Sinusitis treatment of symptoms
Sinusitis - an inflammatory disease of the paranasal sinuses, one or more of the four sinuses in the facial bones.
Sinusitis - the most common diseases in the ENT practice, they make up 25 to 38% of all patients otorhinolaryngology hospital, and each year this figure tends to increase.About 5% of the European population suffers from chronic sinusitis .Most often it affects the maxillary sinuses (sinusitis), in second place - an inflammation of the cells ethmoidal labyrinth (ethmoiditis), the third - an inflammation of the frontal sinus (sinusitis), the fourth - inflammation of the sphenoid sinus - (sphenoiditis).
Children under 3 years old are usually affected ethmoid cells (ethmoiditis), children from 3 to 7 years is more often observed defeat the combined grid and maxillary sinuses.Combined multiple sinus inflammation referred to as polisinusit, defeat all sinuses with one hand - gemisinusit, all sinuses on both sides - pansinusitis.
Listed below are some of the terms are also characterized by
Piosinus - sinter accumulation of pus in the sinus (eg, pus leaking from the cells of a trellised labyrinth and the frontal sinus in the maxillary).
Piotsele - cystoid stretching sinus with purulent contents.
mucocele - cystoid stretching sinuses with mucous content.
Pnevmatosinus - cystoid stretching sinus air.
haematocele - the same blood.
closed empyema - an inflammation of the sinuses, isolated from the nasal cavity.
Open empyema - an inflammation of the sinuses in the breakout of pus through the skin or mucosa.
downstream nature distinguish acute and chronic sinusitis, depending on its causes and ways of introducing infection - rhinogenous, odontogenic, and nosocomial fungal sinusitis.
In case of irritation of the mucous membrane lining the sinus may swell and block small channels that allow mucus to drain into the nose.Increased pressure often causes headaches, stuffy nose and facial pain.
nasal cavity in communication with the paranasal sinuses or sinuses skeleton.These are called the maxillary sinus.They may be subjected to infection and inflamed and thereby causing discomfort and even pain.Predecessors of sinusitis can be acute respiratory disease, cold, cold.
Normally, sinuses are filled with air coming in through your nose.If they penetrate infection, an inflammation - sinusitis.Very often sinusitis observed after suffering flu.Viruses enter the sinuses either directly from the nose, or entered the bloodstream.Often germs get into the sinus during acute rhinitis.Sinusitis sometimes arise as a result of injury.
sinusitis are acute and chronic.Signs of their very diverse and are caused by exactly where there was inflammation, one or more of the sinuses are involved in it.
• Viral or bacterial infection that spreads into the sinuses from the nose.
• Anatomical abnormalities such as curvature of the nasal septum.
• Allergy, resulting in swelling and the formation of polyps.
• Swimming in dirty water.
• The spread of infection from abscesses in the upper teeth.
• Chronic sinusitis can be caused by irritation from dust, air pollutants, prolonged exposure to smoke or be a consequence of untreated acute disease.
Recent studies suggest an association between sinusitis and deficiency of vitamin A.
cold and damp are additional factors.
in the development of sinusitis is important violation of local and general immunity, reduction of the protective function of the mucous membrane of the nasal cavity and sinuses.
case of acute respiratory viral diseases of the upper respiratory tract occurs penetration of pathogenic microflora in these or other sinus through natural anastomosis, and then develops the so-called rhinogenous sinusitis.In acute infectious diseases (diphtheria, scarlet fever, measles, etc.). It is also possible hematogenous path of infection in the sinuses.In addition, frequent source of inflammation of the maxillary sinuses are diseases of the roots of the teeth adjacent to the bottom wall of the sinus, which developed in these cases are referred to as sinusitis odontogenic.
Equally important are predisposing factors, such as anatomical abnormalities within the nasal-structures: the curvature combs, nasal septum spikes, as well as acute and chronic rhinitis, adenoid vegetation, polyps.This creates conditions that violate the aeration and drainage of the paranasal sinuses.
