Acute maxillary sinusitis (maxillary sinusitis)

Acute sinusitis is an acute inflammation of mainly the mucous membrane and submucous layer of the maxillary sinus, sometimes spreading to the periosteum and, in rare cases, with a particularly virulent infection, to the bone tissue with transition to a chronic form.

Causes acute maxillary sinusitis

Indications that inflammatory processes can develop in the maxillary sinus are found in medieval medical manuscripts, in particular in the works of N. Highmore (1613-1685). Acute sinusitis often develops as a complication of acute rhinitis, influenza, measles, scarlet fever and other infectious diseases, as well as due to inflammatory diseases of the teeth (odontogenic sinusitis). Various microbial associations, both activated saprophytes and introduced pathogenic microbiota, can act as etiological factors.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Pathogenesis

The pathogenesis of acute sinusitis is determined by the source of infection, which can be rhinogenic (in the vast majority of cases) and, as noted above, odontogenic, traumatic and hematogenous. Sometimes the primary inflammatory process develops in the cells of the ethmoid labyrinth, or in the frontal sinus, and secondarily spreads to the maxillary sinus. According to foreign statistics, in 50% of cases, combined acute inflammation of the maxillary sinus and cells of the ethmoid bone is observed.

Acute genuine sinusitis is divided mainly into catarrhal (serous) and purulent. However, a number of foreign authors adhere to a different classification. They divide acute sinusitis into catarrhal non-exudative, catarrhal exudative, serous-purulent, allergic, necrotic with damage to bone tissue, etc. In the catarrhal form, significant hyperemia and edema of the mucous membrane of the sinus are observed; round-cell infiltration is expressed around the vessels and glands. This leads to thickening of the mucous membrane, significant exudate and a decrease in the air space in the sinus. Violation of the ventilation function and the occurrence of a "vacuum" supplements the exudate with transudate. In purulent forms of acute sinusitis, round-cell infiltration of the mucous membrane is expressed more than in catarrhal, and the phenomena of edema are less. These two forms represent two stages of the same process. In infectious diseases (especially measles, scarlet fever, typhoid fever) sometimes foci of necrosis occur in the sinus walls. According to some authors, the bone wall is primarily affected by hematogenous transmission in infectious diseases, and only then does the inflammation spread to the mucous membrane.

In diphtheritic sinusitis, fibrinous effusion forms in the sinus cavity, the mucous membrane is sharply hyperemic, and hemorrhages are visible in places.

In early childhood, acute sinusitis is rare and often occurs in the form of osteomyelitis of the upper jaw, which may be accompanied by the subsequent formation of purulent fistulas, as well as more or less extensive necrosis of the soft tissues of the face and bones of the facial skeleton.

[ 6 ], [ 7 ]

Symptoms acute maxillary sinusitis

The symptoms and clinical course of acute sinusitis do not differ greatly. According to origin, rhinogenous, odontogenous, hematogenous and traumatic acute sinusitis are usually distinguished.

The rhinogenic route is observed in acute inflammatory processes in the upper respiratory tract, as well as in intranasal surgical interventions. The onset of acute sinusitis is characterized by the fact that against the background of acute rhinitis of any etiology, the patient develops a unilateral headache, a feeling of distension and pressure in the corresponding half of the face and in the area of the canine fossa; the pain radiates along the second branch of the trigeminal nerve, sometimes spreading to the alveolar process and the frontal region of the corresponding half of the face and head. At the same time, general clinical symptoms (fever, chills, malaise, weakness, loss of appetite, etc.) appear. With the appearance of profuse discharge from the corresponding half of the nose, the general condition of the patient improves, body temperature and pain syndrome decrease. However, after some time, clinical symptoms may increase, which coincides with the cessation of nasal discharge, which again accumulates for one reason or another in the maxillary sinus. Usually, with acute sinusitis, headache and a feeling of distension in the corresponding half of the face increase during the night and reach their peak in the morning, and by the evening these pains subside due to the emptying of the inflamed sinus. The pain syndrome in acute sinusitis is caused by two main factors - the pressure of the exudate on the nerve endings and the resulting neuritis and intoxication of numerous sympathetic fibers. Therefore, the pain syndrome is differentiated into two components - constant, depending on toxic neuritis of the sensory nerve endings, and periodic, synchronized with the filling and emptying of the sinus.

