Chronic Sinusitis

Chronic inflammations of the paranasal sinuses are divided as well as acute ones into the anterior (craniofacial) and posterior (etmoidosphenoid) chronic sinusitis.

In the overwhelming majority of cases, chronic sinusitis is a secondary process, arising as a result of repeatedly recurring acute sinusitis, whose treatment has not been completed for a number of reasons and has not achieved a positive result; either existing endo- and exogenous factors (congenital or post-traumatic deformations of endonasal anatomical formations, chronic foci of infection, immunodeficiency states, harmful climatic and industrial conditions, bad habits, etc.) prevent the achievement of a therapeutic effect. Chronic sinusitis is characterized by a protracted, often relapsing clinical course, and in most cases manifested by productive pathomorphological forms. It is generally believed that the diagnosis of chronic sinusitis can be definitively delivered 2-3 months after the onset of acute sinusitis, provided that the latter recurs at two or three times during this time. As shown by special morphological studies, it is this time, with the continuing flaccid flow of the inflammatory process, that in the mucosa, periosteum and even bone tissue there are deep alterative changes, often irreversible, which serve as the pathomorphological basis of chronic inflammation.

According to AS Kiselev (2000), the variety of pathomorphological changes in chronic sinusitis determines "the diversity of clinical and morphological forms and the difficulty of their classification." Among the numerous pathomorphological classifications, the "classical" classification of B.S. Preobrazhensky (1956) has been cited, and we will dwell on the classification of M.Lazeanu (1964), which most adequately reflects the classifications accepted in Western European literature.

Classification of chronic sinusitis

• Exudative forms:
  • catarrhal;
  • serous;
  • purulent.
• Productive forms:
  • pristenochno-hyperplastic;
  • polyposis.
• Necrotic (alterative) form.
• Cholesteatom form.
• Allergic form.
• Atrophic (residual) form.

In fact, this classification, like any other, delineating the main pathomorphological stages of a progressive pathological process, pursues didactic goals. In reality, in a real clinical excess, many of these forms are combined in one pathological process at different sites of the pathomorphological substrate.