Inflammation of the mucous membranes of the maxillary sinus, sieve sinus, frontal sinus, and pterygoid sinus is collectively called sinusitis. Sinusitis is a non-specific inflammation of the mucous membrane of the sinuses, a common rhinological disease, can be divided into two categories: acute purulent sinusitis secondary to acute nasopharyngitis, with nasal congestion, pus and headache as the main features; chronic purulent sinusitis often secondary to acute purulent sinusitis, with more pus as the main manifestation, can be accompanied by varying severity of nasal congestion, headache and olfactory disorders.
The so-called sinuses are the air-containing cavities of the facial skull around the nasal cavity; there are four pairs: the frontal sinus, maxillary sinus, septal sinus, and pterygoid sinus. Because of its anatomical characteristics each sinus can develop alone, or multiple sinusitis or total sinusitis can be formed. Sinusitis can generally be divided into two types: chronic and acute. Acute sinusitis mostly develops from acute rhinopharyngitis; chronic sinusitis often develops when acute sinusitis is not completely cured or recurrent. At present, it is believed that the pathogenesis of sinusitis is mainly due to is due to various causes of sinus mouth obstruction, poor drainage, resulting in the infection of pus and bacteria in the sinuses can not be discharged in a timely manner, repeated infection and become.
The nasal cavity is an open channel, and under normal circumstances, conditional pathogenic and pathogenic bacteria can be present in the nasal cavity. The mucous membrane cilia system in the nasal cavity is constantly moving and eliminating bacteria and foreign bodies, and the white blood cells and antibodies in the mucous blanket work together to ensure that the bacteria do not exceed the number that the body can tolerate. In case of triggering factors such as cold, rain, and excessive fatigue, the function of the mucous membrane cilia system in the nasal cavity decreases, allowing the proliferation of pathogenic bacteria present in the nasal cavity, which in turn leads to acute nasopharyngitis. Repeated attacks of acute rhinopharyngitis can turn into sinusitis.
In acute sinusitis, the sinus mucosa is congested and edematous, and the mucosal epithelium is still intact. When acute purulent sinusitis develops, there is a large infiltration of leukocytes in the lamina propria of the sinus mucosa, in addition to necrosis of mucosal epithelial cells. In chronic sinusitis, the mucosa is thickened, the lamina propria is edematous, the vessel wall is thickened, the lumen is narrowed or even occluded, and more cells are infiltrated in the interstitium. When acute purulent sinusitis turns into chronic phase, part of the mucosa is destroyed, often accompanied by squamous epithelial metaplasia and granulation tissue formation, the lamina propria is significantly thickened, and local polyps may even be formed.
Symptoms of acute sinusitis.
Acute sinusitis is an acute inflammation of the mucous membrane of the sinuses, which mostly occurs after a cold, and the symptoms of acute sinusitis are related to which sinus inflammation occurs.
1. Headache.
(1) pain in the forehead, light in the morning and heavy in the afternoon. There may also be swelling and pain in the cheeks or pain in the upper molars, mostly from maxillary sinusitis.
(2) The forehead pain is felt in the morning, gradually aggravated, reduced in the afternoon, and disappears completely in the evening, which may be frontal sinusitis.
(3) Headache is mild, confined to the inner canthus or the root of the nose, or it may radiate to the top of the head, which is mostly caused by septal sinusitis.
(4) Pain deep in the eye, which may radiate to the top of the head, and also occipital headache that is light in the morning and heavy in the afternoon, which may be caused by pterygoid sinusitis.
(5) Younger children may appear to be mentally ill and irritable due to poor expression and inability to say where the headache is.
2. Other symptoms
(1) High fever, which may reach 39 to 40°C within a day.
(2) The child feels dizzy and nauseous.
(3) Yellowish face, especially on both sides of the nose and lips or around the mouth, greenish and yellowish, with a foul smell in the whistle.
(4) Stomach discomfort, vomiting or diarrhea. The mucus-like stuff will be vomited, which is actually snot that is swallowed. Unlike vomiting from bad food, the child does not get sicker and sicker, but is comfortable immediately after vomiting.
(5) The symptoms of nose will appear only on the second or third day after the onset of the disease, such as runny nose and blocked nose. After the nose symptoms appear, there will be coughing and phlegm, usually heavier when sleeping and waking up. We call this the trilogy of acute sinusitis: nausea and vomiting, fever, and the trilogy of runny nose, nasal congestion, and cough.
