Purulent sinusitis, ICD code 10. Acute sinusitis: types, features and characteristic symptoms

In this publication, we will explain what the international classification of diseases of the 10th revision means for the disease - sinusitis (ICD code 10). The discussion will naturally go to the chronic and acute form of the disease.

Sinusitis is a problem characterized by the activation of the inflammatory process in the maxillary canals. They are also called maxillary.

This ailment is accompanied by damage to the mucous membrane and blood vessels localized in these sinuses. The main causes of the problem are adenovirus and rhinovirus infections, which are activated after the flu.

All characteristics of the disease are indicated in the regulatory document, it contains all the disease codes.

Sinusitis - ICD 10

According to the international classification of diseases, sinusitis belongs to the tenth class, code J32.0.

It is divided into the following forms:

1. aggravated. According to ICD 10, this condition is called "acute respiratory infection of the upper respiratory tract";
2. Chronic. The form belongs to the heading "other diseases of the upper respiratory tract".

Pathology is classified separately depending on which pathogen provokes it.

These categories are marked with the code B95-B97. The first code B95 refers to pathogens such as streptococci and staphylococci. Code B96 is the designation of an ailment provoked by other bacteria. B97 means that the disease began due to viral infections.

Chronic and acute forms may have an unspecified ICD 10 code.

Adults and children are equally susceptible to infection. According to statistics, inflammation of the maxillary sinuses is the most common disease among all ENT pathologies.

Acute sinusitis - ICD code 10

This inflammatory process refers to acute sinusitis. The symptoms of this condition are pronounced. At the same time, pain is felt in the cheek area closer to the nose. The body temperature also rises, there is discomfort under the eyes when the head is tilted forward.

Even acute sinusitis in a person can be manifested by severe pain, which is hard to endure. Sometimes the tear duct is affected, and as a result, increased lacrimation.

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Treatment of the pathological condition should begin immediately. The whole complexity of this form of the disease is that the walls of the maxillary sinuses are thin and there is a possibility of infection of the brain, but this condition is extremely rare. And an infectious lesion of the orbit and the membrane of the eye occurs with an exacerbated course of the disease much more often.

An untreated disease can provoke a complication in the form of constantly recurrent bronchitis.

Chronic sinusitis - ICD code 10

Chronic accompaniment of pathology belongs to group J32. This condition occurs due to the running period. At the same time, a secret will accumulate in the maxillary sinuses for a long time.

It often happens that initially the inflammation is one-sided, but in the course of its long continuation it spreads to the other side. Then the disease becomes bilateral.

Chronic sinusitis (ICD code 10) is less pronounced. Symptoms include pain with prolonged nasal congestion. Pain in the sinus area is usually mild or absent.

Nasal congestion causes a lot of discomfort to a person, since as a result of this symptom, lethargy, fatigue, headaches, etc. will often appear.

More pronounced symptoms during exacerbation of the chronic form of the disease:

• body temperature rises;
• headache;
• swelling of the cheeks and eyelids.

Swelling of the face with inflammation

According to the ICD, chronic sinusitis can be allergic, purulent, catarrhal, complicated, odontogenic, cystic and fibrous. Only a qualified specialist can accurately diagnose and prescribe treatment. And the normative document helps to make the correct diagnosis.

Bacterial sinusitis very often leads to the accumulation of purulent contents in the accessory cavities of the nose. The main line of therapy in this case is the fight against pathological bacteria with antibiotics. Along with the suppression of the bacterial flora in the inflamed sinuses, each doctor has a second task - to restore the drainage function of the maxillary sinuses. And if…

Ceftriaxone is a fairly strong antibiotic, which is often used for sinusitis. It should be understood how to properly treat and what precautions should be taken. Features of the antibiotic Ceftriaxone is a third-generation antibiotic that has a fairly wide spectrum of action. At the same time, he is prescribed to treat the following problems: infections of the lower and ...

With sinusitis, washing is often prescribed. In this case, various drugs and saline solutions are used. A special effect can be obtained by using the drug furatsilin, which has a disinfecting effect. It is important to know and understand how to properly carry out the washing procedure in order to get the maximum effect. Features of the drug The drug Furacilin belongs to the drugs of the nitrofuran group. He has…

An inflammatory process that occurs in one or more paranasal sinuses is called sinusitis (sinui?t). Sinusitis can occur in two forms - acute and chronic.

Classification according to ICD 10

According to the international classification of diseases of the tenth revision, acute sinusitis (J01) is divided into:

• J01.1 Front
• J01.2 Ethmoid
• J01.3 Sphenoidal
• J01.4 Pansinusitis

In turn, chronic sinusitis (J32) is divided into:

• J32.0 Maxillary
• J32.1 Front
• J32.2 Ethmoid
• J32.3 Sphenoidal
• J32.4 Pansinusitis
• J32.8 Other chronic sinusitis
• J32.9 Chronic sinusitis, unspecified

The terminology of the disease depends on the location of the sinusitis. Most often, the disease occurs in the maxillary sinuses, which are located in the maxillary part of the head. If the inflammatory process affects only the maxillary sinuses, then this condition is characterized as sinusitis.

Maxillary sinusitis (sinusitis) (Mkb10 code J32.0.) - inflammation in the upper paranasal sinuses of the nasal cavity. The disease can occur at any age. According to statistics, every tenth person suffered this disease.

It is very important to start treating the disease at the initial stage of development, otherwise it will turn into a purulent form of leakage and subsequently can provoke the development of serious complications.

Causes

In most cases, sinusitis (ICD code 10) occurs as a result of a repeated, incompletely cured cold and rhinitis. But in addition to SARS and a runny nose, the main cause of the disease is neglected teeth affected by caries, especially in the upper jaw (odontogenic). Diseases that cause disorders in the immune system (allergies, paritosis and other long-term chronic diseases) can provoke the development of maxillary sinusitis.

An important reason for the development of sinusitis is infection. Quite often, during the diagnosis of sinusitis in a person, staphylococcus aureus is detected from a swab taken from the nasal cavity. During the period of occurrence of the most common and harmless cold, staphylococcus begins to show its pathogenic properties.

Also in medical practice, the following reasons are distinguished, as a result of which maxillary sinusitis develops:

• entry into the nasal mucosa of pathogenic bacteria and chemicals
• severe hypothermia
• abnormal anatomical structure of the nasopharynx
• congenital pathologies of the secretory glands
• nasal septal injury
• the presence of polyps or adenoids in a person, etc.

Regular and long-term use of nasal preparations is the main factor provoking an abundant accumulation of mucus in the paranasal sinuses, resulting in the development of sinusitis (International Classification of Diseases 10).

Symptoms

The main signs of the development of maxillary sinusitis include:

• The appearance of abundant mucous discharge from the nasal passages. At the initial stage of the development of the disease, the discharge from the nose is transparent and liquid. Then acute sinusitis develops (ICD 10 J32.0.), And the nasal discharge becomes thicker in consistency and acquires a yellow-green color. If a patient has developed chronic maxillary sinusitis (International Classification of Diseases 10), then nasal discharge may be bloody.
• Memory deterioration.
• Problems with night sleep.
• Weakness and disability.
• Increased body temperature and chills (sometimes the temperature can rise to 38 ° C, and in some cases up to 40 ° C).
• Severe headaches.
• Lack of appetite.
• Pain in the temples, neck and frontal part of the head.

When the first symptoms of the disease appear, you should immediately consult a doctor.

Currently, the most common and most common types of ailment in medical practice are distinguished:

Each type of disease has its own distinctive causes of occurrence, signs and forms of flow.

Spicy

The main factor causing acute sinusitis (international classification of diseases 10 J32.0.) is infections that enter the upper respiratory tract of a person, as well as untreated colds, cause an inflammatory process in the mucous membrane of the maxillary sinus. Against the background of the onset of the disease, the patient develops severe swelling of the mucous membrane of the nasal passages.

Acute sinusitis and its symptoms

With a mild course, acute maxillary sinusitis provokes an increase in pressure in the area of ​​\u200b\u200bthe inflamed sinuses, as a result of which the patient's breathing through the nose is disturbed. Initially, discharge from the nasal passages is clear or white. If not treated to eliminate foci of infection, then over time they become yellow-green in color and become thicker. All these symptoms mean that the patient has developed a purulent inflammatory process. At the acute stage of the course of the disease, a person begins to be disturbed by dizziness, drowsiness, pain in the eyes, cheekbones, occipital and frontal parts of the head.

After the final confirmation of the diagnosis, treatment should be started immediately, since over time the disease becomes chronic.

Treatment of acute sinusitis

As a rule, acute maxillary sinusitis is amenable to effective conservative treatment. Therapy consists in taking antibiotics and antihistamines to reduce swelling of the mucosa.

Chronic

The inflammatory process in the mucous membrane of the maxillary sinuses, which lasts more than one month, turns into chronic maxillary sinusitis (international classification of diseases 10).>

Signs of chronic sinusitis

The symptomatology of the disease is changeable. During remission, there are practically no symptoms. During an exacerbation, the patient may show signs of illness such as congestion of the nasal passages, mucous discharge from the nasal cavity becomes green or yellow, a slight increase in body temperature (no more than 38 ° C), weakness, severe malaise, headache, sneezing, etc. .d.

Causes of chronic maxillary sinusitis

Quite often, chronic sinusitis occurs against the background of not treating the disease, or if the patient during an exacerbation underwent ineffective drug therapy. Also, the chronic stage of the disease occurs if a person has a congenital or acquired abnormal structure of the nasal septum.

The chronic form of the disease should not be left to chance, as it can cause the following complications: tonsillitis, laryngitis, otitis media, pharyngitis, dacryocystitis, apnea and mental impairment.

Treatment

During remission, the nasal cavity should be flushed with a weak saline solution, saline, and other nasal solutions. During an exacerbation, drug therapy is carried out. If the disease is not amenable to conservative treatment, then surgical intervention (genyantrectomy) is performed.

Odontogenic

The causative agent of odontogenic maxillary sinusitis (international classification of diseases 10) are infections such as staphylococcus aureus, escherichiosis, streptococcus. Also, odontogenic sinusitis in humans can occur due to the presence of deep caries in the oral cavity.

Signs of odontogenic sinusitis

When the first symptoms of the disease appear, it is necessary to consult a doctor, as the following serious consequences may occur: severe swelling, inflammation of the eye sockets, circulatory disorders in the head.

Odontogenic maxillary sinusitis is characterized by such signs as general malaise, severe pain in the head, slight fever, disturbed night sleep, decreased immunity, and soreness is felt in the maxillary sinus area.

Treatment

Before carrying out therapy, it is necessary to determine the localization and cause of the inflammatory process in the maxillary sinuses. If odontogenic inflammation was caused by caries, then it is necessary to sanitize the oral cavity. In the future, antibiotic and vasoconstrictor drugs are prescribed.

Prevention

Preventive measures are as follows: you should visit the dentist at least twice a year, do not overcool, increase physical activity, take vitamins in a complex to strengthen immunity, do breathing exercises in the morning, treat viral diseases in a timely manner.

Sinusitis according to the ICD-10 code, features of treatment of various forms

Sinusitis is one of the varieties of sinusitis, which can occur in acute or chronic form. It is considered as a complication of rhinitis, when the inflammatory process affects the maxillary sinus (sinus).

Among all sinusitis, sinusitis occupies a leading position. Adults and children are ill with it, and in everyday life the word "sinusitis" is found quite often, even when the patient actually has a banal runny nose.

People who do not have a medical education interpret rhinitis in different ways. Some say that they suffer from snot, others from sinusitis, although in fact nasal discharge may indicate different forms of rhinitis or sinusitis, but have similar symptoms of the disease.

Sometimes patients with a mild form of the common cold are treated on their own with "shock" doses of nasal remedies, and, in some cases, on the contrary, sinusitis is ignored or weak solutions are instilled. Both are unacceptable.

Doctors must establish the cause of nasal discharge, make a diagnosis, and, based on the studies obtained, prescribe a treatment regimen. For the convenience of systematization of various pathologies and their varieties, an international classification of diseases (ICD-10) has been developed, which helps physicians around the world to group data on the desired disease.

Acute and chronic sinusitis ICD-10 code

In the ICD-10 regulatory framework, sinusitis, like many other diseases, takes its own steps: classes, blocks, codes. Every 10 years, WHO strictly controls this basic document and checks the accuracy of the information entered. Let's focus on the classifier itself, and determine how sinusitis is encoded.

Acute and chronic sinusitis placed in the classroom "Diseases of the Respiratory Organs" (J00-J99) , but these two forms of the disease are in different blocks .

Acute sinusitis placed in a block "Acute respiratory infections of the upper respiratory tract" (J00-J06) under the following name and code – « Acute maxillary sinusitis (J01.0).

Chronic sinusitis assigned to another block "Other diseases of the respiratory tract" (J30-J39) codenamed – « Chronic maxillary sinusitis" (J32.0).

When the causative agent of the disease is found (bacterial culture is carried out), it is recommended to use additional coding (auxiliary):

• B95 - streptococcus or staphylococcus are the cause of sinusitis;
• B96 - various bacteria, not including the above;
• B97 - the viral nature of sinusitis.

The presented classification is actively used in world practice, and otolaryngologists can easily find all the necessary information about sinusitis. And now let's move on to the acute and chronic form of sinusitis, which we examined in the classifier, and dwell on each in detail.

Acute sinusitis - " Acute maxillary sinusitis (J01.0) according to ICD-10

The acute form develops rapidly and after a couple of days the disease has all the characteristic symptoms:

• breathing through the nose is difficult;
• impaired sense of smell;
• body temperature is significantly increased;
• pressing headaches;
• lacrimation;
• swelling over the affected area;
• pain in the facial area when chewing;
• blowing the nose does not alleviate the patient's condition;
• there is pain in the cheekbones and bridge of the nose;
• yellow, green or mucopurulent discharge occurs, sometimes with an unpleasant odor;
• apathy and lack of appetite.

The acute process lasts from 7 to 20 days, and is more common in children from 5 to 14 years old.

The trigger mechanism for acute sinusitis can be:

• adenoids;
• stomatitis;
• tonsillitis;
• untreated runny nose;
• caries;
• bacterial and fungal infection of the maxillary sinuses;
• influenza and SARS;
• anatomical problems causing insufficient ventilation of the paranasal sinuses;
• infectious diseases (scarlet fever, measles, others).

The inflammatory process contributes to obstructive disorders in the sinuses. Bacteria in the maxillary sinus are "delivered" in three ways, consider them:

• hematogenous (through the blood) - observed in infectious diseases;
• rhinogenic - the primary focus is in the nasal cavity;
• odontogenic - occurs as a result of pathological processes in the oral cavity. Such sinusitis is called odontogenic. After sanitation of the focus of infection, this form of sinusitis is quickly cured.

