A persistent inflammatory process that occurs in the maxillary sinuses (sinuses) is more often called chronic sinusitis. The disease affects the departments located in the thickness of the upper jaw. The chronic form of the disease is said when it periodically recurs and affects the patient’s well-being.
Physiology
The nasal cavity in humans is a whole complex of hidden paranasal airways. All of them are located in nearby cranial bones:
- paired maxillary;
- paired frontal (frontal);
- paired trellised;
- wedge-shaped unpaired.
Due to the normal functioning of each sinus, it is ensured that the warming, moisturizing, and disinfection of the air entering them during breathing is fully achieved. In addition, the adnexal structures of the nose are necessary for sound formation and isolation of sensitive structures of the facial skull from temperature jumps.
The maxillary sinuses filled with air minimize 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
As a rule, it is not possible to completely cure chronic sinusitis. The paranasal sinuses are poorly supplied with blood and practically do not have nerve endings, which, in itself, is a prerequisite for the development of an acute inflammatory process. In addition, the physiological peculiarity of the lower wall of the maxillary sinuses, which is most often affected by the disease, cannot be ruled out - it is very thin and easily damaged. For example, dental procedures pose a potential threat to the maxillary sinuses and create the prerequisites for the development of acute, and, after some time, chronic sinusitis.
ICD-10 (“International Statistical Classification of Diseases and Health 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 frontal sinusitis (frontal sinusitis).
- J32.2 - Chronic ethmoiditis (ethmoid sinusitis).
- J32.3 - Chronic sphenoid sinusitis (sphenoiditis).
- J32.4 - Chronic pansinusitis
- J32.8 - Other chronic sinusitis. Sinusitis, an inflammation of more than one sinus, but not pansinusitis. Rhinosinusitis.
- J32.9 - Chronic sinusitis of unspecified etiology.
Among the clinical cases of inflammation of the airways sinuses, maxillary sinus sinusitis most often occurs. They account for more than 70% of calls to specialists. Otolaryngologists note that this disease has become very common over the past few years. Chronic sinusitis occurs in adults and children, equally often in women and men.
Causes of the disease
Speaking about the factors provoking the development of a disease such as chronic sinusitis, it is worth noting first of all acute inflammation of the maxillary sinuses. Less often, the inflammatory process that occurs in other organs becomes the cause of the transition to a chronic form. The disease is activated from the moment of penetration of pathogenic microflora into the maxillary sinus cavity. Bacteria, viruses and simple microorganisms enter the nasal structures in several ways:
- through the bloodstream from the main focus of infection in the body;
- from the middle nasal passage through the connecting hole into the cavity;
- with infection of the dentition, which is accompanied by inflammation;
- with 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 prolonged relapsing also contributes to:
- illiterate self-medication, the appointment of therapy by incompetent specialists;
- anatomical defects and features, including the narrowness of the nasal passage and the communicating opening of the maxillary sinuses, post-traumatic or intrauterine bend of the nasal septum;
- the formation of polyps and the growth of fibrocystic tissue, which impedes the natural outflow of mucus;
- chronic inflammation of the middle ear, upper and lower respiratory tract;
- the presence of a carious lesion in the oral cavity;
- adverse 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 in the cold season. General hypothermia, severe stress and physical exertion 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 in the form of the course. So, sinusitis can be of several types:
- allergic
- odontogenic;
- hematogenous;
- rhinogenic;
- vasomotor;
- cystic.
Distinguish chronic sinusitis and the nature of inflammation. Sinusitis is catarrhal, purulent and mixed. In the first case, it is an exudative form (serous or mucous discharge accumulates in the maxillary sinus cavity), in the second - about stagnant purulent contents, in the third - about pathological purulent-exudative secretion 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 relapse of sinusitis is based on the principles of combating the manifestations of the disease. Symptoms of this disease in adults and children differ from other ailments of the respiratory system by specific features. Patients note:
- a feeling of tension and pressure in the area of the affected nasal cavities;
- persistent runny nose;
- low-grade fever;
- labored breathing;
- hoarseness 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 nose, behind the eyeballs). First, in these zones there are unpleasant sensations, a feeling of internal squeezing and bursting, dull aching pain. Discomfort increases with tilting the head, chewing, pressing on the region of the maxillary sinuses.
In the initial stages of sinusitis, nasal discharge is mucous. 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 worried about a dry cough, which practically does not lend itself to traditional 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 acquire maximum severity during an 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 reasons for 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 at the same time it is accompanied by ethmoiditis occurring in a purulent-cystic form.
