The term "rhinosinusitis" refers to a pathological process characterized by inflammation of the nasal mucosa and closely located sinuses. In most cases, the ailment is the result of not fully cured respiratory disease. According to statistics, rhinosinusitis is most often diagnosed in middle-aged and elderly people, with a greater number of patients being women. Despite this, the likelihood of developing an ailment in children is very high.
Pathogenesis
Rhinosinusitis is a pathology, the main provoking factor of which, as a rule, is ARVI. Its pathogens (rhinoviruses) after illiterate treatment remain in the nasal cavity and actively multiply. A logical consequence is the development of the inflammatory process. Against the background of its course, the nasal mucosa swells, in addition, there is hypersecretion of the glands and plasma extravasation.
Rhinosinusitis is a disease that in 90% of cases is a result of impaired air exchange in the paranasal sinuses and stagnation of the secret. Against the background of these pathological processes, a violation of the mechanism of mucociliary clearance occurs. As a result, pathogenic microorganisms are able to contact the mucous membrane for a long time.
The pathogenetic factor is often played by the habit of often barking. During such cleansing, the pressure indicator changes in the nasal cavity, it varies between 60-80 mm RT. Art. This is enough for the infected secret to be pushed through while blowing into the sinus cavity. The consequence of this is the development of an acute inflammatory process. Normally, the nasal mucosa is as thick as tissue paper. With inflammation, it thickens up to 200 times. In this case, formations are formed that almost completely overlap the lumen of the sinus.
The course of any of the above processes contributes to the creation of a favorable environment for the active reproduction of pathogenic microorganisms.
Rhinosinusitis may be:
- Sharp. It develops against the background of the attachment of a bacterial infection after SARS. J01 "Acute rhinosinusitis" - code according to ICD-10.
- Subacute. In the case of hyporeactivity of the body, the pathology takes a similar nature of the course of the organism to the action of a pathogenic factor on it. The code for ICD-10 is J01.9.
- Chronic. The disease is characterized by a constant change in periods of exacerbation and remission. J32 "Chronic rhinosinusitis" - code according to ICD-10.
Pathology has several forms that differ in the speed of development and the nature of the course. It is important to understand what kind of disease it is. Rhinosinusitis is quite dangerous, it is easily amenable to therapy only with timely medical attention. Self-medication can lead to irreversible consequences.
Etiology
In rare cases, rhinosinusitis is the result of mechanical tissue damage. As a rule, the start of the development of the inflammatory process occurs against the background of the active life of pathogenic microorganisms.
Classification of the disease by the type of pathogen:
- Viral rhinosinusitis. It develops against the background of the multiplication of microorganisms that cause SARS and influenza. In this case, the disease always proceeds in an acute form.
- Bacterial. The causative agents are the following pathogens: enterobacteria, moraxella, streptococci (pyogenic and pneumonia), coli (intestinal, pseudomonas aeruginosa, hemophilus), Staphylococcus aureus.
- Fungal. It develops against the background of the vital activity of culvularia, aspergillus and alternaria.
- Mixed. Initially, inflammation is bacterial in nature, then it is complicated by the addition of viruses or fungi.
As mentioned above, rhinosinusitis is a disease that is often preceded by an incompletely cured ARVI. In addition, the following pathologies and conditions can be the causes of the development of the disease:
- Bronchial asthma.
- Hereditary predisposition.
- Pathologies of a viral nature.
- Reducing the degree of reactivity of the body.
- Fungal diseases.
- Pathologies of a bacterial nature.
- Long-term use of certain medications.
- Interorganic injuries of the tissues of the nose.
- Polyposis.
The disease can be single or double-sided. Rhinosinusitis in the first case affects the sinuses on one side, in the second - on both.
First clinical manifestations
The disease has several types. However, the first signs are similar for all forms.
Clinical manifestations of rhinosinusitis are practically no different from a common cold. Symptoms of pathology at the initial stage of its development:
- Frequent episodes of headache. Unpleasant sensations in this case can have a different degree of severity.
- Swelling of the nasal mucosa.
- A feeling of stuffiness in the ears.
- Pain in the area of the affected sinuses.
- General malaise.
- Constant feeling of weakness.
- Isolation of a pathological secretion from the nose. It can be presented in the form of mucus or pus. Often, patients feel the secret flow down the nasopharynx.
Regardless of the severity of symptoms, treatment of rhinosinusitis in children and adults should not be delayed. With timely medical attention, the healing process is quick and easy. Ignoring the alarming signs often leads to complications.
Types of disease
Pathology has several variants of the course. Each of them is characterized by certain symptoms. A description of the forms of rhinosinusitis is presented in the table below.
| Type of disease | What happens in the body | Characteristic symptoms |
| Polyposis | The mucous membrane of the nose is represented by soft tissues. Against the background of frequent inflammatory processes, its thinning occurs. As a result, the body gives a signal that it is necessary to build up a new layer. It is different from normal mucosa. The surface of the new layer, as if covered with drops. Each polyp is filled with infiltrate. | - Difficult nasal breathing.