At the beginning of the disease, the discharge is serous (catarrhal inflammation stage), then it becomes mucous and mucopurulent, sometimes with an admixture of blood. Hemorrhagic discharge, which occurs at the very beginning of the inflammatory process, is characteristic of influenza sinusitis, at the same time, herpetic rashes may appear in the vestibule of the nose and in the area of the upper lip, as well as along the branches of the trigeminal nerve. A characteristic sign of the onset of acute sinusitis, which has complicated acute rhinitis, is the cessation of discharge from one half of the nose (on the healthy side) and their continued discharge from the other half of the nose. If acute rhinitis does not go away within 7-10 days, then one should think about the presence of acute sinusitis.

Objectively, swelling, redness and local increase in skin temperature in the area of the cheek and lower eyelid, pain on palpation of the anterior wall of the maxillary sinus and on percussion of the zygomatic bone, in which the pain radiates to the area of the anterior wall and the superciliary arch - the place where the branches of the trigeminal nerve exit through the corresponding bone openings onto the surface of the facial skeleton, respectively - foramen (incisura) supraorbital et infraorbitale, - paresthesia and local increase in sensitivity of the skin over the anterior wall of the maxillary sinus can be noted.

During anterior rhinoscopy, mucopurulent discharge (the purulent streak symptom) is observed in the middle nasal passage, usually flowing into the nasopharynx. Therefore, during posterior rhinoscopy and pharyngoscopy, mucopurulent discharge is visible in the nasopharynx and on the back wall of the pharynx. In unclear cases, a test is performed with lubrication of the mucous membrane of the middle nasal passage along its entire length with an adrenaline solution, and after a few minutes the head is tilted down and to the side, with the affected sinus upward. If there is pus in the sinus, it is released through the widened passage (Zablotsky-Desyatovsky symptom). During examination of the nasal cavity, swelling and hyperemia of the nasal mucosa in the area of the middle nasal passage, middle and often lower nasal turbinates are determined. With bilateral sinusitis, the sense of smell is impaired. When the periosteum and bone walls are involved in the process, soft tissue pastosity is observed in the area of the anterior wall of the affected sinus and swelling of the lower eyelid due to compression of the veins that drain blood from the lower parts of the orbit. Sometimes this swelling reaches significant sizes, covering the eye and moving to the other half of the face.

The hematogenous route is typical for the occurrence of common severe infectious diseases (flu, scarlet fever, typhus, etc.), when the pathogen, circulating with the blood, penetrates one or another paranasal sinus and causes inflammation under appropriate local favorable conditions. Sometimes both routes of infection may be involved in the occurrence of acute sinusitis. During some outbreaks of influenza, a sharp increase in the number of patients with acute sinusitis and other inflammatory diseases of the paranasal sinuses is noted. Thus, during the 1918-1920 flu pandemic, which was called the "Spanish flu" in Russia, characteristic pathological changes in the maxillary sinus were found during autopsy in 70% of cases.

Odontogenic sinusitis most often develops in the presence of root inflammatory processes and the close location of the affected tooth root to the bottom of the maxillary sinus.

In its clinical picture, odontogenic sinusitis differs little from sinusitis of other etiologies. As already noted, the disease is associated with the spread of pathogens from infected teeth, which is facilitated by the above-mentioned anatomical features. Usually, the maxillary sinus is located above the sockets of the 2nd premolar (5th tooth) and the 1st and 2nd molars (6th and 7th teeth). With large sinus sizes, it extends posteriorly to the 3rd molar (8th tooth), and anteriorly to the 1st premolar (4th tooth) and less often to the canine (3rd tooth).

