What is the frontal sinus responsible for? Frontal sinuses: structure, functions, diseases

Frontit(frontal sinusitis) - inflammation of the frontal paranasal sinus. Over the past decade, sinusitis (inflammation of the sinuses) has been considered one of the most common diseases in the world. Today, about 10-15% of the population suffers from them. A tenth of patients with sinusitis are diagnosed with acute or chronic sinusitis. Over the past 5 years, the incidence of frontal sinusitis has tripled and continues to increase. In Russia, the number of people suffering from manifestations of frontal sinusitis reaches 1 million people per year. Among those hospitalized, there are more males, and among those treated on an outpatient basis, females are more common.

Anatomy of the frontal sinuses

Adjacent to the nasal cavity are the paranasal sinuses:

• two maxillary (maxillary)
• two frontal
• two lattice mazes
• one wedge-shaped (main)

These are small cavities in the bones of the skull that open into the nasal passages. Normally, the sinuses contain air. They perform a number of important functions:

• humidify and warm the inhaled air
• makes the skull bones lighter
• isolate the roots of teeth and eyeballs from temperature fluctuations
• act as a buffer for facial injuries
• act as a vocal resonator

In humans, the frontal bone contains two frontal sinuses. They have the shape of a pyramid, located base down. The pyramid is divided into two parts by a bony septum.

There are four walls of the frontal sinus:

1. inferior (orbital)– the thinnest
2. front– the strongest and thickest
3. back– separates the sinus from the cranial fossa
4. internal, aka partition– divides the cavity into right and left halves

Dimensions of the frontal sinus different people may vary significantly. Its volume ranges from 3 to 5 cm. And in 10% of people it may be completely absent. Heredity plays a big role in this.

The frontal sinus (like the other sinuses) is lined from the inside with mucous membrane, which is a continuation of the nasal mucosa. But it is much thinner and does not contain cavernous tissue. The sinus is connected to the nasal cavity by a narrow, winding canaliculus, which opens with a small hole in the front of the nasal passage.

Causes of frontal sinusitis

With frontal sinusitis, inflammation of the mucous membrane that lines the sinus occurs. The causes of frontal sinusitis can be varied, often depending on the form and severity of the disease.

Infection

Most often, sinusitis occurs as a result of infection from the nasal cavity. In this case, inflammation can occur in parallel in both the maxillary and frontal sinuses. In this case, the patient is diagnosed with sinusitis and frontal sinusitis. The cause of the disease can be influenza, ARVI, diphtheria, scarlet fever.

The most common causative agents of viral frontal sinusitis are:

• adenoviruses
• coronaviruses
• rhinoviruses
• respiratory syncytial viruses

Bacterial frontal sinusitis is caused by:

• Streptococcus pneumoniae
• haemophilus influenzae
• Pyogenes
• Staphylococcus aureus

Frontal sinusitis in children is caused by the bacterium M.catarrhalis. In this case, the disease is relatively mild.

The cause of inflammation of the frontal sinus can also be a fungal infection. In some cases, infection with bacteria and fungi can occur through the blood (hematogenous). This happens if there are foci of infection in the human body: carious teeth, abscesses.

Allergy

Bronchial asthma and prolonged allergic rhinitis (vasomotor rhinitis) cause inflammation and swelling of the mucous membrane. This closes the hole that allows fluid to exit the frontal sinus.

Nasal polyps

Nasal polyps are benign formations round shape, which arise as a result of degeneration of the mucous membrane. In this case, there is swelling of the mucous membrane, difficulty breathing, and the outflow from the nasal sinuses is blocked.

Injuries to the nose and paranasal sinuses

Inflammation can result from trauma to the skull bones. A bruise causes tissue swelling and disruption of normal blood circulation in the mucous membrane of the nose and paranasal sinuses.

Deviation of the nasal septum and hypertrophy of the nasal turbinates

The curvature may be congenital anomaly, the result of injury or illness. A deviated nasal septum can also impair the free flow of mucus and germs from the sinuses.

Foreign bodies

Prolonged residence of foreign bodies in the nasal passages causes inflammation, which spreads to the nasal cavity and sinuses. Especially often small objects (beads, construction parts) cause frontal sinusitis in children.

Symptoms and signs of frontal sinusitis

Frontal sinusitis is a serious disease that is more severe than other forms of sinusitis. According to the nature of the course, there are two forms of frontal sinusitis: acute and chronic. Each of them has its own characteristics and characteristics.

Acute frontal sinusitis

In the acute form of the disease, the following complaints arise:

• sharp pain in the forehead, aggravated by tapping or pressing on the anterior wall of the frontal sinus (forehead area above the bridge of the nose)
• discomfort occurs in the area of ​​the inner corner of the eye
• eye pain, lacrimation, photophobia
• nasal congestion and difficulty breathing through the nose
• copious discharge from the nose, at first it is transparent, mucous, but over time it can turn purulent
• with right- or left-sided frontal sinusitis, discharge from the corresponding half of the nose;
• swelling of the face, especially at the inner corner of the eye
• the color of the skin over the sinus may be changed
• temperature rises to 39°, but in some cases the temperature may be low;
• feeling of weakness, weakness as a result of general intoxication of the body
• When examined by an ENT specialist, mucopurulent discharge, redness and swelling of the nasal mucosa are detected

Pain in acute frontal sinusitis is cyclical. During periods when the outflow of mucus from the frontal sinus is disrupted, the pain intensifies. This stagnation causes deterioration in the morning hours. The pain becomes severe, radiating to the eye, temple, and the corresponding half of the head. After the sinus is freed from the contents, the pain subsides.

Chronic frontal sinusitis

Acute frontal sinusitis becomes chronic 4-8 weeks after the onset of the disease. This can happen as a result of incorrectly selected treatment or complete ignorance of the manifestations of the disease.

The symptoms of chronic frontal sinusitis are somewhat less pronounced than acute ones:

• aching or pressing pain in the frontal sinus area, which intensifies with tapping
• when pressing, sharp pain in the inner corner of the eye
• profuse purulent discharge from the nose in the morning with an unpleasant odor
• a large amount of purulent sputum in the morning

Just because the symptoms have become weaker does not mean that there has been an improvement. On the contrary, chronic frontal sinusitis can lead to serious consequences and life-threatening complications.

Diagnosis of frontal sinusitis

An experienced otolaryngologist (ENT) will quickly make the correct diagnosis based on the patient’s complaints. Additional Research necessary to clarify the severity of the disease and correctly select a treatment regimen. The main research methods are described below.

Type of diagnosis	Purpose of diagnosis	How is it made
Collection of anamnesis	Collect complaints, clarify symptoms, determine the cause and moment of onset of the disease	The doctor asks questions regarding the course of the disease
Rhinoscopy	Determine the condition of the mucous membrane, swelling, thickening, presence of polyps Determine what comes out of the sinuses and where it flows	Nasal speculums (dilators) and a nasopharyngeal speculum are used
Ultrasound of the paranasal sinuses	Identify the extent of inflammation and monitor the effectiveness of treatment	The study of the frontal sinuses is carried out with ultrasonic linear sensors with a frequency of 8 to 10 MHz. As a result, an image of the source of inflammation appears on the monitor screen
Nasal endoscopy	Examine the condition of the mucous membranes in the nasal cavity and paranasal sinuses Identify the structural features of the sinuses and nasal septum Determine what factors caused the disease	A thin flexible tube with a microscopic camera is inserted into the sinus through the frontonasal canal. The image is displayed on the screen
Diaphanoscopy (transillumination)	Allows you to identify developmental abnormalities and areas of inflammation	Transillumination of the sinuses with a bright beam of light from the tube of the device. Produced in a dark room
Thermal imaging (thermography)	Allows you to get a picture of temperatures in different parts of the body	The thermographic camera records thermal radiation. Based on the results, you can determine where the hotter areas are. They are foci of inflammation
X-ray of sinuses	Determine the shape and condition of the frontal sinuses Determine the presence of inflammation and mucus accumulation in them Identify swelling of the mucous membrane Determine inflammation in other paranasal sinuses	A picture of the head is taken using an X-ray machine
Bacteriological study of secretions from the nasal cavity	Determine which microorganisms cause inflammation and their sensitivity to antibiotics and other drugs	During the examination, the doctor makes a smear. In the laboratory, a sample of mucus is inoculated onto nutrient media, the type of microorganism and the means to effectively combat it are determined.
Cytological examination contents of the nasal cavity	Determine which cells are present in the mucus. This is necessary in order to find the cause of the disease	A sample of nasal contents is taken and examined under a microscope.
Computer tomogram	One of the most informative and reliable methods. Allows you to determine the presence of inflammation, its stage, structural features of the skull bones	The study is carried out using a computed tomograph. The method involves the use of x-rays

Types of frontal sinusitis

There are several classifications of frontites. Let's consider them in more detail.

