Thickening of the mucous membrane of the ethmoid labyrinth. The anatomical structure of the ethmoid bone and ethmoiditis

Definition

Ethmoiditis- inflammation of the cells of the ethmoid labyrinth (cells of the ethmoid bone), a type of sinusitis.

The lattice labyrinth is located between the orbits from which it is separated thin walls paper plate. Its roof, a perforated plate, is part of the front cranial fossa.

By virtue of its location, the lattice plays a prominent role in the pathology of the nose. Due to its close proximity to the frontal sinus, as well as to the maxillary cavity, the lattice is often involved in the disease of these sinuses. Anatomical features its structures explain the originality of the pathological processes developing here, as well as the difficulties of dealing with them. As in other sinuses, the inflammation of the lattice cells is either acute or chronic.

The reasons

Inflammation of the lattice cells (ethmoiditis) is characterized by moments common to inflammation of all sinuses. Depending on the nature of the inflammation, the process is limited to one mucosa or it affects and bone tissue, as, for example, in tuberculosis, syphilis. In addition to the usual pathogens, ethmoiditis b. fusiformis, Leffler's bacillus and gonococcus.

In acute inflammation, the mucous lattice, which is characterized by a looser stroma, the deep layer of which is the periosteum, easily swells, thickens, narrowing the lumen of cells filled with exudate. The reaction of the mucosa to prolonged irritation differs in some features. It is expressed in the formation of limited or diffuse thickenings, elastic, soft consistency, taking the form of tumors on the leg (nasal polyps).

Symptoms

Ethmoiditis, especially chronic, usually proceeds latently, and is also often a companion of the disease of the other sinus. Therefore, its symptoms are characterized by extreme poverty, lack of characteristic features. The patient complains of nasal congestion due to the presence of polyps or crusts in it. This circumstance leads in turn to the development of anosmia, especially when the process is localized in the posterior cells. Headache noted in acute ethmoiditis and exacerbation of chronic. In some acute cases there is pain with pressure on the inner edge of the orbit in the region of the lacrimal bone, as well as when the probe touches the middle shell.

Acute and exacerbated chronic ethmoiditis can lead to the development of orbital and intracranial complications.

Diagnostics

Recognition inflammatory diseases The gratings are based on the data of rhinoscopy, probing and radiography. Considerable difficulties sometimes have to be overcome in cases where the only symptom of the disease are purulent discharge coming from the middle nasal passage. The probing of the lattice cells, due to the inconsistency of its structure, is associated with significant difficulties. Can provide an X-ray screen that facilitates orientation; also orients the radiograph in the anteroposterior plane when the probe is inserted.

The diagnosis often has to be made “on suspicion”, based on the existing extensions of the anterior lattice and polypous changes in the mucosa. The same must be said about the empyema formed from the merger individual cells grids into one cavity containing pus. Its thinned front wall is elastic when touched by a probe; sometimes you can catch crepitus, like the one that is characteristic of a mature mucocele; in fact, we are dealing with a pyocele that developed from an empyema. This kind of limited purulent foci may be in the bulla ethmoidalis, in the region of the semilunar fissure. Their recognition is impossible and they are found by chance, during surgery, for example, when removing the polypous mucosa, or during the development of complications outside the lattice, the source of which they are.

Prevention

Structural diversity lattice labyrinth, also the features of its tissue reactions make treatment often difficult. Acute inflammations are often eliminated under the influence of already given conservative methods of treatment. Only in cases of a rapidly flowing process, threatening development complications, there is a need to resort to surgical intervention.

The situation is different in chronic ethmoiditis, which usually forces one to resort to one or another surgical technique.

The paranasal sinuses are air cavities located around the nasal cavity and connected to it with the help of narrow openings (Fig. 34).

They are called the bones in which they are placed.

All sinuses are paired, divided into anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone).

