Ethmoid sinusitis (ethmoiditis). Chronic ethmoiditis (chronic inflammation of the cells of the ethmoidal labyrinth) (sinuitis ethmoidalis chronica)

Ethmoid sinusitis or acute ethmoiditis is a disease characterized by inflammation of the mucous epithelium located in the cells of the ethmoid bone. Few people know the meaning of this term (more often, sinusitis or sinusitis is heard), but the pathology itself is very common. It is for this reason that it is necessary to know what ethmoiditis is, its symptoms and treatment. Pathology is quite dangerous, since the focus of inflammation is located close to the brain and branches trigeminal nerve, which is responsible for the innervation of the face. Ethmoid sinusitis occurs in both adults and children.

pathogens

The main causative agents of sinusitis are the same viruses that provoke the occurrence, rhinovirus or adenovirus infection. The cause of the disease can be bacteria - and streptococci, as well as pathogenic fungi. In medicine, there have been cases when sinusitis develops due to the so-called mixed infection. In the test material, several pathogens are detected at once.

Ethmoid sinusitis in rare cases develops primarily. Typically, preschool children school age and in adults it appears as a complication from other infectious diseases:,. The infection enters the ethmoid sinus in two ways: hematogenous (most often) and contact. Sinusitis can even affect newborns. The reason is umbilical, intrauterine and skin.

Reasons for the development of the disease

The pathological process is most often triggered due to infectious disease which affects the human body and weakens its immunity. As a result, viruses and bacteria begin to actively develop on the nasal mucosa. The main reasons for the development of sinusitis include:

  • anomalies of the nasopharynx (congenital and acquired throughout life);
  • frequent colds, runny nose;
  • viral infections;
  • fungal, bacterial, viral sinusitis;
  • chronic diseases associated with the nasal cavity (in particular);
  • facial trauma;
  • weakened immunity.

The first signs of ethmoid sinusitis in adults and children appear against the background of a weakened immune system and inflammation of the paranasal sinuses. Older people more easily tolerate this disease. In children, the mucous membrane of the cells becomes inflamed much more often, and the disease is severe, with a high body temperature. The pathological process can move to other paranasal sinuses. In such cases, it is customary to talk about the development of sinusitis and frontoethmoiditis.

Kinds

According to the nature of the course, two forms of ethmoid sinusitis are distinguished:

  • acute;
  • chronic.

By localization inflammatory process distinguish:

  • bilateral - cells on both sides of the ethmoid bone are affected;
  • right-sided - only the cells on the right are inflamed;
  • left-sided - only the cells on the left side are inflamed.

Also, the disease is classified according to the features of its course. There are three forms:

  1. Catarrhal ethmoiditis. The cause is viruses. This form is characterized by profuse lacrimation. The patient shows the first signs of intoxication - headache, dizziness, weakness throughout the body, nausea. The white of the eyes is reddened. In some cases, there may be broken capillaries in the inner corner of the eye. The bridge of the nose is edematous. Edema extends to the corners of the eyes. With this form, the sense of smell is completely absent.
  2. Polypous ethmoiditis. This form of the disease is chronic. It occurs as a result of a prolonged runny nose. The swelling of the mucous membrane does not go away for a long time and often captures the ethmoid bone. Polyps gradually grow inside the cells, which completely cover the gaps. Because of this, the mucous membrane will be constantly edematous. Patients may experience remissions. At this time, the signs of the disease almost completely disappear. The person can breathe freely through the nose. The exacerbation occurs against the background of SARS.
  3. Purulent ethmoiditis. The most difficult and dangerous form diseases. Symptoms are pronounced, body temperature rises to high numbers - 39-40 degrees. Arises strong pain in frontal lobes and bridge of the nose, teeth, eyes. There is profuse lacrimation. The condition is aggravated by signs of general intoxication of the body.

Acute symptoms

Acute ethmoiditis develops against the background of infectious diseases. A person has heaviness at the base of the nose, the nasal passages are blocked. Mucus is secreted along with yellow-green pus. Often this whole process is accompanied by a very severe headache.

This form is characterized by:

  • rise in temperature to high numbers;
  • the general condition worsens;
  • the patient has a feeling of weakness and fatigue;
  • pain in the root of the nose, which extends to the orbits;
  • the skin of the inner part of the orbit is often thickened and very sensitive to touch;
  • throbbing pains at the base of the nose and forehead (aggravated at night);
  • fast fatiguability;
  • photophobia.

In the elderly and young children, the pathological process can destroy the bone walls of the cells, and the inflammation will gradually move to soft tissues inner corner of the eye. If acute ethmoiditis is not treated, then the process will begin to affect the surrounding tissues, and multiple foci will form. As a result, there will be intracranial and orbital complications, osteomyelitis upper jaw.

Symptoms of the chronic form

If the disease has not been previously diagnosed and properly treated, then the patient develops chronic ethmoiditis. Often this pathological process is a complication of inflammation. maxillary sinus(sinus ethmoiditis), or chronic rhinitis. The first signs of this disease appear in a person two months after suffering acute ethmoiditis.

With exacerbation of chronic ethmoiditis, the following symptoms are observed:

  • the upper eyelid is very swollen;
  • coming out of the nose purulent discharge;
  • Strong headache;
  • in the region of the bridge of the nose, the patient notes heaviness, which increases if he tilts his head;
  • pus and mucus flow down the nasopharynx. Much discharge accumulates in the morning, and the patient expectorates it with great difficulty;
  • when moving the eyes, the patient feels severe pain.

