A persistent inflammatory process occurring in the maxillary sinuses (sinuses) is often called chronic sinusitis. The disease affects the departments located in the thickness of the upper jaw. They talk about the chronic form of the disease when it periodically recurs and affects the patient's well-being.
Physiology
The human nasal cavity is a whole complex of hidden paranasal air sinuses. All of them are located in nearby cranial bones:
- paired maxillary;
- paired frontal (frontal);
- pair lattice;
- wedge-shaped unpaired.
Due to the normal functioning of each sinus, full warming, humidification and disinfection of the air entering them during breathing is ensured. In addition, the adnexal structures of the nose are necessary for sound production and isolating the sensitive structures of the facial skull from temperature fluctuations.
Air-filled maxillary sinusesminimize the weight of the cranial bones and serve as a kind of shock absorber, preventing maxillofacial injuries. They have a specific structure, which is the main reason for their vulnerability to the aggressive effects of endogenous and exogenous factors.
What is this disease
Completely cure chronic sinusitis, as a rule, fails. The paranasal sinuses are poorly supplied with blood and practically not supplied with nerve endings, which, in itself, is a prerequisite for the development of an acute inflammatory process. In addition, one cannot exclude the physiological feature of the lower wall of the maxillary sinuses, which is most often affected by the disease - it is very thin and easily damaged. So, for example, dental procedures pose a potential threat to the maxillary sinuses and create prerequisites for the development of acute, and, after some time, chronic sinusitis.
ICD-10 ("International Statistical Classification of Diseases and Related He alth Problems" of the tenth revision) defines a separate code for this disease - J32.0. In addition, chronic sinusitis (sinusitis) has varieties, each of which is endowed with the following encoding:
- J32.0 - Chronic sinusitis (sinusitis of the maxillary sinuses).
- J32.1 - Chronic sinusitis (frontal sinusitis).
- J32.2 - Chronic ethmoiditis (ethmoid sinusitis).
- J32.3 - Chronic sphenoidal sinusitis (sphenoiditis).
- J32.4 - Chronic pansinusitis.
- J32.8 - Other chronic sinusitis. Sinusitis catching inflammationmore than one sinus, but not pansinusitis. Rhinosinusitis.
- J32.9 - Chronic sinusitis of unspecified etiology.
Among the clinical cases of inflammation of the airways, the most common are sinusitis of the maxillary sinuses. They account for more than 70% of calls to specialists. Otolaryngologists note that this disease has become more common over the past few years. Chronic sinusitis occurs in adults and children, equally common in both women and men.
Causes of disease
Speaking about the factors provoking the development of such a disease as chronic sinusitis, it is worth noting, first of all, acute inflammation of the maxillary sinuses. Less commonly, the cause of the transition to a chronic form is an inflammatory process occurring in other organs. The disease is activated from the moment of penetration into the cavity of the maxillary sinus of pathogenic microflora. Bacteria, viruses and protozoa enter the nasal structures in several ways:
- through the bloodstream from the main source of infection in the body;
- from the middle nasal passage through the connecting hole into the cavity;
- in case of infection of the dental system, which is accompanied by inflammation;
- for surgically complex dental procedures.
In addition, the chronic form of sinusitis can be the result of an allergic or vasomotor rhinitis. The transition from the acute phase to a protracted recurrent one is also facilitated by:
- illiterate self-treatment, prescription of therapy by incompetent specialists;
- anatomical defects and features, including narrowness of the nasal passage and the communicating opening of the maxillary sinuses, post-traumatic or prenatal flexure of the nasal septum;
- formation of polyps and proliferation of fibrocystic tissue that obstructs the natural outflow of mucus;
- chronic inflammation of the middle ear, upper and lower respiratory tract;
- presence of a carious focus in the oral cavity;
- unfavorable environmental situation in the region of permanent residence.
Exacerbation of chronic sinusitis can be caused by a number of other provoking factors. Most often, relapses of the disease occur against the background of immunosuppression of the body in the cold season. General hypothermia, severe stress and physical activity can also activate the disease.
Forms of sinusitis
In addition to the classification defined by the ICD, chronic sinusitis has another typology. Distinguish the disease according to the form of the course. So, sinusitis can be of several types:
- allergic;
- odontogenic;
- hematogenous;
- rhinogenic;
- vasomotor;
- cystic.
