The most common pathological process affecting intracranial cavities is inflammation of the sinuses. In clinical practice, the term sinusitis is used, a type of which is sinusitis, developing in the maxillary region of the skull. As the disease develops, a person complains of bursting pain, localized mainly under the eyes. The main symptom is accompanied by concomitant symptoms, which are not specific, but allow one to suspect sinus pathology.
Nasal pain and accompanying symptoms
As a rule, pain is not the only unpleasant symptom that worries a child. It may be accompanied by other unpleasant physiological manifestations:
- swelling and nasal congestion;
- discharge from the nasal passages;
- feeling of pressure in the bridge of the nose;
- frontal headache;
- decreased sense of smell;
- nosebleeds;
- increase in body temperature.
Typically, clinical manifestations depend on the nature of the hidden pathological processes. If parents respond to these signals in a timely manner and seek help from a doctor, the child’s treatment will not be so difficult and lengthy.
What can cause a pain symptom?
Pain in the nasal cavity or bridge of the nose can vary. Intense or aching pain in the nose can be triggered by:
- trauma of varying severity;
- inflammatory process in the paranasal sinuses;
- acute inflammation of the sebaceous gland (furuncle);
- inflammation of the nasal mucosa, including allergic ones;
- accidental entry of a foreign body into the nasal passage;
- neoplasms affecting nerve endings;
- herpetic or fungal infection.
Thus, the cause of nasal pain is obvious to parents only if the child is injured. In all other situations, consultation with an otolaryngologist is necessary.
Rhinitis
Rhinitis, or the more familiar concept of “runny nose,” does not bring severe pain to the patient, but causes a lot of inconvenience. A constantly stuffy nose, accumulation and secretion of mucous masses interfere with the usual way of life: nervousness and fatigue arise. When the body is insufficiently saturated with oxygen, the organs of the cardiovascular system and respiratory organs suffer, and drops in blood pressure occur. The disease is easily treatable, but if it is ignored, the inflammatory process may become chronic. Rhinitis can be caused by colds, allergens, or prolonged exposure to the nasal mucosa of harmful substances.
Friends! Timely and correct treatment will ensure you a speedy recovery!
Types of diseases of the nose and paranasal sinuses
Let us denote the main ENT diseases that are localized in the nasal area and diagnosed by an otolaryngologist:
- rhinitis (runny nose): infectious, allergic, hypertrophic, atrophic;
- all forms of sinusitis: sinusitis, frontal sinusitis, ethmoiditis, sphenoiditis;
- adenoiditis - a disease of the nasopharyngeal tonsils;
- purulent-inflammatory diseases of the external nose (furunculosis);
- nasal deformities acquired due to injury;
- compensatory curvature of the nasal septum;
- neoplasms in the nasal cavity (cysts, polyps);
- nosebleeds.
In order to determine the pathology, the doctor uses a set of diagnostic measures that make it possible to identify hidden inflammatory processes, damage, formations, etc. It is important to do this on time - parents should take care of this.
Sinuses hurt – how to treat?
The primary and most important recommendation is to visit a doctor.
You should not self-medicate, especially with chronic pain. In this situation, you simply cannot do without advanced diagnostics. The most comprehensive examination of the sinuses and paranasal area is carried out using nasal endoscopy and computed tomography. Therapeutic treatment , for example for sinusitis, consists of prescribing vasoconstrictor, mucolytic and antimicrobial drugs. The main goal is to suppress the inflammatory process and normalize the outflow of contents from the sinuses. Additionally, outside the stages of exacerbation, physiotherapeutic procedures, for example, UHF sinuses, can be prescribed. Salt rinses and inhalations also have a fairly good effect. For temporary pain relief, the use of painkillers, for example, NSAIDs (Nise, etc.) is allowed.
Of course, surgical treatment , especially for anatomical changes and chronic inflammatory conditions. Which depends on the root cause of sinus pain:
- For chronic sinusitis, various sinusotomies: maxillary sinusotomy, polysinusotomy, etc.