This form of the disease is dangerous because the mucous membrane of the middle concha of the nose begins to grow very quickly, and soon closes with the nasal septum. Degenerative changes it leads to the formation of polyps. If the edema does not subside, then polyposis will occur. Multiple polyps fill the entire nasal cavity and begin to go out. Nasal septum will be deformed.

Complications

If acute or chronic ethmoiditis is not treated, then purulent masses can spread to nearby organs. Complications develop that are dangerous not only for health, but also for human life. The most common problems are:

  • eye complications - orbital phlegmon, retrobulbar abscess, empyema;
  • the lattice labyrinth is destroyed;
  • the inflammatory process passes to the intracranial regions. This is the most dangerous state, as a brain abscess, spilled, arachnoiditis can develop.

Moreover, chronic ethmoiditis is almost impossible to detect on its own. Therefore, you can not delay! At the first sign of illness, you should immediately visit qualified specialist. A “healed” or not completely cured inflammatory process can lead to irreversible consequences.

Diagnostics

Most informative method to assess the condition of the sinuses of the ethmoid bone in sinusitis is CT scan. AT medical institutions magnetic resonance therapy is also often used. This method has its advantages - high resolution and information content. It can be used to diagnose sinusitis caused by fungi. MRI is the method of choice for diagnosing a disease in children, since it does not use ionizing radio emission.

For the diagnosis of ethmoid sinusitis in adults, radiographic studies are used. The picture will show the darkening of the cells of the ethmoid bone.

Instrumental examination methods:

  1. Endoscopic examination. It is carried out using a probe with an optical system.
  2. Rhinoscopy. The nasal cavity is examined using a dilator and a nasopharyngeal mirror.

Treatment of acute ethmoid sinusitis

Acute ethmoiditis must be treated medicines. Therapeutic measures will be aimed primarily at reducing the swelling of the mucous membrane of the cells of the ethmoid bone.

Most effective method treatment - YAMIK sinus catheter. With the help of such a catheter, specialists remove pus from the affected cells, inject medicinal substances into them that suppress the activity of bacteria and viruses, thereby eliminating inflammation.

Bacterial infections are best treated with antibiotics. a wide range actions - Amoxicillin, Tsipromed, Augmentin, Sumamed, Klacid. It also shows the use of anti-inflammatory drugs, such as Ebastin, Chloropyramine. Nasal congestion is relieved with vasoconstrictors. The most effective are Nafazolin, Dimetinden.

Treatment of chronic ethmoid sinusitis

Chronic ethmoiditis is more difficult to cure. Symptoms are eliminated with the help of treatment with complex preparations - Polydex, Bioparox, Isofra. As part of these funds, there are several active substances- antibiotic, anesthetic, vasoconstrictor drug.

Physiotherapy procedures also give a very good effect:

  • hydrocortisone phonophoresis;
  • electrophoresis with diphenhydramine and calcium chloride solutions;
  • UHF on the sinuses of the ethmoid bone;
  • the nasal cavity is treated with a helium-neon laser.

Surgery

Surgical intervention in this disease is indicated only when complications arise caused by the rapid spread of the inflammatory process to bone tissue and periosteum. Cells of the ethmoid bone are opened from external access. The operation is performed under anesthesia.

The first thing the surgeon needs is to provide full access to the ethmoid bone. To do this, he expands the nasal passage. Then the cells are opened. All affected areas are removed during the operation.

Folk methods of treatment

Ethmoid sinusitis should be treated exclusively folk remedies by no means! They can serve as adjuvant therapy. The main treatment is antibiotics, vasoconstrictor and anti-inflammatory drugs. Additionally, you can wash the sinuses with a decoction of sage, chamomile or strong black tea. You can also wash the sinuses with a warm solution of wild rosemary or fireweed. Treatment of ethmoiditis should be carried out only under the strict supervision of the attending physician!

Ethmoid sinusitis in children

This disease occurs in children in an isolated form. The sinuses are affected, since they are the most developed from birth. Treatment of ethmoiditis in newborns, children of preschool and school age should be carried out only in a hospital!

In children, all symptoms are more pronounced. Complicates the course of the disease heat- up to 40 degrees. Gradually, intoxication phenomena increase - vomiting and nausea.

The eye, located on the side of inflammation, completely closes, and the eyeball moves down and slightly to the side. If you do not provide the patient qualified assistance, then complications may appear already on the third day due to a breakthrough of pus. If the child does not receive adequate treatment, then on the fifth day orbital and intracranial complications, sepsis develop.

Treatment of ethmoiditis in children is carried out only in a hospital. The first step is to actively antibiotic therapy. The drugs are administered intravenously. Removal of pus from the sinuses can be carried out using an electric suction. Vasoconstrictor drugs are also prescribed. It is important to bring down the temperature in time. For this purpose, the child is prescribed Ibuprofen or Paracetamol.

At the recovery stage, physiotherapy is prescribed - ultrasound, UHF, microwave, helium-neon laser, magnet. Children are observed in the clinic until their full recovery.