Distinguish between chronic sinusitis and the nature of inflammation. Sinusitis is catarrhal, purulent and mixed. In the first case, we are talking about the exudative form (serous or mucous discharge accumulates in the cavity of the maxillary sinus), in the second - about stagnant purulent contents, in the third - about pathological purulent-exudativesecret in the sinuses. Depending on the side of the lesion, the disease can be left-, right- or bilateral.
Symptoms of chronic sinusitis
Treatment and recovery of the body after relapses of sinusitis is based on the principles of combating the manifestations of the disease. The symptoms of this disease in adults and children differ from other ailments of the respiratory system with specific features. Patients note:
- feeling of tension and pressure in the affected nasal cavities;
- permanent runny nose;
- subfebrile fever;
- shortness of breath;
- hoarse or nasal voice;
- dry cough;
- malaise and weakness.
In this case, the main symptom of the chronic form of sinusitis is pain in the area of the inflamed sinus (on the side of the wings of the nose, in the forehead and bridge of the nose, behind the eyeballs). First, in these areas there are unpleasant sensations, a feeling of internal squeezing and bursting, dull aching pain. Discomfort increases with tilting the head, chewing, pressing on the area of the maxillary sinuses.
In the initial stages of sinusitis, nasal discharge has a mucous character. After some time, the secret becomes fetid, acquiring a specific yellow-green hue. Respiratory failure occurs due to significant sinus congestion caused by insufficient drainage of their contents.
In addition to these symptoms, patients are often concerned about dry cough, which is almost impossible totraditional antitussive drug therapy. In addition to the above signs of the disease, people with chronic sinusitis often complain of fatigue, irritability, decreased performance and sleep disturbances. Symptoms of the disease become most pronounced during the period of exacerbation. In adults, sinusitis is often asymptomatic.
Sinusitis in childhood
In addition to those factors that provoke an exacerbation of chronic sinusitis in adults, it is worth noting additional causes of the development of the disease in children. Often the disease causes the growth of adenoid tissue in the nasopharynx, foci of ENT infection. At an early age, chronic sinusitis occurs as an independent pathology, but it is accompanied in parallel by ethmoiditis, which occurs in a purulent-cystic form.
Symptoms of sinusitis in children are mild. Clinical manifestations of chronic sinusitis are blurred, pain in the maxillary sinuses, as a rule, is absent, serous secretion from the nose does not change its character for a long period. Often, sinusitis is accompanied by pain in the ear from the side of the inflamed sinus, which is associated with the flow of purulent discharge along the back and side walls of the larynx, followed by the involvement of the structures of the middle ear and the respiratory tree in the inflammatory process with the further development of otitis media. In more rare cases, the pathological process that occurs in the nasal sinuses in children spreads to the conjunctiva and eye tissues, causing the development of keratitis, conjunctivitis.
Because the sinesare formed only by the age of 18-20, in a young child, the maxillary maxillary sinuses are inferior from an anatomical point of view: they are represented by a narrow gap, and their bottom is located much higher than in an adult, due to the structural features of the skull. Due to these specific features, the development of chronic sinusitis in children under the age of three is almost impossible.
Diagnostic measures
Home treatment of chronic sinusitis is preceded by a set of mandatory research procedures. Diagnosis of this disease is based on the results of complex laboratory and instrumental screening. First of all, take into account:
- anamnestic information (the presence of foci of infection, the level of sanitation of the oral cavity, acute sinusitis in the past and other information);
- objective comprehensive examination (palpation of the face in the projection of the nasal maxillary cavities, detection of traces of a separated secret from the inflamed sinus on the back wall of the larynx);
- the results of blood tests (clinical and biochemical) to determine the level of leukocytes, neutrophils, ESR, acute phase indicators;
- conclusion of specialists after rhinoscopy - a procedure that demonstrates inflammatory changes in the nasal mucosa, the presence of pus in the middle nasal passage;
- x-ray of the maxillary sinuses (if it is necessary to treat chronic sinusitis in adults, the affected sinuses will be partially darkened in the picture, and in severe cases - completely darkened).