Symptoms of sinusitis in children are weak. The clinical manifestations of chronic sinusitis are lubricated, pain in the maxillary sinus, as a rule, is absent, serous secretion from the nose over a long period does not change the nature. Sinusitis is often accompanied by pain in the ear from the side of the inflamed sinus, which is associated with the drainage of purulent discharge along the back and side walls of the larynx with the subsequent involvement of the middle ear and respiratory tree structures in the inflammatory process with the further development of otitis media. In more rare cases, the pathological process that occurs in the sinuses in children extends to the conjunctiva and ocular tissues, causing the development of keratitis, conjunctivitis.
Since sinuses form only by the age of 18-20, in a young child, the maxillary maxillary sinuses are inferior from the anatomical point of view: they are represented by a narrow slit, and their bottom is located much higher than in an adult, due to the peculiarities of the structure of the skull. Due to these specific features, the development of chronic sinusitis in children younger than three years of age is almost impossible.
Diagnostic measures
A 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, the following are taken into account:
- anamnestic information (the presence of foci of infection, the level of sanitation of the oral cavity, history of acute sinusitis in the past and other information);
- objective comprehensive examination (palpation of the face in the projection of the maxillary nasal cavities, detection of traces of secretion from the inflamed sinus on the back wall of the larynx);
- blood test results (clinical and biochemical) to determine the level of leukocytes, neutrophils, ESR, acute phase indicators;
- expert opinion after rhinoscopy - a procedure that demonstrates inflammatory changes in the nasal mucosa, the presence of pus in the middle nasal passage;
- radiography of the maxillary sinuses (if necessary, treatment of chronic sinusitis in adults, the affected sinuses will be partially darkened in the picture, and in severe cases, the blackout is total).
Sometimes doctors resort to such a research method as diaphanoscopy. It is used to illuminate the cheeks and lower eyelids on the side of the affected sinus. If the patient does not experience a sensation of light in the eye during the procedure, sinusitis is confirmed. Diagnostic puncture is used in exceptional cases due to the high invasiveness of the examination.
How to treat chronic sinusitis
Therapy of this disease takes place, mainly, in a conservative way. Patients undergo the course of treatment on an outpatient basis. Hospitalization in chronic sinusitis is a rare occurrence. Treatment within the walls of the ENT department is recommended for patients with complicated inflammation of the maxillary sinuses. A stationary regimen is necessary for patients with severe stormy symptoms (severe pain, significant difficulty 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, the following pharmacological groups are indispensable:
- Antibiotics. To combat the pathogenic microflora that affects the maxillary sinus, antibacterial drugs are used on a natural and synthetic basis (penicillins, cephalosporins, fluoroquinolones, tetracyclines, macrolides).
- NSAIDs. Medications that belong to the category of non-steroidal anti-inflammatory drugs are designed to fight heat and have an analgesic effect.
- Antiallergic and desensitizing drugs. They are prescribed for the prevention of an allergic reaction.
- Sedative medicines.
- Vitamin and mineral complexes. They are prescribed for the general strengthening of the body and increase the immune forces.
- Mucolytic drugs. Essential for expectoration and elimination of sputum from the respiratory tract.
- Vasoconstrictive nasal drops and sprays.
In addition to medications, physiotherapeutic methods are recommended for the treatment of chronic sinusitis:
- microwave therapy and electrophoresis procedures;
- the influence of diadynamic currents, a laser;
- ultrasound exposure;
- paraffin baths;
- inhalation;
- lavage of the nasal cavity (“cuckoo”).
Surgical intervention
In the absence of the effect of conservative treatment, the doctor may decide on the need for invasive intervention in the affected sinus. Puncture is performed through a puncture of the maxillary sinus in the medial wall. During the manipulation, the 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 rinse the affected cavity with antiseptic solutions, introduce antibiotics, steroids and enzymes that absorb and dilute the purulent contents in order to accelerate its outflow from the sinus. Sometimes a catheter is installed for patients to accelerate the evacuation of the secrets of the maxillary cavity.
It is usually not possible to cure chronic sinusitis without surgery. A 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 with an exacerbated form of chronic sinusitis usually does not exceed 3-4 weeks.
A disease such as sinusitis cannot be taken carelessly. Complications of untreated pathology can lead to the development of bacterial meningitis, brain abscess, and 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 involves 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 implied is the maintenance of a healthy lifestyle, the general strengthening of immunity and a balanced diet. In addition, to reduce the likelihood of developing chronic sinusitis will help:
- timely influenza vaccination;
- thorough treatment of infections in the body;
- inhibition of foci of inflammation immediately after their appearance;
- annual examination by a dentist and control of oral sanitation;
- lack of contact with allergens;
- maintaining normal humidity and room temperature;
- regular washing of the nose with saline;
- refusal of sports related to immersion in water, stay in the mountains.
These rules are more effective for the prevention of colds. In chronic sinusitis, their observance will allow to achieve a 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 - otolaryngologist and immunologist.