- For a deviated nasal septum – septoplasty.
- For adenoid hypertrophy - adenotomy.
Your counterpart specializes in endoscopic paranasal surgery. This is a more gentle effect, which allows you to minimize the time of both cure and recovery period. Discharge from the hospital usually occurs within 24 hours after surgery.
More detailed information about the surgical treatment of ENT organs is located on the corresponding page: Treatment of ENT diseases
Diagnostic methods
Making a diagnosis includes the following instrumental, hardware and laboratory studies, including:
- rhinoscopy - examination of the nasal cavity and nasopharynx using speculums allows the doctor to visually assess the visible part of the nasal passages;
- endoscopy – examination of the nasal cavity using a fiberscope with image transmission to a monitor, which allows you to assess the condition of the mucous membrane and assess the degree of its swelling;
- X-ray diagnostics - radiography and computed tomography will help identify foci of inflammation in the paranasal sinuses and their boundaries;
- bacteriological examination of nasal secretions will help determine the causative agent of inflammation and select the appropriate antibacterial drug;
- Blood tests (general, biochemistry, ESR, etc.) will complement the information about the clinical condition of the small patient.
Based on the results obtained, the doctor will make a diagnosis and prescribe an adequate treatment plan. With timely treatment and strict adherence to its recommendations, the treatment prognosis is usually favorable.
If your forehead hurts. We're talking about frontal sinusitis
Viruses, hypothermia, tobacco smoke, summer swimming and diving in ponds, seas and rivers... These factors can contribute to the development of acute and exacerbation of chronic rhinosinusitis, in particular sinusitis. What it is? How does it manifest itself? How is it detected and treated? Is it possible to cure sinusitis without antibiotics?
These and other questions are answered by Lyudmila Vladimirovna Vandysheva, Candidate of Medical Sciences, Associate Professor of the Department of Surgery at the Medical Institute of Tula State University, and otolaryngologist at the Expert Clinic Tula.
— Lyudmila Vladimirovna, tell us what kind of disease this is - frontal sinusitis? How common is it?
— Frontitis is an inflammation of the mucous membrane of the frontal (frontal) sinuses. In total, humans have eight paranasal (paranasal) sinuses (four on each side). All of them have anastomoses with the nasal cavity, through which the sinuses are ventilated and mucus is removed into the nasal cavity and pharynx. There are mainly two frontal sinuses. They are located in the frontal bone, behind the brow ridges.
How common is frontal sinusitis? Acute frontal sinusitis is an uncommon disease. In my practice, there are approximately 5–10 cases of sinusitis per 100 cases of inflammation of the paranasal sinuses. But in terms of the frequency of intracranial complications, frontal sinusitis ranks second (after inflammation of the ethmoid sinuses).
Frontitis occurs in both adults and children.
— When talking about sinuses, you can often hear the word “sinusitis.” Please tell me what it is and what is the difference between sinusitis and frontal sinusitis?
— It is more correct to say “rhinosinusitis,” since it has been proven that inflammation of the mucous membrane of the nasal cavity (rhinosinus) and inflammation of the paranasal sinuses (sinusitis) are inseparable from each other. But this is a general concept.
Depending on the location of the inflammatory process, the following are distinguished:
- sinusitis (inflammation of the maxillary sinuses);
- ethmoiditis (inflammation of the ethmoid sinuses);
- sphenoiditis (inflammation of the sphenoid sinuses);
- frontal sinusitis (inflammation of the frontal sinuses).
That is, frontal sinusitis is a special case of rhinosinusitis.
— At what age can a child develop frontal sinusitis?
— The literature indicates that by the age of 12–14 years the frontal sinuses are fully formed. But in practice, we see that even in the sinuses, which have not yet fully formed, there can be an inflammatory process. That is, the development of frontal sinusitis is possible in children aged 7, 8, 9, 10, 12 years, etc.
