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Frontitis - symptoms and treatment in adults, prognosis

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What is it?

Frontite is one of the varieties of inflammatory disease of the paranasal sinuses, i.e.sinusitis, and develops in one or more frontal sinuses.

Sinusitis( frontitis including) is a fairly frequent cause of hospitalization - 25-30% of all patients hospitalized in the ENT department suffer from this or that form. By nature of the flow, the frontite is divided into acute and chronic.

Frontite

The causes of acute frontitis are:

  • Acute rhinitis( runny nose);
  • Acute ethmoiditis is an inflammation of the sinus sinus;
  • ARVI, influenza;
  • Subcooling, cold;
  • Common acute infections, eg measles;Injury of the frontal region.

The anatomical feature of the frontal sinus is the relatively narrow and curved channel between the sinus and the nasal cavity. Swelling of the mucous membrane against the background of the underlying disease leads to a rapid closure of the communication between the cavities, which worsens the timely outflow of inflammatory fluid from the frontal sinus to the nose.

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Accumulating in a confined space, it creates favorable conditions for the reproduction of microflora and the development of infectious inflammation within the sinus.

Chronic frontitis develops during prolonged acute course, which is facilitated by the inhibited functioning of the immune system, impaired frontal sinus drainage due to overlapping of the frontal-nasal canal with mucosal polyps, as well as by curving the nasal septum and increasing the size of the middle nasal concha.

The causative role of microorganisms in the chronic course of sinusitis is lost, and the pathological process is supported by an abnormally functioning immune system that damages the tissues of the frontal sinus.

The chronic process usually extends not only to the frontal, but also to other paranasal sinuses. Most often there is a combination of chronic frontitis and chronic ethmoiditis of the anterior labyrinth cells( the labyrinth is the sinus, located horizontally between the nasal cavity and the cranial cavity).In this case, the disease becomes not only protracted in nature, but also a severe course.

Contents

  • 1 Symptoms of the frontitis in adults
  • 2 Treatment of adult frontalitis, drugs and methods
    • 2.1 Drugs for the treatment of the front
    • 2.2 Other therapies
    • 2.3 Forecast

Symptoms of the frontitis in adults

Symptoms of the frontitis in adults

Depending on the severity of the inflammatory process,light, medium and heavy.

The main symptoms of adult frontalitis are due to the development of local inflammation and general intoxication( especially characteristic of the acute form):

  • Sharp pain in the forehead area, which is enhanced by palpation and tapping of the bones localized above the pathological focus;
  • Headache, common throughout the head or in places;
  • Discharge from the nose: abundant, usually observed on the side of the inflamed sinus, first liquid mucous transparent, then purulent, odorless. Purulent character indicates the attachment of bacterial flora;
  • Nasal congestion and respiratory failure from the affected side, which further aggravates the course of the pathological process;
  • Weakness, weakness;
  • Photophobia, pain inside the eyes;
  • The temperature of 37-380С, at the expressed process can rise above;
  • Reddening of the skin above the bridge of the nose with spreading on the upper edge of the orbit and the upper eyelid, closer to the nose;
  • The inner corner of the eye has a swollen area, sharply painful when pressed;
  • An abscess may appear in the inner corner of the eye or in the upper eyelid, which indicates the destruction of the bone wall and the release of pus from the cavity beneath the skin. The abscess is manifested by severe pain and redness, local fever, through the skin can purulent purulent yellowish color.the skin in this area is very thin;
  • When examining the nasal cavity, the rhinoscopy, the mucoid-purulent fluid accumulates under the middle nasal concha, the mucous membrane in the area of ​​this shell is red, edematous and thickened;

Symptoms of the chronic frontal sinusitis during periods of remission are usually absent. Symptoms that manifest themselves during periods of exacerbation are basically the following:

  • Above the affected sinus, the pain can be abrupt and intensified by pressing on the inner corner of the eye, breaking the outflow of fluid and increasing edema lead to increased pain;
  • Headache throughout the head and / or in the forehead region, which appears quite often and has a pressing or aching character;
  • From the nose on the side of the lesion there are permanent discharges, often they have an unpleasant odor;with polyps and non-infectious inflammation, discharge is bright and liquid, inflammation with the participation of microbes - purulent and thick;
  • Characteristic morning increase in the amount of inflammatory fluid released from the nose, which is associated with the patient's transition to a horizontal position, this circumstance makes it very informative to conduct an examination in the morning, after the patient has risen;
  • At night, secretions drain into the nasopharynx, which also leads to the appearance in the morning of a large number of easily expectorated sputum;
  • There is a violation of nasal breathing and olfactory function, which is most noticeable with a bilateral front;

In addition to the examination, the diagnosis is confirmed by radiography, the use of which in Russia is now very widespread. X-rays are performed in 2 positions( projections): direct and lateral. In the photographs, the characteristic features of the frontitis will be a uniform darkening in the region of the affected sinus, sometimes it is possible to detect the level of the liquid.

