ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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CLINICAL COURSE OF ACUTE SINUSITIS (ACUTUS SINUSITIS).
Muhammadiyeva.F.R.
mukhammadiyeva.farida@mail.ru
Bukhara State Medical Institute,
(998) 65-223-00-50, bsmi.uz
Resume
The purpose of the study is to study the clinical course of acute sinusitis and to
identify and implement new approaches to its treatment.
Key words: sinusitis, allergy, virus, bacteria, treatment
Relevance
Acute sinusitis is a sudden inflammation of the sinuses that lasts at least four
weeks. The synonym "rhinosinusitis" is also used. According to him, inflammation is
a process that affects not only the mucous membrane of the sinuses, but also the nasal
cavity [1].
The main causes of acute sinusitis are viruses or bacteria. Therefore, viral and
bacterial forms of the disease are distinguished. Less often, anaerobes and intracellular
microorganisms are the causative agents of acute inflammation in the paranasal
sinuses.
Viral sinusitis often occurs like a cold and is seasonal. They are usually found in
autumn, winter, spring and autumn during the warm season.
Viruses that cause inflammation of the upper respiratory tract include:
rhinoviruses, influenza and parainfluenza viruses, respiratory syncytial viruses,
adenoviruses and coronaviruses.
Usually, viral sinusitis does not require special treatment and goes away on its
own. But sometimes recovery does not happen. This is due to an increase in the
bacterial flora living in the sinuses. Most often, Streptococcus pneumoniae and
Haemophilus influenzae are found in acute sinuses - they are found in 70-75% of all
cases [2].
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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Predisposing factors for the development of bacterial sinusitis:
• curvature of the nasal septum;
• polyps;
• chronic rhinitis;
• adenoids in children;
• structural features of the ostiomeatal complex: a loop-like tumor, a middle nasal
shell and a large bubble of the lattice bone.
Anaerobic infection in acute sinusitis can lead to maxillofacial pathology or
chronic sinusitis. In this case, it is difficult to determine whether it is an acute or chronic
form.
Allergic process and fungal flora can also cause sinusitis - if the disease is acute,
it becomes chronic.
Symptoms of acute sinusitis
The main symptoms of acute sinusitis:
• difficulty breathing through the nose;
• headache;
• runny nose;
• cough in children.
In addition, in acute sinusitis, a decrease in the sense of smell, ear congestion, an
increase in div temperature, and general weakness may also occur, but these
conditions are not always observed [3][4].
Difficulty breathing accompanies most diseases of the nose, so this symptom
alone does not confirm acute rhinosinusitis. At least two signs must be present for
diagnosis.
In sinusitis, the headache has a squeezing character and is often aggravated by
bending the head down. It can decrease after using drop drugs.
With inflammation in the maxillary and frontal sinuses, pain appears in the face,
bridge of the nose, eyebrows and temporo-parietal region. Maxillary sinusitis manifests
as a diffuse toothache on the affected side. Inflammation of the mucous membrane of
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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the sphenoid sinus (sphenoiditis) is characterized by pain in the center of the head and
in the back of the head.
A runny nose does not always occur with acute sinusitis. Mucous discharge is
characteristic of viral inflammation, if bacterial flora is added, purulent discharge
appears. In children, good sinus drainage function and an open anastomosis are
manifested in secretion secretion during blowing the nose and coughing. When the
posterior parts of the sphenoid sinus and ethmoid labyrinth are affected, secretions flow
into the back wall of the pharynx, causing coughing attacks.
A mild form of acute sinusitis is characterized by:
• difficulty breathing through the nose;
• mucous or purulent discharge from the nose;
• violation of sense of smell;
• mild facial pain without obvious signs of intoxication - the temperature remains
normal or rises slightly.
In severe cases, the temperature rises to 38 ºС and higher, the headache increases,
swelling of the eyelids and soft tissues of the face may develop.
Pathogenesis of acute sinusitis.
With sinusitis, the virus penetrates the mucous membrane of the nasal cavity,
damages the ciliated epithelial cells and enters the human div. At the same time, the
mucous membrane swells, mucus secretion increases in the nasal cavity, which further
blocks the work of ciliated epithelial eyelashes. Usually, their action protects the div
from foreign objects.
At this time, the patient has a runny nose, sore throat, cough, fever and weakness.
The symptoms of the disease last seven days on average and gradually decrease.
