Acute rhinosinusitis in adults and children

The term "acute rhinosinusitis" is applied to acute inflammatory processes in the mucous tissues of the nasal cavity and at least one of the perinasal sinuses (maxillary, frontal, cuneiform, lattice). The disease can accompany many pathologies of the upper respiratory tract, ranging from acute respiratory viral infection to microbial lesions. It is one of the most common pathologic processes of the nasal cavity and paranasal sinuses in children and adults. The disease is sometimes called "sinusitis", which is not quite correct: the sinuses are almost never inflamed in isolation, without a similar reaction in the mucosa of the nasal cavity. [1]

Epidemiology

Statistics on the development of acute rhinosinusitis are ambiguous. There is no official information about it, because it is difficult to trace the incidence of the disease: most patients with mild forms of rhinosinusitis prefer to treat themselves without consulting doctors.

Another problem is the lack of a universally accepted definition of pathology, differences in the criteria for diagnosis. [2]

Most often acute rhinosinusitis develops as a result of acute respiratory viral infection. The incidence increases in the fall-winter and early spring period, naturally decreasing in the warm season. The average annual rate of ARVI for adults is 1-3 episodes (in fact - viral acute rhinosinusitis). The frequency of such diseases in children of school age - up to ten episodes during the year.

Despite the fact that tomographic diagnosis can detect pathologic changes in the sinuses in viral infection in 95% of cases, it is generally believed that viral acute rhinosinusitis is complicated by bacterial rhinosinusitis only in 2-5% of cases.

Acute rhinosinusitis is the fifth most common indication for antibiotic therapy. In particular, about 9-20% of antibiotics in the United States are prescribed for patients with acute rhinosinusitis.

The real number of patients in our country is difficult to name, men and women get sick about equally. [3]

Causes of the acute rhinosinusitis

Acute rhinosinusitis is usually viral or bacterial in nature. Viral origin is the most common, with the causes noted most often being:

• the flu virus;
• parainfluenza virus;
• rhinovirus;
• coronavirus.

Other provoking factors include:

• sudden drop in immunity, hypothermia;
• neglected inflammatory process in the nasal cavity, allergic rhinitis without appropriate treatment;
• deviated septum, trauma affecting the sinuses;
• Adenoid overgrowths, polyps, etc.

Risk factors include:

• old and senile age;
• The presence of adenoid overgrowths, adenoiditis;
• smoking, other bad habits;
• frequent air travel;
• swimming, diving, snorkeling;
• bronchial asthma, allergic processes (including allergic rhinitis);
• dental pathologies;
• immune disorders.

Pathogenesis

Viral rhinosinusitis, as well as pharyngitis, laryngitis, bronchitis, is a typical manifestation of acute respiratory viral infection. The range of probable causative agents of this disease is the well-known respiratory viruses:

• rhinoviruses;
• influenza and parainfluenza;
• respiratory syncytial, adenovirus;
• coronaviruses.

The indicated viral spectrum is almost constant. Streptococcus pneumoniae, Haemophilus influenzae are most often detected in smears and puncture specimens (about 73% of cases).

The spectrum of pathogens can vary, depending on geographic, household and other characteristics, as well as the time of year. [4]

Rhinoviruses, among which more than a hundred serotypes can be counted, settle on the mucosa by binding to intracellular adhesion molecules, a receptor of expression on the epithelium of the nasal and nasopharyngeal cavity. Up to 90% of rhinoviruses enter the human body in this way. The pathogen damages the cilia of the mesenteric epithelium, destroying the ciliated cells. In rhinovirus lesions, in contrast to influenza and adenovirus infection, in which there is a massive lesion and desquamation of the mesenteric epithelium, there is less invasiveness. As a consequence, most of the ciliated epithelium retains relative intactness. Pathological changes in the mesenteric epithelium reach their limit by 7 days of the infectious disease. Full recovery of cilia is noted after 3 weeks.

