About Sinuses
What is Sinus?
The air gaps in the bones around the nose are called sinuses. There are a total of eight sinuses, four on the right and left sides, which are maxillary (cheek sinuses), frontal (forehead sinuses), ethmoid (the anterior and posterior sinuses between the eyes) and the sphenoid sinus (most behind, the sinus within the head). called.
Only ethmoid and maxillary sinuses are present in neonates, which are considerably smaller than adults. In this period, the frontal and sphenoid sinuses are in the form of mucosal recesses. The development of the sinuses continues depending on the development of the skull and the removal of the teeth and is largely completed at the age of 12-14 years. The final shape and size of the sinuses continues until the age of 22-24. In some people, some sinuses, especially unilateral or bilateral forehead sinuses, may not occur at all.
The secretory glands in the sinus mucosa, which lay the inside of the sinuses and are the continuation of the nasal mucosa, produce 0.5-1 liters of mucus (mucus) during the day. The secretion produced in the sinuses is discharged into the narrow sinus drainage channels called ostium and from here into the nose by the whip-like movements of microscopic hairs (cilia) on the mucosa. Slimy secretion plays a role in the filtration of air by holding particles and allergy agents in the breathing air taken from the nose, in the fight against germs with the substances it contains, and in humidifying the air before it goes to the lungs.
These air gaps around the nose also have functions such as reducing the weight of the head bones, preventing the head trauma from reaching the brain by absorbing shock shock, and making a resonator effect in the final shape of the sound formed in the vocal cords.
What is Sinusitis?
The inflammation of the mucosa that covers the sinus cavities is called sinusitis. The most important factor that causes sinusitis is the secretion of mucus produced by the sinus mucosa and accumulation in the sinuses. The most common causes of this condition are obstruction of the sinus emptying canal, disruption of the system that carries the secretion to the sinus emptying canals, and changes in the content or consistency of the outbreak.
The proliferation of microbes in the secretion accumulated in the sinuses as a result of the presence of one or more of these causes leads to inflammation of the sinus, ie sinusitis.
Other conditions that may cause sinusitis; microbes come directly into the sinuses through blood, as a result of penetrating trauma or fractures of the facial bones, or inflammation of the cheek sinus subspecies, which are relatively rare.
Sinus inflammation can also be called inos rhinosinusitis anlam in terms of nasal and sinus inflammation because the mucosa covering the sinuses is embryologically and anatomically consistent with the mucosa within the nose and responds similar to medical and surgical treatment.
Sinus inflammations are divided into four groups according to the disease process;
· Infections that start abruptly and end with complete disappearance of symptoms within 4 weeks, acute rhinosinusitis,
· Infections lasting more than four weeks and ending before 12 weeks, subacute rhinosinusitis,
· Recurrent (recurrent) acute rhinosinusitis in the event of infection that lasts at least 7 days in four or more years,
· Infections (symptoms of acute rhinosinusitis may occur in cases where symptoms and symptoms last for more than 12 weeks) are called chronic rhinosinusitis.
Factors Causing Sinus Infection
Sinus infections occur as a result of the interaction of patient and environmental factors. Upper respiratory tract infections caused by viruses are the most common cause of sinusitis. During the infections caused by viruses, narrowing of the narrowing sinus discharge channels due to swelling and thickening of the mucosa covering the nose and sinuses, as well as the deterioration of the function of the system that carries the secretion to the channels due to the same infection, and the outbreak become thick and thick. It happens. If this does not improve within a few days, secondary bacterial growth and acute bacterial sinusitis occur.
The second most common cause of sinusitis is the occlusion of sinus emptying canals as a result of mucosal edema due to allergic reactions. Anatomical disorders such as nasal curvatures (septum deviation), polyps, nasal flesh growth (concha hypertrophies), which narrow or block the sinus emptying can also cause sinusitis. Rare conditions, such as cystic fibrosis or ciliary movement disorders, disrupt mucus production and or transport, resulting in HIV infection (AIDS), chemotherapies, the use of drugs that suppress the body's defense system, insulin-dependent diabetes, and certain connective tissue diseases that can cause sinusitis by adversely affecting immune functions.
What are the symptoms of sinusitis?
Symptoms encountered in nasal and sinus infections are divided into two groups as major and minor.
Major: Feeling of pain and pressure on the face, swelling and fullness on the face, nasal congestion, inflamed discharge from the nose and nasal passages, reduction in smell (hyposmia) and fever are the first-degree complaints and findings in diagnosis.