The roots of the teeth located in the alveolar process are separated from the bottom of the maxillary sinus by a bony septum of varying thickness. In some cases it reaches 1 cm or more, in others it is sharply thinned and may consist only of the periosteum or only the mucous membrane of the sinus. According to L.I. Sverzhevsky (1904), the thickness of the lower wall of the maxillary sinus is directly dependent on the level of its bottom in relation to the bottom of the nasal cavity: in 42.8% of cases, the bottom of the maxillary sinus is below the bottom of the nasal cavity, in 39.3% - at the same level with it, and in 17.9% - above it. Most often, odontogenic sinusitis occurs in cases where granulating periodontitis or apical granuloma, having destroyed the septum between the bottom of the maxillary sinus and the periodontium, involves the mucous membrane of the sinus in the inflammatory process. The spread of infection in odontogenic diseases is also possible through the venous plexus system located between the tissues of the alveolar process and the mucous membrane of the maxillary sinus. Odontalgia arising in acute catarrhal sinusitis (most often the pain is projected to the areas of the 5th and 6th teeth) often simulate pulpitis or periodontitis, which can lead to an erroneous dental diagnosis and unjustified intervention on the teeth. In surgical interventions on the maxillary sinus and with established high position of the roots of the teeth, one should be careful with the mucous membrane of the bottom of the maxillary sinus, since vigorous scraping can damage the vascular-nerve bundle of the dental pulp, which leads to its necrosis and subsequent infection. Sometimes, with a very thin lower wall of the maxillary sinus and manipulations on the corresponding teeth (extraction, depulpation, etc.), perforation of the bottom of the maxillary sinus occurs with the formation of a lunar fistula. If in this case a complication occurs in the form of acute sinusitis, then purulent discharge appears through this fistula. In such cases, appropriate sanitation of the maxillary sinus and, if necessary, plastic closure of the lunar fistula are necessary.

Worthy of attention are sometimes observed, especially in acute catarrhal sinusitis, odontalgia, imitating pains arising in pulpitis or periodontitis. Patients experience acute pain in the teeth, most often in the 2nd small and 1st large molars of the upper jaw. Such complaints of patients often lead to an erroneous diagnosis and subsequent incorrect and unsuccessful treatment measures in the form of depulpation of teeth, removal of fillings and even the tooth itself. The same pains in the indicated teeth can occur in the early stage of cancer of the upper jaw. Removal of a loose tooth in this case leads to rapid growth of "granulations" (tumor tissue) from the tooth socket.

Traumatic sinusitis is an acute purulent inflammation of the maxillary sinus that occurs as a result of blunt or gunshot trauma to the upper jaw, resulting from:

1. infection of the hematoma of the maxillary sinus;
2. fracture of the bones of the upper jaw with damage to the integrity of the walls of the maxillary sinus, the introduction of bone fragments into it and its subsequent infection;
3. damage to the integrity of the upper jaw due to a gunshot wound with penetration of foreign bodies into the maxillary sinus (bullets, fragments of mines and shells, secondary fragments).

The clinical picture of acute sinusitis in the above injuries depends on the mechanism of the traumatic process, the localization and degree of destruction of bone tissue and the mucous membrane of the sinus, as well as the nature of the damage to adjacent anatomical structures (the eye socket and its contents, the nasal cavity, blood vessels, nerves, etc.). Acute sinusitis that occurs in such injuries is combined with clinical manifestations characteristic of damage to adjacent organs, and treatment measures are determined by the severity of the leading clinical syndrome.

