|Classification according to ICD-10|
|ICD-10 online (WHO version 2019)|
Sinusitis , and sinusitis ( latin paranasal Salis , sinus and -itis , inflammation ') is an inflammatory, caused by viral or bacterial change in the mucosa of the paranasal sinuses . A distinction is made between acute and chronic sinus infections. The sinuses include the maxillary sinuses (maxillary sinusitis, maxillary sinus inflammation ), frontal sinuses , ethmoid cells and the sphenoid sinus .
Acute suppuration of the paranasal sinuses often arises from a runny nose ( rhinitis ), when swelling of the mucous membranes or anatomical peculiarities prevent the discharge of secretions from the sinuses. Usually the maxillary sinuses , more rarely the ethmoid cells and frontal sinuses , very rarely the sphenoid sinus are affected. Involvement of all of the sinuses is known as pansinusitis. The disease is usually associated with fever , headache and general fatigue. Every seventh German is affected by sinusitis once a year. The cause is bacterial infection in only 20–35% of cases . Viruses are usually the trigger; however, other causes such as allergies are also possible. The following speaks in favor of bacterial sinusitis: Symptom duration > 7 days, one-sided facial pain, one-sided purulent nasal discharge. A bilateral symptomatology , however, speaks more for a viral cause. Acute viral sinusitis can be transmitted through droplet infections . As a result of acute sinusitis, the sinubronchial syndrome (post-nasal drip syndrome) can occur.
Chronic sinusitis is sinusitis lasting more than 2-3 months (depending on the source). It usually arises from acute or subacute sinusitis that has not healed, mostly maxillary sinuses and ethmoid cells are affected. Another form of disease is recurrent acute sinusitis. Symptoms are long-lasting loss of smell ( anosmia ), chronic, mostly watery runny nose ( rhinorrhea ), flow of secretions into the throat (post-nasal drip) and permanent, dull pressure over the sinuses or behind the eyes. Often there is also the growth of inflammatory polyps in the sinuses. To treat the polyps, cortisone preparations are used as nasal sprays or in tablet form. Further therapeutic approaches consist of the long-term administration of antibiotics , nasal rinsing or - in the case of chronic sinusitis with polyps - the local application of antimycotics . The measures are in no small number unsuccessful, in the case of antibiotics because of the poor accessibility of the bacterial biofilms formed on the mucous membranes. Local application of antibiotics, on the other hand, would be a malpractice because it would promote resistance.
Contrary to popular belief, a nasal douche is usually only used to rinse the nasal mucous membranes, but not the sinuses, which are much more difficult to reach. Douching of the nose and sinuses is done with various natural agents, e.g. B. with sage concentrate or chamomile, each plus 0.9% salt solution makes sense. The physiological saline solution is required for rinsing in order to prevent damage to the mucous membranes by osmotic processes. For a limited time, decongestant nasal drops can open the accesses blocked by the swelling.
As things stand, optimal drug treatment is as effective or ineffective as surgery. This is why this only makes sense if the patient does not experience sufficient relief from drug therapy.
An operation will improve the condition in 80% of the cases when it comes to polyps or other restrictions of the ventilation, in 10% of the cases the disease comes back. These operations are now usually carried out from inside the nose, cuts in the face ( transfascial access ) are reserved for individual cases. Patients with extensive frontal sinus infections have a poorer prognosis and a poorer risk profile. Due to the proximity to the eyes and the brain, the risks of sinus surgery include injury to the eye socket with the formation of double vision, loss of vision, drainage of cerebrospinal fluid, meningitis and bleeding into the brain. These serious complications now occur in less than 1% of cases.
