Sinusitis

Description:

Sinusitis is the disease of inflammatory character extending to  one or several adnexal bosoms of a nose. Sinusitis is very widespread disease and makes up to 30% of inpatients in LOR-department. The most widespread of sinusitis is antritis - an inflammation of a Highmore's (maxillary) bosom. Also frontal sinusitis (an inflammation of a frontal adnexal sinus), etmoidita (an inflammation of cells of a sievebone), sphenoidites (an inflammation of a wedge-shaped bosom) meet.
Prevalence of antritis is caused by an anatomic structure of a genyantrum. The matter is that clarification of contents of a bosom is complicated since the channel connecting a bosom to a nasal cavity is in wash away to an upper point of an internal wall of a bosom.
The inflammation of cells of a trellised labyrinth also is quite widespread pathology owing to the fact that the trellised labyrinth borders on all bosoms and the inflammatory process which began in any of sine with ease passes in etmoidit.
The inflammation of bosoms can be as isolated, and to take all bosoms (pansinusitis). Gemisinusit - it is distribution of inflammatory process in the bosoms located on left or on the right side from a midline.

Sinusitis reasons:

The major role in emergence of inflammatory process in okolonosovy bosoms is played by disease-producing bacteria. However also the aseptic sinusitis developing without infectious agent is sometimes diagnosed.
Streptococci, staphylococcus, pneumococci, a fungal infection are the most widespread. Microorganisms get into a bosom cavity against the background of reduced immunity.
Quite often the sinusitis developing against the background of dental pathology meets. This way of spread of an infection is called dontogenous. At the same time the discharge from a bosom contains bacterial microflora. At allergic, vasculomotor, serous option of sinusitis a discharge usually aseptic.

Sinusitis symptoms:

Clinical classification of sinusitis by B. S. Preobrazhensky:
1. Exudative form:
а). catarral
б). serous which can be in 2 forms - idiopathic and retentsionny (a bosom edema).
в). purulent

2. Productive form:
а). pristenochno-hyperplastic
б). cystous
в). polypostural

3. Alternative form:
а). caseous
б). holesteatomny
в). atrophic
г). necrotic

4. Vasculomotor, including an allergic form.
5. The mixed forms.

Despite various options of sinusitis, their clinical symptoms have the my general.
At sinusitis patients show complaints to unpleasant feelings in a nose and okolonosovy area or a nose bridge which gradually accrue. Pains are less expressed in the morning, by the evening accrue. Gradually pain ceases to be localized in a certain place, it gains diffuse character, and the head begins to hurt the patient. If process unilateral, then pains are noted on the one hand.
The Sluduyushchy symptom disturbing patients is difficulty of nasal breath. The stuffy nose, a voice gets a nasal shade from the patient. As a rule, both half of a nose are put. Difficulty of nasal breath has almost constant character. The alternate congestion of the right and left half of a nose is possible.
  Quite often sick is disturbed by cold. In most cases at the patient it is observed mucous (transparent) or purulent (yellow, green) allocations from a nose. This symptom can not be if strongly a stuffy nose as outflow from a bosom is complicated (about it it was mentioned above).
  Fervescence to 38 ° is observed above. As a rule, this symptom is observed at acute antritis. At chronic process body temperature increases seldom.
  The disease is followed by such obshcha symptoms as weakness, an indisposition. It is expressed by fatigue, patients refuse food, they interrupt a sleep.

Treatment of Sinusitis:

Treatment of sinusitis includes fortifying, antiinflammatory. Antibacterial therapy and physiotreatment.
Sinusitis usually is not the indication for hospitalization, treatment is possible in out-patient conditions.
At treatment of antritis also surgical methods are used conservative (medicines and physiotherapy).  It is necessary to treat antritis under control of the otorhinolaryngologist (ENT specialist).

Conservative therapy.
Local procedures — irrigations in the form of  the drops, sprays, inhalers capable to eliminate hypostasis of a mucous membrane have to be the cornerstone of drug treatment of antritis surely.
Treat vasoconstrictive drugs: naphazoline ("Naphthyzinum", "Sanorin"), тетризолин (Tizin), xylomethazolinum ("Halazolinum", "Dlyanos"), oxymetazoline (Nazol, Nazivin). At antritis it is necessary to follow certain rules of a flood in a nose of medical liquids. Only after use of these drops it is possible to dig in others — having antibacterial, antiinflammatory or analgesic effect.
In treatment also use antibacterial drugs (preferably tsefalosporinovy), antihistamines (Klaritin, Telfast, etc.). Carry out washing of a nose antiseptic solutions (for example, Furacilin, sodium hypochlorite). From physiotherapy apply such techniques as Ural federal district of a nasal cavity, UVCh on paranasal sinuses, etc.

Puncture of a Highmore's bosom – an operational method of treatment of antritis. The indication to urgent surgical intervention are accession of complications – such as abscesses, phlegmons, meningitis, sepsis.
The puncture (puncture) becomes to pump out pus from a bosom, to wash out a bosom, and after that to enter antibiotics and antiinflammatory drugs there. This procedure is followed by unpleasant feelings, but its efficiency is very high. Now after a puncture in a bosom establish special tubules — catheters through which it is possible to do washing of a bosom daily. At use of this method of the patient very quickly recovers. But to everything there are indications, and in an initial stage of antritis it is not always required to carry out a puncture, it is possible to manage washing of a nose.
It should be noted that use of a puncture of a bosom as method of treatment does not find broad application in other countries. For example, in the USA the puncture is recommended only as the diagnostic procedure — for implementation of a fence of contents of a bosom with further culturological and/or microscopic examination.

Treatment of a sphenoiditis  provides frequent greasing of a mucous membrane of a nasal cavity vasoconstrictors for ensuring the outflow separated from bosoms. At a prolonged disease sounding and washing of a bosom is recommended by solutions of antibiotics. Surgical intervention is sometimes shown (for example, a resection of the back end of an average sink).

At an acute frontal sinusitis conservative treatment is shown. Outflow separated from a bosom is provided by greasing of a mucous membrane of the average nasal course of 0,1% with solution of Naphthyzinum, 0,2% Halazolinum solution. The same solutions can be applied also in the form of drops in a nose. In the first days of a disease the bed rest, reception of acetylsalicylic acid, analginum, aerosol inhalation of antibiotics, physical therapy are recommended (warming up by a blue incandescent bulb, соллюкс. UVCh-therapy). In hard cases introduction of antibiotics in oil is shown. The surgical method of treatment is shown only at failure of conservative therapy. At surgical intervention operation — trepanation of a cranium in the field of a frontal sinus is made (local anesthesia of superficially located fabrics — a lidocaine/novocaine injection is carried out previously, then by means of a drill it is created trepanation otversity with a diameter about 5 mm, later the catheter is inserted into this opening, afterwards, through which washing of a frontal sinus is made).