Predisposing factors for the development of the disease can be:

• bronchial asthma;
• allergic rhinitis;
• foreign bodies (more often in children when putting beads, peas and other small objects into the nose);
• polyps in the nasal cavity;
• violation of the structure of the nasal passages;
• curvature of the nasal septum;
• diseases of the immune system;
• facial trauma;
• otitis;
• medical manipulations in the nose;
• diabetes;
• bad ecology;
• sharp fluctuations in atmospheric pressure;
• other.

Diagnostic methods for detecting acute sinusitis according to ICD-10

The diagnosis of "acute sinusitis" is made on the basis of examination, rhinoscopy and patient complaints. An experienced doctor will immediately say that you are the "owner" of sinusitis. Additional diagnostic methods may be prescribed to confirm the diagnosis:

• radiography of the maxillary sinus;
• survey radiography of the paranasal sinuses;
• CT and MRI;
• sinus puncture;
• laboratory tests (general blood count, bacterial culture of the contents of the sinuses).

Treatment of acute maxillary sinusitis (sinusitis)

The emphasis in the treatment of the disease is reduced to the removal of swelling in the nasal cavity, the release of the sinus from pus and mucous discharge, as well as the elimination of pathogenic microflora, which caused the focus of inflammation. The main task is to prevent the development of purulent sinusitis and take all necessary measures at the first sign of the appearance of pus in the sinuses.

To solve this problem, drugs of the following groups are prescribed:

• antibiotics (augmentin, zinnat, azithromycin, polydex, bioparox, isophra) - local and systemic drugs are used;
• antiseptics (furatsilin, collargol, protargol);
• antihistamines (telfast, suprastin, erius, tavegil, claritin);
• vasoconstrictors (rinazolin, farmazolin, tizin, ximelin, naphthyzinum) - they are not used for a long time;
• moisturizing nasal preparations (salin, rhinolux, quicks, humer, delofen);
• anti-inflammatory drugs (iburprofen, aspirin, paracetamol);
• corticosteroids (nasonex, baconase, avamys, prednisolone) - in drops and tablets;
• probiotics (linex, bifiform, probifor, bifiliz, biosporin) - "cover" the body from the harmful effects of antibacterial agents.

All these drugs are prescribed only by a doctor, taking into account the age, history and weight of the patient.

In the process of rehabilitation, physiotherapeutic methods are used:

Important! During acute sinusitis, all warming procedures are excluded, due to the high probability of the spread of the inflammatory process beyond the lesion.

If conservative therapy is inadequate, they resort to drainage of the maxillary cavity, followed by washing and sanitation, antibiotics are injected into the cavity. Manipulations of this kind are carried out only in the conditions of an ENT hospital.

If acute sinusitis was not cured in time, that is, there is a high chance of the disease becoming chronic, in which the treatment will be longer and not always effective.

Particular attention should be paid to the treatment of bilateral sinusitis, when both sinuses are affected. The sooner therapy is started, the sooner you can get rid of the disease and forget about it forever. Otherwise, the focus of infection can reach other sinuses, affect the brain and enter the systemic circulation through the hematogenous route.

Chronic sinusitis - "Chronic maxillary sinusitis" (J32.0) according to ICD-10

A protracted acute process after a month passes into the chronic stage, which is divided into the following forms:

• catarrhal (superficial, most favorable) - abundant discharge;
• allergic - the source is often an allergen of unknown etiology;
• purulent or purulent-polypous - a dangerous form when bacteria multiply rapidly and the snot becomes green;
• polyposis - the formation of focal hyperplastic growths in the sinuses;
• parietal-hyperplastic;
• necrotic (disintegration of tissues inside the sinus occurs).

Diagnosis of chronic sinusitis is carried out according to the same scheme as in acute forms. Only after the diagnosis is made - chronic sinusitis, according to the ICD-10 code J32.0 The doctor draws up an individual treatment plan. It should be noted that the doctor indicates this code on the disability sheet (“sick leave”).

The causes and predisposing factors for the development of the chronic form are practically no different from acute sinusitis. The only difference is that the main cause of chronic sinusitis is advanced acute inflammation of the maxillary sinuses.

The symptomatology of the disease varies from the degree of damage to the sinuses, and again it is very similar to acute sinusitis, only all manifestations of the disease are less pronounced. The body is so adaptable to infection that the general condition of patients is quite satisfactory. During exacerbations, symptoms tend to be activated.

As a result, we have a sluggish chronic process, which often causes the following complications:

• arthritis;
• myocarditis;
• pyelonephritis or glomerulonephritis;
• tonsillitis;
• dacryocystitis (inflammation of the lacrimal sac);
• inflammatory processes of the lower respiratory tract;
• and many others.

Treatment of chronic sinusitis

Chronic sinusitis is treated not only by an otolaryngologist, but also by other specialists: allergists, immunologists, dentists, gastroenterologists. The patient is washed with nasal sinuses, anti-inflammatory and antibacterial therapy is carried out. It is mandatory to carry out the rehabilitation of the teeth.

In the case of anatomical abnormalities, surgical rhinoplasty is necessary to improve the ventilation of the blocked sinuses.

In general, the treatment is the same as for acute sinusitis, but in addition, a course of treatment with immunomodulators is carried out, which increase the body's defenses. To improve immunity, vitamin therapy, spa treatment on the sea coast, in pine groves, salt mines, hardening, physiotherapy exercises, dietary nutrition and other restorative methods are shown.

Currently, such techniques as bodyflex, reflexology, ozone therapy, Kneipp baths and various meditations are popular, allowing you to focus on the diseased organ and “expel” the disease from the body.

Physiotherapy is possible only after the elimination of the purulent process, when the body is being rehabilitated and the function of the mucous membranes is being restored.

Getting rid of chronic sinusitis is not easy, and only relying on a doctor is a thankless task.. No one argues that pills, drops and procedures eliminate the focus of inflammation, but it should be remembered that any chemical preparations reduce immunity, and each time it becomes more and more difficult for the body to fight the infection.

How to cure sinusitis without a puncture

Sinusitis according to ICD-10 - forms and features of the disease

Almost everyone knows about sinusitis. ICD-10 classified it like all other diseases. Almost every branch of knowledge is systematized and medicine is no exception.

Sinusitis in the ICD-10 system

The basic normative document in this area is the international statistical classification of diseases and problems related to human health (ICD). This edition includes 3 volumes - this is an alphabetical index, instructions and the classification itself.

This compilation was compiled by the World Health Organization. Every 10 years, she reviews the document and makes various additions. Thanks to the ICD, it is possible to compare disease data between different countries. At the moment, the document is valid after the 10th revision - ICD-10.

This document has been drawn up in order to create optimal conditions for the processing of statistical data and their analysis. This way you can analyze various diseases and mortality rates, as well as compare such indicators between countries.

Thanks to the ICD-10 classification, any diagnosis is transformed into a code, a set of letters and numbers, which greatly simplifies the process of analyzing and storing information.

Classification structure

The structure is quite simple. After the introduction of the tenth version of the document, a new feature appeared. Now, in addition to 4 digits, the code will also contain a letter. Thanks to this trick, the dimensional structures are increased by 2 times, since about 300 new categories of a three-digit type have appeared.

By the way, all letters are taken from the Latin alphabet, and only U remains spare. In other words, the codes U00-U49 are used only as temporary ones. They are used to refer to diseases that do not currently have a clearly understood origin. But the codes U50-U99 are used only for various studies.

In addition, the code numbers are extended from A00.0 to Z99.9, and all diseases are divided into 21 classes. By the way, there are also diseases that appear after medical intervention.

• chronic sinusitis according to ICD-10 has code J32.0;
• frontite is numbered J32.1;
• ethmoiditis - J32.2;
• sphenoiditis - J32.3;
• pansinusitis - J32.4.

Other varieties of sinusitis, including the chronic form, should be marked under the number J32.8. If it is unspecified, then the code J32.9 must be set.

Varieties of sinusitis depending on the location of the inflammation

Sinusitis is a very common disease. Moreover, scientists have not established dependence on the region. In almost every country, the microflora of microorganisms are very close.

The most common cause that causes this disease is precisely the influenza epidemic, which is repeated cyclically. Hence, it increases the risk of developing a chronic disease. And human immunity is constantly weakening.

However, in recent years, another relationship has become noticeable - between the development of the disease and adverse environmental factors. For example, it affects gas pollution, toxic emissions into the atmosphere, dustiness.

Sinusitis is often confused with sinusitis, in fact it is not the same disease. Sinusitis is considered a term that combines all diseases associated with inflammatory processes in the sinuses around the nose.

There are 4 main forms of sinusitis:

1. Sinusitis - inflammatory processes occur in one or two maxillary sinuses.
2. Frontitis - only the frontal sinuses are affected.
3. Ethmoiditis - the labyrinth becomes inflamed.
4. Sphenoiditis - the sinuses of the sphenoid type are affected.

Separately, rhinosinusitis is also isolated. This is a disease in which both the mucous membranes of the nasal canals and the paranasal sinuses become inflamed at the same time. For example, with such a disease, sinusitis is often combined with a simple runny nose.

The maxillary sinus is a paired nasal sinus. If we consider the projection on the face, it turns out that they are located directly under the eyes - on the left and right sides of the bridge of the nose. Sinusitis can develop in one or both sinuses. Depending on the side of the lesion, left-sided, right-sided or bilateral are distinguished.

You can even determine the variety visually, since mucus will be released from only one nostril. Severe pain is also felt on one side of the face. Inflammatory processes are always accompanied by the appearance of puffiness, so there will be bags under the eyes. By their appearance, one can determine the type of disease. If the swelling appeared only on one side, then the inflammation is also located in one sinus.

In this case, standard treatment procedures apply. If this does not help with an acute form, then you will have to puncture the sinuses.

Forms depending on the course of the disease

Depending on the course of the disease, there are the following forms:

There are differences in the symptoms, consequences and duration of the course of the disease.

Acute sinusitis

It is the result of a complication. Usually this form lasts about a month. In this case, the patient has a headache, the body temperature rises, chills occur. He feels slightly unwell.

If you often tilt your head forward, then the pain will begin to become more intense. This is due to the fact that the pressure from the front surface of the sinus increases. Sometimes there is photophobia and intense release of tears.

With this form, it is very difficult or impossible to breathe through the nose due to the fact that it is very stuffy. The patient begins to worry because of the profuse secretion of mucus and clots of pus in it. The sense of smell will disappear, the eyelids will swell, and the cheeks will swell.

Treatment of the acute form is carried out by a conservative method. Always apply anti-inflammatory drugs, washing. You can't warm up your nose.

Chronic sinusitis

It is long-term, usually lasting about 2 months, and sometimes more. In this case, the patient constantly suffers from malaise, quickly gets tired, feels weak. The headache gets worse in the evening, as does the congestion.

Since inflammatory processes do not stop for a long time, they can cause serious side effects. For example, the meninges or eye tissue swells, meningitis, brain abscess, and venous thrombosis develop.

Chronic sinusitis is usually treated with physiotherapy. Inhalation helps well, you can use dry type heating. The chronic form of sinusitis is treated much longer than the acute form.

It must be remembered that the mucous membranes change from disease. Sinusitis may be accompanied by an active release of pus and mucus, or the shell itself will begin to actively change. Depending on this, exudative or productive forms are distinguished.

Exudative sinusitis

Mucus and pus come out profusely, making it difficult to breathe. Depending on the secretions themselves, sinusitis will be purulent or catarrhal. In the catarrhal form, the discharge is liquid, but viscous. The mucous layers swell, the intensity of the discharge increases. This condition is dangerous due to the fact that if left untreated, mucus stagnation leads to the formation of a purulent form.

To treat this form, you will need medicines that have vasoconstrictive properties. This will help reduce swelling. Washing should also be done regularly.

Productive form of sinusitis

With a productive form, not only inflammatory processes develop, but the mucous membrane begins to change. In this case, degeneration causes polypous and hyperplastic sinusitis.

With a polyposis form, growths can be found on the mucous membranes - these are polyps. They can completely close the channels so that the mucus will not come out. There are problems with breathing and smell. In severe form, it will be painful for a person to swallow.

In the hyperplastic form, the mucous membranes begin to thicken. It is because of these processes that the lumen of the channels begins to become thinner. Sometimes treatment is complicated by the fact that the nasal septum is curved. In this case, surgery will be required.

Inflammatory processes in the cavities near the nose can be caused by various reasons. These can be viral, bacterial, fungal infections, taking medications, exposure to toxic substances, injuries.

Sinusitis in the ICD-10 classification is listed as a type of sinusitis, although it is one of the most famous diseases. By the way, with an incorrect diagnosis, you can really confuse this ailment with other forms of sinusitis, which are very diverse.

Sinusitis from the point of view of ICD 10 and practical medicine

Inflammation of the maxillary sinuses is a fairly common disease in adults and school-age children, which an otorhinolaryngologist has to deal with. For the convenience of systematizing all information about diseases and pathological conditions, including prevalence, morbidity and mortality among the population, an international statistical standard has been developed, which is updated every 10 years. The tenth revision of this classifier is currently in force. Like all other diseases, sinusitis in ICD 10 has its own code - let's talk about this in more detail.

What it is

Inflammation in the paranasal sinuses is collectively called sinusitis, along the course it can be acute or chronic, infectious or allergic in etiology. Depending on the localization, the following types of this pathology are distinguished:

• sinusitis - an inflammatory process in the maxillary (maxillary) sinuses;
• frontal sinusitis - damage to the frontal (frontal) sinuses;
• ethmoiditis - the cells of the ethmoid labyrinth are affected;
• sphenoiditis - inflammation in the cavity of the sphenoid bone.

Sinusitis is the most common form of sinusitis due to the proximity of the sinus to the nasal cavity and the teeth of the upper jaw. It almost always accompanies any viral infection in which there is acute rhinitis, manifesting itself as symptoms of a common cold. With good immunity, such inflammation in the maxillary sinus ends with recovery simultaneously with the disappearance of signs of rhinitis.

Some people who have anatomical prerequisites for disrupting normal air exchange in the maxillary sinus (polyps, septal defects, etc.) may develop purulent inflammation caused by the penetration of microbes from outside or from internal foci of infection in the body itself.

Acute maxillary sinusitis of this origin is treated conservatively. A chronic process most often requires a certain surgical intervention to eliminate the cause of congestion in the sinus (straightening of the septum, removal of adenoids or polyps, etc.).

Codes and designations

International statistics, which uses a special classification of diseases and health problems, is widely used by doctors in practice to systematize data on various nosologies. Sinusitis according to ICD 10 has its own code designations. It differs in the nature of the course as acute or chronic sinusitis of the maxillary sinuses. The first one belongs to the section of acute respiratory infections of the upper respiratory system (J00-J06) and has the code J01.0. The second is listed among other diseases of the respiratory tract (J30-J39), its code is J32.0. Inflammation of the remaining paranasal cavities are indicated by other codes.

