Rhinosinusitis - what is it and how to treat it at home with medicines or folk remedies. What is rhinosinusitis, its symptoms and treatment in adults Signs and symptoms

Rhinosinusitis is an acute or chronic inflammation of the mucous membrane of the nasal canals and paranasal sinuses, which was caused by a cold and prolonged hypothermia, infection of the upper respiratory tract by fungal, bacterial or viral infection. The disease differs in the severity of the manifestation of the clinical picture, depending on what exactly caused the damage to the epithelial tissues of the nasopharynx.

Rhinosinusitis is a disease that simultaneously covers the entire system of the upper respiratory tract located in the nasopharynx. The inflammation is so extensive that the patient's state of health is extremely unsatisfactory, and the disease itself requires urgent drug treatment. As a result of the pathological process in the nasal canals, a strong swelling of the mucous membrane of all tissues of the nasopharynx develops and the natural air circulation is disturbed. The intensity of symptoms depends on which particular strain of microorganisms caused the disease, as well as how timely the person applied for medical care.

The most dangerous is purulent rhinosinusitis, which has developed under the influence of pathogenic microorganisms such as Staphylococcus aureus, Pseudomonas aeruginosa or streptococcal infection. Treatment of rhinosinusitis, regardless of the form of the disease and the nature of its origin, is based on the patient taking antibacterial drugs, anti-inflammatory drops, warming up and washing the nose with antiseptic solutions. Radical method therapy is a puncture of the inflamed sinus and forced evacuation of purulent exudate.

Individual properties play an important role in the treatment of the disease. immune system sick, since in people with strong immunity, rhinosinusitis goes much faster and without the risk of recurrence in the form of a relapse. Among the large number of factors affecting the development of rhinosinusitis in previously completely healthy people, the following causes of the disease are most often encountered in medical practice:

the presence in the patient's body of a focus of chronic infection, which develops in a sluggish state, but is regularly spread to all parts of the body along with the blood flow (sick teeth, prostatitis, tonsillitis, pyelonephritis, gastritis and other pathologies internal organs, prone to hidden flow).
daily work at low temperatures, which causes constant hypothermia and colds;
acute respiratory bacterial, viral or fungal infection that got into the cavity of the paranasal sinuses along with the air flow during the act of breathing;
bad habits in the form of alcohol abuse, smoking, taking drugs (they have an indirect effect on the occurrence of rhinosinusitis, as they significantly weaken the immune system);
living in a region with an unfavorable ecological situation, where the air is oversaturated with toxic vapors of chemicals;
an acute allergic reaction, manifested in the form of profuse rhinitis, incessant for several weeks;
severe injuries to the surface of the face, as a result of which the integrity of the bones of the bridge of the nose or directly one of the paranasal sinuses was violated;
previous surgery on the upper jaw, which was performed incorrectly, with infection, or ineffective ones were used medications during the recovery period.

It is these causal factors that are most often established by an otolaryngologist based on the results of the initial examination of the patient.

Based on this, the doctor selects for the patient a list of tests that will need to be passed, and further forms a therapy regimen.

The first symptoms of rhinosinusitis

Symptoms of the disease are easily confused with a cold or SARS, which often happens in the early days of the development of the disease. Nevertheless, there are some features of the manifestation of rhinosinusitis in adults, which are characterized by the following symptoms:

Complicated forms of rhinosinusitis can still be manifested by pain in the upper teeth (with inflammation of the maxillary sinus), cough, if infection has entered the lower Airways. When the first signs of the disease appear, you should immediately seek help from an otolaryngologist.

Types and forms of the disease

Depending on what provoked the development of the disease, rhinosinusitis is classified into types and forms of the course. This allows the attending physician to more effectively form a therapeutic course to combat the disease and select medicines that are appropriate to use in a particular clinical case.

Forms of rhinosinusitis

The main forms of rhinosinusitis include:

chronic, characterized by sluggish inflammation, which was formed as a result of an untreated cold, influenza virus, SARS or any other infectious agent (manifested in the form of periodic exacerbations and is difficult to treat conservatively);
acute with a stormy clinical picture, a vivid manifestation of symptoms and an accumulation of purulent exudate in the cavity of the paranasal sinuses (lasts from 3 to 7 days, and then disappears or transforms into a chronic form).

Types of rhinosinusitis

The main types of rhinosinusitis include:

hyperplastic;
odontogenic;
exudative;
viral;
fungal;
bacterial rhinosinusitis;
left-sided;
right hand;
catarrhal;
vasomotor rhinosinusitis
purulent;
allergic.

The most severe type of inflammatory disease of the nasopharynx is the occurrence of bilateral rhinosinusitis in a patient, regardless of the form of its course. In this case, the doctor has to deal with a very extensive focus of the pathological process, the elimination of which will require a long period of time and the patient will take a large number of potent drugs. medicines.

Diagnosis and which doctor to contact?

Rhinosinusitis, like most other inflammatory diseases of the mucous membrane and epithelial tissues of the nasopharynx, are under the supervision of an otolaryngologist. If, due to certain circumstances, this specialist of a narrow profile is not available in the staff of the polyclinic, then in this case the patient needs to make an appointment with a therapist. To make a diagnosis, the doctor prescribes the patient to undergo the following procedures and tests:

blood from a finger for a general clinical study;
urine for which biochemical analysis is carried out;
endoscopy with the introduction of a probe into the cavity of the nasal opening with a visual study internal state inflamed paranasal sinuses;
CT scan of the skull and directly all types of tissues of the facial disc;
x-ray of the frontal part of the head to determine the foci of inflammation and the presence of purulent exudate in the paranasal sinuses;
deoxygenated blood for testing the body's immune response to potential allergens (appointed if there is a suspicion of an allergic type of rhinosinusitis);
bacterial examination of mucus secreted from the nose involuntarily or during blowing your nose.

Having received the conclusions on these types of analyzes, the attending physician has comprehensive information that plays a key role in the diagnosis and further formation of the treatment regimen.

Treatment of rhinosinusitis in adults - how and with what?

In order to get rid of rhinosinusitis once and for all, it is necessary to pay great attention to the selection of drugs and therapeutic methods in general. Only in this case, a complete cure is possible without the risk of relapse and the onset of severe complications. To do this, in modern otolaryngology, drugs of the following pharmacological categories are used.