The clinical course of acute sinusitis can evolve in several directions:

1. Spontaneous recovery is a common outcome in many catarrhal forms of acute sinusitis, which occurs simultaneously with the runny nose that provoked this sinusitis; this is facilitated by good immunological resistance of the body, weak virulence of the microbial factor, favorable anatomical features of the endonasal structures, effective functioning of the excretory ducts of the sinuses, etc.;
2. recovery resulting from adequate treatment;
3. the transition of acute sinusitis to a chronic stage, which is facilitated by the high virulence of the microbiota that caused the inflammatory process, weakened immunity, concomitant chronic diseases of the upper respiratory tract and bronchopulmonary system, general allergies, unfavorable structure of the anatomical elements of the nose and maxillary sinus (curvature of the nasal septum, narrow or blocked excretory ducts), etc.;
4. Complications of acute sinusitis may arise due to the same causes that lead to the chronicity of the inflammatory process; most often, these complications arise by hematogenous and lymphogenous routes and primarily concern intracranial complications (meningitis, brain abscess, sinus thrombosis, sepsis, etc.); among local complications, the most common is phlegmon of the orbit, retromandibular region, and face.

[ 8 ], [ 9 ], [ 10 ], [ 11 ]

Treatment acute maxillary sinusitis

Treatment of acute sinusitis is usually carried out non-surgically, using medications and physiotherapy. Surgical interventions are resorted to when secondary purulent complications arise, when there is a need for a wide opening of the affected sinus with the elimination of foci of infection in the surrounding tissues and organs, for example, with rhinogenic phlegmon of the orbit.

The basic principles of non-surgical treatment of acute sinusitis are as follows:

1. restoration of the drainage and ventilation functions of the opening connecting the maxillary sinus with the middle nasal passage;
2. the use of methods for actively removing pathological contents from the sinus and introducing medicinal preparations into it;
3. use of general antibacterial, desensitizing (antihistamine) and symptomatic agents;
4. application of physiotherapeutic methods;
5. the use of methods to increase the body's immune resistance;
6. use (as indicated) of extracorporeal methods of detoxification of the body;
7. creating comfortable conditions for the patient and eliminating risk factors for the development of complications and superinfection;
8. sanitation of foci of infection that may serve as a source of maintaining the inflammatory process in the sinus, in the volumes that are acceptable for the patient’s condition (for example, acute pulpitis, exacerbation of chronic periodontitis or tonsillitis, etc.).

Treatment of acute inflammatory diseases of the paranasal sinuses should be carried out strictly under the supervision of an otolaryngologist in a comfortable home or (preferably) hospital setting. This provision is dictated by the fact that in some cases, these diseases can cause rapidly increasing life-threatening complications that require timely diagnosis and radical measures, so "self-medication" for acute inflammatory diseases of the paranasal sinuses is unacceptable, just as independent use of some widely advertised "universal" medicine without proper professional diagnosis of the clinical form of the disease is unacceptable. Treatment of inflammatory diseases of the paranasal sinuses should be comprehensive, and its results should be verified by special methods of examining the patient.

Restoration of the drainage function of the excretory canal by instillation, application and lubrication of the mucous membrane of the nose and middle nasal passage with appropriate vasoconstrictors is either ineffective or gives a temporary effect for the period of action of the applied agent. The ineffectiveness of this method is due to the fact that the said canal is usually blocked from the inside by the edematous mucous membrane of the sinus, as well as along its entire short length, which prevents access of the drug to its deep sections and to the area of the sinus opening. These methods can be used only at the preclinical stage of treatment. The most effective means of achieving this goal is puncture of the maxillary sinus and application of a special drainage catheter, which serves simultaneously for spontaneous elimination of the pathological contents of the sinus, its aeration, washing it with antiseptic solutions and introducing medicinal solutions into it (proteolytic enzymes, antibiotics, steroid drugs, etc.). In some cases, puncture of the maxillary sinus does not achieve the "standard" goal due to an insurmountable blockage of the outlet. In this case, an experienced doctor punctures the sinus with a second needle and thus forms a communicating "siphon" that allows for the introduction of lavage fluid through one needle and the removal of pathological contents of the sinus along with the lavage fluid through the second. After this, a catheter is inserted and both needles are removed.