Swelling of the mucous membrane and sinuses leads to nasal cavity blockage. As
a result, drainage function is blocked, secretions stagnate
Intracranial complications:
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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• arachnoiditis (leptomeningitis) - serous inflammation of the arachnoid
membrane of the brain;
• extradural abscess - accumulation of pus between dura mater and skull bones;
• subdural abscess - accumulation of pus between dura and arachnoid mater;
• brain abscess - a purulent focus surrounded by a capsule in the brain substance;
• serous and purulent meningitis - inflammation of the meninges;
• thrombosis of dural sinuses [4][7][10].
As can be seen from the table below, despite the variety of clinical forms of
complications, their manifestations are similar. This makes it difficult to make a
diagnosis and choose the right treatment tactics.
Complications of acute sinusitis
Complexity Clinical manifestations
Reactive swelling of the tissues of the orbit and eyelids Pale, painless, translucent
swollen eyelids, often above the lower part. The eyeball may protrude from the orbit
(exophthalmos).
Diffuse non-purulent inflammation of the tissues of the orbit and eyelids Swelling
and redness of the eyelids (hyperemia) as a result of blood vessel congestion.
Exophthalmos and intoxication
Osteooperiostitis of the orbit Swelling and hyperemia of the eyelids,
exophthalmos and limited mobility of the eyeball
Eyelid abscess Swelling and redness of the eyelids, fluid changes when pressing
the eyeball, intoxication
Subperiosteal abscess Swelling, hyperemia of the skin of the eyelids and
conjunctiva, pain during palpation, displacement of the eyeball
Retrobulbar abscess and orbital phlegmon. Swelling and hyperemia of the eyelids
and conjunctiva, severe exophthalmos, restriction of mobility of the eyeball and pain
during palpation.
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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Thrombosis of orbital tissue and cavernous sinus veins Swelling and hyperemia
of eyelids and conjunctiva of both eyes, severe exophthalmos, decreased visual acuity,
intoxication
Arachnoiditis
(leptomeningitis) Inflammation of the choroid of the brain. Headache, nausea,
dizziness and weakness
Extradural abscess Headache, nausea and intoxication
Subdural abscess Headache, nausea and intoxication
Serous and purulent meningitis Headache, nausea, photophobia, forced position
of the div with the head thrown back and the appearance of meningeal reflexes
Brain abscess Headache, nausea, meningeal symptoms. Focal symptoms are
diverse and depend on the location of the abscess
Dural sinus thrombosis: fever, temperature rise and fall, chills, profuse sweating
and weakness.
Diagnosis of acute sinusitis
May include:
• anterior rhinoscopy;
• radiography of the sinuses;
• ultrasound research;
• diagnostic puncture;
• laboratory research;
• microbiological examination;
• diaphanoscopy.
Previous rhinoscopy
The main method of objective diagnosis of acute sinusitis [1][6][7]. This is done
by an otolaryngologist using a nasal spray. Before its use, the mucous membrane of the
nose is lubricated with a solution of a vasoconstrictor drug (anemization). This is done
to reduce swelling of the mucous membrane.
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The doctor evaluates the condition of the mucous membrane of the nasal conchas
and passages, the absence or presence of flow. Symptoms of sinusitis are the presence
of purulent or mucopurulent discharge in the area of the exit holes of the affected
sinuses. It is accompanied by redness and swelling of the nasal mucosa.
Pathological secretion can be seen on the back wall of the oropharynx and
nasopharynx cavity when examined with a spatula and nasopharyngeal probe (posterior
rhinoscopy) and when examining the pharynx (pharyngoscopy).
Endoscopic examination of the nasal cavity
Detecting the smallest anatomical changes, it allows a detailed examination of the
turbinates of the nasal passages and nasopharynx. Video endoscopy is often performed
and the result is recorded, which later helps to assess how the disease progresses.
X-ray of the sinuses
Use only for chronic runny nose and headache for about 7-10 days [1][6][7].
During the procedure, the head is fixed in a certain position - in nasomental, nasofrontal
and lateral projections. The position of the head is determined by the radiologist. With
sinusitis, the mucous membrane thickens, the level of horizontal fluid is determined,
and the pneumatization of the sinus is significantly reduced.
Computed tomography (CT) is used for chronic pathology of paranasal sinuses,
orbital and intracranial complications. It is not appropriate to use it to diagnose acute
sinusitis. Neither X-ray nor computer tomography can distinguish between viral and
bacterial It is actively used in the examination of children and pregnant women.
