Frontoethmoiditis what is it

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Ethmoiditis: what is it, acute and chronic form

Ethmoiditis is a pathological process that is characterized by inflammation of the mucous membrane of the cells of the ethmoid labyrinth. This labyrinth is a component of the paranasal sinus and the ethmoid bone, which is concentrated deep in the skull at the base of the nose.

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The disease can occur alone or in combination with other concomitant sinusitis.

What kind of disease is this

Ethmoiditis is a disease that can be of bacterial or viral origin. It is classified into two main types - acute and chronic.

Acute ethmoiditis develops against the background of acute rhinitis or influenza. Most often, the inflammatory process occurring in other paranasal sinuses leads to repeated damage to the ethmoid labyrinth. If inflammation affects the maxillary and frontal sinuses, then damage may occur to the anterior cells of the ethmoid bone.

The photo shows what ethmoiditis looks like

Inflammation with ethmoiditis sharply attacks the deep layers of the mucosa. As a result, puffiness and diffuse swelling are observed. The opening between the cells of the ethmoid bone and their excretory tracts are reduced in size. All this leads to drainage.

Considering ethmoiditis, one cannot fail to note the main reasons for its formation. Viruses and bacteria that weaken the body’s defenses and nasal mucosa can affect the development of the disease.

Ethmoiditis can occur for the following reasons:

  • rhinitis and colds, as well as all ailments of viral etiology;
  • sinusitis of various types: fungal, viral and bacterial;
  • septal defects of a congenital or acquired nature;
  • rhinitis of allergic origin;
  • weakened immunity, unable to fight pathogens;
  • facial injuries.

Often the formation of ethmoiditis occurs against the background of influenza and scarlet fever. But still, most often the reason for the development of pathology lies in advanced frontal sinusitis or sinusitis. If the anterior parts of the ethmoid bone are introduced into the process, then the pathology is called frontoethmoiditis and maxillary ethmoiditis. The posterior areas of the bone are involved in the process when the disease is not treated properly and it is in an advanced form.

On video, detection of the disease ethmoiditis:

If the inflammatory process affects two sinuses at once, the disease is called pansinusitis or polysinusitis. It all depends on which cavities are involved in the inflammatory process.

Adenoid sinusitis is the result of growths in the nasal cavity. They prevent mucus from leaving the cells normally, resulting in excellent conditions for the formation of bacteria. There are certain situations when ethmoiditis itself becomes the cause of the formation of polyps. Then the pathology takes on a chronic form, and therapy comes down to surgery. There is no other way to cure the disease, since abnormal growths do not allow the nose to function normally.

Compared to a regular runny nose, ethmoiditis requires urgent treatment. This is due to multiple reasons. Firstly, an acute illness can develop into a chronic one, which is very difficult to treat. Secondly, ethmoiditis, in the absence of proper treatment, can provoke a number of complications that pose a danger to human life.

The most common complications include:

  • violation of the integrity of the ethmoid labyrinth;
  • decreased vision;
  • spread of the inflammatory process to intracranial areas, which may result in complications such as brain abscess or purulent meningitis.

Ethmoiditis can be classified according to the course, etiology and localization of inflammation

Acute course of the disease

The acute form of the disease has more vivid symptoms compared to the chronic form. But only the treatment of an acute illness is simpler. This is due to the fact that it is possible to recognize the symptoms of the pathology as early as possible and begin treatment at the initial stage.

The photo shows what acute ethmoiditis looks like

Acute ethmoiditis is characterized by the following symptoms:

  • severe pain in the head, concentrated in the nose, forehead and corners of the eyes;
  • difficulty breathing;
  • impaired sense of smell or complete loss of it;
  • temperature rise to 38 degrees.

In addition, in acute cases, the patient is bothered by a severe runny nose. But the discharge at the initial stage is serous, that is, there is no pus. Purulent discharge will be observed a little later, when the mucus is thick and green or yellow in color.

If ethmoiditis affects the patient for the first time, then if you consult a doctor in a timely manner, it can be cured quickly and without complications.

But with repeated damage, it is much more difficult to treat the disease, since it quickly becomes chronic. As a rule, complications can develop within two days.

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Which ointment under the nose for colds for children is the best and most effective, is indicated here: http://prolor.ru/n/lechenie-n/maz-ot-prostudy-v-nosu.html

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Chronic

This form of the pathological process is characterized by an unpleasant clinical picture, as well as the presence of complications. The disease becomes chronic due to improper treatment of acute ethmoiditis or weak immunity. Chronic ethmoiditis cannot be completely cured, so it will become a constant companion. It can occur in two stages - remission and exacerbation.

In the photo - chronic ethmoiditis

Symptoms during exacerbation are similar to the clinic of the acute phase of ethmoiditis. In the relief stage, the disease occurs without severe symptoms.

But some patients complain of the following symptoms:

  • discomfort in the root of the nose;
  • constant headaches;
  • purulent mucus coming out of the nose with a foul odor;
  • concentration of discharge in the nasopharynx;
  • nausea, which may lead to vomiting;
  • impaired smell function.

Chronic ethmoiditis is very dangerous, because a person can live with it for more than one year, believing that he has a chronic runny nose. The only way to get rid of the chronic form forever is to have surgery.

In addition, ethmoitis may vary according to the location of the pathology:

  • bilateral - damage is caused from both sides;
  • right-sided - inflammation affects only cells from the right area;
  • left-sided - inflammation affects cells from the left area.

The pathology may also vary according to the characteristics of its course:

Catarrhal

In the photo - catarrhal ethmoiditis

The reason for the development of pathology lies in the penetration of the virus. A characteristic feature of catarrhal ethmoiditis is lacrimation. The patient complains of symptoms of intoxication - headache, dizziness, general weakness, nausea.