The technique of drainage of the maxillary sinus using a catheter is as follows. After puncturing the sinus, make sure that the end of the needle is in the sinus cavity. This is achieved by the fact that when the piston is slightly pulled out, some of the sinus contents appear in the syringe. If, when pulling the piston out, a sensation of "vacuum" (blockage of the outlet) occurs, then 1-2 ml of air is injected into the sinus, and if the needle is in the sinus cavity, then when air is pumped in, it enters the nasal cavity with a characteristic sound and a corresponding sensation in the patient. If both methods do not achieve the goal, then either puncture the sinus with a second needle, keeping the first one, wash the sinus through one of the needles, inject the appropriate medicinal solution and insert a catheter into one of the needles, advancing it to a distance greater than the length of the needle, or until it stops at the back wall of the sinus and then pulling it out by 0.5-0.7 cm. A dense thin plastic conductor is inserted into the needle and, holding it in the sinus cavity, the needle is removed. Then, along this conductor, a special plastic catheter is inserted into the sinus, the end of which is sharply beveled, and at the beginning there is a conical expansion for inserting a syringe cannula into it. The most difficult moment when inserting a catheter into the sinus through a conductor is passing the bone wall. Next, remove the plastic guide and carefully fix the catheter with adhesive tape on the skin of the zygomatic bone, which remains motionless during talking and chewing, thereby eliminating the risk of catheter displacement during movements of the lower jaw. The catheter is used as drainage and for introducing medicinal solutions into the sinus (1-2 times a day) until the complete disappearance of local and general clinical symptoms of acute sinusitis, as well as until the washing fluid is completely cleared. Liquids introduced into the paranasal sinuses should be warmed up to 38°C.

If for some reason the puncture of the maxillary sinus is unsuccessful or contraindicated (hemophilia), then you can try to use the "displacement" method according to Proetz. According to this method, after deep anemization of the nasal mucosa, especially in the area of the middle nasal passage, an olive connected to a suction device or a syringe for rinsing the cavities is inserted into the corresponding half of the nose and, by tightly pressing the wing of the nose on the opposite side, "negative" pressure is created in the nasal cavity and nasopharynx, as a result of which the contents of the sinuses are released into the nasal cavity through natural openings. In this case, "its own" negative pressure is created in the sinus, which sucks in the medicinal substance (proteolytic enzyme, antibiotic, etc.) introduced into them after suction. This method is effective only if it is possible to establish the patency of the sinonasal opening, at least for the duration of the procedure.

In acute catarrhal sinusitis, effective treatment can be achieved without sinus puncture, but for this it is necessary to use a number of complex measures that provide a comprehensive therapeutic effect on the pathological focus. For this purpose, composite vasoconstrictor and medicinal ointments containing essential oils and extracts of medicinal plants, balsamic substances that have a beneficial effect on trophic processes in the mucous membrane of the nose and sinus, steroid drugs that reduce interstitial edema of the mucous membrane of the nose, as well as some antiseptic solutions for rinsing the nasal cavity and preparing it for the introduction of the main therapeutic agent are used locally. The same solutions can be used for sinus lavage. Experience shows that in catarrhal sinusitis, timely and successfully performed lavage of the maxillary sinus, even with a sterile isotonic solution of sodium chloride, is a very effective therapeutic agent. Other solutions recommended for irrigation of the nasal cavity and washing of the maxillary sinus include furacilin (1:5000), rivanol (1:500), potassium permanganate (0.1%), boric acid (4%), silver nitrate (0.01%), formalin (1:1000), soluble streptocide 2 (5%), antibiotic solutions of chloramphenicol (0.25%), biomycin (0.5%), etc., corresponding to the given pathogenic microbiota. In most cases, with uncomplicated acute sinusitis, the severity of general and local signs of the disease decreases on the 2nd-3rd day, and recovery usually occurs on the 7th-10th day. However, a certain regimen should also be followed in the next 2-3 weeks (stay in a warm room, do not cool down, do not drink cold drinks, do not be in a draft, do not engage in heavy physical labor).

