Rhinosinusitis

Rhinosinusitis

Rhinosinusitis or inflammation of the nasal mucosa is a common inflammatory change in the nasal mucosa with simultaneous inflammation of the paranasal sinus mucosa. In most cases, rhinosinusitis can be traced back to a viral infection.

What is rhinosinusitis?

Rhinosinusitis is an inflammation of the nasal mucosa (rhinitis) in combination with an inflammatory change in the mucosa (mucous membrane) of the paranasal sinuses (sinusitis). For misaligned jaw (misaligned teeth) guide, please visit deluxesurveillance.com.

Depending on the course of time, a general distinction is made between an acute and a chronic variant, with symptoms lasting more than 12 months being referred to as chronic rhinosinusitis. In addition, in chronic rhinosinusitis, a distinction is made between the polyp-forming form and rhinosinusitis without manifestation of polyps.

Acute rhinosinusitis is characterized by purulent (purulent) nasal discharge, nasal obstruction, and a feeling of pain and pressure in the face. In contrast, the chronic form of rhinosinusitis is less marked in many cases and, in addition to the more discrete acute symptoms, manifests itself in an increased susceptibility to infections, a general state of exhaustion and reduced resilience.

Causes

Acute rhinosinusitis represents an inflammatory change after a nasal infection that leads to impaired drainage and impaired ventilation in the paranasal sinuses.

The increasing obstruction and tissue formation leads to impaired ventilation and drainage and the development of the chronic form. In most cases, the infection is triggered virally by influenza, parainfluenza or rhino-influenza viruses and bacterially by mycoplasma and Chlamydia pneumoniae.

In addition, the bacterial pathogens Haemophilus influenzae and Streptococcus pneumoniae can lead to a superinfection following a viral infection. Chronic rhinosinusitis is associated with Staphylococcus aureus, Staphylococcus epidermidis, Moraxella catarrhalis, and enterobacteria, among others.

The polyp-forming form of chronic rhinosinusitis is also associated with intolerance to acetylsalicylic acid, bronchial asthma and non-invasive fungal infections. Anatomically caused changes in the lateral nasal wall and allergic rhinitis are considered to be favorable factors, especially for recurrent rhinosinusitis.

Symptoms, Ailments & Signs

Rhino-sinusitis is also known as sinusitis. It presents as a mixture of a runny nose and blocked tubes. The doctors speak of nasal obstruction and rhinorrhea. Rhino-sinusitis can develop different degrees of severity. These can be read from the symptoms. Chronic rhino-sinusitis is possible.

A blocked nose can lead to disturbances in smell perception. The pressure in the tubes may be increased. This leads to symptoms such as headaches, feelings of pressure in the jaw and forehead area and on both sides of the bridge of the nose. At the same time, the nose runs constantly. Acute rhino-sinusitis lasts about 14 to 18 days.

Frequent sneezing can accompany these symptoms. Nocturnal coughing is caused by postnasal secretion. The nose is often closed on one side at night. This makes breathing difficult. A healthy sleep is disturbed by the stuffy nose, the pressure on the tubes and the urge to cough at night. The sleeper breathes through the mouth or snores. Both can dry out or cool down the airways.

As rhino-sinusitis progresses, symptoms can worsen and fever can occur. Rhino-pharyngitis with severe hoarseness and voice problems may develop. Because there can be so many symptoms, the most distressing symptom is critical to treatment.

Diagnosis & History

Rhinosinusitis is diagnosed on the basis of the characteristic clinical symptoms (including inflammatory changes in the nasal mucosa, nosebleeds, pronounced pain, swelling, impaired vision, sensory disturbances in the trigeminal area).

In addition, in many cases of rhinosinusitis, pus (pus) can be detected by rhinoscopy or computer tomography. A nasal endoscopy enables a differentiated assessment of the nasal and paranasal mucosal structure.

In terms of differential diagnosis, a distinction should also be made between bacterial and viral rhinosinusitis with regard to the therapeutic measures to be chosen, with the duration and severity of the disease allowing initial conclusions to be drawn. If rhinosinusitis is diagnosed early and treated consistently, the disease will progress without complications.

If left untreated, severe rhinosinusitis can affect adjacent structures such as the eyes, meninges or brain and, in extreme cases, lead to life-threatening meningitis or encephalitis.

Rhinosinusitis can sometimes cause complications. There is a risk that the infection will spread from its point of origin to neighboring regions of the body.

Complications

Acute inflammation of the paranasal sinuses and nasal mucosa usually heals completely. However, some sufferers experience severe rhinosinusitis several times a year. It is possible that the acute rhinosinusitis turns into a chronic form. This is when the symptoms persist for more than two months.

The possible consequences of rhinosinusitis include inflammation of the nasal cavity wall. If this even breaks through, there is a risk of the infection spreading to all adjacent organs. There is therefore a risk of dangerous purulent meningitis (purulent meningitis). If the inflammation extends further into the eye socket, eyelid edema can occur.

Furthermore, it is conceivable that the eyeball protrudes. If there are also visual disturbances, an immediate surgical intervention must be carried out in the responsible sinus. Other sequelae of rhinosinusitis often affect the respiratory system. There is a risk of chronic bronchitis and bronchial asthma.

Chronic rhinosinusitis is also considered a risk factor for chronic obstructive pulmonary disease (COPD). Bony complications also occur in five to ten percent of all patients as a result of the sinusitis. This includes frontal bone osteomyelitis. In addition, chronic rhinosinusitis carries the risk of tumor formation in the nasopharynx.