Redness of the whites of the eye is observed. Situations cannot be ruled out when burst blood vessels are observed in the inner corner of the eye. Swelling that affects the bridge of the nose can spread to the corners of the eyes. The catarrhal form is characterized by a lack of sense of smell.

Polyposis

This type of ethmoiditis develops in a chronic form of the pathology. The reason for the development is long-term rhinitis. Swelling affects the mucous membrane and does not go away for a long time, sometimes affecting the ethmoid bone.

In the photo this is what polypous ethmoiditis looks like

The inner part of the cells is affected by polyps. They block the lumens, as a result of which the mucous membrane is swollen all the time. Patients may go into remission during which they remain symptom-free. Nasal breathing is restored. But to influence the exacerbation of a cold.

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What causes of swelling of the nasal mucosa without a runny nose are most common, and how such problems can be eliminated, is described in great detail in this article.

Purulent

This form of acute ethmoiditis is the most complex and dangerous. Its clinical manifestations are pronounced, with a rise in temperature up to 40 degrees. There is severe pain in the forehead and bridge of the nose, galls and teeth. The patient has increased lacrimation. It will also be interesting to learn about why pus and purulent plugs appear in the tonsils.

The photo shows purulent ethmoiditis

The general condition of the patient is worsened by general signs of poisoning.

Ethmoiditis is a serious disease in which inflammation affects the ethmoid bone. It can occur in two forms - acute and chronic. Each of them has its own symptoms and treatment methods. Complications of the pathology are quite serious, so treatment should not be delayed.

Source: http://prolor.ru/n/bolezni-n/etmoidit/chto-eto-takoe.html

What is ethmoiditis, characteristic symptoms in adults, diagnosis and treatment

Ethmoiditis is an inflammation of the mucous epithelium that lines the cells of the ethmoid bone located in the back of the nasal cavity.

The ethmoid bone (ethmoid labyrinth) is located between the orbits, which is why the inflammatory process can cause a host of dangerous diseases.

For example, the acute form of the disease often causes sinusitis. This is explained by the close location of the ethmoid bone to the frontal sinus, due to which inflammation leads to blockage of the frontal sinus, as well as the passage of the trigeminal nerve through it.

Ethmoiditis, being a form of sinusitis, is one of the most common diseases of the nasal cavity. The disease occurs as a result of viral, bacterial and fungal infections.

Spreading

Ethmoiditis is a non-contagious disease. In modern medical practice, the dependence of its occurrence on the place of residence is not considered. If the disease occurs quite often in children, then in adulthood about 15% of people are susceptible to it. The acute form of ethmoiditis is more often observed in the autumn-winter period and is classified by most specialists as ARVI.

If there is insufficient outflow of pus, the inflammatory process spreads to the orbital tissue, as a result of which the patient may develop diseases of the eyeball, severe swelling of the eyelids and some other unpleasant symptoms.

Origin of the disease

The ethmoidal (ethmoid) bone is an unpaired rectangular air-bearing bone responsible for the formation of the facial part of the skull. Inside it contains many air-containing cavities covered with mucous membrane. These cavities are connected by air cells, which become inflamed when ethmoiditis occurs.

The inflammatory process, as a rule, occurs against the background of influenza, adenovirus, fungal and rhinovirus infections, as well as some other acute respiratory viral infections.

During the development of infection, inflammation quite often covers the cells of the ethmoid labyrinth. In practice, this happens as follows: harmful microorganisms that get onto the surface of the cells multiply and infect the cells of the mucous membrane, gradually penetrating deep into the tissues. At this moment, the first signs of the disease appear.

Developing pathological changes lead to a decrease in fluid exchange in the ethmoid labyrinth. Ultimately, if the disease is completely ignored, pus can affect the cranial cavity and the surface of the orbit, which entails dangerous consequences.

Causes of ethmoiditis

A variety of factors can contribute to the occurrence of ethmoiditis in adults, ranging from the congenital narrowness of the openings of the cells of the ethmoid labyrinth to weak immunity, as well as the course of infectious diseases. In general, modern medicine considers the following factors among the most likely causes of ethmoiditis:

  • Runny nose associated with inflammatory processes in the nasal cavity caused by bacterial, viral and fungal infections;
  • the presence of sinusitis, regardless of its type;
  • allergic rhinitis and other chronic pathologies that affect the general condition of the nasal cavity;
  • weakened immune system;
  • facial injuries, anatomical abnormalities of the nasopharynx (congenital or acquired).

Quite often, inflammation occurs against the background of respiratory infections, such as scarlet fever, for example. Quite often, neglected sinusitis or frontal sinusitis turns into ethmoiditis. In this case, a diagnosis of sinusroethmoiditis or frontoethmoiditis is made.

Main symptoms of the disease

The acute form often occurs as a complication of ordinary rhinitis or flu. In medical practice, two types of acute course of the disease are distinguished:
  • Primary ethmoiditis, characterized by severe symptoms;
  • secondary, which often leads to serious complications.

General symptoms of the acute form:

  • Headache;
  • difficulty breathing through the nose;
  • discomfort and pain in the area of ​​the bridge of the nose and root of the nose;
  • elevated temperature (usually 37.5-38 degrees, but possible increase to 39-40°);
  • copious discharge from the nasopharynx - at the very beginning of the disease, serous without a specific odor, later serous-purulent.

Symptoms of primary ethmoiditis, as a rule, begin with a sharp deterioration in health, which is accompanied by an increase in body temperature, nausea and a gag reflex. It may also be accompanied by neurotoxicosis, exicosis and toxicosis.