To prevent a microbial allergic reaction, antihistamines are prescribed (see treatment of allergic rhinitis), ascorbic acid, calcium gluconate, antibiotics (in case of a general pronounced reaction of the body), as well as painkillers and sedatives; from physiotherapeutic means - dry heat (sollux), UHF, laser therapy, etc.

If in case of catarrhal sinusitis puncture of the maxillary sinus is not always indicated, especially in case of clearly positive dynamics occurring as a result of non-surgical treatment, then in case of serous sinusitis, characterized by accumulation of a large amount of serous fluid in the sinus, the viscosity of which prevents its independent release from the sinus through a natural opening, puncture is necessary not only to evacuate the contents of the sinus and alleviate the patient's condition, but also to prevent suppuration of the exudate. For this, the methods described above are used (double puncture, insertion of a catheter, washing the sinus with antiseptic solutions and introduction of broad-spectrum antibiotics into the sinus, including those whose action is directed against anaerobes).

For the treatment of patients with exudative sinusitis, V.D. Dragomiretsky et al. (1987) proposed a combined method that included intracavitary laser irradiation using a monofilament quartz light guide with simultaneous oxygenation of the sinus. The method gave a positive effect in more than half of those who received this treatment.

In edematous forms of acute sinusitis that occur against the background of influenza infection, accompanied by high body temperature and excruciating bursting pains radiating along the branches of the trigeminal nerve, with symptoms of pronounced general intoxication, it is recommended to administer glucocorticoids into the sinus in a mixture with an appropriate antibiotic, which significantly enhances the antibacterial effect of the latter and reduces swelling of the sinus mucosa. In edematous forms of acute sinusitis and acute inflammatory diseases of the paranasal sinuses at all stages of the development of the pathological process, it is recommended to use drugs that have a vasoconstrictor, anticongestive and antihistamine effect (phencypiride, pseudoephedrine, xylometazolines, oxymetazoline, miramistin and some others). To combat infection, depending on the type of microbiota and its sensitivity to antibacterial agents, various antibacterial agents (lincosamides, macrolides, azalides, penicillins, etc.) are used locally, or orally and parenterally. At the same time, in case of a protracted course of the inflammatory process, immunomodulators (ribomunil) are prescribed. Non-narcotic analgesics, including non-steroidal and other anti-inflammatory drugs (diclofenac, rapten rapid, etc.), are also prescribed according to indications. In case of viral etiology of acute sinusitis, antiviral agents are used in mandatory combination with antimicrobial drugs.

Antiviral drugs are intended for the treatment of various viral diseases (flu, herpes, HIV infection, etc.). These drugs are also used for prevention. Depending on the form of the disease and the properties of the drug, various antiviral agents are used per os, parenterally or locally (in the form of ointments, creams, drops). According to the sources of production and chemical nature, antiviral drugs are divided into the following groups:

1. interferons (endogenous and genetically engineered, their derivatives and analogues);
2. synthetic compounds (amantadine, arbidol, ribavirin, dovudine, etc.);
3. substances of plant origin (alpazarin, flacoside, helepin, etc.);
4. A large group of antiviral drugs consists of nucleoside derivatives (acyclovir, stavudine, didanosine, ribavirin, zidovudine, etc.).

Nucleoside derivatives (nucleotides) are prescribed as chemotherapeutic agents with a resorptive effect. Their mechanism of action is that they are all phosphorylated in cells infected with the virus, converted into nucleotides, compete with "normal" (natural) nucleotides for incorporation into viral DNA and stop viral replication. Interferons are a group of endogenous low-molecular proteins with antiviral, immunomodulatory and other biological properties, including antitumor activity. Resantadin, adapromin, metisazone, bonafton, etc. are widely used to treat and prevent influenza and other viral diseases.