When should you go to the doctor?

If nasal breathing is severely restricted and typical accompanying symptoms of rhinosinusitis occur, everything speaks for a doctor’s visit. In the event of a pressure headache, increased secretion production or chronic pain in the area of ​​the paranasal sinuses, a doctor should be consulted immediately. This is necessary above all if the symptoms do not go away on their own or even get worse. Smokers and allergy sufferers are particularly at risk. People with genetic predispositions and caries patients are also among the risk groups who should speak to their family doctor if they have the symptoms mentioned.

Poor diet and alcohol consumption are other risk factors that need to be clarified. In addition to the general practitioner or pediatrician, an ear, nose and throat doctor or an allergist can be consulted. In the case of chronic complaints, regular visits to the doctor are indicated so that complications can be reacted to quickly. If rhinosinusitis is diagnosed early and monitored well from then on, the prognosis for a speedy recovery is positive. Therefore, the first signs should be clarified if there is a suspicion of a serious disease of the nose or paranasal sinuses.

Treatment & Therapy

The therapeutic measures for rhinosinusitis depend on the specific cause present, as well as the form, course and symptoms. Analgesics or anti- inflammatory drugs such as ibuprofen, paracetamol or diclofenac can be used to reduce pain.

In addition, antibiotic therapy with amoxicillin or aminopenicillin may be indicated in severe cases of acute bacterial rhinosinusitis. Bacterial chronic rhinosinusitis can also be treated long-term with antibiotics in combination with steroids. In addition, decongestants (nasal sprays or drops to reduce swelling) can be used for short-term (7 to 10 days) symptomatic therapy in acute rhinosinusitis.

In the presence of chronic rhinosinusitis with polyposis, topically applied nasal corticosteroids can support symptom improvement (pain reduction, decrease in obstruction and purulent discharge). Supportive antihistamine therapy may be indicated for affected allergy sufferers. Furthermore, phytotherapeutics such as myrtol or cineole can be applied to alleviate the symptoms and be curative in non-bacterial acute rhinosinusitis, while an additive therapy with Sinupret (primrose mixture) can be used in the case of bacterial acute rhinosinusitis.

The phytotherapeutic agents pelargonium sidoides and bromelaine are also said to have an additive therapeutic effect in acute rhinosinusitis. In the case of chronic rhinosinusitis, the application of saline solutions to improve mucociliary clearance (self-cleaning of the bronchi) is also recommended. If no improvement in symptoms can be detected within the framework of conservative therapy measures, surgical intervention may be indicated, especially in the case of impaired ventilation and drainage or impending inflammatory complications.

The minimally invasive endoscopic paranasal sinus surgery is aimed at reconstructing the nasal physiology by removing focal areas, removing hyperplastic or pathologically altered mucosal areas and polypectomy (polyp resection). Topical application of corticosteroids is recommended after surgery to prevent recurrence of rhinosinusitis.

Prevention

Rhinosinusitis can be prevented by early and consistent treatment of the underlying disease that caused it, especially a common cold. In addition, the risk of rhinosinusitis can be reduced by taking prophylactic measures (flu shots, washing hands frequently, avoiding irritation of the nasal mucosa, sufficiently humidified room air) against bacterial or viral infections, especially during the cold season.

Acute rhinosinusitis usually does not require follow-up care. The acute form heals after a few weeks without the need for further drug treatments. However, if there is a chronic form that leads to surgical intervention, follow-up treatment is considered important.

Aftercare

After every operation on the paranasal sinuses, there are local changes in the mucous membrane. Tamponades are placed in the mucous membrane of the nose and paranasal sinuses to have a positive effect on wound healing. The tamponades fulfill the function of stopping diffuse oozing bleeding from the mucous membrane.

The tamponades dissolve by themselves after a few days or are removed by the doctor. They have the advantage of stopping the bleeding, but they often create an uncomfortable feeling of pressure in the nose. For this reason, tamponades made of self-dissolving materials are increasingly being used.

Once the tamponades have been removed, the wound surfaces are treated gently, using endoscopy. The scope of therapy depends on the wound healing process. Endoscopic control makes it possible to visualize changes that occur during the course of wound healing. In addition, the ethmoid shaft is suctioned out every two days and a free access to the frontal sinus is made.

If inflammatory changes occur, antibiotic drugs are administered. Nasal sprays containing topical glucocorticoids can be used to prevent edema. Salt water rinses are considered helpful against recurrences.

You can do that yourself

A rhinosinusitis must first be clarified by a doctor. The specialist doctor can prescribe a suitable preparation and tell the patient the first means and measures for self-treatment. At the same time, the person concerned should take it easy. Regular breaks should be taken during work. It is also advisable to drink enough water, tea or spritzers and, if necessary, to take zinc or vitamin C supplements. It is best to avoid nicotine and other stimulants in the first few days and weeks after the diagnosis.

Home remedies such as ointments or inhalation baths can also be used to support the treatment in order to reduce the symptoms. If the symptoms do not subside despite all measures, there may be chronic sinusitis. A doctor must quickly make the diagnosis and prescribe suitable medication. Otherwise, complications such as the spread of inflammation or injuries in the area of ​​the maxillary sinus can occur.

In the event of complications, an operation may be necessary. After a surgical procedure, the medical guidelines regarding diet, rest and medication should be followed first and foremost. The rhinosinusitis and any accompanying symptoms should then completely subside within a few weeks.

Rhinosinusitis