Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses, and the most famous of them is sinusitis. Sinusitis takes an “honorable” prize among all diseases of the ENT organs, accounting for up to a quarter of all patient visits. On average, one in six adults suffers from sinusitis occasionally.
Our expert in this field:
Serebryansky Yuri Evstafievich
Cardiologist, geriatrician, therapist, professor, Honored Doctor of the Russian Federation, Doctor of Medical Sciences
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Presumably, sinusitis is included in the TOP 10 of all inflammatory diseases; it is given fifth place in the frequency of antibiotic prescriptions.
The statistics of ENT diseases among Russians is lame, but every year exactly 10 million patients with sinusitis reach doctors, at least the same number simply walk around with sinusitis, hoping for an independent resolution of the problem, which with catarrhal form happens sooner or later.
A 2008 analysis of US health insurance databases revealed that one in seven American adults had symptoms of rhinosinusitis in the previous year. Moreover, women were sick twice as often, and the main group of patients was over 45 years old.
With purulent processes without treatment and the help of a doctor, you can reach osteomyelitis of the skull bone or meningitis. Every fifth “brain inflammation” is due to sinusitis. A quarter of all sinusitis sufferers show signs of depression.
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How many sinuses does a person have?
In the facial skull of an adult there are several pairs of nasal or paranasal sinuses, with a total number of 8 to 16. There is one sinus in the frontal bone, and the bones are paired; these sinuses are called frontal, and their inflammation is called frontal sinusitis. The frontal sinuses communicate through a thin anastomosis with the middle section of the inner nose, where the mucous secretion should flow.
In the upper jaw there is also one sinus on each side, they separate the dentition and the eye orbit, these are the largest air sinuses, their name is maxillary or maxillary, and inflammation of the sinus is sinusitis. The maxillary sinus opens into the middle meatus.
The sphenoid bone also has sinuses; they are small, but located posteriorly in relation to the nose; the brain is adjacent to the upper wall of this sinus, and more specifically, the pituitary gland is located - the main regulator of all endocrine glands. Inflammation of the sinus is called sphenoiditis. The sphenoid sinus opens through a narrow duct into the upper floor of the nose. And this group is enclosed by a lattice labyrinth with paired sinuses, but their number varies from two to eight. Its anterior cells communicate with the middle nasal passage, and the posterior ones with the superior nasal meatus. But the ethmoid bone itself is not visible from the outside; it is located inside the skull, between the maxillary, frontal and sphenoid bones. Its inflammation is called ethmoiditis.
Sinusitis takes precedence in the frequency of inflammatory changes; ethmoiditis, frontal sinusitis and sphenoiditis develop much less frequently. When all the sinuses are inflamed, they speak of pansinusitis, and since sinusitis practically does not occur without inflammation of the nasal mucosa, it is correct to call this condition rhinosinusitis. When all the sinuses on one side of the facial skull are affected, it will be hemisinusitis.
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Complications of chronic rhinosinusitis
Prolonged inflammation carries many dangers, since the sinuses are close to such important structures as the eyes and brain:
- Meningitis (inflammation of the membranes of the brain and spinal cord);
- Sepsis. Generalized infection;
- Other infectious complications. Sometimes the inflammation spreads to the bones (osteomyelitis) or skin (cellulitis);
- Orbital complications. If the infection enters the eye socket, it can cause decreased vision or permanent blindness.
- Partial (or complete) loss of smell. The difficulty of odorants entering the olfactory cleft and inflammation of the olfactory nerve can lead to temporary or permanent loss of odor perception.
Why are sinuses needed?
The facial skeleton is made up of several flat but very strong bones. If there were no air sinuses, then the weight of the skull would be greater, but their main function is not to lighten the weight while maintaining the strength of the facial bones, but to warm the air entering through the nose into the respiratory tract. Compare the temperature outside, and inside a person’s lungs it should be 36.6 ° C, while the time of inhalation and, accordingly, the passage of air “from the street” to the alveoli is a fraction of a second. For these fractions it is necessary to warm up from minus to good plus and at the same time humidify the air flow. The mucous membrane of the sinuses is abundantly supplied with blood vessels, so it is easy to warm the air there. There, various microorganisms are caught and utilized by immune cells.
Our voice receives sound in the sinuses; they act as resonators - just remember how loudly frogs croak when the cheek resonator pouches are inflated. The sinuses are thought to help regulate blood pressure by relating it to changes in barometric pressure.
What is sinusitis like?
Chronic sinusitis can be called after 12 weeks of continuous illness, respectively, if the inflammation is shorter, then it is acute sinusitis. If sinusitis occurs annually or visits a person several times a year, but between exacerbations there is a clear interval without signs of illness of at least 8 weeks, then this will be recurrent sinusitis.