The secondary form is more severe than the primary one and is characterized by rapid development. The first signs of complications may appear on the second or third day of illness. The course is often accompanied by severe septic processes, toxicosis, and parenteral dyspepsia. Orbital symptoms, as a rule, manifest themselves in pain with infiltration of the eyelids, a decrease in the palpebral fissure, a change in the shade of the skin, and difficulty moving the eyeball.

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Chronic ethmoiditis is a consequence of the acute form. It usually develops with improper or untimely treatment or in patients with low immunity.

During exacerbation, the chronic form is characterized by the same symptoms as the acute one. When remission occurs, patients complain of headaches that occur from time to time, pain in the area of ​​the bridge of the nose and the root of the nose, slight discharge from the nasopharynx, and when the infection spreads to the posterior cells of the ethmoid labyrinth and expectoration of discharge in the morning. Also, the chronic form often causes a deterioration in a person’s general condition and a decrease in his performance.

Diagnostic methods

Diagnostic methods are usually based on the results obtained from x-ray examination and clinical manifestations. An x-ray of a sick person shows darkening of the cells of the ethmoid bone. It is also possible to detect darkening of some adjacent sinuses.

Differential diagnosis

The most common diseases with which ethmoiditis can be confused are:

  • Osteomyelitis of the upper jaw, the main symptom of which is redness and swelling of the tissues of the eyelid and face;
  • periostitis of the nasal bones, characterized by the occurrence of inflammatory processes in the periosteum or periosteum;
  • dacryocystitis - inflammation of the lacrimal sac;
  • tooth damage;
  • Erysipelas – redness and swelling of the facial skin.

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Treatment methods for ethmoiditis

The acute form usually responds to drug treatment. In the first days, it is necessary to ensure the outflow of secretions. This is achieved through:

  • Combined drugs;
  • vasoconstrictor drops;
  • installation of cotton-gauze turundas with adrenaline solution into the nasal cavity.

To maintain immunity, it is advisable to take immunomodulatory drugs together with vitamin complexes. Additionally, the doctor prescribes antihistamines. For severe pain, paracetamol-based anti-inflammatory drugs are prescribed.

Physiotherapy

For supportive purposes, the following procedures may be applied:

If conservative treatment is ineffective, the attending physician decides on the need for surgical intervention. As a rule, a low-traumatic endoscopic method is used. Open surgical access to the ethmoidal labyrinth is necessary only in extreme cases.

Depending on the results of radiography and clinical manifestations, a decision is made to perform polypotomy, opening of problematic cells, as well as partial resection of hyperplastic areas during the transition to the acute phase, and drug treatment is prescribed.

Prevention

Since the ethmoiditis in question often occurs as a result of the activity of pathogenic microorganisms and viruses, its prevention consists of general measures to strengthen the immune system and prevent respiratory infections.

Disease prognosis

For the acute form of ethmoiditis, subject to immediate, comprehensive treatment, a positive prognosis is built. Usually, all symptoms disappear without leaving a trace, without causing any serious complications.

The prognosis for the chronic form is much worse.

Although ethmoiditis is a dangerous disease, with proper treatment it goes away without consequences. The main thing is not to miss the moment of the onset of the disease, because every missed day increases the chances of ethmoiditis transitioning to the chronic stage.

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Source: http://www.pulmonologiya.com/lor-zabolevaniya/pazuhi/sinusit/etmoidit.html

Ethmoiditis: causes, signs, how to treat, antibiotics

Ethmoiditis is a special form of sinusitis, characterized by the development of a pathological process in the ethmoid labyrinth. It is part of the ethmoid bone, which separates the skull from the nasal cavity. The labyrinth is a paired formation consisting of air cells, the mucous membrane of which becomes inflamed when infected.

Inflammation of the ethmoid sinuses often develops against the background of acute respiratory infections, rhinitis, sinusitis, frontal sinusitis, adenoiditis, measles or scarlet fever. Ethmoiditis usually affects children of preschool and primary school age. In newborns and adults, pathology is rarely diagnosed. A decrease in the general resistance of the body and frequent viral diseases of the nasopharynx contribute to the development of the disease.

Etiology and pathogenesis

Bacterial ethmoiditis is caused by opportunistic microorganisms - representatives of coccal microflora: staphylococci and streptococci. The causative agents of viral ethmoiditis are influenza viruses, parainfluenza, rhinoviruses, adenoviruses, and coronoviruses. The cause of the disease is often pathogenic fungi.

Often, several pathogenic agents are simultaneously detected in the studied biological material taken from a sick person. In this case, they talk about a mixed infection.

Dysfunction of the immune system and weakening of the body's defenses contribute to the rapid growth and reproduction of microbes.

Ethmoiditis in adults is a complication of infectious pathology of the ENT organs: sinusitis or rhinitis. In newborns, the disease develops against the background of a generalized bacterial infection - intrauterine sepsis.

adenoids and polyps are a possible cause of ethmoiditis

The main causes of ethmoiditis:

  • Viral, bacterial and fungal infections;
  • Inflammation of the nasal mucosa and paranasal sinuses;
  • Diseases of the nasopharynx;
  • Congenital pathologies of the nose;
  • Allergic rhinitis;
  • Polyps, adenoids;
  • Defects of the nasal septum;
  • Nose fracture;
  • Immunodeficiency.

Ethmoiditis often becomes a complication of advanced sinusitis, sphenoiditis or frontal sinusitis. The spread of inflammation to the anterior sections of the ethmoid bone leads to the formation of frontoethmoiditis and maxillary ethmoiditis. Simultaneous damage to two or more paranasal sinuses is called pansinusitis or polysinusitis.

