Purulent rhinosinusitis

Purulent rhinosinusitis - acute, subacute or chronic - is defined when inflammation of the air-bearing sinuses (sinuses or cavities) surrounding the nasal cavity is accompanied by the formation of purulent exudate in them and its discharge from the nose in the form of purulent runny nose (rhinitis).

Epidemiology

Statistically, the prevalence of sinusitis/rhinosinusitis is estimated at 135 cases per 1000 population per year; other reports suggest that acute sinusitis affects about 10-12% of adults each year. And there are no clinical data regarding the incidence of purulent rhinusinusitis.

Causes of the purulent rhinosinusitis

The main causes ofpurulent form of rhinosinusitis/sinusitis - lesion of the mucous membrane of the paranasal sinuses by bacterial infection, in particular by pyogenic bacteria such as beta-hemolytic group A streptococcus (Streptococcus pyogenes), Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae, and Moraxella catarrhalis, an obligate diplococcus of the respiratory tract microflora.

As noted by experts, purulent rhinosinusitis can also be the result of secondary bacterial infection, which is complicated by adenovirus, respiratory syncytial or rhinovirus infection of the upper respiratory tract. And purulent rhinosinusitis in a child can develop as a complication of nasoili rhinopharyngitis.

Why do otolaryngologists consider the term "rhinosinusitis" synonymous with "sinusitis" to be more accurate? Because the adjacent mucous membranes of the respiratory region of the nasal cavity (from Greek rhino - nose) and its accessory cavities (Latin - sinus paranasales), lined with ciliated epithelium, are simultaneously subjected to the inflammatory process.

Acute purulent rhinosinusitis of the maxillary (maxillary) sinuses is traditionally defined as acute maxillary sinusitis or rhinosinusitis, as well as chronic maxillary sinusitis. In frontal rhinosinusitis, inflammation of the mucous membrane is localized in the frontal (frontal) sinuses, and it is a purulent form of acute frontitis.

Purulent rhinosinusitis can affect the wedge-shaped (sphenoidal) paranasal cavities, in which case it is sphenoidal rhinosinusitis/sinusitis.

Acute inflammation of the lattice labyrinth (acute rhinoethmoiditis) can also be purulent: purulent ethmoidal rhinosinusitis/sinusitis or chronic purulent rhinoethmoiditis.

All types of these inflammations of the mucous membrane of the paranasal sinuses with purulent exudate are mainly infectious rhinosinusitis.

Read more: What causes sinusitis?

Risk factors

The list of risk factors for the development of purulent rhinosinusitis includes:

• Exposure to acute respiratory infections with weakened immunity and frequent acute rhinitis (acute runny nose);
• chronic allergic runny nose or vasomotor rhinitis, as well as chronic pharyngitis and epipharyngitis;
• carious teeth and chronic granulomatous periodontitis;
• narrowing of the drainage outlet sinus connections due to deviated nasal septum, and with polyps in the cavities develop polyposis-purulent rhinosinusitis;
• hypertrophied middle nasal concha (concha nasalis media) or the presence of a bulla in it - conchobullosis;
• Anomalies of the hook-shaped process (processus uncinatus) of the middle nasal shell;
• Wegener's granulomatosis.

In addition, there is an increased risk of purulent rhinosinusitis in childhood, not only with frequent colds or acute respiratory viral infections in children, but also with:

• chronic inflammation of the pharyngeal tonsil - adenoiditis;
• hereditary cystic fibrosis in children;
• congenital ciliary dyskinesia of the respiratory epithelium of the nasopharyngeal mucosa - Cartagener's syndrome.

Pathogenesis

The main link in the pathogenesis of purulent inflammation of the perinasal cavity mucosa is the reaction to infection of immunocompetent cells - neutrophils (polymorphonuclear leukocytes), which belong to phagocytes and respond to signals of proinflammatory cytokines that migrate to the site of inflammation in the process of chemotaxis.

