Sinusitis: Symptoms and Treatment
Sinusitis is a disease characterized by acute or chronic inflammation, concentrated in the area of sinuses (paranasal sinuses), which, in fact, determines its name. Sinusitis, the symptoms of which we will consider below, mainly develops against the background of an ordinary viral or bacterial infection, as well as allergies and, in some cases, against microplasma or fungal infection.
Let us dwell first of all on what the sinuses are as a region of interest to us in the context of the disease under consideration. Sinuses are small cavity sizes, centered within the thickness of the skull bones. Each person has seven sinuses (paranasal sinuses): frontal sinuses (2), maxillary sinuses (2), sinuses and sphenoid sinuses.
Each of the sinuses is lined with a mucous membrane, while all of them are communicated with the nasal cavity. Note that the possibility of such a message plays an extremely important role in providing a normal condition for the paranasal sinuses. In the event that as a result of the influence of certain factors, the canal closing the nasal cavity and the paranasal sinus has occured (which in particular can occur, for example, due to swelling of the nasal mucosa due to the common cold), this results in air sucking into the blood From a generally sealed sinus. The sinus itself in this case begins to be filled with an inflammatory fluid, in it, in turn, the bacteria begin to multiply rapidly.
The paranasal sinuses perform extremely important functions, and they consist in the following:
- formation of the facial skeleton, facial features and voice timbre
- warming up the air properly for its subsequent passage through the nose.
It is noteworthy that the mucous sinus is as predisposed to infection by various types of infection as the nasal mucosa, concerns this predisposition and the possibility of inflammation. Actually, the inflammation of the mucous membrane of the paranasal sinuses, which we noted earlier, is sinusitis.
Forms of sinusitis
With sinusitis, compared with the usual rhinitis, involving mainly the entire nasal mucosa in the inflammatory process, infection mainly affects one paranasal sinus or several sinuses. Based on the specific sinus inflammation, a specific form of sinusitis is determined in turn.
- is accompanied by a predominant inflammation of one of the maxillary sinuses (in some cases, the inflammation of both sinuses becomes possible)
- The front — inflammatory process focuses on one frontal sinus or both sinuses
- The — sphenoiditis is the inflammatory process that focuses on the sphenoid sinus;
- Ethemoid — the inflammatory process is concentrated within the latticular sinuses (cells).
Sinusitis of the listed inflammations is the most common variant of sinusitis.
In addition to forms of sinusitis, its species are also distinguished depending on the flow characteristics, which implies acute sinusitis or chronic sinusitis. Acute sinusitis (as, by the way, bacterial and viral sinusitis) can last about 8 weeks or more, while sinusitis in chronic form provokes constant changes in the area of the mucous membrane, which, in turn, determines for the patient a significant tendency in the future to Development of sinus infections in him.
Sinusitis is accompanied by inflammation, concentrated in the area of the maxillary (maxillary) sinus. The disease can occur in acute or chronic form.
The maxillary sinuses are located in the maxillary bone (in its thickness), and they also have common walls with the orbit, oral cavity and nasal cavity. In acute sinusitis, inflammation overwhelmingly focuses within the epithelial layer that covers the inside of the maxillary sinuses and is located in the region of a thin layer of connective tissue immediately adjacent to the bone. In addition to the epithelial layer, blood vessels and loose tissue that are under this layer are also involved in inflammation.
If we consider chronic sinusitis, it is characteristic for him to spread inflammation to the submucosa of the sinuses, and also to their bone walls.
This disease can develop at any age, it is a sinusitis and in children. In particular, the incidence of sinusitis increases by the onset of cold seasons.
As the main reasons provoking the development of sinusitis, it is possible to isolate ARI (measles, influenza, etc.), as well as the spread of infectious processes associated with dental diseases, the effects of bacterial and viral infections.
Symptoms of sinusitis are characterized by their own variety of clinical manifestations, and not always they give reason to assume that the inflammatory process of the maxillary sinus, that is, the sinusitis itself, is actual in the patient’s condition. The main signs of sinusitis determine the form of its course.
