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Frontitis: symptoms and treatment in adults, forms of the disease

What it is?

The front is one of the types of inflammatory disease of the paranasal sinuses, i.e. sinusitis, and develops in one or more frontal sinuses.

Sinusitis (including frontal sinusitis) is a fairly common cause of hospitalization - 25-30% of all patients hospitalized in the ENT department suffer from this or that form. By the nature of the flow, the frontal sinusitis is divided into acute and chronic.

Front

The causes of acute frontalitis are:

  • Acute rhinitis (runny nose);
  • Acute ethmoiditis - inflammation of the ethmoid sinus;
  • ARVI, flu;
  • Hypothermia, cold;
  • Common acute infections, such as measles;
  • Trauma to the frontal area.

The anatomical feature of the frontal sinus is a relatively narrow and curved canal between the sinus and the nasal cavity. Swelling of the mucosa on the background of the underlying disease leads to a rapid overlap of the message between the cavities, which worsens the timely outflow of inflammatory fluid from the frontal sinus to the nose.

Accumulating in a confined space, it creates favorable conditions for the reproduction of microflora and the development of infectious inflammation within the sinus.

Chronic frontal sinusitis develops with a protracted course of the acute form, aided by the depressed work of the immune system, impaired drainage of the frontal sinus due to the overlapping of the frontal-nasal canal with polyps of the mucous membrane, as well as with the curvature of the nasal septum and an increase in the size of the middle turbinate.

The causal role of microorganisms in the chronic course of sinusitis is lost, and the pathological process is supported by an abnormally functioning immune system that damages the tissues of the frontal sinus.

The chronic process usually extends not only to the frontal, but also to the other paranasal sinuses. Most often there is a combination of chronic frontal sinusitis and chronic ethmoiditis of the anterior cells of the labyrinth (a labyrinth is a sinus, horizontally located between the nasal cavity and the cranial cavity). In this case, the disease becomes not only protracted, but also a severe course.

Content

Symptoms of frontitis in adults

Symptoms of frontitis in adults

Depending on the severity of the inflammatory process, acute frontal sinusitis can be mild, moderate and severe.

The main symptoms of frontal sinusitis in adults are due to the development of local inflammation and general intoxication (especially characteristic of the acute form):

  • Sharp pain in the forehead, which increases with the palpation and tapping of the bones with fingers, localized over the pathological focus;
  • Headache, spread all over the head or in places;
  • Discharge from the nose: abundant, usually observed on the side of the inflamed sinus, first the liquid mucous membranes are transparent, then purulent, odorless. Purulent character indicates the accession of bacterial flora;
  • Nasal congestion and respiratory failure on the affected side, which further aggravates the course of the pathological process;
  • Poor health, weakness;
  • Photophobia, pain inside the eyes;
  • Temperature 37-380C, with a pronounced process can rise above;
  • Redness of the skin over the bridge of the nose, spreading along the upper edge of the orbit and the upper eyelid, closer to the nose;
  • At the inner corner of the eye there is an edematous area, sharply painful with pressure;
  • An abscess may appear in the area of ​​the inner corner of the eye or on the upper eyelid, which indicates the destruction of the bone wall and the release of pus from the cavity under the skin. The abscess is manifested by severe pain and redness, local temperature increase, and the purulent contents of the yellowish color can appear through the skin, since the skin in this area is very thin;
  • When examining the nasal cavity, rhinoscopy, an accumulation of a purulent fluid under the middle turbinate is detected, the mucous membrane in the area of ​​this shell is red, swollen and thickened;

Symptoms of chronic frontal sinusitis during periods of remission are usually absent. Symptoms that appear during periods of exacerbations are mainly the following:

  • Above the affected sinus pain can be sharp and aggravated by pressing on the inner corner of the eye, impaired fluid outflow and increased swelling lead to increased pain;
  • Headache all over the head and / or in the forehead, which appears quite often and has a pressing or aching character;
  • From the nose on the side of the lesion, persistent discharge is observed, often they have an unpleasant odor; with polyps and non-infectious inflammation, the discharge is light and liquid, with inflammation with the participation of microbes - purulent and thick;
  • Characteristic morning increase in the amount of inflammatory fluid secreted from the nose, which is associated with the patient's transition to a horizontal position, this fact makes informative the inspection in the morning, after the patient gets up;
  • At night, the discharge flows into the nasopharynx, which also leads to the appearance in the morning of a large number of easily expectorant sputum;
  • There is a violation of nasal breathing and olfactory function, which is most noticeable in the bilateral front;

In addition to the examination, the diagnosis is confirmed by radiography, the use of which in Russia and now is very wide. X-rays are performed in 2 positions (projections): straight and lateral. In the pictures characteristic signs of frontal sinusitis will be a uniform darkening in the area of ​​the affected sinus, sometimes it is possible to detect the level of fluid.

