Chronic sinusitis

Description:

Chronic sinusitis (XC) – the infectious and inflammatory disease which is characterized by involvement in pathological process of okolonosovy bosoms and persistent for 12 weeks and more.
According to data of modern literature, XC practically is always associated with pathological process of a nasal cavity and it is shown by rhinitis symptoms, so, it will be more correct to call the above described state a chronic rinosinusit (HRS).
The diagnosis of HRS is established on the basis of the results of a rinoskopiya confirming existence of inflammatory process of a mucous membrane of a nasal cavity, and also directly RS signs.
According to the last multidisciplinary consensuses on HRS, existence of the following symptoms is characteristic of this disease:
• a mucopurulent discharge from a nose;
• the complicated nasal breath;

Symptoms Chronic sinusitis:

At establishment of the diagnosis of HRS it is extremely important to collect carefully the anamnesis, having detailed at the same time the following data:
• existence of "big" symptoms, such, as:
    • a mucopurulent discharge from a nose;
    • rhinorrhea;
    • difficulty of nasal breath;
    • a hyperemia, morbidity at a palpation and a face edema;
    • hyposmia, anosmia;
• existence of "small" symptoms:
    • headache;
    • pressure sense and ear pains;
    • an unpleasant smell from a mouth (халитоз);
    • dentagra;
    • fever;
    • cough;
    • weakness, increased fatigue;
• duration of symptoms;
• existence of the aggravations and factors facilitating a state;
• existence in the anamnesis of operative measures on okolonosovy bosoms;
• the therapy applied earlier and at the moment and its efficiency;
• existence of associated diseases, such as bronchial asthma, immunodeficiencies, and also the burdened allergological anamnesis.

Reasons Chronic sinusitis:

The contributing factors of development of HRS are:
• persistent infections (including biofilms – the collective communities of microorganisms covering the surface of mucous membranes, osteomyelitis, etc.);
• the allergic and other immunomediated diseases;
• features of a structure of upper respiratory tracts;
• influence of superantigens;
• the fungal colonizations causing and supporting an eosinophilic inflammation;
• metabolic disturbances, for example hypersensitivity to aspirin.
All these factors can play an important role in disturbance of internal mukotsiliarny transport system of a mucous membrane of a nasal cavity. Drainage function of a ciliary epithelium, and also quality of a nasal secret changes that leads to developments of stagnation, change of acidity of a secret: to decrease in level of pH and "gas exchange" in sine, i.e. to reduction of content of oxygen and increase in level of carbon dioxide. Such changes are favorable conditions for bacterial growth that aggravates inflammatory process.
By consideration of the reasons of development of HRS it is also necessary to consider:
• adverse effect on a ciliate epithelium of a nasal cavity of any pathological process or toxic agent;
• possible difference of a range of bacterial activators upon transition of pathological process to a chronic form from that disease in the acute period. The most frequent pathogens are Staphylococcus aureus, koagulazonegativny Staphylococcus spp., anaerobe bacterias and gram-negative bacteria;
• possible participation in development and progressing of HRS of a gastroesophageal reflux which continues to be studied today.

Treatment Chronic sinusitis:

There are conservative and surgical ways of treatment of HRS which main objective is recovery of normal passability of upper respiratory tracts and prevention of bacterial complications, and the choice of this or that method depends on the reason, weight, prevalence of pathological process, etc.
Conservative therapy
Main objective of conservative treatment, in particular pharmacotherapy, reduction of expressiveness of symptoms, prevention of possible complications, decrease in incidence of HRS is.
For prevention of development or elimination of already developed consecutive bacterial infection at HRS use antibacterial drugs, it is preferential in the tableted forms. At the choice of a specific antibiotic it is necessary to consider:
• results of a cultural research if that is pertinent and/or it was carried out;
• assessment of risk factors of development of an antibiotikorezistentnost;
• the allergological anamnesis, especially at the choice of penicillin;
• risk of development of possible side effects;
• drug cost;
• other factors (a dosage, frequency rate of reception) which can affect on комплаенс.
Representatives of new generation of macroleads – azithromycin and кларитромицин which are capable to create the high level of concentration in mucous membranes of upper respiratory tracts – are irreplaceable in treatment of HRS, especially at intolerance of penicillin. Besides, as the given modern researches, new macroleads testify have antiinflammatory properties.
Still urgent in treatment of HRS are an amoxicillin/clavulanate and cephalosporins II of generation. However to early representatives of the II generation of cephalosporins stability of Haemophilus influenzae and Moraxella catarrhalis is observed. In this case it is possible to apply tsefiksy and generation cephalosporins III, but they are insufficiently active concerning Streptococcus pneumoniae.
For elimination of hypostasis of fabrics, recovery of passability of upper respiratory tracts and adequate drainage apply decongestants short courses. Representatives of this group of drugs exist in two forms – topical and peroral.
0,5% solution of Phenylephrinum and 0,5% oxymetazoline solution which provide almost instant elimination of hypostasis of a mucous membrane and simplification of the general state treat topical decongestants. It is impossible to use these drugs more than 3-5 days in a row owing to risk of development of tolerance, medicamentous rhinitis and a withdrawal.
Peroral decongestants of systemic action apply when the vasoconstrictive effect is necessary more than 3 days. Representatives of this group are фенилпропаноламин (it is not applied in the USA) and pseudoephedrine which use is more preferable. Peroral decongestants – agonists of adrenergic receptors of vessels of a mucous membrane of respiratory tracts – cause their narrowing, reduce a hyperemia of fabrics, hypostasis and a congestion of a nose, improve passability of nasal ways. Theoretically these drugs can influence a mucous membrane of an osteomeatalny complex where topical decongestants are insufficiently effective.
Antiedematous action nasal glucocorticosteroids which are recommended at HRS of an allergic etiology in the absence of data on secondary bacterial infection also possess. In complex treatment of allergic HRS use modern antihistaminic drugs, and in the presence of indications and a sensitization – an immunotherapy causal and significant allergens.
In the presence of the accompanying bronchial asthma there can be effective inhibitors of leukotrienes.
Recently in literature data on efficiency of topical antifungal drugs in treatment of HRS of a fungal etiology appeared, however results of such therapy are still rather contradictory.
The refusal of smoking has huge value in success of treatment of HRS both at conservative, and at a surgical method as tobacco smoke injures a mucous membrane of upper respiratory tracts, in particular a ciliate epithelium that leads to disturbance of mukotsiliarny transport.
Use of a so-called nasal shower for prevention of secondary infection, especially after operative measures is considered effective.
In the absence of contraindications it is possible to carry out steam inhalations which moisten the inflamed, often overdried mucous membrane, promote fluidifying of a secret and mitigation of crusts.
Washing of a nasal cavity hypotonic salt solution can promote the best drainage of bosoms and reduction of hypostasis of a mucous membrane.
Surgical methods
Surgical treatment of HRS, as a rule, is addition to conservative therapy at insufficient efficiency of the last and/or existence of direct indications to an operative measure, for example anatomic obstruction.