Ethmoiditis is an inflammation of the ethmoid sinus (ethmoid sinus). Often, the inflammation of the ethmoid sinus is called the generic term “sinusitis,” which should be understood to be the inflammation of any of the four pairs of sinuses.
The paranasal sinuses (in addition to the ethmoid) also include -
- maxillary sinuses - their inflammation is called the term "antritis",
- frontal sinuses - their inflammation is called "frontal sinus",
- sphenoid sinuses - their inflammation is called sphenoiditis.
Lattice sine is paired (Fig. 1). Each ethmoid sinus consists of a multitude of small cavities in the bone (micropascles), filled with air and lined from the inside by a mucous membrane. The sine is oblong and elongated in the anterior-posterior direction.
Etmoiditis: photo scheme
An important anatomical feature of the ethmoid sinus -
micro-sinuses of the anterior part of the sinus (located closer to the surface of the face) have a message using a small hole with an average nasal passage; micro-sinuses of the posterior sinus, located closer to the base of the skull and the sphenoid sinus, have communication with the upper nasal passage.
Accordingly, when inflammation of the front of the sinus inflammatory exudate and pus will drain into the middle nasal passage, and with inflammation of the back of the sinus - into the upper nasal passage. All this will see the ENT doctor when examining the nasal passages. This is important for the diagnosis and determination by the doctor of the treatment strategy for ethmoiditis. Generally, ethmoiditis is an extremely dangerous disease, and if not treated promptly, it can result in an abscess of the orbit, an abscess of the brain, sepsis ...
As we have already said above: the sinus sinus sinuses are lined from the inside by mucous membrane, and communicate with the nasal passages through small openings. This mucous membrane has a large number of glands that produce mucus, and its surface layer is covered with ciliated ciliated epithelium (the cilia of which move, which contributes to the removal of mucus from the sinuses to the nasal passages).
This active transport mechanism (plus ventilation of the sinuses through the openings) ensures the health of the sinuses. If the withdrawal of mucus from the sinuses is blocked, then it accumulates there, and this is what contributes to the development of infection and subsequent suppuration.
Factors that can cause sinus inflammation:
- Acute respiratory viral infections (ARVI and flu) -
the virus dramatically increases mucus production in the sinuses and nasal passages, and also causes the development of swelling of the mucous membranes of the nose and sinuses. Swelling of the mucous membranes leads to the closure of the holes through which mucus from the sinuses enters the nasal cavity. In addition, viral toxins block the motor activity of the ciliated epithelium of the mucous membrane, which also violates the removal of mucus from the sinuses.
At the initial stage, the inflammation in the sinuses has a serous nature, i.e. pus in the sinuses is not detected. But gradually a bacterial infection develops in the closed space of the sinuses (in the absence of their ventilation and the presence of a large amount of mucus), which leads to the formation of pus in the sinuses.
- Chronic inflammatory diseases of the nose (hr. Rhinitis) -
chronic inflammation of the nasal passages is usually bacterial in nature. Pathogenic bacteria and their toxins also contribute to swelling of the nasal mucosa and sinuses, leading to nasal congestion, increase the production of mucus in the nose and sinuses.
All this leads to the formation of pus in the sinuses. Also sluggish chronic inflammation can lead to the formation of polyps in the sinuses and nasal passages.
- Allergic rhinitis -
With allergic rhinitis, there is also a sharp increase in mucus production and swelling of the mucous membranes. As a result, at the beginning of the ethmoid sinuses serous ethmoiditis may occur, with no signs of purulent infection. But over time (if you do not adjust the outflow of mucus from the sinuses) a bacterial infection can join, and ethmoiditis can turn into purulent.
- Factors contributing to the development of ethmoiditis -
→ curvature of the nasal septum,
→ adenoids, polyps in the nasal passages,
→ active and passive smoking,
→ chronic inflammatory diseases of the nose, tonsils ...
Ethmoiditis can have acute and chronic course. Acute ethmoiditis occurs, as a rule, against the background of acute respiratory viral infections and influenza, or allergic rhinitis. For acute ethmoiditis characterized by severe symptoms. Chronic ethmoiditis, in turn, has sluggish symptoms; when it is very often in the nasal passages and the sinuses themselves you can see the formation of polyps. Occasionally, in chronic ethmoiditis, patient complaints may be completely absent (24stoma.ru).
The main symptoms that patients may complain about -
- headache (mainly in the area between the eyes),
- pain in the nose and the inner corners of the eyes,
- eyelid edema (especially in the morning after waking up),
- long runny nose (more than 7-10 days),
- mucous or mucopurulent nasal discharge,
- runoff of mucus, pus on the back of the throat (if the posterior microspasms of the ethmoid sinus are affected).
Photos of a patient with purulent right-sided ethmoiditis (if the serous process turns into purulent, then the eyelids can no longer simply swell, but their redness and swelling appear):
Symptoms of a more general nature, observed with ethmoiditis -
- swelling of the face
- headache, fatigue, fever,
- sore throat, cough,
- bad breath,
- diminished sense of taste and smell.
Important: the ethmoid sinuses are separated by very thin bony walls from the orbits; therefore, when the inflammation goes from serous to purulent, more serious symptoms may appear: loss of vision, double vision, redness of the eyes and eyelids, protrusion of the eyes forward. It is also necessary to take into account that the inflammation of the anterior part of the ethmoid sinus usually proceeds simultaneously with the lesion of the maxillary and frontal sinuses, and the posterior sinuses with inflammation of the sphenoid sinus.
How is ethmoiditis diagnosed?
