Very often, an ENT doctor diagnoses his patients with acute rhinosinusitis, which is a disease of the upper respiratory tract. This disease is treated with antibiotics. Often it causes complications, as a result of which the acute form becomes purulent or chronic. Perhaps sales will require surgery. Consider in more detail such a disease as rhinosinusitis, symptoms and treatment of this pathology.
Forms
Depending on in what place this ailment occurs, distinguish:
- sinusitis ( maxillary sinusitis );
- ethmoiditis (inflammatory lesion of the ethmoid bone);
- sphenoiditis (inflammation of the sphenoid sinus);
- pansinusitis and polysinusitis (lesion of several or all sinuses of the nose);
- frontal sinus (frontal sinus becomes inflamed).
All these pathologies are called by one term - "rhinosinusitis."
Causes of occurrence
Acute rhinosinusitis can occur for the following reasons:
- due to infection;
- under the influence of allergens.
Most often, this disease is caused by a common cold. Viruses enter the paranasal sinuses and contribute to their inflammation. Usually, if an infection enters the nasal cavity, the body immediately responds to this with an immune response, an increase in mucus and the formation of edema. This leads to the fact that from the paranasal sinuses the contents begin to be excreted with difficulty, and favorable conditions are created for the subsequent reproduction of harmful microorganisms and the formation of pus.
In the human body there are constantly some types of bacteria in minimal quantities that do not provoke the occurrence of inflammatory processes. With a decrease in the protective functions of the body, they begin to multiply intensively, often causing acute purulent rhinosinusitis.
In addition, there are pathological conditions that are predisposing factors for the development of this disease:
- anatomical features of the structure of the nose (enlarged nasal concha, deformation of the septum, etc.);
- immunodeficiency state;
- the presence of diseases such as cystic fibrosis, allergic rhinitis, adenoiditis and others;
- reduced immunity.
Symptoms
The following primary signs of sinus inflammation are noted:
- fever;
- Strong headache;
- changes in blood;
- weakness and general malaise;
- nasal congestion.
After a while, acute rhinosinusitis manifests itself as follows:
- increase in body temperature;
- pathological discharge from the nasal cavity;
- swelling of the eyelids or cheeks;
- bad breath;
- cough, often worse at night;
- difficulty in nasal breathing;
- sense of smell disorder;
- tension and pressure in the affected sinuses;
- feeling of constant fatigue;
- toothache, most acute during chewing.
Acute purulent rhinosinusitis can have a fairly large number of diverse general and local signs. Symptoms of it depend on the causes of its occurrence, the presence of other diseases and the age of the patient. Moreover, children are more likely to tolerate this disease.
Polypous rhinosinusitis has almost the same symptoms as the acute form. Since this form of the disease is more severe, endoscopic surgery in combination with anti-allergic therapy is used to treat it.
Diagnostics
As soon as the first signs of rhinosinusitis appeared, which not only do not go away after a few days, but also intensify, you should definitely consult a doctor. To make an accurate diagnosis, the specialist determines the location of the disease, its shape, as well as the type of bacteria or virus that caused the development of the infection.
To confirm the clinical manifestations of acute rhinosinusitis, the following activities are carried out:
- assesses the general condition of the patient;
- analyzes are taken;
- carry out instrumental research methods.
Otolaryngological examination
Examination of the patient begins with a collection of his medical history. For this, the patient describes all the symptoms, the duration of discharge from the nose and their nature, the presence of pain in the head and face and their localization. He should also inform the doctor about any manifestations of allergies and recent colds.
Even the information about the performed dental procedures, medications taken, facial injuries, and immunity disorders will help with the diagnosis.
After that, the doctor conducts a physical examination of the patient by performing palpation of the cheekbones and forehead to determine the pain in the sinuses of the nose. With the help of an otolaryngological examination, defects in the nasal cavity can be detected.
Laboratory tests
The presence of the inflammatory process and the nature of its course helps to determine the general analysis of blood. In this case, an analysis of the number of leukocytes and the ratio of their forms is carried out.
In addition, in the laboratory, the pathogenic contents of the affected sinuses are examined. With the help of microbiological studies, the type of pathogen and its sensitivity to various antibacterial agents are established. But it should be remembered that the results of such analyzes in the acute form are obtained only 3-4 days after the onset of the first signs of the disease. Therefore, very often they lose their relevance.
Instrumental research
To make an accurate diagnosis, special instrumental studies are used:
- Nasal endoscopy - for its use, a fiber optic tube is used, at the end of which there is a light source. With the help of such a study, you can detect even the smallest deviations in the nasal cavity, as well as assess the septal defect and the presence of neoplasms, for example, polyps.
- Computed tomography - is considered the best visual method for examining the sinuses of the nose. It is recommended to carry out in case of complications.
- Radiography - was widely used until endoscopy and computed tomography appeared. Currently, they began to resort to it much less often.
- Magnetic resonance imaging is a wonderful method for diagnosing inflammatory processes, complications inside the skull, and malignant tumors. Maxillary sinusitis is manifested in the form of dimming of the maxillary sinuses.
Treatment methods
Acute rhinosinusitis is treated with both medication and surgery. The effectiveness of each method is considered by the doctor individually for each patient. The choice of treatment method depends on various factors: the patient’s age, the form of the disease and the nature of its course, the possibility of allergic reactions, etc. But whatever treatment regimen is chosen, it should be aimed at:
- eliminate signs of inflammation;
- restore the patency of the passages that connect the nasal passages with the sinuses;
- extract pathogenic contents from the sinuses;
- eliminate the focus of infection.
