Acute purulent rhinosinusitis: causes, symptoms, diagnosis, treatment

Very often the ENT doctor puts his patients such a diagnosis as acute rhinosinusitis, which is a disease of the upper respiratory tract. It is treated with antibiotics. Often it causes complications, as a result of which the acute form becomes purulent or chronic. Perhaps sales will require surgical intervention. Consider in more detail such a disease as rhinosinusitis, symptoms and treatment of this pathology.

Forms

Depending on where this ailment occurs, they distinguish:

• Sinusitis (sinusitis of the maxillary);
• Etmoiditis (inflammatory lesion of the latticed bone) ;
• Sphenoiditis (inflammation of the sphenoid sinus);
• Pansinusit and polisinusit (defeat of several or all sinuses of the nose);
• Frontal (inflamed frontal sinus).

All these pathologies are called one term - "rhinosinusitis".

Causes

Acute rhinosinusitis can occur for the following reasons:

• Because of infection;
• Under the influence of allergens.

Most often this disease is caused by a common cold. Viruses enter the paranasal sinuses and promote their inflammation. Usually, if the infection enters the nasal cavity, then the body reacts instantly to this by an immune reaction, an increase in mucus and edema formation. This leads to the fact that the contents begin to be removed from the paranasal sinuses , and favorable conditions are created for the subsequent multiplication of harmful microorganisms and the formation of pus.

In the human body, there are always some types of bacteria in minimal quantities, not provoking the onset of inflammatory processes. With a decrease in the protective functions of the body, they begin to multiply intensively, often causing acute purulent rhinosinusitis.

In addition, there are pathological conditions that are predisposing factors for the development of this disease:

• Anatomical features of the structure of the nose (enlarged nasal conchas, deformation of the septum, etc.);
• Immunodeficiency status;
• Presence of such diseases as cystic fibrosis, allergic rhinitis, adenoiditis and others;
• Reduced immunity.

Symptoms

The following primary signs of the inflammatory process of the sinuses are noted:

• Feverish condition;
• Strong headache;
• Changes in blood;
• Weakness and general malaise;
• nasal congestion.

After a while, acute rhinosinusitis manifests itself as follows:

• Increased body temperature;
• Pathological discharge from the nasal cavity;
• Swelling of the eyelids or cheeks;
• Bad breath;
• Cough, often worse at night;
• Shortness of nasal breathing;
• Smell disorder;
• Tension and pressure in the affected sinuses;
• A feeling of constant fatigue;
• Toothache, most acute during chewing.

Acute purulent rhinosinusitis can have a sufficiently large number of diverse general and local traits. Symptoms of it depend on the causes of its occurrence, the presence of other diseases and the age of the patient. And children are more difficult to tolerate this disease.

Polyposis rhinosinusitis has almost the same symptoms as the acute form. Since this form of the disease is more severe, endoscopic surgery is used for its treatment in combination with anti-allergic therapy.

Diagnostics

As soon as the first signs of rhinosinusitis have appeared, which not only do not go away in a few days, but also intensify, you should definitely consult a doctor. To establish an accurate diagnosis, the specialist determines the location of the disease, its shape, and the type of bacteria or virus that caused the infection.

To confirm the clinical manifestations of acute rhinosinusitis the following measures are carried out:

• The general condition of the patient is assessed;
• Tests are taken;
• Implement instrumental research methods.

Otolaryngological examination

The examination of the patient begins with the collection of his medical history. To do this, the patient describes all the symptoms, the duration of discharge from the nose and their nature, the presence of pain in the head and face area and their localization. Also, he should inform the doctor about any manifestations of allergies and recent colds.

In the diagnosis, even information about dental procedures, medications taken, a person's injuries, or immunity disorders will help.

After this, the doctor conducts a physical examination of the patient, palpating the cheekbones and forehead to determine the tenderness of the sinuses of the nose. With the help of an otolaryngological examination, defects in the nasal cavity can be detected.

Lab tests

The presence of the inflammatory process and the nature of its course helps determine the overall blood test. In this case, the number of leukocytes and the ratio of their forms are analyzed.

In addition, in the laboratory, the pathogenic contents of the affected nasal sinuses are examined. With the help of a microbiological study, the type of pathogen and its sensitivity to various antibacterial agents are established. But it should be remembered that the results of such analyzes in acute form are obtained only 3-4 days after the onset of the first signs of the disease. Therefore, very often they lose their relevance.

Instrumental research

For the formulation of an accurate diagnosis, special instrumental studies are used:

• Nasal endoscopy - it uses a fiber optic tube with a light source at its end. With the help of such a study, one can detect even the smallest deviations in the nasal cavity, as well as assess the defect of the septum and the presence of tumors, for example, polyps.
• Computer tomography - is considered the best visual method for examining the sinuses of the nose. It is recommended to be performed in case of complications.
• Radiography was widely used until endoscopy and computed tomography appeared. At present, it has been resorted to much more rarely.
• Magnetic resonance imaging is a remarkable method of diagnosing inflammatory processes, complications inside the skull, and malignant tumors. Sinusitis of the maxillary manifests itself in the form of a diminution of the maxillary sinuses.

Methods of treatment

Acute rhinosinusitis is treated with both medicamental and surgical methods. The effectiveness of each method is considered by the doctor individually for each patient. The choice of method of therapy depends on various factors: the age of the patient, the form of the disease and the nature of its course, the possibility of allergic reactions, etc. But whichever treatment regimen is chosen, it should be aimed at:

• Eliminate signs of inflammation;
• To restore patency of the passages that connect the nasal passages with sinuses;
• To extract from the sinuses pathogenic content;
• Eliminate the focus of infection.

