How to relieve swelling during sinusitis: symptoms and treatment of sinusitis

Acute sinusitis is an inflammatory process that occurs in the mucous membrane of the nasal appendages (sinuses), so sometimes the diagnosis of sinusitis is also related to inflammation. This disease is characterized by swelling of the cheeks and purulent discharge, accompanied by an unpleasant odor.

In terms of its symptoms at the onset of the disease, the acute form of sinusitis is very similar to a common runny nose, only the treatment of the disease can be more difficult and lengthy. And the condition itself causes enormous discomfort to the patient and interferes with a full life.

Anatomy of the sinuses

There are 4 types of sinuses in the human skull:

• frontal (in the forehead area);
• maxillary, also known as maxillary (in the area of ​​the cheeks under the eyes);
• ethmoid sinuses, or cells of the ethmoid labyrinth (in the area between the nose and eye);
• wedge-shaped (in the very middle of the skull, behind the eyeballs).

The sinuses are peculiar voids that reduce the weight of the skull, participate in the formation and sonority of the voice, in the process of smell, and also serve as shock absorbers for injuries to the facial skeleton.

They also perform a protective function: when foreign particles and bacteria enter the nasal cavity, the nasal mucosa is irritated, sneezing begins, and the particles are evacuated from the body along with mucus. But if the body’s defenses are weakened, bacteria can enter the sinuses from the nasal passages and cause severe inflammation, which is what we observe during the development of acute manifestations of the disease.

Diagnostics

Diagnosis of diseases that are accompanied by swelling of the nasal cavity is carried out by otolaryngologists. The examination program includes a survey, during which the specialist determines the time and circumstances of the appearance of swelling and other symptoms, their relationship with various external and internal factors. The doctor conducts an external examination and prescribes the following diagnostic procedures:

• Rhinoscopy.
  Allows you to confirm the presence of inflammation, deformities, tumors, polyps, foreign bodies and traumatic injuries.
• Lab tests
  . A microbiological examination of nasal discharge is performed to detect bacterial infections, and RIF to detect viral diseases. For tumors, histological or cytological examination is prescribed.
• Radiography
  . In case of injuries, photographs of the nose are taken, and if sinusitis is suspected, X-rays of the paranasal sinuses are taken.

The listed methods can be supplemented by allergy tests, studying the condition of the pharynx and larynx during pharyngoscopy and laryngoscopy, and other studies.

Rhinoendoscopy

Why do the maxillary sinuses become inflamed more often?

Among inflammations of the paranasal sinuses, acute sinusitis - inflammation of the maxillary sinuses - is most often diagnosed. And there are several reasons for this:

• the maxillary sinuses are the largest in volume;
• The maxillary sinuses are connected to the nasal cavity using anastomoses - small openings covered with mucous membrane (these openings are quite narrow, and even a slight swelling of the mucous membrane with minor inflammation can make it difficult for mucus to come out of them, and the formed and accumulated mucus in the absence of proper outflow becomes a powerful catalyst, if the inflammatory process develops first in neighboring ones.).

Causes of swelling

The maxillary (or maxillary) sinuses are located under the eyes in the thickness of the upper jaw[1]. The entrance to the sinuses is located on the lateral walls of the nasal cavity. The mucous membrane covers the paranasal sinus from the inside. It is necessary for a complete outflow mechanism. The production of mucus in all paranasal sinuses is considered normal. It is necessary to absorb pathogens or solid foreign particles and further remove them from the nasal cavity.

The mucosa consists of multirow epithelium with mobile cilia[2]. They constantly drain fluid from the sinuses. The hole for this is located in the upper part of the sinuses. The process is practically impossible if the mucus secretion mechanism is disrupted. Also, the anastomosis (opening) itself, connecting the sinus with the nasal cavity, has its own mucous membrane. If it swells, then this hole becomes narrow, and the outflow of mucus through it occurs with great difficulty.

If a person is completely healthy, then all of the listed mechanisms work very harmoniously. In this case, sinusitis simply cannot develop. But if an inflammatory process occurs in the nasal mucosa, then not only it swells, but also the mucous membrane of the adjacent anastomosis and maxillary sinus. As the mucous membrane swells, the gap between the sinus and nasal cavity gradually closes.

When the mucous membrane swells greatly and the anastomosis narrows, the maxillary sinus becomes completely cut off from the nasal cavity[3]. Under such conditions, pathological changes occur in it: hypoxia sets in, pressure increases, and the active production of mucus continues, which has nowhere to go due to impaired outflow, so it stagnates in the sinuses. Over time, a strong inflammatory process develops, and the contents of the sinuses become purulent.

Types of acute sinusitis

There are catarrhal and purulent forms of sinusitis.