Acute sinusitis is named after the sinuses in which it develops: sinusitis, sphenoiditis, frontal sinusitis and ethmoiditis. Sinusitis is divided according to the composition of the discharge into purulent, catarrhal and serous, which are combined into one group of exudative. If there are any growths of the mucous membrane in the cavity, then productive sinusitis and its subvariant forms are assumed: cystic, polypous or hyperplastic parietal. Separately, necrotic sinusitis is distinguished as an extremely severe process with tissue decay, and atrophic sinusitis against the background of degeneration of the mucous membrane.
Sinusitis can be caused by viruses, bacteria and fungi. More often, inflammation begins with a respiratory virus, followed by a bacterial infection, often pneumococcus and Pfeiffer's hemophilus influenzae.
Treatment of synovitis of the knee joint
The same procedure is the first stage of treatment for the disease synovitis of the knee joint. A thin needle is used to suck out part of the liquid and then inject it into the joint cavity.
After the puncture, the knee joint should be provided with maximum rest. For this purpose, they resort to immobilization using a tight pressure bandage, a knee brace or special knee orthoses. The goal is not to completely eliminate mobility in the joint; you just need to reduce the load as much as possible. As for complete immobilization, it is rather harmful in this case and can contribute to the development of contractures. To prevent contractures, it is also recommended to limit the period of partial fixation to one week.
Diagnosis of sinusitis
Inspection with a nasal speculum will allow you to see the pathological discharge from the sinus. The examination is necessarily supplemented by an X-ray examination of the facial skull in several projections. With sinusitis, an X-ray shows a decrease in the airiness of the sinus and even the level of fluid inside.
With CT, you can not only localize the lesion, but also see the thickness of the sinus mucosa, the presence of small cysts and polyps in them, which allows you to determine the likelihood of developing a chronic process. But with CT it is not easy to distinguish banal inflammatory edema in the first days of a respiratory infection from “terry” sinusitis; in both conditions, pronounced swelling of the mucous membrane will be noted, so CT is better done for prolonged sinusitis.
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Puncture of the maxillary sinus
Puncture of the maxillary sinus is not only a diagnostic, but also a therapeutic procedure, since rinsing the sinus cavity with an antiseptic solution reduces bacterial contamination.
Russian specialists consider puncture of the maxillary sinus to be the first and best treatment tactic. This “unloading” treatment allows you to remove pathological exudate - pus - from the sinus, restore its airiness and reduce the swelling of the anastomosis itself. Antibiotics are not administered inside the sinuses, because they damage the epithelium and, by and large, do harm, aggravating the pathological process.
For purulent sinusitis, about three to five punctures are quite sufficient, but only one can help. It is preferable not to install long-term catheters inside the sinus, since the locally irritating effect of a foreign object leads to increased edema. For catarrhal sinusitis, puncture treatment is not carried out at all, just as puncture of other sinuses is possible, but requires special skills. To argue for the uselessness of punctures, they use references to “Western schools,” forgetting that ENT diseases are treated there by family doctors who do not master the art available to narrow specialists—Russian otolaryngologists.
Treatment: additional and mandatory
It is mandatory to use vasoconstrictor drugs in the treatment of sinusitis, not only in drops, but also in gels, aerosols or tablets. Oxymetazoline or xylometazoline preparations quickly eliminate swelling and restore the patency of the anastomosis. It is almost impossible to dose nasal drops correctly, and aerosol sprays have the advantage of being able to administer a limited single dose.
It is recommended to use vasoconstrictor drugs for the nose for no more than a week due to the possibility of developing a “ricochet”, when instead of reducing nasal swelling they lead to its increase. The tablets do not initiate a “ricochet”, but have a general effect on the body in the form of increased blood pressure and heart rate. It can be argued that sinusitis will not be cured in a week, therefore, it will not be possible to do without vasoconstrictor drops. True, but a consultation with an ENT doctor will help solve this problem.
Causes of synovitis
They can be very different:
- injuries, bruises, abrasions, penetrating wounds of joints;
- allergic reactions to any external or internal irritant;
- penetration of the infectious agent directly into the synovial membrane;
- excess body weight;
- joint instability.
Doctors separately consider cases when the cause of the disease is other pathologies. Provoking factors can be gonorrhea and syphilis, bursitis, gout, hemophilia. If the disease is congenital, it can cause synovitis of the hip joint in children.
Antibacterial and anti-inflammatory drugs in the treatment of sinusitis
For severe and moderate sinusitis, today it is recommended to carry out antibacterial therapy for up to 12–14 days, preferably by injection, and even better to perform a culture of nasal discharge for sensitivity to antibiotics. But this is not a quick process, so it is more often necessary in case of a chronic process and relapses of sinusitis. For mild cases, antibiotics are also used, but only the doctor will indicate the duration and regimen, as well as the specific drug.