Classification according to the form of the inflammatory process

Type of frontite		Cause of occurrence	Optimal Treatment Methods
Acute frontal sinusitis	Severe headaches that get worse with tapping and pressure.	Injuries Allergic runny nose	Vasoconstrictor drops and sprays Antipyretics Painkillers
Chronic frontal sinusitis	Aching or pressing pain A feeling of “fullness” caused by the accumulation of contents in the sinus Slight rise in temperature Severe difficulty breathing through the nose Loss of smell Copious purulent discharge with unpleasant smell Large amount of phlegm in the morning	Previous flu, acute rhinitis Prolonged course of acute frontal sinusitis or its reoccurrence Deviated nasal septum Polyps in the nose Foreign body in the nasal passages Weakened immunity	Antibiotics Vasoconstrictor drops Decongestants Homeopathic remedies Washing Electrophoresis Expansion of the frontonasal canal Puncture of the frontal sinus

Classification by type of inflammatory process

Type of frontite	Symptoms and external manifestations	Cause of occurrence	Optimal Treatment Methods
Exudative frontal sinusitis
a) Catarrhal frontitis	Severe pain in the central part of the forehead, worsens with pressure and tilting of the head Temperature rises to 39°C Puffiness under the eyes	Occurs as a consequence of infection and inflammatory processes in the nasal mucosa	Nasal lavage Vasoconstrictor drops Antibiotics for fever Preparations for normalizing microflora Allergy remedies
b) Purulent frontal sinusitis	Heat strong headache in the frontotemporal region Weakness Labored breathing Mucopurulent discharge from the nose	Inflammation caused by bacteria Violation of the outflow of contents from the frontal sinus	Antibiotics Possible puncture due to frontal sinusitis Anti-inflammatory and painkillers Decongestant drops
Productive frontitis
Polypous, cystic frontal sinusitis	Labored breathing Constant aching pain in the forehead area Mucus discharge	Pathological proliferation of mucous tissue lining the sinus. Cyst formation	Opening the frontal sinus, removing cysts and polyps
Parietal-hyperplastic frontitis caused by an overgrowth of the sinus mucosa	Labored breathing It's a dull pain in the center of the forehead Mucous discharge from the nose	bacterial infection Increased division of mucosal cells Specific immune response to inflammation	Antibacterial therapy Vasoconstrictor drops

Classification by process localization

Type of frontite	Symptoms and external manifestations	Cause of occurrence	Optimal Treatment Methods
Unilateral frontal sinusitis
left hand Right-handed	Headache and mucopurulent discharge from one nostril Body temperature 37.3-39°C	Caused by bacteria, viruses, fungi, allergens. It can also be a consequence of injuries and decreased local immunity	The choice of treatment method depends on the cause of the disease. Use: antibiotics painkillers, anti-inflammatory, antiallergic, decongestants If treatment does not produce results, then surgery for frontal sinusitis may be necessary.
Bilateral frontitis
Double-sided form	Pain occurs symmetrically on both sides. It can radiate to different parts of the head. Discharge from both nostrils.	The causes of inflammation are the same as for unilateral frontal sinusitis.	Drug treatment with appropriate drugs. Surgical methods treatment

Treatment of frontal sinusitis

Traditional methods of treating frontal sinusitis

Treatment of frontal sinusitis at home is allowed for mild forms of the disease. Treatment prescribed by a doctor can be supplemented with inhalations, ointments and warming agents. Traditional methods can help cope with the disease more effectively and quickly. However, it is necessary that the results of treatment are monitored by an ENT specialist.

There is an indication that this treatment method is right for you. If after the procedure tapping on the central area of ​​the forehead does not cause pain, this means that the frontal sinus has been freed of mucous contents and microorganisms.

There is only one limitation: you must remember that under no circumstances should you heat your forehead if you have purulent frontal sinusitis. This can lead to the spread of pus into surrounding tissues.

Inhalations for the treatment of sinusitis

1. Boil the potatoes in their skins, drain the water. Mash the potatoes and breathe in the steam over the pan. For greater effect, cover your head with a terry towel.
2. Boil chamomile flowers, add a few drops of essential oil to the hot broth tea tree or eucalyptus. Breathe steam over the mixture.
3. Bring one and a half liters of water to a boil, throw in 7-10 bay leaves. Turn the heat to low and breathe steam over the pan for five minutes.
4. Grind 4 cloves of garlic, add half a glass apple cider vinegar and half a glass of boiling water. Breathe over the solution for 15 minutes, 3 times a day, covered with a towel. Add hot water as it cools.
5. Boil water in a saucepan and add a small amount of “Star” balm or dry menthol. Remove from heat and breathe in the steam for five minutes, covering your head with a towel.

Solutions for rinsing the nose for sinusitis

Washing is a mandatory procedure for any form of frontal sinusitis. For her to bring maximum benefit, before rinsing, you need to clean your nose and drip in vasoconstrictor drops (Naphthyzin, Farmazolin, Noxprey). This will help open the gaps in the paranasal sinuses. Then you need to lean over the sink, while keeping your head straight.

Using a small rubber bulb or a special bottle, the liquid is poured under pressure into one nostril. The rinsing solution, along with mucus from the sinuses, is poured out of the other nostril. After this procedure, significant relief occurs.

1. Grind one medium onion on a grater or in a blender and pour a glass of boiling water. When the mixture has cooled, add a teaspoon of honey. Strain and rinse your nose with this mixture three to four times a day. This remedy kills bacteria, helps relieve inflammation and improve local immunity. Not suitable for frontal sinusitis caused by allergic reaction.


2. In one glass of warm boiled water you need to dissolve one teaspoon of salt, a pinch of soda and three drops of tea tree oil. Use for rinsing 3-4 times a day. This composition disinfects the nasal cavity and has a strong antiviral and anti-inflammatory effect.


3. Prepare a decoction of chamomile flowers; this is a strong antiseptic and antimicrobial agent. Cool, strain and use for rinsing every two hours.


4. Dissolve a tablespoon of chlorophyllipt alcohol solution in half a liter of warm boiled water. It has an antibacterial effect and fights even those microorganisms that have developed resistance to antibiotics. The solution is used for washing 3-4 times a day.


5. It is also effective to rinse your nose saline solution. You can make it yourself (one teaspoon of salt per liter of boiled water) or buy it ready-made at the pharmacy. This product cleanses well of mucus, germs and allergens without irritating the mucous membrane.

Drops for the treatment of sinusitis

Traditional medicine uses juices and decoctions to treat frontal sinusitis and other sinusitis medicinal plants. In order for them to have the maximum effect, you must first clear it of its contents - blow your nose well and rinse with saline solution. After instillation, lie down for a few minutes with your head thrown back so that the medicine is evenly distributed throughout the nasal passages.

1. Take black radish, peel and grate. Squeeze the juice and use for instillation 3-4 times a day. The juice contains a large amount essential oils and helps cleanse the sinuses of mucus.