The development of the pathological process in acute rhinosinusitis is caused by secretory stasis and air exchange disorder in the paranasal sinuses, impaired mucociliary clearance mechanism and prolonged contact of mucosal tissues with bacterial flora. Infection-induced inflammatory response leads to edema, plasma transudation and glandular hypersecretion. In the initial stage, obstruction of the natural junction of the maxillary sinuses can be detected. Edema of the mucous membrane blocks the union of the paranasal sinuses (in the norm they have a diameter of about 2 mm and play the role of a kind of valve). As a consequence, the process of self-cleansing of the sinuses, the flow of oxygen from the blocked sinus to the vascular network is disturbed, hypoxia develops. Expressed swelling, accumulation of secretions, lowering the partial pressure in the paranasal sinuses create favorable conditions for the development and growth of bacteria. As a result, the mucous tissue pathologically changes, becomes thicker, forming fluid-filled pillow-like formations that block the lumen of the affected sinus.

The pathogenesis of trauma-induced inflammation is currently poorly understood. As for the involvement of allergy in the development of acute rhinosinusitis, the main role is played by regular or constant nasal breathing difficulties. As a result, conditions favorable to the emergence of the inflammatory process are created.

Acute rhinosinusitis occurs more often in sensitized individuals with symptoms of allergic rhinitis. Intranasal provocation with a potential allergen results in migration of eosinophils into the sinus mucosa. However, there is no evidence that the risk of acute allergic rhinosinusitis is reduced in patients after primary treatment or allergen-specific immunotherapy. [5]

Symptoms of the acute rhinosinusitis

Acute rhinosinusitis is characterized by the sudden onset of a couple or more symptoms, one of which is nasal congestion or nasal discharge, as well as uncomfortable pressing or painful sensations in the facial area, and a change or loss of sensitivity to odors.

In most patients, the acute inflammatory process occurs as a consequence of a previous acute respiratory infection. Viruses affect epithelial cells, mucosal tissue swells, mucociliary transport is impaired. These factors favor the entry of bacterial flora from the nasal cavity into the paranasal sinuses, there is a multiplication of microflora, an inflammatory reaction develops. As a result of edema, the patency of the joints is impaired, drainage is impaired. There is an accumulation of secretion (serous, then - serous-purulent).

According to the severity of the course of acute rhinosinusitis is divided into mild, moderate and severe. Mild course is characterized by the appearance of mucous and mucopurulent discharge from the nose, fever to subfebrile values, as well as pain in the head and weakness. According to the results of X-ray examination, the mucous membranes of the paranasal sinuses thicken to no more than 6 mm. [6]

The moderately severe course of the disease is accompanied by the appearance of mucopurulent or purulent discharge, increased body temperature to febrile indicators, pain in the head and sometimes - in the projection of the sinuses. X-ray demonstrates thickening of the mucous tissue with an excess of 6 mm, with complete darkening or the presence of a fluid level in one or two sinuses.

Severe form of acute rhinosinusitis is characterized by the appearance of abundant purulent secretion, marked fever, severe pain in the projection of the sinus, pain in the head. The radiological picture shows complete darkening or fluid level in more than two sinuses.

Acute rhinosinusitis in adults is an inflammatory process of the mucous tissues of the paranasal sinuses and nasal cavity with a sharp increase in symptoms and a duration of no more than 4 weeks. The disease usually occurs with a different combination of the following clinical signs:

• problems with nasal breathing (stuffy nasal passages);
• opaque discharge;
• pain in the head, pain in the projection of the sinuses;
• occasionally, deterioration or loss of olfactory function.

Acute rhinosinusitis in children is also an inflammatory reaction in the mucosal tissue of the sinuses and nasal cavity, which is characterized by an abrupt development with the appearance of two or all of the following signs:

• nasal congestion;
• opaque nasal discharge;
• cough (mostly nocturnal).

The recurrent form of acute rhinosinusitis is diagnosed when four recurrent pathologic episodes are detected within a year with clear asymptomatic periods between them. Characteristically, each recurrent episode should fall within the symptomatic criteria for acute rhinosinusitis. [7]

Viral acute rhinosinusitis, unlike the bacterial form of the disease, does not last more than ten days. There is also a concept of acute post-viral rhinosinusitis, in which there is an increase in symptoms, starting from the fifth day of the pathological process, with the preservation of clinical signs and after 10 days with a total duration of the episode up to 3 months. This concept is considered insufficiently proven, at the moment it is not yet used as an independently existing diagnosis.

The first signs of the disease should meet the following diagnostic criteria:

• stained nasal secretion (more often unilateral);
• purulent secretion in the nasal passages during rhinoscopy;
• Headache of varying intensity with a characteristic location.