Acute antritis: symptoms
As the main clinical symptoms of acute sinusitis can be distinguished feeling of tension and pressure that occurs within the location of the affected sinuses inflammatory process. At a more severe stage of the disease, severe headaches are noted, and they are concentrated not only in the area of the maxillary sinuses, but also in the forehead and cheekbones, in rare cases — in the region of the temples. Painful sensations thus spread to half the face, corresponding to the concentration of the process, if this process is two-sided, the pain extends entirely to the front surface, that is, on both sides.
In frequent cases, the headache is accompanied by the attachment of dental pain, which also focuses with the corresponding inflammatory process of the face, a strengthening of the toothache noted during chewing. Also in patients there is a violation of nasal breathing with simultaneous appearance of nasal discharge.
In the nasal region, unpleasant sensations gradually appear and grow. Pain sensations in particular are expressed by the evening.
Headache is, so to speak, a classic symptom of sinusitis (as, indeed, sinusitis in any form of its course). There is a headache as a result of the gradual accumulation of pus, which is formed in the sinus, which has undergone inflammation. The character of a headache in genyantritis, as a rule, pressing, often its concentration reduces to the forehead, as if behind the eyes.
It also happens that patients complain of increased pain that occurs as a result of lifting the eyelids or pressing on the skin in the area under the eyes. As another characteristic companion of the headache in sinusitis, there is also a significant relief associated with it, it occurs when taking a lying position or in the night, due to the exit from the affected pus of the pus.
Also, sinusitis is accompanied by difficulty in nasal breathing, against the background of this voice becomes nasal. The nose, as a rule, is laid on both sides. The actual difficulty in breathing is of a permanent nature, short-term relief in the general state, as well as alternate obstruction of the left and right sides are possible.
Also, in combination with stuffiness, the patients have a runny nose in the form of a mucous or purulent discharge (that is, a clear or green-yellow separable). This symptom may not be manifested, which is important for a severe nasal congestion, which makes it difficult for the outflow in the sinus.
High temperature is also not excluded with genyantritis, it reaches 38 or more degrees. In general, the temperature accompanies the acute form of sinusitis, respectively, its increase in the chronic form of the course of this disease is a rare phenomenon.
In addition to the above, it can be noted malaise, manifested in the form of increased fatigue and weakness, poor appetite and sleep disorders. There are also complaints of lacrimation from the side of the affected sinus, photophobia, and a decrease in olfaction.
When there is sinusitis on the background of ARI, its symptoms, respectively, are accompanied by the symptom of respiratory disease. The first signs of sinusitis development in this case are malaise, fever, sneezing and runny nose, nasal congestion. Quickly to this symptomatology pains are added, focused from the area of the lesion on the face, teeth, forehead and root of the nose. It is not excluded also puffiness of the eyelids and their redness.
The duration of the course of the acute form of sinusitis, as a rule, is about 3 weeks, after which, as a result of the application of adequate therapies, the patients recover.
Chronic sinusitis: symptoms
The symptomatology of this form of maxillary sinusitis can have a slight and erased character, which often complicates the diagnosis of the disease, and, accordingly, its treatment. The main symptom is chronic cold, which is not cured by traditional solutions. Often, patients complain of the occurrence of pain in the eye sockets, as well as a headache. The pain intensification is noted during blinking, in the lying position the pain and at all can pass.
A characteristic feature of the course of chronic sinusitis is the swelling of the eyelids, noted in the morning, as well as conjunctivitis, which indicates the spread of the inflammatory process from the maxillary sinuses to the orbital walls.
The chronic sinusitis is also characterized by systematically arising blunt-type pains, centered in the area under the eye sockets. Nasal congestion has a chronic character of manifestation, mainly one-sided. Again, conjunctivitis is noted in the chronic form of the course.
As a fairly important symptom of the disease in this form, chronic dry cough is given, the treatment of which does not give the desired effect when using traditional methods of therapy with expectorants and antitussives. Against the backdrop of sinusitis, this cough is due to irritation, carried out by pus flowing along the pharyngeal wall.
As with acute sinusitis, with genyantritis chronic, the sense of smell is dulled.
This section should not be missed, because knowledge of the features of the course of the disease and, in fact, complications relevant to it, excludes negligent treatment of it.
