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Chronic Frontitis - Treatment
Last reviewed: 06.07.2025
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Goals of treatment for chronic frontal sinusitis
Restoration of drainage and aeration of the affected sinus, removal of pathological discharge from its lumen, stimulation of reparative processes.
Non-drug treatment of chronic frontal sinusitis
Electrophoresis with procaine or phonophoresis with hydrocortisone in combination with oxytetracycline on the facial wall of the inflamed frontal sinus.
Drug treatment of chronic frontal sinusitis
Until the results of the microbiological examination of the discharge are obtained, amoxicillin + clavulanic acid are prescribed, after which - targeted antibiotics. If there is no discharge from the sinus or it cannot be obtained, the previously started treatment of chronic frontal sinusitis is continued. Fenspiride can be used as a drug of choice in complex anti-inflammatory therapy. Vasoconstrictor nasal drops (decongestapts) are prescribed, at the beginning of treatment - a mild vasoconstrictor (ephedrine solution, dimethindene in combination with phenylephrine). In the absence of discharge, decongestant therapy is recommended (furosemide, intravenous administration of 200 ml of 1% calcium chloride solution), the use of antihistamines.
Anemia of the mucous membrane of the anterior part of the middle nasal passage is carried out using vasoconstrictor drugs (solutions of epinephrine, oxymetazoline, naphazoline, xylometazoline, etc.).
Nasal douche (rinsing) of the nasal cavity is a procedure that does not change the pressure in the nasal cavity. The patient is in a sitting position with his head tilted so that the ear touches the shoulder. For rinsing, 100-200 ml of 0.9% sodium chloride solution, heated to 35-36 °C, with lactoglobulin dissolved in it against opportunistic bacteria and salmonella or a targeted antibiotic are used. Olive is inserted into the superior nostril, the solution is infused using a blood transfusion system at a frequency of 30-40 drops per minute. After passing through the nasal cavity and nasopharynx, the liquid is released from the opposite half of the nose.
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Surgical treatment of chronic frontal sinusitis
Probing of the frontal sinus through the frontonasal canal is performed with a Landsberg metal probe or similar special probes after anemia and anesthesia of the anterior section of the middle nasal passage. It should be remembered that this procedure often damages the very thin and scar-prone mucous membrane of the frontonasal canal.
Puncture of the frontal sinus through the lower wall (more often in cases of medium and small sized sinuses) is performed using a blood transfusion needle or a device for sternal puncture.
Trepanopuncture is performed using special trepanation devices. An opening is made in the front (facial) wall of the sinus, through which a cannula is inserted into its lumen for rinsing. It is desirable to use devices with which the intervention is carried out simultaneously, that is, the contents of the sinus are isolated from the soft tissues of the frontal region during or after the introduction of the cannula. The sinus is washed daily and at the end a mixture containing a targeted antibiotic and a hydrocortisone suspension is administered. The infusion of drugs is carried out with the patient lying horizontally on his back with his head slightly thrown back for at least 20 minutes.
Endonasal opening of the frontal pocket and expansion of the frontonasal canal are performed using rigid Hopkins or Karl Storz endoscopes with 0 and 30 degree optics. Often, before this intervention, it is necessary to resect the upper part of the uncinate process.
Extranasal opening of the frontal sinus is carried out mainly through the anterior wall and all ptotic contents are removed. In case of a bilateral process, it is recommended to destroy the intersinusal septum. The frontonasal ostium is formed by removing part of the cells of the anterior group of the ethmoid sinus. Significant expansion of the lumen of the frontonasal canal requires the introduction of a stationary drainage tube for 28-35 days for epithelialization of the formed ostium. On the 8th-10th day, for the convenience of the patient, the tube can be cut at the level of the middle nasal concha.
In some cases, the frontonasal canal can be widened by resecting a portion of its anterior cell group: if the subsequent dye test is positive, an artificial anastomosis may not be applied. The intervention is completed by prosthetics of the postoperative defect of the anterior wall of the frontal sinus.
Further command
Use of mild vasoconstrictors for 4-5 days, gentle wound care. Approximate periods of incapacity for work in case of exacerbation of chronic frontal sinusitis without signs of complications in case of conservative treatment and use of probing or trepanopuncture, as well as with extranasal intervention are 6-12 days.
Information for the patient
- Beware of drafts.
- At the first signs of acute respiratory viral infection, contact a specialist.
- Treatment of acute frontal sinusitis should be continued until complete recovery; if recommended by the attending physician, surgical correction of the nasal cavity should be performed.
Forecast
Favorable if the rules of a gentle regime are followed.
Prevention of chronic frontal sinusitis
Prevention is the maintenance of free nasal breathing and normal anatomy of the structures of the nasal cavity, especially the ostiomeatal complex, as well as complete recovery from acute rhinitis, acute respiratory viral infections, influenza, and acute frontal sinusitis. To prevent the development of the disease, surgical sanitation of the structures of the altered nasal cavity is necessary in order to restore normal nasal breathing.