2. Wash the cyclamen tubers thoroughly, chop them and squeeze out the juice. It must be diluted with water (one part juice to four parts water) and strain well. At night, place two drops in each nostril and massage the sinuses well. Cyclamen is considered a remedy that helps defeat the disease at any stage.


3. Pluck large Kalanchoe leaves and keep in the refrigerator for three days. After this, grind them and squeeze out the juice using gauze. Dilute the liquid twice with water and drop it into the nose 2-3 times a day. Kalanchoe helps to liquefy nasal contents and facilitate their rapid elimination.


4. Place a small piece of propolis in the freezer for several hours. After this, quickly pound it in a mortar and pour in refined vegetable oil. Let it brew for three days in a dark place. The product helps fight inflammation and soothes the nasal mucosa. Do not use if you have an allergic rhinitis.


5. Take 10 g of chamomile flowers, 10 g of marsh grass, 15 g of St. John's wort. Brew the components separately with a glass of boiling water, cool and strain. Place 5 drops in each nostril 3 times a day. This composition helps relieve inflammation and open clogged frontal sinuses.


6. Mix equal parts of celandine juice and chamomile juice. Place 1-2 drops in each nostril. This composition effectively fights frontal sinusitis caused by polyps.

Ointments for frontal sinusitis

1. Take 4 parts pork fat and one part kerosene. Mix and store in the refrigerator. Rub the ointment into the forehead and wings of the nose several times a day. You can insert cotton swabs soaked in this ointment into your nose. The procedure lasts 3 hours once a day. The product disinfects and dissolves adhesions.


2. In a water bath, melt crushed laundry soap (1/2 piece), a teaspoon at a time vegetable oil, 70% alcohol, honey and milk. Cool and soak cotton wool with ointment. Apply 3 times a day for 15 minutes. The course of treatment is two weeks. If necessary, repeat the course after 10 days. The ointment disinfects, cleanses and relieves inflammation.


3. Prepare an ointment from equal parts of honey, aloe juice, onion juice, cyclamen juice, and Vishnevsky ointment. Mix all ingredients thoroughly until smooth and store in the refrigerator. Turunda soaked in ointment are placed in the nose for 30 minutes. The course of treatment is three weeks.


4. Crush the garlic clove and mix with an equal amount of butter. Store this ointment in the refrigerator and lubricate your forehead before going to bed. Garlic phytoncides penetrate deeply into tissues and help get rid of the disease.

Clay cakes

Medical white clay is suitable for these purposes. It must be diluted with water or chamomile decoction to the consistency of a thick dough. The cake should be warm, about 1 cm thick. Apply this compress in the evening, while lying in bed, for two hours. Repeat for 14 days.

It is worth noting that the treatment of frontal sinusitis folk remedies should complement the measures prescribed by the doctor. This will protect against repeated inflammation in the frontal sinus and the disease becoming chronic. At the first sign of an allergy, you should stop using the products. traditional medicine and replace them with others.

Dry heat treatment

1. Heat 3-5 tablespoons of sand or salt in a frying pan. Pour into a fabric bag and apply to the forehead in the frontal sinus area. The duration of the procedure is 20-30 minutes.
2. Boil an egg and apply to your forehead. While it is too hot, you can wrap it in a handkerchief. Keep it until it cools down.
3. Wear a wool bandage on the forehead. This warming up can last for several hours. After the procedure, it is important to avoid hypothermia outdoors.

Only if the doctor has determined that the outflow from the sinus is not impaired and there is no pus in it, warming procedures can be performed. Otherwise, such measures can significantly worsen the patient’s condition.

Drug treatment

When should you start taking antibiotics?

To the question “When should you take antibiotics for frontal sinusitis?” Only the attending physician can give an answer. For inflammation of the frontal sinuses caused by allergies or viruses, antibiotics will not help. They can only worsen the situation: lead to dysbiosis and decreased immunity. Therefore, you cannot take them on your own, without a doctor’s prescription.

Indications for the use of antibiotics for frontal sinusitis are purulent discharge. They mean that bacteria have settled in the sinus. The doctor should take a sample of the discharge for laboratory analysis. With the help of this, it is possible to determine which microorganisms caused the inflammation and their sensitivity to antibiotics. This is the key to successful treatment. For chronic frontal sinusitis, this procedure is mandatory.

Indications for the use of antibiotics for frontal sinusitis are: severe general condition of the patient and severe headache, as well as if a more gentle treatment did not work.

What antibiotics are usually prescribed for frontal sinusitis?

In milder cases, topical agents are prescribed, a spray with antibiotics Bioparox, Isofra and Polydex drops. Antibiotics are also prescribed in the form of tablets Augmentin, Cefazolin, Ceftriaxone, Sporidex.
The most effective is intramuscular or intravenous administration antibiotics. If necessary, the antibiotic solution is injected directly into the frontal sinus through a hole made in the frontal bone.

In acute frontal sinusitis, broad-spectrum antibiotics are prescribed, for example, Sumamed 500 mg per day.
In the treatment of chronic frontal sinusitis, when the sensitivity of bacteria to antibiotics is determined necessarily, narrowly targeted agents are prescribed. If the cause is Haemophilus influenzae, then Ampicillin, Amoxiclav are prescribed.

Administered intramuscularly or intravenously in a daily dose of 200-400 mg. Tetracycline antibiotics are used against pneumococcus: Abadox, Biocyclinde, Medomycin, Doxacin, Doxylin, Extracycline, Isodox, Lampodox. Daily dose for adults it is 0.2 g.

The course of antibiotic treatment should be at least 7-10 days.

What other medications are taken to treat frontal sinusitis?

Antiallergic drugs are often prescribed in parallel: Suprastin, Tavegil, Diazolin, Diphenhydramine. They relieve allergies and reduce nasal swelling.

In cases where it is necessary to remove thick pus from the frontal sinus, ACC-long (600 mg) is prescribed, 1 tablet once a day.

To maintain intestinal microflora, probiotics are taken: Lactobacterin, Probiovit, Bifikol, Linex. They help maintain the balance of beneficial microorganisms and support immunity.

Homeopathic remedies. Sinuforte – has an anti-inflammatory effect and promotes the opening and ventilation of the sinuses. Cinnabsin – facilitates nasal breathing, relieves swelling, improves immunity. Sinupret - thins the thick contents of the sinuses, relieves inflammation.

To combat infection without antibiotics, sulfonamide drugs Sulfadimezin, Norsulfazol, Etazol are also used.

To reduce headaches, the following are prescribed: Analgin, Amidopyrine, Nurofen.

Physiotherapy procedures

In a clinic or hospital, the “cuckoo” procedure is used to rinse the nose. As a result of such rinsing with furatsilin or another solution of drugs, it is possible to cleanse the sinuses well.

To speed up recovery, the following physiotherapeutic procedures are prescribed: electrophoresis with 2% potassium iodide, laser therapy, Sollux, UHF therapy. They are aimed at warming the frontal cavity, ensuring free outflow of its contents, relieving inflammation, and improving blood circulation.

When is a puncture done for frontal sinusitis?

A puncture for frontal sinusitis or a puncture of the frontal sinus is prescribed only when it is not possible to alleviate the patient’s condition with the help of medications.

Pus in the sinus, severe headaches and lack of outflow, cysts in the sinus cavity - these are the signs that indicate the need for a puncture in frontal sinusitis.

When preparing for a puncture, the most important step is an X-ray examination of the structure of the frontal sinuses. This is necessary to accurately determine the puncture site for frontal sinusitis.

There are several puncture techniques:

• through the lower thin wall of the frontal sinus (through the nasal cavity)
• through the anterior wall of the frontal sinus (through the forehead)

The procedure is performed under local anesthesia (Novocaine with the addition of adrenaline, lidocaine). In order to make a hole, a special needle or a special device is used - a trephine. After this, a needle is fixed in the hole, with the help of which the contents of the frontal sinus are removed, rinsing and administration of medicinal agents are performed. After the procedure, the wound is packed and sutures are placed on the skin. Often a drain is attached to the hole. This is necessary for rinsing and removing the contents of the sinuses. After 5 days, the drainage is removed.