Prevention

Since ethmoid sinusitis is caused by a variety of microorganisms, there are simply no specific measures for its prevention. To prevent this development pathological process, it is necessary to prevent the development of diseases that can cause its occurrence. In addition, it is shown to take vitamin complexes to strengthen the immune system in the cold season.

In order for the disease not to develop in children, it is necessary to strengthen them immune system since birth. For this purpose, you can use vitamin preparations(by age), give fruits enriched with vitamin C, harden.

Organs respiratory system Human beings are quite complex. So to the top respiratory tract include not only the nasal cavity, nasopharynx and oropharynx, but paranasal sinuses. In total, there are four pairs of such areas, represented by the maxillary sinuses, cells lattice labyrinth, frontal and sphenoid sinuses. In some cases, these areas can be attacked by aggressive factors, resulting in their inflammation. Let's talk about what is inflammation of the sphenoid sinus, the symptoms, the treatment of this condition, what are they, and also what they are in case of inflammation of the ethmoid labyrinth.

Symptoms of inflammation of the sphenoid sinus

Inflammation of the sphenoid sinus is classified by doctors as sphenoiditis. This disease can be acute or chronic.

To characteristic manifestations This disease includes headaches of varying severity and duration (including excruciating), which are localized in the back of the head or in the depths of the head. Sometimes pains appear in the orbit or in the parietotemporal region.

Acute purulent and chronic form of sphenoiditis leads to the flow of pus from the nasopharynx over the surface rear wall pharynx, which is visible during pharyngoscopy or posterior rhinoscopy. Patients often complain of a constant unpleasant odor, nasal congestion and difficulty in nasal breathing.

If the process is chronic, viscous discharge appears from the nose, the patient forms crusts that are difficult to remove from the nasopharynx.

Among other things, inflammation leads to deterioration general condition a patient, a person's body temperature rises to subfebrile numbers, and general weakness, fatigue and irritability are also felt.

Inflammation of the sphenoid sinus

Treatment

Therapy acute form sphenoiditis is usually conservative. Doctors exercise local treatment and, if necessary, general.

Local therapy is aimed at eliminating increased swelling, restoring drainage, as well as optimizing the outflow of the inflammatory contents of the sphenoid sinus. Patients are prescribed the use of vasoconstrictors, anemization of the area of ​​the olfactory fissure is carried out with turundas with adrenaline. An excellent effect is given by the "movement" method, which makes it possible to wash the sinus with antibiotics and antiseptics. If the course of the disease is delayed, probing and washing the affected sinus is carried out.

In the event that the patient's body temperature rises, he is shown oral antibiotics with a wide spectrum of action, the use antihistamines and analgesics.

If symptoms of complications occur, urgent surgical intervention is performed. Surgery is indispensable for chronic sphenoiditis. Surgeons open the sinus, clean it and insert gauze turunda with antibacterial ointment for two or three days.

Inflammation of the ethmoid labyrinth - symptoms

Inflammation of the ethmoid labyrinth is classified by doctors as ethmoiditis. Given pathological condition may be acute or chronic. With the development of an acute form of the disease, the patient has an elevated body temperature (up to 38C), it can last for a week, he is also worried about weakness and weakness.

The inflammatory process leads to the development of headaches of varying intensity, they are usually localized in the region of the root of the nose, as well as near the orbit. Local manifestations of ethmoiditis include a feeling of nasal congestion and difficulty in nasal breathing. In addition, there is a separation of mucopurulent contents from the nasal cavity and a decrease in the sense of smell. With weakened immunity, destruction of part of the bone walls in the lattice cells can occur, which leads to swelling and redness in the inner corner of the orbit, as well as in the adjacent parts of the eyelids. In these areas, an abscess can form, from which pus can penetrate into the fiber of the orbit. With such a complication, the patient's eyeball deviates outward, exophthalmos, chemosis, and pain during movement may develop. eyeball, decreased visual acuity and increased intoxication.

The chronic form of ethmoiditis is manifested by all the same symptoms that disturb the patient from time to time, interspersed with periods of imaginary well-being.

Inflammation of the ethmoid labyrinth - treatment

Therapy for inflammation of the ethmoid labyrinth is most often conservative. Patients are shown vasoconstrictors, as well as applications of turundas with adrenaline. Doctors usually write combined medicines with secretolytics, antibacterial agents, as well as painkillers in the form of endonasal sprays, for example, Rinofluimucil, Isofra, as well as Polymexin with phenylephrine, etc. Physiotherapeutic treatment methods, such as UHF and a therapeutic laser, will benefit.

At elevated temperature and general intoxication, systemic broad-spectrum antibiotics are used, as well as antihistamines(Dimedrol, Claritin, etc.), carried out symptomatic therapy.

The development of complications or chronic ethmoiditis often becomes an indication for surgical intervention- endonasal opening of the cells of the ethmoid labyrinth with appropriate processing. Doctors can also open an abscess of the eyelid or orbital fiber (external or endonasal access).

Additional Information

It should be noted that inflammation of the sphenoid sinus and the ethmoid labyrinth is often combined. Similar diseases can develop against the background of acute rhinitis, acute respiratory infections, influenza, etc., in the presence of certain predisposing factors. The latter can be presented anatomical features structures, such as: the narrowness of the middle nasal passage and the curvature of the nasal septum. In addition, the predisposing factors include the low resistance of the organism to the disease, the presence of cysts, polyps, foreign bodies, proliferation of adenoids, etc.

