Bronchitis from sinus infection. Bronchitis and Sinus Infections: Causes, Symptoms, and Effective Treatments

19.12.201810.04.2021 by alexxlab

What are the main types of bronchitis. How do sinus infections relate to bronchitis. What are the most effective treatments for bronchitis and sinus infections. How can you differentiate between acute and chronic bronchitis. What self-care methods can alleviate sinus congestion and bronchitis symptoms.

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Understanding Bronchitis: Acute vs. Chronic

Bronchitis is an inflammatory condition affecting the bronchial tubes, the vital airways that transport air to and from the lungs. This inflammation leads to a range of symptoms, with coughing being the most prominent. But what distinguishes the two main types of bronchitis?

Acute Bronchitis

Acute bronchitis is a short-term condition, typically lasting a few weeks. It’s often caused by the same viruses responsible for colds and flu. The infection usually begins in the nose, throat, or sinuses before spreading to the airways.

Duration: Usually resolves within several days to a few weeks
Common causes: Viral infections, rarely bacterial
Key symptoms: Cough (often with mucus), shortness of breath, wheezing, low fever

Chronic Bronchitis

Chronic bronchitis is a long-term condition and a type of chronic obstructive pulmonary disease (COPD). It’s characterized by persistent inflammation of the bronchi, leading to excessive mucus production.

Duration: Persistent, lasting at least three months in two consecutive years
Common causes: Long-term exposure to irritants, especially tobacco smoke
Key symptoms: Persistent cough with mucus, difficulty breathing, frequent respiratory infections

The Connection Between Sinus Infections and Bronchitis

Sinus infections and bronchitis often go hand in hand, with one condition potentially leading to or exacerbating the other. How does this relationship work?

Sinus infections, or sinusitis, occur when the nasal passages become inflamed and swollen. This inflammation can lead to increased mucus production and postnasal drip, where excess mucus flows down the back of the throat. When this mucus reaches the bronchial tubes, it can irritate them, potentially triggering bronchitis.

Conversely, the coughing associated with bronchitis can increase pressure in the sinuses, potentially worsening or even causing a sinus infection. This interconnection highlights the importance of treating both conditions comprehensively.

Recognizing the Symptoms: Bronchitis and Sinus Infections

Identifying the symptoms of bronchitis and sinus infections is crucial for proper diagnosis and treatment. While some symptoms overlap, each condition has its unique characteristics.

Bronchitis Symptoms

Persistent cough, often producing mucus
Shortness of breath or wheezing
Chest discomfort or tightness
Low-grade fever
Fatigue

Sinus Infection Symptoms

Facial pain or pressure
Nasal congestion and discharge
Reduced sense of smell
Headache
Fever
Fatigue

Is it possible to have both conditions simultaneously? Indeed, it’s not uncommon for individuals to experience both bronchitis and sinusitis concurrently, especially during respiratory infections. This dual occurrence can exacerbate symptoms and prolong recovery time.

Effective Treatment Strategies for Bronchitis and Sinus Infections

Treatment approaches for bronchitis and sinus infections vary depending on the cause, severity, and duration of the condition. However, many strategies can be effective for both ailments.

Self-Care Methods

Self-care plays a crucial role in managing both bronchitis and sinus infections. These methods can provide relief and support the body’s natural healing processes:

Rest and hydration: Allowing the body to recover and thinning mucus
Steam inhalation: Helping to loosen mucus and soothe irritated airways
Nasal irrigation: Flushing out nasal passages to remove excess mucus and irritants
Humidifiers: Adding moisture to the air to ease breathing and thin mucus
Over-the-counter pain relievers: Reducing fever and alleviating discomfort

Medical Interventions

When self-care isn’t sufficient, medical treatments may be necessary:

Antibiotics: Prescribed for bacterial infections, though most cases of acute bronchitis and sinusitis are viral
Bronchodilators: Inhaled medications to open airways in cases of bronchitis
Corticosteroids: To reduce inflammation in both conditions
Mucolytics: Medications to thin mucus, making it easier to expel

When should you seek medical attention for bronchitis or a sinus infection? If symptoms persist for more than 10-14 days, worsen significantly, or are accompanied by high fever or difficulty breathing, it’s crucial to consult a healthcare provider.

Prevention Strategies: Reducing the Risk of Bronchitis and Sinus Infections

While it’s not always possible to prevent bronchitis and sinus infections, several strategies can significantly reduce your risk:

Practice good hygiene: Wash hands frequently and avoid touching your face
Avoid irritants: Stay away from smoke, strong fumes, and pollutants
Strengthen your immune system: Maintain a healthy diet, exercise regularly, and get adequate sleep
Stay hydrated: Drink plenty of water to keep mucus thin and easier to expel
Use a humidifier: Keep the air in your home moist, especially during dry seasons
Get vaccinated: Annual flu shots can help prevent viral infections that may lead to bronchitis

Can lifestyle changes impact the frequency of bronchitis and sinus infections? Absolutely. Quitting smoking, reducing alcohol consumption, and managing stress can all contribute to better respiratory health and a reduced likelihood of these conditions.

Chronic Conditions: When to Consider Specialized Care

While most cases of bronchitis and sinus infections are acute and resolve with time and proper care, some individuals may experience chronic forms of these conditions. Chronic sinusitis, for instance, is defined as inflammation of the sinuses lasting more than 12 weeks despite treatment attempts.

Similarly, chronic bronchitis, a form of COPD, is characterized by a persistent cough with mucus production lasting at least three months a year for two consecutive years. In these cases, specialized care may be necessary.

When to Seek Specialist Care

Symptoms persist despite treatment
Frequent recurrence of acute episodes
Development of complications
Significant impact on quality of life

What types of specialists might be involved in treating chronic respiratory conditions? Pulmonologists specialize in lung diseases and may be consulted for chronic bronchitis. Otolaryngologists (ENT doctors) often treat chronic sinus conditions. In some cases, allergists may also be involved, especially if allergies are contributing to the chronic inflammation.

The Role of Allergies in Bronchitis and Sinus Infections

Allergies can play a significant role in the development and exacerbation of both bronchitis and sinus infections. When allergens trigger an immune response, it can lead to inflammation in the respiratory tract, making it more susceptible to infections.

Allergy-Related Respiratory Issues

Increased mucus production
Swelling of nasal passages
Irritation of bronchial tubes
Weakened immune response in the respiratory system

How can managing allergies help prevent bronchitis and sinus infections? By controlling allergies through medications, immunotherapy, or avoiding triggers, you can reduce inflammation in your respiratory system. This, in turn, can lower your risk of developing infections and may help prevent the progression to chronic conditions.

Emerging Treatments and Research in Respiratory Health

The field of respiratory health is constantly evolving, with new treatments and preventive strategies emerging. Researchers are exploring various avenues to improve the management of bronchitis and sinus infections, as well as their chronic counterparts.

Promising Areas of Research

Targeted antibiotic therapies
Novel anti-inflammatory agents
Immunomodulatory treatments
Microbiome-based interventions
Advanced diagnostic tools for early detection

What potential breakthroughs might we see in the treatment of respiratory conditions? While it’s difficult to predict specific outcomes, areas such as personalized medicine, based on an individual’s genetic makeup and specific pathogens involved, show promise. Additionally, research into the lung and sinus microbiomes may lead to probiotic therapies that could help maintain respiratory health and prevent infections.

As our understanding of respiratory health continues to grow, so too will our ability to effectively prevent, diagnose, and treat conditions like bronchitis and sinus infections. By staying informed about these developments and working closely with healthcare providers, individuals can take proactive steps to maintain optimal respiratory health and quality of life.

Sinus Infection & Bronchitis – South County Internal Medicine

SELF CARE

Try the following steps to reduce congestion in your sinuses:

Apply a warm, moist washcloth to your face several times a day.
Drink plenty of fluids to thin the mucus.
Inhale steam 2 – 4 times per day (for example, while sitting in the bathroom with the shower running).
Spray with nasal saline several times per day.
Use a humidifier.
Use a Neti pot to flush the sinuses.

Be careful with use of over-the-counter spray nasal decongestants. They may help at first, but using them for more than 3 – 5 days can make nasal stuffiness worse.

To help ease sinus pain or pressure:

Avoid flying when you are congested.
Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
Try acetaminophen or ibuprofen.

MEDICINE AND OTHER TREATMENTS

Most of the time, antibiotics are NOT needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time it takes for the infection to go away. Antibiotics may be prescribed sooner for:

Children with nasal discharge, possibly with a cough, that is not getting better after 2 – 3 weeks
Fever higher than 102.2° Fahrenheit (39° Celsius)
Headache or pain in the face
Severe swelling around the eyes

Acute sinusitis should be treated for 10 – 14 days. Chronic sinusitis should be treated for 3 – 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

At some point, your doctor will consider:

Other prescription medicines
More testing
Referral to an ear, nose, and throat (ENT) or allergy specialist

Other treatments for sinusitis include:

Allergy shots (immunotherapy) to help prevent the disease from returning
Avoiding allergy triggers
Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be needed. You mayo consider this procedure if:

Your symptoms do not go away after 3 months of treatment.
You have more than two or three episodes of acute sinusitis each year.

Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

Bronchitis

Source: U.S. National Library of Medicine

Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness. There are two main types of bronchitis: acute and chronic.

Most cases of acute bronchitis get better within several days. But your cough can last for several weeks after the infection is gone.

The same viruses that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when people cough, or though physical contact (for example, on unwashed hands). Being exposed to tobacco smoke, air pollution, dusts, vapors, and fumes can also cause acute bronchitis. Less often, bacteria can also cause acute bronchitis.

To diagnose acute bronchitis, your health care provider will ask about your symptoms and listen to your breathing. You may also have other tests.

Treatments include rest, fluids, and aspirin (for adults) or acetaminophen to treat fever. A humidifier or steam can also help. You may need inhaled medicine to open your airways if you are wheezing. Antibiotics won’t help if the cause is viral. You may get antibiotics if the cause is bacterial.

Bronchitis | Johns Hopkins Medicine

What is bronchitis?