Complications with frontal sinusitis

If treated incorrectly, it is possible to develop serious complications with frontal sinusitis:

• The inflammatory process can spread to adjacent paranasal sinuses. This leads to sinusitis, ethmoiditis, sphenoiditis
• Intraorbital complications (edema of the eyelids and orbital tissue, orbital phlegmon, eyelid abscess)
• Intracranial complications (meningitis, brain abscesses)
• In severe cases, blood poisoning is possible - sepsis

Prevention of frontal sinusitis

Among the preventive measures Special attention are given timely and adequate treatment colds. They are the main cause of frontal sinusitis.

It is also necessary to take care of strengthening the immune system and hardening the body, avoiding hypothermia and leading an active lifestyle. Following these simple recommendations is the key to your health.

What is the difference between frontal sinusitis, sinusitis, ethmoiditis, sphenoiditis, sinusitis?

Sinusitis- general term. It refers to inflammation of any paranasal sinuses (another name for sinuses is sinuses). Sinusitis– inflammation of the maxillary, or maxillary sinuses. Ethmoiditis- inflammation lattice labyrinth(cells of the ethmoid bone). Sphenoiditis– inflammatory process in the sphenoid sinus. The symptoms of these two diseases can be very similar, which sometimes makes it difficult to diagnose the disease.

At neuralgia of the first branch of the trigeminal nerve I am worried about attacks of headaches, pain occurs when pressing in the eyebrow area, where the indicated branch of the nerve enters the face.

What kind of procedure is this - “cuckoo”?

“Cuckoo” is a nasal rinsing method developed by the American doctor Arthur Proetz. It is used for frontal sinusitis, ethmoiditis, and sinusitis.

During the procedure, the patient lies on the couch with his head hanging and tilted at approximately 45°. A warm antiseptic solution is poured into one nostril, and through the other it is pumped out along with the pus. A “seething stream” seems to be created in the patient’s nose.

While rinsing the nose, the patient must constantly say “ku-ku,” which is how the method got its name. While pronouncing these syllables soft sky presses against the back wall of the throat, thereby closing the communication between the nose and throat.

Thanks to the constant flow of antiseptic and the pronunciation of the syllables “ku-ku”, negative pressure is created in the nasal cavity. Pus and other pathological contents come out of the paranasal sinuses into the nasal cavity.

Typically, rinsing continues for 10-15 minutes. It can be carried out in a clinic or hospital setting. After the procedure, it is not recommended to go outside for 30 minutes in the warm season, and for 1-2 hours in cold weather.

Possible complications of the procedure:

• sneezing due to irritation of the nasal mucosa;
• nose bleed;
• slight headache;
• burning in the nose;
• redness of the eyes.

Despite their apparent simplicity, the nose and its sinuses have complex structure. Why is sinus anatomy so important? This will help to understand the cause of their diseases, as well as avoid dangerous complications.

Why are paranasal sinuses needed?

The evolutionary origin of the sinuses still remains an incompletely clarified issue.

The paranasal sinuses perform the following functions:

• Protective . The air in the cavities helps to absorb the force of impact during skull injuries.
• Baroreceptor . The presence of sinuses allows the body to respond to changes in environmental pressure.
• Resonator . The paranasal sinuses and nasal cavity influence the volume and timbre of spoken speech.
• Thermal insulation . Some sinuses are located on the border with organs that are sensitive to changes in heat and cold, for example, the eyeballs and the roots of the teeth of the upper jaw. The sinuses play the role of an “air cushion” that prevents sudden temperature changes during breathing.
• Moisturizing . Air circulates slowly in the sinuses communicating with the nasal cavity. Due to the fact that it comes into contact with the mucous membrane of the sinuses, the inhaled flow is moistened and warmed. For this reason, if the sinuses are affected, treatment should be immediate.
• Reduction of cranial mass . The weight of the bones, despite their relatively large volume, remains small due to the air chambers. The main sinus that plays a role in this is the maxillary sinus.

Anatomy of the sinuses and paranasal sinuses

The nose (in Latin - “nasus”) is an organ consisting of external and internal (cavitary) sections. The basis of the outer part is formed by a group of osteochondral joints in the shape of a pyramid.

The external nose is covered with skin and has the following structure:

• the root, also called the bridge of the nose;
• back - is a continuation of the previous anatomical structure;
• clivus - lateral nasal surfaces;
• wings forming nostril openings bordering the outside of the jaw area.

The nasal cavity took place between oral cavity and the anterior cranial fossa. The Latin name is “cavum nasi”. The lateral walls are bordered by the paired maxillary and ethmoid bones. Thanks to the septum, the nasal cavity is divided into two equal parts, communicating with the external environment (via the nostrils) and the nasopharynx (via the choanae).

The inner lateral walls of the “cavum nasi” are represented by 3 nasal conchas:

• top;
• middle;
• bottom.

Under each of these peculiar horizontal “plates”, running parallel to each other, there is a nasal passage of the same name. The sinks do not connect to the partition located in the middle. The space formed between them is called the common nasal passage. All structures considered are covered with mucous membrane.

Each half of the nose is surrounded by air chambers that communicate with them through special openings. The diameter of these canals is so small that swelling of the sinuses can completely block their lumen.

Due to the peculiarities of their anatomical location, the sinuses are divided into two groups:

• Front . Includes the sinuses of the maxilla, frontal bone, as well as the anterior and middle cells of the ethmoid bone.
• rear . It consists of the sphenoid sinus (main sinus), the posterior cells of the ethmoid bone.

This division plays an auxiliary role in diagnosis, since the frequency of lesions and Clinical signs inflammation of different groups of air cavities will differ. For example, the anatomy of the nose and sinuses is such that the likelihood of inflammation of the maxillary sinus is tens of times higher than the sphenoid sinus.

Types of sinuses

There are four of them in total.

Wedge-shaped

The Latin name is “sinus sphenoidalis”. Localized in the body of the bone of the same name.

Each sphenoid sinus is formed by six walls:

• front and back;
• top and bottom;
• internal (at the same time serves as an interaxillary septum) and external.

The main sinus of the nose communicates with the upper nasal passage through an opening. This anatomical location explains the outflow of mucus formed in the wedge-shaped air cavity along the posterior wall of the nasopharynx.

The Highmorovs

The maxillary sinuses are the largest. Their average volume is almost 17 cm³ on each side. The ciliated epithelium lining the sinuses causes mucus to move toward the opening that opens into the middle meatus.

Walls of the maxillary sinuses:

• anterior (front) and posterior;
• top and bottom;
• medial.

The maxillary sinuses surrounding the nose have an anatomical feature that is important in surgery: on the outer side of the facial wall there is a depression (“dog fossa”). Directly above this structure is the area of ​​exit of the infraorbital nerve. If the plate of the fossa is located deep, then all the walls of the maxillary sinus (except the posterior) will be relatively close to each other. This is fraught with the fact that during a puncture examination, an accidental puncture of this anatomical formation is possible. Such a surgical error can lead to traumatic damage to the orbit and cheek tissue.

Frontal

The frontal sinuses are located in the scales of the frontal bone.

Depending on what anatomical structures the uppermost sinus borders on, it is formed by the following walls:

• anterior and posterior (facial and cerebral), converging at an angle with each other;
• orbital (lower);
• interaxillary (middle).

The frontal sinus communicates with the middle nasal passage through a canal up to 1.5 cm long. The average volume of each sinus is 4.5 cm³. In some exceptional cases, the frontal sinuses may be absent in the patient.

Cells of the ethmoid labyrinth

The ethmoid sinuses consist of air cells of the same bone. Each accessory sinus is localized between the other two - frontal and sphenoid. The number of lattice cavities is individual, it can vary from 8 to 10 (both on the left and on the right). The outer border of the sinus is formed by the orbit (its paper plate). The median wall of the ethmoid bone is the lateral wall of the nasal cavity.

