Sinusitis is one of the most common forms of sinusitis (inflammation of the paranasal sinuses), which is characterized by the development of an inflammatory process in the maxillary (maxillary) sinuses.
A small anastomosis (1-2 mm), connecting the cavity with the nasal passage, not only makes it possible for air exchange and mucus separation, but also opens up access to the maxillary sinus for viruses and pathogenic microorganisms, which contributes to the development of the disease. Untimely or improper treatment of sinusitis, especially in children, can lead to serious consequences (damage to the organs of hearing and vision, meningitis, periostitis), so you need to know about the causes, main symptoms and treatment features of this disease. Especially authoritative is the opinion on this matter of an experienced pediatrician, the author of well-known television programs and books on children's health, Evgeny Olegovich Komarovsky.
Development of the paranasal sinuses in children
Doctor Komarovsky draws attention to the fact that before it can enter the lungs and reach the end of the respiratory apparatus - the pulmonary alveoli - the inhaled air must be cleaned, humidified and warmed. To fulfill these three conditions, contact with the nasal mucosa is not enough, therefore in the human body there are 4 pairs of paranasal sinuses (maxillary, frontal, sphenoid and ethmoid sinuses). In these sinuses, the air is purified, warmed to body temperature and humidified up to 100%, and only after that it follows further along the respiratory tract.
Given that a child has a higher respiratory rate and the strength of the respiratory muscles is lower than that of an adult, children are very demanding on air quality and very easily catch various infections, getting sick more often and more severely than adults. Komarovsky emphasizes that in a newborn child, the maxillary sinuses are very small and develop to their normal size only by the age of 5, and there are no frontal (frontal) sinuses at all, they are formed by the age of 7. Therefore, up to 3-5 years old, children cannot have sinusitis, and up to 7 years old they do not suffer from frontal sinusitis.
Rhinitis and sinusitis
According to Dr. Komarovsky, there is a big difference between common rhinitis (runny nose) and sinusitis. However, at the same time, he claims that there can be no rhinitis without sinusitis. After all, when a virus that causes a runny nose (ARVI) enters the human body, including a child (starting from 3-5 years), along with the air, it cannot get exclusively on the nasal mucosa, it also enters the maxillary mucosa. sinuses. As a result, inflammation occurs in the sinuses and mucus begins to be produced there.
Thus, if you take an X-ray of the maxillary sinuses of a child in the first few days of any viral infection, exudate will certainly be visible there. According to Dr. Komarovsky, this is an absolutely normal process and an absolutely natural reaction of the body, since mucus contains mucin protein, which has bactericidal properties and helps in the fight against infections. With effective treatment of ARVI, as the inflammation of the nasal mucosa decreases, the inflammation of the maxillary sinus also disappears. Komarovsky emphasizes that in this case we are talking about viral sinusitis. This form of the disease does not require special treatment.
Types of sinusitis
The word "sinusitis" itself indicates that there is an inflammatory process in the maxillary cavity, but its nature may be different. So, the cause of the pathology can be both viral and bacterial microflora. In some cases, the pathology is mixed. Also distinguish between catarrhal, purulent, allergic and odontogenic sinusitis. In addition, the disease can be acute or chronic.
Catarrhal sinusitis mainly manifests itself in ARVI in the form of mucosal edema, hyperemia and the production of serous matter. Typically, it disappears as the body cope with an acute respiratory viral infection.
As for allergic sinusitis, its course and severity depend on the ability or impossibility to eliminate the allergen that provokes such a reaction of the body. And sinusitis of an odontogenic nature occurs due to an inflammatory process in the oral cavity (inflammation of the teeth of the upper row) and is eliminated with the help of a dentist's intervention.
Acute purulent sinusitis develops in most cases against the background of advanced acute respiratory viral infections or as a complication.
When the anastomosis through which ventilation of the maxillary sinus occurs becomes clogged due to severe edema or thick mucus accumulation (if the child is in a hot room with dry air or does not drink enough liquid), the cavity turns into a closed space with favorable conditions for life and the reproduction of various pathogenic bacteria ... Due to the attachment of bacterial microflora, mucous discharge inside the sinus turns into purulent and does not have a way for outflow. Purulent sinusitis requires mandatory special treatment and does not go away on its own.
Symptoms of sinusitis
According to Dr. Komarovsky, sinusitis is accompanied by the same clinical picture as rhinitis - severe nasal congestion and impaired sense of smell. However, it is possible to diagnose with inflammation of the maxillary sinuses using additional symptoms:
- yellow-green nasal discharge;
- pain in the area of u200b u200bthe location of the maxillary sinuses, which intensifies when turning and tilting the head forward;
- dull aching headache;
- increased body temperature.
