Acute ethmoiditis (inflammation of the ethmoid sinus). Inflammation of the ethmoid sinus symptoms treatment

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

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

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

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

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

Factors predisposing to the development of ethmoiditis are:

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

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

Classification of ethmoiditis

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

Depending on the morphological features The disease and the nature of the discharge are determined by the following types:

• catarrhal;
• purulent;
• edematous catarrhal;
• polyposis.

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

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

• left-handed;
• right-handed;
• bilateral.

Clinical signs of ethmoiditis

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

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

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

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

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

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

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

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

Complications of ethmoiditis

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

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

Diagnosis of ethmoiditis

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

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

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

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

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

Decisive importance in the diagnosis of ethmoiditis belongs to x-ray examination the area of ​​the paranasal sinuses - the image will reveal darkening in the area of ​​the cells of the ethmoid bone. Also highly informative in in this case There will be a computed tomography scan.

Differential diagnosis of ethmoiditis

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

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

Osteomyelitis of the maxilla is a disease usually diagnosed in children younger age. It manifests itself as swelling and infiltration of the soft tissues of the face in the area of ​​the alveolar process of the upper jaw and swelling of the lower eyelid. Redness of the eyelid and tissues above upper jaw however, it is missing.

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

Treatment of ethmoiditis

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

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

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

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

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

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

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

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

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

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

Less often, especially severe cases, use open access to the lattice labyrinth.

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

Prevention of ethmoiditis

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

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

Prognosis of ethmoiditis

In most cases of acute ethmoiditis, provided timely diagnosis and rational treatment, the disease goes away without a trace - the person recovers completely.

The prognosis for chronic ethmoiditis is less encouraging. Full recovery almost impossible; it is only possible to introduce the disease into a stage of stable remission, and then under the condition complex treatment and disease prevention, causing exacerbation inflammatory process in a lattice maze.

(runny nose) are often accompanied by inflammation of the paranasal sinuses (sinuses). There are several of them. Common name their inflammation is called sinusitis. But the inflammation of each individual sinus has its own unique name.

What is ethmoiditis?

What is it - ethmoiditis (ethmoidal)? This is an inflammation of one of the paranasal sinuses, or rather, the cells of the ethmoid bone. Often is secondary disease, which develops against the background of inflammation of the upper respiratory tract. It ranks 5th in terms of the prevalence of diseases that are treated with antibiotics.

The shape of the flow is:

1. Acute – a bright and sudden manifestation. More often observed in children and adolescents.
2. Chronic – a consequence of anatomical pathology or untreated acute ethmoiditis.

The following types of ethmoiditis are distinguished:

1. Together with other departments:
   • Maxillary ethmoiditis is inflammation of the ethmoid bone with the maxillary sinuses.
   • Frontoethmoiditis is a lesion of the frontal sinus along with the ethmoid bone.
   • Rhinoethmoiditis is inflammation of the ethmoid bone together with the mucous membrane of the nasal cavity.
   • Sphenoethmoiditis is inflammation of the ethmoidal labyrinth with the sphenoid sinus.
2. According to the nature of inflammation:

• Catarrhal.
• Polypous.
• Edema-catarrhal.
• Purulent.

1. On the side of inflammation:

• Right-handed.
• Left-handed.
• Bilateral.

Causes

The causes of ethmoiditis are the following factors:

• Penetration of infection into the nasal sinus.
• Complication of other diseases: measles, meningitis, sinusitis, scarlet fever, rhinitis, influenza, encephalitis, sinusitis.
• Spread of infection from other organs through the blood, for example, with tonsillitis.
• Decreased immunity.
• Anatomical pathologies.
• Injuries to the nasal septum and face.
• Allergic predisposition.