The following variant is often observed - the proximity of the air cells to the anterior cranial fossa. The anatomy of the nose and paranasal sinuses in this case should be especially carefully considered during surgical interventions. An accidental error in opening the cells of the ethmoid labyrinth can lead to the penetration of the operating instrument into the cranial cavity.

Sinus diseases

The most common group of diseases affecting the paranasal sinuses is sinusitis (inflammatory damage to the air cavities). An oncological process can be observed much less frequently.

Forms of sinusitis:

• . Characterized by inflammation of the maxillary sinuses.
• . The frontal sinuses are involved in the pathological process.
• . The sphenoid sinus, which communicates with the nasal cavity, is affected.
• . In this case we are talking about the cells of the ethmoid bone.

Inflammation of the sinuses can occur in and. Symptoms of the disease directly depend on where the affected sinuses are located.

Common signs of sinusitis:

• Increase in body temperature to 38°C.
• Deterioration in odor recognition.
• Feeling of nasal congestion.
• Marked sensation of pressure on the eyeballs.
• Toothache (when the maxillary sinuses are affected).
• Swelling of the face on the affected side.

If the sinuses are inflamed, then treatment is based on the following principles:

• Drainage. The paranasal sinuses are punctured () to remove accumulated pus.
• . It is advisable to treat with such drugs if the disease is bacterial in nature.
• . They are necessary to relieve swelling of the sinuses surrounding the nasal cavity.

It is very important to know about the peculiarities of the structure and location of the sinuses. This is explained by the fact that any pathology affecting the air cavities can spread to tissues that may be nearby. Familiarity with the anatomical properties of the sinuses will help to promptly detect the symptoms of a particular disease and, therefore, avoid dangerous complications.

When should you contact an ENT doctor? If, for example, they are inflamed maxillary sinuses, the nose has stopped breathing freely due to swelling and accumulation of mucus - these are serious reasons to visit a doctor. The presence of even “harmless” symptoms does not tolerate self-medication.

Useful video about the anatomy of the sinuses

The frontal sinuses are two cavities in the frontal bone of the skull, located to the left and right of the midline. Their size and configuration vary individually among different people. Frontal sinusitis in children, especially small ones, is quite rare, since their frontal sinuses are not yet formed.

The frontal sinus is limited by four walls. The lower wall separates it from the orbit, the back wall is adjacent to the anterior cranial fossa, the middle wall is the wall between the right and left frontal sinuses. The front thick wall is the human forehead. Inside, the frontal sinuses can be relatively “smooth”, or they can be divided by bony projections and septa into many cells.

In the lower wall of the cavity there is a hole leading into a canal connecting the sinus with the middle nasal passage. The downward frontonasal canal should provide free outflow of the contents of the frontal sinus. But it is quite long (from 15 to 25 mm) and narrow (from 1 to 4 mm), so with the slightest swelling of the mucous membrane, the outflow from the sinus sharply worsens. And the lack of drainage is a direct path to the development of the inflammatory process.

Frontit is an inflammation of the mucous membrane lining the inside of the paranasal frontal sinuses. Depending on the nature of the disease, it can be acute or chronic.

Acute frontal sinusitis

Etiology of the disease

As a rule, the causative agents of acute frontal sinusitis are bacteria, which are normally sown during bacteriological examination of nasopharyngeal material taken from healthy people. Weakened immunity and poor ecology, abnormalities in the structure of the nasopharynx and chronic diseases, frequent acute respiratory viral infections and occupational hazards - all this contributes to the activation of microbes, often causing acute frontal sinusitis. Pneumococcus is the leader; staphylococcus, Haemophilus influenzae and Moraxella are somewhat inferior to it in terms of frequency of inoculation.

Clinical signs and possible complications

The clinical picture of acute purulent frontal sinusitis consists of general and local symptoms. In addition to an increase in body temperature (sometimes up to 39 °C), weakness and general malaise are noted. Local signs of frontal sinusitis are headache, difficulty in nasal breathing combined with nasal discharge, impaired sense of smell.

Painful sensations usually occur in the morning, intensify towards noon and disappear in the afternoon. The intensity of the pain varies from a feeling of pressure in the forehead to sharp, unbearable attacks of pain throughout the head.

With bilateral inflammation, “the whole forehead hurts,” and sometimes the whole head. Breathing through the nose is difficult on both sides. Serous-purulent or purulent discharge is noted from both nasal passages. The sense of smell may be completely absent.

With a unilateral process, pain in the forehead is concentrated in one half of it, at the site of the projection of the inflamed sinus, with the epicenter at the inner edge of the eyebrow. On the same side, nasal congestion and discharge from it are noted. The sense of smell may be partially preserved.

Another symptom characteristic of frontal sinusitis is inflammatory edema and redness of the soft tissues in the area of ​​the eyebrow, inner corner of the eye and upper eyelid.

The clinical forms of modern frontal sinusitis are often erased forms, in which the clinical signs of the disease include only a local headache above one or both eyebrows. At the same time, additional examination methods also do not give clear results.

Due to the proximity of the frontal sinuses to the eye sockets, and due to the anatomical features of the vascular network of the head, purulent inflammation of the frontal sinuses is often accompanied by complications. Pathogenic microbes can penetrate into the cavity of the skull and orbit by contact (when bone melts) or along the course of blood vessels and nerves.

When inflammation spreads to the bone elements that form the sinus, periostitis (inflammation of the periosteum) or subperiosteal abscess can become a complication of acute purulent sinusitis. Possible orbital complications of frontal sinusitis are swelling of the tissue or phlegmon of the orbit and thrombosis of the veins of the tissue of the orbit.

In terms of the frequency of intracranial complications (meningitis, abscess, etc.), frontal sinusitis ranks second, second only to inflammation of the ethmoidal labyrinth. They can be caused by melting of the posterior wall of the frontal sinus, as a result of which the infection penetrates into the anterior cranial fossa and affects the meninges.

A complication of purulent frontal sinusitis involving the brain or orbit in the inflammatory process is always an indication for emergency surgery. It is carried out in a specialized ENT department with the participation of neurosurgeons and ophthalmologists.

How does a doctor diagnose acute frontal sinusitis?

The diagnostic process consists of the following stages:

1. After listening to the patient’s complaints and asking him about the onset of the disease, the ENT doctor conducts an examination. In addition to the external signs of frontal sinusitis described above, it reveals pain when tapping on the frontal bone and pressing on the area of ​​the inner corner of the eye. The doctor detects that the patient has an increase in headache when bending the head forward.
2. When examining the nasal cavity, inflammation of the frontal sinus is indicated by thickening and redness of the mucous membrane of the middle nasal passage and purulent discharge flowing from under the middle nasal concha. To simplify the diagnosis, optical rhinoscopy is used - an endoscopic method. To visually confirm the diagnosis of frontal sinusitis, the otolaryngologist prescribes radiography, ultrasound or CT of the paranasal sinuses.
3. The variability in size and different structure (described above) of the frontal sinuses are the main reasons for the diversity clinical symptoms frontal sinusitis and the development of atypical forms of the disease. Computed tomography helps the doctor to understand the anatomical structure of the sinuses in a particular patient.
4. IN clinical analysis blood with a typical acute frontal sinusitis, there are signs of a purulent-inflammatory process: a significant increase in the number of leukocytes with corresponding changes in the leukocyte formula, a pronounced increase in ESR. If after this the diagnosis of acute purulent frontal sinusitis is in doubt, the doctor performs a diagnostic trepanopuncture of the frontal sinus.
5. In doubtful cases, fluometry, thermography, rheofrontography and digital diaphanoscopy help.

Treatment of acute sinusitis

In most cases, the treatment of an acute purulent-inflammatory process in the frontal sinuses, the otolaryngologist begins with conservative methods of treatment. They are aimed at restoring the patency of the frontonasal canal, at “extinguishing” the inflammatory process and at combating microorganisms that have become the causative agents of the disease.