The chronic process is characterized by a protracted symptomatology that tends to worsen after a temporary period of improvement.

Acute rhinosinusitis in pregnancy

The most common factors in the development of acute rhinosinusitis in pregnancy are hormonal changes and decreased immunity. The placenta begins to produce a large amount of estrogen, affecting the central and vascular systems. As a result, the vessels expand, their permeability increases, mucous membranes (including those in the nose) swell. This condition is usually observed after the sixth week of pregnancy, or in the second half of the term.

Due to changes in immune defense often develop allergic rhinitis, which is accompanied by copious discharge, sneezing, lacrimation, sometimes - skin itching. And constant and intense swelling of mucous membranes is a provoking factor for the development of respiratory pathologies, including acute rhinosinusitis.

Infectious rhinosinusitis is quite common in pregnant women, in most cases - against the background of acute respiratory diseases or viral infections. Symptomatology can be disguised as vasomotor or allergic rhinitis.

The infectious process is most often accompanied by fever, mucous or purulent secretion. Sometimes there is a sore throat, cough and other cold symptoms. In addition, the general breakdown of immunity contributes to the transition of the infectious process into the space of the sinuses. Acute rhinosinusitis in this situation can acquire a chronic course, and even become the cause of intrauterine infection of the future baby. Therefore, you should start treating the disease as early as possible.

One of the safest and most effective means during pregnancy is washing the nasal cavity with saline solutions. Physiological or hypertonic solution, sea water can liquefy and remove pathological secretion from the nose, reduce swelling of the mucosa.

Vasoconstrictors should not be used, due to the risk of reflex spasm of the placental vessels. Oil-based topical agents, cold inhalation, nebulizers with saline solutions are used with caution. Self-treatment is prohibited, medications should be prescribed by a doctor.

Forms

The nature of the course of the pathological process allows us to distinguish acute and recurrent forms of acute rhinosinusitis. The main criteria for diagnosing the acute process are:

• the duration of the disease is no more than 4 weeks;
• complete recovery with the disappearance of symptoms.

The recurrent form is characterized by up to 4 episodes of rhinosinusitis per year, with periods of remission of at least two months.

Depending on the localization of the inflammatory process, distinguish:

• maxillary rhinosinusitis (involving the maxillary sinus);
• sphenoiditis (a lesion of the cuneiform sinus);
• Frontitis (lesion of the frontal sinus);
• ethmoiditis (lesion of the cells of the lattice bone);
• Polysinusitis (simultaneous combined lesions of the sinuses).

Acute bilateral rhinosinusitis in most cases is polysinusitis. Otherwise, it is called pansinusitis. If one side is affected, it is called hemisinusitis - on the right or left side.

Acute right-sided rhinosinusitis is slightly more common than left-sided rhinosinusitis, which is especially characteristic of childhood. The condition of the air-bearing cavities of the laryngeal labyrinth and the maxillary sinuses is of clinical importance from newborn onwards, whereas the cuneiform and frontal sinuses do not reach sufficient size until three to eight years of age.

Acute left-sided rhinosinusitis can occur at any age, while bilateral involvement is more common in adult and elderly patients.

Stages of the course of the disease:

• light;
• medium-heavy;
• heavy.

The stage is determined specifically for each patient based on a subjective assessment of the combination of symptoms on a visual analog scale.

According to the type of pathological process distinguished:

• acute catarrhal rhinosinusitis;
• acute catarrhal edema rhinosinusitis;
• acute exudative rhinosinusitis (purulent-exudative);
• acute purulent rhinosinusitis;
• polyposis and vestibular hyperplastic sinusitis.

Depending on the cause of the development of pathology are distinguished:

• acute bacterial rhinosinusitis;
• acute viral rhinosinusitis;
• traumatic, allergic, drug-induced sinusitis;
• fungal rhinosinusitis;
• mixed.

In addition, septic and aseptic pathology, complicated and acute uncomplicated rhinosinusitis are distinguished. [8]

Complications and consequences

In rhinosinusitis, and especially in the severe form of pathology, intracranial complications may develop. The most dangerous of them is thrombosis of the cavernous sinus. Mortality from this complication is about 30%, regardless of the use of antibiotic therapy. [9]

Without timely diagnostic measures and appropriate treatment, acute rhinosinusitis will not disappear on its own, but will become chronic. In addition, the risks of developing the following complications increase significantly:

• infectious vascular spread, ocular thrombosis;
• middle ear inflammation;
• clotting in the cerebral vessels;
• visual impairment;
• abscesses, phlegmons;
• oroantral fistula.