The causes of polypous ethmoiditis are adenoids or polyps - growths present in the nasal cavity. They prevent the normal outflow of mucus from the ethmoid labyrinth and create optimal conditions for the life of microbes. Chronic polypous ethmoiditis can only be treated surgically, allowing the normal functioning of the nose to be restored.

Classification of ethmoiditis

  1. According to the nature of the course, ethmoiditis is divided into acute and chronic.
  2. Based on the localization of the pathological process, left-sided, right-sided and bilateral ethmoiditis are distinguished.
  3. Based on the nature of the discharge, ethmoiditis is divided into catarrhal, purulent, edematous-catarrhal, and polypous.
  4. The disease can be primary or secondary. Primary ethmoiditis begins acutely with a sharp rise in temperature to significant numbers, the appearance of symptoms of dyspepsia and intoxication. Secondary ethmoiditis is a complication of an existing pathology in the body.

Clinical picture

Acute ethmoiditis begins suddenly, is severe and has characteristic symptoms.

  • The pain syndrome is manifested by a pressing headache, the intensity of which increases when the head is tilted.
  • Intoxication syndrome - fever, weakness, fatigue, impaired appetite and sleep, decreased performance.
  • Impaired nasal breathing, manifested by nasal congestion, decreased or absent sense of smell, and serous nasal discharge. When a bacterial infection occurs, the mucus thickens, the discharge becomes yellow-green and acquires an unpleasant odor. This is how purulent ethmoiditis develops.

The disease, which occurs for the first time, responds well to therapy and resolves without complications. Each subsequent case is much more severe than the previous one, is poorly treated and becomes chronic.

Symptoms of ethmoiditis in children:

  1. Increase in body temperature to febrile values,
  2. General anxiety
  3. Vomit,
  4. Regurgitation.

In the absence of timely and adequate treatment, dehydration occurs and neurotoxicosis develops. The disease is often accompanied by symptoms of eye damage: swelling and redness of the eyelids, narrowing of the palpebral fissure, poor mobility of the eyeball, exophthalmos.

Acute ethmoiditis often becomes chronic. This process is facilitated by decreased immunity and ineffective treatment. In chronic ethmoiditis, exacerbations are replaced by remissions.

During an exacerbation, patients are concerned about:

  • Pressing and bursting pain near the bridge of the nose;
  • Pain in the inner corner of the eye;
  • Serous or purulent discharge from the nose;
  • Swelling of the eyelids;
  • Decreased sense of smell;
  • Signs of intoxication are low-grade fever and deterioration of general condition.

During remission, the intensity of intoxication and pain syndrome weakens, and headaches occur periodically. Nasal discharge becomes scanty serous-purulent. Patients complain of stagnation of discharge in the nasopharynx and decreased sense of smell.

possible ocular manifestations of advanced ethmoiditis

Chronic ethmoiditis is dangerous because a person does not suspect the presence of a serious illness for a long time and treats a common cold. As a result, the inflammation does not go away, and the risk of developing complications steadily increases every day.

Complications

Ethmoiditis is a serious pathology that requires immediate treatment. The acute form of the disease quickly becomes chronic, which is difficult to treat and leads to the development of dangerous complications.

  1. The destruction of the ethmoid labyrinth and the formation of empyema often ends with the breakthrough of pus through the orbit into the cranial cavity. Patients have fever and signs of damage to intracranial structures.
  2. Cellulitis and retrobulbar abscess are formed as a result of the transition of inflammation from the mucous membrane of the ethmoid sinuses to the orbit. Symptoms of these pathologies are severe pain, swelling of the eyelids, changes in the position of the eyeball and decreased visual acuity.
  3. Meningitis, arachnoiditis and brain abscess are intracranial complications of ethmoiditis associated with purulent inflammation of the meninges.

Features of the disease in children

In newborns and infants, ethmoiditis is an exclusively independent disease. The frontal sinus in children is finally formed only by the age of 3. The cause of the disease in infants is sepsis. The spread of infection occurs by hematogenous route.

Preschoolers and schoolchildren are often diagnosed with a combined pathology - sinusitis or frontoethmoiditis. These diseases are manifested by a runny nose, fever, deterioration in general condition, swelling of the eyelids, displacement of the eyeball, pain at the inner corner of the eye, vomiting and diarrhea.

Diagnostics

The otorhinolaryngologist, after listening to the patient’s complaints and studying the history of life and illness, makes a preliminary diagnosis and proceeds to a physical examination of the patient.

Signs of the disease detected during examination of the patient are infiltration of soft tissues in the affected area and swelling of the eyelids.

Palpation of the medial corner of the eye and base of the nose is moderately painful.

Additional research methods:

  • Characteristic inflammatory signs are detected in the patient’s blood: neutrophilic leukocytosis with a shift to the left, increased ESR. In the chronic form of the disease, this analysis is not very informative.
  • Anterior rhinoscopy can detect hyperemia, swelling of the nasal mucosa, and narrowing of the nasal passages.
  • X-ray and computed tomography are the main diagnostic methods to detect darkening of the affected sinus.

ethmoiditis on x-ray

Treatment

Drug treatment

  1. The main method of conservative treatment of ethmoiditis is antibiotic therapy. To prescribe an effective drug, it is necessary to determine the causative agent of the disease and its sensitivity to antibiotics. For this purpose, the patient is sent to a microbiological laboratory to have the throat and nasal discharge analyzed for microflora. Good results in the treatment of ethmoiditis are obtained by using broad-spectrum antibiotics - Amoxicillin, Amoxiclava, Cefotaxime, Cefazolin.
  2. Patients with ethmoiditis undergo anti-inflammatory therapy aimed at reducing pain. For this purpose, non-steroidal anti-inflammatory drugs are prescribed - Paracetamol, Cefekon, Ibuklin.
  3. To strengthen the immune system and increase the overall resistance of the body, patients are recommended to undergo a course of treatment with immunomodulators - Ismigen, Imunorix, Immunal.
  4. To reduce swelling of the mucous membrane, it is necessary to use vasoconstrictor nasal drops based on Xylometazoline or Oxymetazoline, combined medications - Polymyxin, Rinofluimucil. Patients are prescribed hyposensitizing drugs for oral administration - “Cetrin”, “Erius”, “Suprastin”.
  5. Rinsing the paranasal sinuses with medications gives good results. The lavage procedure is carried out with a YAMIK sinus catheter, which sucks out the exudate and flushes the sinuses with medicinal substances. The procedure is repeated until a clear liquid appears.