Mostly antibiotics are prescribed empirically, that is, according to the suspected type of bacterial pathogen. Standard schemes for the first and subsequent lines of application have been developed. Co-trimoxazole (Bactrim, Biseptol), lincomycin and gentamicin are definitely not recommended for the treatment of Russian sinusitis - the domestic bacterial flora that leads to sinusitis is not sensitive to them.
A special local glucocorticosteroid (fenspiride) is used as an anti-inflammatory, because conventional non-steroidal anti-inflammatory drugs for the treatment of sinusitis are rather weak. The glucocorticosteroid reduces swelling, corrects immune defects and prevents bacterial colonies from growing further.
To reduce the viscosity of the secretion, mucolytics with acetylcysteine (ACC) are used, which thins the viscous gel and facilitates easier flow, clearing the cavity of both pus and bacteria.
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To remove the causative agent, it is recommended to rinse the nose with saline solutions or sea water; an ENT doctor will teach you how to do this correctly.
The first symptom of sinusitis is swelling of the nasal mucosa, which significantly complicates breathing. In case of an acute viral infection, it is difficult to combat swelling; vasoconstrictor drugs instilled into the nose, on the one hand, relieve swelling, but irritation of the mucous membrane causes obsessive sneezing, followed by a second wave of swelling. The effect of the drops is very short-lived and in the acute period is low, but without them there is almost no nasal breathing.
After 3-5 days of such suffering, the feeling of nasal congestion decreases somewhat, but there is a feeling of an increase in the area of congestion and the secretion released from the nose changes, it thickens and its color can change from transparent yellowish to cloudy greenish.
The following symptom appears - pain under the eyes inside the cheekbones, if the maxillary sinus is involved in the swelling, and in the bridge of the nose, if the frontal sinus is inflamed. The pain may radiate to the teeth and intensify when blowing your nose.
The density of the secretion increases, it is difficult to blow out, but is extremely abundant. At night, secretions flow down the back wall of the throat; in the morning, a cough with greenish sputum may appear, which is actually just “snot” that has run dry at night.
Chronic hypoxia - starvation of the brain due to constant nasal congestion leads to headaches and a feeling of “brain swelling.” The temperature may be normal or low-grade.
The sense of smell and even the taste of food may be impaired, and the ears may become blocked. The process is most often bilateral, but not symmetrical in flow. When vasoconstrictor drugs are instilled into the nose, the swelling of the nasal mucosa decreases, which facilitates the evacuation of secretions from the diseased sinus.
Chronic sinusitis also begins with ARVI, but its course is not so acute. Due to the constant presence of bacterial flora, the discharge changes earlier from mucous to purulent. Only chronic patients with sinusitis can independently determine which sinus is affected; in an acute process, clinical manifestations in different sinuses give the same type of symptoms.
All troubles in the sinuses begin with inflammation of the upper respiratory tract, usually together with an acute respiratory viral infection (ARVI), often rhinovirus. Therefore, people suffer from sinusitis during the same period as ARVI, at least in winter, early spring, early and late autumn. The mucous membrane affected by the virus swells, the secretion of the glands increases, and the outflow of the secretion produced is impossible due to swelling of the sinus-nasal junction.
In 95 out of a hundred people with ARVI, CT or MRI will show inflammatory swelling of the sinuses, but this does not mean that all of them are at risk of bacterial inflammation of the sinuses, and this will cause sinusitis. Only one or two will be unlucky; the rest will resolve well - with a full recovery. Only every year adults suffer from 3 to 6 acute respiratory viral infections, so the likelihood of getting sinusitis appears repeatedly.
Prevention
Follow these steps to reduce your risk of chronic rhinosinusitis:
- avoid upper respiratory tract infections;
- reduce contact with people suffering from respiratory diseases (colds, ARVI);
- if cold symptoms persist (7 days or more), do not delay going to the doctor;
- manage your allergies. Work with your doctor to keep your symptoms under control;
- avoid tobacco smoke and polluted air, replace filters in your car on time, and clean the air conditioner in a timely manner;
- humidify the air in the house at low humidity;
- avoid hypothermia.
Is it harmful to blow your nose too much?
Active nose blowing is not only unsightly, but harmful. Blowing your nose is accompanied by an increase in nasal pressure, and infected mucus (popularly called snot) enters the maxillary sinus. Therefore, you need to blow your nose carefully and gently.
Sinusitis can develop when the teeth of the upper row are unwell, for example, root caries or an odontogenic cyst maturing on the root of the tooth. Sometimes poor-quality treatment of a carious cavity with subsequent filling leads to inflammatory changes in the bone tissue of the upper jaw and the sinus is involved in the process. Such sinusitis will never be stopped without adequate dental treatment.