— What are the reasons for the development of frontal sinusitis?
— The main cause of inflammation is viral and bacterial infection. It has been proven that 98% of people with ARVI have swelling in the paranasal sinuses. By the time of recovery, this swelling goes away safely. But nevertheless, in 2% of patients this edema persists and leads to the development of rhinosinusitis. Therefore, if the patient’s complaints persist or intensify for more than 10 days after the onset of acute respiratory viral infection, he should be immediately examined for rhinosinusitis. These complaints include:
- difficulty breathing through the nose;
- nasal discharge or mucus running down the back of the throat;
- pain in the projection of the sinuses;
- loss of smell;
- cough in children.
Viral infection, hypothermia, toxic effects, tobacco smoking, etc. can provoke a decrease in the immunological activity of the mucous membrane, i.e. protection. And then its own bacterial infection activates, which constantly lives in our nasopharynx (the nasopharynx is a non-sterile place), and the inflammatory process begins.
Unfortunately, after insufficient treatment, as well as self-medication, swelling of the mucous membrane remains in the paranasal sinuses, the volume of the air cavity of the sinuses decreases, and infection can enter the sinuses through the natural anastomosis, water when swimming, especially diving in various bodies of water, which, naturally, are not sterile. This “recovery” often ends in the doctor’s office.
In addition, in adults, a provoking factor can be riding a motorcycle or bicycle in the cold season, when the wind hits the face and the frontal area is not protected.
— How does frontal sinusitis manifest itself?
— Earlier I listed the symptoms of rhinosinusitis. This is difficulty in nasal breathing, nasal discharge or mucus running down the back of the throat, pain in the projection of the sinuses, loss of smell, cough in children. Frontal sinusitis also manifests itself. Only pain in the projection of the frontal sinuses (in addition to the above complaints) is a clarifying factor of frontal sinusitis. But often frontal sinusitis is diagnosed only after additional examination methods and is a “find”, since the patient can only complain of nasal congestion, nasal discharge, loss or decreased sense of smell (especially if the inflammatory process is non-purulent, i.e. in the edema phase).
— Lyudmila Vladimirovna, what diagnostic methods are used to diagnose “frontal sinusitis”?
— The first is an examination of the nasal cavity, or rhinoscopy. When examined in the middle nasal passage, you can see a strip of pus or infected mucus, swelling of the mucous membrane. Next, it is recommended to take an x-ray of the paranasal sinuses. But today, according to various sources, the percentage of reliability of x-ray examination ranges from 37 to 45%. Therefore, the gold standard is magnetic resonance or computed tomography of the paranasal sinuses. Better, of course, is an MRI. Here you can see everything: swelling or the level of fluid in the frontal sinus, and even what kind of fluid it is (mucus or pus).
Often, acute or chronic frontal sinusitis occurs hidden, masked by other symptoms: headache, migraine, cough, weakness, etc.
Case from practice
MRI images of the frontal sinus of an 8-year-old child with obsessive coughing for 2 years, who was treated by a neuropsychiatrist for obsessive-compulsive disorder syndrome
MRI of the frontal sinuses (before and after treatment)
In addition, in order to correctly diagnose and prescribe quality treatment, swabs are taken from the throat and nose for microflora, and its sensitivity to antibiotics is determined. And to find out the intensity of inflammation, a blood test is performed.
You can sign up for an MRI of the paranasal sinuses here. ATTENTION: the service is not available in all cities
— How is frontal sinusitis treated?
— Treatment of frontal sinusitis can be conservative or surgical. The patient is either sent to a hospital or treated in a clinic office. If there is a level of pus in the sinus, it is necessary to puncture the frontal sinus. This is a traumatic procedure. It is carried out through the anterior wall of the frontal sinus, i.e. practically through the frontal bone. The anterior wall of the sinus is punctured and the pus is removed by rinsing the sinus through the puncture hole.