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The name “catarrhal” comes from the medical term “catarrh,” meaning “to flow, drain.” That is, with this form of sinusitis, inflammation of the mucous membrane and its swelling develop quite quickly. Initially, the changes affect only the mucous membrane. Inflammation during sinusitis of this form is accompanied by severe swelling of the mucous membrane - it noticeably increases in size and, as a result, a little later transparent mucus forms. Only thanks to timely treatment, it is possible to prevent the transition of catarrhal forms into purulent sinusitis, which with a high degree of probability can become chronic.

With purulent sinusitis, direct contact of pus with the mucous membrane degenerates it, quite quickly and, what is most dangerous, irrevocably. Thus, with improper treatment or no treatment at all, you can very easily and simply join the army of people suffering from a chronic form of sinusitis.

The cause of the purulent form of sinusitis (acute sinusitis) is bacteria. The secreted mucus contains streptococci, staphylococci, and less commonly pneumococci and fungi, which leads to the appearance of purulent contents in the sinus itself.

How to relieve swelling from sinusitis: safe ways

Many people are very afraid of punctures and are interested in how to relieve swelling of the maxillary sinuses in more gentle ways. A good alternative to puncture is the YAMIK sinus catheter [8]. This device was developed by Yaroslavl specialists - G.I. Markov. and Kozlov V.S. During therapeutic manipulation, the mucous membranes are not injured and the bone structures of the nasal cavity are not damaged.

With this procedure, it is possible to restore normal communication between the sinus and nasopharynx, as well as locally administer antibiotics or antiseptics. The principle of operation of such a catheter is to seal the nasal cavity and create negative pressure in it.

After inserting a thin catheter into the nasal cavity, the patient's pressure changes, which eliminates swelling and improves local blood circulation. As a result, the functionality of the ciliated epithelium is restored, and the pathological contents from the sinuses are easily removed[9]

Reasons for the development of sinusitis

Acute sinusitis can be caused by the following factors:

• colds;
• viral infections: ARVI, measles, influenza, etc.;
• allergic reactions;
• damage and injury to the nose;
• untreated teeth, tooth roots entering the cavity of the maxillary sinus, inflammation of the gums.

In medicine, it is customary to distinguish two ways of infection entering the maxillary sinuses: when the infection penetrates from the nasal mucosa into the maxillary sinus or when the infection develops directly in the maxillary sinus through blood flow and general inflammation.

Sinusitis (in addition to bacteria) can be provoked by factors that interfere with normal air circulation and the release of mucous masses from the sinuses. These include:

• deviated nasal septum;
• adenoids;
• cyst;
• polypous formations;
• and etc.

Unfavorable environmental conditions - dust, gas pollution, work in hazardous industries - can also disrupt the process of the release of mucous masses from the sinuses and further treatment.

Why does the nasal mucosa swell?

Physiological reasons

The most common cause of physiological edema is irritation of the mucous membrane by various substances contained in the air: household and industrial dust, chemical aerosols, detergents, and pesticides. Sometimes the symptom is provoked by too dry air in the room. In some people, swelling of the mucous membrane appears when swimming in cold water, eating chilled foods and drinks, or staying outside without a hat in the winter season.

Acute infections

Most acute respiratory bacterial and viral infectious diseases are accompanied by acute rhinitis. Nasal congestion becomes one of the first signs of the disease, combined with weakness and general hyperthermia. Initially, swelling of the nasal mucosa is manifested by a feeling of dryness, itching and burning; after a few hours or the next day, heavy discharge appears. A runny nose persists for 1-2 weeks, the severity of the symptom gradually decreases.

Chronic rhinitis

Swelling of the nasal mucosa is provoked by the following forms of rhinitis:

• Catarrhal rhinitis.
  Occurs with frequent respiratory infections, other ENT pathologies, and weakening of the body. Swelling and difficulty breathing are moderate, breathing becomes easier when changing position. The discharge is also moderate and mucous in nature.
• Hypertrophic rhinitis.
  The swelling itself may not be noticeable, but against the background of connective tissue growths it leads to significant breathing difficulties and constant nasal congestion.
• Vasomotor rhinitis.
  Occurs due to prolonged use of vasoconstrictors, taking certain general medications, and frequent infections. It is characterized by a paroxysmal course with a sharp increase in symptoms in the morning, when inhaling irritating substances, cold or hot air.

Swelling of the nasal mucosa

Other ENT pathologies

Swelling of the nasal mucosa can occur not only with rhinitis, but also with some other diseases of the ENT organs, which include:

• Sinusitis.
  The symptom is especially pronounced with sinusitis and frontal sinusitis. There is difficulty in nasal breathing, discharge of yellowish-green purulent contents, headaches, weakness, weakness.
• Adenoids.
  Observed in children, they arise due to the proliferation of the nasopharyngeal tonsil. Swelling of the mucous membrane causes constant or periodic nasal congestion and difficulty breathing. Copious serous discharge is discharged from the nose. The child's mouth is constantly half-open, and a nasal sound is possible.
• Disorders of the structure of the nose
  . A deviated nasal septum and narrowness of the nasal passages do not in themselves lead to swelling, but they increase the likelihood of developing inflammatory processes in the mucous membrane.
• Polyps and tumors
  . The mucous membrane swells against the background of volumetric processes in the nasal cavity. Vasoconstrictor drops alleviate the condition to some extent in the initial stages, but cease to act in case of large formations that block the lumen of the nasal passages.

