Sinusitis

Sinusitis, and sinusitis, (Latin paranasal salis, sinus and -itis, inflammation ') is an inflammatory, caused by viruses or bacteria of the lining of the sinuses. A distinction is made between acute and chronic sinusitis. The paranasal sinuses include the maxillary sinuses ( maxillary sinusitis, maxillary sinusitis ), frontal sinuses, ethmoid and sphenoid sinuses.

Acute sinusitis

Acute suppuration of the sinuses often arises from a runny nose ( rhinitis), when the secretion drainage from the sinuses is hindered by swelling of the mucous membranes and anatomic conditions. Most are the maxillary sinuses, ethmoid and frontal sinuses, the rare, very rarely affected the sphenoid sinus. A participation of all the sinuses is called pansinusitis. The disease is usually accompanied by fever, headache, and general lassitude. Every seventh German is even affected by sinusitis every year. Cause is a bacterial infection only in 20-35 % of cases. Most viruses are the triggers; However, other sources such as allergies are also possible. For bacterial sinusitis says: symptom duration > 7 days, unilateral facial pain, unilateral purulent nasal discharge. Bilateral symptoms speaks against it more for a viral cause. Acute viral sinusitis can be transmitted by droplet infection. As a result of acute sinusitis may occur sinubronchialen syndrome (post -nasal -drip syndrome).

Chronic sinusitis

As chronic sinusitis is considered a more than 2-3 month long ( depending on the source ) sinusitis. It generally starts out from a not healed acute or subacute sinusitis, usually maxillary sinuses and ethmoid sinuses are affected. Another waveform is the recurrent acute sinusitis. Symptoms are long-lasting loss of smell ( anosmia ), chronic, usually aqueous runny nose ( rhinorrhea ), secretions flow into the throat (post nasal drip ) and permanent, dull pressure on the sinuses or behind the eyes. In addition there is often the growth of inflammatory polyps in the nasal sinuses. For the treatment corticosteroids are used as a nasal spray or in tablet form. Additional therapeutic approaches exist in the long-term administration of antibiotics, nasal irrigation or - in case of chronic sinusitis with polyps - the local application of antifungal agents.

According to current optimal medical treatment is just as effective as surgery. Therefore, this is only necessary if the patient experiences through drug therapy does not provide adequate relief.

An operation will improve the condition in 80 % of cases, in 10% of cases, recurrence of the disease. These operations are now generally performed from inside the nose, cuts on the face ( transfazialer access ) are individual cases reserved. Patients with extensive frontal sinusitis have a worse prognosis and a worse risk profile. Risks of sinus surgery are made in violation of the orbit with the formation of double vision, the vision loss, the drainage of cerebrospinal fluid, the meninges inflammation and hemorrhaging in the brain due to the proximity to the eyes and brain. These serious complications occur today in less than 1% of cases.

A polypoid sinusitis is most frequently associated with the occurrence of bronchial asthma and analgesic intolerance ( intolerance). The incidence of all three diseases in a patient called Samter 's triad. These patients have a significantly increased tendency for recurrence with standard therapy. As newer, supportive therapy is the adaptive deactivation available. For this one takes after adjustment by the doctor permanently acetylsalicylic acid (ASA / aspirin) and thus can successfully counteract the polyp formation. A renovation of the paranasal sinuses in asthmatics leads these to an average of 5 mg reduced intake of cortisone to control the asthma.

As a result of chronic sinusitis diseases of the lungs can ( Sinubronchiales syndrome ) can occur. If chronic sinusitis despite therapy does not heal or recur, should also be clarified whether a cystic fibrosis may be present or whether any previously unnoticed inflammation of the tooth roots in the maxillary sinuses radiate ( Panoramaröntgen! ).

Species

• Ethmoid sinusitis, an inflammation of the ethmoid sinuses
• Frontal sinusitis, an inflammation of the sinuses
• Maxillary sinusitis, an inflammation of the maxillary sinuses
• Sphenoid sinusitis, an inflammation of the sphenoid sinus
• Pansinusitis, a simultaneous inflammation of all sinuses

Investigation

By simple endoscopic examination of the nasal swab fluid ( nasal secretions ) and targeted survey of the case of sinusitis symptoms pretty unique, the doctor can often make the diagnosis of sinusitis. ( Although this rather unequivocal symptoms may, but need not necessarily occur. Chronic sinusitis / pansinusitis can ever cause any noticeable symptoms under certain circumstances. ) To clarify imaging techniques must ( ultrasound ), computed tomography ( CT) or magnetic resonance imaging (MRI ) can be used. Radiography and ultrasonography for the diagnosis of chronic sinusitis are rather unreliable. Sonography is only for monitoring and at an acute attack of value. In general lassitude the absence of any other symptoms can easily result together with the result of an X-ray of the sinuses to reach a premature exclusion of sinusitis.