This method is not 100% reliable, since the dark parts can be caused by other causes, for example, thickening of the mucous membrane or bone walls of the sinus.

A more informative method is computed tomography( CT), which in many countries is considered " gold standard " in the diagnosis of sinusitis.

The advantages of CT are that in the study receive information that gives a comprehensive idea of ​​the ongoing pathological process, allows you to assess the degree of tissue damage, reveals the nature of violations of the anatomical structures of the near-nasal space. In the diagnosis of frontitis, axial computed tomography is often used.

  • Trepanation, or puncture, of the frontal sinus with a diagnostic purpose is used more often with a chronic front, with an acute process, this procedure is performed only with the development of complications or lack of treatment effect in the first day.

Puncture is performed both in a clinic and in a hospital. Puncture is performed with a special device in the forehead area, through the front wall of the frontal sinus. This procedure is performed after anesthesia.

Thus, the appearance of a runny nose that persists for more than 7 days is an indication for the consultation of an ENT doctor. Usually, he recommends performing an X-ray study to exclude the frontitis.

Treatment of adult frontalitis, drugs and methods

Treatment of gonorrhea in adults

Yamic catheter, photo

Treatment of acute and chronic process is similar to each other. Treat the frontal often begin conservatively, that is, with the help of medications. When the frontitis is detected, adult treatment consists of 2 main directions:

  1. Unloading therapy, which restores the normal outflow of fluid from the sinus;
  2. Infection agent exposure.

Local lubrication of 1% of the adrenaline ration is carried out, vasoconstrictive agents are sprayed into the nasal cavity: otrivine, naphthysine, galazoline, etc. These preparations reduce the diameter of the vessel, which reduces the sweat of plasma from it. It is this that is the main component of the pathological secretion that flows from the nasal cavity.

The unloading stage of treatment consists in aspiration of fluid from the sinus with the help of a special catheter "Yamik".After the evacuation of the discharge, the doctor rinses the cavity with a solution of furacillin and injects inward the anti-inflammatory drugs, as well as antibiotics. The latter are only shown in the stage of exacerbation of the chronic process.

In the remission phase, they will be ineffective, becausemicroorganisms are not active at the moment - they do not multiply. It is on the suppression of this process that most antibiotics are directed.

With the front, resulting from ARVI, it is often enough to restore the drainage function, while the attachment of a bacterial infection requires the appointment of antibacterial drugs. They are recommended to be used only with medium-heavy and severe currents.

Preparations for the treatment of the

frontitis Advantage is given to tableted preparations from the cephalosporin or penicillin series. Antibiotics reserve are assigned only if the cephalosporins( penicillins) are ineffective or if there are contraindications to them.

However, modern diagnostics can not always separate the viral and bacterial nature of inflammation in frontins, and the findings are not true indicators of severity. Therefore, the decision to prescribe antibiotics in the treatment of the frontitis is based on determining the severity of the general condition, the nature of complaints and the presence of a purulent discharge.

Of the antibacterial drugs, the following are proven effective:

  • Amoxicillin;
  • Amoxicillin + clavulanic acid: Augmentin, Amoxiclav;
  • Cephalosporins 2 and 3 generations, such as Cefuroxime or Ceftibutin inside, Ceftriaxone IM.
  • In case of ineffectiveness or allergy to the above drugs, macrolides are used: clarithromycin, azidomycin, roxithromycin, as well as fluoroquinolone levofloxacin, which is represented by such drugs as lefokcin, Tavanik.

In the treatment of moderate-sized frontitis, the intake of antibiotics is allowed inside, with severe - in the form of intramuscular or intravenous injections.

At elevated temperature, paracetamol, aspirin, ibuprofen is added to the treatment to stop the systemic inflammatory reaction, the objective manifestation of which is fever.

Other methods of therapy for

UHF or UHF are performed only with the restoration of normal outflow of fluid from the sinus, otherwise physiotherapy can significantly aggravate inflammation. With chronic frontitis, if there are no polyps, laser therapy, microwaves may be used. These methods of physical stimulation stimulate the process of restoring tissues within the frontal sinus. They activate the regeneration of the mucous membrane lining the sine.

With prolonged course or development of complications, as well as inefficacy of the therapy, surgical treatment of the frontis is carried out, which consists in performing frontal sinus puncture, followed by its washing and administration of drugs.

The period of sanitation( washing and introducing solutions) usually lasts 1-1.5 weeks. All this time the patient walks with a drainage tube, through which solutions are placed inside the sinus.

Forecast

A favorable prognosis is observed only with timely diagnosis and adequate treatment. Absence or low efficiency of treatment can lead to occurrence of such complications, as:

  • of a phlegmon of an orbit;
  • brain abscess;
  • is a rhinogenic meningitis;
  • sepsis.
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