Bronchitis is an inflammation of the main air passages (bronchi) to the lungs. Coughing often brings up yellow or greenish mucus. There are two main types of bronchitis: acute and chronic. Acute bronchitis, often caused by the same viruses that cause colds, usually starts as a sore throat, runny nose or sinus infection, then spreads to your airways. It can cause a lingering dry cough, but it usually goes away on its own. In chronic bronchitis, a type of chronic obstructive pulmonary disease (COPD), the inflamed bronchi produce a lot of mucus, leading to cough and difficulty getting air in and out of the lungs.

Symptoms

Symptoms of acute bronchitis include:

Cough
Shortness of breath
Wheezing
“Rattle” sensation in chest
General ill feeling, or malaise
Slight fever
Tickle feeling in back of throat that leads to soreness
Chest pain, soreness, and tightness in the chest
Poor sleep
Chills (uncommon)

Symptoms of chronic bronchitis include:

Cough that produces mucus (sputum), which may be blood streaked
Shortness of breath aggravated by exertion or mild activity
Frequent respiratory infections that worsen symptoms
Wheezing
Fatigue
Headaches

Diagnosis

Tests to diagnose acute and chronic bronchitis include:

Treatment for Acute Bronchitis

Antibiotics usually aren’t helpful because acute bronchitis is almost always caused by a virus, which will not respond to antibiotics. Antibiotics are usually only needed if your doctor diagnoses you with whooping cough or pneumonia.
Medications called bronchodilators are used to open tight air passages in the lungs. Your doctor may prescribe this type of medicine if you are wheezing.
Decongestants may also help relieve symptoms of bronchitis. Medications that loosen mucus can also be prescribed, but how well they work remains uncertain.
Your doctor will tell you to drink more fluids to help thin mucus in the lungs, rest and soothe your airways by increasing humidity in the air with a cool mist humidifier.

Symptoms will usually go away within seven to 14 days if you don’t have chronic pulmonary disease. However, in some people it may take much longer for the cough to go away.

Treatment for Chronic Bronchitis

There is no cure for chronic bronchitis. Treatments to relieve symptoms and prevent complications include:

Inhaled medications that dilate (widen) the airways and decrease inflammation may help reduce symptoms such as wheezing.
Antibiotics to fight infections
Corticosteroids may occasionally be used during flare-ups of wheezing or in people with severe bronchitis that does not respond to other treatments.
Oxygen therapy may be needed in severe cases.

Treatment will help symptoms, but chronic bronchitis is a long-term condition that keeps coming back or never goes away completely.

Prevention

Good handwashing is one of the best ways to avoid getting viruses and other respiratory infections.

Since flu viruses have been shown to be a major cause of bronchitis, getting a flu shot may also help prevent acute bronchitis.
Limit exposure to cold, damp environments.

Bronchitis: What Causes It and How to Prevent It

What causes the dry coughing, extra mucus, and other cold symptoms you’ll suffer when you get a case of acute bronchitis? Bronchitis is inflammation of the lining of your bronchial tubes, which are the airways that carry oxygen to and from your lungs. But it’s either a viral or bacterial infection that sets the wheels in motion that result in those symptoms.

“The majority of acute bronchitis in kids and adults is caused by a viral infection,” explains Fernando Holguin, MD, associate professor of medicine at the University of Colorado School of Medicine and director of the asthma clinical research program at the Center for Lungs and Breathing at University of Colorado Hospital in Aurora. Research suggests that majority is between 85 and 95 percent of all cases of acute bronchitis. (1)

The illness typically improves in about 3 to 10 days and has no lasting effects, though a cough may linger for weeks after the infection has ended. But for people who have weaker immune systems, such as young children, the elderly, or those who have an illness like cancer or a health condition like as diabetes, there is a risk that acute bronchitis may develop into a more severe illness, such as pneumonia.

The rest of this article will focus on what causes acute bronchitis and how to prevent it. But it’s important to note that the other type of bronchitis, chronic bronchitis, is a long-term, serious condition that, similar to acute bronchitis, is caused by inflamed bronchial tubes that produce a lot of mucus, making it difficult to breath.

The difference in chronic bronchitis is that the inflammation is caused by long-term exposure to industrial dust, fumes in the workplace, air pollution, secondhand smoke, other air pollutants, long-term uncontrolled asthma, or frequent childhood respiratory infections — and the inflammation is constant and does not go away.

When viruses or bacteria infect the already-inflamed bronchial tubes in people with chronic bronchitis, those individuals can experience periods when symptoms become even worse than usual. Early diagnosis and treatment, along with behavior changes (such as quitting smoking) can improve daily management of symptoms of chronic bronchitis, but the chance of the condition going away completely is low, especially for those who have severe cases.

But when it comes to acute bronchitis, if the same types of infections that cause the cold and flu — viral and bacterial ones — are to blame, why do some infections turn into acute bronchitis? Here’s what you need to know, and some tips for avoiding and warding off a case of acute bronchitis.

Acute Bronchitis and Rhinosinusitis: Perspectives From Antimicrobial Stewardship

Much of the inappropriate use of antimicrobials in the outpatient setting is for respiratory infections, including acute bronchitis and rhinosinusitis.⁴ Below is a review of the treatment of acute bronchitis and rhinosinusitis in healthy adult patients who do not have chronic lung disease or who are immunocompromised.

Acute bronchitis is a self-limited lower respiratory tract infection affecting the large airways of the lung and produces a cough that typically lasts less than 3 weeks.^6-8 It affects about 5% of adults annually and is more common in the fall and winter.⁶ It is caused primarily by respiratory viruses, including adenovirus, coronavirus, enterovirus, human metapneumovirus, influenza A and B parainfluenza, respiratory syncytial virus, and rhinovirus.⁷ Less than 10% of cases are bacterial in origin, with atypical bacteria such as Bordetella pertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae as the culprits.^9-11

The early course of acute bronchitis mimics that of the common cold, with symptoms including malaise, nasal congestion, rhinitis, and sore throat occurring in the first few days.¹² This is followed by the onset of a cough, which becomes the dominant symptom.¹² The cough associated with acute bronchitis can take 2 to 3 weeks to resolve.¹³

The treatment of acute bronchitis involves primarily supportive care.¹⁰ Patients may benefit from symptomatic relief, with antihistamines, β-agonists, cough suppressants, decongestants, and expectorants.^6-8 Nonpharmacologic measures, such as avoiding cigarette smoke, drinking hot tea, and using throat lozenges, may also provide symptom relief. Because this syndrome is primarily viral in origin, the American Academy of Family Physicians, the American College of Physicians, and the CDC all recommend against the empiric use of antimicrobials as treatment in most cases.^7,8

There are 2 scenarios in which antimicrobials are indicated for acute bronchitis. The first is acute bronchitis caused by seasonal influenza. Treatment with neuraminidase inhibitors (Table 1 is recommended in patients who are hospitalized, have a complicated or severe disease, or are at high risk for complications.¹⁴ The clinical benefit of treatment with neuraminidase inhibitors is greatest if treatment is initiated within 48 hours of symptom onset.^14,15 The second scenario mandating treatment is acute bronchitis caused by pertussis. Prompt treatment with a macrolide (Table 2) is indicated to eradicate the organism from the nasopharynx and decrease the risk of transmission to others.¹⁶

Acute Rhinosinusitis

Rhinosinusitis is a common condition that affects the nasal cavity and paranasal sinuses. The term rhinosinusitis is preferred to sinusitis because inflammation of the sinuses is typically associated with inflammation of the nasal cavity.^17,18 In a 2012 national health survey, 1 in 8 adults in the United States reported being given a diagnosis of rhinosinusitis in the previous 12 months.¹⁹ Acute rhinosinusitis (ARS) is defined as having symptoms of purulent nasal drainage accompanied by facial pain (fullness or pressure) and/or nasal obstruction for up to 4 weeks.¹⁹ Other symptoms include anosmia or hyposmia, cough, ear fullness or pressure, fatigue, fever, halitosis, and headache. This syndrome is usually viral in origin and caused less commonly by bacteria.

Viral rhinosinusitis (VRS) is defined as symptoms of ARS that are present for fewer than 10 days and not worsening. Patients with VRS present with cough, nasal congestion, rhinorrhea, sneezing, and sore throat. VRS symptoms usually peak within 3 days and then gradually resolve within 10 to 14 days.^18,19 Acute VRS is usually caused by the influenza virus, the parainfluenza virus, or the rhinovirus.²⁰

Acute bacterial rhinosinusitis (ABRS) is defined by one of 3 clinical scenarios: the onset of severe symptoms such as high fever (>39°C, or >102°F) and purulent nasal discharge for at least 3 to 4 consecutive days at the beginning of illness, the initial improvement of symptoms followed by worsening symptoms after 5 to 6 days (double worsening), or symptoms of ARS that do not improve within 10 days of onset.^17-22 The most common pathogens that cause ABRS are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus.^18,19

For symptomatic relief from ARS, patients can take analgesics (such as acetaminophen and nonsteroidal anti-inflammatory drugs), cough suppressants, mucolytics, nasal saline irrigation, and topical intranasal steroids. For ABRS, watchful waiting without antibiotics is recommended, unless the patient will not follow up.^18,19,22 An antibiotic may be needed during watchful waiting if there is no improvement by day 7 or a worsening of symptoms.¹⁹ Amoxicillin/clavulanate is recommended as first-line treatment. See Table 3 for treatment options and Table 4 for risk factors for antimicrobial resistance; duration of treatment is 5 to 7 days.¹⁸

Conclusion

Considering the threat of antimicrobial resistance and a postantibiotic era, antimicrobials must be used prudently in acute bronchitis and ARS. It is imperative to note that both syndromes are caused most commonly by viruses and are self-limiting in nature. In most cases, the mainstays of management include symptomatic relief and watchful waiting. Nonetheless, patients should be instructed to reach out to their medical providers if they have a fever ((>38°C, >100.4°F), a prolonged duration of symptoms (>3 weeks for bronchitis, >10 days for rhinosinusitis, recurrent infections, symptoms not relieved by OTC medication, or a worsening of symptoms. If antimicrobials are prescribed, they should be taken consistently and for the entire duration. Antimicrobials are a vital nonrenewable resource and ultimately should be used judiciously.

Saira Chaudhry, PharmD, MPh, is a clinical assistant professor at the Ernest Mario School of Pharmacy at Rutgers University in Piscataway, New Jersey, and a clinical pharmacist at Jersey Shore University Medical Center in Neptune City specializing in infectious diseases.Siddharth Swamy, PharmD, BCPS, is a clinical assistant professor at the Ernest Mario School of Pharmacy at Rutgers University and a clinical infectious diseases pharmacist at Hackensack University Medical Center in New Jersey.