Antibiotics and other medicines

Effective in the treatment of rhinosinusitis caused by bacterial invasion of pathogenic microorganisms. Antibiotics for rhinosinusitis are indispensable if, according to the results of bacteriological culture of the mucus secreted from the nasal cavity, pathogenic bacteria are found in a concentration exceeding the permissible norms. The most commonly used are antibacterial agents, how:

These medicines can be used in the form of tablets and intramuscular injections. The latter method of administering the drug into the patient's body brings a more positive result and the active components of the drug are better absorbed, and therefore reach the focus of infectious inflammation. In most cases, injections are prescribed in the form of a therapeutic course, lasting from 7 to 10 days, 2 injections per day (morning and evening).

Antibacterial tablets are taken 2-3 times a day before or after meals, depending on the manufacturer's recommendations displayed in the instructions for use of the medication.

Tablets

Medicines for rhinosinusitis, produced by pharmacological companies in the form of tablets, have the following therapeutic properties:

Each group of tablets finds its application at one stage or another of the treatment of rhinosinusitis, and the task of the attending physician is to choose the right type of medication and in the required dosage with the duration of administration.

Drops and sprays

This category of drugs is designed to directly affect the mucous membrane of the nasal canals, as well as the expansion of blood vessels that are spasmodic as a result of extensive and acute inflammation. In this case, the following types of anti-inflammatory sprays and drops differ in the best therapeutic effect:

The patient independently instills these drops 2-3 times a day for 5-7 days. If the patient is being treated for rhinosinusitis in an inpatient department, then the introduction of drops is performed by a nurse as a therapeutic procedure. Drops and sprays are always included in the complex of the treatment course, as an auxiliary element and cannot be used as an independent medicine.

Inhalation with a nebulizer

One of the newest ways to treat rhinosinusitis. It is indicated for use in chronic forms of this disease, since the acute type of the disease does not always allow steam inhalation, because there is a real risk of an even greater aggravation of the inflammatory process and a deterioration in the general condition of the patient. The following drugs are used as a therapeutic basis for inhalation:

decoctions of anti-inflammatory herbs (chamomile, St. John's wort, thyme, sage, coltsfoot, plantain);
saline to provide a general steam effect without saturating inflamed epithelial tissues with active components of chemicals;
mineral water without gases, which contains an increased concentration of alkali;
soda solution prepared by mixing baking soda with distilled water;
syrups and antibacterial suspensions, which are prescribed by a doctor in case of therapeutic expediency of their use.

In each clinical case, one or another inhalation base is effective. Throughout the course of treatment, each type of drug can be applied in turn to ensure the maximum antimicrobial or anti-inflammatory effect.

The principle of treating rhinosinusitis with a nebulizer is as follows:

the patient fills the filling compartment of the inhaler with a liquid drug base, which will be used to relieve inflammation and fight pathogenic microorganisms;
the device is turned on and starts heating the liquid with its conversion into steam;
the mouthpiece of the nebulizer, like a hookah, is inserted into the cavity of the nostrils and the patient draws in the healing steam, thereby inhaling the mucous membrane of the upper respiratory tract of the nasopharynx, as well as the paranasal sinuses;
the duration of the procedure for each nostril is from 3 to 5 minutes, but no more.

The general treatment course for inhalation with a nebulizer if the patient has rhinosinusitis lasts from 5 to 7 days, and depends on the type of drug used as a healing base. If necessary, at the insistence of the attending physician, the duration of therapy can be extended up to 10-15 days.

Alternative treatment at home

Non-traditional methods of treating rhinosinusitis are based on the practical application of folk recipes that have been popular among a large number of people for many centuries and have proven to be a really effective means of dealing with acute or chronic inflammation in the area of the nasal canals and paranasal sinuses. They were used when there was no medicine, in the modern sense of the word, in principle, and in the matter of treating diseases, people could rely only on their own strength. There are the following most effective ways folk treatment rhinosinusitis while at home.

Aloe juice with honey

These are natural anti-inflammatory drops, which are quite realistic to prepare yourself from improvised means. To do this, you need to take 1 leaf of an indoor aloe flower, wash it under running water, put it in a food processor or a mechanical meat grinder, and then grind it to a pulp. Having received the green mass, it must be laid out on a clean gauze folded in two layers, wrap it and squeeze the juice into the dishes prepared in advance for this. Add half a teaspoon of honey to the resulting green liquid and stir thoroughly until completely dissolved.

This home remedy is instilled into the nose in the morning and in the evening, 1 drop for 5 consecutive days. During the introduction of drops, unpleasant sensations inside the nose, itching, urge to scratch, copious secretion of mucus from the nasal canals are possible. Despite all the discomfort, the effect of aloe juice in combination with honey is very high and in its own way medicinal properties acts as an alternative to chemical antibacterial drugs. If this indoor plant does not grow in the house, then it can be replaced with Kalanchoe. This flower is no less effective.

Nasal lavage

At home, this is one of the most useful and at the same time affordable folk remedies for the treatment of rhinosinusitis. To prepare an antiseptic solution, use kitchen salt and boiled water, cooled to a temperature of 37 degrees Celsius. To make a saline solution, you will need to take 1 teaspoon of salt and dissolve it in 1 liter of warm water. After all the salt crystals are completely dissolved, salt water is poured into a metal bowl and the patient begins the procedure for washing the paranasal sinuses.

To do this, one nostril is clamped with a finger, and an antiseptic liquid is drawn in with a free nasal opening. As soon as the paranasal sinuses are completely filled, the blocked nostril is released and the patient releases a solution through it, along with which purulent mucus accumulated in the paranasal sinuses comes out, as well as a large number of bacterial microorganisms. Thus, an anti-inflammatory and antibacterial effect is achieved. At the same time, the saline solution destroys not only bacteria, but also viral and fungal microorganisms.

An alternative to table salt can be potassium permanganate (potassium permanganate), the preparation of which is not a particularly difficult task even for those people who have not previously encountered this kind of antiseptic solutions. 1-2 manganese crystals dissolve in 1 liter of warm water. It is very important that they dissolve completely, otherwise a chemical burn is possible if a small grain of this chemical substance gets on the delicate mucous membrane of the nasal canal. Subsequently, all manipulations are similar, as in the case of washing the nose with a salt-based solution.

Warming up with dry heat

In order to warm up the paranasal sinuses at home and achieve a positive therapeutic result, you need to take 3 tablespoons of kitchen salt and pour it onto the surface of a clean handkerchief. After that, a bag is formed from it by tying the corners. A handkerchief with salt is placed on a dry frying pan or battery so that it warms up to the optimum temperature. As soon as the salt reaches a sufficient temperature, the handkerchief is leaned against the surface of the face in the area where the focus of chronic inflammation is located.