- Deterioration of smell.
- Foreign body sensation in the nose.
|
| Purulent | The inflammatory process develops when viruses enter the mucosa. Against his background, the tissues swell, because of which the secret cannot come out and begins to accumulate. Pathological fluid is a favorable environment for the propagation of pathogens. The result of their life is the formation of pus. | - High body temperature (often it reaches critical levels).
- Headache worse during bending.
- Weakness.
- General malaise.
- Difficult nasal breathing.
- Bad breath from the mouth.
- Feeling of fullness in the area of the affected sinuses.
|
| Allergic | The development of the inflammatory process starts when an irritating factor penetrates the body. The mucous membrane swells, due to which the mucus in full cannot come out. It accumulates, the consequence of this is the formation of exudate. The most common allergens are pollen, pet hair, dust, medicines, household chemicals. | - Redness of the sclera of the eyes.
- The formation of a rash on the skin.
- Lacrimation.
- Isolation of clear mucus from the nose.
|
| Vasomotor | Rhinosinusitis in this case is associated with impaired functioning of nerve endings. During exposure to any irritant (heat, cold, pungent odors), a violent reaction of the mucous membrane occurs. She swollen, in addition, a secret begins to stand out in large quantities. | - Liquid mucus. She is transparent and plentiful. Over time, it acquires a greenish tint.
- High body temperature.
- Signs of general intoxication of the body.
- Sleep disturbance.
- General weakness.
|
| Catarrhal | It is a variant of a respiratory disease, the course of which is accompanied by inflammation of the mucosa and paranasal sinuses. Acute catarrhal rhinosinusitis is not dangerous and can be easily treated. Difficulties arise with the attachment of a bacterial infection. | - Pain in the area of inflamed sinuses.
- Redness of the mucosa.
- Increased body temperature (sometimes it reaches critical levels).
- Lacrimation.
- Conjunctivitis.
- Excessive secretion from the nose.
|
Rhinosinusitis can have both acute and chronic course. In the first case, the symptoms are pronounced. A favorable outcome is considered if the clinical manifestations completely disappear in one week. If this does not happen, it is customary to talk about joining a bacterial infection.
Acute rhinosinusitis is classified by the localization of the lesion:
- Sinusitis It is characterized by severe sinus pain, aggravated by tilting or turning the head.
- Frontite. The main symptom is severe discomfort in the frontal area.
- Ethmoiditis. The lesion is localized in the area of the ethmoid bone. A distinctive symptom is pronounced nasal.
- Sphenoiditis. It is characterized by severe headache.
Symptoms of chronic rhinosinusitis are not so pronounced. Pathology is characterized by a change in periods of exacerbation and remission. As practice shows, in adults, relapse occurs 3-4 times a year. In children, exacerbation occurs much more often.
Diagnostics
Rhinosinusitis is a disease treated by an otorhinolaryngologist. It is to this specialist that you need to contact if alarming symptoms occur. At the time of admission, the doctor must provide information on all available clinical manifestations and their severity. In addition, you need to voice how long they appeared. The specialist can make a diagnosis already at the stage of the conversation with the patient.
To confirm it and identify the pathogen, the doctor prescribes a comprehensive examination, including:
- Clinical analysis of blood and urine.
- Rhinoscopy
- CT
- MRI
- Roentgenography.
- Pharyngoscopy.
The most important part of the diagnosis is the identification of the pathogen in the laboratory. Biological material is taken by means of a maxillary sinus puncture. In addition, often sowing pathological secretions.
Treatment
The treatment regimen depends on the severity of the course of the disease, and on the individual characteristics of the patient's body.
The classical treatment regimen for acute rhinosinusitis includes the following items:
- Topical application of drops and sprays with a vasoconstrictor effect. These funds are prescribed to reduce swelling of the mucosa and improve nasal breathing. Examples of effective drugs: Xylen, Galazolin, Rinonorm, Snoop, Naphthyzin.
- Flushing the nasal passages with solutions based on sea water. This procedure contributes to a faster restoration of the mucosa. Most often, doctors prescribe Marimer and Aqualor solutions.
- The fight against the pathogen. In some cases, taking antibiotics is indicated. Examples of drugs: Amoxiclav, Azithromycin, Ampicillin, Ceftriaxone. If the pathology is viral in nature, immunostimulating drugs are indicated. As a rule, doctors prescribe the following drugs: Anaferon, Derinat, Viferon, Kagocel, Ergoferon.
- Symptomatic treatment. In order to liquefy mucus, mucolytics are prescribed (Sinuforte, Rinofluimucil), and antipyretic drugs (Ibuprofen, Paracetamol) are used to stop inflammation and reduce pain intensity. If rhinosinusitis is allergic in nature, antihistamines are indicated (Suprastin, Zodak, Tsetrin, Zirtek). At the present time, combined products are also presented on the pharmaceutical market. These include: Polydex, Isofra.