Physiotherapy

Physiotherapeutic procedures are carried out after signs of acute inflammation have reduced. Patients are recommended the following types of effects on the affected sinuses: UHF, phonophoresis, electrophoresis, ultrasound with antibiotics or hydrocortisone.

Surgery

Surgery is indicated in cases where conservative therapy is ineffective and the patient develops severe complications.

Endoscopic operations are performed under local anesthesia. To do this, use a flexible probe, which is inserted into the cavity of the ethmoid bone. All manipulations are performed under visual control.

Chronic ethmoiditis is often treated surgically. Patients undergo septoplasty or removal of polypous growths.

ethnoscience

Folk remedies are complementary in the treatment of ethmoiditis.

  • At home, to treat the disease, drops are prepared from onion, aloe and honey, taken in equal proportions. The product is instilled into the nose 3 times a day for a week.
  • Laundry soap is mixed with half a teaspoon of honey and 2 tablespoons of milk. The resulting mixture is heated in a water bath until a homogeneous mass is obtained. These drops are designed to thin and remove mucus from the sinuses.
  • Beetroot, carrot juice and melted honey are mixed in equal proportions and dropped into the nose.
  • A mixture of celandine and cyclamen juice stimulates the sneezing reflex, which clears mucus from the nose and sinuses.

Prevention

There is no specific prevention, since the causative agents of etomiditis are very diverse. To prevent the disease it is necessary:

  1. Maintain the immune system at an optimal level,
  2. Take vitamin-mineral complexes and immunomodulators periodically,
  3. Avoid drafts and hypothermia,
  4. Get vaccinated against influenza in a timely manner,
  5. Carefully treat acute sinusitis,
  6. Sanitize existing foci of infection in the body,
  7. When the first signs of an acute runny nose appear, contact a specialist immediately.

Acute or chronic ethmoiditis - what is it?

Ethmoiditis - what is it? This is not an uncommon question, because the disease occurs quite often, but its name is little known to those who are lucky enough not to encounter it. Usually everyone hears sinusitis and sinusitis, less often frontal sinusitis, but when a diagnosis of acute ethmoiditis is made, the patient is lost. In fact, this ENT pathology is well known to doctors, studied and treatable.

Ethmoiditis is called inflammation of the mucous membrane of the posterior parts of the nose: the ethmoid sinus. This formation is located in the anterior base of the skull, its projection on the face is a depression on the bridge of the nose, between the eyebrows and eyes. It is in this place that, at the onset of the disease, aching pain is felt, which forces the patient to see a doctor.

Causes and symptoms of ethmoiditis

The causative agents of the disease can be viruses (influenza or ARVI), pathogenic fungi and bacteria (staphylococci or streptococci). There are known cases of detection of pathogens of different nature in the analysis of discharge.

Most often, viruses and bacteria penetrate this area hematogenously, that is, through the bloodstream, and much less often through other routes. Therefore, acute ethmoiditis can be considered one of the complications of acute respiratory infections, influenza, and other infectious diseases.

Factors that provoke ethmoidal sinusitis (ethmoiditis) can be very different. Among them are the infections mentioned above, allergic rhinitis, chronic diseases of the nasal mucosa (sinusitis, sinusitis, etc.), injuries. The first signs of incipient ethmoid sinusitis:

  • headache;
  • aching pain at the root of the nose, in the bridge of the nose, at the inner edge of the eye on one or both sides;
  • breathing through the nose is usually difficult;
  • there is a lack of sense of smell or its impairment;
  • temperature rise to 38°C;
  • nasal discharge: first serous, then serous-purulent, odorless.

The child may experience swelling and redness at the inner corner of the eye, on the eyelids.

The disease is classified depending on the characteristics of its course. The following varieties are distinguished:

  1. Polypous ethmoiditis is chronic and occurs as a result of a prolonged runny nose. In this case, swelling of the mucous membrane persists for a long time, covering the area of ​​the ethmoid bone. Polyps growing inside the cells completely block the lumens and ensure constant swelling of the mucous membrane. This form is characterized by remissions, during which the symptoms of ethmoiditis are practically not manifested and breathing through the nose is free. An exacerbation occurs against the background of ARVI with characteristic symptoms.
  2. Catarrhal ethmoiditis is caused exclusively by viruses and is characterized by profuse lacrimation; signs of intoxication also appear (nausea, cephalic lobes, weakness, dizziness). Noticeable swelling appears on the bridge of the nose, extending to the corners of the eyes. The whites of the eyes appear red and there may be broken capillaries in the inner corner of the eye. The sense of smell is often completely absent.
  3. The purulent form of the disease manifests itself as acute ethmoidal sinusitis with pronounced symptoms and an increase in temperature to high numbers (39-40 ° C), general intoxication of the body, pain in the bridge of the nose and frontal lobes, eyes, teeth. There are signs of a catarrhal process in the form of profuse lacrimation.

