Sinusitis is an inflammatory disease of the maxillary sinuses located in the upper jaw (Fig. 1). Often this disease is also called "sinusitis." This is due to the fact that the maxillary sinuses in professional literature is often called the term "maxillary sinus".
Sinusitis is most often unilateral, i.e. as a rule, only one sinus is inflamed. Only in rare cases, inflammation occurs immediately in both maxillary sinuses.
Each person has two maxillary sinuses, which are located to the left and right of the nasal passages. Each of the maxillary sinuses is a cavity in the thickness of the bone, lined from the inside by the mucous membrane. Each sinus has a message with an average nasal passage with a small hole in the bony wall separating the nasal passage and the sinus.
Sinusitis: symptoms in adults
Important: The symptoms of sinusitis in adults can vary greatly in each clinical case. This is due to the fact that antritis can occur in three different forms, each of which has its own symptoms -
- in the form of acute inflammation,
- in the form of chronic inflammation,
- exacerbations of chronic inflammation.
Also, the nature of the inflammatory process has an effect on the symptoms. It can be serous (inflammatory exudate without purulent contents), purulent, and also polypous (when polyps begin to grow on the mucous membrane of the maxillary sinus).
1. Symptoms of acute sinusitis -
At the very beginning of the patient’s inflammation, only an indisposition can disturb; this during this period of the disease occurs only swelling of the mucous membranes of the maxillary sinus and nose (without the development of purulent inflammation). However, swelling of the mucous membrane leads to a narrowing or complete closure of the opening between the maxillary sinus and the nasal cavity, which leads to a violation of the outflow from the maxillary sinus inflammatory infiltration and blockage of the sinus. This leads to the fact that acute purulent inflammation develops in the sinuses (sinuses).
During this period, the patient may complain of -
- Lethargy, weak smell, chills, loss of appetite, weakness,
- Body temperature rises to 37.5 - 39.0 degrees (sometimes up to 40 degrees),
- Increasing pain, which is first localized near the inflamed sinus, but then can spread to the frontal, temporal, occipital regions, as well as to the area of the teeth, which can simulate their inflammation.
- There may be a feeling of heaviness in the corresponding half of the face, which is typical if only one maxillary sinus is inflamed,
- From the nasal passage from the side of the inflamed maxillary sinus, mucus or pus can be secreted, which is especially enhanced when the head is tilted forward (Fig. 5). In the morning, you can also see traces of purulent fluid leaking from the nose on the pillow.
- In case of severe sinusitis, swelling of the soft tissues of the face, their reddening, as well as the development of purulent inflammation from the side of the oral cavity,
- When pressing on the skin in the projection of the front wall of the sinus can feel pain; there may also be pain when tapping on the teeth located in the projection of the inflamed sinus (usually these are 5.6.7 teeth of the upper jaw).
Signs of acute sinusitis on radiographs -
on the radiograph, the inflamed sinus will always be darkened compared with the healthy sinus. If the darkening is intense, then this indicates that the sinus is filled with pus. A sinus puncture may be performed to confirm the suppuration. Instead of radiography, computed tomography (CT) can be performed. CT is more expensive, but more informative for diagnosis.
2. Symptoms of chronic form of sinusitis -
Chronic sinusitis can be as an independent form of the disease, as well as the result of poorly treated acute sinusitis. There are three forms of chronic sinusitis:
- Catarrhal form -
characterized by a practically asymptomatic course, but sometimes patients may complain of a feeling of heaviness in a certain half of the face, a periodic disturbance of nasal breathing, some discomfort by the end of the day. On examination of the nose, the ENT doctor can detect the cyanosis of the nasal mucosa. X-rays may not give results, but CT may show a thickening of the mucous membrane of the maxillary sinus in the place of its inflammation.
- Purulent and polypoid forms -
The difference between these forms is that in addition to the purulent exudate with the polypous form, so-called polyps are also formed on the surface of the mucous membrane of the maxillary sinus (something like papillomas, only larger). Polyps in the maxillary sinus are no different from polyps, which often grow in the nasal passages, and also look (Fig. 11).
Patients with these forms of chronic sinusitis complain of -
→ putrid odor,
→ periodic discharge of pus from the corresponding half of the nose,
→ Temperature 37.5 - 37.8.
Diagnosis is based on symptoms, X-ray or CT data (computed tomography).
3. Symptoms of acute chronic sinusitis -
For various reasons (hypothermia, reduced immunity, etc.), sluggish inflammation in the sinus can become acute. Those. There is an aggravation of the chronic process with the development of acute symptoms of inflammation, which will be identical to the symptoms of the acute form of sinusitis (described above).