Rice. 34. Frontal section through nasal cavity and paranasal sinuses: 1 - frontal sinuses; 2 — cells of a trellised labyrinth; 3 - middle turbinate; 4 - lower nasal concha; 5 - nasal septum; 6 - maxillary sinus

The medial wall borders on the lower and middle nasal passages; the nasolacrimal canal passes in its anterior section. The sinus opening (ostium maxillare) is located under the orbital margin - highest place sinuses behind the protrusion of the nasolacrimal canal. Violation of the function of this opening leads to the accumulation of secretions from the sinus, contributing to the development of the inflammatory process in it. The upper wall of the sinus is also the lower wall of the orbit. She is very thin. It contains the canal of the infraorbital nerve and the vessels of the same name. Sometimes there are dehiscences, covered only by the mucous membrane.

A thinned wall, along with defects in it, can contribute to the spread of the inflammatory process to the contents of the orbit, which requires caution during surgery. The lower wall is the alveolar process of the maxillary bone. In most cases, the floor of the sinus lies below the floor of the nasal cavity, which promotes close contact between the teeth and the sinus. Closest to the bottom of the sinus is the second premolar and first molar. The posterior wall is represented by the maxillary tubercle, behind which the maxillary nerve is located, pterygopalatine node, internal maxillary artery, pterygosby venous plexus. The maxillary sinus is in close contact with the ethmoid labyrinth, with which it has a common wall.

The frontal sinus (sinus frontalis) is located in the scales and orbital region frontal bone. There are the following walls of the sinus: anterior (facial); posterior (cerebral), bordering the anterior cranial fossa; lower (orbital), bordering the orbit and cells of the lattice labyrinth; medial - interaxillary septum. The front wall is the thickest. The thinnest is the orbital wall. The rear wall is in the middle in terms of thickness.

The inter-axillary septum may be deviated to one side or the other. On the lower wall, on the border with the partition and closer to back wall, there is an opening of the fronto-nasal canal, The sizes of the frontal sinuses vary widely up to their total absence on one or both sides. The anatomical proximity of the frontal sinuses to the contents of the anterior cranial fossa and orbit determines their pathogenetic relationship.

Lattice cells (celhdae ethmoidales) are represented by air cells located between the frontal and sphenoid sinuses. The number, volume, and placement of cribriform cells vary considerably. On each side, on average, there are 8-12 of them. These cells are delimited from the outside by a paper plate (lamina papyracea), which comes to the lacrimal bone from the front, to the sphenoid sinus from behind, borders on the frontal bone from above and from below - with the maxillary and palatine bones.

According to their location, the lattice cells are divided into anterior and middle ones, which connect with the middle nasal passage in the anterior part of the semilunar fissure (hiatus semilunaris), and the posterior ones, which open into the upper nasal passage. From the individual cells of the ethmoidal labyrinth, it is necessary to distinguish: 1) the ethmoid bladder (bulla ethmoidalis) - behind the lunar fissure, it laterally borders on a paper plate, and medially, sometimes reaching significant sizes, can move the middle shell to the nasal septum; 2) frontal bubble (bulla frontalis) - protrudes into the hole frontal sinus; 3) fronto-orbital cells - located along the upper wall of the orbit; 4) bulla conchae - located in the anterior part of the middle turbinate.

It should be noted that the cribriform plate (lamina cribrosa) most often lies below the arch of the nasal cavity, therefore, when opening the cells of the cribriform labyrinth, it is necessary to strictly adhere to the lateral direction so as not to penetrate the cranial cavity.

The sphenoid sinus (sinus sphenoidalis) is located in the body sphenoid bone. The partition divides it into two (often unequal) parts. The hole (ostium sphenoidale) is located on its front wall under the very roof of the nasal cavity.

The lower wall of the sinus is part of the arch of the nasal part of the throat, the upper one is represented by the lower surface of the Turkish saddle, on which the pituitary gland is located. The lateral wall of the sinus is very thin, it is bordered by the internal carotid artery, the cavernous sinus (sinus cavernosas), the first branch trigeminal nerve, oculomotor, block and efferent (III, IV, V and VI pairs cranial nerves) nerves.

