Sinusitis
Sinusitis is an inflammation of one or more of the four sinuses (maxillary, frontal, sphenoidal or ethmoidal) that includes the human body.
Causes
When a virus, a fungus (fungus), a bacteria or an allergy affecting the lining of the nose, they react s'inflammant and swelling, causing obstruction of the sinuses. Therefore, mucus is no longer drained normally, and viruses or bacteria can grow rapidly. Sinusitis start then, in most cases, a viral nasopharyngitis causing impairment in the purifying apparatus ciliated nasal sinus and may evolve into a true bacterial sinusitis. The sensations of pressure that the patient may feel are due to the pressure caused by obstruction of the sinuses.
Major infectious agents:
* Rhinovirus
* Myxovirus
* Adenovirus
Major bacteria causing sinus superinfections:
* Haemophilus influenzae
* Streptococcus pneumoniae
* Moraxella catarrhalis
* Staphylococcus aureus
* Anaerobic (rare, linked to a dental home)
Mushrooms:
* Aspergillus
Sinusitis can be of two types:
* Acute: caused in most cases by a viral infection of the cold type, it heals in two or three weeks. It can also be caused by allergies or dental abscess.
* Column: they are the consequence of inadequately treated infection episodes, and are often favored by anatomical factors or allergies.
Various locations:
1. the maxillary sinuses (sinusitis most frequent possible from the age of 4-6 years as before, the maxillary sinus is not completely formed)
2. the frontal sinus (possible from his training at age 11-13 years)
3. the sphenoid sinus (after 15 years)
4. the ethmoid sinuses (infant and child)
Diagnosis
People at risk
Some people are more likely than others to contract sinusitis. Adults are generally more exposed, because the sinuses are formed gradually until age 12. Sometimes, however, that infants and young children are suffering from sinusitis. Individuals with a history of sinusitis were also more likely to incur again. People with allergies or whose immune system is weakened (due to another illness, for example) are more likely to report a sinusitis. Three other factors increase the risk of sinusitis, people with congenital defects of the nose or sinuses, nasal polyps or cystic fibrosis.
Risk factors
In addition to medical history, environmental factors facilitate the occurrence of sinusitis. Examples of moisture or air pollution, stress or exposure to cigarette smoke.
Clinical signs
A diagnosis of acute purulent sinusitis with bacterial infection can be made when at least two of the three signs below are present:
* Constance or increased pain in the sinuses orbits despite taking a symptomatic treatment for at least 48 hours.
* A unilateral or throbbing pain that increases possibly: the end of the day, night and when the head is bent forward.
* Increased nasal discharge (rhinorrhea), especially if they are unilateral.
Other secondary signs can reinforce the diagnosis, persistent fever beyond 3 days and / or sneezing, nasal congestion, coughing, discomfort in the throat if they stay longer than 10 days. Nasal secretions yellowish or greenish often indicate an infection caused by bacteria. A reduction or loss of smell and a bad breath are also symptoms of reinforcing the diagnosis. A radiograph is useful in cases of doubt about the diagnosis or possibly after an initial failure of treatment with antibiotics. The scanner is meanwhile reported that suspected cases of complex or sphenoidal sinusitis, the latter is not visible radiographically. Collection of secretions through the endonasal middle meatus or by sinus puncture is rarely performed.
Acute maxillary sinusitis in adults
It is easy to confuse with rhinosinusitis acute viral nasopharyngitis or where the appearance of purulent nasal secretions is normal during the first days.
Maxillary sinusitis in children
It can mean two different ways during the early days in children:
* In its acute severe, there is a high fever (above 39 ° C) associated with headache (headache), purulent rhinorrhea and sometimes even a periorbital edema.
* In its subacute cough associated with rhinorhée purulent nasal obstruction are signs that last for more than 10 days without improvement.
Sphenoid Sinusitis
It is rare and is revealed by deep pain, sleepless retro-orbital on which painkillers have little effect. It usually involves a posterior rhinorhea (flow of nasal secretions in the throat).
The ethmoidite
Extremely serious in infants, it remains relatively rare. It leads to high fever (39 to 40 ° C) accompanied by headache, prostration (withdrawal), purulent rhinorhea and possibly swelling of the eyelid.
Complications
In rare cases, if the infection remains untreated it can spread and affect the eyes (especially for ethmoidites) or brain (frontal and sphenoid sinusitis), leading to serious complications. We find among them, meningitis, brain abscess, thrombophlebitis of the cavernous sinus or longitudinal, the sub dural empyema or osteomyelitis (mainly in children).
Treatment
It is imperative to see a doctor, sinusitis often treated by self-medication over time may be chronic ....
Acute sinusitis
Antibiotics are usually prescribed in cases of sinusitis, but this approach remains controversial. Some recommendations say that the antibiotic is indicated in cases of sinusitis prolonged (more than a week) which may be indicative of bacterial infection. They are however not always indicated from the outset, in fact they are recommended in the following cases:
* In all cases of purulent frontal sinusitis, ethmoidal or sphenoidal (see complications).
* When sinusitis is diagnosed based on criteria defined in the "clinical signs". (Recommendation Grade B = Presumption scientific)
* In case of failure of treatment of symptoms or complications. (Professional Agreement)
* In the case of a unilateral maxillary sinusitis associated with dental infection. (Professional Agreement)
* In other cases of purulent sinusitis.
Antibiotic treatment of purulent maxillary sinusitis usually lasts between 7 and 10 days. (Recommendation Grade C = Weak evidence). The antibiotic most commonly used in bacterial sinusitis is Augmentin for a period of 10 days.
Antibiotic therapy is usually associated with treatment of symptoms. These treatments are generally composed of painkillers such as aspirin, ibuprofen or Tylenol (R) to fight against pain, particularly headaches. Corticosteroids may be prescribed oral short course (maximum 7 days) to decongest the nose. Local vasoconstrictors are also sometimes prescribed.
Chronic sinusitis
Chronic sinusitis usually appear after several episodes of acute sinusitis. Sometimes, however, that the very first episode, acute sinusitis progresses to chronicity, especially when the latter is inadequately treated. Chronic sinusitis is most often explained by allergies, especially certain fungi. This explains why some anti-fungal would be able to reduce patients' symptoms. Surgery may be used in rare cases, it is to restore sinus drainage or restore structural congenital anomalies of the nose. It should however be used as a last resort.
Read also Allergy
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