Means for the conservative treatment of acute frontal sinusitis are as follows:

• To combat swelling of the mucous membrane, vasoconstrictors (anemia) are used in the form of nasal drops or nasal sprays. Sometimes they resort to lubricating the mucous membrane of the middle nasal passage with anemic drugs;
• to evacuate the contents of the frontal sinuses and subsequently wash them with medicinal solutions, the YAMIK sinus catheter is used with high efficiency;
• To eliminate the pathogen and in case of severe intoxication (fever, chills, weakness), antibacterial drugs are prescribed. The ideal option is to use an antibiotic to which the infectious agent that caused the disease is sensitive. But in some situations (severe disease, frontal sinusitis in pregnant women, frontal sinusitis in children, etc.) you can’t risk wasting time waiting for results bacteriological research. Therefore, broad-spectrum antibiotics become the drugs of choice;
• according to indications, mucolytics, painkillers and antihistamines are prescribed;
• if frontal sinusitis in adults and children occurs without intoxication, physiotherapy is carried out (EF in the nose, UHF in the sinus area, etc.), local warming procedures are recommended.

Frontitis on an x-ray:

Before treating frontal sinusitis at home, for example, using traditional medicine, be sure to visit an ENT doctor. Believe me, he will not convince you that, for example, apitherapy or homeopathy is ineffective or miraculous. The doctor will refer you to right direction, will tell you what means in your particular case are best to treat frontal sinusitis at home.

If, against the background of conservative treatment of purulent frontal sinusitis, confirmed by radiography or CT, after three days the condition has not improved (headaches and fever persist), the ENT doctor performs trephine puncture of the frontal sinus. Its result is the evacuation of the purulent contents of the sinus, the ability to rinse the cavity and introduce medicines. Sometimes the frontal sinus is punctured with a thin needle through the inferior orbital wall.

There is no need to be afraid of trepanopuncture - it is performed in a hospital setting, is always performed under local anesthesia and is the most effective way removal of pus from the frontal sinuses.

Using a special instrument, the doctor drills a hole in the front wall of the frontal bone, inserts a metal cannula (tube) into it and leaves it there. Every day for 2-7 days, the sinus is washed through the cannula and medications are injected into it.

If the clinical signs of acute frontal sinusitis persist for 3-4 weeks, and the patency of the frontonasal canal is not restored, surgical endoscopic intervention is performed on the frontal sinus with access through the nasal cavity. But in 20% of cases doctors have to resort to radical operations with external access to the frontal sinus. The goal of all interventions is to restore the patency of the frontonasal canal.

Chronic frontal sinusitis

Causes of development of chronic sinusitis

An ENT doctor makes a diagnosis of chronic frontal sinusitis if the acute process has dragged on for a month or more.

Most common cause chronic inflammation in the frontal sinuses is an untreated acute process. Anatomical anomalies, a long-term absence of normal sinus drainage, and polypous processes in the adjacent sinuses and in the nasal cavity contribute to the development of chronic frontal sinusitis.

Very often, chronic frontal sinusitis is caused by associations of microbes, including: streptococci, Haemophilus influenzae, staphylococci and moraxella. The incidence of fungal frontitis, candidiasis and actinomycosis has increased. They are often very severe and malignant. Fungi often destroy bone walls sinuses, which leads to the development of complications.

Clinical picture of the disease

All clinical signs typical for frontal sinusitis also occur in the chronic course of the disease. But they are not expressed so clearly and are characterized by inconstancy.

Chronic frontal sinusitis rarely occurs in isolation: the cells of the ethmoid bone are involved in the pathological process. Intracranial and orbital complications - frequent companions chronic inflammation of the frontal sinuses. They appear as protrusions eyeball, pain in the orbit, blurred vision and other symptoms.

Diagnosis and treatment of chronic sinusitis

The diagnosis of chronic frontal sinusitis is made by an ENT doctor based on the history of the disease and clinical symptoms. The results of instrumental examination, laboratory and other examination methods (endoscopy, radiography, CT, etc.) play an important role.

To formulate an accurate clinical diagnosis of chronic sinusitis, doctors use a classification common to all sinusitis, distinguishing productive, exudative, alterative and mixed forms of the disease, as well as vasomotor and allergic sinusitis.

The treatment tactics for the disease are determined by its form. Allergic, catarrhal and serous chronic frontal sinuses are treated with conservative methods, including:

• applications and instillations of vasoconstrictors;
• YAMIK procedures;
• antibiotic therapy;
• probing of the sinuses.

You can treat chronic sinusitis at home using a variety of traditional medicine methods. But do not hesitate to consult an ENT doctor. He will tell you when and what means can be used, and when even the most popular and simple procedures are contraindicated.

Surgical treatment is indicated for alterative, productive and mixed forms of chronic frontal sinusitis. Thus, aspergillus sinusitis is treated only surgically: the sinus is opened, the fungal body is removed from it and the anastomosis with the nasal cavity is expanded. If gentle methods are ineffective, radical operations with external access are resorted to. They are indicated for chronic frontal sinusitis with frequent relapses, and for complicated forms of the disease.

Another treatment method is balloon dilatation (expansion) of the frontonasal canal. A balloon filled with air presses on the bone walls of the anastomosis, causing microfractures of the bones, compressing the surrounding tissues and thereby expanding the canal. A catheter is inserted into the expanded channel, through which the sinus is then washed. This is a relatively safe method of treating chronic sinusitis.

In some cases, doctors use the method of obliteration (fusion, closure) of the frontal sinuses, using tissue from the patient himself or synthetic materials.

Frontal sinusitis is a disease in which an inflammatory process develops in the mucous membrane of the frontal (frontal) sinus.

The frontal sinuses are paired cavities located in the frontal bone of the skull on either side of the midline. The size and configuration of the sinuses vary from person to person. In some cases, the frontal sinuses may be underdeveloped or completely absent. The close location of the frontal sinuses to the anterior cranial fossa and orbits is fraught with serious complications of inflammation.

All age groups are equally susceptible to the disease; men suffer from frontal sinusitis more often than women.

Frontitis is an inflammatory process in the mucous membrane of the frontal sinus of the nose

Causes and risk factors

The most common cause of acute frontal sinusitis is an infectious process that has spread to the mucous membrane of the frontal sinus from the nasal cavity during acute respiratory and other infectious diseases. The causative agents can be viruses, bacteria or microscopic fungi.

Risk factors for developing frontal sinusitis include:

• injuries to the nose and/or paranasal sinuses;
• congenital or acquired curvature of the nasal septum;
• impaired breathing through the nose (polyps, adenoids, vasomotor rhinitis, etc.);
• weakened immune system;
• foreign bodies in the nasal cavity.

Chronic frontal sinusitis develops against the background of incorrect or untimely treatment acute form disease, it is facilitated by features anatomical structure paranasal sinuses and/or nasal septum.

Chronic form frontal sinusitis can take a persistent course with periodic relapses.

Forms of the disease

Depending on the character pathological process Frontal sinusitis is divided into acute, recurrent, subacute and chronic.

By prevalence:

• one-sided (left- or right-sided);
• bilateral.

Depending on the etiological factor:

• bacterial;
• viral;
• fungal;
• allergic;
• traumatic;
• mixed.

Along the route of infection:

• rhinogenic – develops against the background of rhinitis;
• hematogenous - the pathogen penetrates the frontal sinus with the bloodstream;
• traumatic – occurs as a result of damage to the skull in the area of ​​the frontal sinuses.

According to the nature of inflammation:

• catarrhal;
• serous;
• purulent;
• polypous (cystic).

The purulent form of frontal sinusitis is the most dangerous, since with inadequate or insufficient treatment it can cause serious complications.