Swelling of the mucous membrane of the ethmoid labyrinth in the catarrhal form leads to disruption of the outflow of mucus from the organ into the nasal cavity or nasopharynx. The attached bacterial infection causes suppuration and the transition of the disease to a purulent form. The formation of pus leads to the melting of bone tissue and the formation of empyema. This aggravates the inflammation and, when pus breaks through, can cause the process to spread to neighboring areas: the eye sockets, the cranial cavity. In this case, there is a sharp deterioration in the patient’s condition with an increase in body temperature, signs of inflammation of the orbit (exophthalmos - protrusion of the eyeball) or intracranial diseases (meningitis, arachnoiditis, brain abscess, etc.) appear. In patients with reduced immune function of the body, acute ethmoiditis passes into the chronic phase.

How to diagnose ethmoidal sinusitis?

Based on the results of the examination, a preliminary diagnosis is established. In this case, swelling may be noted at the inner corners of the eyes, and during rhinoscopy, the doctor will note swelling of the nasal concha in the middle part, their redness and characteristic discharge. When palpating (feeling, pressing) the bridge of the nose, the patient will feel pain in the affected areas.

An endoscopic examination will help determine the localization of inflammation in the anterior or posterior cells of the ethmoid bone, and determine the presence of polypous growths in the cells. The diagnosis can only be definitively confirmed by radiographic or tomographic examination. In this case, the photographs will show a noticeable darkening in the area of ​​the bridge of the nose (Fig.). Thus, making an independent diagnosis, even if it corresponds to the described symptoms, may turn out to be erroneous, and the resulting self-medication will bring nothing but harm. Acute ethmoiditis should be treated only as directed and under the supervision of an otolaryngologist to avoid complications.

Treatment of ethmoidal sinusitis

The acute form of the disease and exacerbation of the chronic phase are treated with the same methods.

To successfully help the patient, it is necessary to restore the normal outflow of secretions from the mucous membrane of the ethmoidal labyrinth and relieve swelling.

To do this, vasoconstrictors are prescribed (xylometazoline, oxymetazoline, etc.), and an adrenaline solution is injected into the nasal cavity using cotton-gauze turundas. To reduce swelling, antiallergic drugs (Cetrin, Aleron, Erius, etc.) can also be prescribed.

If the test results indicate a bacterial etiology of the disease, the doctor will definitely prescribe antibiotics. In a hospital setting, they can be prescribed in the form of injections, but during outpatient treatment, the patient must take the pills independently, following the doctor’s instructions as accurately as possible. By interrupting treatment before the end of the course, the patient risks causing bacteria to become addicted to this drug, which can cause a relapse of the disease later. In this case, the previously prescribed drug may be ineffective.

The patient's paranasal sinuses are treated with antibiotic solutions or antiseptics using a YAMIK sinus catheter or other modifications. During the procedure, the fluid from the cells of the ethmoid bone is sucked out with a device and the cavities are washed with appropriate solutions until the fluid becomes clear.

For severe pain, paracetamol (Panadol, paracetamol, etc.) or ibuprofen (Nurofen, Brufen, Ibuprom, etc.) are prescribed. An additional effect of these drugs is their anti-inflammatory and antipyretic effects. To maintain the immune status of the body, immunomodulators (immunal, ribomunil, echinacea preparations and others) and vitamin-mineral complexes can be used.

After the acute period of the disease subsides, treatment will be supplemented with physiotherapeutic methods:

  • electrophoresis with antibacterial drugs;
  • phonophoresis;
  • UHF therapy.

When is surgery indicated?

Surgical treatment of ethmoiditis is performed in cases of purulent complications or in the absence of relief with drug therapy. Surgery is usually performed using endoscopy. Penetrating the nasal passages naturally, the surgeon performs the necessary actions under the control of a video camera. Recovery after such an operation occurs in a fairly short time and complications in the postoperative period are rare. The extranasal method of surgical intervention is used extremely rarely, in very severe and advanced cases.

For the treatment of the chronic form of the disease, surgical treatment is more suitable. It is used to relieve a person of the cause of a permanent source of inflammation (polyps, deviated nasal septum, hyperplasia of the middle turbinate area or other causes). In this case, the operation is performed using endoscopy and does not leave a mark on the face.

It is impossible to prevent the occurrence of acute ethmoiditis using specific prophylaxis: a variety of microorganisms can become the causative agent. The only form of prevention can be called timely treatment of influenza and acute respiratory infections, bacterial infections of the nasopharynx. With inadequate and untimely treatment, they most often lead to inflammation of the paranasal sinuses and the mucous membrane of the ethmoid labyrinth.

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Ethmoiditis: symptoms and treatment

Ethmoiditis is an acute or chronic inflammation of the mucous membrane of the cells of the ethmoid labyrinth. This labyrinth is one of the paranasal sinuses and is part of the ethmoid bone, located deep in the skull at the base of the nose. It can occur as an independent disease, but more often it is accompanied by other sinusitis - sinusitis, frontal sinusitis, sphenoiditis. Ethmoiditis most often affects preschool children, but it can be diagnosed in both newborns and adult patients. We will talk about what kind of disease this is, why it occurs and how it manifests itself, as well as the main diagnostic methods and principles of treatment of ethmoiditis. So…

Etiology (causes of occurrence) and mechanism of development of ethmoiditis

The main causative agents of this disease are ARVI viruses - influenza, parainfluenza, adenovirus and rhinovirus infections, bacteria (mainly from the group of cocci - staphylococci and streptococci), as well as pathogenic fungi. There are frequent cases of so-called mixed infection: when several infectious agents are detected in the material taken from the affected cells of the ethmoid labyrinth.