Summary
We reviewed Russian and imported broad-spectrum antibiotics and briefly described the classification of drugs. Let's answer the question: which antibacterial agents to choose?
It is important to understand that antimicrobial drugs for extensive use are toxic and therefore negatively affect the microflora. In addition, bacteria mutate, which means the drugs lose their effectiveness. Therefore, antibacterial agents with the latest structure will be a priority over their earlier counterparts.
Self-medication with antibiotics is dangerous to health. In case of an infectious disease, the first step is to consult a doctor. The specialist will determine the cause of the disease and prescribe effective antibacterial agents. Self-medication “at random” leads to the development of antibiotic resistance.
How inflammation and sinusitis develop
The paranasal sinuses are of different sizes and locations, but all communicate with the nasal cavity by very small anastomoses, slightly overlapping the inflamed nasal mucosa.
When the external opening of the anastomosis is closed by edema, the normal outflow of intercellular fluid is blocked and swelling of the anastomosis itself occurs. The sinus becomes closed, which interferes with normal air circulation; the air in the sinus is gradually absorbed, the pressure in it decreases, which also contributes to its swelling. The place of the absorbed air is taken by a non-flowing mucous secretion. In warmth and dampness, microorganisms that have flown in the air flow begin to multiply, and inflammation of the sinuses themselves begins to form.
The cavity of the inner nose is small, and the proximity of the inlet openings facilitates easy “transfer” of inflammation, therefore combinations of sinusitis and frontal sinusitis, ethmoiditis and sphenoiditis are common. Local anatomical features predispose to the development of sinusitis, for example, a deviated nasal septum more easily contributes to blockage of the anastomosis.
Similarly, inflammation of the sinuses and sinusitis are promoted by the growth of mucous membranes - polyps or hypertrophy - an increase in the nasal turbinates. In addition, local immunity disorders and allergic edema help inflammation.
The material was prepared by a cardiologist, geriatrician, therapist, professor, Honored Doctor of the Russian Federation, Doctor of Medical Sciences at the international clinic Medica24 Yuri Evstafievich Serebryansky.
Treatment of chronic rhinosinusitis
The goal of treatment is to reduce the number of exacerbations of sinusitis and reduce or disappear the symptoms of the disease. The main therapy is aimed at improving the drainage of the paranasal sinuses, as well as improving the functioning of the local immunity of the mucous membranes. To do this, it is necessary to eliminate the blockage of the sinus-nasal anastomosis, reduce the viscosity of the mucous secretion, and carry out immunotherapy. Sometimes surgery is required to clear the sinuses.
Drug therapy
The first stage of treatment for chronic rhinosinusitis is conservative therapy.
It includes:
- Regular cleansing of the nasal cavity and sinuses with isotonic sodium chloride solution (sterile saline solution).
- Nasal topical corticosteroids. These are nasal sprays that help reduce inflammation and swelling in the area of sinus anastomosis and improve drainage (mometasone, fluticasone, beclomethasone).
- Inhalation administration of a solution of antibiotics, corticosteroids, mucolytics into the sinuses. The use of sinus inhalers (Pari inhalers) allows medications to be administered precisely into the sinuses.
- Systemic administration of corticosteroids gives a strong anti-edematous, anti-inflammatory effect, reduces nasal polyps, improves drainage, but has serious side effects with long-term use of the drugs.
- Local and systemic use of antibacterial and antifungal agents. The use of antimicrobial agents for infectious chronic rhinosinusitis allows one to cope with exacerbation of the disease.
- Immunotherapy - Your allergist-immunologist may add immune-boosting or allergy-regulating medications to your sinusitis treatment.
Surgery
With low effectiveness of conservative therapy, surgical treatment of chronic rhinosinusitis is indicated. It is aimed at eliminating the mechanical obstacle to sinus drainage (enlarged turbinate, deformed nasal septum, anatomical narrowing of the sinus anastomosis area, polyp in the anastomosis area, etc.), as well as cleansing the sinuses of foreign inclusions (fungal bodies, tooth roots, filling material, material for sinus lifting), cysts, polyps.
Endoscopic sinus surgery
For this procedure, the doctor uses an optical system consisting of a thin tube with magnifying lenses and a camera that transfers the image to a screen. Good visualization of the operated area, the ability to change the viewing angle ensures delicate and safe removal of obstacles at the exit from the sinus, and also allows you to clear it of foreign inclusions.
The surgical treatment performed only creates conditions for improving drainage and cleaning, so it is necessary to continue postoperative treatment to achieve a lasting effect.