Regardless of the severity of symptoms, treatment of chronic rhinosinusitis is carried out according to the same scheme. During remission, it is enough to follow the recommendations of the doctor and avoid exposure to the body of provoking factors. If an exacerbation occurs, therapy should be started as soon as possible. In severe cases, patients are hospitalized in a hospital.
According to medical reviews, rhinosinusitis is not a sentence. The disease is quite easily treatable in the early stages of its development. You can speed up the healing process with the help of physiotherapy. The following procedures are most effective: electrophoresis, UHF, laser and diadynamic therapy.
Regarding the treatment of rhinosinusitis in children, the symptoms in babies are a little brighter due to the age-related characteristics of the body. However, in therapy, doctors focus only on local remedies.
Children are usually prescribed the following drugs:
- Otrivin;
- "Bioparox";
- "Polydex";
- "Protargol."
Thus, even if a child needs antibiotic therapy, most often doctors prescribe topical agents.
In severe cases or with the ineffectiveness of conservative methods, the doctor decides whether surgery is appropriate. The most common surgical treatment is puncture of the maxillary sinuses. This procedure is performed under local anesthesia. Immediately after the operation, the patient's condition improves: the inflammatory process stops, pain disappears, nasal breathing improves. But for a complete recovery, several procedures are required.
Other methods of intervention:
- Use of a JAMIC catheter. This method is an alternative to puncture. The intervention is non-invasive, the doctor introduces antiseptics and drugs into the sinus through a special probe. In this case, several procedures are also required for a complete recovery.
- Endoscopy and sinusotomy. During the intervention, the doctor removes the polyps. In the first case, damage to healthy tissues does not occur, the risk of relapse is reduced by 50%. Sinusotomy is an open operation, it involves opening the facial bone and resection of its part. Relapses are not excluded, the disadvantage is also a long rehabilitation.
The method of surgical treatment is chosen exclusively by the doctor on the basis of the history and diagnosis.
Folk remedies
It is important to understand that the use of non-traditional methods of treatment does not eliminate the need to seek qualified medical help. Folk remedies are acceptable, but they can only be considered as an auxiliary measure. Their use helps to reduce the intensity of the symptoms of rhinosinusitis (both chronic and acute), but does not contribute to the destruction of pathogens.
The most effective are the following recipes:
- Take 1 cyclamen root. Rinse and grind thoroughly. Using gauze, squeeze the juice out of the resulting mass. Healing fluid must be diluted with water (1: 5). The resulting product is placed in the refrigerator. Instill 2 drops 1 time per day.
- Squeeze juice from 3 lemons. Grind the horseradish root with a meat grinder. Mix the ingredients thoroughly. Store the resulting mixture in the refrigerator. Take it on an empty stomach in 0.5 tsp. daily. According to reviews, this tool is especially effective in chronic rhinosinusitis.
- Cut 1 leaf scarlet. Rinse and grind it. Using gauze, squeeze the juice from the resulting slurry. Instill the healing fluid in the nose 4 times a day, 3 drops each.
- Take baking soda, honey and vegetable oil in equal proportions. Mix the ingredients thoroughly. The resulting mass is slightly warmed up and soaked with cotton or gauze turunds. The latter must be inserted into each nasal passage three times a day for 25 minutes.
It is important to know that any medicinal plant is a potential allergen. If there are signs of an undesirable reaction, treatment of rhinosinusitis with folk remedies must be completed.
Forecast
The outcome of the disease largely depends on the timeliness of contacting a doctor. If the treatment was carried out correctly, the prognosis in most cases is favorable. Ignoring the signs of acute sinusitis leads to a chronic process. This means that the patient will be disturbed by unpleasant symptoms for a long time. In addition, chronic rhinosinusitis is often accompanied by the formation of polyps, which can only be removed during surgery.
A common complication of the disease is eye damage. Decreased visual acuity, diplopia, difficulty trying to raise the eyelids, fever, drowsiness, headache - this is a list of symptoms indicating the development of negative consequences. If they occur, you should immediately contact a medical institution.
The most dangerous consequence of the disease is inflammation of the meninges, thrombosis of the cavernous sinuses and abscess. These pathological conditions can lead to coma or death.
Prevention
People suffering from a disease of a chronic nature, in order to prevent the development of relapse, should follow certain rules. They can also be considered as the primary prevention of rhinosinusitis.
Doctor's recommendations:
- Irrigate the nasal passages daily with moisturizing solutions.
- Avoid dusty places and areas where you often smoke.
- Follow the principles of a healthy lifestyle in order to strengthen the body's defenses.
In addition, during adverse epidemiological conditions, it is recommended to avoid visiting too crowded places.
Finally
Rhinosinusitis is a disease in which the nasal mucosa and adjacent sinuses become inflamed. . ( -10 - J01). (J32 ).