Acute sinusitis is an inflammatory process that occurs in the mucous membrane of the nasal appendages (sinuses), so sometimes the diagnosis of sinusitis is also related to inflammation. This disease is characterized by swelling of the cheeks and purulent discharge, accompanied by an unpleasant odor.
In terms of its symptoms at the onset of the disease, the acute form of sinusitis is very similar to a common runny nose, only the treatment of the disease can be more difficult and lengthy. And the condition itself causes enormous discomfort to the patient and interferes with a full life.
Anatomy of the sinuses
There are 4 types of sinuses in the human skull:
- frontal (in the forehead area);
- maxillary, also known as maxillary (in the area of the cheeks under the eyes);
- ethmoid sinuses, or cells of the ethmoid labyrinth (in the area between the nose and eye);
- wedge-shaped (in the very middle of the skull, behind the eyeballs).
The sinuses are peculiar voids that reduce the weight of the skull, participate in the formation and sonority of the voice, in the process of smell, and also serve as shock absorbers for injuries to the facial skeleton.
They also perform a protective function: when foreign particles and bacteria enter the nasal cavity, the nasal mucosa is irritated, sneezing begins, and the particles are evacuated from the body along with mucus. But if the body’s defenses are weakened, bacteria can enter the sinuses from the nasal passages and cause severe inflammation, which is what we observe during the development of acute manifestations of the disease.
Diagnostic methods
To determine a treatment regimen, it is necessary to undergo an examination and establish the exact cause of pain in the head and bridge of the nose. To do this, the doctor will prescribe a series of tests, thanks to which you can make an accurate diagnosis and assess your general condition. Based on the examination data, the following diagnostic methods may be required:
- rhinoscopy – instrumental examination of the nasal mucosa, including in hard-to-reach areas;
- Ultrasound is a non-invasive method for diagnosing the condition of the paranasal sinuses and nasal passages, in order to determine inflammatory processes;
- laboratory analysis of nasal swabs (bacteriological culture) - prescribed to identify the causative agent of purulent inflammation and further selection of effective antibiotics;
- CT and MRI are informative techniques that are prescribed if neoplasms or head injuries are suspected.
At the Clinical Institute of the Brain, an individual diagnostic program will be selected for the patient. It will include only those techniques that will be informative for obtaining a general picture of the disease. Modern equipment, qualified specialists, the ability to conduct several examinations in a short time are a guarantee of obtaining a quick and accurate result.
Why do the maxillary sinuses become inflamed more often?
Among inflammations of the paranasal sinuses, acute sinusitis - inflammation of the maxillary sinuses - is most often diagnosed. And there are several reasons for this:
- the maxillary sinuses are the largest in volume;
- The maxillary sinuses are connected to the nasal cavity using anastomoses - small openings covered with mucous membrane (these openings are quite narrow, and even a slight swelling of the mucous membrane with minor inflammation can make it difficult for mucus to come out of them, and the formed and accumulated mucus in the absence of proper outflow becomes a powerful catalyst, if the inflammatory process develops first in neighboring ones.).
Types of acute sinusitis
There are catarrhal and purulent forms of sinusitis.
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The name “catarrhal” comes from the medical term “catarrh,” meaning “to flow, drain.” That is, with this form of sinusitis, inflammation of the mucous membrane and its swelling develop quite quickly. Initially, the changes affect only the mucous membrane. Inflammation during sinusitis of this form is accompanied by severe swelling of the mucous membrane - it noticeably increases in size and, as a result, a little later transparent mucus forms. Only thanks to timely treatment, it is possible to prevent the transition of catarrhal forms into purulent sinusitis, which with a high degree of probability can become chronic.
With purulent sinusitis, direct contact of pus with the mucous membrane degenerates it, quite quickly and, what is most dangerous, irrevocably. Thus, with improper treatment or no treatment at all, you can very easily and simply join the army of people suffering from a chronic form of sinusitis.
The cause of the purulent form of sinusitis (acute sinusitis) is bacteria. The secreted mucus contains streptococci, staphylococci, and less commonly pneumococci and fungi, which leads to the appearance of purulent contents in the sinus itself.
Treatment
Headaches cannot be tolerated, so during attacks you should take analgesics. These can be drugs based on paracetamol, ibuprofen, ketorol and others that help a particular patient.
The main treatment for headaches is always aimed at their cause. If there are serious pathologies of internal organs, hormone therapy or chemotherapy, drugs for migraines or epilepsy, and drugs for heart disease are prescribed. Treatment is selected individually, taking into account the results of the examination and the general condition of the patient.