In the study of the contents of the inflamed sinus identify primarily bacterial flora - Streptococcus pneumoniae, Haemophilus influenzae, Moraxella cataralis, Staphylococcus aureus, hemolytic streptococcus, E. coli, rarely anaerobes.Very often the cause of sinusitis is a mixed infection, fungi, viruses.Play a role trudnokultiviruemye bacteria - chlamidia pneumoniae and mycoplasma pneumoniae.In nosocomial (hospital-acquired) sinusitis, which has recently become increasingly common and usually associated with prolonged nasotracheal intubation, crops often identify Pseudomonas aeruginosa, Klebsiella pneumoniae and other gram-negative bacteria.
frontal and maxillary sinuses communicate with the nasal cavity through a complex system of narrow spaces, ensuring their drainage and ventilation.Frontal pocket frontal sinus and ethmoid sinus funnel play a key role in the physiological state of the large sinuses.These spaces are lined, like the rest of the nasal cavity, ciliated epithelium, but since they are very narrow, the epithelial surfaces are very close to each other.
established that if there is swelling and the opposing surface of the mucous membrane in these narrow spaces are beginning to come into contact, the activity of the ciliary epithelial cells decreases dramatically, and these spaces are completely blocked.Disturbed ventilation and evacuation of mucus from the sinuses, reduced oxygen partial pressure, all this further inhibits mucociliary clearance until it stops.Very fast developing microbial flora and showing signs of an infectious inflammation of the adjacent sinuses.Thus, in the development of acute and chronic sinusitis, considerable importance is the violation of the secretory and transport functions mucociliary apparatus of the mucous membrane of the nasal cavity.
Please note that under unfavorable environmental conditions (pollution, dust, industrial emissions) also occurs inhibition of glandular cells, and directional movement of the cilia of ciliated epithelium (mucociliary clearance).This leads to stagnation of mucus disruption evacuation of foreign bodies from the nasal cavity and paranasal sinuses, which in turn provokes a further development in which the infection and inflammation.
When catarrhal form of acute sinusitis occurs serous impregnation of the mucosa and pronounced edema develops.Very, dozens of times, increasing the thickness of the mucous membrane, it can fill the entire sinus, in its thicker form pseudocysts.Swelling of the mucous membrane leads to a complete obstruction of the anastomoses.The cilia of ciliated epithelium disappear.
When purulent sinusitis in the form of the inflammatory process involves not only the mucous membrane, but periosteal layer, and in severe cases the inflammation extends to the bone.Abscess develops, which causes a prolonged duration and the transition of the disease into a chronic form, and sometimes the formation of rhinogenous complications.
There are different classifications of inflammatory diseases of the UNP, however, the most efficient clinical practice is a modified classification of BSTransfiguration.It involves the division of sinusitis in accordance with histopathological changes in the mucous membrane of the nose and sinuses tentatively determines treatment policy with each form.
Permanent sinusitis symptoms - headache: dull or sharp, limited to a certain area (forehead, back of the head) or diffuse.Acute sinusitis is often laid the corresponding half of the nose, reduced sense of smell, a person does not feel the taste of food.Discharge from the nose at first mucous, become purulent.Sometimes there are photophobia and tearing, which is associated with narrowing or blockage of the nose - the tear duct.
Acute sinusitis often develops after a cold or flu.Most sinusitis runs itself and lends itself well to home treatment.How to use folk remedies in this illness, see here.
Occasionally infection can spread to the eyes or the brain and lead to vision loss, meningitis or brain abscess.
If signs of sinusitis do not seek medical advice promptly, the disease can become chronic.Chronic sinusitis is called the constant or recurring disease that is generally milder than acute sinusitis.Headache with the less intense, diffuse, but a runny nose does not stop, sometimes accompanied by an unpleasant odor.Often lost sense of taste, and then the loss of appetite.In addition, the constant leaking of purulent secretions in the throat and stomach can cause heartburn, bad taste in the mouth, nausea and even vomiting.Some patients with chronic sinusitis reduced efficiency, bad mood.
• necessary medical history and physical examination.
• Removal of fluid from the maxillary sinus with a needle or aspirator may be necessary to determine the type of bacterial infection.
• X-rays can be used to identify the infected area or areas.
Symptoms of sinusitis depends on the localization of the inflammatory process, but there are general symptoms common to all forms of sinusitis.This is due, in particular, often combine multiple lesions of the paranasal sinuses.
Common symptoms include fever or febrile to low grade, poor health, loss of appetite.As a rule, the patient observes a one- or two-sided obstruction of nasal breathing, mucous or purulent nasal discharge, headache, disturbance of smell varying severity.
Headache can be localized in the frontal, especially for frontal sinus disease.With the defeat of the maxillary sinus pain is projected in the area of the upper jaw, temple, radiating to the teeth;in inflammation of the ethmoidal labyrinth cells - in the root of the nose and the temples;when sphenoiditis - in the neck and the head.The intensity of pain varies - from mild feelings of gravity and the sharp pain in violation of well-being and reduces efficiency of the patient.Characteristically gain pain when bending the head.
Blood (shift to the left, moderate leukocytosis, accelerated erythrocyte sedimentation rate) usually indicates inflammation development.