Sinusitis: causes of development
Sinusitis - treatment will be different, depending on the cause of its development. The reasons may be -
- acute and chronic inflammatory diseases of the nose (rhinogenic sinusitis),
- foci of inflammation in the roots of the upper teeth (approximately 32%),
- fractures of the upper jaw and zygomatic bone (traumatic sinusitis),
- allergic sinusitis (a consequence of allergic rhinitis).
Predisposing factors include: abuse of sprays from the common cold, active and passive smoking (24stoma.ru).
Rhinogenic sinusitis -
62% of patients have this form of sinusitis. It can be acute and chronic. Acute rhinogenic sinusitis usually develops on the background of acute respiratory viral infections and influenza due to nasal congestion and the difficulty of outflow of inflammatory exudate from the maxillary sinus into the middle nasal passage. Those. the trigger is a virus, and the bacterial infection joins only later.
Chronic rhinogenic sinusitis develops on the background of chronic inflammation in the nasal passages, chronic nasal congestion. Chronic rhinogenic sinusitis is caused in most cases by a bacterial infection, sometimes a fungal infection.
As a rule, patients with chronic nasal congestion for a long time and constantly use drops from the cold, which only increases the risk of developing antritis (for chronic stuffiness, you should use not traditional drops from the cold, but sprays with a low content of corticosoids, for example, "Nasonex", which can apply for 2-3 months).
Odontogenic sinusitis -
the development of the so-called "dental" antritis is associated with the anatomical proximity of the tops of the roots of the teeth of the upper jaw to the lower wall of the maxillary sinus. The most common "dental" cause of inflammation of the sinuses, are chronic foci of inflammation (cysts) at the apex of the roots of the teeth of the upper jaw (Fig. 12).
However, inflammation can also trigger the removal of 5.6.7 teeth, if the top of the tooth root is pushed into the sinus during the removal, or a message appears between the sinus and the oral cavity through the hole of the extracted tooth. Such a message should be immediately sutured by a doctor tightly immediately after the extraction of the tooth from the hole. Sometimes doctors neglect this ... Also, inflammation can provoke the refilling of root canals of 5-6-7 teeth of the upper jaw, if the excess filling material falls into the sinus or near it.
Important: it is often difficult to determine the cause of sinusitis; in any case, it is necessary to make targeted X-rays of the chewing teeth of the upper jaw in the projection of the inflamed maxillary sinus. If these teeth do not have foci of chronic inflammation in the pictures, then the origin of sinusitis is almost certainly associated with an infection in the nasal passages.
Below we will talk about whether it is possible and how to cure sinusitis at home, which antibiotics should be taken for antritis, which nasal drops for sinus are best used (vasoconstrictor from a cold or with low doses of corticosteroids) ...
How to treat sinusitis - will depend on the cause of its occurrence (rhinogenous or odontogenic) and the nature of the inflammatory process (serous or purulent). For example, it is simply pointless to treat sinus inflammation with punctures, flushing, antibiotics, if you have foci of an uncured chronic infection on the teeth in the projection of the sinus.
It is necessary to understand that the cure for sinusitis is not just any drug (there are no such drugs) ... First of all, it is a whole range of diagnostic and therapeutic procedures (washing the sinuses with antiseptics, sinus surgery, dental treatment), and already as an addition - using a complex of drugs : drops, antibiotics, etc.
Thus, for the initial consultation you need to contact the ENT doctor. However, an experienced ENT will also refer you to the dentist in order to eliminate the cause of sinusitis associated with inflammation at the roots of the teeth. Doctors will direct you to the necessary x-rays of the teeth and sinuses, or computed tomography of the upper jaw. Further treatment is planned taking into account the identified causes of sinus inflammation, symptoms, as well as X-ray or CT data.
1. Treatment of acute and chronic rhinogenic sinusitis -
Acute rhinogenic sinusitis in the absence of suppuration in the sinus can be treated without the use of antibiotics (this is possible with the patient's immediate treatment to the doctor). In this case, the main thing is to create an outflow for the inflammatory exudate formed in the maxillary sinus, by eliminating nasal congestion with drops or sprays for the common cold, and also by stimulating the outflow of inflammatory exudate from the sinuses.
Traditional vasoconstrictor drops and antritis sprays can be applied for no more than 3-4 days. Prolonged use of such drops and sprays from the common cold leads to the opposite effect - persistent edema of the mucous membrane, which will prevent the discharge of inflammatory exudate from the sinus through the nose. To relieve nasal congestion and swelling of the mucous membranes for sinus it is best to use:
- spray from rhinitis "Rinofluimucil" (Italy, about 250 rubles) -
components of this spray reduce mucous and purulent-mucous secretions, and facilitate their discharge, and also remove swelling from the nasal mucosa. It will be perfectly combined with plant drops “Sinupret” or “Sinuforte”, which facilitate the removal of inflammatory exudate from the maxillary sinus (read about these drops below, in the section “folk remedies”).
