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Allergic diseases of the paranasal sinuses (allergic sinusitis)
Acute and chronic allergic diseases of the paranasal sinuses represent a special category of pathological conditions of the mucous membrane of the upper respiratory tract resulting from an increased sensitivity of the patient's body to a foreign protein (antigen or allergen) and due to neurogenic and endocrine disorders.
In the pathology of the disease, a large role belongs to non-infectious allergens - dust, epidermal, pollen, household. As a rule, the maxillary sinuses and ethmoid labyrinth are involved in the process. The remaining sinuses are rarely affected. Usually, allergic sinusitis accompanies allergic rhinitis and is sometimes accompanied by a number of other etiologically related diseases (urticaria, bronchial asthma, eczema). With allergic sinusitis, a secondary infection of the mucous membrane is possible, in which case the disease acquires the features of a purulent sinus lesion. In case of allergy, the mucous membrane undergoes a number of changes, in particular, pronounced edema of the mucous membrane and serous transudation occur, as well as its hyperplasia, polyps form, edema of the submucous layer with eosinophil infiltration occurs.
K l and n and with to and to kartin and. Signs of allergic sinusitis are always combined with the effects of damage to the nasal mucosa. It is more correct to talk about the symptoms of allergic rhinosinitis. The disease is characterized by a paroxysmal course. Such an attack can develop suddenly, accompanied by incessant sneezing, itching in the nose, severe difficulty in nasal breathing and the appearance of copious liquid secretions. At the end of the attack, the patient notes heaviness in the head and tinnitus. With rhinoscopy, the nasal mucosa (shells) has a cyanotic hue; against this background, individual white spots are detected (due to spasm of the capillaries). In the interictal period, the mucous membrane can be pale, swollen, less often has a normal appearance.
A prolonged course of allergic rhinosinitis often leads to polypous degeneration of the mucous membrane. With rhinoscopy in such cases, you can see polyps of various sizes, coming from the mid-nasal passage from under the middle nasal concha.
On the radiograph of the paranasal sinuses of a patient with allergic sinusitis, a moderate homogeneous decrease in the transparency of the maxillary sinus and ethmoid labyrinth cells (usually on one side). Unlike purulent sinusitis, repeated sinus radiography performed after a few days can give a diametrically opposite result, i.e. that sinus that was opaque became transparent. Suction and lavage of the sinus on the affected side may not produce any pathological contents or receive serous fluid (it is necessary to differentiate from the cyst) or mucus.
The diagnosis of allergic sinusitis is based on patient complaints, anamnesis, examination data, and laboratory tests.
In the diagnosis of the disease, one should take into account the age of the patient, the presence of intolerance of any substances, odors, or relatives. A significant role belongs to the seasonality of exacerbation. The final diagnosis should be made by an allergist based on special laboratory tests, such as scarification and intradermal tests with allergens, determination of the content of eosinophils in the blood, which is separated from the nose and the contents of the maxillary sinuses.
If there are polyps in the nose or if the patient has increasing pain in the forehead, it is necessary to perform a radiography of the paranasal sinuses with the introduction of a contrast medium (iodolipol, if there is no reaction to iodine) in the maxillary sinus of the side where, when examined, there are more polyps in the nose.
Treatment should be carried out together with an allergist. Therapy of allergic rhinosinusopathy provides, firstly, the elimination of factors that cause an exacerbation of the disease (food for fish aquariums, pets, food, various kinds of dust and smells, medications, etc.); secondly, hyposensitization. It can be specific when the treatment is carried out with small doses of the allergen found in tolerance tests, or nonspecific. It is advisable to prescribe antihistamines, such as diazolin (0.05 g 3 times a day), pernovin (0.025 g 3 times a day, for children - at a rate of 0.5 mg per 1 kg of body weight per reception), suprastin (0.025 g 3 times per day), allergodil, bacon, flixonase, etc. Some patients are shown the introduction of a suspension of hydrocortisone into the sinus (25 mg of the drug, diluted in 4 ml of isotonic sodium chloride solution). For local application treatment, you can use flixonase according to the scheme. The patient needs the supervision of an allergist.
Sinus surgery should be clearly justified. It should be borne in mind that radical surgery is necessary only with a polyposis form, with other forms, an endonasal opening of the maxillary sinus can be performed in order to improve its aeration and emptying. Small changes in the mucous membrane allow you to perform microsurgical intervention through the natural anastomosis or the anterior wall of the sinus, however, with extensive polyposis, a typical radical operation must be done with the removal of all polyps. Operations in the nasal cavity should pursue a single goal - improving breathing; In this regard, laser destruction methods, submucosal vasotomy of the lower and middle shells deserve preference. In this case, surgery, as a rule, is one of the stages of complex treatment. To increase the local and general resistance of the body, attention should be paid to the organization of work and life of the patient, and recommended walks in fresh air.
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Allergic diseases of the paranasal sinuses (allergic sinusitis)
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