Ethmoiditis rarely develops primarily - in children of preschool, school age and adults it is usually a complication of other infectious diseases of the ENT organs: rhinitis, sinusitis, in newborns - against the background of intrauterine, skin or umbilical sepsis.

Infection in the ethmoid sinus spreads more often by hematogenous (through the bloodstream), less often by contact.

Factors predisposing to the development of ethmoiditis are:

  • structural features of the nasopharynx (excessively narrow outlet openings of the cells of the ethmoidal labyrinth, narrow middle nasal meatus);
  • adenoid vegetations;
  • traumatic injuries to the face (for example, a broken nose or deviated nasal septum);
  • allergic diseases of the nasopharynx (allergic rhinitis, sinusitis);
  • chronic infectious processes in the nasopharynx (chronic pharyngitis, rhinitis, sinusitis, etc.);
  • congenital and acquired immunodeficiencies.

The inflammatory process from nearby organs spreads to the cells of the ethmoid labyrinth: in case of inflammation of the maxillary and frontal sinuses, the anterior cells are primarily affected, and in the case of inflammation of the mucous membrane of the sphenoid sinus, the posterior cells are affected. Microorganisms, once on the mucous membrane of the cells, multiply and damage its cells, penetrating deep into the tissues - signs of inflammation appear (the mucous membrane is swollen, hyperemic, the lumens of the cells and their excretory ducts are significantly narrowed). These changes lead to disruption of the outflow of fluid from the ethmoid labyrinth, and in children they also contribute to the transition of the pathological process to the bone with its subsequent destruction, resulting in purulent complications of ethmoiditis - abscesses, fistulas, empyema. If left untreated, the pus can spread into the eye socket or cranial cavity, also causing life-threatening complications.

Classification of ethmoiditis

As mentioned above, according to the nature of the course, acute and chronic ethmoiditis are distinguished.

Depending on the morphological characteristics of the disease and the nature of the discharge, the following types are determined:

The last 2 types are characteristic of the chronic form of the disease.

Depending on the side of the lesion, inflammation of the mucous membrane of the cells of the ethmoidal labyrinth can be:

Clinical signs of ethmoiditis

The acute form of the disease occurs suddenly and is characterized by pronounced symptoms.

One of the symptoms of ethmoiditis is nasal congestion.

Adult patients complain of intense, pressing headaches with a predominant localization in the base of the nose and orbit, which intensify when the head is tilted forward and down. In addition, patients are concerned about difficulty in nasal breathing, a feeling of nasal congestion, mucous, mucopurulent or purulent discharge from the nose, decreased sense of smell or its complete absence. In addition to local symptoms, patients note the presence of signs of general intoxication of the body: an increase in body temperature to subfebrile, less often febrile, numbers, general weakness, decreased performance, poor appetite and sleep.

In adult patients with reduced immunity and in pediatric patients, part of the bone may be destroyed by purulent masses and penetrate into the tissue of the orbit. Manifestations of this are hyperemia and swelling of the inner corner of the eye, the medial part of the upper and lower eyelids, deviation of the eyeball outward, its protrusion (exophthalmos), pain during eye movement, and decreased visual acuity.

In newborn children, ethmoiditis is much more severe than in other patients. The disease begins with a sharp increase in temperature to febrile levels. The child is restless, refuses to eat, does not digest the food he eats - vomiting and regurgitation appear. If assistance is not provided in a timely manner, signs of dehydration and neurotoxicosis develop. In addition, clear eye symptoms are revealed: the eyelids are hyperemic or cyanotic, sharply swollen, infiltrated; the palpebral fissure is tightly closed; the eyeball is motionless, protruding.

Chronic ethmoiditis develops with untimely and inadequate treatment of the acute form of the disease, with frequent infections of the ENT organs, as well as against the background of a decrease in the immune status of the body.

Chronic ethmoiditis, as a rule, proceeds latently, with alternating periods of exacerbation and remission. During an exacerbation, the patient may complain of:

  • a feeling of heaviness or moderately intense pressing pain in the area of ​​the root of the nose and bridge of the nose, which intensifies when the head is tilted forward and down;
  • copious mucous or mucopurulent discharge from the nose;
  • decreased sense of smell;
  • swelling of the upper eyelid and forward displacement of the eyeball;
  • soreness at the medial corner of the eye and in the root of the nose;
  • symptoms of intoxication: increased body temperature to low-grade levels, lethargy, weakness, fatigue.

As for the symptoms of intoxication, they do not leave the patient even during the period of remission of the disease. In addition, these symptoms gradually worsen, become more pronounced and, in some cases, significantly reduce the quality of life. Remission is also characterized by mild pain of uncertain localization, scanty discharge of a serous-purulent or purulent nature, and impaired sense of smell to varying degrees.

Complications of ethmoiditis

When purulent masses spread to nearby organs, the following complications may develop:

  • if the orbit is affected - retrobulbar abscess, empyema or orbital phlegmon;
  • with damage to intracranial structures - arachnoiditis (inflammation of the arachnoid membrane of the brain), meningitis (inflammation of the soft meninges), brain abscess.

Diagnosis of ethmoiditis

An otolaryngologist can diagnose this disease. A preliminary diagnosis is established on the basis of the patient’s complaints, the history of the disease (under what conditions it arose) and life (the presence of concomitant pathology that affects the immune status of the body), and the results of a physical examination.

During an external examination, the doctor can detect infiltration and swelling of the medial (inner) corner of the eye, upper and lower eyelids.

When performing anterior rhinoscopy (examination of the nasal cavity), hyperemia and swelling of the mucous membrane of the middle turbinate and mucopurulent discharge from under it are noticeable.