Minor: Headache, bad breath, indulgence, toothache, cough, ear pain are second-degree complaints and findings in diagnosis.
Complaints are more pronounced at night and in the early hours of the morning due to the increase in the amount of blood and edema in the sinus and nasal mucosa depending on the body position and the secretion transfer being adversely affected.
Long-term and chronic inflammation usually reduces the severity of the complaints and it is difficult to diagnose only with history. The most significant complaints in this group of patients are behind the nose, from the nasal to the throat with a thick viscous discharge and a feeling of tenderness on the sinus of the facial bones. In people with a history of allergy, mild complaints and examination findings should suggest allergy before sinus inflammation.
During the examination of patients with sinusitis, general ENT and head and neck examination as well as swelling of the face, redness and edema (especially around the eyes), lymph node enlargement and inflammatory discharge behind the nose should be carefully examined. Nasal examination of patients with sinusitis; Anatomical disorders such as swelling and redness of the mucosa, inflamed crusts, inflamed discharge, flesh growth that may cause obstruction in the nasal opening of the polyps or sinus canals may be observed.
In the diagnosis of chronic sinus inflammation, it is particularly important to see a dark, inflamed discharge in the posterior part of the nose (nasopharynx) during the examination. Endoscopic examination of patients with no pathological findings detected by simple examination of the nasal side wall of the sinus emptying canal areas can be detected by inflammation of the sinuses that discharge.
How is sinusitis diagnosed?
Laboratory tests have limited value in the diagnosis of sinus inflammation. Especially for the differential diagnosis of allergic rhinitis mixed with mild sinusitis, blood or skin tests for allergies may be performed in cases with high Ig E levels and suspected allergies. Microscopic examination of the nasal secretion, and the presence of intense white blood cells (leukocytes), viral or bacterial rhinosinitis, eosinophil, plasma and mast cells can help in the diagnosis of allergic rhinitis.
In case of suspicion of some rare special diseases, mucosal biopsies should be performed, frequent recurrent resistant inflammations as well as other ear and neck infections such as middle ear infections, tonsillitis, pharyngitis, skin infections, familial, drug related or HIV infection (AIDS) related immune system deficiencies should be investigated. Recurrent infections are observed with encapsulated microorganisms in congenital or acquired antibody deficiencies, fungi and viruses in T-lymphocyte disorders and gram negative microorganisms in compulsive system disorders. Complete blood count, sedimentation and serum immune globulins should be considered as basic tests in these patients.
Which Imaging Techniques are Used in Sinusitis?
In classical sinus x-rays, full sphenoid sinus in the cheek, forehead and head, air-fluid level and mucosal thickening exceeding 6 mm in children and 8 mm in adults are significant for the diagnosis of sinusitis.
However, the anterior ethmoid sinus region, which is usually the first starting point of sinus infections, and the ostiomeatal complex where the discharge channels of the sinuses that play a key role in the formation of infections, cannot be evaluated as sufficient with normal x-ray films. For this reason, paranasal sinus computed tomography (CT) is usually preferred in the diagnosis of chronic and severe acute inflammations and in the planning of the treatment.
How is sinusitis treated?
The main components of medical treatment in sinus infections are preventive measures, supportive treatments and drug therapies.
Preventive measures against sinus infection:
Measures to prevent the formation of sinusitis can be considered as the first step of treatment. In addition to factors such as lack of oxygen in the respiratory air, air pollution, allergens and cigarette smoke, which have a negative effect on the functions of the sinus mucosa, upper respiratory tract infections due to viruses are rapidly spreading in crowded and poorly ventilated environments and are an important factor in the formation of sinusitis. Therefore, well ventilated living and working environments and non-smoking in these environments play an important role in the prevention of sinus infections.
Dry air breathing increases the risk of sinusitis due to the darkening of the nose and sinus secretions and the negative effect of the delivery system which provides the discharge of the secretions from the sinuses. For this reason, it is recommended to control the moisture content of the air conditioners and central ventilation systems and humidify the air with additional precautions when necessary. In case of inadequate fluid intake or excessive water loss, it may be beneficial to consume at least 2 liters of warm water per day, especially in cases of fluid loss, as it provides the basis for sinus infections by reducing the viscosity and viscosity of mucus secretion. Since tea, coffee and cola drinks other than water increase the excretion of water from the kidneys, it is necessary to increase water intake along with these drinks.