Nose injuries

Swelling is observed with injuries (including minor injuries) and foreign bodies in the nasal cavity, which is explained by the large number of vessels and the high sensitivity of the mucous membrane to mechanical stress. Along with congestion, nosebleeds, hematomas, and skin hyperemia are detected. With fractures of the nasal bones and damage to the nasal septum, deformation may be detected.

Allergic reactions

Swelling of the mucous membrane is often provoked by allergic reactions to house dust, pollen, dead particles of animal skin and other allergens. Seasonal allergic rhinitis most often develops in the spring-summer season, during the flowering period of plants. The mucous membrane swells within a few minutes. Initially, itching and discomfort appear in the nose. Then the nose becomes stuffy and watery eyes occur. Symptoms disappear after stopping contact with the allergen.

With year-round allergic rhinitis, substances that are constantly present in the air act as allergens. Middle-aged and elderly women are more often affected. The clinical picture is the same as for the seasonal form of the disease. With hay fever, swelling of the nasal mucosa is complemented by swelling of the eyes and skin symptoms. Manifestations of rhinitis are combined with signs of conjunctivitis, urticaria, dermatitis, and asthmatic bronchitis.

Other reasons

Swelling of the mucous membrane is observed after cosmetic and otolaryngological operations on the nasal cavity and adjacent anatomical structures. Gradually decreases and disappears after 1-2 weeks. Other reasons for the development of symptoms are:

• Changes in hormonal levels.
  Edema of this localization can be detected in adolescents, women in the first trimester of pregnancy and premenopause.
• Kartagener's syndrome.
  In children, rhinitis with purulent discharge, otitis media, and eustachitis are detected. Subsequently, inflammatory diseases of the paranasal sinuses, bronchi and lungs appear.
• Cystic fibrosis.
  Manifests in childhood. The symptom is detected against the background of inflammatory diseases of the ENT organs, bronchitis, and pneumonia.
• Autoimmune diseases.
  Swelling of the nasal cavity is observed in systemic scleroderma, Sjögren's syndrome, and Wegener's granulomatosis.

Symptoms

Symptoms of acute sinusitis include:

• pain in the cheek area under the eyes;
• pain in the orbital region;
• pressure on teeth and toothache;
• headache;
• pain when tilting the head forward (the pain “radiates” to the back of the head and forehead; the nature of the sensation resembles the pain of a migraine; as a rule, the pain intensifies in the evening);
• difficulty breathing through the nose;
• a feeling of continuous nasal congestion (it may be accompanied by itching, sneezing, dryness);
• the nature of the mucous discharge helps determine the severity of the disease (transparent discharge in a mild form of the disease and thick green discharge in a purulent form);
• bad odor from the nose and mouth (the nose and pharynx are connected to each other; with sinusitis, pus accumulates in the sinuses and causes bad breath; it is difficult to get rid of it, even after brushing your teeth);
• eyes become watery;
• nasality appears in the voice;
• impaired sense of smell;
• high body temperature from 37.5 to 39°C - the body’s response to the presence of infection;
• increased fatigue, decreased appetite, sleep problems;
• swelling of the eyelids, cheekbones, and areas near the nose;
• pain when pressing on the area where the sinuses are located.

Vasoconstrictors

Decongestants for sinusitis are prescribed topically: nasal drops, sprays, aerosols, gels or ointments. Among the vasoconstrictors, one can highlight the drug Xilong with two active ingredients: xylometazoline and dexpanthenol. They reduce swelling and make breathing easier, and also promote healing of the nasal mucosa. The drug is available in the form of a nasal spray. Approved for use from 6 years of age. For the little ones there is Xilong Kids - children from 2 to 6 years old.

Are complications possible with acute sinusitis?

With delayed treatment or lack of properly selected treatment, acute sinusitis can become chronic and lead to the development of a number of other serious complications.

Friends! Timely and correct treatment will ensure you a speedy recovery!

Chronic inflammation in the sinuses is the most common complication of acute sinusitis. The chronic form requires long-term competent treatment.

An infection from the maxillary sinuses can enter the middle part of the ear and provoke a severe inflammatory process there (otitis media). Otitis is accompanied by sharp pain in the ear, hearing loss occurs, and body temperature may rise.

