the moving method (“cuckoo”). It is carried out using a special suction - an aspirator; in the process, pathological contents are removed from the nasal cavity and sinuses and the drug is injected into the sinuses.
Inhalation therapy using a special inhaler PARI SINUS. This method is based on the introduction of microparticles of the drug into the affected paranasal sinuses through a pulsating supply of an aerosol. In this case, the aerosol of the medicinal substance is deposited in the sinuses and has an effect directly at the site of inflammation.

All proposed methods for treating sinusitis are painless and effective.

When using combined treatment, complete recovery in case of acute sinusitis is achieved within 7-10 days.

If puncture treatment is necessary, it is possible to install special catheters in the sinus, which eliminate the need for repeated punctures.

Acute sinusitis - symptoms and treatment

May include:

anterior rhinoscopy;
radiography of the sinuses;
ultrasonography;
diagnostic puncture;
laboratory research;
microbiological examination;
diaphanoscopy.

Anterior rhinoscopy

The main method of objective diagnosis of acute sinusitis [1][6][7]. It is carried out by an otorhinolaryngologist using a nasal speculum. Before its administration, the nasal mucosa is lubricated with a solution of a vasoconstrictor drug (anemization). This is done in order to reduce swelling of the mucous membrane.

The doctor assesses the condition of the mucous membrane of the nasal turbinates and passages, the absence or presence of discharge. Signs of sinusitis are the presence of purulent or mucopurulent discharge in the area of the outlet openings of the affected sinuses. It is accompanied by redness and swelling of the nasal mucosa.

A pathological secretion can be visible on the posterior wall of the oropharynx and in the nasopharynx when examined with a spatula and a nasopharyngeal speculum (posterior rhinoscopy) and examination of the pharynx (pharyngoscopy).

Endoscopic examination of the nasal cavity

Allows you to examine in detail the nasal passages and turbinates to the nasopharynx, identifying the smallest anatomical changes. Often, video endoscopy is performed and the result is recorded, which later helps to assess how the disease progresses.

X-ray of the sinuses

Use only for prolonged runny nose and headache for about 7–10 days [1][6][7]. During the procedure, the head is fixed in a certain position - in the nasomental, nasofrontal and lateral projections. The position of the head is determined by the radiologist. With sinusitis, the mucous membrane thickens, a horizontal fluid level is revealed and the pneumatization of the sinus is significantly reduced.

Computed tomography (CT) is used for chronic pathology of the paranasal sinuses, orbital and intracranial complications. It is not advisable to use it to diagnose acute sinusitis. Neither X-ray nor CT scan can differentiate between viral and bacterial sinusitis.

Ultrasound examination (ultrasound)

Non-invasive screening method. Allows you to identify effusion in the lumen of the frontal and maxillary sinuses and evaluate the effectiveness of the therapy [2]. It is actively used in examining children and pregnant women.

The action of ultrasound is based on the reflection of an ultrasonic signal at the boundary of two substances with different acoustic properties (bone - air, air - exudate, etc.) in a linear and two-dimensional mode. In the first case, ultrasound scanners are used for the paranasal sinuses (“Sinuscope”, “Sinuscan”), in the second case, standard ultrasound machines are used.

Diagnostic puncture

Sinus puncture (from Latin “puncture”) is not a routine diagnostic method due to the high risk of complications. It is used if there are contraindications to radiography, for example during pregnancy.

Laboratory diagnostics

Includes a complete blood count and determination of C-reactive protein (CRP).

Allows:

distinguish viral sinusitis from bacterial sinusitis, and therefore determine whether you need to take antibiotics;
assess the severity and dynamics of the disease.

Microbiological examination

It is carried out in cases of prolonged forms of sinusitis and the ineffectiveness of antibiotic therapy. For the study, you will need nasal cavity discharge or material from the affected sinus, extracted by puncture.

The reliability of the method is relative, and the information content is small. Firstly, the microflora of the nasal cavity and sinuses are initially different. Taking a smear, even if all conditions are met, does not guarantee that the bacterium cultured on the media is the cause of inflammation in the sinus, and not an accidental “fellow traveler” when removing a cotton probe from the nose.

In children, the information content of microbiological research is even lower. This is due to the child’s negative reaction to the manipulation and the inability to carry out the procedure correctly [11].

Secondly, the reliability may be affected by non-compliance with the storage and transportation conditions of the biomaterial [12]. Therefore, assessing the results of microbiological research is complex and ambiguous.

Diaphanoscopy

An outdated non-invasive method for diagnosing sinusitis of the maxillary sinus. This is done using a special lamp. If the cavity is airy, then the sinus will be highlighted in red. [5]. If the sinus contains pus, the glow becomes black.