References

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Dyar OJ, Huttner B, Schouten J, Pulcini C; ESCGAP (ESCMID Study Group for Antimicrobial Stewardship). What is antimicrobial stewardship? Clin Microbiol Infect. 2017;23(11):793-798. doi: 10.1016/j.cmi.2017.08.026.
Swedish National Veterinary Institute. Swedres-Svarm reports. sva.se/en/antibiotics/svarm-reports. Updated May 29, 2018. Accessed September 19, 2018.
Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864-1873. doi: 10.1001/jama.2016.4151.
Schroeck JL, Ruh CA, Sellick JA Jr, Ott MC, Mattappallil A, Mergenhagen KA. Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother. 2015;59(7):3848-3852. doi: 10.1128/AAC.00652-15.
Wenzel RP, Fowler AA III. Acute bronchitis. N Engl J Med. 2006;355(20):2125-2130. doi: 10.1056/NEJMcp061493.
Kinkade S, Long NA. Acute bronchitis. Am Fam Physician. 2016;94(7):560-565.
Harris AM, Hicks LA, Qaseem A; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164(6):425-434. doi: 10.7326/M15-1840.
Clark TW, Medina MJ, Batham S, Curran MD, Parmar S, Nicholson KG. Adults hospitalized with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample. J Infect. 2014;69(5):507-515. doi: 10.1016/j.jinf.2014.07.023.
Gencay M, Roth M, Christ-Crain M, Mueller B, Tamm M, Stolz D. Single and multiple viral infections in lower respiratory tract infection. Respiration. 2010;80(6):560-567. doi: 10.1159/000321355.
Macfarlane J, Holmes W, Gard P, et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001;56(2):109-114.
Walsh EE. Acute bronchitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Sanders; 2015:806-809.
Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients’ expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5-13. doi: 10.1370/afm.1430.
Influenza antiviral medications: summary for clinicians. CDC website. cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. Updated February 23, 2018. Accessed August 13, 2018.
Fiore AE, Fry A, Shay D, et al. Antiviral agents for the treatment and chemoprophylaxis of influenza — recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(1):1-24.
Tiwari T, Murphy TV, Moran J; National Immunization Program, CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC guidelines. MMWR Recomm Rep. 2005;54(RR-14):1-16.
Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg. 2004;131:(suppl 6):S1-62. doi: 10.1016/j.otohns.2004.09.067.
Chow AW, Benninger MS, Brook I, et al; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. doi: 10.1093/cid/cir1043.
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Bronchitis and sinusitis- What do these words mean?

Every winter, when colds and flus create floods of runny noses and blasts of prolonged coughing, the words bronchitis and sinusitis erupt. It makes sense to take a moment and understand what these words mean, and how they are currently used, and misused.

The best place to start is with the common medical suffix, –itis. This ending keeps showing up in all sorts of places when we talk about illness and disease. Some uses are very familiar, like dermatitis, or appendicitis, or arthritis. But in every instance, the ending -itis always means the same thing, inflammation.

Inflammation means that some tissue is red, swollen, tender, warm, and or has lost some function. Perhaps the most familiar example of inflammation is a mosquito bite, where the skin gets red, warm, tender, swollen. The inflammation is so mild there is no loss of function in this example. But the point is that inflammation is a response to a threat in the body. That threat can be a chemical in the mosquito’s bite, and infection, or the body’s own self attacking itself for no good reason.

In the case of bronchitis and sinusitis, the inflammation is in the airways of the lung (bronchitis) or the sinuses of the head (sinusitis). And for both, the cause is an infection. This is where it gets interesting.

Bacterial v. Viral infection

The real confusion in the use of the terms bronchitis and sinusitis comes from the widely assumed meaning, namely that if you say the word bronchitis or the word sinusitis, you have proven you have a bacterial infection. But the truth is that bronchitis and sinusitis can be caused be either viruses or bacteria. If a virus infects your lung’s airways or sinuses, you have a viral bronchitis or sinusitis. If a bacteria infects either, it’s a bacterial bronchitis or sinusitis.

A major difference between any respiratory viral infection (except influenza) and any bacterial infection is that there is no antibiotic or medication that can decrease the impact of a viral illness, but regular antibiotics kill bacteria very well.

Bronchitis
Now to the illnesses themselves. Bronchitis literally means, inflamed airways of the lungs. This can happen, as noted, as a result of either a viral or bacterial infection. It turns out that, with few exceptions, every time you get a cold, you have a viral bronchitis. After all, a cold is when the virus inflames the lining of the nose, throat, and lungs, and when the lungs get inflamed, you have a viral bronchitis. It’s the lung inflammation in a cold that causes the horrible experience of a cough. And you can’t really get your lungs inflamed without the airways being affected. So, all colds are bronchitis.

But that’s not what is meant when a doctor tells someone has bronchitis. When that happens, what is usually implied is that a cold has developed into something more complicated, that a bacterial infection has erupted.

Now, the question is, how does one tell if your child has a viral bronchitis (a cold) or a bacterial bronchitis?

It turns out this is very hard to tell, since both cause the same symptoms.

There are no findings on exam, or blood tests, or X-rays that can tell the difference.

At a certain point, the question really turns on how long your child has been ill, since typical cold symptoms last up to about 25 days, and symptoms persisting longer than that may be due to bacteria getting involved. Or, sometimes it is clear that the illness is getting much worse when it should be getting better. As you can see, this question is truly best answered by a judicious weighing of all the facts, more than a test.

Sinusitis
The exact same discussion goes for sinusitis.

Literally the word simply means inflamed sinuses, that is sinus linings that become red, swollen, and make a lot of mucus. But the word is usually used as a code word to imply that someone has a bacterial infection and that antibiotics are needed and will cure the condition.

Unfortunately, as with bronchitis, most sinusitis situations are caused by infections with viruses.

In fact, a cold can be truly thought of as a viral sinusitis. A cold is a situation where a virus attacks the lining of the airways. That attack destroys the linings of the nose and its sinuses, throat, and lung. This is physically no different than a shallow burn. The viral burn in the sinuses cause the lining to get very red, swollen, and make loads of mucus. This is clearly a sinusitis.

But, as noted above, viruses are not killed or slowed by antibiotics, and antibiotics do nothing to heal the burn created by the virus. So if your child’s sinus infection is due to a virus, an antibiotic offers no help, only harm from side effects.

And, as with bronchitis, X-rays and CT scans and MRI’s do not help. These imaging technologies cannot tell the difference between mucus from a virus and pus from bacteria.

So once again ,the distinction relies on the course of illness. Colds typically last 1-3 weeks. So, unless some unusual experiences are noted, someone with a runny nose, fever, achy and feeling ill, for less than 10 days almost certainly has a viral infection, and antibiotics will not help.

BOTTOM LINES
1. Everyone gets colds. These are viral infections that cannot be helped in any way by antibiotics.
2. Bronchitis and sinusitis are terms broadly used to imply that a person’s illness has advanced beyond a cold to a bacterial infection that antibiotics could help.
3. If someone has been ill with runny nose, fever, cough, and feeling achy and ill for less than 10 days, unless some other unusual symptoms are present, it is very, very likely the illness is a viral infection, and antibiotics will not work. These viral infections can cause some symptoms, especially cough, to last well beyond 10 days, often for 3-4 weeks!
4. So the words bronchitis and sinusitis turn out not to mean one has a bacterial infection, only the course of the illness can determine that.
5. We at Advanced Pediatrics are happy to help you determine if your child’s runny nose, cough, or such illness is typical for a viral infection, or if other signs have appeared to suggest bacteria are now involved. This will help determine if an antibiotic would help or hurt the situation.

To your health,
Dr. Arthur Lavin

14 Sinus Infection Signs and Symptoms You Need to Know

Sinus infection symptoms overlap so much with allergy, cold, and flu symptoms that it can be hard to differentiate between them all. A runny and itchy nose, congestion, fatigue, difficulty sleeping, fever, and phlegm are pretty standard across the board. But there are some unique symptoms that can help you determine if you’ve got a sinus infection—a bacterial infection that usually needs to be treated with antibiotics.

A sinus infection usually starts as a virus, like the cold or flu. The virus then makes your mucous so thick that it doesn’t cycle through your system like it normally would. “Bacteria then overgrows in that mucous. That’s how a virus turns into a bacterial infection,” Erich Voigt, M.D., director of the division of general otolaryngology at NYU Langone Medical Center, tells SELF.

Since the initial virus won’t respond to antibiotics, doctors want to make sure you’re actually experiencing a bacterial infection before they give you meds. They’ll usually want to confirm your symptoms have lasted long enough and may also take a culture of your sinus mucous to check for bacteria.

OK, so on to how to get rid of a sinus infection once you know you have it: While these are pretty miserable, the good news is that they can be wiped away pretty easily with antibiotics. In addition to getting to your doctor for some meds, there are also some sinus infection home remedies that may be helpful, like using saline nose spray or a saline nasal irrigation (like a neti pot). But if your symptoms persist despite treatment, you might be dealing with chronic sinus infections. Some chronic sinus infection causes include nasal polyps, a deviated nasal septum, allergies, and other medical conditions, according to the Mayo Clinic.

So how can you tell when you’ve got a sinus infection? Here are the sinus infection symptoms to look out for.

1. Cold symptoms that last longer than a week.

Usually a sinus infection starts out as a classic cold, “with symptoms of a stuffy nose, maybe a fever, scratchy throat, and feeling fatigued and just sick,” says Voigt. Colds can also cause some chest tightness, dizziness, and just all-over congestion. After three to five days, those symptoms should start improving—by day five or seven, you should be feeling better. If you don’t, or the symptoms are getting worse, it’s likely it turned into a bacterial infection.

2. Discolored snot—and lots of it

Your symptoms will also become more sinus-focused when a sinus infection develops. “The congestion and stuffiness may get worse, and mucous coming out of the nose may be more productive and discolored,” Voigt says.

3. Post-nasal drip

More snot also means you might experience post-nasal drip. This happens when mucous accumulates in the back of the sinuses and, yes, drips down into the throat and chest.