Folk remedies

Treatment of inflammation of the sinuses can be carried out not only with the use of medicines, but also with the help of herbal medicines. So you can prepare the plant chamomile officinalis. Namely, a couple of tablespoons of crushed flowers this plant brew two hundred milliliters of boiling water. Infuse the medicine for an hour, then strain. Use a ready-made infusion of chamomile for irrigation of the sinuses.

The feasibility of using funds traditional medicine you should definitely discuss with your doctor.

Etiology and pathogenesis

The causes of chronic inflammation of the cells of the ethmoid labyrinth are the same as the rest of the sinuses. Almost always, chronic ethmoiditis is observed in combination with chronic diseases others paranasal sinuses, which is explained by the central position of the lattice labyrinth and its immediate proximity to the latter. The predisposing moment to the transition of acute ethmoiditis to chronic are transferred common diseases as well as hereditary and constitutional factors.

Symptoms

Subjective symptoms are often mild. Headache is localized in the region of the nose, less often at the inner corner of the orbit. Violation of nasal breathing and discharge, which can be abundant in the edematous-catarrhal form of chronic ethmoiditis, often disturb patients. In purulent forms, the scanty discharge may dry out into crusts.

Complaints about copious discharge, which is expectorated from the nasopharynx, especially in the morning, is characteristic of the defeat of the posterior cells of the ethmoid labyrinth. With this localization of the lesion, a violation of the sense of smell is often noted, which may be due to the transition of inflammation to the mucous membrane of the olfactory region. Hyposmia to a lesser extent can be expressed with inflammation of the anterior cells of the ethmoid labyrinth.

Rhinoscopic picture in chronic ethmoiditis it can be varied. At catarrhal forms inflammation thickening of the mucous membrane is accompanied by the development of granulations and the formation of polyps. Polyps are more often multiple, since the initial place of their growth is often the edematous-hypertrophied mucous membrane in the circle of numerous excretory openings of the lattice cells.

In some cases, they perform not only the middle nasal passage, but the entire nasal cavity. The accession of a secondary infection entails the formation of pus in the cells, flowing into the nasal cavity. Purely purulent forms of ethmoiditis are less common. With open empyema (more often with damage to individual lattice cells), it is often possible to see crusts or a strip of pus located under the middle shell, and with damage to the posterior cells of the lattice labyrinth - above it, around the excretory openings.

Sometimes pus is released after the removal of polyps. A closed empyema can be latent for a long time: only an atypical expansion (bloating) at the anterior end of the cribriform labyrinth gives reason to suspect the formation of a pyocele that has developed from an empyema. This kind of limited swelling and pus-filled cells are usually found in the area of ​​the bulla ethmoidalis, in the thickness of the anterior end of the middle shell, they are often accidentally detected during polypotomy or probing. With a breakthrough of pus from the empyema through the outer wall of the ethmoid labyrinth, swelling is formed, and then a fistula at the inner corner of the orbit, slightly above the lacrimal fossa.

Diagnosis put on the basis of patient complaints and objective data, including data x-ray examination, sometimes including . In some cases it is necessary differential diagnosis chronic purulent ethmoiditis from purulent forms of the common cold. The appearance of purulent discharge in the places of the excretory openings after cleaning and anemization of the middle nasal passage indicates damage to the anterior cells of the ethmoid labyrinth, and the presence of pus over the middle shell in the upper nasal passage is characteristic of the defeat of the posterior cells of the ethmoid labyrinth or the main sinus.

With closed empyema individual cells diagnosis is often difficult. In these cases, X-ray examination is especially valuable, which reveals the darkening of the cells of the ethmoid labyrinth, as well as the condition of other paranasal sinuses.

Treatment can be performed conservatively, but in combination with small intranasal surgical interventions aimed at improving the outflow of discharge (resection of the anterior end of the middle turbinate, polypotomy, resection of the nasal septum). Intranasal methods of surgical intervention are indicated for uncomplicated ethmoiditis, they are aimed at opening all the cells of the ethmoid labyrinth, which is usually not always possible and necessitates repeated interventions. External opening of the cells of the ethmoid labyrinth is used in complicated cases, as well as in the presence of a fistula and tumors of the ethmoid labyrinth.

"Handbook of otorhinolaryngology", A.G. Likhachev

Ethmoiditis is an inflammation of the mucous membrane of the cells of the ethmoid labyrinth related to the paranasal sinuses. Along with other sinusitis, ethmoiditis is one of the most common ENT pathologies, occurs in 15% of the adult population, and is even more often diagnosed in children.

Classification

The ethmoid bone is unpaired, together with others bone structures is facial department skulls. From the inside, the ethmoid bone is permeated with air cells lined with mucous epithelial tissue similar to that lining the nasal passages. The collection of cells forms a structure called a lattice labyrinth.

The labyrinth, like the maxillary, frontal and sphenoid sinuses, belongs to the paranasal sinuses. And inflammation of the ethmoid labyrinth is a type of sinusitis.

According to the nature of the flow, two forms of ethmoiditis are distinguished:

  • spicy;
  • chronic.

