Introduction
Pathogenesis of chronical sinusitis
Symptoms of chronical sinusitis
Diagnosis
Treatment
Conclusion
Приложение
Introduction
Sinusitis is an inflammation of the sinuses. Most often, sinusitis is a complication of infectious diseases such as scarlet fever, flu, measles, acute rhinitis, etc. Sinusitis can occur in both acute and chronic form.
Chronic Inflammation of the nasal cavities and the paranasal sinuses is not an uncommon finding in the paediatric population [1]. Children are known to have an immature immune response [1]. They are also exposed to a significant and variable viral load in their daily activities herd community. The result is a higher incidence of viral upper respiratory tract infections [1]. The concomitant nasal mucosal inflammation, edema and dysfunction of the muco-ciliary clearance system set the stage for superimposed bacterial rhinosinusitis; not to mention the active role of the adenoids in sinonasal infections [2] The frequency and severity of such episodes are aggravated by any background of atopy, exposure to environmental toxins, immunodeficiency and/or anatomical abnormality [3]. Iatrogenic aggravators of chronic rhinosinusitis (CRS) include the unwise and untimely use of antibiotics which have led to a rise in resistant bacterial strains [4].
Pathogenesis of chronical sinusitis
The pathogenesis of chronic sinusitis is based on many factors, the combination of which leads to the development of a chronic inflammatory process. Predisposing factors, that lead to the development of chronic sinusitis also include chronic allergic inflammation, structural abnormalities (for example, polypus), irritating environmental factors (air pollution, tobacco smoke) and other infectious processes.
The bacteria are most often act as a causative agent (possibly as part of a biomembrane on the surface of the mucosa), but fungal infections may also take place. There can be involved a lot of bacteria, including gram-negative bacteria and anaerobic oropharyngeal microorganisms; and just polymicrobial infection is common. In some cases, the cause of maxillary sinusitis can be an odontogenic process. Fungal infection (Aspergillus, Sporothrix, Pseudallescheria) can have a chronic course but affects mostly elderly patients and immunocompromised patients.
Symptoms of chronical sinusitis
Acute and chronic sinusitis have similar symptoms, including purulent discharge from the nose, active pain on the face in the area of the projection of the paranasal sinuses, nasal congestion, hyposmia, bad breath and productive cough (especially at night). The pain is more often expressed in acute sinusitis. The skin and soft tissues in the area of the projection of the inflamed sinus can be swollen, hyperemic, painful during palpation. So, the general symptoms can be summarized like this:
˗ With inflammation of the maxillary sinuses, pain occurs in the upper jaw, toothache and headache, localized in the anterior regions.
˗ Inflammation of the frontal sinus is accompanied by pain in the forehead and headache.
˗ With ethmoid sinusitis (inflammation of the ethmoid sinus), pain occurs behind the eyes and between them, a headache is often noted, which patients describe as “splitting,” periorbital phlegmon and lacrimation.
Diagnosis
When diagnosing chronic sinusitis there are a few ways to do so. The most popular ways, though, are:
1. Otorhinolaryngological examination.
2. Radiography (or computed tomography) of the paranasal sinuses.
3. Ultrasound examination of the paranasal sinuses is a safe method that has no contraindications and is used to diagnose sinusitis and control the treatment process.
4. Laboratory diagnostics (general blood test, culture of sinus or lavage on the flora, etc.).
5. Endoscopic examination of the nasal cavity for the nasal cavity and nasopharynx to identify features of the anatomical structure and definition.
Symptoms of acute sinusitis and chronic sinusitis (during exacerbations) are mostly the same. These include fever, general malaise, headache, nasal congestion (usually on one side) and copious mucous discharge from the nasal cavity. Accurate diagnosis of sinusitis is made on the basis of a survey of the patient, anamnesis, a study of the nasal cavity, diaphanoscopy, sounding and radiography [10].
If all sinuses of the nose become inflamed at the same time (on both sides or on one side), this disease is called pansinusitis. In the acute form of sinusitis, conservative treatment is used, in chronic it leads to surgery.
Treatment
It should be noted that most sinusitis has a viral etiology, and recovery occurs spontaneously, previously all patients were prescribed antibacterial drugs, since there was insufficient experience in differentiating bacterial and viral sinusitis. However, the widespread use of antibiotics has led to the development of a large number of resistant microorganisms, which requires a more selective prescription of antibiotics. The Infectious Diseases Society of America recommends the use of the following options for prescribing antibiotics:
˗ Duration of mild to moderate symptoms ≥ 10 days
˗ Severe symptoms (e.g. fever ≥ 39, severe pain) ≥ 3–4 days
˗ Deteriorating symptoms after short-term improvement after a typical ARI ("double course of the disease")
Since many causative microorganisms develop resistance to previously used drugs, the first-line drug is amoxicillin / clavulanate at a dose of 875 mg every 12 hours (25 mg / kg, orally, every 12 hours for children). Patients with antibacterial resistance are prescribed higher doses of 2 g every 12 hours (children 45 mg / kg every 12 hours). Resistance can also be present in children under 2 years of age, and adults over 65 who received antibiotics a month ago were hospitalized for the last 5 days and immunocompromised patients.
If positive dynamics are observed 3-5 days after the start of treatment, treatment is recommended to be continued. In adults without resistant risk factors, a course of treatment lasting 5-7 days can be carried out; the rest should be prescribed treatment for 7-10 days. In children, the course of treatment is 10-14 days. If positive dynamics are not observed 3-5 days after the start of treatment, the drug should be changed [7]. Given bacterial resistance, drugs such as macrolides, trimethoprim / sulfamethoxazole and cephalosporin monotherapy are not currently used. An emergency operation is necessary in case of loss of vision or a high probability of imminent loss of vision.
Conclusion
Sinusitis diseases pose a major problem in children and may require surgical intervention. It is estimated that worldwide 44–120 per 10,000 children (7.5–17.3% of all children) younger than 15 years undergo tonsillectomy and adenoidectomy. Apart from the associated surgical complications, the surgery also has psychological and financial impact on the patients and their families. Medical treatment for the eradication of infections appears to be a more suitable option [7].
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