As a rule, inflammation of the ethmoid sinuses is diagnosed by the ENT doctor on the basis of the patient's complaints and the results of the examination of your nasal passages. The doctor will check the patency of your nasal passages, the presence of edema of the mucous membrane, polyps or purulent discharge in the nasal passages, the presence of adenoids. However, the absence of purulent exudate from the ethmoid sinuses cannot speak of the mandatory absence of ethmoiditis, since in conditions of pronounced swelling of the mucous membrane of the sinus can be completely blocked.
Additional research methods -
1) Computed tomography (CT) will determine the degree of inflammation of the ethmoid sinus, the presence of polyps in it, pus. Especially, it is important to hold it if the patient has symptoms that indicate the spread of infection to the orbits or other paranasal sinuses.
2) X-ray examination is possible, but unlike CT, it is very informative for this pathology.
3) Ideally, if your doctor notices heavy discharge from the nose, he will take a sample of mucus for a microbiological examination. This will determine the nature of ethmoiditis (viral, bacterial or allergic). If allergy was the cause, then many eosinophils will be found in the mucus.
Treatment may be conservative and / or surgical. The choice of treatment tactics will depend on your symptoms, the reason that caused the development of ethmoiditis, as well as the nature of the inflammatory process (serous, purulent or polypous).
1. Treatment of acute ethmoiditis -
Etmoiditis treatment, as a rule, is conservative, but this is only in situations where the fusion of the ethmoid sinus has not yet occurred. The main goal of conservative therapy is the restoration of nasal passages, the removal of mucosal edema, in order to restore the outflow of mucus and inflammatory exudate from the sinuses into the nasal cavity.
For this, nasal drops and sprays + systemic anti-inflammatory drugs based on ibuprofen can be used. Also, the patient should regularly rinse his nose with saline solutions, try to sleep with his head elevated, because This contributes to the outflow of exudate from the sinuses (24stoma.ru).
Drops to reduce nasal congestion -
It must be borne in mind that traditional vasoconstrictor drops from a cold can be used for sinusitis for no more than 2-3 days, because Addictiveness to them quickly develops and they only begin to aggravate inflammation. To relieve nasal congestion and edema of the mucous membrane with ethmoiditis, it is best to use -
- Spray "Rinofluimucil" (Italy, price about 250 rubles) -
The drug consists of 2 active components that reduce the secretion of mucus and facilitate its discharge, and also remove swelling from the nasal mucosa. This drug will be well combined with drugs "Sinupret" and "Sinuforte", which stimulate the evacuation of the inflammatory exudate from the sinuses.
- Spray "Nasonex" (Belgium, price from 500 rubles) -
as an active ingredient contains a low dosage of glucocorticoids. Spray well removes nasal congestion (especially with allergic rhinitis), plus it can be used for a long time (courses of 2 or 3 months). Nasonex will also be excellently combined with stimulants for mucus discharge from the sinuses (with Sinupret and Sinuforte preparations).
Drugs that stimulate the discharge of mucus from the sinuses -
There are several drugs of plant origin that can enhance the function of the ciliated epithelium of the mucous membrane. This leads to accelerated evacuation of mucus and pus from the sinuses into the lumen of the nasal passages through the openings between them.
- The drug "Sinupret" (Germany, price from 350 rubles.) -
available in the form of drops and dragee. Contains extracts of medicinal plants, which have anti-inflammatory action, and facilitate the evacuation of mucus and inflammatory exudate from the sinuses.
- The drug "Sinuforte" (Spain, price from 2300 rubles.) -
comes in the form of nasal drops Contains only vegetable ingredients. As well as the previous preparation, it also contributes to the evacuation of pus, mucus and inflammatory exudate from the sinuses.
Treatment of acute ethmoiditis allergic nature -in acute ethmoiditis of allergic nature, treatment consists in avoiding contact with allergens, conducting desensitization therapy with antihistamines, corticosteroids, antiallergic nasal sprays with low glucocorticoid concentrations (for example, Nasonex spray), use of calcium preparations.
Surgical treatment of acute ethmoiditis -in case of development of alarming symptoms, such as: exophthalmos, restriction of the mobility of the eyeball, loss of visual acuity - an urgent start of intensive therapy, including intravenous administration of antibiotics, is necessary. In the absence of positive dynamics with such therapy (and even more so with worsening of symptoms), urgent surgical intervention is necessary. The operation can be carried out endoscopically (from the inside of the nose), as well as by external access through an incision in the canthus.
2. Treatment of chronic ethmoiditis -
In chronic ethmoiditis (both catal and purulent) in the sinuses and nasal passages, as a rule, polyps are formed, the presence of which requires their surgical removal.
Antibiotics for ethmoiditis -
As we wrote above: acute frontal disease most often develops against the background of acute respiratory viral infection and influenza, and antibiotics, as we know, do not act on viruses. It is sensible to drink antibiotics for acute frontal disease only if a bacterial infection joins and purulent inflammation develops, but this does not happen immediately.
If there are indications for taking antibiotics, then the drug of first choice is Amoxicillin in combination with Clavulanic acid. Drugs that contain this combination: "Augumentin", "Amoxiclav". If the patient is allergic to antibiotics of the penicillin group, then it is better to use -
- fluoroquinolone antibiotics (for example, Ciprofloxacin),
- or macrolides ("Clarithromycin", Azithromycin ").
Antibiotics at the front are prescribed for about 10-14 days. However, after 5 days from the start of treatment, it is necessary to evaluate the effectiveness of therapy. If a significant improvement is not achieved, then it is best to prescribe a more potent antibiotic.
Complications with ethmoiditis -
The most frequent complications are: intracranial meningitis, thrombophlebitis of the head veins, abscess of the orbit, abscess of the brain. If you suspect the presence of complications need urgent hospitalization, because loss of time can lead to loss of health and even death of the patient. We hope that our article on the topic: Etmoiditis symptoms treatment in adults has proved to be useful to you!
Author: dental surgeon Kamensky KV, 19 years experience.