• 1 - in the frontal sinuses;
• 2 - in the lattice labyrinth;
• 3 - in the cavity of the sphenoid bone;
• 4 - defeat of all sinuses (pansinusitis);
• 8 - acute polysinusitis;
• 9 - acute rhinitis with sinusitis.

Chronic inflammatory processes:

• 1 - in the frontal sinuses;
• 2 - in the cells of the ethmoid bone;
• 3 - in the sphenoid sinus;
• 4 - in all sinuses (pansinusitis);
• 8 - other polysinusitis;
• 9 - chronic sinusitis of unspecified origin.

Sometimes it becomes necessary to indicate the causative agent of sinusitis if it was isolated as a result of a bacteriological analysis (sowing from the nose) in a particular patient. In this case, an auxiliary code designation is added:

• B95 - streptococcal or staphylococcal infections;
• B96 - other bacteria;
• B97 - the disease is caused by viruses.

From the video you will learn how to easily cure sinusitis with folk remedies:

Peculiarities

Inflammation of the maxillary sinus does not occur from scratch, usually the patient has anomalies of the facial skeleton, nasal septal defects, polyps, adenoids and other obstacles to normal air exchange between the nasal cavity and the accessory sinus. Hypothermia, an unfavorable allergic background, poor ecology, frequent respiratory infections, pathology of the teeth of the upper jaw and heredity can provoke the development of the disease. Acute inflammation of the maxillary sinuses is usually a complication of SARS and is manifested by symptoms such as:

• heat;
• nasal congestion;
• persistent general headache;
• local pains in the areas of projection of the sinuses on the face, aggravated by pressure, when turning the head or tilting the torso forward.

Chronic sinusitis develops from poorly treated acute inflammation with the anatomical conditions available to maintain it. Its manifestations are not so pronounced, but they are stable: constant runny nose, frequent headache, increased fatigue, nasal voice and decreased sense of smell, increased susceptibility to respiratory infections. Chronic sinusitis can occur in different forms: catarrhal, purulent, hyperplastic, polypous, cystic. Each of these forms will differ in the choice of patient management tactics.

Treatment

It is necessary to treat sinusitis, the sooner the disease is detected, the better it will end for the patient.

Complicated forms of inflammation of the maxillary sinuses are dangerous for the patient, since such vital organs as the brain (shells and substance) and organs of vision are involved in the process, fortunately, they are rare in weakened patients with a low level of immunity.

Treatment of acute sinusitis is carried out mainly by conservative methods, puncture is used in rare cases. The chronic process often has to be eliminated with the help of surgical interventions in order to normalize the normal function of the sinus. Conservative therapy includes the following activities:

• ensuring the outflow of pus and restoring normal ventilation of the sinus with the help of vasoconstrictors;
• antibacterial therapy with broad-spectrum drugs from the group of macrolides, penicillins or cephalosporins;
• anti-inflammatory drugs are prescribed according to indications (steroid hormones, non-steroidal and antihistamine drugs).
• washing the nose with solutions of sea salt or Dolphin;
• physiotherapeutic procedures are applied in the phase of subsiding of the acute process.

You can’t self-medicate with sinusitis, this disease is one of the dangerous pathologies in children and adults, so any suspicion of inflammation in the sinuses should be a reason for immediate medical attention.

Codes for acute and chronic sinusitis in ICD-10

The key basis for statistics and classification of health problems is the International Classification of Diseases. For a patient with sinus inflammation, knowing the ICD-10 code for his illness is not important. This classification helps the doctor to bring together and systematize data on diseases at the global level.

To date, the current classification is the International Classification of Diseases 10th revision. In Russia, healthcare institutions switched to this system back in 1999.

What role in the classification is assigned to the paranasal sinuses?

In the international classification, acute and chronic forms of sinusitis belong to class X (respiratory diseases), heading J00-J99.

Acute maxillary sinusitis is classified under J00-J06, which includes other diseases of the respiratory system. Acute sinusitis ICD-10 is designated by the code J01.0.

Acute maxillary sinusitis (acute sinusitis) is an infectious and inflammatory disease of the mucous membrane of the maxillary (maxillary) sinus. Sinusitis is unilateral and bilateral.

The cause of development are bacteria, viruses, fungi and protozoa. Anomalies in the structure of the nose, a decrease in local and general immunity, hypothermia, prolonged colds and chronic sources of infection in the body contribute to the development of sinusitis.

ICD-10 code for sinusitis - J01.0, but when it is required to determine the infectious agent that provoked the disease, then additional codes are used:

• B95 - the cause of the disease is staphylo and streptococci;
• B96 - other identified bacteria;
• B97 - the cause of the disease is viruses;
• B98 Other specified infections caused disease.

Chronic maxillary sinusitis is classified under J30-J39, which includes other pathologies of the respiratory system.

Chronic sinusitis ICD-10 is designated as J32.0. This disease is a long-term inflammatory process in the maxillary sinuses, which occurs with periods of exacerbations and remissions and is accompanied by an irreversible restructuring of the sinus mucosa.

History of creation and development prospects of the ICD-10

The first attempts to systematize diseases belong to the French scientist Sauvage, who published his scientific work "Methodology of Nosology" in the 18th century.

A century later, the first international congress was held in Brussels, at which it was decided to create the first unified classification of causes of death. Since then, the International Classification of Diseases has been revised 10 times, hence its abbreviated name ICD-10.

Interesting! The sixth revision was the most significant, because then for the first time diseases and conditions that did not lead to death were included in the list.

The tenth revision of the ICD is a huge international work of specialists from different countries. This version of the classification was adopted at an international conference in Geneva, and since 1990 it began its work in WHO countries.

In this revision, conditions that resulted from postoperative interventions and manipulations, such as perforation of a blood vessel with a catheter, were included in a separate rubric.

Since 2012, work has been underway on the 11th revision of the classification. Specialists and experts of different levels take part in its preparation, trying to reflect in it all aspects of modern medical knowledge and advanced technologies.

How is the classification arranged?

The ICD 10th revision includes three volumes. The first volume includes the classification itself, and the other two contain instructions for its use and an alphabetical index.

The classification is based on an alphanumeric coding, where the first character is always a letter of the Latin alphabet denoting a certain class.

The exceptions are the letters "D" and "H", which are used in several different classes at once. In addition, 4 classes (1,2,19 and 20) use more than one letter in the first character of their code.

The classification is divided into 21 classes, which in turn consist of three-digit headings and four-digit subheadings. The heading is separated from the subheading by the sign ".".

Acute, chronic sinusitis: ICD-10 code

If a person has sinusitis, ICD-10 has a special code for any kind of this disease. Usually people consider sinusitis inflammation of any sinuses near the nose. In fact, such a disease is understood only as inflammatory processes in the sinus of the upper jaw. Everything else is other varieties of sinusitis (the same rhinosinusitis). But it is sinusitis that is the most common chronic ailment among all other ENT pathologies.

Why was the ICD-10 created?

ICD-10 is an international document that contains a list of all diseases, pathologies and injuries by sections. Like all other industries, medicine and healthcare also has various classifications that are documented according to certain standards and criteria.

The International Classification of Diseases was developed by the World Health Organization. Thanks to the ICD-10, the correlation of data on diagnoses and the diagnosis itself in various countries of the world is carried out. The same applies to the process of treating ailments, since they have different names in different countries, but thanks to the ICD-10, all data is standardized, which is convenient not only for collecting, but also storing and analyzing information. This is precisely the main purpose of the ICD-10. This document makes it possible to systematize all the received statistical data on the levels of mortality and morbidity both in different countries of the world and within one state.

To systematize the data, all ailments are given a separate code, which consists of alphabetic and numeric values. The tenth revision of the edition made some changes. For example, now not only a code of 4 digits is used, but 1 letter is also assigned to them. This makes coding easier by simplifying the whole process.

Letters from the Latin alphabet are used. Of the 26 letters, only 25 are used, but the letter "U" is reserved. In other words, all codes with this letter from 00 to 49 are used to designate various diseases that are not studied and have an unknown origin. These codes are temporary. But codes from 50 to 99 with such a letter are used for research tasks.

ICD-10 has now increased the number of codes. Numbers from A00.0 to Z99.9 are used. All pathologies and diseases are divided into classes - a total of 21 categories. Another innovation is the inclusion in the list of pathologies of those diseases that appeared after medical intervention. For example, after surgery on the stomach, some develop dumping syndrome.

Classification of pathology

For all pathologies and diseases in the ICD-10 there is a code, including for sinusitis. For example, the acute form of the disease refers to acute respiratory ailments of the upper organs of the respiratory system. The number J01.0 is used. If a person has chronic sinusitis, according to ICD-10 it refers to other diseases of the respiratory system, so the code will be different - J32.0. Thanks to this, the accounting of information is noticeably facilitated, as well as its storage.

Acute sinusitis is accompanied by fever, headaches, chills, deterioration of health. When a person tilts his head, the pain in the forehead and eyelids increases. There are problems with breathing. Sometimes the secretion of tears increases, light intolerance appears. The discharge is copious, contains pus clots.

For the first form of sinusitis, separate numbers are used. If this is an acute form of sinusitis, then the number J01.0 is applied, while the maxillary sinuses become inflamed. If the frontal sinuses are inflamed, then code 01.1 is written with the same letter. This disease is called frontitis. For the acute form of ethmoiditis, the number 01.2 applies. If the patient has sinusitis of the sphenoidal type, then code 01.3 from this group is used. When inflammatory processes cover all the sinuses around the nose at once, then such an ailment is called pansinusitis. In this case, doctors use the number 01.4 if a person has another acute form of sinusitis. If the patient has an unspecified form of this disease, then the code with the last digit 9 is applied. This is rhinosinusitis.

The chronic form of the disease is characterized by the same symptoms as for the acute stage, but they are clearly manifested only during the period of exacerbation. By the way, it must be taken into account that the disease can provoke various complications: meningitis, brain abscess, swelling of the eye, blood clots.

Chronic sinusitis is diagnosed if there were at least 3 exacerbations in a year. In ICD-10, separate codes have also been created for the chronic form of sinusitis. For example, the chronic form of sinusitis involves the use of the number J32.0. For frontitis in chronic form, code 32.1 is used, and the letter will be the same. If the patient has chronic ethmoiditis, then code 32.2 is written. When sphenoiditis has become chronic, then code 32.3 with the letter J is used. If inflammatory processes become chronic in all paranasal sinuses, then code 32.4 is used, and such an ailment is called chronic pansinusitis. If another chronic sinusitis is found, code J32.8 is used. Usually such a number is given when the pathology captures several sinuses, but not all of them, so this is not pansinusitis. If the ailment in the chronic form is unspecified, then the code J32.9 is written.

It is also necessary to take into account that the disease is classified depending on the zone of localization of inflammation. Allocate unilateral and bilateral sinusitis. The first, in turn, is divided into left- and right-handed.

In addition, it must be borne in mind that clarifications are also written, depending on what provoked the disease. For example, if the pathogens are streptococcal or staphylococcal infection, then the code B95 is written. If these are bacterial infections, but not streptococcus or staphylococcus aureus, then the number B96 is put. When the disease is viral in nature, doctors use the code B97. However, such an additional code is written only if the causative agent of the disease is accurately determined with the help of special laboratory tests - a sowing is carried out for the patient.

Types of illness depending on the causes

There are several provoking factors due to which inflammatory processes develop in the maxillary sinuses.

Types of mucosal changes

To determine the variety of sinusitis, one takes into account how the mucous layers in the maxillary sinus change, and also pay attention to nasal discharge. Depending on this, productive and exudative forms are distinguished:

1. Exudative sinusitis. This disease is characterized by profuse discharge from the nose, which makes it difficult for the patient to breathe. The discharge itself may have a mucous and purulent hue. If a person has a catarrhal form of the disease, then a secret is released in large quantities. It is very plentiful. Due to the fact that blood flow increases, the sinuses swell, and the volume of secretions increases. But the purulent form develops due to the fact that the patient ignored his painful condition for a long time and did not begin to treat the catarrhal form of the disease in time. If the patient has an exudative type of sinusitis, then the therapy will be traditional medication. It is aimed at eliminating swelling on the mucous membranes, removing inflammation and reducing mucus secretion. To facilitate the breathing process, additional agents with vasoconstrictive properties are prescribed. They also remove swelling. It is also important to rinse the nasal cavity in order to restore normal secretion.

2. Productive. This form of the disease is characterized by the growth of the mucous layer. In addition, its structure gradually changes, as do the mucosal tissues themselves, which leads to the formation of polyps or the formation of hyperplastic edema.

If the disease acquires a polyposis form, then the mucous membrane gradually grows, neoplasms appear from its tissue. It is because of them that many patients have difficulty breathing, their sense of smell weakens, and discomfort appears when swallowing. Due to such neoplasms, the passage is blocked, so that air does not enter the maxillary sinuses. For the outflow of the secret, the exit is also closed. If the polyps have not grown much, then to determine them, you need to do x-rays and computed tomography. If the disease is actively progressing, polyps will be visible when examined by a doctor. Treatment of the polyposis form of sinusitis involves the use of conservative methods in order to reduce the rate of progression of the disease. If this method does not help, then the tissues are removed surgically.

In the hyperplastic form of the disease, the mucous layers become denser, and the lumen of the nasal canal decreases in diameter. Breathing is difficult, but not completely disturbed. If the patient also has a deviated nasal septum, then surgery is required.

Conclusion on the topic

If the patient has sinusitis, the ICD-10 code will differ depending on the type of disease. There are several forms of sinusitis, depending on where the mucous layers become inflamed - in which sinus near the nose, and sinusitis is only one of the varieties of this disease, but the most common. The ICD-10 code is used by doctors to facilitate the process of collecting, storing and analyzing data.

- maxillary sinusitis. This is an inflammatory process that occurs on the mucosa of the largest maxillary sinus. The acute form of the disease is considered when its duration is not more than 12 weeks and the complete disappearance of clinical manifestations. The disease is a complication of acute respiratory infection.

Classification according to the ICD-10 code

The disease is characterized by a prolonged inflammatory process of the mucous membrane of the nasal sinuses.

It is characterized by the presence of purulent discharge, an unpleasant odor and swelling of the cheeks. An x-ray will show blackouts in the part where the mucus has accumulated and does not come out.

Acute sinusitis develops against the background, and. Trauma, surgical procedures performed on the nose, or exposure to allergens are capable of provoking its appearance. In the ICD-10 classification of diseases, acute sinusitis is assigned the code J01. The following categories are at risk of infection:

1. Adults and children who often get colds
2. Having allergies, the manifestation of which is swelling of the nasal passages
3. Patients with nasal septum defects
4. Having problems with the health of the upper teeth

At risk for the development of many diseases, including those who lead an unhealthy lifestyle. With the right approach, treatment can take about a month.