A polypoid sinusitis is particularly common with the appearance of bronchial asthma and a analgesics - intolerance (incompatibility) connected. The occurrence of all three diseases in a patient is called the Samter triad . With standard therapy, these patients have a significantly increased tendency to relapse. Adaptive deactivation is available as a newer, supportive therapy. For this purpose, after being stopped by the doctor, acetylsalicylic acid (ASA / aspirin) is permanently taken and can thus successfully counteract the formation of new polyps. Rehabilitation of the paranasal sinuses in asthmatics leads to an average of 5 mg less cortisone intake in order to control asthma.
As a result of chronic sinusitis, diseases of the lungs ( sinubronchial syndrome ) and many other organs, e.g. B. the gastrointestinal tract or the heart, occur or these are affected by toxins. If the chronic sinusitis does not heal or recurs despite therapy, it should also be clarified whether cystic fibrosis may be present or whether previously unnoticed inflammation of the tooth roots radiates into the maxillary sinuses (panoramic x-ray , DVT !).
- Ethmoid sinusitis , an inflammation of the ethmoid cells
- Frontal sinusitis , an inflammation of the frontal sinuses
- Maxillary sinusitis , an inflammation of the maxillary sinuses
- Sphenoid sinusitis , an inflammation of the sphenoid sinus
- Pansinusitis , a simultaneous inflammation of all sinuses
Odontogenic maxillary sinusitis
Odontogenic maxillary sinusitis is an inflammatory change in the lining of the maxillary sinus, which occurs primarily as a result of an odontogenic infection or dental treatment. Usually only one side of the maxillary sinus is affected. Ondontogenic maxillary sinusitis must be clearly differentiated from rhinosinusitis in terms of etiology and usually also therapy.
The most common cause is the persistent mouth-antral connection (MAV), for example after a tooth extraction , followed by apical periodontitis as a result of an inflammatory pulp disease . Other causes can be residual roots, periodontitis, peri-implant inflammation, odontogenic cysts , teeth or implants displaced in the maxillary sinus, and augmentation material after a preprosthetic sinus lift .
The doctor can often diagnose sinusitis through a simple endoscopic examination, smear of the nasal fluid ( nasal secretion ) and targeted questioning of the symptoms, which are quite clear in the case of sinusitis . (These very clear symptoms can, but need not, occur. Chronic sinusitis / pansinusitis may not cause any recognizable symptoms at all.) For further clarification, the imaging methods computed tomography (CT) or magnetic resonance imaging (MRT) must be used. X-rays and sonography are rather unreliable in diagnosing chronic sinusitis. Sonography is only of value for follow-up and in the event of an acute episode. If you are generally exhausted, the absence of any other symptoms, along with a result of a sinus x-ray, can easily lead to the premature ruling out of sinusitis.
- In acute sinusitis, headaches are often accompanied by a feeling of pressure or boring pain in the front of the head. This pain worsens when you lean forward, bend your upper body, or stand firmly. The location of the symptoms varies depending on the sinuses affected. For example, throbbing pain can occur over the forehead, in the cheek area (possibly accompanied by a toothache), behind the eyes or, less often, in the back of the head. For localization, the patient can hit the back of the head with the palm of the hand; the impulse causes a dull, stabbing pain in the fluid-filled sinuses.
- Often at the same time rhinitis (runny nose) with purulent (yellowish-green) changed nasal secretions , obstructed nasal breathing, constant flow of secretions in the throat.
- In the case of severe inflammation, fever , fatigue and visual disturbances , also strong cough, which can disturb the night's sleep in particular due to the leakage of mucus in the respiratory tract, and in the case of persistent coughing, the chest muscles pain and weakens.
- Sometimes visible painful swelling.
- Increased nosebleeds should remind you of rare malignant neoplasms in the sinus area. The autoimmune disease granulomatosis with polyangiitis (GPA; formerly Wegener's disease ) manifests itself in the early stages as persistent sinusitis, which is ultimately accompanied by increased nosebleeds. The rheumatologist should clarify the matter as soon as possible, as a much gentler medication can then be selected than in the later stage, which can also be accompanied by severe organ damage to the lungs and kidneys.