The fact is that the structure and anatomical location of the maxillary sinuses determines a serious danger in the development of sinusitis, which is due to direct contact with the medullary membranes. That is, the spread of infection is not excluded to the cranial cavity, which, in turn, leads to the development of meningitis. Fortunately, it is because of adequate response and treatment that the sinusitis reaches this stage rarely, most often the infection gets to the orbit, which determines the subsequent puffiness of the eyelids with a certain bulge of the eye from the side of the affected area that occurs in combination with severe pain.
If you consider the complications of chronic sinusitis, they consist primarily in the fact that as a result of the urgency of inflammation in chronic form, this determines the presence of a constant source of infection in the body, against the background of which, in turn, you can talk about frequent Relapses of pharyngitis and sore throat, as well as dental and osteomyelitis of the upper jaw area.
Acute maxillary sinusitis can provoke the development of the trigeminal neuritis, which, in turn, is accompanied by extremely pronounced painful sensations of the facial region.
Often the complication of chronic sinusitis becomes the formation of an abscess in the form of a closed type of cavity, inside of which is pus.
If a chronic rhinitis occurs in the background of a chronic form of the course of sinusitis, an atrophy of the nasal mucosa may occur, which in turn leads to loss of sense of smell.
As a rule, patients with sinusitis, and especially with chronic forms, are treated unsuccessfully and for a long time from chronic form of bronchitis and other diseases / causes provoking chronic cough.
Frontitis (frontal sinusitis): symptoms
With frontal inflammation, the frontal paranasal sinus is exposed, in particular the process centers around the mucosa that lines the frontal sinus. The course of the frontitis is possible in acute or chronic form.
The acute form of the frontitis is accompanied by sharp painful sensations arising in the forehead. In addition, there is headache (another area of localization), lacrimation, pain in the eyes, difficulty in nasal breathing, photophobia. From the corresponding half of the nose, there are abundant secretions that do not have an odor. The temperature is about 39 degrees, but it can be lower (subfebrile). Possible swelling, noted in soft tissues.
The chronic frontitis is somewhat weaker in its manifestations. So, the headache in this case is aching or pressing, it is mainly localized from the side of the sinus, which has suffered defeat. If the outflow of exudate is difficult, as well as at elevated pressure marked in the sinus, the pain, respectively, is increased, pressing on the orbit (inner corner or inner wall) can be accompanied by sharp pain. As for the actual for this disease symptom in the form of nasal secretions, they are especially abundant in the morning, often they are characterized by an unpleasant odor. In a dream, they drip off during sleep to the nasopharynx, resulting in expectoration of a significant amount of sputum in the morning.
Complications of the frontitis (mainly in chronic form), often reduce to the transition of inflammation to the frontal sinus, that is, to the front of its bone wall, resulting in subsequent necrosis, sequestration and fistula formation. Rarely, the process spreads to the lower wall, resulting in inflammation of the orbital tissue, and due to the involvement of the posterior wall, intracranial complications (brain abscess, extradural abscess or meningitis) develop, respectively. Sepsis may also develop.
Sphenoiditis (sphenoidal sinusitis): symptoms
This disease involves inflammation of the mucosa, affecting, this time, the sphenoid sinus, which, like in previous versions of sinusitis, develops against the background of exposure to a bacterial or viral infection. The disease is encountered in practice infrequently and, as a rule, is caused by the prevalence of inflammation from the posterior cells of the latticed labyrinth.
Sphenoiditis can occur in the form of acute or chronic. Acute sphenoiditis is accompanied by nasal secretions and a characteristic headache for sinusitis, which, as a rule, centers in the occipital part (much less often in the parietal, temporal or frontal). There is also a symptom such as an olfactory disorder, an increase in temperature and a general weakness. As a possible complication, the possibility of spreading inflammation to the orbit and to the skull is determined, as a result of which the optic nerve is exposed, meningitis, abscess and other accompanying processes are developed.
The transition to chronic form with sphenoiditis occurs against the background of the acute form of this disease. Its main symptomatology is reduced to the appearance of a headache (parietal, in some cases — occipital). There may also be a feeling of unpleasant smell to the patient due to the opening of the aperture of the sphenoid sinus to the olfactory nose.