Sometimes doctors resort to such a research method as diaphanoscopy. It is used to translucent the cheek and lower eyelid on the side of the affected sinus. If the patient does not feel light in the eye during the procedure, sinusitis is confirmed. Diagnostic puncture is resorted to in exceptional cases due to the high invasiveness of the examination.
How to treat chronic sinusitis
Therapy of this disease is mainly conservative. Patients undergo treatment on an outpatient basis. Hospitalization for chronic sinusitis is rare. Treatment within the walls of the ENT department is recommended for patients with complicated inflammation of the maxillary sinuses. Inpatient treatment is necessary for patients with severe turbulent symptoms (severe pain, significant difficulty in breathing, intoxication syndrome).
To permanently cure chronic sinusitis, as a rule, it takes a lot of time and the use of effective medicines. In the treatment of sinusitis, drugs of the following pharmacological groups are indispensable:
- Antibiotics. To combat the pathogenic microflora that affected the maxillary sinuses, antibacterial drugs are used on a natural and synthetic basis (penicillins, cephalosporins, fluoroquinolones, tetracyclines, macrolides).
- NSAIDs. Medicines belonging to the category of non-steroidal anti-inflammatory drugs are designed to fight fever and have an analgesic effect.
- Antiallergic anddesensitizing drugs. Appointed to prevent an allergic reaction.
- Sedative drugs.
- Vitamin and mineral complexes. They are prescribed for the purpose of general strengthening of the body and increasing immune forces.
- Mucolytic drugs. Necessary for expectoration and removal of sputum from the respiratory tract.
- Vasoconstrictive nasal drops and sprays.
In addition to drugs, physiotherapy methods are recommended for the treatment of chronic sinusitis:
- microwave therapy and electrophoresis procedures;
- exposure to diadynamic currents, laser;
- ultrasonic treatment;
- paraffin applications;
- inhalations;
- washing the nasal cavity ("cuckoo").
Surgery
In the absence of the effect of conservative treatment, the doctor may decide on the need for invasive intervention in the affected sinus. The puncture is carried out through a puncture of the maxillary sinus in the medial wall. During manipulation, exudate is removed from the maxillary sinus. This surgical procedure is often the only rational solution for chronic sinusitis. The operation allows you to thoroughly wash the affected cavity with antiseptic solutions, introduce antibiotics, steroids and enzymes that absorb and thin the purulent contents in order to accelerate its outflow from the sinus. Sometimes a catheter is installed in patients for accelerated evacuation of the secrets of the maxillary cavity.
Cure chronic sinusitis without surgery, as a rule, fails. The severe and persistent course of the disease is a direct indication for the surgical opening of one or both walls of the sinus in order to restore the normal passage of the secret between the nasal passage and the sinus. The duration of therapy for an acute form of chronic sinusitis usually does not exceed 3-4 weeks.
A disease like sinusitis should not be treated lightly. Complications of untreated pathology can lead to the development of bacterial meningitis, brain abscess, sepsis. In general, the prognosis for patients with a normal course of the disease is favorable.
Prevention
High-quality treatment of chronic sinusitis at home implies not only the fight against the symptoms of the disease, but also the observance of certain preventive measures in order to prevent re-exacerbation. The first thing that is meant is maintaining a he althy lifestyle, general strengthening of immunity and a balanced diet. In addition, to reduce the likelihood of developing chronic sinusitis will help:
- timely influenza vaccination;
- careful treatment of infections in the body;
- inhibition of foci of inflammation immediately after their appearance;
- annual dental check-ups and oral hygiene checks;
- no contact with allergens;
- support for normal humidity and indoor air temperature;
- regular rinsing of the nose with saline;
- withdrawal from sports related toimmersion in water, stay in the mountains.
These rules, to a greater extent, are effective for the prevention of colds. In chronic sinusitis, their observance will allow achieving long-term remission, which, in fact, is the main goal of treatment. With each subsequent relapse, the patient's condition worsens, the patient loses the ability to fully breathe through the nose, suffers from headaches and constant purulent discharge. It is extremely important to realize the seriousness of possible complications and start treatment on time.
If exacerbations of sinusitis occur more often, you should seek help from qualified specialists - an otolaryngologist and an immunologist.