Moving to the site of infection, neutrophils destroy bacteria by absorbing them and destroy dead cells of the mucous tissue covering the inner walls of the perinasal cavities. But under the influence of bacterial exotoxins, the leukocytes themselves are destroyed to form pus, a protein-rich fluid (liquor puris) that contains dead leukocytes, dead or living bacteria, and dead tissue cells.

And the accumulation of mucus and pus in the paranasal sinuses is the result of dysfunction of their ciliated (mesenteric) epithelium - the system of nasal mucociliary clearance, carrying the layer of mucus covering the nasal epithelium, due to the beating of cilia (cilia), which are elongated mobile cylindrical outgrowths of the membranes of the cells of the mucous epithelium.

More details in the articles:

• Diseases of the paranasal sinuses
• Acute sinusitis - causes and pathogenesis

Symptoms of the purulent rhinosinusitis

The first signs of acute purulent rhinosinusitis are manifested by increasing purulent discharge from the nose - purulent rhinitis, which persists for a long time. Such runny nose is accompanied by nasal congestion, and if the nose is completely congested with inability to breathe, it is evidence that the patient has bilateral purulent rhinosinusitis. Depending on the severity of the disease, nasal congestion may be mild, moderate, intermittent or persistent.

In cases of purulent inflammation of the maxillary (maxillary) cavities, there is a general malaise and weakness, throbbing pain in the forehead, temples and ears (often with hearing loss), there is a feeling of looseness behind the bone of the upper jaw, fever, bad breath. [1]

Symptoms of purulent rhinosinusitis of the frontal sinuses: fever, mucopurulent nasal discharge, aching pain in the frontal and ocular areas (which increases in the morning). Inflammatory process in the cuneiform sinuses causes dull headaches of pulsating character with their spread to the back of the head and intensification when bending over. [2]

Read also - Symptoms of sinusitis

Complications and consequences

Purulent inflammation of the paranasal sinuses can lead to complications and consequences such as:

• inflammation of the eustachian tube (tubo-otitis);
• persistent anosmia-- loss of sense of smell;
• Phlegmon of the eye socket and orbital cellulitis;
• Inflammation of the dura mater (pachymeningitis) of the skull base;
• Opticochiasmal arachnoiditis (in purulent sphenoidal rhinosinusitis of chronic course);
• osteomyelitis adjacent bone structures;
• development of rhinogenic brain abscesses.

Diagnostics of the purulent rhinosinusitis

Diagnosis of sinusitis is made based on the patient's history, clinical symptoms, and examination of the nasopharynx. [3]

To identify the focus of inflammation, instrumental diagnostics is performed:

• anterior rhinoscopy;
• endoscopy (examination) of the nasal cavity;
• X-ray of the nasal cavity and paranasal sinuses; [4]
• CT scan of the paranasal cavities. [5]

Tests may be taken, such as a general blood test and nasal mucus analysis. [6], [7]

Differential diagnosis

Differential diagnosis includes purulent nasopharyngitis, inflammation of adenoid vegetation, ozena, benign and malignant neoplasms of the nasal cavity, etc.

Treatment of the purulent rhinosinusitis

How purulent rhinosinusitis is treated and what medications can be used in this case, detailed in publications:

• Sinusitis treatment
• Antibiotics for sinusitis [8]
• Antibiotics for maxillary sinusitis
• Drops for maxillary sinusitis
• Sprays for maxillary sinusitis
• Nasal rinses
• Physiotherapy for maxillary sinusitis
• Physiotherapy for rhinitis

Surgical treatment is also performed:

• for polyps - functional endoscopic paranasal sinus surgery - nasal polyp removal;
• in cases of deviated nasal septum - septoplasty, i.e. Its surgical correction.

More information in the materials:

• Surgery for chronic maxillary sinusitis
• Surgical treatment of chronic frontitis

Prevention

Prevention of purulent rhinosinusitis is to prevent the mucous membrane of the paranasal sinuses from being affected by bacterial infection. The main recommendations of physicians in the articles:

• Healthy habits that will protect you from catching a cold
• Prevention of upper respiratory tract infections in children

Forecast

Purulent rhinosinusitis/sinusitis is treatable, and its prognosis depends largely on the timeliness of treatment and its effectiveness. [9]