The effect of ultrasound is based on the reflection of the ultrasound signal in a
linear and two-dimensional mode at the boundary of two substances with different
acoustic properties (bone - air, air - exudate, etc.). In the first case, ultrasound scanners
("Sinusoscope", "Sinuscan") are used for the paranasal sinuses, and in the second case,
standard ultrasound devices are used.
Diagnosis through puncture
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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Sinus puncture (from the Latin "puncture") is not a routine diagnostic method due
to the high risk of complications. It is used if there are contraindications to radiography,
for example, during pregnancy.
Laboratory diagnostics
Includes complete blood count and C-reactive protein (CRP) determination.
Allows:
• to distinguish viral sinusitis from bacterial sinusitis and, therefore, determine the
need to take antibiotics;
• assessment of disease severity and dynamics.
Microbiological examination
It is carried out in cases of long-term forms of sinusitis and ineffectiveness of
antibiotic therapy. For the study, you will need material taken from the nasal cavity or
a puncture from the affected sinus.
The reliability of the method is relative, and the information content is small. First,
the microflora of the nasal cavity and sinuses is initially different. Taking a smear, even
if all the conditions are met, does not guarantee that the bacterium grown in the media
is the cause of inflammation in the sinus and is not an accidental "traveler" when
removing a cotton probe from the nose.
The information content of microbiological studies in children is even lower. This
is due to the child's negative reaction to the manipulation and inability to perform the
procedure correctly [11].
Secondly, reliability may be affected by non-compliance with the conditions of
storage and transportation of biomaterial [12]. Therefore, the evaluation of the results
of microbiological studies is complicated and uncertain.
Diaphanoscopy
An outdated non-invasive method for diagnosing sinusitis of the maxillary sinus.
This is done using a special lamp. If the space is airy, then the sinus is highlighted in
red. [5]. If there is pus in the sinus, the glow will turn black.
Treatment of acute sinusitis
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The choice of treatment tactics depends on the form and severity of acute sinusitis.
Mild to moderate exudative sinusitis is often treated with conservative or invasive sinus
drainage techniques.
Conservative treatment
The goal of treatment of acute sinusitis is to restore the patency of the inflamed
sinus anastomosis and prevent orbital and intracranial complications. For this, in the
first days of treatment, but no more than seven days, vasoconstrictors are used, and the
nasal mucosa is moistened and washed with a saline solution (sodium chloride 0.9%)
Such measures prevent the growth of bacteria.
Intranasal glucocorticosteroids (InGCS) reduce swelling of the mucous
membrane and the formation of mucus and pus (exudate). Due to this, nasal breathing
improves and exudate from the sinuses is restored [12]. They can be used as
monotherapy for mild forms and in combination with other drugs in more severe cases.
It is not recommended to use antibiotics in the first seven days. The indication for
antibiotic therapy is only bacterial sinusitis. This diagnosis is made by the doctor on
the basis of complaints, anamnesis, objective data, additional examination methods and
differential diagnosis.
Sinus drainage
Invasive methods of sinus drainage include:
• hole;
• Use of "YAMIK" sinus catheter;
• balloon sinusotomy - expansion of the natural anastomosis.
Puncture of the maxillary sinus is performed through the lower nasal passage with
a Kulikovsky needle.
Then the contents of the sinus are removed by washing with a syringe with a saline
or antiseptic solution.
The frontal sinus is often pierced with a thin needle through the orbital wall;
trephine puncture is performed less often - a hole is made through the anterior wall
with the help of a drill or tools for drilling bones (trepans).
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The course of treatment consists of several punctures, so the catheter is inserted
into the sinus for an average of 10 days.
Sinus puncture is an invasive procedure associated with the risk of serious
complications. Alternatively, YAMIK sinus catheter can be used. The device was
designed by the Russian otorhinolaryngologist V.S. Kozlov.
The catheter is inserted into the nasal cavity into the nasopharynx. Air-filled
chambers create negative pressure, which helps drain the sinuses.
All invasive procedures are performed after topical anesthesia and anesthesia of
the nasal cavity.
Puncture of the maxillary sinus is associated with the risk of needle penetration
into the soft tissues of the cheek, orbit and pterygopalatine fossa. In addition, nazolacri
during the procedure
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