Localization of sinusitis

Forms and types of disease

Acute sinusitis has its own classification. The division is made according to the content type. It can be:

• serous
• mixed

The disease can be divided according to the severity of its course. There are no clear division boundaries, they are more based on the sensations of the patient himself and are evaluated on a ten-centimeter scale, which is called VAS.

The disease can occur in mild (0-3 cm), moderate (4-7 cm) and severe (8-10 cm) degrees. The viral and allergic nature of the appearance of sinusitis refers, as a rule, to a mild degree. Can be double sided, left sided or right sided.

A purulent type of disease with an associated bacterial infection can occur in moderate or severe form.

What is the difference between acute sinusitis and chronic sinusitis, see our video:

Symptoms of acute sinusitis

Acute depending on severity. The common symptoms of the disease are:

• Difficulties in nasal breathing
• Profuse clear or purulent discharge from the nose
• Pain in the frontal part and in the area of ​​\u200b\u200bmucosal inflammation

With a moderate or severe degree of manifestation, the body temperature rises, and appear. eyelids and cheekbones may swell, and the sinuses seem to burst from the inside. In this case, there is a high probability of inflammation spreading to the brain, especially in a child whose sinuses are not fully formed.

Acute sinusitis, which did not go away in 5 days during treatment, is characterized by the addition of a bacterial infection. In this case, the likelihood of complications increases, and it is necessary to change the course of treatment. The work of the organs of hearing and vision may be partially affected.

Signs of sinusitis

The difference between acute sinusitis and other forms

In order not to confuse the acute form of sinusitis with similar chronic symptoms, one should clearly understand the differences between them.

The chronic form of the disease is almost asymptomatic, while the acute form is characterized by the presence of obvious signs of the disease. Another difference between maxillary sinusitis is that it manifests itself immediately after the influencing factor (infection, acute respiratory infections, trauma).

Features of treatment

The patient will not be able to independently diagnose sinusitis, and even more so to determine its form and degree. The disease can be easily confused with another disease that has similar symptoms.

To identify maxillary sinusitis, it is better to contact an otolaryngologist. Before the final diagnosis, the following studies are recorded in the medical history:

1. visual inspection. It is necessary to collect disturbing symptoms and draw up a preliminary clinical picture.
2. X-ray. It is done to study the contents of the maxillary sinuses.
3. CT scan. Rare, because it is a rather expensive procedure for examining the nasal cavity.
4. Puncture. This diagnostic method is performed when it is not possible to take an x-ray. A puncture is taken from the maxillary sinuses to establish their contents.

When hospitalization of the patient is not required, you can continue treatment at home. Only in the case of cleansing the sinuses with a puncture, the patient can be left under medical supervision for 2-3 days. The rest of the therapy is carried out by patients at home. There he takes the drugs prescribed to him and performs the necessary manipulations for the nose. If it involves visiting physiotherapy procedures, then they are performed by medical workers in the clinic.

The puncture performed with sinusitis refers to surgical procedures. It became possible to do without surgical intervention thanks to the use of the YAMIK catheter.

Its use is painless, and the procedure itself does not imply a violation of the integrity of the nasal cavity, as occurs with a puncture.

How to treat sinusitis, see our video:

Possible Complications

If you let the development of the disease take its course, then the risk of developing dangerous and unpleasant complications is very high. Elevated body temperature can cause the patient to lose consciousness. In addition, suffer:

• organs of vision
• hearing organs
• Musculoskeletal system

Untreated sinusitis in acute form can cause development. The accumulated purulent mass, when certain conditions are created (humidity and high temperature), causes an inflammatory process in the cerebral cortex. Inflammation can also affect bone tissue in the body.

Complications of sinusitis

Forecast

With timely treatment, acute sinusitis is cured completely without consequences and complications within a month. It is important to follow all medical recommendations and take prescribed medications.

How to treat sinusitis without a puncture:

Definition and background[edit]

Acute sinusitis is an inflammatory disease of the SNP (paranasal sinuses) of a bacterial, viral, fungal or allergic nature. This is one of the most common diseases that general practitioners and otorhinolaryngologists deal with.

The term "sinusitis" means inflammation of the mucous membrane of the SNP, regardless of the cause of the inflammation. Sinusitis is invariably accompanied by inflammatory changes in the adjacent nasal mucosa, so the term “rhinosinusitis” is more correct, and if an acute inflammatory process of SNP is considered, then “acute rhinosinusitis” (ARS).

The common occurrence of carious teeth can also cause acute sinusitis, which, if left untreated, can turn into chronic sinusitis, treatment will require more time and effort.

There are the following types of SNPs: frontal, maxillary, ethmoid sinuses, sphenoid sinuses. It is possible both an isolated inflammation of one of them, and a combined lesion of several or even all SNPs.

Inflammatory diseases of SNPs are one of the urgent problems of otorhinolaryngology. Among patients treated in otorhinolaryngological hospitals, from 15 to 36% are people suffering from rhinosinusitis. An even greater percentage is sinusitis among outpatient diseases of the upper respiratory tract. According to the US National Center for Disease Statistics, in 1994, sinusitis became the most common chronic disease in this country. Nearly one in eight people in the US has or has ever had sinusitis. In 1998, 34.9 million people in the United States had rhinosinusitis. In Germany, from 7 to 10 million diagnoses of acute and (or) chronic rhinosinusitis have been made over the past decade. That is why the treatment of rhinosinusitis is currently becoming one of the most urgent problems of otorhinolaryngology. Thus, in the United States in 1996, the costs associated with the diagnosis and treatment of sinusitis amounted to 5.8 billion dollars.

Taking into account the severity of the clinical manifestations of the disease, there are mild, moderate and severe ARS.

In addition, there are acute community-acquired bacterial rhinosinusitis and nosocomial (nosocomial) rhinosinusitis. The latter is most often the result of transnasal intubation. The main pathogens are gram-negative rods.

It has features of sinusitis in patients with immunodeficiency, including AIDS patients.

In practice, rhinosinusitis is divided into acute (symptoms last less than 4 weeks), subacute (symptoms last from 4 to 12 weeks) and chronic (symptoms last more than 12 weeks). There may be recurrences of acute rhinosinusitis or exacerbation of CRS.

Etiology and pathogenesis[edit]

The presence of fungi in the upper respiratory tract is normal, but sometimes they can lead to the development of rhinosinusitis. Aspergillus is the most common cause of invasive and non-invasive (in immunocompromised patients) fungal sinusitis. Other pathogens that cause non-invasive sinusitis are Pseudallescheria boydii, Schizophillum commune, Alternaria.

The main bacterial pathogens in community-acquired bacterial ARS are Streptococcus pneumoniae and Haemophilus influenzae. Less common are Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pyogenes, gram-negative rods, anaerobes.

Clinical manifestations[edit]

Acute sinusitis, unspecified: Diagnosis [edit]

Complaints and anamnesis

Depending on the severity of the clinical manifestations of acute sinusitis, a mild course of the disease, moderate sinusitis and severe forms of the disease are distinguished.

- With a mild course of ARS, the patient notes nasal congestion, mucous or mucopurulent discharge from the nose and (or) into the oropharynx, an increase in body temperature up to 37.5 ° C. There are complaints of headache, weakness, impaired sense of smell.

- The moderate course of acute sinusitis is accompanied by nasal congestion, purulent discharge from the nose, body temperature is usually above 37.5 ° C, there is pain and tenderness on palpation in the projection of the affected SNP. Headache, hyposmia are more pronounced, there may be irradiation of pain in the teeth, ears, and malaise. On the radiograph of the SNP - thickening of the mucosa of more than 6 mm, complete darkening or fluid level in one or two sinuses.

- In severe acute sinusitis, nasal congestion is also noted, often abundant purulent discharge from the nose (but there may be their complete absence, which is a sign of a violation of the drainage of the SNP through natural anastomoses), body temperature is more than 38 ° C, severe pain on palpation in the projection of the SNP , headache, anosmia, severe weakness. On the radiograph of the SNP - complete blackout or fluid level in more than two sinuses; in the general blood test - increased leukocytosis, shift of the formula to the left, increased ESR.

It should be noted that in each case, the severity is assessed by the totality of the most pronounced symptoms. For example, if an orbital or intracranial complication of the course of ARS is suspected, it is always regarded as severe, regardless of the severity of other symptoms.

The severity of clinical manifestations of ARS is determined by general and local signs of inflammation. Manifestations of a general reaction may be, in particular, headache, fever, malaise, weakness and typical changes in the blood. These symptoms are nonspecific, so local manifestations of the disease are of paramount importance in the diagnosis of ARS.

The most common complaints in ARS are headache, difficulty in nasal breathing, pathological discharge from the nose and nasopharynx (the secret flows down the back of the pharynx), and a disorder of smell. Headache is more often localized in the frontotemporal regions, often aggravated by tilting the head. When the sphenoid sinus is affected, a persistent nocturnal headache with localization in the center of the head and occipital regions is characteristic. Complaints of headache are sometimes absent, especially if the outflow of exudate through the natural fistula is not disturbed. Difficulty in nasal breathing in sinusitis develops as a result of obstruction of the nasal passages with edema or hyperplasia of the mucous membrane, in the presence of a pathological secret in the nasal passages. With the defeat of the SNP on one side, the violation of nasal breathing usually corresponds to the side of the lesion.

With ARS, an increase in body temperature up to 38 ° C and above is possible (as a rule, this symptom is not expressed with CRS).

Characterized by a feeling of heaviness in the root of the nose and adjacent areas, gradually turning into a severe, difficult to treat headache; these phenomena usually occur in the morning and intensify, reaching a maximum intensity in the evening. The patient notes increased fatigue, malaise, fatigue and lethargy, impaired appetite and sleep.

In children, the symptoms and manifestations of ARS are very variable and rarely specific, often common with manifestations of SARS. The main complaints, as a rule, are a prolonged, persistent cough, aggravated upon awakening, nasality, difficulty in nasal breathing, weakness, prolonged subfebrile temperature, loss of appetite, and rapid fatigue. Headache is rare and mostly occurs in children over 10 years of age.

Rhinoscopy in a patient with ARS reveals hyperemia and swelling of the nasal mucosa on the affected side. Narrowing of the lumen of the nasal passages, difficulty in nasal breathing, impaired sense of smell are also noted here. In the middle or upper, as well as in the common or lower nasal passage, a purulent secret is usually determined. With the defeat of the posterior group of SNPs (sphenoid sinus, posterior cells of the ethmoid labyrinth), purulent exudate often flows down the back of the pharynx. It should be borne in mind that the absence of pathological discharge in the nasal cavity does not exclude SNP disease. Detachable may not be with a block of the natural anastomosis of the affected sinus, with a high viscosity of the pathological secret.

Instrumental and laboratory research

The most accurate anatomical differentiation, including the degree of damage to the mucous membrane at the mouth of the sinus, gives CT. The disadvantages of conventional x-ray examination are well known, especially in relation to the diagnosis of ethmoiditis. Comparative X-ray and endoscopic studies showed the coincidence of the results only in 50% of cases. The main reason for this dissociation is the high frequency of false-positive X-ray results. CT has recently become considered the "gold standard" in the diagnosis of diseases of the paranasal sinuses. The disadvantages of the latter are traditionally attributed to the high cost of the study, although, as the modern experience of most X-ray centers shows, 4-5 CT scans cost no more than a traditional X-ray examination. The indication for X-ray examination is the express or screening diagnosis of sinusitis. The indications for CT are listed below.

Intended surgical treatment.

ARS with suspected intracranial or intraorbital spread of infection.

Severe pain in the projection of the SNP or headache (especially when endoscopic examination has failed).

Resistance to standard antibiotic treatment. In patients with clinically suspected sinusitis, most otolaryngologists consider endoscopy to be the standard diagnostic tool prior to CT. As for the diagnostic value of CT, its sensitivity exceeds 90%, and the specificity can be relatively low. Detectable thickening of the mucous membrane does not allow to distinguish between the viral and bacterial nature of ARS. However, the presence of a fluid level in the sinus usually indicates a bacterial infection. In the diagnosis of ARS, endoscopic examination is informative. Endoscopic diagnostics allows you to examine the nasal cavity and middle nasal passage in detail. The results of CT and endoscopic examination coincide in 90% of cases and above. In some cases, the sensitivity of endoscopic examination may be even higher than that of CT. The procedure is performed under local anesthesia and is generally well tolerated by the patient.

In some clinical cases, when evaluating the effectiveness (including microbiological) of antibacterial drugs, a bacteriological study is mandatory.

SNP puncture is a relatively painless and safe procedure when performed by an experienced physician. The maxillary sinus is punctured through the lower nasal passage, the frontal sinus through the edge of the orbit. In the absence of free fluid in the SNP, isotonic sodium chloride solution should be injected. Optimal is the sowing of aspirate from the SNP with a quantitative assessment of microbial contamination. The threshold value of "significant bacterial contamination" is considered to be 10 4 -10 5 /ml.

To detail the functional disorders of the nose in the defeat of the SNP allow special methods of examination - acoustic rhinometry and anterior active rhinomanometry.

Differential diagnosis[edit]

Clinical manifestations of ARS may be similar to those of inflammatory diseases of the dentoalveolar system. It is necessary to take into account the proximity of the roots of the upper teeth to the sinuses. X-ray of the SNP, consultation of a dentist are shown.

Some neurological symptoms - headache and facial pain (prosopalgia) - can also simulate ARS. The methods of instrumental examination and the data of the survey radiograph allow clarifying the diagnosis.

SNP tumors in the early stages have a similar clinical picture with ARS. In these cases, an instrumental examination of the patient is also indicated - CT of the SNP, endoscopic examination, including endoscopic sinusoscopy.

Acute sinusitis, unspecified: Treatment[edit]

Evacuation of the pathological secret from the SNP;

Elimination of the focus of infection and inflammation;

Restoration of aeration and drainage of the SNP.

Indications for hospitalization

Treatment of acute SNP inflammation is usually outpatient. With orbital and intracranial complications, hospitalization is indicated. The severe clinical course of ARS, especially in the presence of severe comorbidity or immunodeficiency, the inability to perform the necessary manipulations on an outpatient basis, and social indications should also be taken into account when deciding on the need for hospitalization.

In the treatment of ARS, physiotherapeutic methods are also used: microwaves, UHF and pulsed currents, laser therapy, magneto- and magneto-laser therapy. With severe pain syndrome, sinusoidal modulated or diadynamic currents are prescribed.

However, if there is exudate in the maxillary sinuses before physiotherapy, they must be freed from the contents by puncture and washing. The evacuation of pathological secretions from SNPs in case of their exudative inflammation is an important component of pathogenetic therapy. For this purpose, non-puncture and puncture methods are widely used on an outpatient basis and in a hospital.

Among the non-puncture methods of treating inflammatory diseases of the SNP, the method of "moving" according to Proetz (the "cuckoo" method) is widely used, which allows creating a vacuum in the nasal cavity using surgical suction. At the same time, pathological contents are removed from the sinuses, and after infusion into the nasal passages of medicinal solutions, the latter rush into the sinuses that have opened and freed from purulent exudate.