In acute sinusitis may develop an inflammatory swelling of the soft tissues of the face.So, in the sinus swelling usually extends to the lower eyelid and cheek soft tissues;when ethmoiditis and Front - captures the upper eyelid, sometimes soft tissue brow region.
palpation can be detected pain in the canine fossa (the sinus), on the side of the nose slope (at ethmoiditis), in the projection of the frontal sinus (at the front).
disease duration may be small - up to 2 weeks.However, the process is delayed with inadequate therapy, taking a chronic course.
Diagnostics. Diagnosis is based on complaints, inspection data, palpation of the sinus walls, rhinoscopy results, including optical performed using endoscopes.Of great importance in the diagnosis results are diaphanoscope and radiological methods - conventional radiography and computed tomography (CT) scan of the paranasal sinuses, at least - magnetic resonance imaging (MRI).If necessary, perform a catheterization or diagnostic puncture sinuses.
In front rhinoscopy reveals swelling of the nasal mucosa more pronounced in the middle nasal passage, here define the pus.At the rear rhinoscopy pus flowing out of the front of the paranasal sinuses, the nose can be seen in the average course, and pus cells from the back of a trellised labyrinth and sphenoid sinus - in the upper nasal passage.Sometimes pus in the nasal passages reveal only after anemizatsii (lubrication vasoconstrictor) of the mucous membrane.
X-ray picture in acute inflammation of the front of the paranasal sinuses is quite characteristic.Typically, X-rays performed in a straight line (nosolobnoy and nosopodborodochnoy) and lateral projections.When catarrhal sinusitis and the front can be seen on radiographs parietal thickening of the mucosa of the sinuses, sometimes a slight decrease in their pneumatic properties;purulent process appears homogeneous dimming sinus.If the image is in the upright position of the patient, in the lumen of the maxillary sinus you can see the level of liquid.To detect inflammatory changes posterior ethmoid cells and sphenoid sinus traditional X-ray projection little information in this case is a computer tomography.
With diagnostic (and therapeutic), the purpose of performing puncture of the maxillary and frontal sinuses trepanopunktsiyu.
puncture of the maxillary sinus. order to facilitate the evacuation of liquid through the natural sinus fistula with a nose in front puncture produce anemisation nasal mucosa, especially in the middle nasal passage.For this purpose, vasoconstrictor drugs.The mucosa of the lower nasal passage anesthetics lubricate applicator (10% solution or diphenhydramine lidocaine, cocaine 5% solution and others.).
optimal puncture site is located at the top of the arch of the lower nasal passage at a distance of about 2 to 2.5 cm posterior to the anterior end of the inferior turbinate.Here, the thickness of the lateral wall of the nasal bone is minimal, and it facilitates puncture.Once the needle Kulikovskii placed under the inferior turbinate, her head is removed in the medial direction to the needle itself was positioned vertically as possible to the lateral wall of the nose and the sharp end of it was directed to the outer corner of the eye on the same side.Needle capture all his right hand so that her head rested against the palm and the index finger was on the needle, fixing and directing it.By applying moderate force and producing light rotational movement needle, make a puncture sinus wall, penetrating into its cavity to a depth of about 10-15 mm.
Making sure that the end of the needle is in the sinus, using a syringe aspirated contents, then washed with an antiseptic solution sinus (furatsilina, Octenisept, hlorafillipta et al.).Fluid flows into the sinus through the needle, and pours out - through the natural sinus fistula with the nose, pulling out its contents.When washing the patient's head is tilted forward and downward, so that the liquid was poured through the nasal vestibule in the substituted tray.In those cases where the anastomosis is obturated by a pathological process, is introduced into the sinus second needle (also through the lower nasal meatus), and washing produce two needles.The presence of abnormal content in the washing liquid can reliably recognize the nature of the disease.
treatment if necessary, followed by washing with punctures sinus administration of antibiotics and antiseptics solutions carried out daily for 7 - 8 days.The first time through a thick needle puncture, or you can enter a special trocar synthetic tube (catheter) and leave it for the next sinus washings, securing outside plaster.
Complications of maxillary sinus puncture, both local and general, are relatively rare.Typically, they involve a violation of puncturing technique.
Minor bleeding was stopped swab inserted into the nasal cavity.
incorrectly made puncture leads to the fact that the puncture needle misses the bosom.If through the front wall of the sinus, it penetrates the soft tissue of the buccal region, the puncture is called "buccal" puncture, and in contact with the needle through the wall of the infraorbital sinuses into the orbit - "orbital" puncture.Such punctures may lead to fluid pumped into the orbit or cheek soft tissues and cause abscess formation.