With the bloodstream, the infection spreads through the body, affecting the oropharynx, lungs, inner ear, other organs and systems. Sometimes complications are life-threatening:

• meningitis (spread of the inflammatory process to the brain membranes);
• intracranial abscesses (formation of purulent foci).

In addition, complete loss of vision is possible (if the inflammatory reaction spreads to the ocular region). [10]

Diagnostics of the acute rhinosinusitis

Diagnostic measures are based primarily on the patient's complaints, history of the disease, as well as clinical symptoms, and the results of physical, laboratory, and instrumental examinations. It is important to find out what diseases have been recently transferred, whether there has been hypothermia, whether teeth on the upper jaw have been extracted during the last week, whether there have been other dental problems. [11]

Examination of the nasal cavity often reveals signs of an inflammatory response:

• redness and swelling of the mucous membranes;
• purulent secretion in the nose or posterior pharyngeal wall;
• pathologic discharges in the area of natural accessory sinuses.

The main diagnostic value is radiologic examination. In the course of review radiography of the sinuses, it is possible to identify typical signs of rhinosinusitis: darkening, the presence of a level of fluid in the affected sinus.

Among the most significant methods we can single out computed tomography, especially recommended for patients with severe or complicated course of acute rhinosinusitis, chronic sinusitis. CT helps to obtain complete information about the anatomical and pathological features of the sinuses.

Sometimes take tests of secretions from the mucous membrane of the nasal cavity. Microbiological examination of the secretion or punctate of the affected sinus is indicated in prolonged rhinosinusitis, ineffectiveness of empirical antibiotic therapy.

The general blood analysis demonstrates leukocytosis, a shift of the leukocytic formula towards immature neutrophils, an increase in COE.

Additional instrumental diagnostics is mainly represented by radiography and ultrasound.

X-ray in acute rhinosinusitis is indicated only in severe, complicated course of the disease, in diagnostically difficult situations. The study is performed in the nasolabial projection, sometimes with the addition of nasolabial and lateral projections. Typical rhinosinusitis is characterized by such radiological signs as mucosal thickening, horizontal level of fluid or total reduction of sinus pneumatization.

Ultrasound is used mainly as a screening test to detect effusion in the frontal and maxillary sinuses, or to determine the effectiveness of the prescribed treatment. Compared to other diagnostic methods, ultrasound is more accessible and cheaper. It is especially often used to diagnose rhinosinusitis in pediatric patients.

Puncture of the paranasal sinuses, probing - these are invasive and quite dangerous methods, which, if performed correctly, allow to determine the volume of the affected cavity, the type of contents, patency of the joint. To obtain a sample of sinus contents, syringe aspiration or lavage is performed. To determine the volume of the cavity, it is filled with fluid. The need for puncture in acute rhinosinusitis is rare. [12]

Differential diagnosis

The lack of specific symptoms adds to the difficulty in differential diagnosis between viral and microbial acute rhinosinusitis. Culture tests have a high percentage of false results, so it is impossible to rely on them completely. For differential diagnosis, specialists use information on the duration of the disease, total symptomatology with determination by the VAS scale.

The differential symptom of acute rhinosinusitis provoked by the most typical pathogen Streptococcus pneumoniae or Haemophilus influenzae is the presence of the effect of empirical antibiotic therapy.

Acute bacterial rhinosinusitis is usually differentiated from chronic, fungal and odontogenic forms of rhinosinusitis. A distinctive feature is often the simultaneous occurrence of pathology in two sinuses (in fungal or odontogenic lesions, unilateral pathology is more often noted).