How is conservative therapy carried out? To remove the contents of the frontal sinus, it is necessary to create conditions for its drainage through a natural anastomosis that opens into the nasal cavity. In our clinic, frontal sinusitis is treated using the moving method. To do this, we insert a turunda (a small narrow gauze swab) with a vasoconstrictor into the nose. This relieves swelling of the mucous membrane and opens the passage into the frontal sinus. If necessary, we perform local anesthesia and begin to rinse the paranasal sinuses using the fluid displacement method.
There are several modifications of this method. In my practice, I rinse the sinuses with the patient sitting, with his head tilted back. A saline or antiseptic solution is slowly injected into one half of the nose using a syringe without a needle; mucus and pus along with the solution are evacuated from the other half of the nose using an electric suction. In this case, the patient either closes or opens his mouth, thereby changing the pressure in the nasopharynx.
Broad-spectrum antibiotics, a herbal preparation, and a mucolytic (expectorant) agent are required to help remove mucus better. And do not forget to give the patient a drug to normalize the intestinal microflora along with the antibiotic.
When we have completely cleared the sinuses, we prescribe decongestant therapy, magnetic therapy, and rehabilitation measures.
And I would like to dwell a little on frontal sinuses in pregnant women. The method of rinsing the nose by moving the liquid while the patient is sitting helps a lot here. With its help, the nose and paranasal sinuses are washed very well.
— Is it possible to cure frontal sinusitis without antibiotics?
— In my practice there were such cases. This is possible if frontal sinusitis is not advanced, if there is mucus in the frontal sinus and not pus. The displacement method is quite acceptable and sufficient for the treatment of non-purulent frontal sinusitis.
Read materials on the topic:
How to use antibiotics correctly? Instructions for use Why don't antibiotics help?
— Tell me, is it possible to treat frontal sinusitis at home, and if so, how?
- I don't recommend doing this. From the story of one patient: “I stuck a piece of chestnut in my nose and pus came out. I have recovered." This patient will come to us anyway, sooner or later. There is no fear of chestnut infection. Perhaps the immune system has somehow dealt with the small amount of pus, but the bacterial infection is still alive. And the strength of this infection depends on its quantity. As soon as provoking factors appear - ARVI, getting your feet wet, riding a motorcycle, diving (water under pressure entered the nose and sinuses) - what I said at the beginning of our conversation, the infection immediately activates. And then a chronic inflammatory process will begin. Therefore, such diseases are not treated at home either in children or adults.
— Is it possible to warm the forehead during frontal sinusitis?
- Of course you can’t. The strength of the infection, I repeat, depends on its quantity, and the number of bacteria is growing, there is active reproduction on the warm, moist mucous membrane of the paranasal sinus. At a certain stage of treatment, magnetic therapy, laser therapy can be used on the frontal area, on the area of the paranasal sinuses. But as for warming your forehead with salt, buckwheat, sand - this should not be done under any circumstances.
— What complications can there be if frontal sinusitis is not treated?
- Firstly, next to the frontal sinus there is an orbit. And the pus can destroy its wall and exit into the cavity of the orbit. That is, even complete loss of vision is possible.
Secondly, rhinogenic meningitis may develop. That is, meningitis, which is a consequence of purulent or even non-purulent inflammation of the sinuses. First, the forehead hurts, then nausea and vomiting begin, not associated with food intake, stiffness of the neck muscles occurs, that is, they become hard, the patient cannot touch the sternum with his chin. There may be headache and dizziness. If the diagnosis of meningitis is confirmed, then surgery is performed.
With complications of frontal sinusitis, there can be no talk of any conservative methods of therapy.
Read more about meningitis in our articles:
Attack to the head. How to protect yourself from summer meningitis? Will an MRI show meningitis?
— Is frontal sinusitis contagious to others?