In acute serous or purulent sinusitis, the sinus contents often thicken and cannot be removed by conventional lavage. In such cases, proteolytic enzymes are introduced into the sinus, which in vivo in the "proteolytic enzymes - proteinase inhibitors" system play an important role in maintaining tissue homeostasis when inflammation occurs in them. For treatment, proteolytic enzymes are used as a means of lysing thickened conglomerates of protein fractions for their transformation into a fluid substance and free removal from the pathological cavity by lavage. For this purpose, crystalline chymotrypsin, lidase (hyaluronidase), lysozyme are used, which are produced in the form of powders in sterile ampoules, from which the appropriate solutions are prepared ex tempore for administration into the sinus: 0.01 crystalline chymotrypsin is dissolved in 5 ml of sterile isotonic sodium chloride solution; 0.01 (64 U) of lidase is dissolved in 1 ml of sterile distilled water; lysozyme, available in 0.05 g vials, is dissolved in 10 ml of sterile isotonic sodium chloride solution and 5 ml is injected into the sinus.

Proteolytic enzyme solutions are introduced into the pathological cavity after it has been washed with an antiseptic solution and then with distilled water. The remaining washing fluid is then removed from the sinus by suction and a proteolytic enzyme solution is introduced for 10-15 minutes. After this, the sinus is again washed with distilled water and an appropriate etiotropic drug is introduced, usually an antibiotic selected for the given pathogenic microbiota. The procedure is carried out daily until the sinus is cleared of pathological contents and the general condition of the patient improves.

In severe forms of acute inflammatory diseases of the paranasal sinuses, accompanied by septicemia, severe general intoxication, treatment is carried out with detoxifying agents in combination with symptomatic treatment aimed at normalizing the functioning of the cardiovascular, respiratory and digestive systems, eliminating pain syndrome and other disorders.

Detoxification is a complex of therapeutic measures carried out to stop the effects of toxic substances and remove them from the body. A large number of methods aimed at stimulating natural detoxification, as well as artificial and antidote detoxification therapy serve to achieve this goal. Methods aimed at enhancing physiological detoxification in relation to lesions of the ENT organs and in particular to inflammatory diseases of the paranasal sinuses include forced diuresis and regulation of enzyme activity (dimephosphone, potassium aspartate, sodium bicarbonate, sodium chloride, sodium citrate, polyhydroxyethyl starch, electrolytes, ammonium chloride, acetazolamide, hydrochlorothiazide, etc.). Artificial detoxification is based on the use of dilution, dialysis and sorption processes. The methods of its implementation include apheresis (dilution and replacement of blood or lymph), dialysis and filtration (hemo-, plasma- and lymphodialysis, ultra- and hemofiltration), sorption (hemo-, plasma- and lymphosorption) and physiohemotherapy methods (UV and laser irradiation, magnetic blood treatment). The implementation of artificial detoxification methods involves the use of a large number of pharmacological agents related to blood and plasma substitutes (albumin, dextran, dextrose, copolyvidone, rheopolyglucin, etc.).

Surgical treatment of acute sinusitis is indicated only in complicated cases (osteitis, osteomyelitis, orbital phlegmon, soft tissues of the face, retromaxillary region, intracranial complications, sepsis). The goal of surgical intervention is the elimination of pathological tissues and ensuring wide drainage of the pathological cavity. In this case, deep curettage of the mucous membrane should be avoided so as not to cause the spread of infection through the intraosseous emissary veins anastomosing with the veins of the face, orbit and meninges. In the postoperative period, the wound is treated openly with continuous or frequent periodic irrigation with a solution of the appropriate antibiotic.

Forecast

The prognosis of acute sinusitis is generally favorable, even with local and intracranial complications, except for those cases when the disease occurs against the background of a sharply weakened organism, some general severe infection (for example, pulmonary tuberculosis, severe flu, etc.). In these cases, with the occurrence of intracranial complications, the prognosis for life is very doubtful. In complicated forms of acute sinusitis and other paranasal sinuses, the prognosis is unfavorable in AIDS. According to many authors, a characteristic feature of acute inflammatory diseases of the paranasal sinuses that have arisen against the background of HIV infection is the absence of any effective result from the traditional treatment. As a rule, RICHO in AIDS ends in death.

[ 12 ]