With a therapeutic puncture of the sinus, in most cases the maxillary one, after washing it with an antiseptic, drugs are introduced into the cavity.

With viscous, thick purulent contents, proteolytic enzymes such as trypsin, chymotrypsin, and lidase are used for injection into the sinuses. When applied locally, enzymes break down necrotic tissues to polypeptides and amino acids, liquefy viscous secretions, exudates, blood clots, and also have an anti-inflammatory effect.

The main task of ongoing drug therapy in ARS is the eradication of the pathogen and the restoration of the SNP biocenosis. The most effective etiotropic therapy. However, even with modern equipment of the bacteriological service of a medical institution, accurate identification of the pathogen is possible only by the 5-7th day after sending the material for research. Also, having an idea about the nature of a possible infectious agent, it is impossible to predict the presence or absence of acquired resistance to a particular antibiotic without special studies.

In these conditions, drugs should be used, the likelihood of resistance to which is minimal. That is why, in the initial appointment of antibacterial treatment, the basis is empirical therapy for ARS, taking into account the nature of the likely pathogen and the characteristics of the clinical manifestations of the disease. The choice of drug depends on the nature of the most likely pathogen and the characteristics of the clinical manifestations of the disease. According to available data, in Russia, S. pneumoniae and H. influenzae isolated from ARS remain highly sensitive to penicillin drugs, in particular, to ampicillin, amoxicillin, amoxicillin + clavulanic acid and II-III generation cephalosporins. An important problem in Russia is the high resistance of pneumococci and Haemophilus influenzae to co-trimoxazole: a moderate and high level of resistance was found in 40% of S. pneumoniae and in 22% of H. influenzae.

When choosing an antibiotic for the treatment of ARS, the severity of the patient's condition is taken into account. An indispensable requirement for antibacterial agents is also their maximum safety, the absence of ototoxic and other undesirable effects.

With a mild course of the disease, antibiotics are prescribed orally. Drugs of choice: ampicillin, phenoxymethylpenicillin, roxithromycin, spiramycin, doxycycline, cefuroxime. The course of treatment with these drugs is 7-10 days.

Fusafungin has a wide spectrum of antibacterial activity against the most common pathogens that cause respiratory infections, including pneumococci, Haemophilus influenzae, and staphylococci. Fusafungin is effective in infection with fungi of the genus Candida, mycoplasma, and some anaerobic pathogens. It has an anti-inflammatory, antioxidant effect, reduces swelling and exudative activity of the mucous membrane, indirectly improves mucociliary clearance.

In the moderate course of the disease, the drugs of choice are oral β-lactam antibiotics from the group of penicillins and cephalosporins of the II-III generation, fluoroquinolones: amoxicillin + clavulanic acid, cefuroxime, cefaclor, levofloxacin, sparfloxacin. Due to their high efficacy and low toxicity, penicillins and cephalosporins occupy one of the first places in terms of frequency of clinical use among all antibiotics.

In particular, amoxicillin + clavulanic acid, according to numerous studies, demonstrate a high percentage of eradication of the pathogen and good tolerance in both adults and children. Both components of the drug are well absorbed after oral administration, regardless of food intake. The drug is characterized by a good volume of distribution in body fluids and tissues, including penetration into the mucous membrane of the SNP. For adults and children over 12 years of age (or more than 40 kg of body weight), the usual dose is 625 mg 3 times a day or 1.0 g 2 times a day.

Cefuroxime should be taken with food, all other drugs should be taken with or without food. As a rule, the frequency of taking these drugs is 2 times a day, the duration of the course of treatment is 10-12 days. Among the adverse reactions in penicillins and cephalosporins, the most common are various types of allergic reactions, and in some cases (1-3%) a cross-allergy to penicillins and cephalosporins is possible. In addition, taking this group of drugs is accompanied by immunosuppression of varying severity (which fluoroquinolones are deprived of). In this regard, fluoroquinolones are increasingly used in the treatment of sinusitis.

Macrolides are currently considered second-line antibiotics and are used for allergy to β-lactam antibiotics.

In severe ARS and the threat of complications, drugs are prescribed parenterally (intramuscularly or intravenously). It is recommended to use inhibitor-protected penicillins, III-IV generation cephalosporins (cefotaxime or ceftriaxone, cefepime or cefpirome), fluoroquinolones (levofloxacin, ciprofloxacin, sparfloxacin) or carbapenems (imipenem). In case of allergy to β-lactam antibiotics, intravenous fluoroquinolones are prescribed, which also have a wide spectrum of bactericidal action against pathogens of upper respiratory tract infections - ciprofloxacin, pefloxacin. Given the possible development of adverse reactions, fluoroquinolones are not recommended for children and gerontological patients, as well as for violations of the liver and kidneys.

In the presence of clinical signs of anaerobic infection in the sinuses, metronidazole, a synthetic antimicrobial agent from the group of imidazoles, which has a wide spectrum of action, is most pronounced in relation to anaerobes and protozoa, is included in the antibacterial therapy complex.

In some cases, it is possible to prescribe a stepwise therapy, in which treatment begins with intravenous or intramuscular administration of an antibiotic for 3-4 days, and then they switch to oral administration of the same or a drug similar in spectrum of activity.

It is not advisable to prescribe antihistamines simultaneously with antimicrobial and mucolytic agents, since in this period the main task is drainage and cleansing of the mucous membrane. Their use is justified in the presence of allergic inflammation of the mucous membrane, and then the blockade of the H 1 receptor relieves nasal obstruction.

Simultaneously with systemic therapy in various forms of ARS, a local effect on the mucous membrane of the nasal cavity and sinuses is necessarily carried out. In the complex of therapeutic measures, the use of vasoconstrictor drops is of great importance, which makes it possible to reduce the swelling of the mucous membrane, improve drainage, and at least partially restore the aeration of the SNP through natural anastomoses. Vasoconstrictor drugs are represented by derivatives of xylometazoline, naphazoline, oxymetazoline, etc. However, the introduction of drops into the nasal cavity is not performed correctly by all patients - to achieve the effect, they increase the volume and frequency of administration, and this is always fraught with side effects, often very severe. The most preferred aerosol forms of vasoconstrictor drugs, and even better dosed. The pump form of xylometazoline meets these requirements. Rinofluimucil nasal aerosol is currently widely used, which simultaneously provides a vasoconstrictive, mucolytic and anti-inflammatory effect and is practically devoid of irritating action on the nasal mucosa. According to the indications, with purulent forms of SNP lesions, a good effect is achieved with the use of combined preparations. In the presence of an allergic process, the use of polydex with phenylephrine (antibacterial components + phenylephrine and glucocorticoid) is recommended.

Prevention[edit]

Prevention of recurrence of ARS involves the following requirements:

Elimination of various anatomical defects in the nasal cavity that prevent normal nasal breathing, leading to disruption of mucociliary transport and drainage of SNPs through natural fistulas.

Timely sanitation of the oral cavity in order to prevent the development of periodontitis in the area of ​​the roots of the teeth adjacent to the bottom of the maxillary sinus.

Elimination of predisposing factors (anomalies in the development of the nasal septum and mucous membranes of the nose and SNP). An important role is played by regular hardening of the body.

Systematic implementation of measures to increase the natural local and general resistance of the body.

Other [edit]

Indications for consulting other specialists

In the absence of the effect of ongoing antibiotic therapy, consultations with a neurologist, maxillofacial surgeon, infectious disease specialist are recommended.

The prognosis is favorable, with adequate treatment started in a timely manner, the disease is cured without consequences, and the ability to work is fully restored. Transition to chronic forms is possible. In such cases, the question of surgical treatment is decided.

Acute rhinosinusitis: treatment, symptoms and code ICD 10

Sinusitis from the point of view of ICD 10 and practical medicine

Inflammation of the maxillary sinuses is a fairly common disease in adults and school-age children, which an otorhinolaryngologist has to deal with. For the convenience of systematizing all information about diseases and pathological conditions, including prevalence, morbidity and mortality among the population, an international statistical standard has been developed, which is updated every 10 years. The tenth revision of this classifier is currently in force. Like all other diseases, sinusitis in ICD 10 has its own code - let's talk about this in more detail.

Inflammation in the paranasal sinuses is collectively called sinusitis, along the course it can be acute or chronic, infectious or allergic in etiology. Depending on the localization, the following types of this pathology are distinguished:

sinusitis - an inflammatory process in the maxillary (maxillary) sinuses;

frontal sinusitis - damage to the frontal (frontal) sinuses;

ethmoiditis - the cells of the ethmoid labyrinth are affected;

sphenoiditis - inflammation in the cavity of the sphenoid bone.

Sinusitis is the most common form of sinusitis due to the proximity of the sinus to the nasal cavity and the teeth of the upper jaw. It almost always accompanies any viral infection in which there is acute rhinitis, manifesting itself as symptoms of a common cold. With good immunity, such inflammation in the maxillary sinus ends with recovery simultaneously with the disappearance of signs of rhinitis.

Some people who have anatomical prerequisites for disrupting normal air exchange in the maxillary sinus (polyps, septal defects, etc.) may develop purulent inflammation caused by the penetration of microbes from outside or from internal foci of infection in the body itself.

Acute maxillary sinusitis of this origin is treated conservatively. A chronic process most often requires a certain surgical intervention to eliminate the cause of congestion in the sinus (straightening of the septum, removal of adenoids or polyps, etc.).

International statistics, which uses a special classification of diseases and health problems, is widely used by doctors in practice to systematize data on various nosologies. Sinusitis according to ICD 10 has its own code designations. It differs in the nature of the course as acute or chronic sinusitis of the maxillary sinuses. The first one belongs to the section of acute respiratory infections of the upper respiratory system (J00-J06) and has the code J01.0. The second is listed among other diseases of the respiratory tract (J30-J39), its code is J32.0. Inflammation of the remaining paranasal cavities are indicated by other codes.

1 - in the frontal sinuses;

2 - in the lattice labyrinth;

3 - in the cavity of the sphenoid bone;

4 - defeat of all sinuses (pansinusitis);

8 - acute polysinusitis;

9 - acute rhinitis with sinusitis.

Chronic inflammatory processes:

2 - in the cells of the ethmoid bone;

3 - in the sphenoid sinus;

4 - in all sinuses (pansinusitis);

8 - other polysinusitis;

9 - chronic sinusitis of unspecified origin.

Sometimes it becomes necessary to indicate the causative agent of sinusitis if it was isolated as a result of a bacteriological analysis (sowing from the nose) in a particular patient. In this case, an auxiliary code designation is added:

B95 - streptococcal or staphylococcal infections;

B96 - other bacteria;

B97 - the disease is caused by viruses.

From the video you will learn how to easily cure sinusitis with folk remedies:

Inflammation of the maxillary sinus does not occur from scratch, usually the patient has anomalies of the facial skeleton, nasal septal defects, polyps, adenoids and other obstacles to normal air exchange between the nasal cavity and the accessory sinus. Hypothermia, an unfavorable allergic background, poor ecology, frequent respiratory infections, pathology of the teeth of the upper jaw and heredity can provoke the development of the disease. Acute inflammation of the maxillary sinuses is usually a complication of SARS and is manifested by symptoms such as:

heat;

nasal congestion;

persistent general headache;

local pains in the areas of projection of the sinuses on the face, aggravated by pressure, when turning the head or tilting the torso forward.

Chronic sinusitis develops from poorly treated acute inflammation with the anatomical conditions available to maintain it. Its manifestations are not so pronounced, but they are stable: constant runny nose, frequent headache, increased fatigue, nasal voice and decreased sense of smell, increased susceptibility to respiratory infections. Chronic sinusitis can occur in different forms: catarrhal, purulent, hyperplastic, polypous, cystic. Each of these forms will differ in the choice of patient management tactics.

It is necessary to treat sinusitis, the sooner the disease is detected, the better it will end for the patient.

Complicated forms of inflammation of the maxillary sinuses are dangerous for the patient, since such vital organs as the brain (shells and substance) and organs of vision are involved in the process, fortunately, they are rare in weakened patients with a low level of immunity.

Treatment of acute sinusitis is carried out mainly by conservative methods, puncture is used in rare cases. The chronic process often has to be eliminated with the help of surgical interventions in order to normalize the normal function of the sinus. Conservative therapy includes the following activities:

ensuring the outflow of pus and restoring normal ventilation of the sinus with the help of vasoconstrictors;

antibacterial therapy with broad-spectrum drugs from the group of macrolides, penicillins or cephalosporins;

anti-inflammatory drugs are prescribed according to indications (steroid hormones, non-steroidal and antihistamine drugs).

washing the nose with solutions of sea salt or Dolphin;

physiotherapeutic procedures are applied in the phase of subsiding of the acute process.

You can’t self-medicate with sinusitis, this disease is one of the dangerous pathologies in children and adults, so any suspicion of inflammation in the sinuses should be a reason for immediate medical attention.

Do you have a runny nose and have you already bought all kinds of pharmacy drops?

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Symptoms, causes, treatment of acute rhinosinusitis in adults

Acute rhinosinusitis can be diagnosed in both children and adults. The disease requires immediate treatment, as it often leads to serious complications.. If it is not treated in time, it can take a chronic form, in which the regulation of the vascular tone of the nose is disturbed (vasomotor rhinosinusitis). Therefore, the patient will have a runny nose almost all year round.

Acute rhinosinusitis is a pathology in which the nasal mucosa becomes inflamed.. The inflammatory process can also spread to the paranasal sinuses. Most often, the frontal sinuses are affected, but inflammation of the posterior sinuses is very rare. Rhinosinusitis is an independent disease, which is classified according to ICD 10 code J01.9.

Usually the disease is the result of an untreated runny nose and occurs approximately 7-10 days after a cold. Sometimes rhinosinusitis also appears under the influence of other factors (bacterial or viral infections, allergies, and others).

Acute rhinosinusitis in adults can have several main forms. The following are distinguished:

Sinusitis (maxillary sinusitis). In this case, inflammation of the maxillary sinuses occurs, which are located above the upper jaw.

Frontitis (frontal sinusitis). The inflammatory process affects the frontal sinuses.

Etmoiditis. There is inflammation of the ethmoid sinuses.

Sphenoiditis. The sphenoid sinuses become inflamed.

Pansinusitis. In this case, the inflammation spreads to all paranasal sinuses.

There is unilateral and bilateral rhinosinusitis. In the first case, inflammation is observed only on one side, and in the second - on both sides.

Depending on how much the inflammatory process has progressed, the disease can be of the first or second stage. In the first case, rhinosinusitis is acute catarrhal. If a person has a runny nose, inflammation passes into the paranasal sinuses in about 2-3 days. Such rhinosinusitis almost does not differ from the common cold and is accompanied by nasal congestion, mild discharge from it, in some cases, patients complain of pain in the nose.