Sections of the ethmoid bone are in contact with other sinuses, nasal passages, and the lacrimal bone. Therefore, inflammation of the labyrinth rarely proceeds autonomously, more often combined with damage to the nasal passages or other paranasal sinuses. Such inflammation is called combined and is divided into types depending on which sinuses are inflamed. There is a simultaneous defeat of the ethmoid bone and sinuses:

  • maxillary - maxillary etmoiditis;
  • frontal - frontoethmoiditis;
  • wedge-shaped - sphenoethmoiditis.

Inflammation affecting the cribriform labyrinth and nasal passages is called rhinoethmoiditis.

Areas of inflammation in ethmoiditis and other types of sinusitis

By the nature of the secretion secreted and the morphological signs of the disease, ethmoy dit:

  • catarrhal;
  • purulent;
  • polyposis;
  • hyperplastic.

According to the location of the inflammatory process, ethmoiditis happens:

  • left-sided;
  • right hand;
  • bilateral.

The reasons

Chronic ethmoiditis usually occurs against the background of:

  • untreated acute inflammation;
  • weakened immunity;
  • frequent colds and infections of the upper respiratory tract.

The main causes of acute ethmoiditis include:

  • penetration of infection from the primary focus;
  • complication caused by a viral infection;
  • complication after inflammation of the nasal passages or sinuses (rhinitis, sinusitis, frontal sinusitis).

In newborns, acute ethmoiditis can occur against the background of umbilical, skin or intrauterine sepsis.

Infectious diseases of a viral and bacterial nature are a common cause of ethmoiditis in school-age children and adolescents. Often ethmoiditis is complicated by scarlet fever, much less often - measles, influenza, and other infections.


Acute ethmoiditis in children often develops after scarlet fever, the causative agent of which is group A hemolytic streptococcus.

In adults, the main cause of the disease is sinusitis, frontal sinusitis or rhinitis. The causative agents are streptococci and staphylococci, Haemophilus influenzae. And with a combination of ethmoiditis with sinusitis or frontal sinusitis bacteriological analysis more often a microbial association is detected - the presence of several types of bacteria.

Predisposing factors

Factors contributing to the development of ethmoiditis include:

  • structural features of the nasopharynx (narrow nasal passages);
  • structural anomalies (congenital or acquired curvature of the nasal septum, adenoids, polyps);
  • allergic rhinitis;
  • chronic and pharynx (pharyngitis, rhinitis, sinusitis);
  • weakened immunity.


A weakened immune system contributes to the formation and development of microbial associations that are difficult for the body to cope with. As a result, there is acute inflammation, which can turn into chronic ethmoiditis

Symptoms

The main symptoms of ethmoiditis:

  • pain;
  • pressure, feeling of fullness in the nose;
  • violation of nasal breathing;
  • separation from the nose of the secret;
  • deterioration or complete loss of smell.

Pain syndrome

Patients with acute inflammation may experience the following unpleasant symptoms:

  • recurrent pain in the region of the bridge of the nose, forehead and eye sockets (intensifies at night);
  • constant headache (caused by general intoxication of the body);
  • pain in the eyes (during the movement of the eyeball), hypersensitivity to light, blurred vision.

Pain syndrome in acute ethmoiditis occurs abruptly, suddenly. In chronic ethmoiditis, the patient experiences a dull aching pain at the base of the nose. Wherein pain can spread to the forehead and eye sockets, worse at night. During periods of exacerbation, the pain becomes pulsating, in parallel, rapid eye fatigue is noted.

Acute pain with inflammation of the ethmoidal labyrinth, they are due to the pressure that the edematous mucous membrane exerts on other structures.


In acute and exacerbation of chronic inflammation, very severe, debilitating pain often causes insomnia.

Feeling of fullness in the nose

Both in acute inflammation and in chronic ethmoiditis, the mucous membrane of the ethmoid labyrinth swells, and pus accumulates in the cellular structures.

The pathological process affects the mucous tissues, affects vascular walls changing their permeability. The vessels expand, fluid comes out through their walls, as a result of which the mucous membrane swells.

In addition, the liquid actively develops pathogenic flora, pus is formed. Cluster pathological secretion in the cells of the labyrinth causes a feeling of fullness in the nasal cavity, which intensifies at night.

Difficulty breathing

Swelling of the mucous membrane of the labyrinth gradually passes to the tissues lining the nasal cavity, which leads to impaired nasal breathing. This process proceeds very quickly: breathing through the nose becomes difficult already a few hours after the onset of the disease.

In young children, unlike adults, the nasal passages are very narrow, with swelling they can completely close, which is why nasal breathing becomes absolutely impossible.

Secretion from the nose

With ethmoiditis, a secret can be released from the nose:

  • slimy;
  • purulent;
  • bloody.

On the initial stage disease, clear, viscous, scanty discharge from the nose is present. As the inflammation worsens, a purulent secret of yellow or greenish color begins to stand out in copious amounts. This is the fluid that accumulates in the anterior cells of the ethmoid bone.

The excreted secret contains dead pathogens and their metabolic products, immune cells (leukocytes), due to which the liquid content becomes yellow or green color. If inflammatory processes affect the bone and periosteum, nasal discharge acquires a characteristic putrid odor.


When damaged blood vessels penetrating the mucous membrane, contents with blood impurities are released from the nose

Deterioration of smell

Inflammatory processes can affect the fibers olfactory nerve. In addition, there is a blockage of the olfactory gap with mucous or purulent secretions. As a result, the patient has a complete or partial loss of smell.