4. Phlegmy cough

Post-nasal drip usually means more mucous gets into your chest. Having a phlemy sounding cough, and coughing up all that mucous (what doctors call a “productive” cough), is a classic sinus infection symptom. (If you feel a heaviness in your chest and rattling when you breathe on top of this, you may have bronchitis.)

5. Sinus pressure and pain

A sinus infection can actually make your face and sinus area feel so congested that it hurts and causes a headache. “This can range from severe pain for some people where think that their tooth is infected, to pain behind the eye or pain just between the eye and the nose,” Voigt explains. Some people may just find their sinus area feels swollen and tender to the touch. As sinus headache headache often gets worse when you bend forward, according to the Mayo Clinic.

Of course, there are other sinus infection symptoms that can also overlap with allergies, cold, and the flu.

Those symptoms include these, from the Mayo Clinic:

Nasal congestion
Ear pressure
Headache
Pain in your jaw or teeth
Impaired sense of smell or taste
A cough that often gets worse at night
Bad breath
Fatigue
Fever

If you’ve got several of the above symptoms, head to your doctor to get some relief. Even though you may be able to guess if it’s a virus or a sinus infection, they’ll be able to tell you for sure.

Related:

When a “Chest Cold” Is Something More

When I see patients with chest colds, they usually don’t need antibiotics. Instead, I tell them about some simple treatments they can do at home.

About the Author

Dr. Shilpa Mehta

Shilpa Mehta, MD, FAAFP, is a family physician with OSF HealthCare in Bloomington, Illinois. She also volunteers as an associate professor in the Department of Family and Community Medicine at Southern Illinois University (SIU) School of Medicine, Springfield. For the past five years, she has worked in an urgent care setting. Prior to that, she spent 10 years providing primary care. Dr. Mehta completed her residency at SIU Decatur Family Medicine Residency Program.

You probably know the feeling of having cold symptoms that move from your head into your chest. Many people call this a chest cold. The medical term for it is “acute bronchitis.” Bronchitis is an inflammation (or irritation) of the airways. Airways are the tubes in your lungs that air passes through. They are also called “bronchial tubes.” When these tubes get infected, they swell. Mucus (thick fluid) forms inside them. This narrows the airways, making it harder for you to breathe.

Acute bronchitis is usually caused by the same viruses that cause the common cold or the flu. In these cases, the virus may affect your nose, sinuses, and throat first. Then, the infection travels to your bronchial tubes. A bacterial infection or an irritant in the air (for example, fumes or cigarette smoke) can also cause acute bronchitis.

The early signs of acute bronchitis often seem like the symptoms of a cold. That was the experience my patient Susan had. Susan (not her real name) is a 35-year-old woman. About two weeks before she came in for an office visit, she had started using over-the-counter (OTC) cold medicine and saline nasal spray to treat a stuffy nose, a sore throat, and sinus pressure. Her sinuses had started to feel better, but then she developed the following symptoms:

Persistent cough that brought up yellowish-green mucus
Chest tightness
Difficulty taking deep breaths
Wheezing (especially at night when she was lying down)
Occasional low-grade fever (under 102°F)

When these symptoms had not gone away after a week, Susan decided to make an appointment to see me.

Looking at Susan’s medical record, I was glad to see that she had come in previously for her yearly flu shot. I could also see that she does not have any lung conditions (for example, asthma) or chronic (ongoing) problems with her immune system. She doesn’t smoke or live with anyone who smokes.

After asking Susan about her symptoms, I gave her a physical examination. I listened closely to her lungs with a stethoscope. I didn’t hear any breathing sounds that might be a sign of pneumonia. Because Susan is otherwise healthy and doesn’t smoke, I didn’t need to order a chest X-ray to look at her lungs.

Most cases of acute bronchitis are caused by a virus, so antibiotics will not help. Antibiotics can only treat bacterial infections. I told Susan that mild cases of acute bronchitis will almost always go away on their own in 7 to 10 days. But I also let her know that she might continue to have a cough for several weeks after the other symptoms went away.

I recommended that Susan try the following simple home treatments to help her feel better in the meantime:

Get plenty of rest
Use a humidifier or try breathing steam from a hot shower to loosen mucus
Drink lots of water to stay hydrated and thin mucus
Use extra pillows to prop herself up in bed. This can help ease coughing and chest congestion.
Use an over-the-counter (OTC) expectorant called guaifenesin to help break up chest congestion
Avoid exposure to secondhand smoke

Even when acute bronchitis is caused by a virus, it’s possible for bacteria to grow in the infected airways. This is called a “secondary bacterial infection.” Your family doctor may treat it with an antibiotic. Signs of a secondary bacterial infection in a person who has acute bronchitis include the following:

Continuing to get sicker instead of getting better
Coughing up blood
Having a high fever (103°F or higher)
Having trouble breathing

I told Susan to call me if she had any of these symptoms. If she had contacted me, I would have asked her to come back into the office for a follow-up examination and additional tests, such as a chest x-ray. Fortunately, Susan got better without any complications.

Quick Tip

When I diagnose acute bronchitis in patients who smoke, I talk to them about the importance of quitting. Smoking damages your bronchial tubes and puts you at risk for infection. Smoking also slows down the healing process when you’re sick.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

90,000 symptoms and treatment in adults, a description of the disease and recommendations, which nasal spray to use for sinusitis

Among the dangerous complications, doctors distinguish:

meningitis – inflammation in the membranes of the brain or spinal cord;
otitis media – an inflammatory process in the ear;
pneumonia, acute bronchitis;
epidural or subdural abscess (focal accumulation of pus) of the brain;
sore throat, tonsillitis;
conjunctivitis, optic neuritis;
formation of blood clots in the vessels of the head;
blood poisoning.

Some of these conditions can be fatal.

Treatment methods

Conservative treatments for untreated sinusitis are aimed at fighting infection, pain, and inflammation. It is extremely important to restore the drainage of the sinuses, that is, to ensure the free excretion of mucus. For this, vasoconstrictor drugs are used, for example, “Afrin”. They are able to eliminate swelling of the nasal mucosa, due to which the stagnant contents are gradually released.In parallel, the washing procedure is carried out. During it can be used:

Sinus catheter YAMIK. The doctor creates negative pressure in the patient’s nasal cavity, as a result of which the purulent contents are pumped out. Then he injects an antibacterial solution. As a rule, about 3-5 such procedures are required for a complete recovery.
Suction-aspirator “Cuckoo”. First, the vessels of the nasal cavity are narrowed using a nasal spray, then the medicine is injected into one nasal passage, and through the second, it is sucked off with an aspirator.During the manipulation, the patient must say “cuckoo” all the time. After washing, drugs are injected into the sinuses.

“AFRIN®” against sinusitis

90,000 Causes of Chronic Cough | Clinic “Oberig”

Chronic cough is most often associated with the following diseases: cough syndrome of the upper respiratory tract, bronchial asthma and non-asthmatic eosinophilic bronchitis, as well as gastroesophageal reflux disease:

(rhinitis, including allergic, sinusitis), in which a chronic cough is caused by irritation of the respiratory tract (bronchi) with mucus flowing down the back of the throat from the nasal cavity.Mucus causes irritation and even inflammation of the bronchi, provokes a cough reflex. In addition, the presence of constant inflammation and the accumulation of mucus in the nose “overexcites” the cough center in the brain, it becomes overly active and “works” in the form of a cough on the slightest irritants.

Bronchial asthma is a chronic inflammatory disease manifested by episodic narrowing of the bronchi (bronchospasm). Typical manifestations of asthma are choking (shortness of breath, shortness of breath) and wheezing in the chest, but coughing may be its only symptom.

Non-asthmatic eosinophilic bronchitis is the same inflammation of the bronchi as in asthma, but not accompanied by narrowing of the bronchi. The main symptom of the disease is dry cough.

Gastroesophageal reflux disease (GERD) is a reflux of gastric juice into the esophagus, larynx and even bronchi. The hydrochloric acid and digestive enzymes contained in it cause severe irritation and inflammation of the mucous membrane. GERD often manifests itself as heartburn, a sensation of gastric contents being thrown into the esophagus, and a sour taste in the mouth.However, in a significant proportion of cases, cough is the only symptom of the disease.

** Smoking is not only one of the most common causes of coughing, but also aggravates the condition in the presence of other conditions that cause coughing.

Other possible causes of chronic cough may be: taking certain medications for the treatment of arterial hypertension (angiotensin converting enzyme inhibitors), occupational or household hazards, chronic bronchopulmonary infectious diseases (bronchiectasis, cystic fibrosis), pulmonary tuberculosis, interstitial lung diseases, tumors of the lungs and bronchi, ingestion of a foreign body into the respiratory tract, heart disease and heart failure, neurological pathology, psychogenic causes.

Rhinitis and sinusitis are common causes of cough .

Rhinitis is an inflammation of the mucous membrane of the nasal cavity. The main symptoms are a runny nose, nasal congestion, a “running” nose. Rhinitis can be allergic, i.e. associated with an allergic reaction to an external factor, and non-allergic, when an external provoking factor cannot be detected. Allergies must be confirmed with specific tests. Some strong odors and irritants in the air, changes in the weather, certain medications, and foods can cause non-allergic rhinitis.These diseases require different treatment, so they must be diagnosed as carefully as possible.

Sinusitis is an inflammation of the paranasal sinuses (maxillary, frontal, ethmoidal), excess production of mucus and a violation of its outflow from the sinuses. Chronic sinusitis can be caused by a bacterial infection, polyps, a deviated nasal septum, or trauma to the facial part of the skull. Treatment includes mandatory identification and elimination of the causes of the disease.

Post-nasal mucus leakage .The mucous membrane of the nose constantly produces mucus to cleanse the nasal cavity. Usually we do not notice this, however, if for some reason this process is disrupted, unpleasant symptoms may occur. If the mucus becomes too thick, and its amount is large, its outflow and excretion from the nasal cavity may be impaired. This can be manifested as “anterior runny nose” and excess mucus draining down the back of the pharynx into the larynx – this is the syndrome of postnasal flow or “posterior runny nose”.Postnasal mucus leakage is a very common cause of chronic cough.