Symptoms of sinusitis

In acute frontal sinusitis, patients complain of sharp pain in the superciliary region, which intensifies when tilting the head, during sleep, during palpation, can radiate to the temporal region and is not relieved by taking analgesic drugs. Also, symptoms of frontal sinusitis may include headaches in other localizations, unpleasant bursting sensations in the bridge of the nose, photophobia, pain in the eyes, copious nasal discharge without odor or with an unpleasant odor and particles of pus (with purulent frontal sinusitis), difficulty nasal breathing. These phenomena are accompanied by increased body temperature, cough with sputum in the morning, worsening general condition, sleep disturbance.

The clinical picture of chronic frontal sinusitis in adults is less pronounced compared to acute sinusitis. As a rule, the chronic form of the disease is accompanied by inflammation of other paranasal sinuses, especially often the ethmoid sinus (ethmoiditis). The pain in the forehead is aching, intensifies with pressure, and its intensity varies throughout the day. Discharge from the nose often has an unpleasant odor, and there is a decrease in the sense of smell up to complete loss. Swelling of the eyelids indicates the spread of the pathological process to the orbit. Chronic frontal sinusitis is characterized by alternating periods of exacerbation and remission. Signs of frontal sinusitis during remission may include a feeling of heaviness in the superciliary area, decreased sense of smell, and nasal discharge.

Features of the course of frontal sinusitis in children

In children under 5-7 years of age, the frontal sinuses are not developed, so they do not suffer from frontal sinusitis; the disease is detected in primary school and adolescence. Isolated inflammation of the frontal sinuses is rare in children; frontal sinusitis in this age group is much more often diagnosed as a component of pansinusitis.

The causative agents of frontal sinusitis can be viruses, bacteria or microscopic fungi.

In general, children are characterized by a severe course of frontal sinusitis with bilateral involvement of the sinuses; the clinical picture is similar to acute respiratory infections, but the disease’s duration is longer than that of acute respiratory infections, but it is alarming regarding inflammation of the paranasal sinuses. Specific symptoms of frontal sinusitis in children include:

• persistent headache, aggravated by head movements;
• pain in the projection of the frontal sinuses, aggravated by pressure;
• purulent nasal discharge;
• nasal voice;
• lacrimation;
• cough in the morning;
• stuffy nose and ears.

In some cases, children develop conjunctivitis against the background of frontal sinusitis.

There are also a number of nonspecific signs of the disease:

• rise in body temperature (rarely above 38.5 °C);
• pallor of the skin;
• difficulty or complete impossibility of nasal breathing;
• swelling;
• decreased appetite;
• weakness, fatigue;
• irritability;
• sleep disorders.

Frontal sinusitis in children tends to spread to other paranasal sinuses (if it was isolated), as well as to quickly develop into a chronic form.

Diagnostics

The diagnosis is made based on the results of the following studies:

• taking anamnesis (previous respiratory disease, sinusitis of other localization, duration of manifestations, etc.);
• objective examination;
• rhinoscopic examination (helps determine the presence of an inflammatory process in the nasal cavity);
• bacteriological examination of nasal discharge (makes it possible to identify the infectious pathogen and determine its sensitivity to antibacterial drugs);
• general and biochemical blood test, urine test (determines signs of the inflammatory process, allows you to assess the general condition of the body);
• X-ray examination (allows for differential diagnosis of purulent sinusitis and non-purulent forms of the disease, damage to other sinuses, and to determine the presence of curvatures of the nasal septum);
• magnetic resonance or computed tomography (help identify anatomical features nose and paranasal sinuses and the prevalence of the pathological process).

If necessary, additional studies may be used:

• cytological analysis of the contents of the nasal cavity;
• scintigraphy;
• thermography;
• diaphanoscopy, etc.

All age groups are equally susceptible to the disease; men suffer from frontal sinusitis more often than women.

Differential diagnosis of frontal sinusitis with inflammatory diseases other paranasal sinuses, trigeminal neuralgia, inflammation of the meningeal membranes, etc.

Treatment of frontal sinusitis

Treatment of frontal sinusitis is selected depending on the form of the disease, the prevalence of the pathological process, age, general condition of the patient and other factors.

Acute frontal sinusitis is an indication for hospitalization in an otolaryngological hospital.

To reduce swelling of the nasal mucosa and paranasal sinuses in order to create conditions for the outflow of pathological contents from the inflamed frontal sinuses, local vasoconstrictors are used, which lubricate the mucous membranes of the nasal cavity (these drugs are also used in the form of drops and sprays). After the swelling is removed, antiseptic and anti-inflammatory drugs are injected into the sinuses.

General therapy for acute frontal sinusitis consists of the use of broad-spectrum antibacterial drugs, antihistamines and anti-inflammatory drugs.

In addition to drug treatment For frontal sinusitis, physiotherapeutic methods such as laser therapy, UHF therapy, electrophoresis with drugs, etc. can be used.

The purulent form of frontal sinusitis is the most dangerous, since with inadequate or insufficient treatment it can cause serious complications.

If conservative treatment is ineffective, complications occur and there is a significant deterioration in the patient’s condition, it is indicated surgical intervention(trephine puncture). During trepanopuncture, penetration into the frontal sinus is carried out through a section of the frontal bone of the smallest thickness. Manipulation can be done in two ways - by piercing the bone tissue or drilling. After removing the pathological secretion, the sinus is washed with an antiseptic solution and treated with an antibacterial and anti-inflammatory drug. With proper care of the puncture site, the puncture heals without a scar or scar. In some cases, surgery is performed endoscopically. If all other methods are ineffective, they resort to trephination of the frontal sinus: after cutting the skin with a scalpel, the sinus is opened, washed with an antiseptic, a plastic tube is installed in the canal connecting the frontal sinus with the nasal cavity for drainage, then the incision is sutured.

In the treatment of chronic frontal sinusitis, generally the same approach is used, however antibacterial drug is selected taking into account the sensitivity of the infectious agent to it, anti-inflammatory therapy is carried out using glucocorticoid drugs. Vitamins and other means of strengthening are prescribed immune system. Physiotherapy (magnetic therapy, ultraviolet irradiation, etc.) also provides a positive effect.

Treatment for acute frontal sinusitis lasts from several days to a week, for chronic sinusitis – 1-2 weeks or more.

Possible complications and consequences

With absence necessary treatment acute frontal sinusitis can become chronic - this is the most common complication. Frontal sinusitis can also be complicated by the following conditions:

• atrophy of the nasal mucosa;
• conjunctivitis;

  Forecast

  With timely and adequate treatment, the prognosis is favorable. The chronic form of frontal sinusitis can take a persistent course with periodic relapses.

  Intracranial complications of frontal sinusitis are characterized by a poor prognosis and can lead to death.

  Prevention

  1. Timely treatment of respiratory diseases.
  2. Rejection of bad habits.
  3. Avoiding hypothermia.

  Video from YouTube on the topic of the article:

The frontal sinuses are an integral part of the system of paranasal air cavities and perform a number of functions related to the protection of the body, the organization of normal breathing and speech. They are located in close proximity to the brain membrane, so their diseases can lead to serious complications.

Structure and functions of front cameras

The frontal sinuses, like the maxillary sinuses, in their location belong to the anterior voids, which communicate with the nose through the tortuous and long middle frontonasal passage. This anatomy predetermines much more frequent infectious diseases anterior cavities.

The frontal chambers are a paired organ located deep in the frontal bone.

Their size and configuration can vary markedly from person to person, but on average each frontal sinus has a volume of about 4.7 cubic centimeters. Most often, it looks like a triangle, lined inside with mucous membrane, with four walls:

• The orbital (lower) is the thinnest, most of its area is the upper wall of the orbit, with the exception of the edge adjacent to the ethmoid bone. On it there is a canal anastomosis 10-15 mm long and up to 4 mm in diameter, opening into the nasal cavity.
• The facial (front) is the thickest, represented by the outer part of the frontal bone, which has a thickness of 5 to 8 mm.
• Medullary (posterior) - consists of a thin but strong compact bone, bordered by the anterior cranial fossa and the dura mater.
• The inner (medial) divides the two chambers; in its upper part it can deviate to the left or to the right.