The mucous membrane of the paranasal sinuses is a continuation of the mucous membrane of the nasal cavity, but it is much thinner, instead of 5-6 layers of cells, it has only 2. It is poor in blood vessels and glands and at the same time acts as a periosteum. The movement of the cilia of the ciliated epithelium is directed towards the outlet openings of the sinuses.

Newborns have two sinuses: the maxillary and ethmoid labyrinth, represented by rudiments. At the age of 6 years, the maxillary sinus acquires normal form, but its dimensions remain small. By the age of 8, the bottom of the sinus descends to the level of the bottom of the nasal cavity, and by 12 - below its bottom. By the time the child is born, the cells of the ethmoid labyrinth are formed, but their number and size increase with age, especially in children from 3 to 5 years old. Frontal and sphenoid sinuses are absent in newborns, their formation begins by the age of 4, and ends at 16-20 years.

DI. Zabolotny, Yu.V. Mitin, S.B. Bezshapochny, Yu.V. Deeva

The expression is often used: the sinuses are airy, what is it?

In the process of breathing, the spaces that represent the paranasal sinuses are filled with oxygen, they are air cavities.

In the sinuses, it is cleansed, warmed and then enters the lungs of a person.

The paranasal sinuses have an important feature in life. They are responsible for sneezing, that is, cleansing the nose of harmful bacteria and allergens that enter the human body during breathing. Also, a person’s sense of smell depends on them and a timbre is created during a conversation.

Having received the result, in the diagnosis you can see the phrase: "pneumatized paranasal sinuses." While pneumatization persists, no pathological processes are detected; if it deviates from the norm, they are present.

There are three varieties:

1. Preserved pneumatization . This is the natural state of the paranasal sinuses, which allow oxygen to pass through. In this form, a person's breathing remains normal, without deviations. The inflammatory process in the sinuses can only begin its development, without causing discomfort and disruption of functional features.
2. Reduced pneumatization . Changes occur in the progression of the inflammatory process, in the collection of mucous fluid and in the presence of a foreign body in the paranasal sinuses.
3. Increased pneumatization . It's rare pathological process. It occurs against the backdrop of a violation endocrine system and pathological features of the bones of the face. Increased pneumatization occurs in humans with gigantism.

Anatomical structure and location of the sinuses on the face

Humans have 4 pairs of paranasal sinuses:

1. wedge-shaped
2. Frontal
3. Gaimorovs
4. lattice

The sinuses of the nose have a surface in the form of a mucous membrane. Almost no surface vascular network and nerve endings. The inflammatory process in early stage passes without any symptoms. At x-ray examination the bones are pronounced, the ethmoid labyrinth has a clear outline.

Main (sphenoid) sinus

Main (sphenoidal) sinus

The main sinus is located in the body of the sphenoid bone, from which it takes its name. Its peculiarity lies in the fact that it does not have a pair. Inside it there is a wall that divides the sinus in half. Each half has its own output channel, while they do not have a message between them. They are uneven in size.

The sinuses are made up of:

• Anterior, which includes the ethmoid and nasal. They include an anastomosis that helps keep the sinuses connected to the nose.
• The back, which is too thin in thickness, and may be injured when surgical intervention to the wedge cavity.
• Inferior, leading to the vault of the nasopharynx.
• Upper, which is the lower part of the Turkish saddle.
• medial or internal.
• Lateral, located close to carotid artery and ocular nerve endings.

Ethmoid sinuses (ethmoid labyrinth)

Ethmoid sinus

The sinuses of the ethmoid bone are localized along anatomical structure between the sphenoid and frontal sinuses. It contains several cells total which ranges from eight to ten on both sides. They are arranged in several tiers and communicate with each other and with the nasal cavity.

All components of the lattice labyrinth are divided into anterior, middle and posterior. Each person has their own location.

Frontal (upper) sinuses

Frontal (frontal) sinuses

The frontal sinuses are located behind the eyebrows inside the frontal bone. They have front, back, inner and bottom walls. Front side considered to be the strongest. In it, the bridge of the nose is located below, and the frontal tubercles are on top. In the presence of an inflammatory process in the frontal sinuses of the ENT, the doctor will hear a complaint from the patient when pressed into the area between the eyebrows.