- spray "Nasonex" (Belgium, from 500 rubles) -
spray containing a low dosage of glucocorticoids. Especially it can be recommended for long-term chronic sinusitis, when you can not always use the traditional cold sprays. Also, the drug is especially indicated if sinusitis occurs in a patient with a history of allergic rhinitis. It will also be well combined with Sinupret or Sinuforte.
If pus has begun to form in the sinus (this can occur with acute sinus infection in the event of bacterial infection and chronic sinus infection), then this is an indication for immediate antibiotic therapy, as well as daily procedures for washing the sinus with antiseptic solutions (the latter is done at the reception ENT doctor). Independently you can not wash the sinus, but you can wash the nasal passages with maximum, which is not enough.
2. Treatment of odontogenic sinusitis -
The most important thing in the treatment of this form of sinusitis is to eliminate the source of infection, which has led to inflammation of the sinus. This may be the removal of the causative tooth. If you wish to preserve the causative tooth, the root of which has an inflammatory focus in the form of a granuloma or a radicular cyst, an urgent opening of this tooth is necessary to create an outflow of pus from the cyst cavity through the tooth. Without this requirement, all subsequent treatment will be in vain.
Next, you need to create an outflow for the resulting inflammatory exudate in the sinus. At the very beginning of inflammation, this can be done with the help of vasoconstrictor nasal drops, however, in the case of the development of purulent inflammation, this will not be enough. There is an urgent need to run to the ENT doctor and do puncture and washing the maxillary sinus from the nose or the hole of the extracted tooth. In parallel, antibiotic therapy is prescribed (see below), anti-inflammatory drugs.
After the subsidence of acute purulent inflammation in the sinus, the ENT doctor or the maxillofacial surgeon will decide on the need for "sinus surgery". Such an operation is indicated in the development of a purulent or polypoid form of sinusitis. In this case, the patient is hospitalized. The operation involves the removal of the inflamed mucous membrane of the maxillary sinus. This is done under general anesthesia, with access from the oral cavity. Before surgery, treatment of all teeth is mandatory.
Antibiotics for sinus -
Sinusitis: antibiotic treatment is best to start with Amoxicillin in combination with clavulanic acid. Trade names of such drugs: "Augumentin", "Amoxiclav". If the patient has allergic reactions to penicillin, antibiotics of the fluoroquinolone group (for example, Ciprofloxacin), or the macrolide group (Clarithromycin, Azithromycin) are considered.
The first analysis of the effectiveness of antibiotic therapy is carried out after 5 days, if during this time improvement is not achieved, then a more potent antibiotic is prescribed. Antibiotics for sinus are appointed on average for 10-14 days. However, there are exceptional clinical cases where antibiotics are prescribed up to 21 days.
Sinusitis: treatment of folk remedies
You need to understand that folk remedies can not be the main method of treatment. They can only be considered as secondary therapy. There are excellent vegetable drops from sinusitis, which are used to stimulate the outflow of inflammatory secretion (exudate) from the maxillary sinus through the nasal passages.
Treatment of sinusitis folk remedies: the most effective drugs
- The drug "Sinupret" (Germany) -
produced by a very good European company "Bionorica". Available in the form of drops or dragee. It contains exclusively herbal extracts of herbs that facilitate the removal of inflammatory exudate from the maxillary sinus, as well as reduce inflammation. The cost of about 350 rubles.
- The drug "Sinuforte" (Spain) -
Comes in drops of the nose day. Made on the basis of exclusively herbal ingredients, which also contribute to the removal of inflammatory exudate from the maxillary sinus. The cost of 2300 rubles.
How to treat sinusitis at home: quickly ...
You must understand that sinusitis with suppuration is a pus focus in the center of the head, the size of a golf ball. And besides pus (in which there can be not only bacteria, but also fungi, which requires different treatment), there can also be polyps. If you suddenly decide that an expensive antibiotic and drops for the nose may be enough, then most likely you will be deeply mistaken. The consequence of ineffective treatment will be the transformation of the acute form of antritis into a chronic, with the need for surgical intervention (sinus surgery, in a hospital).
The maximum that you can do at home is to regularly flush the nasal passages, as well as take appropriate medications (pills, shots, drops). Keep in mind that when there is no purulent inflammation in the sinus - the treatment can be carried out in the clinic. If acute purulent inflammation of the sinus has developed, then hospital treatment is necessary. Complications of sinusitis with improper treatment: cellulitis, sepsis, facial vein thrombophlebitis, abscess of the orbit, brain abscess ... We hope that our article on the topic: How to cure sinusitis at home - has been helpful to you
Author: dental surgeon Kamensky KV, 19 years experience.