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Reasons for the development of sinusitis
Acute sinusitis can be caused by the following factors:
- colds;
- viral infections: ARVI, measles, influenza, etc.;
- allergic reactions;
- damage and injury to the nose;
- untreated teeth, tooth roots entering the cavity of the maxillary sinus, inflammation of the gums.
In medicine, it is customary to distinguish two ways of infection entering the maxillary sinuses: when the infection penetrates from the nasal mucosa into the maxillary sinus or when the infection develops directly in the maxillary sinus through blood flow and general inflammation.
Sinusitis (in addition to bacteria) can be provoked by factors that interfere with normal air circulation and the release of mucous masses from the sinuses. These include:
- deviated nasal septum;
- adenoids;
- cyst;
- polypous formations;
- and etc.
Unfavorable environmental conditions - dust, gas pollution, work in hazardous industries - can also disrupt the process of the release of mucous masses from the sinuses and further treatment.
Diagnosis of diseases
The doctor may not always be able to make a diagnosis right away. First, you need to see a therapist for a face-to-face consultation. Activities carried out by the doctor:
- survey - clarifying complaints will help to better understand the clinical picture;
- collecting anamnesis - the presence of allergic diseases in the patient or his relatives will allow us to make more accurate assumptions about the nature of the disease;
- examination - characteristic swelling in the sinus area will help to suggest the presence of inflammation in this area;
- palpation - pain in the projection areas of the sinuses indicates inflammatory edema.
Based on the results of a physical examination, it is not always possible to identify the cause of the disease. Then additional studies are prescribed. These include a general blood test (increased number of eosinophils in case of allergies and leukocytes in case of inflammation) and a throat smear for eosinophils (their presence means an allergic reaction). You can also detect an increase in the concentration of immunoglobulin E (IgE) in the blood, which indicates an allergy.
If you have an allergic reaction, you need to find out its nature. To do this, a blood test is performed for allergens or skin allergy tests are performed. If a provoking substance is detected, contact with it should be tried to be completely avoided for the duration of treatment.
Read also: How can you cure a runny nose?
Symptoms
Symptoms of acute sinusitis include:
- pain in the cheek area under the eyes;
- pain in the orbital region;
- pressure on teeth and toothache;
- headache;
- pain when tilting the head forward (the pain “radiates” to the back of the head and forehead; the nature of the sensation resembles the pain of a migraine; as a rule, the pain intensifies in the evening);
- difficulty breathing through the nose;
- a feeling of continuous nasal congestion (it may be accompanied by itching, sneezing, dryness);
- the nature of the mucous discharge helps determine the severity of the disease (transparent discharge in a mild form of the disease and thick green discharge in a purulent form);
- bad odor from the nose and mouth (the nose and pharynx are connected to each other; with sinusitis, pus accumulates in the sinuses and causes bad breath; it is difficult to get rid of it, even after brushing your teeth);
- eyes become watery;
- nasality appears in the voice;
- impaired sense of smell;
- high body temperature from 37.5 to 39°C - the body’s response to the presence of infection;
- increased fatigue, decreased appetite, sleep problems;
- swelling of the eyelids, cheekbones, and areas near the nose;
- pain when pressing on the area where the sinuses are located.
Features of manifestation
Cephalgia cannot be considered as a specific symptom specifically for infection with the SARS-CoV-2 coronavirus strain, since it can accompany many infectious and non-infectious diseases. Influenza, among other things, often occurs with headaches. And the frequency of their appearance does not always correlate with the severity and specificity of the pathological process.
Frequent attacks or even constant headaches are one of the most common complaints of people who have had coronavirus infection. At the same time, rarely does anyone notice exactly when it first appeared, since, as a rule, the headache begins to hurt in the first days of the disease, even before the appearance of the main symptoms, i.e. cough, fever, runny nose, weakness, etc. Therefore Cephalgia is often called a sentinel symptom of Covid. At the height of the illness, the pain can become simply excruciating, which is largely due to persistent fever. But the course of the disease without a significant increase in temperature does not guarantee the absence of cephalalgia. Usually it is closely associated with other disorders, in particular a decrease in the acuity of smell, taste disturbances, and disorders of the gastrointestinal tract.
With recovery, the headache does not always go away, and for many it persists for several weeks or even months afterward. This may be accompanied by a feeling of heaviness in the head, tingling in the limbs, persistence of impaired sense of smell and taste, and weakness.