(6) High blood count. Do a routine blood test, the white blood cell count will be particularly high, 15 to 30,000 are possible.
Special reminder.
In some children, the total white blood cell count is not too high, but the neutrophil count (i.e., neutrophils, usually “G” or “N” in the laboratory test) is very high, which indicates that the child’s fever will get higher.
Symptoms of chronic sinusitis.
1, pus snot: the snot is mostly purulent or mucopurulent, yellow or yellow-green, the amount is variable, more flow to the throat, there can be phlegm in the throat, cough.
2, nasal congestion: light and heavy, mostly due to congestion and swelling of nasal mucosa and increased secretions.
3, headache: chronic purulent sinusitis generally ground obvious local pain or headache. If there is a headache, often manifested as a dull pain or head heaviness, heavy during the day, light at night. Pre-group sinusitis mostly shows forehead and nasal root distension or boring pain, post-group sinusitis headache in the top of the head, temporal or posterior occipital region. Deafness and other symptoms.
Diagnosis: For a comprehensive diagnosis of sinusitis includes the following.
1. nasal examination, paying attention to the presence or absence of swelling of the mucosa, the presence or absence of discharge from the nasal passages, and the presence or absence of polyps, turbinate hypertrophy or polypoid changes in the middle nasal passages. Observe the site of pus outflow, and if necessary, make postural drainage examination after fully contracting the nasal mucosa.
2.Posterior nostril examination, pay attention to the presence of polyps, turbinates and mucosa of the posterior end of the septum for congestion, swelling, hypertrophy or adhesion of secretions.
3.X-ray examination of sinuses. If necessary, a coronal CT examination of the sinuses is performed. CT examination has become an important means of diagnosing sinusitis, but CT has more radiation, so you have to weigh the pros and cons when doing the examination.
4, allergic reaction examination, allergic rhinitis is the basis of sinusitis, sinusitis can easily occur on the basis of allergic rhinitis.
5, systemic examination: chronic sinusitis can affect the growth and development of children, pay attention to the development of the whole body, due to long-term post-nasal drip stimulation of the pharynx, can form chronic pharyngitis, lymphatic follicle formation, and even cobblestone-like changes or gully-like changes.
Treatment of sinusitis.
The most effective way to treat sinusitis is to exercise, improve body resistance and prevent infection. Since chronic sinusitis is prone to recurrence, I came up with the three methods of infectious disease control: control the source of infection, treat the infected area thoroughly, and reduce the number of susceptible people. Such an approach works well.
Control the source of infection: In the clinic, I found that some children have recurrent sinusitis, and many of them have an attack once a month or once every two months, so I thought it must be related to a certain factor. We then conducted a multi-factor survey and finally found that 80％ or more children have a chronic sinusitis in their family (including the three generations of relatives who often live together and often come and go, and the nanny, who is the easiest person to ignore), and the diagnosis of sinusitis needs to rely on the CT diagnosis. There are 10 ％ more than the family has old slow bronchial or bronchial dilatation, often cough, and even often thick sputum. Because adults are relatively resistant and have been ill for a long time, the bacteria present in adults are generally more stubborn and resistant, and some are still conditionally pathogenic and resistant to most drugs. When these bacteria infect the child after the onset will be very characteristic, is the chronic onset, from clear nasal discharge —- thick nasal discharge —- yellow nasal discharge —- yellow-green nasal discharge – to ear symptoms, if the fever is also gradually high fever, rarely sudden high fever. Acute sinusitis is only sudden high fever, these infections are usually from the school or outside the infection, the treatment is relatively easy. The antimicrobial agent for treatment is usually a third-generation cephalosporin for 10-14 days. Or second generation cephalosporin antimicrobial combined with azithromycin. If yellow nose is not good for 5 days, or high fever with yellow nose, blocked nose and ear pain, intravenous medication is required. Bacterial resistance is more often than not the result of using too much antibacterial, but rather the result of using less antibacterial and not using it long enough.
If the child is not to recur in the future, we need to treat the adults thoroughly, that is, to control the source of infection. However, many parents excuse that adults are not well treated, or that there is no problem since, not to treat. Just like the management of the Yellow River, we do not care about the source, but only the downstream, so we get half the result with twice the effort.
Which situation adults need to treat, if parents have a foul taste in the mouth, or frequent throat clearing or nose blockage, or other sore throat to get a cold, adults have to eat anti-inflammatory drugs (is experience, not necessarily scientific), as if for the sake of the child to eat, if adults do not treat, this situation will be infectious to children.