- Yes, frontal sinusitis is contagious. This is a severe bacterial infection. Often the whole family comes with rhinosinusitis: dad has sinusitis, little one has ethmoiditis, mom has sinusitis. Therefore, the patient needs not only separate dishes, but also a separate towel, a separate pillow, etc. Close contact between a sick mother, father, grandmother, etc. and a child is prohibited (you cannot kiss the child). A spoon and pacifier are only the baby’s personal property; it is important to always remember this.
Interviewed by Marina Volovik
The editors recommend:
What will an MRI of the sinuses show? Not breathing! How to treat a runny nose in children? Deviated nasal septum: leave it or fix it?
For reference:
Vandysheva Lyudmila Vladimirovna
In 1982 she graduated from the pediatric faculty of the Voronezh Medical Institute. 1989 – specialization in otolaryngology. 2007 – 2009 – Postgraduate studies at the Medical Institute of Tula State University. Currently, he is a doctor of the highest category, Candidate of Medical Sciences, Associate Professor of the Department of Surgery at the Medical Institute of Tula State University, and an otolaryngologist at the Expert Clinic in Tula. Receives at the address: st. Boldina, 74.
Methods for treating nasal diseases
The main goal of treatment carried out by a pediatric otolaryngologist is to relieve pain, relieve inflammation and restore patency of the nasal passages. It is also equally important to strengthen the local and general immunity of the body. Thus, treatment of diseases of the nose and its paranasal sinuses can be:
1. medicinal:
- antibacterial therapy;
- vasoconstrictors and antihistamines;
- immunostimulating drugs.
2. local:
- rinsing the nose and paranasal sinuses (cuckoo method);
- intranasal blockades (introduction of medicinal drugs into the side wall of the nose);
- physiotherapy (UHF and UV therapy).
3. surgical:
- puncture (puncture) of the maxillary sinus;
- surgical intervention.
Let us remind you that surgical methods are used in exceptional cases when conservative treatment is impossible or has not brought the desired result. In this regard, we note that a puncture is a radical measure, which is resorted to if the purulent contents of the paranasal sinuses are not eliminated by medication. This will significantly improve the child’s condition and avoid serious complications. The procedure is performed under local anesthesia.
What are the consequences of delaying a visit to the doctor?
Rhinitis is the lesser of “all evils” that may be hidden behind a painful symptom. Delaying the situation can result in the following serious complications:
- Sinusitis is inflammation of the maxillary sinuses. The danger is that the infection can spread to the eyes, brain, ears, which are located in close proximity to the sinuses.
- Frontitis is inflammation of the frontal sinus. This dangerous disease, which occurs against the background of untimely and improper treatment of rhinitis, can even lead to a brain abscess or meningitis.
- Otitis is an inflammation of the outer and middle ear. This disease can be triggered by pathogenic microorganisms that enter the ear from the nasal cavity, through the auditory tube, or when a child sneezes or incompetently blows his nose. This complication occurs quite often (in 80% of cases) in children under 3 years of age.
- Abscess of the nasal septum. An ordinary hematoma formed after a nasal injury can provoke inflammation and suppuration in the area of the nasal septum if an infection occurs. As a result, the cartilage may suffer, even to the point of its complete destruction.
- Blockage of the upper respiratory tract, which can occur due to foreign objects entering the nasal cavity. Small toys or candies in the form of dragees, which a child 1.5-3 years old can accidentally push into the nose, can partially or completely restrict air access.
In order not to lead the situation to the above-mentioned complications, parents need to contact a pediatric otolaryngologist in a timely manner, and not engage in self-diagnosis and self-medication. To conclude the “sore topic,” we remind Kaliningrad residents of the telephone numbers by which they can make a scheduled or urgent appointment with an otolaryngologist for their child:
+7 (4012) 357-773 or +7 (4012) 973-100.
To schedule a consultation, you can also fill out a preliminary application on our website using the red “book online” button.