Rinosinusit

Description:

Allocate acute, recurrent and chronic rinosinusit. Criteria of an acute rinosinusit are disease duration less than 12 weeks and total disappearance of symptoms after recovery. Are characteristic from 1 to 4 episodes of an acute rinosinusit a year of a recurrent rinosinusit, the periods between aggravations (when symptoms of a disease are absent and treatment is not carried out) last not less than 8 weeks. Existence of symptoms within more than 12 weeks is the main criterion of a chronic rinosinusit. Other criterion consider preservation of signs of inflammatory changes on RG and KT within 4 weeks, despite the carried-out adequate treatment.
At a rinosinusita inflammatory process can be localized in maxillary (antritis), wedge-shaped (sphenoiditis), frontal bosoms and in cells of a sievebone (etmoidit) (frontal sinusitis).
Depending on etiological factors acute and recurrent rinosinusita divide on virus, bacterial and fungal, and chronic on bacterial, fungal and mixed.
Besides, taking into account features of a pathogeny allocate intrahospital, dontogenous, polypostural, developed against the background of immunodeficiency of a rinosinusit and an acute (fulminant) form of mycosis of okolonosovy bosoms.
Chronic fungal rinosinusita subdivide on:
· allergic (eosinophilic) fungal sinusitis;
· fungal sphere;
· superficial sinonazalny mycosis;
· chronic invasive form of mycosis.

Rinosinusit's symptoms:

The main symptoms of a rinosinusit are difficulty of nasal breath, a headache and allocations from a nose, less constant - decrease in sense of smell, a congestion of ears, fervescence, a febricula and cough (is more characteristic of children).
At an inflammation in VChP and frontal sinuses pain is localized in the person, area of a bridge of the nose and a frontal bone. Pains in the center of the head and a nape are characteristic of a sphenoiditis.
Allocations happen mucous, purulent and can depart at a smorkaniye or flow down on a back wall of a throat. The last is more characteristic of damage of a wedge-shaped bosom and back departments of a trellised labyrinth.
Chronic rinosinusit is followed by the same symptoms, as acute, but out of an aggravation they are considerably less expressed.

Rinosinusit's reasons:

Streptococcus pneumoniae and Haemophilus influenzae are considered as the main activators of an acute bacterial rinosinusit. Among other activators call Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus viridans., etc. The main anaerobic activators of a rinosinusit are anaerobic streptococci. However the range of activators of an acute bacterial rinosinusit can significantly vary depending on geographical, social and economic and other conditions.
The list of activators intrahospital, developed against the background of immunodefitny states, and dontogenous rinosinusit along with the bacteria mentioned above includes Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus spp., and at immunodeficient patients also saprophytic bacteria and fungal microflora. In recent years the role of chlamydias and other atypical microflora in an etiology of a rinosinusit is discussed.
Fungal sinusitis is caused by Aspergillus mushrooms more often (in most cases And. fumigatus), is more rare - Candida, Alternaria, Bipolaris, etc.
The acute invasive form of mycosis of okolonosovy bosoms is most often caused by Mucoraceae family fungi: Rhizopus, Mucor and Absida.

Rinosinusit's treatment:

Main objectives of treatment of a rinosinusit are:
· reduction of duration of a disease;
· prevention of development of orbital and intracranial complications;
· activator eradikation.
From these positions a basic method of treatment of an acute bacterial rinosinusit (medium-weight and severe forms) and aggravations of a chronic rinosinusit is empirical antibacterial therapy.
For purpose of antimicrobic medicines treat the main indications:
· anamnesis, characteristic of a rinosinusit;
· expressiveness of clinical manifestations;
· existence purulent separated in the nasal courses.
Antibacterial therapy taking into account a look and sensitivity of the specific activator identified at a bacteriological research does not guarantee success in connection with high probability of hit in the studied microflora material "traveling" at a material intake at all. Besides, results of a research of sensitivity of the revealed in vitro microorganism not always correlate with clinical performance of separate antibacterial medicines. Can be the reasons of it considerable strengthening of antibacterial activity as a result of the unidirectional effect of an antibiotic and its metabolite and ability to purposefully reach bactericidal concentration in the infection center. These qualities are characteristic, in particular, of makrolidny antibiotics which clinical performance significantly exceeds results of a laboratory research of sensitivity.
At the choice of antimicrobic medicine paramount value has sensitivity to it typical infestants of S. pneumonia and N. of influenzae. However increase in quantity of strains of these microorganisms, resistant to the most widespread antibacterial drugs is observed in recent years that is the main problem in rational antibacterial therapy of RS.