When the above symptoms appear, you need to immediately contact a specialist, since in order to avoid complications, purulent sinusitis is better to start intensively treating with special drugs as early as possible.
Sinusitis treatment
Treatment of sinusitis is usually inextricably linked with antibiotic therapy. However, Dr. Komarovsky warns parents against taking antibiotics uncontrollably. First of all, it is necessary to establish an accurate diagnosis. If the child has a viral infection, the use of antibiotics will only harm the body. And the widespread opinion that antibiotic therapy for ARVI will help prevent complications, according to Komarovsky, is nothing more than a myth. In addition, the specialist insists that the use of antibiotics before the onset of a bacterial infection increases the likelihood of complications several times.
Thus, the symptoms and treatment are inextricably linked, since the reason for taking potent drugs should be not just a long-lasting rhinitis, but a runny nose, accompanied by pain in the maxillary sinuses. If the diagnosis of purulent sinusitis has already been made, then in this case, antibiotic therapy is the only reliable and effective way to treat the disease. In order to reduce swelling of the mucous membrane, dissolve thick or dry mucus and resume normal air exchange in the sinuses, vasoconstrictor drops are usually also prescribed to patients.
Dr. Komarovsky has repeatedly noted that now there are many effective drugs in tablets, so antibiotics are no longer prescribed in an injectable form. A feature of the treatment is also that the patient is usually shown high doses of the drug, since in order to effectively fight bacteria, the antibiotic must accumulate in high concentration not just in the blood, but in the maxillary cavity itself.In addition, the duration of the course of therapy is usually 10-14 days.
It is important not to interrupt taking the drug at the very first improvements, since there is a high likelihood of recurrence of an untreated disease and its acquisition of a chronic nature.
Puncture
In the countries of the post-Soviet space, washing according to the Proetz method (popularly "cuckoo") and a puncture remain a widespread practice of treating sinusitis. The essence of flushing is that a catheter and a suction are inserted into the nasal passages. Thanks to the first device, a solution of chlorhexidine or furacilin enters the sinus, and with the help of the second, mucopurulent exudate is pumped out of the cavity. Thus, bacteria are washed out and mucopurulent secretions are removed from the sinuses. However, it makes sense to carry out the "cuckoo" only at the earliest stages of the development of the disease, since in more severe forms of pathology, it does not bring the desired effect.
As for the puncture, before carrying out this procedure, the patient is injected with local anesthesia, after which the wall of the maxillary cavity is punctured from the inside of the nose.
Then a syringe with saline is attached to the large needle, the ingress of which into the sinus contributes to the excretion of mucopurulent exudate accumulated there through the oral cavity.
Before the end of the procedure, in order to prevent the accumulation of purulent masses, anti-inflammatory drugs or antibiotics are injected into the sinuses.
Despite the large number of fans of these procedures, there is also an opinion that once having made a puncture, then it will have to be repeated several times and done almost throughout the life of a patient suffering from sinusitis. Dr. Komarovsky believes that this opinion is fiction. However, in no case can he be counted among the supporters of this manipulation. According to him, in most countries of the world, a puncture is not a medical, but a diagnostic procedure. Moreover, it is done only as a last resort, if the treatment of sinusitis with antibiotics does not give a result for 2-3 weeks. With the help of a puncture (puncture), pus is taken from the sinus for analysis. Then sowing takes place, bacteria are grown, and it becomes clear which drugs act on them most effectively.
That is, Dr. Komarovsky believes that the puncture should be done only in cases where human life is in danger (high fever, acute pain, lack of treatment results). By the way, in such severe cases, patients usually need hospitalization. However, most sinusitis resulting from complications of acute respiratory viral infections is treated mainly at home without washing and puncturing.
Traditional methods of treating sinusitis
There are a large number of alternative methods for treating inflammation of the maxillary sinuses, which are used in addition to drug treatment. The most popular among them:
- rinsing with salted water and a variety of herbal decoctions;
- instillation of drops made from various oils and juices of plants and vegetables into the nose;
- nasal turundas soaked in medicinal solutions;
- compresses;
- inhalations based on oils or herbal decoctions;
- warming up the nose with eggs, salt or buckwheat.
Some of the recipes of traditional medicine really have a positive effect and help accelerate recovery, however, they can be used only after consulting your doctor. So, Dr. Komarovsky emphasizes that in no case should you warm up your nose with purulent sinusitis, since this can be fraught with serious consequences (breakthrough of purulent masses). In addition, in his opinion, inhalations are not very effective for sinusitis, but the risk of getting a burn of the respiratory tract is quite high. Komarovsky believes that civilized medicine should not consider such methods as a treatment.