Spirometry is a respiratory function test that allows you to detect bronchial obstruction (narrowing of the bronchi) in many diseases of the lungs and bronchi. Spirometry measures the volume of air exhaled by the patient during forced (“enhanced”) expiration and the air flow rate. Spirometry is the “gold standard” in the diagnosis of diseases such as bronchial asthma and chronic obstructive pulmonary disease.

If asthma is suspected, but spirometry results are normal, this does not mean that there is no disease. In this case, a bronchoprovocation test is required – a series of sequential inhalations of a special medicinal substance and subsequent spirometric tests. With the help of such a medicinal substance, some narrowing of the bronchi is provoked in people with asthma, but this does not happen in healthy people. If the bronchial challenge test is negative, bronchial asthma can be ruled out with a high degree of probability.

Radiography of the lungs is a diagnostic method in which an X-ray image (image) of the patient’s chest organs (heart, lungs, blood vessels, bronchi, bones) is taken. This method must be performed by all patients with chronic cough to detect many serious diseases (lung cancer, pulmonary tuberculosis, pneumonia, emphysema, pulmonary fibrosis, and others).

Treatment of sinuses and Staphylococcus aureus in Kaliningrad

Treatment of nose is one of the main areas of work of ENT .The Potocki clinic in Poland has everything you need to deal with pathologies such as curvature of the septum, polyps, etc. It is in the treatment of the nose that surgical techniques are most widely used.

Symptoms of nasal diseases are most often associated with infectious or allergic causes . It can also be various neoplasms, as well as accumulations of fluid or mucus in the sinuses. To accurately identify the sources of the disease, you should undergo a full examination with an ENT.You can sign up for diagnostics in our clinic in Kaliningrad by phone: +7 (921) 262-29-59.

Diseases of the nose and their treatment

There are several types of common pathologies, the treatment of which we offer:

vasomotor rhinitis;
chronic sinusitis;
nasal polyps;
curvature of the septum;
staphylococci.

Each of these diseases causes breathing problems (chronic nasal congestion), pain, malaise, loss of smell and many other unpleasant consequences, including external changes in the shape of the nose.At the same time, drug treatment often does not give a significant result.

In the Potocki clinic in Poland, modern complexes of hardware and surgical equipment have been installed, allowing for minimally invasive and effective procedures for the treatment of sinuses . Recovery from such operations does not take long. Almost always, patients leave the clinic on the day of surgery and, after following the doctor’s recommendations, return to their normal daily routine within a few days.

Treatment of staphylococcus in the nose

Laura’s help may also be needed in the fight against staphylococcus. It is curious that these bacteria accompany a person throughout his life. They manifest themselves only during periods of weakened immunity, serious inflammation and nose injuries.

Staphylococcus aureus is especially dangerous. Usually this type of bacteria is not present in the body. It gets into it from the outside and is capable of provoking severe inflammation. This is not only about rhinitis, otitis media or sore throat.All adjacent respiratory organs are affected and diseases such as:

bronchitis;
tracheitis;
adenoiditis;
sinusitis.

In the most unfavorable scenarios, in the absence of diagnosis and treatment of Staphylococcus aureus, bones, heart, kidneys, and brain are affected. The bacterium is especially dangerous for the elderly and children. Remember the symptoms in which you need to immediately consult an ENT doctor: the presence of impurities of pus in the mucus from the nose, impaired sense of smell, a change in the timbre of the voice, fever (up to 39 degrees or more), general malaise, sinusitis, frontal sinusitis.

Treatment of staphylococcus in the nose in adults and children should be timely and effective . Most often it is associated with taking medications, injecting drugs and local treatment of the mucous membrane. If abscesses appear, surgical intervention may also be required. Treatment for Staphylococcus aureus in adults should be fully supervised by a physician. This will help avoid dire consequences.

You can make an appointment for diagnostics and treatment of the nose at the Pototski clinic in the town of Braniewo, 5 km from the border of Poland and the Kaliningrad region, by phone or through the form on the website.Contact the professionals and be healthy!

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Science: Science and technology: Lenta.ru

If you have a sore throat, a stuffy nose, your temperature rises to 38 degrees, and you have a dry, exhausting cough at night, then this is most likely ARVI – an acute respiratory viral infection.This is not one disease, but a whole group of diseases caused by various viruses. They feel comfortable in the upper respiratory tract, multiply in the mucous membrane and give a whole bunch of unpleasant symptoms.

ARVI includes rhinitis, sinusitis, nasopharyngitis, laryngitis, tracheitis and other types of inflammation of the upper respiratory tract. The common cold can be caused by hundreds of viral strains, and rhinoviruses are the most common pathogens.

Naturally, due to the huge number of potential pathogens, vaccine prophylaxis is impossible, therefore the most common ways to combat ARVI are to alleviate symptoms and fight the causative agent of the disease.

On average, every person falls ill with a viral infection once or twice a year, most often children. For them, a seemingly not dangerous viral infection can result in serious complications. The fact is that the mucous membrane affected by viruses becomes vulnerable to bacteria, which can be much more dangerous than viruses. As a result, sinusitis, bronchitis and even pneumonia can develop. Germs can enter the sinuses, causing sinusitis, and the Eustachian tubes, which is the cause of otitis media.

Sinusitis is a common complication of the common cold. The infection enters the maxillary sinuses, which are small “caves” that connect to the nasal cavity, and causes inflammation, swelling and pus there. A characteristic symptom is pain when the head is tilted forward. The timbre of the voice changes – it acquires a nasal tone, nasal breathing becomes difficult. Over time, the pain can spread to the entire head. With severe edema, the outflow of secretions from the sinus stops, which aggravates the situation.During acute sinusitis, the temperature can rise to 38 degrees. If sinusitis is caused by a bacterial infection, the doctor prescribes an antibiotic, while the choice of medication depends on the severity of the disease and the strain of the pathogen microbe.

Children after ARVI often develop acute otitis media. Bacteria that multiply on the mucous membranes of the upper respiratory tract damaged by viruses, with strong sneezing and blowing their nose, enter the middle ear through the Eustachian tube. Again, inflammation occurs, which is accompanied by pain, partial hearing loss, and fever.The causative agents of acute otitis media are often streptococci, staphylococci, haemophilus influenzae and moraxella.

For acute otitis media, if symptoms such as severe pain or high fever persist for more than three days, doctors prescribe antibiotics.

But bacteria have a way not only up, but also down to the lungs. In this case, bronchitis and even pneumonia, pneumonia, may develop.

In total, more than 300 viruses are known that can cause ARVI. They are constantly present around us, and the immune system successfully copes with their attacks.But due to vitamin deficiency, stress and worsening weather, immunity can weaken. For more information on how to protect yourself from illness, read the special project “Lenta.ru”.

Bronchitis is an inflammation of the bronchial mucosa caused by bacteria, accompanied by cough and sputum production. Sometimes, due to mucus blockage of the small bronchi, respiratory failure develops. Bronchitis develops when microbes such as Haemophilus influenzae, streptococci and pneumococci enter the lower respiratory tract.Your doctor will likely prescribe an antibiotic for treatment as well.

The acute stage of bronchitis lasts a little over a week, after which the inflammation disappears, and the restoration of the lung mucosa may take a month or more. But sometimes, against the background of chronic bronchitis, an even more unpleasant complication develops – pneumonia.

Pneumonia is a life-threatening condition whose late diagnosis and treatment can have serious consequences. Every year, about 17 million people fall ill with pneumonia, and for about 265 thousand, pneumonia ends in a sad ending.The only effective way to treat pneumonia is to take antibiotics prescribed by your doctor.

To avoid complications, some patients begin to drink antibacterial drugs as a prophylaxis, but it is absolutely impossible to do this without consulting a doctor. Antibiotics are used only to fight bacterial infections as directed by a doctor. With their frequent and incorrect use, microbes can develop resistance, after which the drug becomes useless. Recently, more and more drug-resistant strains of bacteria have appeared.

How then to prevent complications?

If sometimes ARVI ends for you with otitis media, sinusitis or bronchitis, you should think about increasing the activity of the immune system. Bacterial lysate preparations help the immune system fight off infection. When using bacterial lysates, weakened immunity is activated, which leads to an increase in the production of antiviral compounds, an increase in the activity of immune cells and the production of antibodies. All this helps to reduce the risk of developing bacterial complications.

Bacterial lysates are fragments of dead bacterial cells, so they cannot cause infection (disease). Some preparations contain lysates of several strains of bacteria at once. For example, Broncho-Munal® includes fragments of 21 strains of the main causative agents of upper and lower respiratory tract infections. This drug, like other lysate-based immunostimulants, is designed to activate immune cells at the intestinal level, after which cells and antibodies with lymph flow enter the respiratory tract mucosa, where bacteria attack.In addition, Broncho-Munal® stimulates non-specific immunity that is directed against a wide range of pathogens, including viruses. It can be used for the prevention or during the treatment of ARVI, in combination with other medicines.

Bacterial lysates help to reduce the frequency and duration of antibiotic use *, reducing their effects on the body and preventing the development of drug resistance. They also help reduce the risk of complications ** – both life-threatening and unpleasant.When complications do not arise, recovery can be quicker *.

* Instruction for medical use of Broncho-Munal®,
** Jara-Pèrez JV et al. Primary prevention of acute respiratory tract infections in children using a bacterial immunostimulant: a double-masked, placebo-controlled clinical trial. Clin Ther 2000; 119: 1742-8.

CONTRAINDICATIONS ARE AVAILABLE, CONSULT A SPECIALIST.

ZAO Sandoz, 125315, Moscow, Leningradsky prospect, d.72, bldg. 3. Tel. +7 (495) 660-75-09. www.sandoz.ru

Brief instructions for use.

RU1811923766

Chronic rhinitis in cats

Chronic rhinitis – is a common and significant problem in cats that can develop as a result of a number of nasal or systemic disorders. Idiopathic chronic rhinosinusitis and nasal neoplasms are the most common causes of chronic nasal disease in cats.Most cases of chronic rhinitis in cats require imaging, endoscopy, and nasal biopsy to make a diagnosis. A discussion of some of the common causes of chronic nasal diseases is presented.

Chronic rhinitis is a common and significant problem in cats that can result from a number of nasal and systemic disorders (Table 1). Idiopathic chronic rhinosinusitis and nasal neoplasms are the most common causes of chronic nasal disease in cats.¹ Nasopharyngeal polyps, fungal rhinitis, nasal foreign bodies, dental disease and nasopharyngeal stenosis are less common but also significant causes of chronic rhinitis in cats.