In children, differential diagnosis of acute rhinosinusitis and adenoiditis is of particular importance: it is important to distinguish one disease from the other, since the principles of treatment will be radically different. To some extent, endoscopic examination of the nasal cavity and nasopharynx, allowing to determine mucus and pus in the middle nasal canal, the upper shell, on the adenoids, becomes diagnostically significant. [13]

Treatment of the acute rhinosinusitis

Treatment is aimed at accelerating the recovery of the mucosa, preventing the development of complications (including intracranial), destruction of the causative agent of the disease (if possible, if identification was carried out). [14]

The basic therapeutic method for acute rhinosinusitis is systemic therapy with broad-spectrum antibiotics. Since instrumental diagnostic methods do not distinguish between viral and bacterial lesions, the decision on the need for antibiotic therapy is based on the assessment of the general condition of the patient, anamnesis, complaints, the nature of discharge. As a rule, the indication for taking antibiotics is the lack of improvement during a week of the disease process, or worsening of well-being, regardless of the timing of the disease.

For recurrent acute rhinosinusitis, about 4 courses of systemic antibiotic therapy per year are recommended.

The choice of antibacterial agent is determined by the sensitivity of the most likely causative agents of the inflammatory process - that is, S. Pneumoniae and H. Influenzae. Most often, the optimal drug is Amoxicillin. If the effect of it is absent, then after 3 days it is replaced with an antibiotic with activity against penicillin-resistant pneumococci and strains of Haemophilus influenzae producing beta-lactamase. In such a situation, it is appropriate to prescribe Amoxicillin/clavulanate (Amoxiclav). Another option is the use of oral third-generation cephalosporin drugs with pronounced antipneumococcal activity. A typical representative of such antibiotics is Cefditoren. [15]

In addition to these antibacterial drugs, macrolides may be used. Usually they are prescribed in case of penicillin intolerance, in case of previous treatment with beta-lactams, in case of confirmed hypersensitivity to cephalosporins.

Severe and complicated course of acute rhinosinusitis is an indication for injection administration of antibacterial agents.

When choosing antibiotics, it is important to consider possible side effects:

• microflora disruption;
• diarrhea;
• toxic effect on the liver, etc.

The most dangerous side effect of antibiotic therapy is cardiotoxic effect, which can lead to severe arrhythmias. This often happens when taking Levofloxacin or Azithromycin.

Side effects such as tendonitis, peripheral neuropathy, tendon injuries, QT interval prolongation, and retinal detachment have been associated with fluoroquinolone drugs.

Medications

Patients with acute rhinosinusitis are treated with the following medications:

• Painkillers and antipyretics (Ibuprofen, Paracetamol can be used to reduce pain and normalize temperature if necessary);
• irrigation with physiologic or hypertonic sodium chloride solution;
• Intranasal administration of glucocorticosteroids (appropriate in both allergic and viral or bacterial rhinosinusitis);
• Ipratropium bromide (an anticholinergic aerosol drug that can reduce secretion and provide relief to the patient);
• Oral medications to relieve mucosal edema (appropriate in cases of eustachian tube dysfunction);
• Intranasal administration of vasoconstrictors (aerosol preparations based on oxymetazoline or xylometazoline for temporary relief of nasal congestion).

Intranasal administration of glucocorticosteroids reduces the secretion of the glandular system of mucous tissues, reduce swelling, optimize nasal breathing, restore the exit of exudate from the sinuses. Intranasal corticosteroids can be used as monotherapy in mild and moderate acute rhinosinusitis, or as an adjunct to systemic antibiotic therapy in severe and complicated course of the disease.

To eliminate the swelling of the mucous membrane and obstruction of the sinus canals, it is advisable to use topical vasoconstrictors based on xylometazoline, naphazoline, phenylephrine, oxymetazoline, tetrizoline. Means are available in the form of drops or aerosols, the main action is to regulate the tone of the capillaries of the nasal cavity. It is important to take into account that with prolonged use (more than one week) decongestants provoke the development of tachyphylaxis and addiction. Somewhat less often such an effect is observed with phenylephrine. [16]

It is possible to use oral decongestants in the form of combined agents with H1-histamine receptor antagonists (pseudoephedrine with loratadine or cetirizine). Such drugs get rid of swelling, contribute to the restoration of nasal breathing without the development of tachyphylaxis. However, side effects from the cardiovascular or nervous system are possible.

A common therapeutic measure is also nasal lavage with physiologic sodium chloride solution (sometimes a weak hypertonic solution or sea water is used).

