Chronic rhinosinusitis: symptoms and treatment


Chronic rhinosinusitis is an inflammatory ailment of a chronic nature, affecting the mucous membranes of the nose and gradually spreading to the paranasal sinuses. More often pathology affects people from the age category of 45-70 years. Representatives of the fair sex are more likely to suffer than men.

Chronic rhinosinusitis can affect the maxillary sinus, frontal, sphenoidal and latticed paranasal sinuses. As the disease progresses, the mucous sinuses and nose become thicker due to inflammation, and swells. In this case, anastomoses are blocked — a specific chamber is formed, in which gradually accumulates exudate of mucous or purulent nature. The duration of chronic rhinosinusitis is about 12 weeks. The ICD-10 code is J32.

Etiology

The following factors can provoke the progression of this disease:


  • fungal pathologies
  • deformation of the lateral nasal septum
  • the presence of bacterial agents;
  • allergic rhinitis
  • bronchial asthma
  • viral infections (acute respiratory viral infection, influenza, etc.)
  • decreased body reactivity
  • vasomotor rhinitis
  • the impact on the human body of adverse environmental factors
  • not fully treated with acute rhinosinusitis
  • Dental disease.

Classification

Clinicians use several classifications of chronic rhinosinusitis, which are based on the localization of the pathological process, its prevalence, type of inflammation. Also important is the classification of the causative agent pathological process.

Localization:


  1. chronic ethmoid rhinosinusitis or etmoiditis — sinusitis inflames
  2. chronic maxillary rhinosinusitis — the inflammatory process affects the maxillary sinuses
  3. frontitis — the mucous membrane of the frontal sinuses becomes inflamed
  4. sphenoiditis — the sphenoid sinuses are affected.

By prevalence:

  • chronic hemisinusitis. In this case, all sinuses located on one side of the face are affected;
  • chronic maxilloembolism. The inflammatory process covers the latticular and maxillary sinuses;
  • Chronic Pancinusitis. The inflammatory process affects all sinuses at once;
  • chronic polysynusitis. About its progression speak in the event that the inflammation is observed at once in several sinuses, localized from different sides of the nose.

According to the type of inflammatory process:

  1. chronic catarrhal rhinosinusitis
  2. chronic purulent rhinosinusitis. Characterized by the presence of periods of exacerbation with the release of purulent exudate;
  3. chronic polyposis rhinosinusitis. A characteristic feature is the proliferation of outgrowths in the sinuses (polyps)
  4. chronic cystic rhinosinusitis. In the sinuses, cystic formations are formed, inside of which exudate accumulates.

Depending on the pathogen:

  • bacterial rhinosinusitis. Progresses due to the pathogenic activity of bacterial agents. Treatment of this form of pathology is carried out using antibacterial drugs
  • fungal rhinosinusitis. Pathology begins to progress due to the pathogenic activity of fungal microorganisms. It should be noted that with this type in the sinus, a mycetoma is formed — a specific dense fungal body. In the treatment plan, in this case, necessarily include antifungal pharmaceuticals.

Separately it is necessary to distinguish chronic allergic rhinosinusitis. It is seasonal in nature and completely independent of the activity of microbial agents. The main reason for its progression is the effect on the body of various allergens (spores of fungi, pollen, wool, etc.). A characteristic feature of allergic rhinosinusitis — together with the inflammation of the mucous sinuses, skin rashes appear, eyes blush.

Symptoms

Symptoms of the pathology are manifested in the patient gradually. Sometimes they can not be expressed clearly, and the patient himself does not pay attention to them. But as the progression of the disease manifests such signs:





  1. smell reduction
  2. Nasal congestion. This symptom gives the patient a lot of inconvenience, as he can not fully breathe;
  3. the voice becomes nasal;
  4. Purulent exudate may periodically be released from the nose
  5. the mucus from the nose drains down the back of the throat;
  6. lacrimation
  7. Severity in different parts of the face. This symptom is due to the accumulation of exudate in the sinuses;
  8. headache. Taking painkillers gives only temporary relief, after which this symptom returns again.

During the period of exacerbation there are such symptoms:

  • increased nasal congestion
  • Hyperthermia, but not higher than 37.5-38 degrees;
  • Viscous mucus of brown, green or white color is released from the nasal cavity
  • pain in the facial area
  • severe headache. This symptom manifests itself most intensively in the case of progression of the purulent process.

Diagnostics

The standard diagnosis plan for the disease includes such activities:

  1. medical history of patient complaints
  2. anamnesis of the disease itself
  3. general examination involving palpation and percussion
  4. Rhinoscopy
  5. X-ray of the sinuses;
  6. CT of the sinuses of the nose;
  7. Diagnostic sinus puncture;
  8. Ultrasound of the sinuses;
  9. seeding the contents from the sinuses.

Treatment

The ENT doctor deals with the treatment of ailment. For the duration of therapy the patient is placed in a hospital so that doctors can monitor his condition, as well as the effectiveness of treatment. If necessary, carry out its correction. Treatment of chronic rhinosinusitis is carried out by conservative and surgical techniques.

Medication:

  • antibiotics. This group of drugs is prescribed after receiving the results of a microbiological study of the contents of the affected sinuses;
  • Antibacterial sprays for topical use
  • Antihistamines and corticosteroids are included in the treatment plan to minimize inflammation;
  • vasoconstrictive and decongestants for topical use (usually in the form of drops)
  • immunomodulators
  • mucolytics
  • antipyretic drugs
  • Anti-inflammatory drugs

Surgical treatment:

  1. The puncture of the affected sinuses. Carry out this intervention to remove purulent exudate from the sinuses, and then introduce antibacterial drugs into them;
  2. YAMIK catheter. This is a special tool, equipped with 2 cylinders, which can be inflated. A given rubber catheter is introduced into the nasal passage, balloons are inflated, and then the contents of the sinuses are removed with a syringe.

Traditional medicine

You can use traditional medicine only with the permission of the attending physician and in tandem with the methods of official medicine. They help to eliminate the unpleasant symptoms of the disease, but the disease itself will not heal.

For the use of such folk remedies:

  • tincture of eucalyptus, chamomile, sage, valerian and calendula. This folk remedy can be used for both inhalation and compressing;
  • a mixture of onions, potato juice and honey
  • A mixture of horseradish and lemon. Effective means for treating the disease.