Chronic sinusitis

Chronic inflammation of the paranasal sinuses is divided in the same way as acute inflammation, into anterior (craniofacial) and posterior (ethmoidosphenoidal) chronic sinusitis.

In the vast majority of cases, chronic sinusitis is a secondary process that occurs as a result of repeated acute sinusitis, the treatment of which for a number of reasons was not completed and did not achieve a positive result; or existing endo- and exogenous factors (congenital or post-traumatic deformations of endonasal anatomical structures, 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 recurrent clinical course, and in most cases manifested by productive pathomorphological forms. It is generally accepted that the diagnosis of chronic sinusitis can be finally made 2-3 months after the onset of acute sinusitis, provided that the latter relapses two or three times during this time. As special morphological studies have shown, this is precisely the time during which the sluggish course of the inflammatory process continues, which is sufficient for deep alterative changes, often irreversible, to occur in the mucous membrane, periosteum and even bone tissue, which serve as the pathomorphological basis for chronic inflammation.

According to A.S. Kiselev (2000), the diversity of pathomorphological changes in chronic sinusitis determines the “diversity of clinical and morphological forms and the difficulties of their classification.” Among the numerous pathomorphological classifications, the “classical” classification of B.S. Preobrazhensky (1956) is given, and we will dwell in more detail on the classification of M. Lazeanu (1964), which most adequately reflects the classifications accepted in Western European literature.

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Classification of chronic sinusitis

• Exudative forms:
  • catarrhal;
  • serous;
  • purulent.
• Productive forms:
  • parietal hyperplastic;
  • polypous.
• Necrotic (alternative) form.
• Cholesteatoma form.
• Allergic form.
• Atrophic (residual) form.

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

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