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Rinosinusit - an inflammation of a mucous membrane of okolonosovy bosoms.
Allocate acute, recurrent and chronic rinosinusit. Criteria of an acute rinosinusit are illness duration less than 12 weeks and a total disappearance of symptoms after recovery. Are characteristic from 1 to 4 episodes of an acute rinosinusit a year of a recurrent rinosinusit, the periods between aggravations (when symptoms of a disease are absent and treatment is not carried out) last not less than 8 weeks. Existence of symptoms within more than 12 weeks is the main criterion of a chronic rinosinusit. As other criterion consider preservation of signs of inflammatory changes on RG and KT within 4 weeks, despite the carried-out adequate treatment.
At a rinosinusita inflammatory process can be localized in maxillary (antritis), wedge-shaped (sphenoiditis), frontal bosoms and in cells of a sievebone (etmoidit) (frontal sinusitis).
Depending on etiological factors acute and recurrent rinosinusita divide on virus, bacterial and fungal, and chronic on bacterial, fungal and mixed.
Besides, taking into account features of a pathogeny allocate intrahospital, dontogenous, polypostural, developed against immunodeficiency of a rinosinusit and an acute (fulminant) form of mycosis of okolonosovy bosoms.
Chronic fungal rinosinusita subdivide on:
· allergic (eosinophilic) fungal sinusitis;
· fungal sphere;
· superficial sinonazalny mycosis;
· chronic invasive form of mycosis.
According to settlement data, acute rinosinusit in Russia annually transfer up to 10 million people. According to the National center according to the statistics of diseases of the USA, chronic rinosinusit became in this country the most widespread chronic disease, it is diagnosed for 14,7% of residents of the USA. Most often meet antritis and etmoidit.
Polypostural rinosinusit is diagnosed approximately for 1% of the population.
Allergic (or eosinophilic) fungal rinosinusit occurs at young people with the accompanying bronchial asthma.
The acute invasive form of mycosis of okolonosovy bosoms usually occurs at the patients with dekompensirovanny diabetic ketoacidosis who transferred an organ transplantation, receiving a hemodialysis concerning a renal failure, therapy by iron preparations.
The chronic invasive form of mycosis is not typical for Russia, meets in the African countries and Southeast Asia.
There is a number of morbid conditions which, breaking air exchange and mechanisms of clearance of okolonosovy bosoms, are the factors contributing to development of a rinosinusit:
· intolerance of NPVS;
· anomalies of a structure of a nasal cavity and okolonosovy bosoms (nose partition curvature; bull of an average nasal sink; additional anastomosis of VChP, etc.);
· immunodeficiency (The H-linked agammaglobulinemia; general variable immunological insufficiency; deficit of subclasses of IgG;
· the selection insufficiency of IgA; hyper-IgM syndrome; HIV);
the diseases which are followed by delay of MTsT (Kartagener's syndrome; Young's syndrome; mucoviscidosis);
· Wegener's granulomatosis;
· hyperplasia of a pharyngeal almond, adenoiditis;
· gastroesophageal reflux disease;
· fistula between an oral cavity and VChP.
Streptococcus pneumoniae and Haemophilus influenzae are considered as the main activators of an acute bacterial rinosinusit. Among other activators call Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus viridans., etc. The main anaerobic activators of a rinosinusit are anaerobic streptococci. However the range of activators of an acute bacterial rinosinusit can significantly vary depending on geographical, social and economic and other conditions.
The list of activators intrahospital, developed against immunodefitny states, and dontogenous rinosinusit along with the bacteria mentioned above includes Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus spp., and at immunodeficient patients also saprophytic bacteria and fungal microflora. In recent years the role of chlamydias and other atypical microflora in an etiology of a rinosinusit is discussed.
Fungal sinusitis is caused by Aspergillus mushrooms more often (in most cases And. fumigatus), is more rare - Candida, Alternaria, Bipolaris, etc.
The acute invasive form of mycosis of okolonosovy bosoms is most often caused by fungi of Mucoraceae family: Rhizopus, Mucor and Absida.
RS practically always develop at disturbance of mukotsiliarny clearance when optimal conditions for development of a bacterial infection are created.
The SARS happens the starting moment in development of OBRS usually. It is revealed that almost at 90% of sick SARS in ONP changes in a type of hypostasis of a mucous membrane and stagnation of a secret come to light. However only at 1 — 2% of such patients OBRS develops.
In development of chronic RS, in addition to disturbances of MTsT, an important role is played by the anomalies of a structure of intranasal structures and a trellised labyrinth blocking passability of natural foramens of ONP and breaking mechanisms of clarification of bosoms. Presence of two or more sousty VChP also creates conditions for throwing of the slime which already visited a nasal cavity and infected back in a bosom. In the conditions of a chronic inflammation in a mucous membrane there is a focal or diffusion metaplasia of a multirow cylindrical epithelium in multilayer, deprived of cilia and lost ability to delete from the surface bacteria and viruses by active MTsT.
Intrahospital RS is most often caused by the prolonged nazotrakhealny intubation.
Dontogenous antritis develops against the chronic centers of an inflammation, cysts or granulomas in fangs of an upper jaw, as a result of hit in VChP of pieces of sealing material, fangs or burrowing between an oral cavity and VChP after extraction of tooth.
A key role in a pathogeny of PRS is played by eosinophils and SILT-5 causing their proliferation, migration in fabrics and degranulation. However now it is not known how the eosinophilic inflammation leads to education and growth of polyps. There is an assumption that migration of eosinophils in a mucous membrane of ONP is a specific immune response on the fungi getting to ONP in the course of air exchange which develops at predisposed persons. As a result of degranulation in a gleam of ONP very dense mucin containing a large amount of proteins which have the damaging effect on a mucous membrane is formed, causing in it chronic inflammatory process and growth of polyps.
The mucopurulent discharge from the affected okolonosovy bosoms can be transported by a ciliary epithelium directly through the mouth of an acoustical pipe that is the starting moment in development of exudative or chronic inflammatory process on average to fish soup.
Superficial sinonazalny mycosis is caused by growth of a mycelium of a fungus on the crusts which are formed in cavities of the operated okolonosovy bosoms on a surface of new growths and on accumulations of antimicrobic medicines or GKS for topical administration, is long being in a nasal cavity.
Clinical signs and symptoms
The main symptoms of a rinosinusit are the difficulty of nasal breath, a headache and allocations from a nose, less constant - decrease in sense of smell, a congestion of ears, fervescence, a febricula and cough (is more characteristic of children).
At an inflammation in VChP and frontal sinuses pain is localized in the person, area of a bridge of the nose and a frontal bone. Pains in the center of the head and a nape are characteristic of a sphenoiditis.
Allocations happen mucous, purulent and can depart at a smorkaniye or flow down on a back wall of a throat. The last is more characteristic of damage of a wedge-shaped bosom and back departments of a trellised labyrinth.
Chronic rinosinusit is followed by the same symptoms, as acute, but out of an aggravation they are considerably less expressed.