The procedure is done in the morning and evening for 10-15 minutes. In acute rhinosinusitis, heating is not recommended.

Acupressure

This physiotherapeutic method of treatment is easy to perform at home, and it is based on the fact that 2 times a day the patient independently massages the wings of the nose in the upper and lower parts in order to provide additional blood flow to the epithelial tissues of the nasopharynx, with which it enters the inflammation site a greater number of cells of the immune system that ensure the fight against a pathogenic infection. Massage movements should be circular so that there is a physical opportunity to cover the entire area of the inflamed sinus.

The duration of one massage session is 15-20 minutes. To enhance the therapeutic effect in combination with massage, it is recommended to use the warming ointment Asterisk, sea buckthorn or eucalyptus oil.

Complications and consequences

Rhinosinusitis, regardless of the type and form of its origin, is a dangerous disease in terms of the high probability of developing severe complications and negative consequences for organs and tissues located in close proximity to the inflamed paranasal sinuses, as well as the nasal canals in general. This is possible if the patient ignored the symptoms of the disease for a long period of time and did not seek medical help at the clinic, or because of the incompetence of the doctor, there was an incorrectly formed course of treatment. In this case, the patient expects the following health problems:

in women who are pregnant, rhinosinusitis can provoke premature birth if the period is at the beginning of the 3rd trimester, and a miscarriage is possible in the 1st trimester (rhinosinusitis during pregnancy is still dangerous for fetal developmental pathologies);
osteomyelitis of the facial bones with untimely evacuation of pus from the paranasal sinuses;
root infection upper teeth with their destruction and loss;
the spread of pathogenic microorganisms from the tissues of the nasopharynx throughout the body along with the blood;
bacterial inflammation of the heart muscle, destruction of its valves and various heart dysfunctions;
violation of the integrity of the paranasal sinus and the ingress of purulent exudate into the cavity of the cranium, which in 89% of cases ends with meningitis of varying severity;
complete or partial loss of sensitivity to odors with irreversible consequences;
depletion of the immune system caused by the constant presence of a chronic focus of inflammation saturated with pathogenic microorganisms.

The most dangerous complication of rhinosinusitis for each patient is blood poisoning and the onset lethal outcome. These consequences are possible if a person has been ill with acute purulent rhinosinusitis for a long time, initially had a severely weakened immune system and did not take anti-inflammatory and antibacterial drugs.

Rhinosinusitis like any other inflammatory disease of the upper respiratory tract of the nasopharynx, it is better to prevent than subsequently to engage in its therapy. Therefore, it is necessary to take the following clinical guidelines disease prevention measures:

always dress according to weather conditions, wear a hat in the cold season;
harden the body with daily douche cold water, taking a contrast shower, wiping with snow and a damp towel;
do a light jog in the fresh air every day to strengthen immunity and saturate all tissues with oxygen (20-30 minutes of easy running is enough);
sleep at least 8 hours a day, avoid physical and psycho-emotional overwork;
balance your diet bad habits, eat more fresh vegetables, fruits, cereals, boiled chicken, beef, lamb, which contain a maximum of protein and a small percentage of fat.

The main preventive rule of rhinosinusitis is to control the state of one's health and timely treatment of colds and acute respiratory diseases, inflammatory processes in the tonsils and the anterior wall of the throat.

Rhinosinusitis is a complex disease in which both the infection or viruses affect the paranasal sinuses and, in fact, the mucous membranes of the nasal cavity. As a rule, the inflammatory process starts in the maxillary sinus and later passes to the main mucous protective structures.

Signs and symptoms

The main symptoms of rhinosinusitis usually include significant difficulty in breathing. Regardless of the degree and severity of the disease, the patient is also observed with localization at the base of the nose, a constant release of purulent secretion with its regular entry into the nasopharynx, as well as a general swelling of the nasal mucosa.

Other symptoms determine the main type this disease and its specific form.

The main types and forms of rhinosinusitis

The course and clinical pictures for different types of the above disease differ in particular cases:

Acute rhinosinusitis

The acute form of this type of disease is characterized by severe intoxication of the body, a rapid and vivid manifestation of the above symptoms. Within five to seven days after the onset of inflammatory processes, a person cannot lead a full life, his performance is significantly reduced, pain syndromes in the head become paroxysmal in nature.

At the same time, body temperature almost always rises, often overcoming the mark of 39 degrees Celsius. Puffiness of the mucous membranes can go beyond the organ, and spread to the eyelids and upper facial tissues. Pathogenic microflora actively reproduces and captures more and more spaces, affecting neighboring sinuses and provoking complications.

Chronic rhinosinusitis

The inflammatory process of this kind is less pronounced when compared with the previous form of rhinosinusitis, but it is longer and can often proceed in a sluggish form from twelve to thirty weeks. The main symptoms of this condition are normal temperature, a significant weakening of hearing and smell, constant moderate swelling of the mucous membranes with a strong blockade of the nasal passages, as well as a nasal voice and a mucopurulent secret released from the nose.

Pain syndromes in this case appear much less frequently, they are “smeared” and, if they occur regularly, cause a feeling of weakness and irritation.

In the chronic form of rhinosinusitis, the likelihood of getting a complication is much higher than in the case of an acute course of the disease.

Polypous rhinosinusitis

Further progression of chronic rhinosinusitis usually leads to the formation of polyps - active growth and thickening of the walls of the mucous membranes, as a result of which the swelling increases significantly in size, and vasoconstrictor drugs do not help temporarily restore normal breathing. This condition is often accompanied by stagnation in the sinuses, a large amount of purulent masses, which further activate the inflammatory processes in the body and form the basis for the development of concomitant complications, in particular deadly meningitis and tissue damage / eyeballs.

This type of rhinosinusitis can only be cured with surgical methods by mechanically removing polyps.

Allergic rhinosinusitis

The main cause of allergic rhinosinusitis and catarrhal purulent course of the disease is the effect of allergens on the body. Such allergens can be plant pollen, wool, body reactions to certain drugs, fungal spores, car smog and dust, etc.