Preventing the patients with diagnosed nasal allergies from the environment that causes the allergies, taking the precautions such as house plants containing high amounts of allergens, removing the long hairy carpet-like sources from the living areas will contribute to reducing the risk of developing sinusitis due to swelling in the nasal mucosa.
Influenza (influenza) vaccine, pneumococcal vaccine and oral vaccine vaccines are useful in decreasing the number of recurrent infections in patients with frequent sinus infections or chronic sinusitis.
Applications supporting medical treatment:
In addition to medical treatment, the most important parts of the supportive treatment are providing a moist environment in the nose and cleaning the accumulated crust and inflamed secretions. Pressure sprays containing the appropriate concentration of saline are the most commonly used agents for this purpose. Antimicrobial drugs can be added to these washing solutions in case of infection and bacterial carriage which cannot be prevented by antibiotics.
Drugs used in the treatment of sinusitis
Mucolytics: Drugs that reduce the consistency of mucus secretion and increase the flowability of these drugs are used to prevent mucus accumulation due to deterioration in cilia activity carrying the mucus from sinuses and dark mucus production.
Decongestants: Decongestant drugs that reduce the swelling of the intranasal mucosa can be used by the nose (spray) and orally. Drugs in this group are intended to open or expand the sinus ostia as a result of contraction of the vessels in the nose and sinus mucosa and thinning of the mucosa, and to provide sinus emptying and aeration. It is recommended not to use the medications used as a spray for more than 4-5 days due to its swelling increasing effect and irritating effects on the mucosa. Oral decongestants can be used safely for 7-10 days in patients who do not have high blood pressure, heart disease, rhythm disorders or prostate enlargement.
Antistamines: They are used to prevent mucosal edema due to allergic reactions, but they have effects that increase mucus density and make sinus emptying difficult. Therefore, they are not recommended for use other than patients with allergic origin sinusitis and known allergies.
Steroid-containing nasal sprays: Chronic sinus inflammation and allergic conditions, mucous edema and inflammation-induced reactions are used to reduce. Especially since the last generation of spray steroids into the bloodstream are extremely low, they can be used in pregnant and infants in cases where there is no other treatment option.
Steroid use in the form of pills or injections: The use of steroids orally or injections prior to surgery in allergic patients and especially in chronic sinus inflammation with polyps may facilitate surgery due to shrinkage of polyps and reduction in tissue reaction. Such treatments should be administered with caution and under the supervision of the specialist specialist of diseases in patients with high blood pressure and or diabetes.
Anti-bacterial drugs (Antibiotics): In acute infections that are not characteristic, treatment is generally applied without taking culture. Antibiotic resistance in the community, compliance of patients with drug dose ranges, hypersensitivity to drugs, changeable side effects and drug interactions for each antibiotic affect antibiotic selection. Since the microbes that cause more than 60% of acute sinus infections are pneumococci or H. influenza, it would be appropriate to select antibiotics effective against these agents in acute infections. The duration of antibiotic use in acute infections is 10-14 days. Drugs with a long half-life can be used for shorter periods.
In the absence of improvement in symptoms and symptoms in five to seven days, it should be considered that a drug effective against bacteria proliferating in oxygen-free environment should be added to the treatment. Especially in patients with a history of failed antibiotic use, antibiotics should be chosen to be effective against microorganisms known to be resistant.
The duration of antibiotic treatment should be at least 2-3 weeks in chronic sinus infections. In these infections, the choice of drug according to the results of endoscopy-guided intranasal cultures may be preferred considering the increased rate of resistance to antibiotics, the possibility of microorganisms proliferating in more than one bacterial or oxygen-free environment at the same time and the long treatment period. Antibiotics should be selected according to culture and antibiogram in all types of sinus infections in patients with immune system failure or in hospitalized infection.
In patients treated with chronic sinusitis, appropriate doses of antibiotics and cortisone nasal sprays should be used for 2-3 weeks before computed tomography. Even if there are no sinusitis findings on tomography in patients without significant complaints, it would be appropriate to follow up the patient and check the complaints before making a decision for surgery. Surgical treatment should be considered as an alternative in patients whose complaints do not improve or recur.
How is sinusitis surgery performed?
Today, the current technique used in the treatment of sinusitis is endoscopic sinus surgery (ESC). Information about this surgical technique is shared under the title of oskop Endoscopic Sinus Surgery ”.
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