There are still no reliable official statistics on the consequences of coronavirus. But according to some data already collected, headaches are observed in approximately 20% of people who required hospitalization. And WHO says that they are present in every 10th patient.
Headache after coronavirus can have varying intensity from mild to very strong and spread over the entire head like a “helmet”, or remain localized only in certain areas, for example, in the temples, back of the head, forehead, around the eyes, etc. By nature it can be one- or two-sided, squeezing, pulsating, dull and bursting, or even stabbing, and this largely depends on the causes of its occurrence. The data collected to date shows that after the coronavirus, there is an increase in previously noted headaches or a completely new manifestation.
An alarming symptom is the late appearance of headaches.
Are complications possible with acute sinusitis?
With delayed treatment or lack of properly selected treatment, acute sinusitis can become chronic and lead to the development of a number of other serious complications.
Friends! Timely and correct treatment will ensure you a speedy recovery!
Chronic inflammation in the sinuses is the most common complication of acute sinusitis. The chronic form requires long-term competent treatment.
An infection from the maxillary sinuses can enter the middle part of the ear and provoke a severe inflammatory process there (otitis media). Otitis is accompanied by sharp pain in the ear, hearing loss occurs, and body temperature may rise.
Diseases of the ternary nerve are associated with sinusitis, since it is located close to the source of inflammation. This condition is characterized by shooting pains in the face. Patients describe the sensations as electric shocks. Such neuritis is extremely difficult to treat.
Complications of sinusitis associated with the eyes are possible. With inflammation, we observe swelling of the eyelids, pain when pressing on the eye socket, and vision may begin to “deteriorate.” Pus entering the eye socket and vein thrombosis can lead to loss of vision and even loss of the eye itself (panophthalmitis).
The worst consequence of sinusitis is inflammation of the lining of the brain (meningitis). A similar complication develops with prolonged and incorrect attempts to independently cure sinus inflammation.
Other common complications of sinusitis in adults: periostitis of the jaw, meningoencephalitis, sinus thrombosis, up to generalized blood poisoning (sepsis).
Remember, sinusitis with complications is much more difficult to treat, so it is very important to promptly seek qualified help from an ENT specialist.
How is diagnosis carried out?
Treatment of acute sinusitis in adults and children must be carried out under the supervision of an experienced otolaryngologist.
At the appointment, the ENT doctor will collect anamnesis and conduct an examination of the nasal cavity. Painful sensations when palpating the area under the eyes at the level of the cheeks will indicate the presence of an inflammatory process in the sinuses.
A reliable diagnostic method is x-ray examination. But young children and pregnant women are not prescribed x-rays. They are shown CT and ultrasound examination of the sinuses - sinus scanning.
To obtain complete information about the disease, rhinoscopy and endoscopy of the nasal cavity and nasopharynx are performed.
Diagnostics
A neurologist is involved in determining the cause of pain. According to indications, the patient is referred for consultation to an otolaryngologist, ophthalmologist, and other specialists. The doctor finds out when the symptom first appeared, how often it appeared, how it changed over time, and what manifestations it was accompanied by. Collects a life history, clarifies the presence of chronic diseases that could cause pain.
During the examination, it is sometimes possible to detect external changes, for example, lacrimation, redness and swelling of the face, but in most cases the physical examination is not very informative. To make a final diagnosis, the following are prescribed:
- Otorhinolaryngological examination.
Along with the standard techniques used during a general examination, the doctor conducts an examination using mirrors and special instruments. For sinusitis, rhinoscopy is indicative, confirming the presence of edema, hyperemia, serous or purulent discharge. Sinusoscopy requires expansion of the natural openings of the sinuses, so it is rarely performed for diagnostic purposes. - Ophthalmological examination
. Includes visometry, ophthalmoscopy, measurement of intraocular pressure, refraction studies, eye biomicroscopy, and other studies. Helps determine the nature of visual impairment, the preferred correction option, and the need for surgical intervention. - Neurological examination
. Involves assessing the symmetry of the palpebral fissures, pupils, facial features, examining the sense of smell, checking the integrity of the function of the facial muscles, and palpating the exit sites of the branches of the trigeminal nerve. The doctor examines movements, sensitivity, reflexes in the torso and limbs. Identifies pathological symptoms (for example, meningeal). - Radiography
. For sinusitis, radiography of the paranasal sinuses is indicated. The study reveals the accumulation of dense masses, and in a chronic process - deformation of the bone walls of the sinuses. To increase information content, it can be carried out with contrast. X-ray of the skull is required if a TBI is suspected. With long-standing intracranial hypertension, “finger impressions” are visualized. - Ultrasound techniques
. During echoencephalography, hydrocephalus, cerebral edema, displacement of midline structures due to tumors, hematomas, and other space-occupying processes are determined. Duplex scanning and Doppler sonography are recommended for patients with vascular lesions. They allow you to get an idea of the speed of blood flow and the state of blood circulation in various parts of the brain. - Tomography
. Computed tomography and magnetic resonance imaging of the brain provide complete information about structural changes in brain tissue, size, and location of pathological foci. Used at the final stage of diagnosis. To assess the condition of blood vessels, differentiation of tumor processes is performed with contrast enhancement. and MRI of the paranasal sinuses are required when the basic diagnostic procedures are insufficiently informative; they confirm the presence of sinusitis and other pathologies (tumors, cysts). - Lumbar puncture.