The main symptom, directly indicating an allergic type of disease, is considered to be side rashes on the skin, a significant reddening of the membranes. eyeball, itching in the nasopharynx, abundant clear discharge from the nose. Fighting allergic rhinosinusitis with antibiotics is useless; antihistamines and isolating the person/environment from the allergen are used to effectively get rid of the problem.

Treatment of rhinosinusitis

The treatment of rhinosinusitis in adults is a complex process, including the elimination of the cause that caused the reaction, the elimination of the focus of inflammation, the reduction of symptoms, and the restoration of natural immune defenses.

Antibacterial therapy with broad-spectrum antibiotics is drugs or alternative Augmentin. The duration of such a course does not exceed ten days.
Maximum removal from the nose and sinuses, pathogenic secretions. For this, (Naphthyzinum), moisturizing and mucolytic drugs (Aquamaris), as well as means for (saline) are used.
Reducing inflammation. For this, the ENT doctor may advise corticosteroids (hydrocortisone) and antihistamines (Loratadine).
Strengthening immunity. It can be carried out both at the local level with the help of special homeopathic sprays (IRS 19), and general procedures, including normalization of nutrition, taking interferon, and regular exercise.

Treatment of the disease in children

Rhinosinusitis in children is treated in a more gentle way, excluding the use of broad-spectrum antibiotics and glucocorticosteroids. In this case, it is rational to use local steroids / antibiotics (Isofra, Bioparox, Protargol), rinse the sinuses more often with saline solutions, use Borjomi, and strengthen the child's immunity.

Only in the most extreme case, with a very advanced form of the disease and in the event of a direct danger to the life of the baby, is it necessary to use classic "adult" drugs that have strong side effects and causing serious harm to the liver, kidneys and heart of your child.

Folk remedies

Folk remedies against rhinosinusitis, of course, are not a panacea for this disease, but they can really help to recover faster in the case of complex therapy with medications.

The most popular methods "from the people" are considered to be heating the nasal septum with hot salt in a bag, inhalation and instillation into the nose. herbal preparations based on calendula, valerian, chamomile, eucalyptus and sage, as well as compresses based on tinctures of the same herbs. It should be understood that the above methods must be agreed with your doctor in order to prevent deterioration and the occurrence of concomitant diseases.

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Rhinosinusitis - what is it? The disease occurs as a result of damage to the mucous membranes of the nose and paranasal sinuses by infections or viruses. If signs of illness appear, you should immediately consult a doctor. Treatment must begin in a timely manner, otherwise the disease will move to a severe stage..

Reasons for the development of the disease

In most cases, the disease becomes a consequence of the course of acute respiratory viral infections or the common cold, in which there was no treatment or therapy was not completed to the end. The presence of inflammation in the mucous membrane is a concomitant factor, so the disease has many manifestations.

A significant place is occupied by the deformation of the side wall of the nose. These can be anomalies of the nasal concha, which manifests itself in the form of polyps in the nose, curvature of the septum and adenoids. The hypertrophic form of rhinitis leads to stagnation of the secret and a violation of the cleaning of the sinuses.

Many viral infections lead to the development of edema in the mucosa, which leads to increased secretion of the glands. There is a blockage of the sinus openings due to the large amount of mucus. The edematous state of the membrane also matters, which also contributes to clogging. Violations can occur with improper blowing of the nose. The ingress of purulent secret into the sinuses leads to increased blocking of fistulas and an increase in the viscosity of the contents.

With bacterial and fungal infections, the patient's situation is also aggravated. In the first case, the appearance of bacteria is a consequence of mucus stagnation and outflow failure. The fungal form of rhinosinusitis is a complication that occurs when antibiotics are used improperly.

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Contribute to the occurrence of the disease and the following factors:

development bronchial asthma;
the presence of an allergic type of rhinitis;
unfavorable ecological situation;
weakened immune system;
the development of chronic inflammatory processes in the sinuses of the nose - vasomotor rhinitis.

Signs of illness

With rhinosinusitis, the symptoms are mixed. Therefore, there is a need for differentiation of signs. The presence of manifestations similar to other diseases can confuse the patient, therefore, with the development of symptoms, it is necessary to visit a doctor.

Most patients develop the following symptoms:

the general nature of the malaise;
edematous condition of the paranasal sinuses and mucous membrane;
high body temperature;
headache;
a feeling of congestion in the ears;
cough may be present;
mucus is formed;
the work of smell is disturbed, and breathing is difficult.

Symptoms of pathology differ from each other due to the development of certain forms. The main feature of this factor is the duration of manifestations. The following stages of the development of the disease are distinguished:

acute rhinosinusitis, which lasts up to 1 month;
subacute type develops no more than 3 months;
the recurrent form may occur several times a year;
chronic rhinosinusitis has been observed in a patient for more than 3 months.

Types of pathology and their characteristics

Types of diseases differ in causes, stages of development and duration. There are some features in the manifestations of diseases. Acute rhinosinusitis is more common, in which the inflammatory process occurs in the nasal mucosa. However, there is a possibility of transition of the pathology to the region of the paranasal sinuses. Acute rhinosinusitis is more often a complication that occurs after colds. The following signs appear:

lack of smell and appetite;
nasality occurs;
body temperature rises;
nose is constantly stuffed up;
a headache develops;
discharge from the nose has a different color and structure.

It is necessary to take into account the typical symptoms of pathology. Often an acute type of sinusitis is formed. Occurs in the cheek area strong pain. Pain may be aggravated if the patient turns his head. Similar manifestations have an acute form of frontal sinusitis, however, painful signs are localized in the forehead. Another typical manifestation is acute sphenoiditis. The disease affects the sphenoid sinuses and is accompanied by constant pain in my head.

The acute type is divided into several stages of development. With a mild form, the signs are poorly expressed. The temperature is slightly elevated, and there is no fluid in the sinuses, which is clearly visible during the diagnosis. In the middle stage, the temperature rises, the patient has an increase in headache. When pressing on the forehead and cheeks, the patient will experience pain that can spread to the teeth. In severe form, the temperature exceeds 38, pain occurs when you press on the sinuses. The patient's face swells, and complications can be detected during x-rays.

In the chronic type, there is also a headache and discharge that becomes purulent. The patient has a nasal and unpleasant symptoms in the face. The temperature rises, the sense of smell decreases, congestion is observed constantly. The following factors exacerbate the situation:

improper elimination of the acute type of rhinosinusitis;
dental diseases;
drinking and smoking;
bad ecology;
allergic reaction;
changes in the shape of the nasal septum.