Other symptoms

Except specific manifestations ethmoiditis, occur general symptoms intoxication:

  • elevated temperature;
  • weakness;
  • muscle pain;
  • regurgitation (in young children);
  • vomit;
  • confused mind.

Such manifestations are due to the action on the body of specific bacterial toxins. Toxins produced different types microorganisms differ from each other and act on different organs and systems of the human body.

If toxins act on nervous system, there are symptoms of neurotoxicosis - excruciating headache, vomiting, agitation, followed by weakness and apathy. Toxins that affect gastrointestinal tract cause digestive disorders (diarrhea, vomiting).

Acute ethmoiditis begins suddenly, progresses rapidly. The temperature rises sharply, myalgia (muscle pain) develops, vomiting and confusion are possible. After a few hours, nasal breathing is disturbed, mucus begins to stand out from the nose. After a while, serous inflammation acquires a purulent form. In adults, this process lasts from several days to several weeks, in children it proceeds more rapidly.


Acute ethmoiditis develops most quickly in newborns: catarrhal inflammation turns into a purulent form in just a few hours

Chronic ethmoiditis occurs with alternating exacerbations and remissions. With an exacerbation, the symptoms worsen, and signs of intoxication of the body (weakness and lethargy, fatigue) persist even at the stage of remission.

Diagnostics

An accurate diagnosis is made on the basis of the results:

  • examinations by an ENT doctor;
  • laboratory tests;
  • radiography.

A visit to an otolaryngologist is a mandatory event to confirm the diagnosis. The specialist conducts a visual examination and rhinoscopy, studies the patient's complaints.

External manifestations of ethmoiditis:

  • redness and swelling of the eyelids, conjunctiva;
  • soreness when touching the eyelids;
  • cyanosis skin in the eye area;
  • narrowed palpebral fissure;
  • Difficulty moving the eyeball.

With inflammation of the ethmoid labyrinth, the patient has sharp pain with pressure on the lacrimal bone and bridge of the nose.


With advanced ethmoiditis, the upper and lower eyelids become inflamed, small hemorrhages appear on the mucous membrane of the eyes.

With the help of anterior and posterior rhinoscopy (examination of the nasal mucosa using an endoscope), the doctor can see the morphological signs of ethmoiditis. It:

  • swollen, red mucosa of the nasal passages;
  • mucous or purulent discharge from the nose;
  • accumulation of pus in the upper and middle parts of the nasal passages;
  • polypous growths (polypous ethmoiditis);
  • narrowing of the nasal passages.

X-ray signs of ethmoiditis a:

  • darkened cells of the lattice labyrinth;
  • reduced density of other sinuses;
  • symptoms of damage to the periosteum (sometimes).

To spend effective treatment, it is important to differentiate ethmoiditis from other diseases with similar symptoms: dacryocystitis, periostitis of the nasal bones, osteomyelitis of the upper jaw.

Medical treatment

Treatment of ethmoiditis is carried out in three directions. It:

  • suppression bacterial infection that caused inflammation;
  • restoration of the outflow of fluid, removal of edema and normalization of air exchange in the cells of the labyrinth;
  • elimination of symptoms and relief of the patient's condition;
  • recovery defensive forces body, strengthening immunity (special attention should be paid to the state of the immune system when chronic form diseases).

Antibacterial therapy

Treatment of ethmoiditis is carried out with broad-spectrum antibiotics. If home treatment is expected, doctors prescribe penicillin group drugs (Amoxicillin, Augmentin) in the form of tablets or capsules, suspensions for children. In a hospital setting, cephalosporins are more commonly used in injection form(Cefotaxime, Ceftriaxone).


With ethmoiditis, antibacterial agents may additionally be prescribed. local action– Bioparox, Polydex, Isofra

A patient with ethmoiditis is also washed with paranasal sinuses with antibacterial solutions. The procedure is carried out using a special device that allows you to clean the cells from pus and treat them with a medicinal substance.

Restoration of fluid outflow and removal of edema

To help normalize nasal breathing:

  • Galazolin, Xymelin, Nazivin, Tizin (nasal drops and sprays with a vasoconstrictor effect);
  • Rinofluimucil aerosol ( combination drug thins mucus and facilitates its evacuation, constricts blood vessels and reduces swelling);
  • adrenaline solution (cotton turundas soaked in medicine are placed in the nasal passage from the affected side);
  • Allerzin, Tsetrin, Erius (antihistamines).

Symptomatic treatment

If the disease is accompanied by severe pain syndrome and an increase in temperature, are assigned nonsteroidal drugs based:

  • ibuprofen (Nurofen, Ibuprom, Imet);
  • nimesulide (Nimesil);
  • paracetamol (Panadol).

These drugs quickly stop pain, lower the temperature, and are characterized by a pronounced anti-inflammatory effect.

Immunostimulating therapy

To strengthen the immune system, the patient may be prescribed immunostimulating drugs (Immunal, Ribomunil) and vitamin-mineral complexes (Vitrum, Multi-Tabs, Duovit, Supradin). At home, you can prepare healthy vitamin decoctions and teas with rose hips, linden, raspberries, and currants.

Inflammation of the ethmoidal labyrinth - serious illness dangerous with its complications. Therefore, the treatment of ethmoiditis with folk remedies is unacceptable.