A newborn child does not have frontal sinuses; they begin to form only at 3-4 years of age and finally develop after puberty.

They appear at the upper inner corner of the orbit, consist of cells of the ethmoid bone, and the nasal mucosa grows into them. In parallel with this, the process of resorption of the spongy bone, which is located between the inner and outer plates of the frontal bone, occurs. In the vacated space, frontal voids are formed, which can sometimes have niches, bays and internal partitions in the lumen. The blood supply comes from the ophthalmic and maxillary arteries, and the innervation comes from the ophthalmic nerve.

The cavities are most often unequal, since the bone plate separating them is usually not located exactly in the center, sometimes it may be absent, then the person has one large cavity. In rare cases, the dividing bone is not located vertically, but horizontally, and the chambers are located one over the other. According to various studies, 5-15% of people have no frontal sinuses at all.

The main functions of front cameras today are:

• protecting the brain from injury and hypothermia (acting as a “buffer”);
• participation in the formation of sounds, enhancing vocal resonance;
• regulation of pressure levels in the nasal passages;
• warming and humidification of inhaled air;
• reduction in the mass of the skull during its growth.

Acute frontal sinusitis: etiology and symptoms

Since the paranasal compartments are covered inside with mucous membranes, the main disease is the inflammatory process in them. If we are talking about the frontal sinuses, then their inflammation is called frontal sinusitis. The inflammation has a wave-like course, can quickly move from the acute stage to the chronic stage and then be asymptomatic or go away without treatment.

The main cause of the disease is usually an inflammatory process in the upper respiratory tract, from where it passes to the frontal compartments in an ascending manner.

In case of untimely or insufficient treatment due to changes in the pH of the secretion, the immune barrier from ciliated epithelium weakens, and the pathogenic microflora penetrates into the chambers, covering the mucous membranes. Many doctors are of the opinion that the acid-base balance of mucus can be disrupted by drops with a vasoconstrictor effect, which are used for a long time.

The main prerequisites for the development of the disease:

• long lasting runny nose;
• colds that have been poorly treated or suffered “on your feet”;
• hypothermia of the body, in particular the legs;
• stress;
• injuries to the front of the head.

The inflammatory process is accompanied by hyperemia and swelling of the mucous membranes, resulting in increased secretion while simultaneously impeding the outflow of fluid. The supply of oxygen is sharply limited or completely stopped. Gradually increasing internal pressure is the cause severe pain in the forehead area.

Symptoms of the disease are divided into general and local, which together give a characteristic clinical picture of acute frontal sinusitis.

Local signs:

• complete absence or severe difficulty in nasal breathing;
• throbbing and pressing pain above the eyebrows, which intensifies when you tilt your head forward or press your hand on your forehead;
• copious purulent discharge from the nasal passages (one or both);
• secretion flowing into the oropharynx;
• Swelling may spread to the upper eyelid or the corner of the orbit of the eye.

Simultaneously with the local ones, general signs indicating intoxication of the body also increase:

• temperature rise to 37.5-39 degrees, chills are possible;
• blood reaction (increased ESR, leukocytosis);
• muscle weakness;
• diffuse headaches;
• hyperemia of the skin in the projection of the affected organ;
• aches in bones and joints;
• fatigue and drowsiness.

Diagnosis and conservative treatment of frontal sinusitis

For studying clinical picture and making the correct diagnosis, you must contact an otolaryngologist. The ENT doctor interviews the patient, after which he performs rhinoscopy - a visual examination of the nasal cavities and paranasal sinuses in order to determine the location of pus and the condition of the mucous membranes. Palpation and percussion (tapping) help to identify pain in the anterior wall of the forehead and the corner of the eye on the affected side.

To confirm the suspected diagnosis, the patient donates blood for analysis, and also undergoes radiography (in lateral and direct projections) or computed tomography.

These methods best allow us to determine the lesion, the amount of accumulated pus, the depth and shape of the chambers, and the presence of additional partitions in them. The mucus released undergoes microbiological examination to determine the pathogen and prescribe adequate treatment.

In most cases, conservative treatment is used, including anti-inflammatory therapy, unblocking of the frontonasal canal and restoration of drainage of the cavity. The following medications are used:

• broad-spectrum antibiotics if available high temperature(Klacid, Avelox, Augmentin) with subsequent correction if necessary;
• analgesics (askofen, paracetamol);
• antihistamines (claritin, suprastin);
• drugs to reduce mucous secretion through high adrenalization (sanorin, nazivin, galazolin, sinupret, naphthyzin);
• means for strengthening the walls of blood vessels (vitamin C, rutin, ascorutin).

In the absence of severe intoxication of the body, it is indicated high efficiency physiotherapy (laser therapy, UHF, compresses). A YAMIK sinus catheter is also used, which allows the chambers to be flushed with medicinal substances.

In case of ineffectiveness of conservative treatment (persistence of high fever, headache, impaired nasal breathing, secretion of thick mucus or pus) for three days, as well as when detected by X-ray or computed tomography pus in the cavities, trephine puncture of the sinus is prescribed. Today this is a very effective technique that gives high level convalescence. This is a fairly simple operation that is well tolerated by patients, regardless of their age.

The essence of the operation is to penetrate the bone tissue mechanically in order to:

• removal of purulent contents;
• restoration of drainage through the connecting channel;
• reducing swelling of the membranes;
• suppression of pathogens that cause inflammation.

To carry out surgical intervention, a hand drill no more than 10 mm long with a penetration depth limiter and a set of plastic or metal cannulas for rinsing are used.

When determining the optimal entry point, special calculations are used, which are confirmed by x-rays in different projections.

Trepanopuncture is performed in the inpatient department of the hospital, and local infiltration anesthesia (ledocaine, novocaine) is mainly used. Using a drill, a hole is made in the thick anterior wall of the bone, through which the entire organ is probed. A special cannula is inserted and secured into the hole, through which medications are administered over the next few days. In addition, the sinus and connecting canal are washed with antiseptic solutions, followed by evacuation of blood clots, polyps, cystic formations, granulation tissue.

Less commonly, otolaryngologists use the method of punching the bone with a chisel. The resulting vibration is contraindicated for:

• meningitis;
• abscesses;
• osteomyelitis of the cranial bones;
• thrombophlebitis.

There is also a technique that is widely used in practice for puncturing the lower wall of the cavity, which is much thinner than the front, with a sharpened special needle. In this case, a thin subclavian catheter is inserted into the lumen of the needle, which is fixed to the skin after removal of the needle and serves as a passage for washing and delivery medicines into the camera. However, this operation is considered less preferable and more difficult due to the presence of the orbit in close proximity.

Due to the location of the meninges near the lesion, delaying contact with a doctor or attempting self-medication can lead to serious consequences, including death. Complications of frontal sinusitis can include diseases such as purulent inflammation of the orbit, meningitis, osteomyelitis of the cranial bones, etc.

Traditional methods of treatment and prevention of frontal sinusitis

Traditional recipes are mainly aimed at reducing swelling and removing mucus; their use should be coordinated with your doctor:

• Boil bay leaves (5-10 pcs.) in a saucepan, transfer to low heat and breathe, covered with a towel, for five minutes. Repeat for several days in a row, this promotes the outflow of pus.
• A teaspoon of salt, a little baking soda and three drops of tea tree oil are mixed in a glass of warm water. Clean your nose, then, tilting your head forward, use a small syringe to pour the solution under pressure into one nostril so that it flows out of the other. Repeat 2-3 times a day, then apply drops for a runny nose.

Prevention of the disease is as follows:

• timely treatment of rhinitis and sinusitis; if the runny nose does not go away within three days, you should contact the clinic;
• strengthening the immune system through hardening and physical exercise;
• vitamin therapy in autumn and spring;
• control of cleanliness of the nose and free nasal breathing.

Sources: medscape.com,