Ethmoiditis (etmoidal sinusitis): symptoms
Etmoiditis is an inflammatory process that focuses on the area of the mucosa of the latticed bone (the membrane of its cells). There is a disease on the background of bacterial or viral effects, may occur in acute or chronic form.
Symptoms of acute etmoiditis occur often with the usual flu, rhinitis, etc. Diseases. The main symptom is headache, as well as pain in the nose and nose. If the pain occurs mainly from the inner edge of the orbit, as well as the root of the nose, then in this case it is possible to speak of the damage to the posterior cells of the bone, which directly affects the disease in question.
Nasal breathing is often difficult, there may be a violation or a complete absence of nasal breathing. Gradually, the general condition only deteriorates, which is accompanied by an increase in the temperature of the order of up to 38 degrees.
The first days of the course of the disease are characterized by the appearance of copious nasal secretions, as a rule, at that time they do not have a smell, afterwards a change in their character is noted — they become serous-purulent or purulent, which is accompanied by a change in color and the acquisition of a certain odor.
Etomoiditis in children is often accompanied by hyperemia and swelling from the inner corner of the orbit, as well as the inner part of the lower and upper eyelid.
Primary acute etmoiditis is accompanied by the most pronounced changes in the general condition of patients. The onset of the disease is accompanied by a sudden increase in temperature to 40 degrees, regurgitation and vomiting, a general concern.
Acute secondary etmoiditis is characterized by increased severity of manifestations and gradual progression. By the third day complications of this disease are noted. These include, in particular, the destruction that occurs in part of the bone walls, the formation of an empyema, as a result of which a pus may break through to the fiber of the orbit (in some cases, into the cranial cavity). When the process spreads to the orbit, visual disturbances are noted, in which the field of vision narrows, its acuity decreases, etc. If it is a question of intracranial complications in the breakdown of pus, they consist in meningitis, brain abscess, and arachnoiditis.
As for the chronic form of ethmoiditis, it occurs against the background of an acute form of the disease, developing, as a rule, in those patients who have significantly reduced resistance forces of the organism and those for whom the effectiveness of treatment is defined as insufficient. Symptoms of the chronic form are revealed on the basis of the general degree of activity of inflammation. Patients are faced with increased fatigue and deterioration in general, working capacity is reduced. Exacerbation of the chronic form occurs with symptoms that are relevant to the acute form.
Acute sinusitis: symptoms
The clinic of the acute form of sinusitis is characterized by signs of an inflammatory process of general and local scale. Symptoms of headache, general malaise, fever and weakness can be identified as manifestations of a general reaction. When analyzing blood, the appropriate blood changes are determined. The listed symptoms in general are not specific, and therefore the diagnosis of the disease occurs on the basis of manifestations of a local disease.
The most frequent complaints, acute in acute sinusitis, are difficulties associated with nasal breathing, headache, abnormal nasal and nasopharyngeal discharge, and also in the sense of smell.
Most often the headache is concentrated in the frontotemporal areas, its strengthening is not excluded even during head inclinations. If a wedge-shaped sinus is affected, a very characteristic symptom appears, which is expressed in so-called nocturnal headaches, which determines their character, as well as localization — in this case it lies in the center of the head, as well as in the nape. In some situations, there are no complaints of headaches.
With regard to the difficulty of nasal breathing in this disease, it develops against the background of the current obstruction of the nasal passages occurring against the background of hyperplasia or edema of the mucosa and the formation of a pathological secretion in the nasal passages. As a rule, the same side of sinus lesions corresponds to the defeat of nasal breathing from a particular side.
Based on the severity of the symptoms characteristic of acute sinusitis, the specificity of the course of the disease as a whole is also determined — in particular, acute sinusitis can be mild, moderate and severe.
About easy flow the disease can be said in the absence of X-ray and local signs indicating a sinusitis, or with a minimum degree of signs of intoxication in combination with a headache and localization of pain sensations from the sinuses subjected to inflammatory damage . This form of the disease is accompanied mainly by normal or subfebrile temperature.