Treatment of rhinosinusitis in adults should be carried out under the strict supervision of a doctor, as uncontrolled use of medications often leads to complications. And the main goal of the treatment is to eliminate the causative agent of infection and restore the ability of the paranasal sinuses to clean themselves.

Medication

Acute purulent rhinosinusitis is treated with the following medicines:

• Decongestants;
• Immunocorrectors;
• Antibiotics;
• Additional symptomatic drugs.

Decongestants and vasoconstrictors are usually prescribed first and use no more than 4-5 days, as long-term use only increases the swelling and stuffiness of the nose. These drugs include "Ephedrine", "Nazivin", "Sanorin", "Galazolin", "Naphthyzin", etc. Such drugs do not treat the disease, but temporarily eliminate its symptoms.

In certain forms of a disease such as rhinosinusitis, treatment is possible only with antibiotics, which should be taken within two weeks. They help to completely eliminate all the symptoms, but they should be taken only under the supervision of a specialist. Most often, an antibiotic such as "Amoxicillin" is prescribed. But if, three days after his admission, there has been no improvement, it must be replaced with preparations with an active substance such as tetracycline or cephalosporin. Also, the following antibiotics are justified: Clarithromycin, Azithromycin and Roxithromycin.

Despite the wide variety of medicines that are used to treat acute rhinosinusitis, they are not always effective. This is due to the fact that many microorganisms that cause inflammation of the upper respiratory tract successfully resist antibiotics. That is why with acute rhinosinusitis, especially when the frontal sinus is inflamed, stimulation of the human immune defense is used.

For this purpose, immunomodulators and immunocorrectors are used. They contain substances that restore the function of immune defense. The course of treatment is usually 1.5-2 weeks.

If such a form of the disease as polypous rhinosinusitis is detected, treatment should be carried out with the help of mucolytic drugs (Myrtol, Sinupret, Acetylcysteine). They help dilute the thick and viscous contents of the nasal sinuses, resulting in an outflow of pus. Also, the medicines of this pharmacological group can also have an antibacterial effect.

If the body temperature has increased, the patient must comply with bed rest. To do this, he is prescribed such antipyretic drugs as "Amidopyrin" and "Aspirin". As anaesthetising drugs are usually prescribed "Paracetamol", "Ibuprofen". Stronger funds are rarely used and should be taken no more than 7 days.

Allergic rhinosinusitis is treated with antihistamine drops and tablets. You can also use ointments and creams, but hormone drugs are rarely prescribed.

It is worth adding that, in addition to drug treatment, the following therapy is carried out:

• Wash the sinuses of the nose with antiseptic solutions to remove pathological contents;
• It is recommended to drink a lot of warm liquid: fruit drinks, fruit compotes from dried fruits, natural fruit juices, loose tea, broth of wild rose;
• Use physiotherapy methods: microwave therapy, ultrasound, UHF.

If these methods do not bring the right result, they resort to surgical treatment.

Surgical intervention

If the medication therapy of such a disease as rhinosinusitis has not helped, the treatment in this case is performed surgically. Most often, a puncture is prescribed, which helps:

• Quickly remove the purulent contents from the paranasal sinuses;
• Directly affect the mucosa of the paranasal antiseptic, anti-inflammatory and antibacterial drugs.

But there are disadvantages to such treatment. There is a risk of developing blood infection, loss of vision, etc. Therefore, most often it is not recommended to be carried out.

Features of the disease in children

Rhinosinusitis in children is the dominant disease, as it accounts for one third of all diseases that are associated with the upper respiratory tract. And, having matured, half of the children continue to suffer them.

With such a disease, the probability of serious complications is great. The most dangerous is a purulent-septic orbital complication leading to a visual impairment, and in 2% of cases intracranial changes occur. If the disease is not diagnosed in a timely manner and not treated, the inflammation of the lungs develops.

Acute rhinosinusitis in children is manifested as follows:

• Painful prolonged cough;
• Shortness of breath through the nose;
• fast fatiguability;
• General malaise;
• Nasal voice;
• Fever.

The main treatment is the implementation of antibiotic therapy against the background of increased immunity.

Features of the disease in pregnancy

Often there is acute purulent rhinosinusitis in pregnancy, moreover, it can be accompanied by complications, since in this period any treatment is limited.

Only the attending physician can prescribe antibiotics that can harm a woman and a child if taken uncontrolled. If penicillin group and cephalosporin are badly tolerated, then macrolides are used. These can be "Moxifloxacin", "Levofloxacin" and "Sparfloxacin". Under their influence, protein synthesis in cells of pathogenic microorganisms is destroyed. Such drugs are considered to be the most effective and safe for the treatment of pregnant women.

Prevention

To avoid such a disease as acute rhinosinusitis, the following preventive measures should be taken:

• Avoid drafts and hypothermia;
• A lot of walking outdoors, exercise;
• To be hardened;
• do sport;
• Timely treatment of colds and runny nose;
• In time to apply to the dentist for the treatment of teeth of the upper jaw;
• It is desirable to bathe in sea water and inhale the healing sea air.

Conclusion

Thus, acute purulent rhinosinusitis must necessarily be treated under the supervision of a doctor, so that there are not quite dangerous complications that may even pose a threat to life. It is necessary to avoid disease-provoking factors, spend less time in unventilated and dusty rooms, and quit smoking. With adequate and timely treatment, rhinosinusitis is completely cured.