If the first stage of rhinosinusitis is not cured, the disease can progress to grade 2. In this case, acute purulent sinusitis is observed. Due to severe swelling of the mucous membrane, pus accumulates in the paranasal sinuses. This leads to an increase in the patient's body temperature, as well as to a deterioration in his general well-being.

The main causes of the disease and the mechanism of its occurrence

Rhinosinusitis is usually caused by a streptococcal infection.. If a person has problems with the immune system, the disease can also be caused by saprophytic bacteria (chlamydia) and fungi (for example, Candida).

Factors contributing to the occurrence of rhinosinusitis are as follows:

1. Frequent rhinitis, colds.
2. Incorrect structure of the nasal cavity, anomalies in the development of the paranasal sinuses. Often rhinosinusitis appears if a person has a deviated nasal septum.
3. Immune deficiency, vitamin deficiency, lack of micro and macro elements.

Usually rhinosinusitis appears in people suffering from a violation of the MCC (mucociliary clearance). In this case, conditions are observed in the human body that are optimal for the development of an infectious process. Violations of the MCC often occur with colds, for example, SARS. That is, usually rhinosinusitis is preceded by another disease. During ARVI, the vast majority of patients inflame the mucous membrane, as a result of which the secret (snot) stagnates in the paranasal sinuses. Nevertheless, rhinosinusitis after SARS appears only in 1-2% of all patients.

Besides, the disease also develops in patients with various anomalies of the structure of the nose. As a result, the permeability of the holes is blocked, which leads to a violation of the process of its purification. In the chronic course of the disease, the contents of the sinuses are very difficult to remove, since the cylindrical epithelium has practically lost its ability to remove bacteria and viruses from the mucous membrane.

There are several characteristic signs of acute rhinosinusitis. These include:

4. Severe headache in the region of the paranasal sinuses. Most often, discomfort is localized in the frontal part..
5. Viscous discharge from the nose. They can be yellow, brown, green or white.
6. Nasal congestion, resulting in a nasal voice. That is, he speaks muffledly, and his speech is incomprehensible to others.
7. Feeling of heaviness in the face. As a rule, it intensifies when the head is tilted.
8. Temperature increase. However, this symptom is not observed in all patients.
9. Drainage of mucus into throat. As a result, a person can expectorate it.
10. Decreased sense of smell, decreased sensitivity of the nose.

But it must be borne in mind that different forms of the disease are accompanied by different signs. For example, in acute sinusitis, there is severe pain in the cheeks and forehead. But with acute sphenoiditis, patients complain of constant headache.

Symptoms and treatment of acute rhinosinusitis in adults are interrelated with each other. Therefore, before prescribing various medications, the doctor must examine all the patient's complaints, as well as conduct a series of diagnostic tests. After all, different forms of the disease are treated differently. In addition, other diseases of the nasopharynx (measles, whooping cough, scarlet fever and others) also manifest similar symptoms.


After contacting a specialist, the patient should describe his feelings as accurately as possible.. He must say how long ago nasal congestion appeared, whether there are abundant discharges, whether they are purulent in nature. Be sure the patient notes whether he has headaches, how intense they are. During a conversation with a patient, the doctor may ask additional questions regarding the course of the disease.

Then the doctor conducts a general examination. To do this, he feels his forehead and cheeks, beats them. If severe pain appears during this, the doctor can make a preliminary diagnosis - frontal sinusitis or sinusitis. If there is severe swelling in the area of ​​the cheeks and eyes, the likelihood of a severe form of sinusitis is high. In this case, immediate hospitalization of the patient is required. However, to make a definitive diagnosis, the doctor must conduct additional diagnostic tests, which include:

11. Rhinoscopy, or general examination of the nose. With rhinosinusitis, the nasal mucosa is red and swollen, and purulent or mucous discharges are observed in the passages.
12. Endoscopic examination. This is a method that is an alternative to radiography. If purulent discharge is found in the middle nasal passages, the doctor diagnoses sinusitis or frontal sinusitis. When pus is present in the upper passage, the likelihood of ethmoiditis or sphenoiditis is high.
13. Radiography. Using this method, you can determine if there is a pathological process in the paranasal sinuses. If they are filled with mucus or pus, then the sinuses will be darkened on an x-ray. Depending on the form of darkening, the doctor distinguishes catarrhal sinusitis from purulent.
14. Puncture of the maxillary sinus. The procedure is quite unpleasant and painful, so it is carried out using an anesthetic.. The maxillary sinus is pierced with a thin long needle and its contents are drawn out with a syringe. Then the sinus is washed and the medicine is injected into it.
15. ultrasound. It is rarely used to diagnose rhinosinusitis, since it is not always possible to make an accurate diagnosis with the help of ultrasound.
16. CT scan. It is also rarely used because this method is expensive.

The material taken during the puncture is used to determine the bacteria that has become the causative agent of the disease. The analysis also allows you to determine whether the microorganism is resistant to antibiotic drugs. The doctor begins to treat rhinosinusitis only after an accurate diagnosis and determination of the form of the disease.

Therapy of rhinosinusitis involves the use of medication or non-pharmacological agents. With drug treatment, nasal drops and sprays are prescribed, and the duration of their use is 5-7 days. They are designed to reduce swelling of the mucous membrane, and also contribute to the rapid removal of the contents of the paranasal sinuses.

Antibiotics for rhinosinusitis are indicated only if the disease has a purulent form. The doctor prescribes Amoxicillin. If it does not help, stronger drugs are prescribed. Also during therapy, anti-inflammatory drugs are used, as well as mucolytics (thinn mucus).

Non-drug treatment of rhinosinusitis in adults includes several main methods:

17. Puncture of the maxillary sinuses. It is also used to diagnose the disease. The maxillary sinus is pierced with a thin long needle in the thinnest place, all the pus is removed with a syringe, and then the drug is injected inside. However, this procedure has a significant drawback - to achieve the effect, it must be repeated several times until the sinus is completely cleared. Moreover, during the process, the patient may experience psychological stress. Complications after it appear very rarely (for example, the hole heals heavily after a puncture).

The doctor may install a special drainage (thin tube) after the first procedure. Due to this, there is no need to carry out repeated punctures - washings are carried out directly through the tube. However, if the drainage is not removed for more than a month, this will adversely affect the mucous membrane.

18. Puncture of the frontal sinuses. It is carried out only in cases where there is a very severe course of the disease. After the procedure, the patient must stay in a hospital for 4-5 days.
19. YAMIK catheter. In this case, the treatment is carried out without the use of a puncture. The patient is given an anesthetic injection, after which the doctor inserts a rubber catheter into the nose. Due to this, an airtight space is formed inside. Then the contents of the sinuses are sucked out with a special syringe. During this procedure, access immediately to all paranasal sinuses appears. Moreover, the integrity of the mucous membrane is not violated, so there is no need for a long stay of patients in a hospital. However, at one time it is impossible to get all the contents, so the procedures are repeated.

A fairly effective method of treatment is nasal lavage using saline or a special antiseptic solution. The process can be performed at home or in an ENT doctor's office.

If the patient has complications from the eyes or brain, immediate surgical intervention is required. Among the possible consequences are: the flow of the disease into a chronic form, the spread of inflammation to the respiratory tract and eyes (which can lead to partial or complete loss of vision), brain abscess, meningitis. The last two diseases are fatal if they are not treated promptly.

Treatment of rhinosinusitis with folk remedies is possible, but only after consultation with your doctor. To quickly eliminate the symptoms of pathology, such home remedies will help:

20. Steam inhalation over jacket potatoes. Boil several potatoes, drain the water, and then breathe over the steam. The duration of the procedure is at least 15 minutes. Immediately after the procedure, you must lie down in a warm bed.
21. Steam inhalation with "Asterisk". A small amount of balm is added to boiling water, after which the patient covers his head with a towel and breathes in steam. The procedure should last about 5-7 minutes.
22. Egg compress on the nose. Eggs are hard boiled, wrapped in a cloth, and then applied to the nose. Keep until the eggs are completely cool. You have to be careful not to burn yourself.

To prevent rhinosinusitis, it is necessary to avoid hypothermia. You should also lead a healthy lifestyle, eat right and exercise. When the first symptoms of the disease appear, you should be examined by a doctor.

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Short description

Classification of chronic sinusitis Exudative sinusitis Purulent form Catarrhal form Serous form Productive sinusitis Parietal - hyperplastic form Polypous form Cystic form Cholesteatoma sinusitis Necrotic sinusitis Atrophic sinusitis Mixed forms.

Etiology Infection of the sinuses with various microflora Acute sinusitis is characterized by a monoculture: bacterial infection (pneumococcus, streptococcus, staphylococcus; only in 13% of patients), viral infection (influenza virus, parainfluenza, adenoviruses) , Escherichia coli, fungal infection (fungi of the genera Aspergillus, Penicillium, Candida) Previous SARS Tamponade of the nose with nosebleeds.

Routes of entry of infection into the sinuses Rhinogenic (through natural sinus fistulas) Hematogenous Odontogenic With sinus injuries.

Rhinoscopy Acute sinusitis Hyperemia of the nasal mucosa, most pronounced in the middle nasal passage. A purulent discharge flows from the middle turbinate. Palpation of the anterior wall of the maxillary sinus is painful. Acute ethmoiditis. Purulent discharge is usually found in the middle and upper nasal passages (because all groups of ethmoid cells are affected). Painful palpation of the nasal clivus at the inner corner of the eye Acute frontal sinusitis - pronounced changes in the anterior part of the middle turbinate are characteristic. The mucous membrane in this area is hyperemic, edematous. Localization of accumulations of pus in the anterior sections of the middle nasal passage. Painful palpation of the anterior and especially the lower walls of the sinus Acute sphenoiditis - with anterior rhinoscopy after anemia of the mucous membrane, a strip of pus is visible in the most posterior parts of the upper nasal passage. The posterior parts of the nasal cavity are hyperemic and edematous. With posterior rhinoscopy - accumulation of pus in the vault of the nasopharynx.

Acute sinusitis For uncomplicated sinusitis, treatment is usually conservative Antibiotic therapy (eg, benzylpenicillin 500,000 units 4–6 times a day) for 7–10 days Sulfa drugs (eg, sulfadimethoxine 2 g on the first day, then 1 g/day, co-trimoxazole 1 tablet 3 r / day after meals) Non-narcotic analgesics Vasoconstrictor drops in the nose, for example 0.05-0.1% r - ry naphazoline or xylometazoline; instillation is carried out by laying the patient on his side. The vasoconstrictive effect gradually decreases, therefore, after 5-7 days of use, a break for several days is recommended. The drugs are contraindicated in arterial hypertension, tachycardia and severe atherosclerosis Physiotherapy (with good outflow from the sinus), for example, microwave therapy (LUCH-2 apparatus), UHF currents, a sollux lamp - rum nitrofural (1:5,000), iodinol, 0.9% r - rum sodium chloride and the introduction of antibacterial agents into it, for example, benzylpenicillin (2 million units), 1% r - hydroxymethylquinoxylindioxide (assigned only to adults, before use carry out a tolerance test, contraindicated in pregnancy), 20% r-ra sulfacetamide In case of severe edema, 1-2 ml of hydrocortisone suspension is injected into the sinus simultaneously, 1% r-r diphenhydramine In acute frontal sinusitis, ethmoiditis or sphenoiditis and the absence of the effect of conservative therapy, it is indicated hospitalization for punctures or probing of these sinuses In complicated acute sinusitis - surgical treatment ie Radical sinus surgery Endoscopic sinus surgery.

Forecast: in acute sinusitis it is favorable with timely treatment and prevention of complications, in chronic sinusitis it can be favorable if the allergen is eliminated and good drainage is provided.

Age features Children and adolescents The incidence of acute and chronic sinusitis increases in late childhood An increase in the incidence among children with tonsillitis and adenoids is observed The presence of chronic sinusitis indicates the need to determine the underlying cause of the disease (nasal deformity, infection, adenoids) then decrease Sinusitis is more difficult to treat in this age group.

ICD-10 J01 Acute sinusitis J32 Chronic sinusitis

Sinusitis is an acute or chronic inflammation of one or more paranasal sinuses. It has many manifestations and arises from many causes, therefore, over the years of studying this disease, a huge number of various classifications of this inflammatory process have been proposed.

In order not to get confused in the mass of forms, stages and manifestations, first we will break them down into the main types of sinusitis, and we will consider them in more detail.

It develops against the background of allergic rhinitis, with this form, sinusitis and ethmoiditis often develop. The remaining sinuses are affected extremely rarely. Allergic sinusitis is caused by an exaggerated response of the immune system to external irritants - allergens.

It develops very rarely. The main causative agents of infection are fungi of the genus Aspergillus, Mucor, Absidia and Candida. Fungal sinusitis is divided into non-invasive - in people with a normal state of the immune system and invasive - in patients with immunodeficiency.

In the invasive form, the mycelium of the fungus grows into the mucous membrane with the development of a large number of complications, many of which are life-threatening.

It develops due to the anatomical proximity of the teeth and sinus cavity. In addition, the maxillary sinus has a common blood supply with the teeth of the upper jaw, so bacteria can enter the maxillary sinus as a result of tooth extraction if the alveoli is damaged, and during filling, filling material can enter the sinus cavity.

The transition of infection is possible with periodontitis, pulpitis and other inflammatory diseases of the dentition.

It develops as a result of an anomaly of the sinus mucosa. With some developmental deviations, cavities form between the epithelial cells, which eventually fill with intercellular fluid. After a certain period of time (everyone is different), the fluid stretches the surrounding cells and a cyst forms. It can block the fistula like edema.

It develops as a result of chronic changes in the nasal passages. A prolonged inflammatory process changes the structure of the ciliated epithelium lining the mucous membrane. It becomes dense, additional growths appear on it.

The cells of these growths begin to multiply - to proliferate. In those areas where cell proliferation is particularly intense, a polyp develops. Then there are several of them, and then they completely fill the nasal passages, blocking not only the withdrawal of fluid, but also breathing.

Refers to chronic forms. Differs in the absence of discharge from the nose. This is due to the fact that as a result of prolonged exposure to a bacterial infection, the nasal structures lose their function of secretion production, and begin to accumulate them in themselves.

As the name implies, it develops as a result of damage to the wall of the paranasal sinus, more often - the maxillary or frontal. Damage to the wall is observed in fractures directly, the upper jaw and zygomatic bone.

When describing the focus of the inflammatory process, its localization is always mentioned, therefore sinusitis is called by the name of the sinus in which inflammation has developed. So allocate:

Frontit- inflammation of the frontal sinus. The frontal sinus is a steam room and is located in the thickness of the frontal bone above the bridge of the nose.

Polysinusitis. When several sinuses are involved in the inflammatory process, for example, with bilateral sinusitis, this process is called polysinusitis.

Hemisinusitis and pansinusitis. If all the sinuses on one side are affected, right-sided or left-sided hemisinusitis develops, and when all the sinuses become inflamed, pansinusitis develops.