Clinical signs of chronic diseases of the nasal cavity

Nasal discharge, sneezing, shortness of breath and breathing with an open mouth (rare) are typical signs of chronic nasal disease in cats. ^2.3 Chronic sneezing is a common clinical symptom in cats, often accompanied by nasal discharge.If the nasolacrimal duct is blocked, lacrimation may occur. If the mouth or pharynx is affected, gagging, trouble swallowing, or bad breath may occur. In the later stages of neoplasms of the nasal cavity, extraocular structures or oral cavity, as well as fungal rhinitis, deformity of the muzzle is possible. In cats with nasopharyngeal polyps, chronic nasal discharge may accompany otitis externa or vestibular disorders. In cats with a chronic nasal process as a result of neoplasm or fungal rhinitis, if the perforated plate is damaged and the disease spreads to the brain, behavioral changes, seizures or a stunned state are possible.

The type and location of nasal discharge may help rule out some differential diagnoses. Unilateral nasal discharge is possible with foreign bodies, at an early stage of neoplasms and with dental diseases. Bilateral effusions are most common and it is impossible to further establish the cause of rhinitis based on this criterion. Mucopurulent discharge is the most common type, in a large number of cases of secondary rhinitis caused by a secondary bacterial infection. Strong outflows are rare and are usually observed with allergic rhinitis or early stage viral infection.If the main cause of the disease of the nasal cavity is not eliminated, they often change their character to mucous or mucopurulent. With a large number of diseases of the nasal cavity in mucopurulent outflows, an admixture of blood may sometimes appear as a result of erosion of blood vessels and sneezing. Epistaxis in chronic nasal diseases is not very common in cats compared to dogs. Nosebleeds occur when aggressive processes in the nasal cavity cause erosion of blood vessels (eg, tumors, inflammation) or clotting disorders.The ingestion of food into the nasal discharge can be caused by a fistula between the nasal and oral cavities in adult cats or a cleft palate in kittens.

Breed, sex, age, history and clinical examination for chronic diseases of the nasal cavity

Information on age, breed and lifestyle can help rule out some possible causes of chronic rhinitis. Young to middle-aged cats are less likely to develop tumors than older cats (> 8 years). ¹ Nasopharyngeal polyps commonly occur in cats 8 years old.⁴ Brachycephalic (e.g. Persian) cats housed with a large number of other animals in a small area (several cats in an apartment, shelters with poor conditions or pet shops), as well as stray cats or cats living in garages, are more likely to have idiopathic chronic rhinosinusitis on the background of viral infections of the upper respiratory tract. ⁵ Nasal foreign bodies, trauma and fungal rhinitis are more common in free-walking cats. ^1.6-9 Vaccination data are important for both the sick cat and other cats in the household.Vaccination does not prevent viral upper respiratory tract infections, but may reduce the severity of clinical symptoms. A viral infection should be suspected if symptoms of an acute upper respiratory tract infection occur in multiple cats in the household.

Table 1. Differential diagnoses for chronic rhinitis in cats

Viral infection
Feline rhinotracheitis virus
Feline Calcivirus
Bacterial infection
Mycoplasma spp
*Pasteurella multocida*
*Bordetella bronchiseptica*
Anaerobic bacteria
Fungal infection
Cryptococcus spp
Aspergillus spp
Parasitic invasion
Nasopharyngeal gadfly
**Eucoleus (Capillaria) boehmi**
Neoplasms (nasal, oral, extraocular)
Dental diseases
Foreign body
Palate defects
High viscosity syndrome
Coagulopathy
Idiopathic chronic rhinosinusitis
Lymphocytic-plasmacytic rhinitis
Allergic rhinitis
Nasopharyngeal polyp
Nostril stenosis
Diseases outside the nasal cavity
Nasopharyngeal stenosis
Pneumonia
Vomiting
Narrowing of the esophagus
Damage to the cricopharyngeal muscle

When purchasing an adult cat, you should, if possible, find out its history, in particular, lifestyle, maintenance and vaccination.Many cats with past upper respiratory tract infections suffer from episodes of rhinitis throughout their lives. Any sudden change in the nature or severity of nasal discharge should warrant investigation of other causes of chronic rhinitis (eg, neoplasm, fungal infection). In the event of acute sneezing and nasal discharge, the cat should be quickly examined for foreign bodies, nasal trauma, and clotting disorders. Chronic nasal discharge is more often associated with idiopathic chronic rhinosinusitis, neoplasms, dental diseases, lymphocytic-plasmacytic rhinitis and nasopharyngeal polyps.

When evaluating cats with chronic rhinitis, a thorough clinical examination with particular attention to the oral and facial structures is important. ³ The upper jaw and frontal sinus area should be examined and palpated to detect possible asymmetry or swelling. The eyes should be examined for any signs of exophthalmos. The nostrils are assessed for patency, symmetry, and visible neoplasms. Asymmetry of the muzzle or exophthalmos is the basis for suspicion of a tumor process or fungal rhinitis.Approximately 35% of cats with cryptococcosis have significant swelling over the nasal dorsum, and in some cases, a polypoid mass protrudes through the nostrils. The patency of each nostril can be determined by condensation on a glass slide held in front of the nose, or by pinching each nostril alternately to assess the passage of air through the opposite. The inability to pass air through one or both nostrils indicates obstructive disease, but not enough to establish its cause.Plugs made of compacted mucopurulent material easily clog the lumen, as well as volumetric formations (tumors, fungal granulomas). An attempt should be made to examine the oral cavity (depending on the cat’s temperament), in particular around the teeth and the hard palate, for neoplasms or clefts in the hard or soft palate. The teeth should be examined for fractures or fistulas between the oral and nasal cavities (the latter are easiest to detect with a dental probe under anesthesia).The mandibular lymph nodes should be palpated to detect possible enlargement or asymmetry. Otoscopy is used to investigate possible signs of otitis media that occurs in cats with nasopharyngeal polyps. Finally, a complete ophthalmologic examination should be performed to detect signs of systemic or fungal disease (eg, anterior uveitis, chorioretinitis, optic neuritis) and signs of hypertension or hyperviscosity syndrome (retinal hemorrhages, tortuous vessels, retinal detachment).

Diagnostic examination for chronic diseases of the nasal cavity

Diagnosing the causes of chronic rhinitis in cats is often difficult. To exclude systemic diseases accompanied by outflows from the nasal cavity (for example, high viscosity syndrome, polycythemia, thrombocytopenia), it is necessary to do a complete clinical blood test, biochemical blood test and urinalysis. A coagulogram is indicated for nosebleeds and suspected coagulopathy.If hypertension is suspected, blood pressure should be measured. Determination of the titer of antibodies to cryptococcal antigen in serum is a very specific and sensitive method for diagnosing cryptococcosis, which should be carried out if this disease is suspected by the clinical picture. ⁸ Chest x-rays are of limited diagnostic value, but should be done if pneumonia is suspected. Sowing of nasal discharge for bacteria and fungi is not recommended, as this usually produces microorganisms due to secondary bacterial contamination.If idiopathic chronic rhinosinusitis is suspected, culture from the deep layers of the nasal cavity may provide diagnostic information (see Idiopathic Chronic Rhinosinusitis below).

Most cases of chronic rhinitis in cats require imaging and endoscopy, as well as a nasal biopsy, to make a diagnosis. Visual diagnostics should be done prior to endoscopy or nasal biopsy. The insertion of instruments into the nasal cavity often causes bleeding, which interferes with visual diagnosis.Further examination of cats with chronic rhinitis is performed under general anesthesia. Before visual diagnostics, it is necessary to carefully examine the oral cavity and probe it for the presence of neoplasms, fistulas connecting the nasal and oral cavities or clefts of the hard or soft palate. All upper and lower arch teeth should be examined with a periodontal probe, even if the teeth appear normal. This is especially important in unilateral chronic rhinitis. The probe is placed in the gingival trough and deeper into the gingival pocket.In cats with chronic rhinitis as a result of dental disease, the probe may pass into the nasal cavity or maxillary sinus. The soft palate should be palpated to look for possible growths in the nasopharynx (eg, nasopharyngeal polyp). If a neoplasm is palpable over the soft palate, the soft palate can be gently retracted with the oophorectomy hook to visualize it.

If a nasopharyngeal polyp is found, an otoscopy should be performed to determine if the ear canal is affected.If the ear is affected in cats with polyps, a neoplasm in the vertical or horizontal ear canal or a bulging eardrum may be found. If the ear is not affected, the polyp can be removed by tearing it through the mouth. If the ear is affected, an osteotomy of the tympanic bladder is indicated to reduce the risk of recurrence. If a nasal neoplasm is strongly suspected in cats, nasopharyngoscopy is performed with a backward-curved endoscope (i.e., prior to visual diagnosis, the flexible endoscope is rotated 180 ° around the caudal border of the soft palate to visualize the dorsal surface of the soft palate, the nasopharynx region, and the caudal part of the nostrils as many times as required to visualize a neoplasm protruding through the choanae into the rostral nasopharyngeal region).

After a thorough examination of the oral cavity and nasopharynx, x-rays of the skull or, preferably, a computed tomography of the nasal cavity should be taken. Visual diagnostics are performed under general anesthesia and before any invasive procedures in the nasal cavity. When evaluated on x-rays, the severity or extent of the process may be grossly underestimated due to overlapping structures, inadequate contrast resolution, and the complexity of the nasal anatomy. ¹⁰ For these reasons, computed tomography is preferred for examining the nasal cavity, sinuses, and surrounding structures in cats with chronic rhinitis.The only exception is the suspicion of a dental disease, followed by a detailed examination of the latter. High-resolution dental x-ray films provide very detailed information about the roots of the teeth and the surrounding bone structures. The rostral and mid-nasal cavity can be examined with a small rigid endoscope. With a small-diameter conical otoscope, only the most rostral part of the nasal cavity can be examined. The nasopharynx area is easy to examine with a flexible small diameter endoscope.The endoscope is inserted into the oral cavity up to the caudal border of the soft palate, and then the tip is rotated 180 ° to visualize the area above the soft palate and choanns. Alternatively, you can gently pull the caudal border of the soft palate forward and downward with the oophorectomy hook and examine the nasopharynx area with a dental speculum and light source. MRI is a highly effective method for diagnosing diseases of the nasal cavity. This type of study is much more effective for neoplasms in the nasal cavity, since it allows you to directly visualize the neoplasm itself, perifocal edema if the neoplasm grows into the brain.

