Viral or bacterial
This is the key question that determines whether antibiotics are needed. Viral rhinosinusitis accompanies the common cold and does not require antibacterial treatment.
- Viral: symptoms are maximum in the first 2–3 days and then gradually subside; discharge changes color from transparent to yellowish and back - this is normal and not a sign of bacteria
- Bacterial: symptoms last more than 10 days without improvement; or there was a “second wave” - it got better, and then sharply worse; or from the very beginning a severe course with a temperature above 39 ° C and purulent discharge
Symptoms
- Nasal congestion, difficulty breathing, often on one side
- Bursting pain or pressure in the cheek area, under the eye, aggravated by tilting the head forward
- Purulent or thick nasal discharge, mucus running down the back of the throat
- Decreased or loss of sense of smell
- Headache, heaviness in the head, pain in the upper teeth
- Fever, weakness
Why it occurs and why it repeats
- Viral infection is the main trigger
- A deviated nasal septum and narrow anastomosis are the main cause of recurrent sinusitis.
- Allergic rhinitis and nasal polyps
- Diseased teeth of the upper jaw: the roots of the premolars are adjacent to the sinus, hence odontogenic sinusitis
- Adenoids in children
- Dry air, smoking, working in dust
If sinusitis recurs several times a year, you need to treat not each episode separately, but the cause: straighten the septum, remove polyps, cure a tooth, take control of allergies.
Survey
- Осмотр ЛОР-врача с риноскопией; при возможности — эндоскопия полости носа.
- КТ придаточных пазух — метод выбора: точно показывает состояние всех пазух, соустий, перегородки и зубов. Значительно информативнее рентгена.
- Рентген пазух — доступен, но часто даёт ложные результаты, особенно у детей.
- Консультация стоматолога и снимок зубов при одностороннем процессе.
- Аллергообследование при частых рецидивах и круглогодичном насморке.
Treatment: is a puncture necessary?
Sinus puncture (puncture) is not a routine method today and is performed much less frequently than before. The basis of treatment is restoration of outflow from the sinus.
- Rinsing the nose with saline is the simplest and most effective method, performed several times a day.
- Vasoconstrictor drops for a short course of up to 5–7 days: they relieve swelling of the anastomosis. Longer use causes medicinal rhinitis
- Intranasal glucocorticosteroids - reduce swelling, especially with allergies and polyps
- Antibiotics - only for signs of bacterial sinusitis, full course
- Puncture - in case of severe pain, lack of effect from therapy, threat of complications
- Endoscopic surgery on the sinuses - for a chronic process, polyps, cysts, anastomosis block
- Elimination of the cause: septoplasty, dental treatment, allergy control
Complications to avoid
- Orbital: swelling of the eyelids, phlegmon of the orbit - a threat to vision
- Intracranial: meningitis, brain abscess, sinus thrombosis
- Osteomyelitis of the facial bones
- Transition to a chronic form with constant congestion and loss of smell
All of them are rare, but that is why it is important to know the “red flags”: swelling around the eye, double vision, severe headache with vomiting and confusion - a reason to contact immediately, and not wait for a scheduled appointment.