Inflammatory processes are also divided along the course, that is, according to the time that passes from the onset of the disease to cure. Allocate:

Acute inflammation develops as a complication of a viral or bacterial infection. The disease is manifested by severe pain in the sinuses, aggravated by turning and tilting the head.

Pain in acute form and adequate treatment usually lasts no more than 7 days. The temperature rises to 38 or more degrees, chills occur. The feeling of nasal congestion is disturbing, the voice changes - it becomes nasal. With proper treatment, complete recovery of the mucosa occurs in about 1 month.

The subacute course is characterized by a milder clinical picture and lasts up to 2 months. The patient experiences mild symptoms of sinusitis for a long time, mistaking it for a common cold. Accordingly, no special treatment is undertaken and the subacute stage flows into the chronic.

The chronic form is less amenable to therapy than others, and the disease can last up to several years. This form of sinusitis develops as a result of improper treatment or its complete absence.

The chronic forms are odontogenic, polypous and fungal sinusitis. This form is characterized by very meager symptoms - discharge from the nose is constant, but not abundant, pains, if they develop, are unexpressed and dull, they also do not really bother the sick person, as a rule, there is no fever.

But chronic sinusitis tends to periodically worsen and manifest itself with all the symptoms of acute sinusitis.

A special form of the chronic form is distinguished - hyperplastic sinusitis. This form develops when different types are combined - purulent and allergic sinusitis. Due to the presence of an allergic process, the mucous membrane grows, polyps can develop in it, which block the fistula between the sinus and the nasal cavity.

The World Health Organization proposes to classify various diseases according to the International Classification of Diseases (ICB 10), where each of the forms is assigned a specific code. For example, here is the ICD code for sinusitis. Disease coding greatly simplifies the work with statistical data.

By slime production

Allocate exudative and catarrhal sinusitis. The difference between these two forms is the secretion of the mucous membrane of the paranasal sinus. With catarrhal inflammation, only hyperemia and edema of the mucous membrane are observed, without discharge.

In the exudative process, the main place in the formation of the clinical picture of the disease is occupied by the production of mucous secretion, which accumulates in the sinus cavity when the fistula is blocked.

These species differ in the nature of the pathogen that caused the disease. In the viral form, respectively, these are influenza, parainfluenza, measles, scarlet fever and others. In the bacterial form, the causative agents are more often staphylococci and streptococci and other types of bacteria.

Diagnosis always begins with asking the patient about how long ago the disease began, how it started, what was in front of him. This information, even without additional research methods, will help the doctor navigate and make the correct diagnosis and prescribe the right treatment in the early stages.

During a visual examination, the doctor will determine the severity of the inflammatory process and accurately establish its localization - is it right-sided or left-sided sinusitis. The condition of the nasal mucosa and the patency of the anastomoses will also be assessed.

It will allow you to establish the degree of damage to the inflamed sinus, assess the condition of the mucous membrane - how thick or atrophic it is, whether there are polyps in the sinus. Also, using x-rays, you can evaluate the volume of fluid in the sinuses.

A variety of X-ray research methods is computed tomography (CT) - it allows you to more accurately assess the condition of the sinuses by obtaining separate images of different parts of the sinus.

In general, it is desirable to study in more detail all the methods for diagnosing sinusitis. so as not to make a mistake in choosing the procedure you need.

When examining a general blood test, it will be established what state the body's immune forces are in, how much it needs help - is it worth it only to help or will it be necessary to prescribe drugs and operations that will do everything instead of immunity.

A rather rare procedure, in general it provides the same information as an x-ray, however, it is safer due to the absence of radiation exposure and can be used in pregnant women.

In the diagnosis of sinusitis, it is no better than computed tomography, with the exception, again, of the absence of radiation exposure. It is absolutely contraindicated in the presence of any metal implants in the body.

All people are prone to sinusitis to one degree or another. But besides this, there are risk factors that increase the possibility of sooner or later discovering this disease. These include:

Professions related to chemical or bacteriological production;

Childhood and old age;

Cystic fibrosis (increased secretion viscosity);

Smoking;

Kartagener's syndrome (weak activity of the mucosal cilia).

Sinusitis is an inflammation of the maxillary sinuses. In the people, sinusitis is mistakenly understood as inflammation of any of the paranasal sinuses, which is actually called sinusitis. Sinusitis worries a person more often than other chronic diseases, and takes the first place among the pathology of ENT organs.

ICD 10 code for acute sinusitis (sinusitis):

J01.0 - Acute sinusitis (or acute sinusitis of the maxillary sinuses);

J01.1 - Acute frontal sinusitis (acute sinusitis of the frontal sinuses);

J01.2 - Acute ethmoiditis (acute ethmoid sinusitis);

J01.4 - Acute pansinusitis (inflammation of all sinuses at the same time);

J01.8 - Other acute sinusitis;

J01.9 Acute sinusitis, unspecified (rhinosinusitis).

ICD code 10 for chronic sinusitis:

J32.2 Chronic ethmoiditis (chr. ethmoid sinusitis);

J32.8 Other chronic sinusitis Sinusitis involving inflammation of more than one sinus, but not pansinusitis. Rhinosinusitis;

The name of sinusitis depends on the site of inflammation. More often it is localized in the maxillary sinuses and is called sinusitis. This happens because the outlet from the maxillary sinuses is very narrow and is in a disadvantageous position, therefore, combined with the curvature of the nasal septum, the complex shape of the nasal ridge, it becomes inflamed more often than other sinuses. With simultaneous inflammation of the nasal passages, the disease is called acute / hr. rhinosinusitis, which is more common than isolated sinusitis.

If there is a need to specify the pathogen xp. sinusitis, then an auxiliary code is added:

B95 - the causative agent of the infection is streptococcus or staphylococcus aureus;

B96 - bacteria, but not staphylococcus and not streptococcus;

Sinusitis (sinusitis) can appear for the following reasons:

After a cold, flu.

Fungal infection (more often superimposed on inflammation caused by bacteria). It plays a major role in persistent protracted purulent processes.

Mixed reasons.

allergic inflammation. Occurs rarely.

The main cause of sinusitis is a bacterial infection. Among various bacteria, streptococci and staphylococci are more often detected (in particular St. Pneumoniae, beta-hemolytic streptococci and S. Pyogenes).

Haemophilus influenzae is in second place, Moraxella is slightly less common. Viruses are often sown, and fungi, mycoplasmas and chlamydia have recently become widespread. Basically, the infection enters through the nasal cavity or from the upper carious teeth, less often with blood.

Women are twice as likely as men to suffer from sinusitis and rhinosinusitis, because they have closer contact with children of school and preschool age - they work in kindergartens, schools, children's clinics and hospitals, women help their children do their homework after work.

Sinusitis is acute and chronic. Acute appears for the first time in life after a cold, hypothermia. Has a bright clinic with severe symptoms. With proper treatment, it is completely cured and never bothers a person again. Chronic sinusitis / frontal sinusitis is a consequence of an acute process that does not end within 6 weeks.

Chronic sinusitis happens:

In accordance with the severity of the disease, the choice of drugs is carried out. This is important because mild cases can be treated without antibiotics.

Sinusitis is often accompanied by high fever, general weakness and fatigue, headaches and facial pain.

Treatment of sinusitis, especially in a pregnant woman or a child, should always be carried out under the supervision of a physician.

Like other diseases, sinusitis has its own code in the basic regulatory medical document of the ICD. This edition is published in three books, the content of which is updated once every ten years under the supervision of the World Health Organization.

Like other human knowledge, the healthcare industry has classified and documented its standards, which are systematically itemized in the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD 10).

With the help of ICD 10, the correlation of information on diagnoses, approaches to diagnosis and treatment of diseases between different countries and continents is ensured.

The purpose of ICD 10 is to create maximum conditions for the analysis and systematization of statistical information on the level of morbidity and mortality in different countries, within one country. For this, all diseases were given a special code, which consists of a letter and a number.

For example, acute sinusitis refers to acute respiratory diseases of the upper respiratory organs and has the code J01.0, and xp. sinusitis refers to other diseases of the respiratory system and has the code J32.0. This facilitates the recording and storage of necessary medical information.

J01.3 - Acute sphenoidal sinusitis (acute sphenoiditis);

Sinusitis (sinusitis) is called chronic if there are more than 3 episodes of exacerbation per year.

J32.0 - Chronic sinusitis (sinusitis of the maxillary sinuses, anthrite);

J32.1 - Chronic frontal sinusitis (chr. frontal sinusitis);

J32.3 - Chronic sphenoidal sinusitis (chr. sphenoiditis);

J32.4 - Chronic pansinusitis;

J32.9 Chronic sinusitis, unspecified (chr. sinusitis)

B97 - the disease is provoked by viruses.

An auxiliary code is set only if the presence of a particular pathogen is proven by special laboratory tests (crops) in a particular patient.

After injury.

bacterial infection.

The dependence of the development of sinusitis on the geographical location of a person has not been determined. And, interestingly, the bacterial flora found in the sinuses of people living in different countries is very similar.

Most often, sinusitis is recorded in the winter season after suffering the flu or an epidemic of a cold, which significantly undermine the human immune system. Doctors note the dependence of the frequency of exacerbation of sinusitis on the state of the environment, i.e. the frequency of the disease is higher where the air contains more harmful substances: dust, gas, toxic substances from vehicles and industrial enterprises.

Every year, about 10 million of the Russian population suffers from inflammation of the paranasal sinuses. In adolescence, sinusitis or frontal sinusitis occurs in no more than 2% of children. At the age of 4 years, the incidence rate is scanty and does not exceed 0.002%, because in young children the sinuses have not yet been formed. The main convenient and simple method of mass examination of the population is the x-ray of the sinuses.

Frontitis in adults is much more common than in children.

Depending on the symptoms of the disease, three degrees of sinusitis are distinguished:

mild degree;

severe severity.

The main, and sometimes the only, complaint of patients is nasal congestion. With a bright clinic in the morning, mucous discharge, pus appear. An important symptom is heaviness, pressure or pain in the area of ​​the canine fossa, the root of the nose.

It includes vasoconstrictor nasal drops, hypertonic irrigation solutions. In most cases, antibiotics are prescribed that penetrate well into all environments of the body and are detrimental to a wide range of bacteria - amoxicillins, cephalosporins, macrolides. In severe cases, hormones, puncture, surgery are prescribed.

Treatment of acute sinusitis and rhinosinusitis lasts from 10 to 20 days, chronic from 10 to 40 days.

The information provided should be used for informational purposes only - it does not claim to be medical reference accuracy. Do not self-medicate, letting your health take its course - consult a doctor. Only he will be able to examine the nose, prescribe the necessary examination and treatment.

Sinusitis - description, causes, symptoms (signs), diagnosis, treatment.

sinusitis- inflammatory diseases of the paranasal (paranasal) sinuses associated with infection or allergic reactions. Frequency- 10% of the population. More often, the cells of the ethmoid bone are affected, then the maxillary, frontal and, finally, the sphenoid sinuses.

Classification of acute sinusitis Acute sinusitis Acute ethmoiditis Acute frontal sinusitis Acute sphenoiditis.

Risk factors Aggravated allergic anamnesis Immunodeficiency states Diseases of the dentoalveolar system Bathing in polluted water.

Acute sinusitis General symptoms of acute sinusitis Nasal congestion Headache Fever Nasal discharge Cold symptoms Acute sinusitis Nasal congestion Feeling of heaviness, tension in the cheek area, especially when bending forward Feeling of pressure on the eyes Pain in the teeth on the affected side purulent or purulent nature Deterioration of smell Lachrymation (due to impaired patency of the nasolacrimal canal) Acute ethmoiditis. Symptoms differ little from acute sinusitis. Additionally, pain is noted in the region of the root of the nose and orbit Acute frontal sinusitis - a headache in the forehead, especially intense in the morning (due to difficulty in outflow from the sinus when the patient is in a horizontal position) Acute sphenoiditis Headache in the back of the head, in the depths of the eye back of the throat Unpleasant odor.

Chronic sinusitis The clinical picture of chronic sinusitis without exacerbation is less pronounced than in acute cases. Fungal sinusitis is characterized by: pronounced unilateral or bilateral nasal congestion; pain in the area of ​​the affected sinus; a pronounced feeling of pressure in the sinus; toothache (with sinusitis) The nature of the discharge depends on the pathogen: with mold mycoses - viscous, grayish-white or dark, jelly-like; with aspergillosis - gray with blackish dots (reminiscent of cholesteatoma); with candidiasis - yellow or yellow - white (reminiscent of curdled masses) More often than with other forms, swelling of the soft tissues of the face is observed, and sometimes fistulas. Usually occur as monosinusitis, more often the maxillary sinus is affected.

X-ray of the sinuses - accumulation of fluid, fluid level, thickening of the mucous membrane in the affected sinuses.

Diagnostic puncture - determination of the nature of the discharge.

CT in some obscure cases of chronic sinusitis.

Differential Diagnosis Viral rhinitis Allergic rhinitis Tumors Foreign bodies Wegener's granulomatosis.

With exacerbation - a combination of general and local treatment. Peculiarities With staphylococcal lesions, antibiotic therapy is not always effective. Apply anti-staphylococcal plasma (250 ml 2 r / week), staphylococcal g - globulin (1 ampoule every other day, 5 injections in total) For fungal sinusitis and without exacerbation - sulfanilamide drugs, antifungal drugs, such as nystatin 3-4 million units / day or levorin 2 million U/day for 4 weeks For allergic sinusitis - see Allergic rhinitis.

Drainage of the maxillary sinus is performed using a puncture - either a Kulikovsky needle is first inserted into the polyethylene tube, or after a puncture, a smaller tube is passed through the needle into the sinuses. Similarly, drainage is introduced into any sinus. To carry out the drainage of the frontal and sphenoid sinuses through natural openings, it is advisable to use a probe - a conductor, on which a tube is put on. After probing, the tube is left, and the probe is removed. The outer end of the tube is attached with adhesive tape to the skin. Antibacterial agents are injected into the sinuses through drainage, taking into account the sensitivity of the microflora to them. For liquefaction of pus, enzymes (chymotrypsin 25 mg or chymopsin 25 mg) can be simultaneously injected into the sinus. In allergic sinusitis, a suspension of hydrocortisone (2-3 ml) or antihistamines sinusitis, levorin sodium salt or nystatin is injected into the sinus at the rate of 10 thousand units per 1 ml of 0.9% solution of sodium chloride, solution of quinozole 1: 1,000 or amphotericin B.

Physiotherapy: microwaves, mud therapy (contraindicated in exacerbation of sinusitis). Physiotherapy is contraindicated in hyperplastic, polypous and cystic sinusitis.