The polyposis form is more common in patients who have a weakened immune system. The following factors also influence:

viruses;
swelling of the mucosa;
exposure to allergens;
exposure to chemicals.

The development of pathology is influenced by concomitant diseases. It refers to allergic rhinitis, obstructive form of bronchitis and asthma. Treatment is complicated by the occurrence of the aspirin triad, which is characterized by the formation of nasal polyps, the appearance of aspirin intolerance, and the development of bronchial asthma. The intervention of the surgeon can lead to suffocation and exacerbation of the pathology. However, endoscopic surgery is often used as the most effective tactic for eliminating an allergic focus.

Purulent rhinosinusitis occurs as a result of penetration bacterial infection. In some cases, this leads to the development of allergies and changes in the nasal septum. To eliminate the disease, doctors prescribe antibiotics. The disease can appear with the following types:

sinusitis;
frontitis;
sphenoiditis;
ethmoiditis.

The allergic form is formed when exposed to irritating factors in the form of allergens. They may be:

fungal spores;
wool;
dust;
plant pollen;
medications;
smog.

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During the development of pathology, the patient has a variety of manifestations, which are represented by redness of the eyes and the development of a rash on the skin. In addition, clear mucus is secreted from the nasal cavity. Treatment is represented by the elimination of the focus of an allergic reaction and the use of antihistamines.

Catarrhal rhinosinusitis is formed when an infection or SARS is attached. The patient has increased lacrimation and impaired sense of smell. Appetite is absent, sleep disturbances occur. There is burning and dryness in the nasal cavity. There are manifestations of general intoxication of the body.

Therapeutic measures

Treat the disease in adults as soon as possible. Lack of intervention can lead to the development of complications or the transition of the disease to the next stage, which will be much more difficult to get rid of. It is important to find the source of the disease and eliminate it. For this purpose, diagnostic measures are carried out, which are represented by the following methods:

x-ray, which is used to determine the degree of the inflammatory process;
rhinoscopy;
ultrasonic examination to determine the level of liquid;
with the help of an endoscope, it is possible to identify all violations that are associated with the nasal septum;
CT scan;
at an exacerbation apply a puncture.

Symptoms and treatment are interconnected with each other, since the treatment tactics will depend on the manifestations of the pathology and its form. Antibiotics and local therapy are used. The task of using antibiotics is related to the need to eliminate pathogens. There are no universal means. Therefore, the choice of the drug should be carried out with the help of a specialist. It is forbidden to take medicines on your own.

To eliminate rhinosinusitis, the following groups of drugs are used:

tetracyclines;
macrolides;
cephalosporins.

The duration of medication is 5-7 days. However, the duration of therapy may vary, due to the peculiarities of the course of rhinosinusitis. This process is affected by the development of complications, the form of the disease and the stage. The dosage of the drug is prescribed by the attending physician after the diagnosis and determination of the type of pathogenic microorganisms.

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If symptoms are detected and treatment has already been started, then topical agents are used. It is necessary to clean the nasal cavity and paranasal sinuses from purulent and mucous contents. Antibiotics and other drugs cannot accomplish their task if foci for the development of bacteria and viruses remain. Therefore, the following groups of funds are assigned:

nasal drops of antibacterial action;
nasal sprays and vasoconstrictor drops;
solutions for washing the nasal cavity with antiseptic properties.

Acute, purulent, chronic and other types of inflammation require special attention to this problem. Your doctor may recommend certain medications, but you should never use medications on your own. Before using each drug, you should consult your doctor.

Preventive measures

Prevention is essential for healthy people and patients struggling with rhinosinusitis. For patients, preventive measures are needed, as they will avoid the further development of the disease and deterioration of well-being. For healthy people, such activities help to avoid the formation of the disease.

It is necessary to strengthen the immune system. To this end, you should include in the diet foods that are rich in vitamins, minerals and nutrients. Drinking alcoholic beverages should be avoided, as alcoholic beverages significantly undermine health. Smoking, which acts as a provoking factor, has a negative effect.

You need to exercise and lead an active lifestyle. It is useful to harden your body with various procedures: air, water and solar. A walk in the fresh air away from the tracks is not only a pleasant pastime, but also hardens the body. For the same reason, you should regularly ventilate the room and carry out regular cleaning. It is especially important to eliminate dust and objects that can accumulate it. If you have a predisposition to allergies, you should not have pets.

An important component of prevention in adults is represented by rest. During this process, the body restores its strength. Improper rest can disrupt human health, so you need to be careful about such activities too.

The resulting diseases associated with the nasal cavity and respiratory tract must be eliminated in a timely manner. Rhinosinusitis often occurs as a result of untreated common cold, so you should be careful about your health.

Thus, the development of rhinosinusitis must be stopped at early stage formations.

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The presence of symptoms is a reason to seek help from a doctor

It is not recommended to use a variety of means for self-treatment, since a lack of knowledge about the characteristics of drugs can lead to a negative result.

Acute rhinosinusitis is a generalized designation of the inflammatory process of the mucous membrane in any paranasal sinus. Inflammation can be localized in the maxillary sinuses (sinusitis), frontal (frontal), ethmoid (ethmoiditis), sphenoid (phenoiditis). This condition can be provoked by viruses, bacteria or fungi, and allergic rhinosinusitis is also distinguished.

Pathology can occur in acute, subacute, recurrent and chronic forms, depending on the duration. clinical symptoms. Rhinosinusitis in subacute form can persist from 1-3 months. The relapsing form of the disease is characterized by recurrence acute rhinosinusitis at least 3-4 times a year. In cases where symptoms persist for more than 3 months, chronic rhinosinusitis is diagnosed.

Symptomatic manifestations

Acute rhinosinusitis develops against the background of an untreated cold, its manifestations are delayed indefinitely, preventing a person from breathing fully. The symptoms of acute rhinosinusitis are as follows:

nasal congestion;
viscous thick discharge of various colors, from white to brown;
headache;
unilateral or bilateral facial pain, dislocating in the area of the cheeks and forehead;
increased body temperature;
reduced sense of smell;
nasty voice.

Etiology of the phenomenon

Reasons for the development of the disease:

A deviated nasal septum, polyps, adenoids interfere with the natural process of sinus cleansing, and secretion stagnates.
Viral, fungal and bacterial infections causing swelling of the mucosa and enhancing its secretion. Edematous mucosa and excess secretions block the openings of the sinuses.
Violation of the cleansing of the nasal cavity. When you blow your nose, pus can enter the sinuses, increasing the viscosity of the secretions and causing mucus to stagnate.
Weak immunity.
Unfavorable climatic conditions, bad ecology.