Uncomplicated course of acute rhinosinusitis does not require the use of systemic antibiotic therapy: symptomatic treatment is sufficient, as in viral pathology. In most cases, a wait-and-see approach is practiced for a week: in about 80% of cases, patients recover without the use of antibiotics for 14 days. If there is no improvement, or on the contrary, the condition worsens, then it is necessary to connect systemic antibiotic therapy. The drug of choice in this case is Amoxicillin, or a well-known and effective combination of Amoxicillin with Clavulanate (Amoxiclav), significantly expanding the range of antibacterial activity. Such a combination is especially preferable for use in children and in patients over 65 years of age. [17]

If the patient is allergic to penicillins, Doxycycline, cephalosporins, Clindamycin may be prescribed. Alternatively, fluoroquinolones can be used if the use of other drugs for some reason is impossible.

Antibiotic therapy is usually prescribed for 5-7 days, less often - up to 2 weeks. In complicated cases, it is sometimes necessary to repeat the antibiotic course with drugs with an extended range of activity or another class of drugs. [18]

Amoxicillin	Orally 0.5-1 g three times a day in adults, 45 mg per kilogram per day in children (for 2-3 receptions), for 1-2 weeks.
Amoxiclav	Orally 0.625 g three times a day for adults, 20-45 mg per kilogram per day for children (in three doses), for 1-2 weeks.
Cefditoren	Orally 0.4 g once daily or 0.2 g morning and evening, in adults and children over 12 years of age, for 1-2 weeks.
Azithromycin	500 mg daily for adults, 10 mg per kilogram per day for children, for 4-6 days.
Clarithromycin	Intravenously 0.25-0.5 g twice a day in adults, 15 mg per kilogram per day in two doses in children, for two weeks.
Amoxiclav	Intravenously administered 1.2 g three times a day for adults, 90 mg per kilogram per day in three injections for children. The course of treatment is up to 10 days.
Ampicillin/sulbactam	Intramuscularly 1.5-3 g per day, in 3-4 administrations for adults, 200-400 mg per kilogram per day in 4 administrations for children (preferably intravenous administration), for 7-10 days.
Cefotaxime	Intramuscularly or intravenously 1-2 g three times a day for adults, 100-200 mg per kilogram per day in 4 injections - for children, for a week. Cefotaxime is not used in children under 2.5 years of age!
Ceftriaxone	Intramuscularly or intravenously 1-2 g daily for a week (for adults), 50-100 mg per kilogram of weight per day (for children).
Clarithromycin	Intravenous drip 0.5 g twice a day for adults, for up to 5 days, followed by transfer to tablet preparations.
Levofloxacin	Orally 0.5-0.75 g daily for 5-10 days (for adults).
Moxifloxacin	Orally 0.4 g daily for 5-10 days (for adults).
Gemifloxacin	Orally at 320 mg daily for 5-10 days (for adults).
Mometasone furoate spray	Intranasally 100 mcg in each nostril twice a day for adults. Duration of treatment - 2 weeks.
Xylometazoline 0.1%	Intranasally 1-2 doses in each nostril up to three times a day, for no more than a week. In children use a solution of 0.05% concentration.
Oxymetazoline 0.05%	Inject 1-2 drops or 1-2 doses into each nostril up to 4 times a day for no more than a week. In children, 0.0025% or 0.01% drops are used.
Phenylephrine 0.25%	It is administered intranasally by 3 drops or 1-2 injections into each nostril up to four times a day. In children 0.125% solution is used.

Physiotherapeutic treatment

Among other therapeutic techniques used to treat acute rhinosinusitis, physiotherapy is often prescribed, namely:

• pari-sinus;
• ultrasound;
• UVB therapy, etc.

Let's take a look at the most common of the physical treatments:

• Pari-sinus is an effective treatment for acute and chronic rhinosinusitis of infectious and allergic nature. During the procedure, an aerosol is pulsed, which ensures successful penetration of the drug solution directly into the affected sinus. In case of purulent rhinosinusitis, additional sanation is performed.
• Proetz movement (known as "cuckoo") - helps to drain pathologic secretions from the paranasal sinuses, often successfully replaces puncture. It is used in acute uncomplicated inflammatory process in children over three years of age.
• Ultrasound - used in children from 2 years of age (intensity up to 0.4 W/cm²) and adults (intensity 0.5 W/cm²). Ultrasound therapy is not prescribed in pregnancy, thyroid pathologies, oncologic diseases.
• UVO - local exposure to ultraviolet light - has a pronounced bactericidal effect, stimulates local immunity, improves metabolism.
• Infrared irradiation - exposure to electromagnetic streams, helps relieve pain, activate local immunity, improve capillary blood circulation. The beam is able to penetrate to a depth of 15 mm, has anti-inflammatory, restorative effect.