This method is not 100% reliable, since the darkness of the fate may be due to other causes, such as thickening of the mucous membrane or the bony walls of the sinus.

» в диагностике синуситов. A more informative method is computed tomography (CT), which in many countries is considered the “ gold standard ” in the diagnosis of sinusitis.

The advantages of CT in the study that receive information that gives a three-dimensional idea of ​​what is happening pathological process, allows us to estimate the degree of tissue damage, reveals the nature of violations of the anatomical structures of the paranasal space. In the diagnosis of frontal sinusitis, axial computed tomography is often used.

  • Trepanation, or puncture, of the frontal sinus with a diagnostic purpose is used more often in chronic frontal sinusitis; in the acute process, this procedure is performed only with the development of complications or the absence of the effect of treatment on the first 24 hours.

Puncture is carried out both in polyclinic and in hospital. The puncture is performed with a special device in the forehead, through the front wall of the frontal sinus. This procedure is performed after anesthesia.

Thus, the appearance of rhinitis, persisting for more than 7 days, is an indication for consulting an ENT doctor. He usually recommends radiographic examination to rule out frontal sinusitis.

Treatment of frontal sinusitis in adults, drugs and methods

Treatment of frontal sinusitis in adults

catheter Yamik photo

Treatment of acute and chronic process is similar to each other. Treatment of frontitis most often begin conservatively, that is, with the help of medicines. When detecting frontal sinusitis, treatment in adults consists of 2 main areas:

  1. Relief therapy, restoring the normal outflow of fluid from the sinus;
  2. Impact on infectious agent.

Conduct local lubrication with 1% r-rum of adrenaline, spray vasoconstrictor agents in the nasal cavity: otrivin, naphthyzinum, galazolin, etc. These preparations reduce the diameter of the vessel, which reduces the exudation of plasma from it. That it is the main component of the pathological secretion arising from the nasal cavity.

The discharge stage of treatment consists in aspiration of fluid from the sinus with the help of a special YAMIK catheter. After the evacuation of the discharge, the doctor rinses the cavity with a solution of furacillin and injects anti-inflammatory drugs, as well as antibiotics. The latter are shown only in the acute stage of the chronic process.

In remission they will be ineffective, because microorganisms are not active at the moment - their reproduction does not occur. It is to suppress this process that most antibiotics are directed.

With frontal sinusitis resulting from SARS, it is often sufficient to restore drainage function, while the addition of a bacterial infection requires the prescription of antibacterial drugs. They are recommended to be used only for medium-heavy and severe course.

Drugs in the treatment of frontitis

Preference is given to preformed preparations from the cephalosporin or penicillin series. Reserve antibiotics are prescribed only if cephalosporins (penicillins) are ineffective or when there are contraindications to them.

However, modern diagnostics can not always separate the viral and bacterial nature of inflammation in frontal sinusitis, and the data obtained are not true indicators of severity. Therefore, the decision on the appointment of antibiotics in the treatment of frontal sinusitis is based on determining the severity of the general condition, the nature of complaints and the presence of purulent discharge.

From antibacterial drugs, the following have proven effectiveness:

  • Amoxicillin;
  • Amoxicillin + clavulanic acid: Augmentin, Amoxiclav;
  • Cephalosporins 2 and 3 generations, such as cefuroxime or ceftibuten inside, ceftriaxone in / m.
  • In case of inefficiency or allergy to the above drugs, macrolides are used: clarithromycin, azidomycin, roxithromycin, and also fluoroquinolone levofloxacin, which is represented by such drugs as Lefoktsin, Tavanic.

In the treatment of moderately severe frontal disease, antibiotics can be taken orally, and in severe cases, as intramuscular or intravenous injections.

At elevated temperatures, paracetamol, aspirin, ibuprofen are added to the treatment to relieve a systemic inflammatory response, the objective manifestation of which is fever.

Other methods of therapy

UHF or microwave is carried out only when the normal outflow of fluid from the sinus is restored, otherwise physiotherapy can significantly aggravate inflammation. In chronic frontal sinusitis, if there are no polyps , it is possible to use laser therapy, microwaves. These physical methods stimulate the process of tissue repair within the frontal sinus. They activate the regeneration of the mucous membrane lining the sinus.

With a protracted course or the development of complications, as well as the ineffectiveness of the therapy being carried out, surgical treatment of frontal sinus is performed, which consists in carrying out a puncture of the frontal sinus followed by washing it and administering drugs.

The period of rehabilitation (washing and injection solutions) usually lasts 1-1.5 weeks. All this time, the patient walks with a drainage tube, through which solutions are fed into the sinus.

Forecast

Favorable prognosis is observed only with timely diagnosis and adequate treatment. Absence or low effectiveness of treatment can lead to the appearance of such complications as:

Interesting

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