There are bilateral and unilateral rhinusitis. Depending on the severity of the inflammatory process, the disease is divided into:

mild course - acute catarrhal rhinosinusitis;
rhinosinusitis moderate;
and severe - purulent rhinosinusitis.

Catarrhal rhinosinusitis refers to a mild form of the disease and proceeds with signs of a common cold. There is nasal congestion, the mucous membrane swells, heaviness in the bridge of the nose, discharge from the nose may be noted. Most often, catarrhal rhinosinusitis is preceded by an untreated respiratory infection. Reduced local immunity of the nasal mucosa and polyps are also favorable factors for the development of acute catarrhal rhinosinusitis. A distinctive feature of this form of rhinosinusitis is clear discharge from the nose. Excess mucus accumulates, as a rule, in the maxillary sinuses, and an inflammatory process of the mucosa may develop. The absence of therapeutic measures will translate the catarrhal form of the disease into a chronic course of pathology.

With moderate rhinosinusitis, body temperature rises above 37ºС. Pain is noted in the cheeks and forehead, radiating to upper jaw, headache and general aggravated condition.

Severe form of acute rhinosinusitis - what is it. In the event of a complication of the disease, a severe form of pathology develops. The body temperature will rise above 38ºС, there will be severe pain in the sinuses, swelling of the face, headaches, weakness.

Acute purulent rhinosinusitis occurs due to infection epithelial tissue paranasal sinuses by viruses and bacteria. Pathology can develop as a result of inadequate treatment of an acute respiratory disease, in the presence of polyps and adenoids in the nasal cavity. A purulent process can provoke dental diseases of the upper teeth, in particular, pulpitis is able to spread the inflammatory process to the paranasal sinuses. A high probability of infection occurs with facial injuries that disrupt the normal structure of the nose. Purulent rhinosinusitis can also develop due to allergic rhinitis with an associated bacterial or viral infection. The symptoms of the disease appear severe congestion nose, disturbed breathing, high temperature body and swelling of the face. There is purulent discharge from the nose. The patient's appetite decreases, sleep is disturbed, general weakness develops, and working capacity decreases. In the absence of proper treatment, acute rhinosinusitis acquires a chronic course. Purulent sinusitis is treated with antibacterial and antiviral drugs.

In cases where the inflammatory process does not subside within 12 weeks, we are talking about a chronic form of rhinosinusitis. The chronic form of the disease occurs with constant nasal congestion, a nasal voice, a weakened sense of smell and mucopurulent discharge. There is a cough that occurs when pus drains into the throat. Due to nasal congestion, nasal breathing is disturbed, lack of oxygen causes headaches, general weakness.

Diagnosis of acute rhinosinusitis

The purpose of diagnosis is to confirm the presence of rhinosinusitis and clarify the form of the disease. Treatment tactics will depend on the severity of the pathology. Acute rhinosinusitis is diagnosed by anterior rhinoscopy. The method helps to identify typical signs of purulent rhinosinusitis, pus can be found in the middle, upper nasal passage, nasopharynx.

An endoscopy is performed, which examines the condition of the inner surface of the nose from different angles and under magnification. Endoscopy allows you to detect polyps, adenoids, tumors, altered structure of the mucous membrane.

Diaphonoscopy is performed to examine the nose and paranasal sinuses. The method is based on different throughput, diseased walls transmit light worse. Ultrasonography used to diagnose inflammation and cysts in the maxillary and frontal sinuses. Radiography is carried out in the naso-chin projection, the state of the frontal and sphenoid sinuses is clarified.

Computed tomography is recognized as the most informative study of the paranasal sinuses and is called the "gold standard". The method establishes the type and prevalence of pathological changes, reveals structural features of the nasal cavities and sinuses. Computed tomography visualizes structures that are not defined by radiography.

Diagnostic puncture and probing is carried out in order to determine the volume and nature of the contents of the inflamed sinus, the patency of natural openings. A bacteriological study is carried out to determine the sensitivity of the causative agent of the disease to antibiotics.

Treatment of the disease

Treatment of acute rhinosinusitis will largely depend on the forms of the disease. Antibacterial therapy prescribed when bacteria are detected, with a viral etiology of the inflammatory process, taking antibiotics will be a mistake.

How to treat the catarrhal form of pathology? Symptoms of catarrhal rhinosinusitis are eliminated by antiviral and antihistamine drugs. The use of nasal vasodilator drops is recommended for profuse and watery discharge. Tonic and immunomodulatory agents, vitamins and minerals are prescribed. The patient will need to rinse the nasal cavity with saline solutions and consume more hot liquids. Catarrhal rhinosinusitis is well cured folk remedies.

Taking vasodilators will help reduce swelling and free up the natural ducts. Long-term use of such drugs is not recommended, the maximum use is no more than 10 days. Drugs can be substituted on the recommendation of the attending physician.

For local treatment rinsing of the nasal cavity with antiseptic solutions, agents with antiviral properties, saline solutions is used. The intake of mucolytic and secretolytic agents will restore the natural balance between the production of mucus and its removal from the nasal cavity.

If necessary, antipyretic and analgesic drugs are prescribed. Immunomodulating agents are prescribed to speed up the healing process.

The puncture of the inflamed sinuses is carried out as a diagnostic and therapeutic measure. The procedure accelerates the evacuation of pathogenic contents, after which it is necessary to carry out antibacterial and antiseptic treatment.

In cases of diagnosing frontitis or ethmoiditis, catheter hardware washing is used. A probe is inserted into the paranasal sinuses and pus is washed out under the pressure of an antiseptic solution. After thorough washing, a drug is injected into the sinuses.

As an alternative to a puncture, a non-puncture method of treatment using a YAMIK catheter can be used. The procedure is performed under local anesthesia, a catheter is inserted into the lower part of the nasal canal and a vacuum is created. The pus is then sucked out with a syringe. For the treatment of purulent rhinosinusitis, 3-6 procedures are required.