Symptoms

• Of acute sinusitis headaches are often accompanied by a feeling of pressure or a penetrating pain in front of the head. These pains are worse when one leans forward, herunterbückt with the upper body or solid occurs. Depending on the affected sinuses, the location of the discomfort varied. Thus, throbbing pain over the forehead, the cheeks ( possibly accompanied by toothache ), occur behind the eyes, or more rarely in the occipital region. In order to locate the patient can beat with the flat hand on the back of the head, the pulse causes a dull, stabbing pain in the liquid-filled sinuses.
• Frequently co rhinitis (runny nose ) with purulent (yellowish - green) modified nasal discharge, nasal obstruction, constant flow of secretion in the throat.
• In severe inflammation fever, fatigue and blurred vision even severe cough, which may interfere with outgoing mucus in the airways particularly the night's sleep, as well as long-lasting cough chest muscles can ache and weakens.
• Sometimes the visible painful swelling.
• Increased nosebleeds should make you think of rare malignant neoplasms in the paranasal sinuses. The autoimmune disease granulomatosis with polyangiitis (GPA; earlier Wegener's disease ) manifests itself at an early stage by a persistent sinusitis, which will eventually also accompanied of increased nosebleeds. The referral should be made as soon as possible by the rheumatologist, since then a much gentler medication can be selected, as in the late stage, which can be also accompanied by severe organ damage to the lungs and kidneys.
• Performance loss, chronic fatigue.
• Pressure and pain-related drowsiness states up to delirium in advanced stages.

Therapy

The goal of therapy is primarily to reduce the inflammation and restore the natural mucus drainage of the sinuses:

• Measures for liquefaction and improved excretion of mucus (increased fluid intake by drinking, ensuring high relative humidity of the inhaled air, steam inhalation, infrared treatment ( red light ), short wave treatment, isotonic saline as nasal wash / shower or sea water sprays, drugs for the mucus / liquefaction or. increased mucus production such as acetylcysteine ​​and ambroxol, herbal supplements or enzyme preparations. )
• Use of decongestant nasal sprays or drops.
• Taking myrtolhaltigen or cineolhaltigen drugs.
• Measures to reduce the inflammation ( for example, by use of enzyme preparations or corticosteroid nasal sprays ).
• In severe cases surgery may be necessary in order to facilitate drainage of mucus, which is made ​​more difficult due to organic. ( Polyp removal, reduction of the turbinate, Knochenabschabung, straightening of the nasal septum ).
• Caldwell -Luc operation

Additional self-help

• Strong heat or cold should be avoided, since temperature changes reinforce the sinus pain.
• The head of the bed lift, so that the head is mounted higher.
• Herbal combination preparations with mucolytic agents, facilitate the healing process are, for example, Gentian root, cowslip, garden sorrel herb, elder flowers and verbena.
• Drink plenty of, for example, Herbal teas with chamomile, peppermint or thyme.
• A proven home remedies are steam inhalations with the addition of dried chamomile flowers or with chamomile concentrate or ointments containing eucalyptus oil.

Pathogen

• Haemophilus influenzae
• Pneumococcal
• Streptococci
• Staphylococci

Complications

In severe cases the inflammation may exceed the sinuses and cause damage to adjacent structures:

• When the thin bone plate which orbital and paranasal sinus separates, is affected by the inflammation, it may come to a breakthrough. Pus and bacteria and enter into the eye socket, which can lead to severe eye damage and even blindness.
• The bony separation of brain and sinuses can be broken by the inflammation. A life-threatening meningitis can be the result.
• Most neglected is the interplay between the maxillary sinus and tooth root inflammation.
• An often overlooked and underestimated problem is snoring. Due to the disturbed nasal breathing the air flow is restricted, the secretion located in the way " gurgles " unmistakable with each breath. With progressive closure is a switch to mouth breathing, which leads to dehydration of the pharyngeal mucosa. The sinusitis is thus adversely affected because, firstly, the mucous membranes become irritated and on the other hand fails the necessary recovery during sleep.
• It can form a mucocele.
• Post-nasal -drip syndrome

Prevention

In general, the defenses need to be strengthened, for example through regular visits to the sauna, exercise in the fresh air, cold showers and vitamin-rich diet. Smokers have an increased risk. In winter, the head should be kept warm.

In common cold nose should be used with little pressure (preferably only one nostril) are geschnäuzt; high pressure brings bacteria-containing mucus often only up to the sinuses.

With frequently recurrent sinusitis often benign mucosal growths ( polyps), a crooked nasal septum and / or narrowed outflow paths for the nasal discharge are the cause. The removal of the cause, for example, by surgery or the avoidance of contact with allergens can help.