The back side of the frontal sinus is localized close to the cranial fossa. From below, the wall is the base of the frontal sinus and the upper wall of the eye. There is an anastomosis here, which, according to the anatomical structure, has the second name of the frontal-nasal canal.

Inside the sinuses there is a thin partition that separates them into two parts. The left and right halves are asymmetrical.

Maxillary (maxillary) sinuses

Maxillary (maxillary) sinuses

Maxillary sinuses are the largest cavities in the anatomical structure. They are located above the upper jaw where their name comes from. They take their base at the outer wall of the nose. The shape is similar to a triangle.

From below they border on the roots of the teeth of the upper row. ENT doctors warn that it is important to treat minor dental diseases, starting from banal caries, in order to prevent the transition of the inflammatory process to the maxillary sinuses. Neglect of this rule threatens a person with the development of odontogenic sinusitis.

From above, they border on the lower part of the orbit and are its lower wall. At inflammatory process the maxillary sinus may cause blurred vision.

Front maxillary sinus has the hardest and densest wall. An ENT doctor can palpate it when examining a patient. Inside it there is an anastomosis that leads to the eyes. The maxillary sinuses are airy and their thrombosis can lead to inflammation.

Functions of the paranasal sinuses

The paranasal sinuses have functional features for every person:

Sinus development in children

From birth to the age of twenty, the formation of paranasal sinuses nose. Infants do not have frontal cavities, the rest are in an underdeveloped state. The formation occurs in the process of the growth of the child and the increase in the bones of the face. At the age of two years, the frontal sinuses are formed in the baby and the maxillary sinuses increase in size. Upon reaching four years the lower nasal passage is formed.

The formation of the sinuses in children

Acute inflammation of the cells of the ethmoid labyrinth is observed!

most often after an acute cold, flu, often in combination with acute inflammation other paranasal sinuses. AT childhood acute inflammation of the ethmoid cells occurs after acute respiratory disease, measles, scarlet fever, other infections and sometimes has the character of necrotic osteitis, often accompanied by acute sinusitis.

The pathoanatomical feature of acute ethmoiditis is that the loose stroma of the mucous membrane of the cells of the ethmoid bone easily forms an edematous swelling, which narrows the lumen bone cells and nasal outlets.

These features contribute to the rapid development of inflammation, its spread to the bone and the occurrence of abscesses and fistulas of the inner angle of the orbit, which are especially common in children.

clinical picture. Signs of acute ethmoiditis are pressing pain in the area of ​​​​the back of the nose and bridge of the nose, headache of various localization, significant difficulty in nasal breathing. In the first days of the disease there are abundant serous you!

divisions from the corresponding half of the nose and mucopurulent or purulent in the future. The discharge is usually odorless. In childhood, edema and hyperemia often appear in the area of ​​​​the inner angle of the orbit and adjacent sections of the upper and lower eyelids and conjunctivitis on the side of the disease. As a rule, there is hyposmia, anosmia. A decrease in inflammation is accompanied by an improvement in the sense of smell, however, in some cases, influenza infection reflects the olfactory receptor, causing essential hypo- or

anosmia, which is usually irreversible.

Body temperature is often a reaction to the flu or another infectious disease

hyperemia of the middle turbinate; discharge usually drains from under it. In some cases, especially in childhood, with scarlet fever or influenza ethmoiditis, part of the bone walls of the cells of the ethmoid labyrinth is destroyed; a closed abscess (closed empyema) can form here, which usually increases in the absence of outflow, causing deformations in the nasal cavity and in the region of the inner wall of the orbits. From such an abscess, pus can break into the tissue of the orbit, which is accompanied by a deviation outward eyeball, exophthalmos, severe pain in the orbit, headache, sharp rise body temperature. Education purulent fistula at the inner corner of the orbit reduces inflammation, while the breakthrough of pus into the cranial cavity through the orbit sharply aggravates the condition.