- Loss of performance, chronic fatigue.
- Pressure and pain-related drowsiness up to delirium in advanced stages.
The primary goal of therapy is to reduce inflammation and restore the natural drainage of mucus from the sinuses:
- Measures for liquefaction and improved excretion of the mucus (increased fluid supply through drinking, ensuring a high relative humidity of the breath, steam inhalation , infrared treatment (red light lamp ), short-wave treatment , isotonic saline solution as a nasal rinse / shower or sea water sprays, active ingredients for mucus loosening / liquefaction or increased mucus production such as acetylcysteine and ambroxol , herbal supplements or enzyme supplements.)
- Use of decongestant nasal sprays or drops.
- Taking medication containing myrtol or cineol .
- Measures to reduce inflammation (for example using enzyme preparations or nasal sprays containing cortisone).
- Use of vegetable mustard oils made from nasturtiums and horseradish , effectiveness and tolerance proven by clinical studies: work against viruses, bacteria and anti-inflammatory.
- Administration of antibiotics is only for severe symptoms and when a bacterial infection secured or at least probable.
- In severe cases, surgery may be necessary to facilitate the drainage of mucus, which is difficult for organic reasons (removal of polyps, reduction of the nasal concha, bone scraping, straightening of the nasal septum ).
- Caldwell-Luc operation
- In odontogenic maxillary sinusitis, a purely dental treatment of the cause is often sufficient (for example, a root canal treatment , tip resection / revision treatment , extraction and, if necessary, a plastic covering of an oral-maxillary sinus connection).
- Strong heat or cold should be avoided, as changes in temperature increase sinus pain.
- Raise the head of the bed so your head is higher.
- Herbal combination preparations with expectorant ingredients that facilitate the healing process are z. B. gentian root, cowslips, sorrel herb, elderflower and verbena.
- Drink plenty, e.g. B. Herbal teas with chamomile, peppermint or thyme.
- A home remedy often recommended by doctors is steam inhalation with the addition of dried chamomile flowers or with chamomile concentrate or ointments that contain eucalyptus oil. However, a clinical benefit from these steam inhalations has not been established.
In severe cases, the inflammation can cross the sinuses and damage neighboring structures:
- If the inflammation affects the thin bone plate that separates the eye socket and the sinuses, a breakthrough can occur. Pus and bacteria get into the eye socket, which can lead to serious eye damage and even blindness.
- The inflammation can also break through the bony separation of the brain and sinuses. Life-threatening meningitis can result.
- The interplay between maxillary sinus and tooth root inflammation is mostly neglected .
- An often overlooked and underestimated problem is snoring . Due to the disturbed nasal breathing, the air flow is obstructed, the secretion in the way "gurgles" unmistakably with every breath. As the closure progresses, mouth breathing is switched to, which leads to the dehydration of the pharynx. This has a negative impact on sinusitis because, on the one hand, the mucous membranes are irritated and, on the other hand, the necessary rest during sleep does not occur.
- A mucocele can form.
- Post nasal drip syndrome
In general, the immune system needs to be strengthened, for example through regular sauna visits, lots of exercise in the fresh air, alternating showers and a diet rich in vitamins. Smokers are at increased risk. In winter the head should be kept warm.
If you have a cold, the nose should only be blown with little pressure (preferably only one nostril at a time); high pressure often brings bacteria-containing mucus into the sinuses first.
With frequently recurring sinusitis, benign growths of the mucous membrane ( polyps ), a crooked nasal septum and / or narrowed drainage channels for the nasal secretions are often the cause. Eliminating the cause, for example by means of operations or avoiding contact with allergens, can help.
- Lacrimal sinus ( sinus lacrimalis )
- Palatine cavity ( sinus palatineus )
- Jürgen Strutz, Wolf Mann (ed.): Practice of ENT medicine, head and neck surgery. 2nd, completely revised and expanded edition. Thieme, Stuttgart / New York, NY 2010, ISBN 978-3-13-116972-3 .