By palpation in the area of ​​the root of the nose and the medial corner of the eye, the patient will note moderate pain.

Examination of the nasal cavity using an endoscope allows one to reliably determine the condition of the mucous membrane of the area where the cells of the ethmoidal labyrinth exit and determine the source of purulent masses - the anterior or posterior cells. In chronic ethmoiditis, this research method can detect polypous growths of various sizes around the outlet openings of the cells of the ethmoid labyrinth.

Of decisive importance in the diagnosis of ethmoiditis is an x-ray examination of the area of ​​the paranasal sinuses - the image will reveal darkening in the area of ​​the cells of the ethmoid bone. Computed tomography will also be highly informative in this case.

Differential diagnosis of ethmoiditis

The main diseases with which ethmoiditis should be differentiated are periostitis of the nasal bones, osteomyelitis of the upper jaw and dacryocystitis.

Periostitis of the nasal bones is an inflammation of the periosteum, or periosteum, as a result of injury or as a complication of an infectious disease. Signs of this disease are deformation of the external nose, intense pain, sharply intensifying during palpation examination.

Osteomyelitis of the maxilla is a disease usually diagnosed in young children. It manifests itself as swelling and infiltration of the soft tissues of the face in the area of ​​the alveolar process of the upper jaw and swelling of the lower eyelid. There is no redness of the eyelid and tissues above the upper jaw.

Dacryocystitis is an inflammation of the lacrimal sac located between the bridge of the nose and the inner corner of the eyelids, resulting from obstruction of the nasolacrimal duct. This disease is diagnosed in both adults and children. Its characteristic signs are a palpably painful rounded protrusion in the area of ​​the inner edge of the lower eyelid, the inability to produce tears on the affected side, as well as swelling and redness of the soft tissues in the medial corner of the eye.

Treatment of ethmoiditis

To completely get rid of ethmoiditis and avoid the development of complications of the disease, it is necessary to begin comprehensive treatment immediately after diagnosis.

The principles of treatment of acute and exacerbation of chronic ethmoiditis are similar.

First of all, it is necessary to restore the outflow of fluid from the lattice labyrinth and normalize air exchange in its cells. To do this, you need to reduce the swelling of the mucous membrane, which is achieved by using vasoconstrictor nasal drops (xylometazoline, oxymetazoline), special combination drugs (polymyxin with phenylephrine, Rinofluimucil), cotton-gauze turundas soaked in a solution of adrenaline, placed in the nasal cavity on the affected side. Also, for this purpose, antihistamines should be prescribed - Cetrin, Aleron, Erius, etc.

If the bacterial nature of the disease is proven, then taking tablets or, in a hospital setting, injectable forms of antibiotics is indicated. It is advisable to choose a drug based on the sensitivity of the pathogen to it, but if the latter is not reliably determined, then broad-spectrum antibiotics are used - Augmentin, Zinnat, Cefix, etc.

In addition, the patient is advised to rinse the paranasal sinuses with solutions of antibacterial substances. This procedure is best carried out using a special device - the YAMIK sinus catheter. During the procedure, the inflammatory fluid is sucked out of the cells and treated with a medicinal substance. Rinsing is carried out until the cloudy fluid from the sinus is replaced by clear.

If the disease is accompanied by severe pain, non-steroidal anti-inflammatory drugs are used - based on paracetomol (Panadol, Cefekon) and ibuprofen (Brufen, Ibuprom, Nurofen). They also normalize elevated body temperature and reduce inflammation.

In order to increase the immune status of the body as a whole, the administration of vitamin-mineral complexes (Duovit, Multitabs, Vitrum, etc.) and immunomodulatory drugs (Echinacea compositum, Immunal, Ribomunil, etc.) is indicated.

When the inflammatory phenomena begin to subside, physical therapy can be added to the main treatment. The following methods can be used:

  • electrophoresis with antibiotic;
  • phonophoresis with hydrocortisone;
  • UHF to the sinus area;
  • helium-neon laser on the nasal mucosa.

If there is no effect from conservative therapy, as well as with the development of various complications of the disease, surgical intervention becomes necessary. More often, endoscopic methods are used: with a flexible endoscope, they penetrate into the cavity of the ethmoid bone through the nasal passage and, under visual control, perform all the necessary manipulations there. After operations performed using this technique, patients recover quickly and in the postoperative period they are less likely to experience purulent complications.

Less commonly, in especially severe cases, open access to the ethmoid labyrinth is used.

In case of chronic ethmoiditis, surgical treatment is resorted to much more often. This is due to the need to eliminate the causes that led to the chronicization of the process or aggravate the course of the disease. In this case, septoplasty, polypotomy, partial resection of hyperplastic areas of the middle or inferior nasal concha, etc. can be performed. These operations are also often performed using endoscopes through endonasal access.

Prevention of ethmoiditis

Since ethmoiditis is a disease caused by a wide variety of microorganisms, there are no specific preventive measures. To prevent the development of ethmoiditis, it is necessary to prevent the occurrence of diseases that can provoke it, or, if the disease has already developed, to begin adequate treatment in a timely manner.

In addition, the immune system should be supported by periodic intake of vitamin-mineral complexes and immunomodulatory agents, especially in the autumn-winter period.

Prognosis of ethmoiditis

In most cases of acute ethmoiditis, subject to timely diagnosis and rational treatment, the disease goes away without a trace - the person makes a full recovery.

The prognosis for chronic ethmoiditis is less encouraging. Full recovery is almost impossible; it is only possible to introduce the disease into a stage of stable remission, and then subject to complex treatment and prevention of diseases that cause exacerbation of the inflammatory process in the ethmoid labyrinth.

Source: http://otolaryngologist.ru/654