Diagnostics. Based on the symptoms described. An X-ray examination, and, if necessary, an ophthalmological and neurological examination, an examination by an infectious disease specialist will help clarify the diagnosis. A study of the discharge on the microflora and its sensitivity to antibiotics will allow you to correctly assess the severity of the infection and prescribe the appropriate antimicrobial drug. Early diagnosis of the disease, especially its complications, is the basis for timely effective treatment.

Treatment. In acute ethmoiditis, conservative treatment, and in case of beginning or developed complications, surgical treatment. Assign an infusion of vasoconstrictor drops into the nose, applications of the same. preparations under the middle sink, UHF or microwave on the area of ​​the lattice labyrinth. At elevated body temperature, antibacterial drugs are indicated orally, and in severe cases, parenterally. After receiving the results of the study of the discharge on the microflora, it is necessary to clarify the choice of antibiotic. When a closed empyema or orbital complication occurs, the cells of the ethmoid labyrinth and abscess in the orbit should be opened.

Chronic inflammation of the cells of the ethmoid labyrinth

Chronic inflammation of the cells of the ethmoid labyrinth (chronic ethmoiditis) usually begins after acute illness, Not-rarely, acute and chronic inflammation of the maxillary, frontal and sphenoid sinuses leads to a secondary lesion of the cells of the latticed labyrinth, since they occupy a central position in relation to these sinuses. In this regard, chronic ethmoidish rarely occurs in isolation; usually in combination with inflammation of other paranasal sinuses, more often the maxillary one.

In most cases, there are catarrhal-serous, catarrhal-purulent and hyperplastic forms of chronic ethmoiditis, which are characterized by a significant thickening of the mucous membrane, the formation of polypous lesions. The cause of polyposis degeneration of the mucous membrane is considered to be prolonged irritation of its pathological discharge; another cause may be a local allergic reaction. Sometimes polyps are solitary, but more often they are multiple. The usual each has a relatively thin stem, and the shape depends on the surrounding contours of the nose. Rarely, polyposis changes are not represented by individual polyps, but in the form of a continuous polyposis section of the mucous membrane. . |

In cases where there are multiple polyps, they can put pressure on the walls of the nose and even cause its external deformation. In children early age polyposis changes in the nasal mucosa are rare. Histologically, polyps are edematous inflammatory formations of the mucous membrane; the architectonics of connective and other tissues is disturbed by the type of stratification and chaotic displacement of fibers by the wall liquid; diffuse infiltration of tissues by neutrophils occurs; there are also other cells (eosinophils, mast cells). The surface of the polyps is covered with a cylindrical ciliated epithelium, which metaplasias in places into flat

clinical picture. In chronic ethmoiditis, oi depends on the activity of the process. During the period of remission of the patient< риодически беспокоит головная боль, чаще в области корня Hod переносицы, иногда диффузная. При серозно-катаральной фор] отделяемое светлое, обильное; гнойная форма сопровождается cK ным отделяемым, которое подсыхает и образует корки. Часто выд* ления из носа имеют запах. Вовлечение в процесс задних клет<1 решетчатого лабиринта приводит к скоплению отделяемого в н глотке, чаще по утрам, отхаркивается оно с трудом. Обоняние, правило, нарушено в различной степени.

With rhinoscopy, catarrhal changes are found in the new in the region of the middle sections of the nose; under the middle shell of the oba there is a mucous or mucopurulent discharge. Polyposis! formations are also localized in the middle and upper sections but< Полипы могут быть светлые, в других случаях - серые или бледн розовые, иногда студенистые; как правило, они имеют гладкую гв верхность. Число и величина их индивидуальны - может быть 1

large polyps that fill the entire nasal cavity, or many small ones; in most cases, with ethmoiditis, there are multiple small polyps, which is explained by their formation around numerous excretory openings from the cells of the ethmoid bone.