Treatment of rhinosinusitis in adults should be carried out under the strict supervision of a doctor, since uncontrolled medication often leads to complications. And the main goal of treatment is to eliminate the pathogen and restore the ability of the paranasal sinuses to cleanse themselves.
Drug treatment
Acute purulent rhinosinusitis is treated with the following medications:
- decongestants;
- immunocorrector;
- antibiotics
- additional symptomatic drugs.
Decongestants and vasoconstrictors are usually prescribed first and they should be used no more than 4–5 days, since prolonged use only enhances swelling and nasal congestion. Such drugs include Ephedrine, Nazivin, Sanorin, Galazolin, Naftizin, etc. Such drugs do not cure the disease, but temporarily eliminate its symptoms.
In certain forms of a disease such as rhinosinusitis, treatment is only possible with antibiotics, which should be taken for two weeks. They help to completely eliminate all symptoms, but their reception should be carried out only under the supervision of a specialist. Most often, an antibiotic such as Amoxicillin is prescribed. But if there is no improvement three days after taking it, it must be replaced with preparations with such an active substance as tetracycline or cephalosporin. The following antibiotics are also justified: Clarithromycin, Azithromycin and Roxithromycin.
Despite the wide selection of various drugs that are used to treat acute rhinosinusitis, they are not always effective. This is due to the fact that many microorganisms that cause inflammatory processes of the upper respiratory tract, successfully resist antibiotics. That is why with acute rhinosinusitis, especially when the frontal sinus becomes inflamed, a stimulation of the person’s immune defense is used.
For this purpose, immunomodulators and immunocorrectors are used. They contain substances that restore the function of immune defense. The course of treatment is usually 1.5–2 weeks.
If a form of the disease such as polypous rhinosinusitis is identified, treatment should be carried out using mucolytic drugs (Mirtol, Sinupret, Acetylcysteine). They contribute to the liquefaction of the thick and viscous contents of the sinuses, as a result of which the outflow of pus begins. Also, medications of this pharmacological group can also have an antibacterial effect.
If the body temperature rises, then the patient should observe bed rest. To do this, he is prescribed antipyretic drugs such as Amidopyrine and Aspirin. Paracetamol and Ibuprofen are usually prescribed as painkillers. Stronger drugs are rarely used and should be taken no more than 7 days.
Allergic rhinosinusitis is treated with antihistamine drops and tablets. You can also use ointments and creams, but hormonal drugs are prescribed quite rarely.
It is worth adding that, in addition to drug treatment, the following therapy is carried out:
- washed sinuses of the nose with antiseptic solutions to remove pathological contents;
- It is recommended to drink a lot of warm liquid: fruit drinks, dried fruit compotes, natural fruit juices, weak tea, rosehip broth;
- use physiotherapeutic methods: microwave therapy, ultrasound, UHF.
If these methods do not bring the proper result, resort to surgical treatment.
Surgical intervention
If drug therapy of a disease such as rhinosinusitis has not helped, treatment in this case is carried out by the surgical method. Most often, a puncture is prescribed, which helps:
- quickly extract purulent contents from the paranasal sinuses;
- directly affect the mucosa of the sinuses with antiseptic, anti-inflammatory and antibacterial drugs.
But there are disadvantages to such treatment. There is a risk of developing blood poisoning, loss of vision, etc. Therefore, most often it is not recommended to conduct it.
Features of the disease in children
Rhinosinusitis in children is the dominant disease, as it accounts for one third of all diseases that are associated with the upper respiratory tract. Moreover, having matured, half of the guys continue to suffer from it.
With this disease, the likelihood of developing serious complications is high. The most dangerous is a purulent-septic orbital complication leading to visual impairment, and in 2% of cases intracranial changes occur. If you do not timely diagnose the disease and treat it, then pneumonia develops.
Acute rhinosinusitis in children is manifested as follows:
- painful prolonged cough;
- difficulty breathing through the nose;
- fast fatiguability;
- general malaise;
- nasal voice;
- fever.
The main treatment is antibiotic therapy against the background of increased immunity.
Features of the disease during pregnancy
Quite often, acute purulent rhinosinusitis occurs during pregnancy, moreover, it can be accompanied by complications, since any treatment is limited during this period.
Only the attending physician can prescribe antibiotics that can harm a woman and a child if they are taken uncontrollably. If the penicillin group and cephalosporin are poorly tolerated, then macrolides are used. These can be Moxifloxacin, Levofloxacin and Sparfloxacin. Under their influence, protein synthesis is destroyed in the cells of pathogens. Such drugs are considered the most effective and safe for the treatment of pregnant women.
Prevention
To avoid a disease such as acute rhinosinusitis, the following preventive measures must be taken:
- avoid drafts and hypothermia;
- walk a lot in the fresh air, show physical activity;
- harden;
- do sport;
- timely treat ARVI and runny nose;
- go to the dentist in time to treat the teeth of the upper jaw;
- It is advisable to swim in sea water and inhale the healing sea air.
Output
Thus, acute purulent rhinosinusitis should be treated under the supervision of a doctor, so that rather dangerous complications do not arise, which can even pose a threat to life. It is necessary to avoid the factors provoking the disease, spend less time in unventilated and dusty rooms, and stop smoking. With adequate and timely treatment, rhinosinusitis is completely cured.