Chronic frontitis

Chronic frontal sinusitis (chronic inflammation of the frontal sinus, frontitis chronica) is a long-term frontal sinusitis, manifested by periodic pain in the corresponding half of the forehead and nasal discharge, hyperplasia of the mucous membrane with the development of polyps and granulation.

ICD-10 code

J32.1 Chronic frontal sinusitis.

Epidemiology of chronic frontal sinusitis

There are clear indications of a connection between frontal sinusitis and atmospheric pollution by toxic waste and violation of environmental standards. In areas where large industrial enterprises are located, the incidence of frontal sinusitis is significantly higher.

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Cause of chronic frontal sinusitis

The causative agents of the disease are most often representatives of coccal microflora, in particular staphylococci. In recent years, there have been reports on the isolation and quality of causative agents of the association of three opportunistic microorganisms: Haemophilus influenzae, Streptococcus pneumoniae and Maxarelae catharrhalis. Some clinicians do not exclude anaerobes and fungi from this list.

Chronic Frontitis - Causes and Pathogenesis

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Symptoms of chronic frontal sinusitis

Frontitis is a disease of the whole organism, therefore it has general and local clinical manifestations. General manifestations include hyperthermia as a manifestation of intoxication and diffuse headache as a consequence of impaired cerebral blood and cerebrospinal fluid circulation. General weakness, dizziness and other vegetative disorders are often noted. Local clinical manifestations are represented by local headache, nasal discharge, difficulty in nasal breathing.

The leading and earliest clinical sign of frontal sinusitis is a local spontaneous headache in the superciliary region on the side of the affected frontal sinus; in chronic cases, it has a diffuse character.

Chronic Frontal Sinusitis - Symptoms

Classification of chronic frontal sinusitis

There are catarrhal, purulent, polypous, polypous-purulent and complicated chronic frontal sinusitis.

1. Pneumosinus of the frontal sinus, caused by the presence of a valve mechanism, in which air can enter the sinus cavity, but cannot exit it. In this case, inflammatory phenomena are usually absent, but increased pressure in the sinus occurs, accompanied by pain syndrome.
2. Chronic closed (often latent) and open (with manifestations) forms of frontal sinusitis.
3. Etiological types of microbiota: common microbiota, anaerobic, specific, mycotic.
4. Pathogenetic forms: rhinitis, allergic, traumatic, etc.
5. Pathomorphological forms: chronic catarrhal (vacuum sinus type) or transudative form, polypous, cystic, exudative, purulent, caseous, osteoiscrotic, hyperplastic, mixed forms.
6. Symptomatic forms: latent oligosymptomatic, neuralgic secretory, anosmic.
7. Age-related forms: frontal sinusitis in children, adults, and the elderly.
8. Complicated forms with damage to the eyelids, lacrimal ducts, deep cellulitis and orbital phlegmon, thrombophlebitis of the longitudinal and cavernous sinuses, meningitis, frontal lobe abscess, etc.

This classification, like many described earlier, does not claim to be a holistic scientific approach, but reflects only the diversity of aspects and positions from which inflammatory processes in the paranasal sinuses can be considered, and therefore is of an exclusively didactic nature.

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Diagnosis of chronic frontal sinusitis

At the stage of assessing the anamnesis, it is important to collect information about previous diseases, acute respiratory viral infections, sinusitis and exacerbations of frontal sinusitis, and treatment features, including surgery.

Among the complaints, one can immediately highlight the local headache typical for frontal sinusitis, pain in the area of the eyebrows, specify its nature and intensity, the side of the lesion, the presence of irradiation to the temple or crown; the appearance and consistency of the discharge, the time and features of its entry into the nasal cavity or nasopharynx

Chronic Frontal Sinusitis - Diagnosis

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Screening

Diaphanoscopy of the frontal sinuses could become a method for mass non-invasive examination of a large number of people.

Treatment of chronic frontal sinusitis

Until the results of the microbiological examination of the discharge are obtained, amoxicillin + clavulanic acid are prescribed, after which - targeted antibiotics are prescribed. If there is no discharge from the sinus or it cannot be obtained, the previously started treatment is continued. Fenspiride can be used as a drug of choice in complex anti-inflammatory therapy. Vasoconstrictor nasal drops (decongestants) are prescribed, at the beginning of treatment - a mild vasoconstrictor (ephedrine solution, dimethindene in combination with phenylephrine). In the absence of discharge, decongestant therapy is recommended (furosemide, intravenous administration of 200 ml of 1% calcium chloride solution), the use of antihistamines.

Chronic Frontitis - Treatment