Surgical treatment may be required for growing polyps. Currently, using endoscopic equipment, polyps are removed endonasally, without incisions. Endoscopic surgery is performed with millimeter precision and minimally injures healthy tissues. By removing polyps in the nasal cavity, the surgeon can correct the deviated nasal septum and free the sinus fistula. In the postoperative period, it is necessary to observe the hygiene of the nasal cavity, blowing your nose and eating hot food is prohibited. Nasal lavage with medicinal solutions, antihistamines, hormonal sprays are prescribed.

ethnoscience

As an adjunct to the treatment of rhinosinusitis, folk recipes. Nasal drops can be obtained by mixing vegetable oil with 20% propolis tincture in a 1:1 ratio. Drip one drop into each nostril. kalanchoe juice, sea buckthorn oil also used against the common cold.

Prevention of acute rhinosinusitis is the timely and adequate treatment of colds, infectious rhinitis and SARS. Hypothermia should be avoided and drafts should be avoided. Engage in physical education and hardening, walk more in the fresh air and actively relax. Strengthen the immune system, regularly take mineral and vitamin complexes. It is recommended to use the humidifier in dry climates and during the winter heating season. Rinse your nose regularly with saline solutions, especially during a flu epidemic.

Nasal congestion.
Viscous thick discharge from the nose of white, yellow, green, brownish color.
Headache.
Facial pain or a feeling of heaviness, most often in the cheeks or forehead, may be unilateral, aggravated by tilting the head forward.
Increase in body temperature.
Drainage of mucus down the back of the throat.
Decreased sense of smell.
Nasty voice.

Different forms of acute rhinosinusitis are characterized by different most typical symptoms:

in acute sinusitis (inflammation of the maxillary sinuses), there is pain and heaviness in the cheeks (or one cheek), which increases when the head is tilted down;
with acute frontal sinusitis (inflammation of the frontal sinuses), there is pain and heaviness in the frontal region, which increases when the head is tilted down;
acute ethmoiditis (inflammation of the ethmoid sinuses) is characterized by nasality;
acute sphenoiditis (inflammation of the sphenoid sinuses) is characterized by a constant dull headache.

Forms

According to localization, they distinguish:

acute maxillary sinusitis (sinusitis) - inflammation of the maxillary (maxillary) sinuses;
acute frontal (frontal) sinusitis (frontal sinusitis) - inflammation of the frontal sinuses;
acute ethmoid sinusitis (ethmoiditis) - inflammation of the ethmoid sinuses;
Acute sphenoidal sinusitis (sphenoiditis) is an inflammation of the sphenoid sinuses.

Often different paranasal sinuses are involved in the inflammatory process:

acute maxillary ethmoiditis (inflammation of the maxillary and ethmoid sinuses);
acute hemisinusitis (inflammation of all sinuses on one side);
acute polysinusitis (inflammation of several different sinuses from different sides, for example, the right maxillary, left maxillary and frontal);
acute pansinusitis (inflammation of all paranasal sinuses).

All forms of acute rhinosinusitis can be unilateral (inflammation in the sinuses on one side) or bilateral (inflammation on both sides).

Depending on the degree of inflammation, the first and second stages of the disease are distinguished.

The first stage is acute catarrhal rhinosinusitis.
- With a runny nose, inflammation from the nasal cavity passes into the paranasal sinuses on the 2nd-3rd day of illness, which is manifested by swelling of the mucous membrane in them.
- Clinically, usually catarrhal rhinosinusitis does not differ from the common cold (nasal congestion, discharge from the nose, sometimes there is a slight heaviness in the nose or face).
- This stage may end in recovery or move to the second stage.
The second stage is acute purulent rhinosinusitis. Bacterial inflammation in the sinuses and swelling of the mucous membrane in the fistulas (holes connecting the sinus cavity with the nasal cavity) leads to the accumulation of pus in the paranasal sinuses, which is manifested by a deterioration in general well-being, an increase in body temperature, and headache or facial pain.

According to the severity are distinguished:

mild form - body temperature is not higher than 37.5 o C, the symptoms are moderately expressed, the general condition is satisfactory; on the x-ray of the paranasal sinuses, the level of fluid is absent;
moderate form - body temperature over 37.5 o C, pain when pressing on the cheeks and forehead, headache, pain can be given to the teeth, ears, deterioration in general well-being; on the radiograph of the paranasal sinuses - complete blackout or fluid level, no complications;
severe form - body temperature over 38 o C, severe pain on palpation in the projection of the sinus, swelling in the cheek or eye (reactive phenomena), headache, severe weakness; on the radiograph of the paranasal sinuses - complete blackout or fluid level; the presence of complications or suspicion of them.

Causes

Acute rhinosinusitis, as a rule, develops when a bacterial infection is attached to SARS. Predisposing factors are:
- anatomical features of the nose that prevent free cleansing of the sinuses (for example, curvature of the nasal septum, etc.);
- reduced immunity;
- Availability chronic diseases(reduce the overall resistance of the body);
- the presence of allergies.
Acute sinusitis can develop after dental procedures, since the lower wall of the maxillary (maxillary) sinus borders on the upper dentition. Such sinusitis is called odontogenic.

Diagnostics

Analysis of complaints and anamnesis of the disease: does the patient notice nasal congestion, thick discharge from the nose, headache or facial pain, aggravated by tilting the head forward, nasal, fever; how long ago the complaints appeared; whether the present complaints were preceded by an episode of a cold, runny nose; whether the patient has been treated by a dentist in recent days.
General examination: Feeling and tapping the cheeks and forehead may be painful. Swelling in the cheek or eye area indicates severe sinusitis and is an indication for hospitalization.
Examination of the nose (rhinoscopy): the nasal mucosa is red, edematous, in the nasal passages, mucous or purulent discharge.
Endoscopic examination of the nose allows you to examine individual areas in more detail, in some cases it helps to make a diagnosis without resorting to x-rays.
- So the detection of pus in the middle nasal passage indicates purulent sinusitis (inflammation of the maxillary sinus), frontal sinusitis (inflammation of the frontal sinus) or anterior ethmoiditis (inflammation of the anterior cells of the ethmoid sinus); in the upper nasal passage - about posterior ethmoiditis (inflammation of the posterior cells of the ethmoid sinus) or sphenoiditis (inflammation of the sphenoid sinus).
X-ray examination: allows you to assess the presence of a pathological process in the maxillary and frontal sinuses (which is manifested by darkening in the corresponding sinus on the x-ray). By the form of blackout, in many cases it is possible to differentiate catarrhal sinusitis from purulent (with purulent, the level of fluid is determined). Assessment of the state of the ethmoid and sphenoid sinuses by X-ray in most cases is difficult.
Often, according to x-ray data, it is impossible to determine due to which the sinus is darkened, especially with doubtful clinical picture. In these cases, they resort to a diagnostic puncture of the maxillary sinus: a special thin needle under local anesthesia pierces the wall of the maxillary sinus in the nose, in the place where it is the thinnest. Then, using a syringe, the contents of the sinus are drawn out. Upon receipt of pus, the sinus is washed and a medicinal substance is injected into it.
An ultrasound of the paranasal sinuses is sometimes used as an alternative to x-rays.
To confirm the diagnosis of acute sphenoiditis, in doubtful cases, CT (computed tomography) of the paranasal sinuses is performed.
Upon receipt of the contents from the sinuses (as a result of a puncture or YAMIK procedure - non-puncture vacuum pumping of pus from the sinuses), it can be sown to determine the causative agent of infection and sensitivity to antibiotics. This information can be useful if the prescribed treatment fails for several days or if you have recurrent (recurring) sinusitis.