Thorough treatment of sinusitis: Once diagnosed with chronic sinusitis, start by eradicating the cause, ensuring smooth drainage of the sinus openings, controlling infection and preventing complications. Depending on the degree of the lesion, different methods are chosen.
(1) Topical nasal medication: 0.5％ ephedrine saline nasal drops is an inexpensive and widely used nasal drop that reduces the swelling of the sinus mucosa and opens up the sinuses, making it easier for the pus in the sinuses to flow out. It is usually used twice a day, 1-2 drops per side of the nose each time. Nasal drops should be applied with attention to body position. Generally more supine and drooping position with nostrils facing upward is used. After the drops, you should stay for 5-8 minutes before getting up and gently blowing out the medicine and nasal snot, or sucking it into your mouth afterwards and then spitting it out. Do not pinch the bilateral nostrils and blow hard, as this will press the snot through the pharyngeal canal toward the middle ear, thus causing otitis media. This type of nasal decongestant may lead to drug rhinitis if used for a long time, so the duration of medication should not exceed 7 days.
We can also put antibiotics or other medications into the child’s nasal cavity to increase their anti-infective and anti-allergic effects, for example, Gemini eye drops and Rifampin eye drops. It is important to note that these drugs are usually used 15 minutes after the use of ephedrine saline.
If chronic sinusitis is accompanied by allergies, the nasal mucosa edema is more pronounced and there is no obvious yellow nasal discharge, then anti-allergic nasal sprays can be applied. For example, Nesuna and Renolcort nasal spray.
(2) Oral medicine: oral antibiotics should be based on bacterial culture and drug sensitivity test, and the duration of medication is usually 2-4 weeks. Commonly used drugs include compound penicillin, azithromycin, second-generation cephalosporin, and third-generation cephalosporin. If accompanied by allergy, some anti-allergy drugs can also be added, such as: loratadine, montelukast, ketotifen, etc. Some proprietary Chinese medicines are also effective in the treatment of chronic sinusitis, such as nasal abyssal shu and nasal abyssal tongqi granules. For patients with otitis media or a lot of yellow nasal discharge after five days of treatment, it is better to use the medicine intravenously.
(3) Positive and negative pressure replacement method: It is suitable for chronic whole group sinusitis and is a simple and effective method. During treatment, let the patient lie flat on the treatment bed, with a small pillow under the shoulder and head tilted back and down. First put 0.5％ ephedrine saline drops into the nasal cavity to fully contract the nasal cavity and open the sinus opening, then insert an olive tip outside the suction tube into one nostril, pinch the opposite nostril, open the suction device, the pus in the nasal cavity and sinuses will be sucked out, and the sinuses become negative pressure. Then put antibiotic drops into the nasal cavity, and the medicine will enter the sinuses. So many times, the pus in the sinuses will be discharged and replaced into the medicine, to achieve the purpose of treatment. This is usually done once a day for 10 days. This method is very effective and is suitable for patients who are apprehensive about taking oral antimicrobials. However, hospitalization is required.
(4) You can also use some treatment instruments, there are special sinusitis treatment instruments, for example: the German Parade sinusitis treatment instrument, the effect is good, expensive. Also you can use nebulizing humidifier twice a day for 5-10 minutes each time. For chronic sinusitis with yellow nasal discharge it is best to use 0.5％ ephedrine saline nasal drops 15 minutes in advance of each use, and then nebulize for better results.
Reduce susceptible people: chronic sinusitis is mainly a bacterial infection, the growth of bacteria in the human body is generally divided into four stages, slow growth period, rapid growth period. The former takes about 4 hours and bacteria must adhere to the nasal mucosa before they can hatch and grow and multiply, so if we use water to spray the nose 1-2 times a day or nebulize the nose 1-2 times a day, we can completely stop and slow down the growth and multiplication of bacteria and reduce the occurrence of sinusitis.
Strengthen physical exercise, and cold water washing to improve your child’s ability to adapt to cold as well as various environments, reducing the secretion of nasal mucosa and making it less likely for bacteria to adhere to the nasal mucosa.
Keep your child’s bowels open, as the child’s bowels are not open, causing a decrease in the amount of secretory IgA (secretory IgA is mainly produced in the lymph-like tissues of the intestine), making it easy for infections in the city’s aspiratory tract including the nasal sinuses.