Diseases of the ternary nerve are associated with sinusitis, since it is located close to the source of inflammation. This condition is characterized by shooting pains in the face. Patients describe the sensations as electric shocks. Such neuritis is extremely difficult to treat.

Complications of sinusitis associated with the eyes are possible. With inflammation, we observe swelling of the eyelids, pain when pressing on the eye socket, and vision may begin to “deteriorate.” Pus entering the eye socket and vein thrombosis can lead to loss of vision and even loss of the eye itself (panophthalmitis).

The worst consequence of sinusitis is inflammation of the lining of the brain (meningitis). A similar complication develops with prolonged and incorrect attempts to independently cure sinus inflammation.

Other common complications of sinusitis in adults: periostitis of the jaw, meningoencephalitis, sinus thrombosis, up to generalized blood poisoning (sepsis).

Remember, sinusitis with complications is much more difficult to treat, so it is very important to promptly seek qualified help from an ENT specialist.

How is diagnosis carried out?

Treatment of acute sinusitis in adults and children must be carried out under the supervision of an experienced otolaryngologist.

At the appointment, the ENT doctor will collect anamnesis and conduct an examination of the nasal cavity. Painful sensations when palpating the area under the eyes at the level of the cheeks will indicate the presence of an inflammatory process in the sinuses.

A reliable diagnostic method is x-ray examination. But young children and pregnant women are not prescribed x-rays. They are shown CT and ultrasound examination of the sinuses - sinus scanning.

To obtain complete information about the disease, rhinoscopy and endoscopy of the nasal cavity and nasopharynx are performed.

Anti-inflammatory drugs

Glucocorticosteroids are popular among otolaryngologists. They have the following effect[11]:

• suppress the development of mucosal edema;
• restore the functional ability of the openings connecting the nasal cavity and sinuses;
• prevent the development of blood eosinophilia;
• reduce inflammation caused by the interaction between cells of the nervous and immune systems.

Also, in order to eliminate the inflammatory process in case of sinusitis, complex preparations based on medicinal plants can be prescribed.

Treatment methods for acute sinusitis

The mildest disease does not require the use of any special measures or antibacterial agents for treatment. It is enough to take anti-inflammatory drugs to relieve general symptoms and use vasoconstrictor drops to relieve swelling and facilitate the release of mucus.

Sinusitis with a purulent form is treated with the help of antibiotics (for example, Amoxiclav).

Therapy for the acute form of the disease is best supplemented by rinsing the nasal cavity and paranasal sinuses. The most effective method of treating sinusitis is Proetz lavage, better known as the “cuckoo” method.

Physiotherapeutic procedures and irrigation of the nasal cavity with antiseptic agents will help to consolidate the effect of treating sinusitis.

Taking antibiotics

To treat sinusitis, groups of antibiotics are more often used[10]:

• penicillin series in combination with clavulanic acid;
• cephalosporins;
• macrolides.

For local therapy, antibiotics from the aminoglycoside group are prescribed. As a result of complex therapy, it is possible to overcome infection, reduce inflammation and swelling, restore nasal breathing, and alleviate the general condition of a person.

Washing “cuckoo”: description of the method of treating sinusitis

The “cuckoo” method is a painless and, most importantly, effective procedure. Thanks to conservative treatment, purulent masses, mucous secretions along with pathogenic microorganisms are effectively washed out of the sinuses, the mucous membrane improves its function, nasal congestion decreases, and inflammation subsides. In some cases, thanks to Proetz lavage, puncture can be avoided. How is this procedure carried out?

The patient is positioned comfortably, lying on the couch, face up. The ENT doctor carefully pours an antiseptic into one nostril (Chlorhexidine, Furacilin, Miramistin, etc.). And at the same time, with the help of a special metal olive connected by a medical suction device, it sucks out this rinsing solution, but from the other nostril. The manipulation is repeated three times on each side, using a sterile plastic syringe with a volume of twenty ml. The entire procedure lasts about five minutes.

Puncture for sinusitis

If all conservative methods of treating sinusitis do not help, the ENT doctor will suggest a puncture of the maxillary sinus. This measure is necessary because pus accumulated in the sinus, as we already know, can lead to serious consequences, including inflammation of the brain.

During the procedure, the otolaryngologist releases the purulent contents of the sinuses and injects medication into the sinus. There is no need to be afraid of a puncture - before the procedure, anesthesia is performed: the ENT doctor inserts a cotton swab soaked in a lidocaine solution into the nasal passage of the patient sitting in a chair. It is completely safe and does not require patient preparation.

As soon as the anesthesia takes effect, the otolaryngologist, using a Kulikovsky needle, carefully inserts it into the sinus through the nasal cavity. Using a syringe, the purulent contents are sucked out. As soon as the purulent masses are completely removed, rinsing is carried out. The sinus should continue to be rinsed for several days after the procedure.

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