Herbal treatment

Proven effectiveness have medicines of plant origin, which have mucolytic and anti-inflammatory activity. So, the most common classic drug for acute rhinosinusitis is considered a collection of such herbs:

• gentian rhizome;
• sorrel;
• vervain;
• the color of elderberry and primrose.

This collection reduces swelling of the mucosa, facilitates the excretion of secretion from the sinuses, increases the activity of ciliated epithelium, has immunostimulant and antiviral action.

Another popular remedy is an extract from cyclamen tubers. It is available in pharmacies in the form of nasal spray, which improves microcirculation in mucous tissues, stimulating mucociliary transport.

Extract of gentian rhizome + primrose + sorrel + sorrel + elderflower + verbena herb (Sinupret preparation) is taken orally for 2 dragees or 50 drops three times a day. Children 2-6 years old take 15 drops of the drug three times a day. School-age children take 1 dragee or 25 drops three times a day. Duration of treatment - 1-2 weeks.

Cyclamen tuber extract (Sinuforte preparation) is injected into the nasal cavity 1 dose in each nostril daily for 8 days.

To rinse the nasal cavity you can use infusions of sage, thyme, birch or poplar buds, aspen bark, rhizome of turnip. These plants have antimicrobial and anti-inflammatory action. Geranium rhizome and blackhead herb has an antibacterial and restorative effect. A mild analgesic effect has an infusion of chamomile, eucalyptus, hop cones. To facilitate the discharge of pathological secretion from the sinuses use decoctions of such plants as plantain, pine needles, Ledum. They can be taken internally and dripped into the nasal passages a few drops three times a day.

Surgical treatment

Auxiliary procedures that can be used to treat acute rhinosinusitis are puncture and probing of the sinuses. Thanks to these methods, the doctor can wash the affected sinus cavity, eliminate pathological secretions. Often by washing it is possible to restore the patency of the canaliculus.

Puncture of the maxillary sinus is the most accessible and common. To puncture the frontal sinus, a thin needle is used, which is passed through the ocular wall, or a trepan or burr (through the front wall of the frontal sinus).

Puncture is performed only if there are appropriate indications, if a significant purulent process develops in the sinus. Important: in patients with acute uncomplicated rhinosinusitis, puncture is inappropriate and does not increase the effectiveness of standard antibiotic therapy. The indication for puncture can be considered a severe bacterial course of the disease, the presence of a threat of orbital and intracranial complications.

Prevention

To reduce the risks of acute rhinosinusitis morbidity, you should:

• avoid infectious diseases of the upper respiratory tract, avoid contact with sick people, wash hands regularly with soap and water (especially before eating and after coming from the street);
• Monitor possible allergens, take timely action when the first signs of allergy are detected, and visit a doctor;
• avoid rooms and areas with polluted, dusty air;
• use humidifiers during the heating season;
• prevent mold from growing indoors;
• Visit the dentist in a timely manner and treat existing diseases of the teeth and gums, brush your teeth regularly;
• Eat a nutritious and high-quality diet, favoring vegetables, greens, fruits and berries instead of sweets and fast food;
• support the immune system, walk a lot in the fresh air, be physically active in all weathers;
• drink enough water throughout the day;
• dress for the weather, avoid hypothermia;
• get an annual flu vaccination;
• do not smoke, do not abuse alcohol, avoid secondhand smoke.

Forecast

The prognosis for acute rhinosinusitis can be favorable, provided that timely medical attention is sought, competent treatment and prevention of complications. In allergic pathologies, it is important to quickly identify the allergen and ensure adequate drainage of pathologic secretion.

In many patients, the disease is cured within 10-14 days. In the absence of treatment, a chronic form of the pathological process often develops, which lasts a long time, often relapses, and the risks of complications increase. Therefore, it is important to direct all efforts to avoid chronicization of the disease.

The prognosis is worse if acute rhinosinusitis spreads to the eye socket and internal cranial structures. If the infectious agent penetrates into the deep structures threatens to affect the bone tissue and the further development of osteomyelitis. Meningitis, subdural or epidural brain abscess are also considered dangerous complications.