It is carried out to determine the pressure of the cerebrospinal fluid, detect hemorrhages, and inflammatory processes. During subsequent microscopic examination of the cerebrospinal fluid, the composition of the cerebrospinal fluid is clarified. For bacterial and viral infections, a microbiological analysis or PCR test is performed.
In some cases, special samples are required. For example, ganglionitis of the pterygopalatine ganglion is confirmed if the symptoms disappear after lubricating the nasal cavity with a solution of dicaine and adrenaline. For a number of pathologies, laboratory tests are necessary to confirm the inflammatory process and determine the pathogen.
Neurological examination
Treatment methods for acute sinusitis
The mildest disease does not require the use of any special measures or antibacterial agents for treatment. It is enough to take anti-inflammatory drugs to relieve general symptoms and use vasoconstrictor drops to relieve swelling and facilitate the release of mucus.
Sinusitis with a purulent form is treated with the help of antibiotics (for example, Amoxiclav).
Therapy for the acute form of the disease is best supplemented by rinsing the nasal cavity and paranasal sinuses. The most effective method of treating sinusitis is Proetz lavage, better known as the “cuckoo” method.
Physiotherapeutic procedures and irrigation of the nasal cavity with antiseptic agents will help to consolidate the effect of treating sinusitis.
Washing “cuckoo”: description of the method of treating sinusitis
The “cuckoo” method is a painless and, most importantly, effective procedure. Thanks to conservative treatment, purulent masses, mucous secretions along with pathogenic microorganisms are effectively washed out of the sinuses, the mucous membrane improves its function, nasal congestion decreases, and inflammation subsides. In some cases, thanks to Proetz lavage, puncture can be avoided. How is this procedure carried out?
The patient is positioned comfortably, lying on the couch, face up. The ENT doctor carefully pours an antiseptic into one nostril (Chlorhexidine, Furacilin, Miramistin, etc.). And at the same time, with the help of a special metal olive connected by a medical suction device, it sucks out this rinsing solution, but from the other nostril. The manipulation is repeated three times on each side, using a sterile plastic syringe with a volume of twenty ml. The entire procedure lasts about five minutes.
Puncture for sinusitis
If all conservative methods of treating sinusitis do not help, the ENT doctor will suggest a puncture of the maxillary sinus. This measure is necessary because pus accumulated in the sinus, as we already know, can lead to serious consequences, including inflammation of the brain.
During the procedure, the otolaryngologist releases the purulent contents of the sinuses and injects medication into the sinus. There is no need to be afraid of a puncture - before the procedure, anesthesia is performed: the ENT doctor inserts a cotton swab soaked in a lidocaine solution into the nasal passage of the patient sitting in a chair. It is completely safe and does not require patient preparation.
As soon as the anesthesia takes effect, the otolaryngologist, using a Kulikovsky needle, carefully inserts it into the sinus through the nasal cavity. Using a syringe, the purulent contents are sucked out. As soon as the purulent masses are completely removed, rinsing is carried out. The sinus should continue to be rinsed for several days after the procedure.
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These are two completely different pathologies that require their own treatment regimens. Therefore, when characteristic symptoms appear, you need to think about whether you may be allergic to anything. Often such pathologies are familial, that is, among relatives there are people with similar diseases.
If the condition is accompanied by fever or characteristic swelling of the face in the sinus area, sinusitis can be suspected. In this case, urgent medical intervention is required. Delaying a trip to the doctor risks spreading the infection to the brain, which causes serious complications.