In chronic ethmoiditis, empyema can also form; at the same time, even closed empyema can proceed latently for a long time. In such cases, only the external deformation of the nose or eye socket, as well as a sharp violation of nasal breathing, can be the reason for their recognition. The general condition of patients remains satisfactory, however, irritability, fatigue, and general weakness may be noted. During the period of exacerbation, symptoms of acute inflammation appear; in this case, the data of the anamnesis and the rhinoscopy picture can help to make the correct diagnosis.

Treatment. In uncomplicated forms of chronic ethmoiditis, it is most often conservative; in some cases, it is combined with intranasal operations (polypotomy, opening of the cells of the ethmoid labyrinth, partial resection of the nasal concha, etc.).

Endonasal opening of the cells of the ethmoid labyrinth is performed under local application anesthesia. To penetrate into the zone of ethmoid cells, it is necessary to expand the middle nasal passage, this is achieved by removing the anterior end and displacing the middle nasal concha medially (or partially removing it). After achieving good visibility of the middle nasal passage with nasal forceps, double curettes and a conchotome, the middle and partially anterior ethmoid cells are opened; while the nasal cavity expands due to the destroyed cells. Penetration of the instrument through the sieve plate into the cranial cavity is of great danger - this usually leads to liquorrhea and the occurrence of meningitis and other severe intracranial complications.

In most cases, it is sufficient to remove a part of the aged cells of the ethmoid bone, which leads to the recovery of the rest under the influence of conservative treatment. In rare cases, it still becomes necessary to open all the lattice cells, including the rear ones; for this, an operation is performed with an external approach to the ethmoid bone or through the maxillary sinus.

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 other bone structures, it makes up the facial part of the skull. 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 when ethmoiditis is combined with sinusitis or frontal sinusitis, bacteriological analysis often reveals a microbial association - 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, acute inflammation occurs, which can turn into chronic ethmoiditis.

Symptoms

The main symptoms of ethmoiditis:

• pain;
• pressure, feeling of fullness in the nose;
• violation of nasal breathing;
• secretion from the nose;
• 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), increased sensitivity 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. In this case, painful sensations can spread to the forehead and eye sockets, intensify at night. During periods of exacerbation, the pain becomes pulsating, in parallel, rapid eye fatigue is noted.

Acute pain during inflammation of the ethmoid labyrinth is due to the pressure that the edematous mucosa exerts on other structures.

In acute and exacerbation of chronic inflammation, very severe, exhausting 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 the 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, pathogenic flora actively develops in the liquid, pus is formed. The accumulation of pathological secretions 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 makes nasal breathing absolutely impossible.

Secretion from the nose

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

• slimy;
• purulent;
• bloody.

At the initial stage of the disease, there is a clear, viscous, scanty discharge from the nose. 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. If inflammatory processes affect the bone and periosteum, nasal discharge acquires a characteristic putrid odor.

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

Deterioration of smell

Inflammatory processes can affect the fibers of the 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

In addition to the specific manifestations of ethmoiditis, there are general symptoms of 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 by different types of microorganisms differ from each other and act on different organs and systems of the human body.

If toxins act on the nervous system, symptoms of neurotoxicosis occur - excruciating headache, vomiting, agitation, followed by weakness and apathy. Toxins that affect the 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 rapidly 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 the 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 of the skin in the eye area;
• narrowed palpebral fissure;
• Difficulty moving the eyeball.

With inflammation of the ethmoid labyrinth, the patient has a sharp pain when pressing 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).

In order to carry out 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 of the bacterial infection that caused the 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;
• restoration of the body's defenses, strengthening of immunity (special attention should be paid to the state of the immune system in the chronic form of the disease).

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 often used in injectable form (Cefotaxime, Ceftriaxone).

With ethmoiditis, topical antibacterial agents may additionally be prescribed - 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 (combined 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 and fever, nonsteroidal drugs are prescribed based on:

• 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 ethmoid labyrinth is a serious disease, dangerous for 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

The lack of positive results of treatment or the development of complications become the reason for surgical intervention. Operations are usually carried out by the endoscopic method, which allows 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.

Surgical methods are 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 of the arachnoid membrane), meningitis (inflammation of the soft membrane) 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 make an accurate diagnosis and prescribe adequate 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.