Physiotherapy procedures

Physiotherapy procedures are prescribed after the relief of acute inflammation, that is, when the symptoms of the disease begin to subside. Most often carried out:

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

Surgery

Absence positive results treatment or the development of complications become a reason for surgical intervention. Operations are usually carried out endoscopic method, allowing to shorten the rehabilitation period as much as possible and minimize the risk of postoperative complications.


Very rarely, mainly with advanced ethmoiditis, the operation is performed using the open access method.

To surgical methods more often resorted to in chronic ethmoiditis, which is due to the need to eliminate disease-provoking factors. Can be carried out:

  • septoplasty -;
  • polypotomy - removal of polyps;
  • partial resection of overgrown turbinates.

Complications

In chronic ethmoiditis, inflammation gradually passes from the mucous membrane to the bone itself, complications develop:

  • periostitis - damage to the periosteum of the ethmoid labyrinth;
  • osteitis - damage to the ethmoid bone;
  • purulent lesions of the orbit - empyema, phlegmon, retrobulbar abscess;
  • involvement in the purulent process of the brain - arachnoiditis (inflammation arachnoid), meningitis (inflammation soft shell) or brain abscess.

The destruction of the partitions between the cells leads to the penetration of purulent contents into other structures, which is dangerous not only for health, but also for the life of the patient. Therefore, ethmoiditis cannot be treated independently at home. If you suspect the development of the disease, you should immediately contact an ENT doctor. The specialist will put accurate diagnosis and prescribe appropriate treatment.

Timely and competent therapy allows you to completely cure acute ethmoiditis. As for chronic inflammation, the prognosis is not so favorable: it will not be possible to cure the disease completely, it can only be transferred to the stage of stable remission.

It is easier to prevent the development of chronic ethmoiditis - timely and correctly treat acute inflammation, eliminate all factors contributing to the development of the disease, support the immune system with periodic intake of vitamin-mineral complexes, immunostimulating drugs.

  • Which Doctors Should You See If You Have Ethmoid Sinusitis (Ethmoiditis)

What is ethmoid sinusitis (ethmoiditis)

Ethmoiditis- inflammation of the mucous membrane of the cells of the ethmoid bone; has a bacterial (usually staphylococcal and streptococcal) or viral nature. There are acute and chronic ethmoiditis.

What provokes ethmoid sinusitis (ethmoiditis)

The narrowness of the outlet openings of the cells of the ethmoid labyrinth, as well as the middle nasal passage and adenoid growths, contribute to the emergence of ethmoiditis. Children are more likely to suffer from acute ethmoiditis preschool age. Chronic ethmoiditis occurs in people who are weakened, suffering from frequent viral diseases nasopharynx.

In newborns and infants ethmoiditis usually occurs in isolation, predominantly by the hematogenous route, secondarily against the background of sepsis (intrauterine, umbilical, skin) as a metastatic purulent focus and is most severe.

In older children after the formation of the maxillary and frontal sinus acute ethmoiditis is combined with their defeat and is defined as maxillary ethmoiditis or frontoethmoiditis.

The predisposing moment is the narrowness of the middle nasal passage and excretory openings. With an easily occurring edema of the mucous membrane, the outflow of discharge from the sinus quickly becomes difficult and stops.

Symptoms of ethmoid sinusitis (ethmoiditis)

Acute ethmoiditis may occur in patients with acute banal rhinitis, influenza, etc. Often acute or chronic inflammation other paranasal sinuses leads to a secondary lesion of the ethmoid labyrinth. With inflammation of the frontal and maxillary sinus the anterior cells of the ethmoid bone are involved in the process, with inflammation of the sphenoid sinus - the posterior cells. The inflammatory process quickly spreads to the deep layers of the mucous membrane. There is its edema and diffuse swelling, the gaps of the cells of the ethmoid bone and their excretory ducts are narrowing. This leads to disruption of drainage, and in childhood- the spread of the process to the bone, the formation of abscesses and fistulas.

The main symptom of acute ethmoiditis- headache, pain in the root of the nose and bridge of the nose. The predominant localization of pain at the root of the nose and the inner edge of the orbit is characteristic of the defeat of the posterior cells of the ethmoid bone. Difficulty in nasal breathing, a violation of the sense of smell (hyposmia) or its absence (anosmia) are often observed. The general condition of the patients worsens, the body temperature rises to 37.5-38°. In the first days of the disease, abundant serous discharge from the nose, usually odorless, subsequently acquiring a serous-purulent or purulent character. In children, edema and hyperemia are often observed in the region of the inner corner of the orbit and internal department upper and lower eyelids, a sharp increase in the middle nasal concha, mucopurulent or purulent discharge in the middle (with inflammation of the anterior cells of the ethmoid bone) or in the upper (with inflammation of the posterior cells) nasal passage.

At primary acute ethmoiditis changes in the general condition are most pronounced. The disease begins with a sharp rise in temperature to 39-40 ° C, anxiety, regurgitation, vomiting, parenteral dyspepsia, a rapid increase in the phenomena of toxicosis, exsicosis and neurotoxicosis.

Secondary ethmoiditis proceeds much harder and progresses faster than the primary. Complications occur already on the 2-3rd day of the disease.