- Werner Hosemann , Rainer K. Weber, Rainer Keerl: Minimally Invasive Endonasal Sinus Surgery: Principles, Techniques, Results, Complications, Revision Surgery. Thieme, Stuttgart / New York, NY 2000, ISBN 3-13-124611-1 .
- Patient information from the University Clinic Greifswald
- Article on the subject ( Memento from June 4, 2009 in the Internet Archive ) In: Der Arzneimittelbrief , independent journal, focus on pharmacotherapy.
- S3 guideline : Rhinosinusitis from DEGAM, AWMF register number 053/012, status 02/2008
- S2- guideline rhinosinusitis of Dt. Ges. F. Ear, nose and throat medicine, head and neck surgery. In: AWMF online (as of 05/2007)
- S2 guideline for maxillary sinusitis from Dt. Ges. F. Oral and maxillofacial surgery. In: AWMF online (as of 04/2008)
- ↑ German Society for General Medicine and Family Medicine (DEGAM): Rhinosinusitis DEGAM - Guideline No. 10 . 2008.
- ↑ W. Fokkens, V. Lund, J. Mullol: European Position Paper on Rhinosinusitis and Nasal Polyps 2007 . In: Rhinol Suppl. No. 20 , 2007, p. 95-96 , PMID 17844873 .
- ↑ W. Fokkens, V. Lund, J. Mullol: European Position Paper on Rhinosinusitis and Nasal Polyps 2007 . In: Rhinol Suppl. No. 20 , 2007, p. 67 , PMID 17844873 .
- ^ Wellington S. Tichenor: FAQ - Sinusitis. April 22, 2007, accessed October 28, 2007 .
- ↑ S2k guideline odontogenic maxillary sinusitis (PDF) long version, AWMF register number: 007-086 as of: 06/2019. Retrieved July 25, 2019.
- ↑ Glucosinolates against bacterial infections. In: Deutsche Apotheker Zeitung , No. 25, June 2010, pp. 105-107.
- ↑ Werner Stingl: Fight Influenza Viruses with Phytotherapy . In: Ärzte Zeitung , December 16, 2010.
- ^ A. Conrad et al .: In-vitro studies on the antibacterial effectiveness of a combination of nasturtium herb (tropaeoli majoris Herba) and horseradish root (Armoraciae rusticanae radix) . In: Drug Res , 56/12, 2006, pp. 842-849
- ↑ A. Conrad et al .: Broad spectrum antibacterial activity of a mixture of isothiocyanates from nasturtium (Tropaeoli majoris herba) and horseradish (Armoraciae rusticanae radix) . In: Drug Res , 63, 2013, pp. 65-68
- ↑ V. Dufour et al .: The antibacterial properties of isothiocyanates . In: Microbiology , 161, 2015, pp. 229-243
- ↑ A. Borges et al .: Antibacterial activity and mode of action of selected glucosinolates hydrolysis products against bacterial pathogens . In: J Food Sci Technol , 52 (8), 2015, pp. 4737-4748
- ^ A. Marzocco et al .: Anti-inflammatory activity of horseradisch (Armoracia rusticana) root extracts in LPS-stimulated macrophages . In: Food Func. , 6 (12), 2015, pp. 3778-3788
- ↑ H. Tran et al .: Nasturtium (Indian cress, Tropaeolum majus nanum) dually blocks the COX an LOX pathway in primary human immune cells . In: Phytomedicine , 23, 2016, pp. 611-620
- ↑ ML Lee et al .: Benzyl isothiocyanate exhibits anti-inflammatory effects in murine macrophages and in mouse skin . In: J Mol Med , 87, 2009, pp. 1251-1261
- ↑ Cold patients do not benefit from ibuprofen and steam inhalations . , aerzteblatt.de, November 6, 2013; accessed on November 10, 2015