Surgical treatment - with polyposis, mixed forms, as well as with the ineffectiveness of conservative treatment of exudative forms Radical operations on the sinuses in order to sanitize them by imposing an artificial fistula with a nasal passage (for sinusitis - methods according to Caldwell-Luke, Dliker-Ivanov, for frontal sinusitis - according to Killian) Osteoplasty with a closed method (Mishenkin N.V. 1997) Ultrasonic surgery.

Complications Orbital (orbital) Phlegmon Optic neuritis (rare) Orbital periostitis Edema, abscess of retrobulbar tissue Panophthalmos (inflammation of all tissues and membranes of the eye) - very rarely Intracranial Meningitis Arachnoiditis Extra - and subdural abscesses Brain abscess Thrombophlebitis of the cavernous sinus Thrombophlebitis of the superior longitudinal sinus Septic cavernous thrombosis .

Concomitant pathology Rhinitis Barosinusitis Pansinusitis.

The etiology and pathogenesis of acute frontal sinusitis are typical for banal sinusitis, symptoms, clinical course and possible complications are determined by the anatomical position and structure of the frontal sinus, as well as the length and size of the lumen of the frontonasal canal.

The incidence of acute frontal sinusitis and its complications, the severity of the clinical course are directly dependent on the size (airiness) of the frontal sinus, the length of the fronto-nasal canal and its lumen.

Acute frontal sinusitis can occur for a number of the following reasons and occur in various clinical forms.

According to etiology and pathogenesis: banal rhinopathy, mechanical or barometric trauma (baro- or aerosinusitis), metabolic disorders, immunodeficiency states, etc. According to pathomorphological changes: catarrhal inflammation, transudation and exudation, vosomotor, allergic, purulent, ulcerative necrotic, osteitis . By microbial composition: banal microbiota, specific microbiota, viruses. According to the symptoms (according to the predominant symptom): neuralgic, secretory, febrile, etc. According to the clinical course: torpid form, subacute, acute, hyperacute with a general severe condition and involvement of neighboring organs and tissues in the inflammatory process. Complicated forms: orbital, retro-orbital, intracranial, etc. Age forms: distinguish, like all other sinusitis, frontal sinusitis in children, mature individuals and the elderly, with their own clinical features.

The above symptoms are aggravated at night due to an increase in swelling of the nasal mucosa: general headache, throbbing radiating pain in the orbit and in the retromaxillary region, in the region of the pterygopalatine node, which plays a large role in the pathogenesis of inflammation of all anterior paranasal sinuses. The pterygopalatine node, which belongs to the parasympathetic nervous system, provides excitation of the cholinergic structures of the internal nose and the mucous membrane of the paranasal sinuses, which is manifested by the expansion of blood vessels, an increase in the functional activity of the mucous glands, and an increase in the permeability of cell membranes. These phenomena are important in the pathogenesis of the disease under consideration and play a positive role in the elimination of toxic products from the affected paranasal sinuses.

When examining the facial region, attention is drawn to diffuse swelling in the region of the superciliary arch, root of the nose, internal commissure of the eye and upper eyelid, swelling of the outer integument of the eyeball and lacrimal ducts, edema in the area of ​​the lacrimal caruncle, hyperemia of the sclera and lacrimation.

Do you have a sore forehead, head, decreased sense of smell, stuffy nose? This may indicate the presence of sinusitis, one of the types of which is frontal sinusitis. In this article, we will discuss with you, dear readers, what sinusitis is, what symptoms it has, causes and how to treat sinusitis with traditional and folk remedies. So…

Frontit- inflammation of the mucous membrane of the frontal sinuses, which are the paranasal sinuses.

Frontitis is included in a group of diseases called sinusitis. and due to its location, it is sometimes called - frontal (frontal) sinusitis or acute frontal sinusitis .

The main cause of sinusitis is various infections - viruses, fungi, bacteria, so treatment is mainly aimed at eliminating them, i.e. based on antibiotic therapy.

Of all sinusitis, frontal sinusitis is the most difficult disease in terms of course and treatment. the frontal sinus in most people is actually isolated from the general system of the nasal passage by the ethmoid labyrinth (ethmoid bone). Here it is worth noting the fact that in infants and children up to 7-8 years old, the frontal sinuses are not separated from the nose, the ethmoid labyrinth is absent, and begins to form after this age. The so-called "partition" of the bone is fully formed by puberty, although ENT doctors indicate that in 5% of the population it is absent for the entire period of a person's life.

The complexity of treatment, mainly when it comes to surgery (puncture), lies in the close location of the frontal sinuses with the eyes and brain.

Causes of frontitis

As we said at the beginning of the article, dear readers, inflammation of the frontal sinus most often has an infectious etiology (cause), therefore, in most cases, this disease develops against the background or as complications of such infectious diseases as sinusitis (runny nose, sinusitis and etc.), flu. SARS. scarlet fever. measles. diphtheria, etc.

Infections are staphylococci. streptococci. Haemophilus influenzae, adenoviruses, rhinoviruses, coronaviruses, etc.;

Patients complain of constant or throbbing pain in the forehead, radiating to the eyeball, into the deep parts of the nose, accompanied by a feeling of fullness and fullness in the area of ​​the superciliary arches and nasal cavity. The upper eyelid, the inner commissure of the eye, the periocular region appear edematous, hyperemic. On the side of the lesion, lacrimation increases, photophobia, scleral hyperemia, and sometimes anisocoria due to miosis on the affected side appear. At the height of the inflammatory process, when the catarrhal phase turns into an exudative one, the pains in this area intensify, generalize, their intensity increases at night, sometimes becoming unbearable, bursting, tearing. At the onset of the disease, nasal discharge is scanty and is mainly due to inflammation of the nasal mucosa, the endoscopic picture of which is characteristic of acute catarrhal rhinitis. Headaches increase with the cessation of discharge from the nose, which indicates their accumulation in the inflamed sinus. The use of application decongestants improves nasal breathing, widens the lumen of the middle nasal passage and restores the drainage function of the frontonasal canal. This results in profuse discharge from the corresponding frontal sinus, which appears in the anterior sections of the middle nasal passage. At the same time, headaches decrease or stop. Only soreness remains on palpation of the frontal notch, through which the medial branch of the supraorbital nerve exits, dull headache when shaking the head and when tapping along the superciliary arch. As the secretions accumulate, the pain syndrome gradually increases, the body temperature rises, the general condition of the patient worsens again.

These changes cause pronounced photophobia. The skin in these places is hyperemic, sensitive when touched, its temperature is elevated. When pressing on the outer-lower corner of the orbit, a pain point described by Ewing is revealed, as well as pain on palpation of the supraorbital notch - the exit site of the supraorbital nerve. A sharp soreness of the nasal mucosa in the region of the middle nasal passage is also revealed with indirect palpation with a bellied probe.

With anterior rhinoscopy, mucous or mucopurulent discharges are detected in the nasal passages, which, after their removal, reappear in the anterior sections of the middle nasal passage. Particularly abundant discharge is observed after anemization of the middle nasal passage with a solution of adrenaline. The mucous membrane of the nose is sharply hyperemic and edematous, the middle and lower nasal conchas are enlarged, which narrows the overall nasal passage and makes nasal breathing difficult on the side of the pathological process. There is also unilateral hyposmia, mainly mechanical, due to swelling of the nasal mucosa and the addition of ethmoiditis. Sometimes there is an objective cacosmia, due to the presence of an ulcerative necrotic process in the region of the maxillary sinus. Sometimes the middle turbinate and the area of ​​ager nasi are thinned, as if corroded.

The evolution of acute sinusitis goes through the same stages as the acute sinusitis described above: spontaneous recovery, recovery due to rational treatment, transition to the chronic stage, the occurrence of complications.

The prognosis is characterized by the same criteria that apply to acute sinusitis and acute rhinoethmoiditis.

Acute rhinitis: types and forms of the disease, signs, treatment, prevention

Acute rhinitis is a respiratory disease that manifests itself in the form of copious discharge from the nose of various consistency and color. At the same time, there are various types of this pathology, in which various symptoms are manifested. It is an acute inflammation of the nasal mucosa.

The etiology of acute rhinitis is manifested in an intense form by copious discharge from the nasal passages. Sometimes the process affects only the passages themselves, and sometimes the paranasal sinuses are also involved.

As a rule, the latter is already referred to as a complicated or advanced form. ICD of acute rhinitis - J00.

Acute rhinitis is divided into several types, including:

Allergic, manifested both seasonally and year-round in the form of clear discharge, sneezing, tearing, dry throat, perspiration, and so on.

Vasomotor also manifests itself, like allergic, but always has a time-limited manifestation, for example, during the flowering period of a plant or as a reaction to a specific stimulus - cold, dryness, and so on.

Viral rhinitis is provoked by viruses and manifests itself like allergic. At the same time, the symptoms of a cold, flu or other acute respiratory infections often develop in parallel. There is catarrhal inflammation of the mucous membranes.

Hypertrophic is manifested to a greater extent by growth with subsequent thickening of the mucous tissue in the nasal passages, which leads to difficulty breathing through the nose;

Atrophic is the opposite of the previous one and leads to thinning of the mucous membranes, as well as to degeneration of bone tissues. It manifests itself in the dry type without discharge, and in the lake - with purulent discharge and a characteristic odor;

Infectious bacterial or fungal is manifested by the release of a secret with purulent contents.

Features of acute rhinitis:

Symptoms are generally the same for all ages:

Discharge from the nose of various consistency and color;

sneezing;

Swelling of the mucosa;

Nasal congestion and inability to breathe through the nose;

Headache;

Dry mouth.

The photo shows the symptoms of acute rhinitis

The disease goes through three stages:

Dry irritation;

Serous discharge (clear);

Purulent discharge (yellow-green).

Basically, a visual examination and listening to the patient's complaints is enough for the doctor. In the case of bacterial rhinitis, mucus can be taken for bacteriological culture.

Nasal sinuses with different types of rhinitis

It is not advisable to treat rhinitis on your own, especially when it comes to children and pregnant women, since this pathology often not only causes complications, but also becomes chronic.

Self-selection of the drug is also impossible without an examination by a doctor and a diagnosis, since the same bacterial rhinitis has similar symptoms with atrophic purulent rhinitis (ozena), and the viral one is often confused with allergic.

Nasal lavage is mandatory. Adults do this with the help of a special teapot with a long nose. In the case of children, either a special aspirator pear is used, or a small syringe no more than 2 cubes, or a pipette.

Flushing is done with various formulations depending on the type of disease, but saline or saline is most commonly used. Especially for children, there are preparations based on sea water, which take into account the dosage of the composition, as well as the method of administration in the form of special nozzles.

Principles of treatment of acute rhinitis in our video:

Treatment of any rhinitis is carried out in a complex manner, depending on which type is detected. Most often used:

Antibiotics for bacterial rhinitis or ozen (the latter is incurable, but it stops well if the treatment process is properly approached);

Antiviral drugs for viral rhinitis;

Antihistamines of a general systemic or local type (depending on the patient's condition);

Inhalations and nasal lavages: with bacterial types - with a solution of furacilin, with the rest - with saline or saline.

Prevention are:

• With allergies - timely intake of antihistamines, elimination of the allergen as far as possible;
• With vasomotor, it is important to eliminate the influence of the irritating factor;
• For viral and bacterial infections, prophylactic treatment is carried out after contact with an infected person or before the period of epidemics;
• Daily ventilation of the room;
• Air humidification;
• Timely examination and treatment of pathologies of ENT organs;
• Strengthening immunity;
• Rejection of bad habits.

The prognosis is generally positive in almost all types of rhinitis, if therapy is carried out on time and in full, prescribed by the doctor. Hypertrophic and atrophic can not be completely cured, but you can stop and stop the progression.

Treatment of sinusitis includes general strengthening, anti-inflammatory. Antibacterial therapy and physiotherapy.
Sinusitis is not usually an indication for hospitalization and can be treated on an outpatient basis.
In the treatment of sinusitis, conservative (drugs and physiotherapy) and surgical methods are used. It is necessary to treat sinusitis under the supervision of an otorhinolaryngologist (ENT doctor).
conservative therapy.
The basis of medical treatment of sinusitis must necessarily be local procedures - irrigation in the form of drops, sprays, inhalers that can eliminate the swelling of the mucous membrane.
Vasoconstrictor drugs include: naphazoline (Naftizin, Sanorin), tetrizoline (Tizin), xylometazoline (Galazolin, Dlyanos), oxymetazoline (Nazol, Nazivin). With sinusitis, it is necessary to adhere to certain rules for pouring therapeutic liquids into the nose. Only after using these drops can others be instilled - having an antibacterial, anti-inflammatory or analgesic effect.
Antibacterial drugs (preferably cephalosporins), antihistamines (Claritin, Telfast and) are also used in the treatment. Rinse the nose with antiseptic solutions (for example, furacilin, sodium hypochlorite). From physiotherapy, methods such as UVI of the nasal cavity, UHF on the paranasal sinuses, etc. are used.
Puncture of the maxillary sinus is an operative method for the treatment of sinusitis. Indications for urgent surgical intervention are the addition of complications - such as abscesses, phlegmon, meningitis, sepsis.
A puncture (puncture) is done in order to pump out pus from the sinus, rinse the sinus, and then introduce antibiotics and anti-inflammatory drugs there. This procedure is accompanied by unpleasant sensations, but its effectiveness is very high. Currently, after a puncture, special tubes are installed in the sinus - catheters, through which the sinus can be washed daily. When using this method, the patient recovers very quickly. But everything has its indications, and in the initial stage of sinusitis, it is far from always necessary to carry out a puncture, you can do with washing the nose.
It should be noted that the use of sinus puncture as a treatment method is not widely used in other countries. For example, in the USA, puncture is recommended only as a diagnostic procedure - for sampling the contents of the sinus with further cultural and / or microscopic examination.
Treatment of sphenoiditis involves frequent lubrication of the nasal mucosa with vasoconstrictors to ensure the outflow of discharge from the sinuses. With a protracted disease, probing and washing the sinus with antibiotic solutions is recommended. Sometimes surgical intervention is indicated (for example, resection of the posterior end of the middle shell).
In acute frontal sinusitis, conservative treatment is indicated. The outflow of discharge from the sinus is provided by lubricating the mucous membrane of the middle nasal passage with a 0.1% solution of naphthyzinum, a 0.2% solution of galazolin. The same solutions can also be used in the form of nasal drops. In the first days of the disease, bed rest, taking acetylsalicylic acid, analgin, inhalation of antibiotic aerosols, physiotherapy (heating with a blue light lamp, sollux, UHF therapy) are recommended. In severe cases, intramuscular antibiotics are indicated. Surgical treatment is indicated only in case of failure of conservative therapy. During surgical intervention, an operation is performed - trepanation of the cranium in the region of the frontal sinus (local anesthesia of superficially located tissues is first performed - an injection of lidocaine / novocaine, then a burr hole with a diameter of about 5 mm is created using a drill, after which a catheter is inserted into this hole, subsequently, through which the frontal sinus is washed).