A biopsy of the tissues of the nasal cavity is performed under anesthesia and only after visual diagnostics and rhinoscopy. We must not forget to carry out tracheal intubation, as blood and fluid during rhinoscopy can enter the trachea. Small shell-shaped forceps are suitable for blind biopsies of the nasal tissue in cats. Biopsy forceps are inserted in the direction of the neoplasm based on the results of X-ray and tomography. In a diffuse process, several samples should be taken from random locations.Tissue samples are preferable to brush scrapings, as the latter method often fails to correctly identify chronic inflammation. ¹¹ The cat’s nose should be tilted downward to minimize the accumulation of blood in the nasopharynx and caudal oropharynx. If idiopathic chronic rhinosinusitis is suspected, tissue samples from deep layers should also be sent for microbiological culture under aerobic and anaerobic conditions. In addition, if fungal rhinitis is suspected, tissue samples can be sent for culture on fungal media.In cats with a deformity of the muzzle, puncture of the deformed area with a thin needle can be done to obtain cytological material. Alternatively, a stabbing skin incision can be made over the swelling and a tissue sample taken with a biopsy instrument. Hemorrhage is the only significant complication after biopsy that can be controlled with epinephrine diluted 1: 10,000 or 1: 100,000 with cold saline. After the biopsy, the caudal pharyngeal region should be suctioned off of blood clots, blood, and other secretions.After the biopsy, steps must be taken to relieve pain. In many cases, meloxicam is very effective, which can be given before the procedure, as well as for 1 to 3 days after it.

Common Causes of Chronic Nasal Disease in Cats

Idiopathic chronic rhinosinusitis

Chronic rhinosinusitis is an extremely significant cause of chronic rhinitis and one of the two most common causes of sneezing and nasal discharge in cats.^1.11 Chronic rhinosinusitis can develop after severe acute respiratory tract infections, especially in kittens or adult cats who have been in contact with an infected cat. Acute upper respiratory disease is thought to be caused by infection with feline herpesvirus type 1, feline calcivirus, Chlamydia felis , or a combination of several agents. ⁵

Although viral (especially type 1 herpesvirus infection) or chlamydial infections are often the initiating cause of acute rhinitis, the pathogenesis of idiopathic chronic rhinitis is unknown and it is unclear whether acute rhinitis is associated with chronic syndrome.¹² Although cats with idiopathic chronic rhinosinusitis have similar clinical features, the disease syndrome is heterogeneous in the population, probably due to individual susceptibility to pathogens, genetic characteristics of the inflammatory response, and environmental factors (such as stress) that play a role in in the development of clinical signs. ¹² The relative importance of existing or past viral and / or bacterial infections and the complex relationships between viruses and bacteria involved in the pathological process, combined with individual differences in inflammatory response, may play a large role in the onset of chronic rhinitis.It is likely that a complete understanding of these characteristics will help provide appropriate treatment recommendations.

Feline herpesvirus type 1 is estimated to be responsible for the majority of acute severe upper respiratory infections in cats, although it is possible that calcivirus is more prevalent in some populations. It is possible that feline herpesvirus type 1 plays an important role in the initial development of chronic rhinitis. ^12-14 Experimental infection of germ-free cats with feline herpesvirus type 1 can cause severe upper respiratory tract disease in the absence of microflora.It is likely that in the natural population of cats, the relationship between herpesvirus type 1 and various bacterial pathogens is an important factor in the severity and duration of upper respiratory tract disease. Clinical signs of chronic rhinosinusitis can become permanent due to chronic or recurrent bacterial infection of the nasal cavity and paranasal sinuses, a strong inflammatory reaction to the presence of a bacterium or virus, irreparable destruction of the nasal epithelium and bone conchas due to acute cell lysis by the virus during an episode of acute severe rhinitis or cumulative destruction of the epithelium of the nasal cavity and bone concha after chronic reactivation of the virus in the trigeminal ganglion and transition into the tissues of the nasal cavity.¹² The role of any pathogen or combination of pathogens in the pathogenesis of chronic rhinosinusitis is not fully understood. ¹⁵ Detection of bacteria or viruses by culture, antibody titers or molecular methods does not imply that clinical signs are caused by the microorganism detected. In general, it is likely that the development of chronic rhinosinusitis is due to a complex sequence of interactions between microbiological, physiological, anatomical and immunological mechanisms.

Fig. 1. The result of computed tomography of the nasal cavity of a cat with idiopathic chronic rhinitis. (A, B) The structure of the turbinates is not clearly visible due to edema of the mucous membrane and material with X-ray density similar to soft tissue (mucopurulent material) in the nasal passages. (C) The caudal nasal cavity and frontal sinuses in this patient were relatively unaffected by the disease.

Idiopathic chronic rhinosinusitis can develop in cats of any age, although young animals are most often affected.¹² Cats with this disorder typically have chronic recurrent or progressive symptoms such as sneezing, snoring and nasal discharge. Nasal discharge is usually profuse, bilateral, mucopurulent or purulent, although sometimes unilateral discharge or occasional blood is found. There are usually no signs of systemic disease or eye damage. Older cats may develop anorexia due to loss of smell, which can worsen other underlying diseases and conditions (eg, chronic kidney failure, liver disease, or gastrointestinal disease).The main list of differential diagnoses, taking into account most of the possibilities, includes neoplasms of the nasal cavity, fungal rhinitis, nasopharyngeal polyp, dental diseases, and nasopharyngeal stenosis. The results of clinical examination were generally unremarkable, except for disorders limited to the upper respiratory tract.

The following structures should be carefully examined: dental arches (gingivitis, tooth root abscess, fistula between the oral and nasal cavities), hard palate (neoplasms, fistula between the nasal and oral cavities), soft palate (nasopharyngeal neoplasm or polyp) and regional lymph nodes ( lymphadenopathy).If cryptococcosis is suspected, fundus examination is recommended.

After chronic persistent rhinosinusitis has been established, further diagnostic studies should be carried out to exclude other treatable diseases and further clarify the existing disease. ¹² To assess overall health, a complete screening with serologic testing for viral leukemia and immunodeficiency in felines should be performed. After that, a complete examination of the oral cavity should be performed under anesthesia and an x-ray or computed tomography of the skull should be done.The pathological process often affects the nasal passages, paranasal sinuses and the tympanic bladder. Intraoral X-rays on dental plates often provide a fairly detailed image of both halves of the nasal cavity, although subtle changes in turbinate structure and differences in soft tissue X-ray density can be difficult to distinguish. Usually, examination by visual methods detects lysis of the nasal conchas of varying degrees and an increase in density due to fluid in the nasal cavity.Since the frontal sinuses in cats are small, pathological changes in these structures may not be noticed when projected for imaging the frontal sinuses. In general, computed tomography allows better localization of lesions and the extent of the process in the nasal cavity, paranasal sinuses and tympanic bladder than X-ray images. ¹⁶ Computed tomography often reveals such changes as darkening of the soft tissues of the nasal cavity and frontal or sphenoid sinus, lysis of the nasal and frontal bones, destruction of the turbinates and asymmetry of the perforated plate ^12,15,16 ( Fig.1 ). Computed tomography is also better suited for differentiating neoplastic and fungal diseases. However, computed tomography has the ability to better visualize bone structures, while magnetic resonance imaging has a feature of visualizing soft tissues. With an appropriate set of programs and the introduction of contrast, it is possible with the help of MRI to determine the nature of the pathological process much more accurately than with computed tomography. After completing the diagnostic procedures, it is necessary to examine the nasal cavity and the nasopharynx area as carefully as possible.The area of the nasopharynx and choana can be viewed with a flexible endoscope bent back along the caudal border of the soft palate.

Alternatively, the soft palate can be retracted cranially with a castration hook and a dental speculum inserted into the oropharynx to examine the nasopharynx area. Examination should be carried out carefully to identify possible masses protruding from the choanas, as well as neoplasms or foreign bodies in the nasopharynx.

A flexible endoscope or rigid arthroscopic equipment can be used for rhinoscopy of the rostral nasal cavity.Cats with chronic idiopathic rhinitis have mild to severe flushing of the nasal mucosa; Moderate to large-volume mucous or purulent discharge between the turbinates and destruction of the turbinates of varying severity (although the turbinates appear normal in some cats). ^12.16 The extent of the observed disturbances may be uneven in both halves of the nasal cavity. It should be understood that the appearance of the nasal cavity does not necessarily reflect the presence or absence of an underlying pathology.

Histological examination is critical. A biopsy of material from both halves of the nasal cavity is required. The visible changes can be very different from the changes found on histological examination. ¹⁷ In cats with relatively normal-looking nasal tissue, histological examination may show moderate to severe inflammation. Histological examination may reveal moderate to severe neutrophilic, lymphocytic, or mixed inflammation with epithelial ulceration, destruction and remodeling of the turbinates, fibrosis, necrosis, and glandular hyperplasia.Histological changes can be predominantly one-sided. Biopsies from the nasal cavity or material obtained by aspiration from deep layers should be sent for microbiological culture with determination of antibiotic susceptibility. In this case, culture for aerobic, anaerobic microorganisms and mycoplasmas should be requested. After nasal imaging and biopsy, the nasal cavity should be suctioned and flushed with plenty of warm isotonic solution to remove secretions and temporarily relieve clinical symptoms.When flushing the nasal cavity with fluids, the tip of the nose should be lowered, the trachea should be intubated with an inflated cuff to prevent aspiration of the wash solution and nasal secretions into the trachea. After the rhinoscopy, it is necessary to remove the accumulated discharge, blood.

It has been noted that idiopathic chronic rhinosinusitis in cats is often very difficult to treat. ¹² Broad-spectrum antibiotics are often used to treat secondary bacterial colonization or nasal and sinus infections.A recently published study showed that cats with idiopathic chronic rhinitis shed potentially pathogenic bacteria and more bacterial species than cats without signs of the disease. ¹⁵ In cats with idiopathic chronic rhinosinusitis, only Mycoplasma spp and anaerobic bacteria were isolated.