Treatment of acute rhinosinusitis

Medical treatment:

vasoconstrictor drops and nasal sprays in a short course (5-7 days) - relieve swelling of the mucous membrane, improve the outflow of contents from the sinuses, facilitate the entry of oxygen into the sinuses;
nasal sprays with antibiotics and steroid hormones;
systemic antibiotics are indicated for purulent sinusitis, especially in moderate and severe forms. Prescribe amoxicillin;
non-steroidal anti-inflammatory drugs;
mucolytics - drugs that thin the contents of the sinuses;
herbal preparations with complex action (anti-inflammatory, immunomodulatory, mucolytic).

Non-drug treatment.

Punctures (puncture) of the maxillary sinuses. To do this, a special thin needle under local anesthesia pierces the wall of the maxillary sinus in the nose, in the place where it is the thinnest.
- The sinus is washed with an antiseptic solution and a medicinal substance is injected into it.
- The advantage of this method is the possibility of rapid evacuation of purulent contents (which leads to a decrease in headache and facial pain, an improvement in general condition), targeted administration of various drugs into the sinus.
- The disadvantage is the need for repeated repetition of the procedure in the presence of a purulent process (until the final cleansing of the sinus), psychological stress for the patient, the possibility of complications in the atypical structure of the sinus (rarely), access only to the maxillary sinus.
- Contrary to popular belief, a puncture (puncture) of the maxillary sinus does not lead to the development of chronic sinusitis and the need to constantly be treated with punctures.
- A hole after a puncture with a diameter of 1-2 mm overgrows in a few days without any consequences.
- Puncture of the maxillary sinus is the method of choice for:
  - odontogenic sinusitis (caused by the pathology of the teeth of the upper jaw);
  - severe facial pain in the projection of the maxillary sinus;
  - the presence of a clear level of fluid in the maxillary sinus on the x-ray and the absence of inflammation in other sinuses.
- Carrying out punctures of the maxillary sinuses in many cases allows you to do without the appointment of antibiotics.

In order not to carry out repeated punctures, in some cases, drainage is installed at the site of the first puncture - a thin rubber tube through which further lavages are performed. Prolonged installation of drainage adversely affects the mucous membrane.
Punctures of the frontal sinuses (trepanopuncture) are carried out according to strict indications in a hospital with a severe course of the disease and treatment failure. The sinus is pierced from the side of the forehead.
YAMIK catheter is a non-puncture method of sinusitis treatment, an alternative to punctures. Under local anesthesia, a rubber catheter is inserted into the nose, in which 2 balloons are inflated: in the nasopharynx and in the nostril area.
- Thus, the nasal cavity is hermetically sealed, after which the contents of the sinuses are aspirated through a separate channel with a syringe, and then the medicine is injected there.
- The advantage is the non-invasiveness of the procedure (the integrity of the mucous membrane is not violated), access to all paranasal sinuses at once (not only to the maxillary one).
- Disadvantages - the inability to evacuate all the contents from the sinuses, the need for several repeated procedures (as in the case of punctures), the absence of catheters in many medical institutions.
Rinsing the nose with saline or antiseptics:
- independently at home with the help of special devices for nasal douche, sprays or douches;
- in the conditions of an ENT cabinet, the nose and paranasal sinuses are washed by the method of moving drugs (the popular name for the method is “cuckoo”).
  - A solution is poured into one nostril of the patient, the contents are aspirated from the other nostril with suction, while the patient repeats “cuckoo” so that the solution does not enter the oropharynx.
  - The procedure is absolutely painless and non-invasive, but much less effective than puncture and YAMIK.

Physiotherapy (treatment with the help of natural and artificially created physical factors) is prescribed at the stage of recovery, with a good outflow of contents from the sinuses.

Surgery: performed in the presence of orbital (ocular) and intracranial complications.

Complications and consequences

With untimely and inadequate treatment, the following are possible:

the transition of the process into a chronic form;
the transition of inflammation to the soft tissues of the face;
the spread of inflammation to the respiratory tract - bronchi (bronchitis) and lungs (pneumonia), as well as ears (otitis media);
orbital (eye) complications: the purulent process spreads to the tissues of the orbit, which leads to its purulent inflammation, the formation of abscesses in it. May cause permanent vision loss;
intracranial complications: abscess (a cavity filled with pus) of the brain, meningitis (inflammation of the meninges), osteomyelitis (inflammation of the bones of the skull), encephalitis (inflammation of the brain tissue);
thrombosis of the cavernous sinus (a cavity in the dura mater in which venous blood collects). In this case, there is a severe headache, exophthalmos (bulging eyes), convulsions, coma (lack of consciousness) and other severe disorders of the nervous system;
sepsis - the spread of infection throughout the body through the bloodstream;
risk of death.

Additionally

The paranasal sinuses are air-filled cavities in the bones of the skull, lined with a mucous membrane and communicating with the nasal cavity through small openings - anastomoses.

The following pairs (right and left) of the paranasal sinuses are distinguished:

maxillary (maxillary) - located in the maxillary bones. Their front wall corresponds to the upper part of the cheek;
frontal (frontal) - located in the frontal bone, in the central part of the forehead, above the bridge of the nose;
ethmoid (ethmoid) - consist of separate air cells connected to each other, which are divided into anterior ethmoid and posterior ethmoid cells located in the depth of the nose;
sphenoid (sphenoidal) - located in the sphenoid bone, the deepest paranasal sinuses, their back wall borders on the cranial cavity and the brain.