Acute sinusitis is accompanied by moderate toxicity with simultaneous moderation of pain syndrome, which, again, focuses on the affected sinuses in combination with a headache. The temperature in this state rises to 38-38.5 degrees, also slightly reactive phenomena are possible in the variants of the eyelid edema, edema in the area of the paranasal sinuses affecting the soft tissues.
For severe sinusitis, the symptoms are in the form of intoxication, severe headache and pain from the affected sinus walls. The temperature in this period exceeds the mark of 38.5 degrees. The urgency acquires the possibility of developing complications.
Chronic sinusitis: symptoms
The transition to chronic sinusitis occurs in the case of unfinished acute inflammatory processes, their lack of treatment or complete absence of treatment. In particular, the transition to a similar course is relevant for the violation of one of the functions of the sinuses, as well as under unfavorable conditions affecting their ability to aerate and to outflow pathologically secreted.
It is noteworthy that the microflora provoking the chronic course of the inflammatory process of the paranasal sinuses can be of a very different nature, being both highly pathogenic, and conditionally pathogenic or saprophytic.
Chronic sinusitis also has its own classification, built on the basis of histomorphological features in combination with the inherent clinical manifestations.
- Exudative form:
- catarrhal chronic sinusitis
- Serous chronic sinusitis
- Purulent chronic sinusitis.
- Productive form:
- parieto-hyperplastic chronic sinusitis
- polyposis sinusitis.
- Alternative form:
- atrophic chronic sinusitis
- Cholesteatomy chronic sinusitis.
- The form is mixed (or polypous-purulent).
In general, considering chronic sinusitis, it can be noted that the disease in this form are mainly children. Chronic sinusitis in children, as a rule, occurs against the background of the course of such diseases as acute rhinitis, measles, influenza, tonsillitis, scarlet fever, etc.
The main danger of the course of this disease in the chronic form is that it leads to a significant reduction in protective forces, as a result of which small patients become even more susceptible to a number of diseases, of which, first of all, respiratory diseases (bronchitis, Tracheitis, pharyngitis, etc.). In general, chronic sinusitis in children has its own characteristics for each of the individual age groups.
So, for example, children of the early and preschool age group are confronted with a rather pronounced symptom of the general type, prevailing over the local symptoms. In particular, a subfebrile temperature can be distinguished here that is retained within a long time span. In addition, there is sluggishness and weight loss, sleep and appetite worsen. Children quickly become tired, they develop cervical lymphadenitis, under the eyes there is a bluish, in addition cough is noted. Against the background of the general condition, irritability and moodiness appear, in many cases keratitis and relapsing conjunctivitis develop. As a result of these symptoms, the condition of patients is defined as chronic sinusogenic intoxication.
The sinusitis clinic in older children is slightly different from the course of this disease in adults. Manifestations of a subjective scale are expressed in this case somewhat less than in the case of acute sinusitis. The disease is also characterized by the duration of the flow with frequent exacerbations. There are complaints of difficulty in nasal breathing, headaches of various types and arising mainly in the second half of the day. Nasal secretion increases, the sense of smell decreases, and patients quickly become tired.
Diagnosis and treatment of sinusitis
Diagnosis of the form and characteristics of the course of the disease is made on the basis of a general history, as well as the results of the examinations in conjunction with radiography, tomography of the facial part and sinuses in particular.
Conservative or surgical therapy may be used in treatment.
Conservative therapy consists of taking medications that are aimed at reducing the swelling of the nasal mucosa, as well as improving the outflow from the paranasal sinuses. These include local vasoconstrictor drugs (duration of use not more than a few days). Antibacterial medications, antihistamines are also used. Nasal rinses are carried out using antiseptic solutions. The application of physiotherapy procedures is topical.
As for surgical treatment, it reduces to washing the nasal cavity with subsequent puncture (puncture) of the maxillary or frontal sinuses. Due to puncture, the pressure in the sinuses decreases, as a result of which the seeding material can also be obtained. Subsequently, anti-inflammatory drugs and antibiotics are introduced into the sinus.
If the listed measures were also ineffective, which is accompanied by corresponding complications in the form of meningitis, etc., then surgical intervention is performed in a more active way.
To diagnose sinusitis and other listed forms of the disease, you need to contact the otolaryngologist (LOR).