Antibiotic therapy should be selected based on the results of culture of biopsies from the nasal cavity or material obtained by deep lavage of the nasal cavity.Recommended antibiotics include doxycycline, clindamycin, amoxicillin-clavulanic acid, cefodoxime, marbofloxacin, and azithromycin. Cats with idiopathic chronic rhinitis that respond to initial therapy should continue treatment for 6 to 8 weeks or longer. Routine antiviral therapy is not recommended because the role of active viral infection in chronic idiopathic rhinosinusitis has not been established. There is no evidence of a major role for feline herpesvirus type 1 in this syndrome.¹⁵ However, it is likely that feline herpesvirus type 1 plays a role in the disease in certain cats. In some cases, lysine therapy (500 mg orally every 12 hours) is effective. Lysine replaces arginine in viral proteins, rendering them dysfunctional and therefore decreasing viral replication. Cats responding to lysine therapy can be used indefinitely as it is safe for both young and elderly cats. The role of immunosuppressants in the treatment of idiopathic chronic rhinosinusitis is not well understood.Glucocorticoids can aggravate a viral infection, promote virus shedding again, or suppress the immune response to a bacterial infection. Piroxicam is a non-steroidal anti-inflammatory drug that relieves clinical symptoms in some cases of chronic idiopathic rhinosinusitis. ¹² In general, piroxicam is well tolerated at a dose of 0.3 mg / kg orally once a day or every other day. Possible side effects include lack of appetite, diarrhea, or vomiting. Piroxicam can also be combined with antibiotic therapy.An increase in the moisture content of the discharge from the nasal cavity promotes sneezing and evacuation of mucus from the nasal cavity. Some cats tolerate nasal instillation of saline well. Finally, the benefits of immunostimulants (such as interferon) in the treatment of this disease have not been proven in clinical studies. ¹²

In summary, it should be noted that the prognosis for idiopathic chronic rhinosinusitis in cats is very cautious. Chronic nasal discharge and sneezing are very difficult to control, and if these symptoms still manage to be eliminated, it is often temporary and a relapse should be expected in the future.A number of surgical techniques have been described and are not recommended initially. However, ablation of the frontal sinus can sometimes control clinical signs, although it does not eliminate sneezing and nasal discharge. ¹² A possible complication of this procedure is loss of appetite due to loss of smell.

Neoplasms

Nasal neoplasms and idiopathic chronic rhinosinusitis are the most common causes of chronic rhinitis in cats. ¹ However, exceptions are possible, most often neoplasms occur in cats over 8 years of age.Lymphoma of the nasal cavity is the most common type, sometimes there are different types of cancer, and other neoplasms are much less common. In many cats with severe lymphocytic-plasmacytic rhinitis, the condition progresses to nasal lymphoma. It is likely that at the time of the initial diagnosis, the lymphoma was either in a precancerous state or at an early stage. In the case of severe lymphocytic-plasmacytic inflammation, immunohistochemical analysis should be done for markers of B and T cells to exclude lymphoma.

Lymphocytic-plasmacytic rhinitis

This is a relatively rare disease of unknown etiology in cats. ^3.18 There is usually no history of acute episodes of upper respiratory tract infection. The course of the disease is progressive, with minimal symptoms of nasal disease at an early stage. The diagnosis of lymphocytic-plasmacytic rhinitis should be made only after excluding all other causes of chronic rhinitis. Lymphocytic-plasmacytic inflammation can accompany other diseases, especially tumors.If the clinical picture is characteristic of a neoplasm, the diagnosis of lymphocytic-plasmacytic rhinitis should be made only preliminary; a second biopsy or rhinotomy is strongly recommended. Severe lymphocytic-plasmacytic inflammation may be associated with lymphoma or progress to lymphoma. Cats with severe lymphocytic-plasmacytic inflammation should have immunohistochemistry for B- and T-cell markers to rule out lymphoma.

Fungal rhinitis

Fungal infection is an uncommon cause of chronic rhinitis in cats, although it is common in some geographic areas.^8,9,19 The most common cryptococcosis of the nasal cavity, aspergillosis occurs only in rare cases. In cats with cryptococosis, deformities of the rostral nose are often conspicuous. Sometimes granulomatous tissue can be seen protruding through the nostrils. Clinical signs of cryptococcosis are obstructive rhinitis with mucopurulent nasal discharge. Some cats develop mucopurulent conjunctivitis. Cytological examination can be a very informative method for diagnosing cryptococcosis of the nasal cavity.Fresh material from nasal granulomas is gently smeared on glass and stained with Chinese ink. Cryptococcus spp . appear as thick, encapsulated round to oval yeast cells.

Aspergillosis of the nasal cavity is rare in cats. The initial clinical signs are profuse unilateral mucopurulent discharge from the nose. At a later stage, expirations can become double-sided. Periodic bleeding is not uncommon. The nose is often painful. As the disease progresses, anorexia and depression can develop, especially with damage to the frontal sinus and destruction of the maxillary bones.Strong destruction of the turbinates is found. Computed tomography is best for assessing the degree of destruction and determining the damage to the sinus or maxillary bone. The diagnosis of aspergillosis is made on the basis of direct detection of fungal plaques, fungal elements in biopsies or cytological preparations from the affected tissue, or a positive result of sowing the affected tissues on media for fungi.

Nasopharyngeal polyps

Polyps of the nasopharynx and (less often) polyps of the nasal cavity develop mainly in young cats and kittens.^2,4,18,20 Nasopharyngeal polyps can form in the middle ear and grow into the nasopharynx through the Eustachian tube. Sometimes polyps are visible in the ear canal. Clinical signs are due to direct obstruction of the oropharynx or nasopharynx. Chronic rhinitis develops secondarily against the background of nasopharyngeal polyps due to excessive bacterial growth due to a violation of the outflow of secretions from the nasal cavity. Clinical signs early in the disease include shortness of breath (sniffling sounds), gagging, minimal sneezing or nasal discharge.As the size of the polyps increases, airway obstruction and increased nasal discharge with sneezing appear. These symptoms may be indistinguishable from those of idiopathic chronic rhinitis, especially in young cats with previous acute upper respiratory tract infections. For this reason, any cat with chronic rhinitis (especially a young cat) should be closely examined for polyps.

Diagnosis of nasopharyngeal polyps is relatively simple. The diagnosis is made on the basis of the detection of a neoplasm during examination of the oropharynx and palpation of the area above the soft palate, or direct visualization of the nasopharynx area.Once a polyp is diagnosed, X-rays of the skull (under anesthesia) or computed tomography of the tympanic bladder area should be taken. MRI is preferable, since this pathology is often accompanied by inflammatory diseases of the brain with the development of neurological symptoms, which can lead to the death of the cat (Fig. 2-3).

Careful evaluation of the bony walls, tympanic bladder and petrosal part of the temporal bone is very important for detecting signs of inflammation of the middle ear or infection, in particular, thickening of the tympanic bladder, thickening of the bony wall of the tympanic bladder, the presence of material corresponding to the density of soft tissue in the tympanic cavity or sclerosis of the petrous part of the temporal bone.⁴ X-rays may not always show signs of inflammation or infection of the middle ear, while CT scans are more effective in detecting middle ear involvement.


Left (Fig. 2.) -Inflammatory process in the tympanic cavity (thick arrow) and brain tissue is indicated by thin arrows. Center and right (Fig. 3.) – Accumulation of contrast by the membranes of the brain (arrow).

Nasopharyngeal polyps can be removed by tearing; however, they often recur. ^4.20 An osteotomy of the tympanic bladder is definitely indicated and should be performed if there is evidence of middle ear involvement on x-rays or CT scans. There are recommendations for osteotomy of the tympanic bladder from the side of the polyp, even in the absence of changes in the bone tympanic bladder on X-ray images. In cases of recurrence of the polyp after rupture, an osteotomy of the tympanic bladder from the side of the polyp is always recommended to remove the site of polyp formation.

Rhinitis due to foreign body

Nasopharyngeal foreign bodies are uncommon in cats and are usually blades of grass trapped in the nasal cavity. ^6.7 Seeds and awns of plants are found less frequently. Clinical signs of a foreign body in the nasopharyngeal region are often hyperacute: cough, gagging, and severe, hard swelling. Over time, you may experience shortness of breath, voice changes, nasal discharge and sneezing. Clinical signs of a foreign body in the nasal passages can be acute or chronic and often consist only of sneezing and nasal discharge.If the foreign body is not removed from the nose immediately, the cat’s nose gradually increases, and a periodic admixture of blood often appears. With prolonged presence of a foreign body, a strong reaction in the form of granuloma formation is possible. Usually, foreign bodies enter the nasal cavity through the choanae. Foreign material is swallowed, and then exits as a result of vomiting or vomiting, spontaneously transported into the nasopharynx, and then into the caudal part of the nasal cavity through the choanae.

Blades of grass and similar material can usually be removed by direct examination of the nasopharynx or nasal cavity.A foreign body can be diagnosed using nasopharyngoscopy with an endoscope deployed 180 ^about. Alternatively, the soft palate can be pulled forward with the oophorectomy hook (with or without a speculum) to view the nasopharynx area. Flushing the nose with a large volume of warm saline helps to dislodge small particles (such as seeds) in the nasal cavity. The nose should be down and the caudal part of the oropharynx filled with gauze to avoid aspiration of solution and nasal discharge into the trachea.In cases with a long-term process and an excess of granulation tissue, or if a foreign body cannot be removed directly (for example, plant spines), rhinotomy may be required.

Stenosis of the nasopharynx

Nasopharyngeal stenosis is a rare complication of acute upper respiratory tract infections or episodes of severe vomiting (aspiration rhinitis). ¹ Usually characterized by progressively worsening snoring breathing sounds in the absence of nasal discharge. In severe stenosis, nasal discharge and extreme difficulty in nasal breathing are observed.Nasopharyngoscopy with an endoscope rotated 180 ^to often reveals annular strictures or narrowing of a limited area of the nasopharynx. The early stage of stenosis can be treated by stretching the affected area, followed by corticosteroid therapy to reduce the formation of scar tissue and restore the shape of the narrowed area. Unfortunately, relapses often occur, requiring extensive surgery to remove the narrowed area.

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