The condition of patients, as a rule, is very severe, the phenomena of a septic process are expressed with multiple metastatic purulent foci(omphalitis, pyoderma, acute purulent ethmoiditis, osteomyelitis of the upper jaw, pneumonia, staphylococcal lung destruction, pyelonephritis), toxicosis and exsicosis, parenteral dyspepsia.

Bright orbital symptoms are revealed: intense dense and painful infiltration of the eyelids, hyperemia and bluish tint of their skin, tightly closed palpebral fissure, conjunctival chemosis, sharp exophthalmos and immobility of the eyeball, sharp prolapse of the lateral wall of the nasal cavity with narrowing of the common nasal passage and impaired nasal breathing. Due to the osteomyelitic process of the ethmoid labyrinth and the lateral wall of the nasal cavity, purulent discharges are found in the nasal passages. In children infancy the purulent form of the disease is less severe than in newborns, and occurs less frequently.

One of complications of acute ethmoiditis is the destruction of part of the bone walls of the ethmoid labyrinth with the formation of an empyema, which, if the outflow of the discharge is disturbed, rapidly increases: in this case, pus may break into the fiber of the orbit or (extremely rarely) into the cranial cavity. The patient's condition deteriorates sharply, body temperature rises, signs of ophthalmic or intracranial complications appear. The spread of the inflammatory process from the anterior cells of the ethmoid labyrinth to the orbit causes the formation of a phlegmon or a retrobulbar abscess in it; pain increases sharply, eyelids swell, exophthalmos develops, the eyeball shifts outwards. In the case of the spread of the process from the posterior cells of the ethmoid bone to the orbit, visual disturbances mainly occur - narrowing of the visual field, decreased visual acuity, the appearance of scotoma, etc. Intracranial complications are manifested by diffuse purulent meningitis, brain abscess, arachnoiditis.

Chronic ethmoiditis is the result of an acute It usually develops in solo individuals with reduced body resistance, with insufficient affective treatment and concomitant chronic inflammation of other paranasal sinuses.

Symptoms of chronic ethmoiditis depend on the degree of activity of the inflammatory process. So, during the period of remission, patients are periodically disturbed by pain in the root of the nose, headaches of indeterminate localization, scanty purulent discharge from the nose with bad smell. With the defeat of the posterior cells of the ethmoid labyrinth, the discharge (especially in the morning) accumulates in the nasopharynx, is difficult to expectorate. The sense of smell is usually impaired. Rhinoscopy reveals polyposis growths, sometimes granulations on average and upper divisions nasal cavity, mucopurulent or purulent discharge under the middle nasal concha. As a rule, in chronic ethmoiditis, there is a deterioration in the general condition of the patient, increased fatigue, irritability, weakness, and decreased performance. During the period of exacerbation, chronic ethmoiditis is characterized by the same manifestations as acute.

In chronic ethmoiditis, ethmoid bone empyema also sometimes develops, which, however, unlike empyema, which complicates the course of acute ethmoiditis, can long time proceed latently against the background of a general satisfactory condition the patient, manifesting only a violation of nasal breathing and deformation of the nose or changes in the eyeball. It is also possible the development of intraorbital and intracranial complications.

Diagnosis of ethmoid sinusitis (ethmoiditis)

Diagnosis of acute ethmoiditis is based mainly on clinical signs and x-ray data. On radiographs and tomograms of the bones of the skull and paranasal sinuses, darkening of the cells of the ethmoid bone is found, often in combination with darkening of neighboring sinuses (with inflammation).

The seasonality of the disease should be borne in mind, since acute ethmoiditis is mainly observed in the autumn-winter period and is regarded as an acute respiratory disease, and intraorbital complications as a manifestation of adenovirus infection, allergic edema eyelid, conjunctivitis, stye, dacryocystitis, eyelid abscess, or insect bites.

Differential diagnosis. Acute ethmoiditis must be differentiated from osteomyelitis of the upper jaw, damage to the teeth, dacryocystitis, suppuration of a congenital cyst of the back of the nose, and erysipelas.

Treatment of ethmoid sinusitis (ethmoiditis)

Treatment of acute ethmoiditis predominantly conservative. In the first days of the disease, the outflow of discharge is ensured by introducing vasoconstrictor agents into the nasal cavity, which help to reduce swelling of the mucous membrane, painkillers, antibiotics are prescribed, after a few days, with improvement in the condition, physiotherapeutic procedures. Surgical treatment acute E. (opening the cells of the lattice labyrinth) is used only in cases of extreme serious condition the patient and in the absence of the effect of conservative therapy, which is usually observed in acute empyema in children, as well as with the appearance of signs of ophthalmic and intracranial complications. The operation of opening the cells of the ethmoid labyrinth can be performed by intranasal and extranasal methods. AT postoperative period the opened cavity is washed with warm sterile isotonic saline sodium chloride. Forecast in case of uncomplicated course of E. with timely and proper treatment favorable.

Treatment of chronic ethmoiditis predominantly operational. Produce polypotomy, partial resection turbinates, opening the cells of the ethmoid labyrinth. In the period of exacerbation, treatment is conservative.

Forecast with an uncomplicated course of chronic ethmoiditis, as a rule, favorable.

Prevention of ethmoid sinusitis (ethmoiditis)

Prevention of ethmoiditis is the timely and rational treatment of diseases that contribute to its development.