Symptoms and signs of ethmoiditis of the ethmoid bone cells

The following symptoms and signs of ethmoiditis of the ethmoid bone cells are distinguished:

• Pain. Localized in the bridge of the nose and fronto-orbital region. Accompanied by headaches high temperature, photophobia, visual impairment. IN chronic form Insomnia, eye fatigue and swelling are observed.
• A feeling of fullness in the nasal cavity due to the occurrence of pus and swelling of the cells. Nasal congestion.
• Difficulty breathing through the nose due to swelling of the mucous membrane. In children it is possible complete absence nasal breathing.
• Nasal discharge, which characterizes exudate accumulated in inflamed cells. They can be mucous, purulent or bloody. At first they are scanty, and then they become abundant.
• Partial or complete absence of smell.

These symptoms are characteristic of both acute and chronic forms. The following signs appear clearly only when acute form ethmoiditis, and in chronic cases they are weak and unexpressed:

• Fever.
• Regurgitation (in children) and vomiting.
• Malaise.
• Loss of appetite.
• Neurotoxicosis.
• Weakness.
• Intestinal disorders: as with colitis or proctitis, stool disturbance is observed.
• Kidney failure.
• Tearing.
• Swollen eyelids that are slightly or completely closed. It occurs as a result of the destruction of part of the ethmoid bone and the penetration of exudate into the tissue of the orbit. Here there is deviation, protrusion of the eyeball, decreased vision and pain when moving the eye.
• Skin is hot and damp.

During remissions in chronic ethmoiditis, symptoms worsen only in intoxication (weakness, fever, decreased performance, headache).

Ethmoiditis in children

Ethmoiditis often occurs in children (more often than in adults). It's connected with anatomical structure and low body resistance. It often develops against the background colds V winter time when children transmit the infection to each other. It can manifest itself in both newborns and children of primary school age, and especially in adolescents.

Ethmoiditis in adults

Ethmoiditis also occurs in adults, often in winter, when they are not treated. The presence of chronic diseases also provokes the transfer of infection to the cells of the ethmoid bone.

Diagnostics

Diagnosis of ethmoiditis is general examination based on the patient’s complaints, in which some manifestations of the disease are already visible, as well as in carrying out laboratory and instrumental procedures:

• Rhinoscopy.
• Blood analysis.
• X-ray of the nasal sinuses.
• Endoscopic examination.
• CT and MRI.
• Exclusion of dacryocystitis, periostitis of the nasal bones, ostiomyelitis of the upper jaw.

Treatment

Treatment of ethmoiditis consists of undergoing medication and physiotherapeutic procedures. How to treat inflammation of the cells of the ethmoid area of ​​the nose? The ENT doctor prescribes the following course of medications:

• Antibiotics and antiviral drugs.
• Immunostimulating drugs. Immunomodulators.
• Vasoconstrictor medications.
• Antipyretic medications.
• Antihistamines.
• Non-steroidal anti-inflammatory drugs.
• Painkillers.
  1. Galazolin.
  2. Xymelin.
  3. Oxymetazoline.
  4. Amoxicillin.
  5. Augmentin.
  6. Cefotaxime.
  7. Bioparox.
  8. Ceftriaxone.
  9. Rinofluimucil.
  10. Paracetamol.
  11. Aqua Maris.
  12. Sinuforte.

At home, the patient must adhere to the following rules:

• Increase immunity.
• Ventilate the room and humidify the air.
• Follow a diet:
  1. Drink plenty of fluids.
  2. Consume vegetables, fruits, dairy products, nuts, meat, cereals, legumes.
  3. Avoid alcohol, fatty foods, fried foods, causing allergies products.
  4. Use decoctions of herbs, berries and fruits.

As physiotherapy and surgical intervention are used:

• Sinus catheter "YAMIK" rinsing cells with antibiotics.
• Other types of washing.
• Electrophoresis with antibiotics.
• Phonophoresis with hydrocortisone.
• Helium-neon laser.
• Endoscopic removal of exudate.
• Septoplasty.
• Resection.
• Polypotomy.

Lifespan

Ethmoiditis is easily and quickly treated. However, if the patient ignores treatment for the disease, then it reduces the quality of life. How long do patients live? The disease itself does not affect life expectancy, but it provokes several fatal complications:

• Empyema.
• Meningitis.
• Destruction of the ethmoid bone.
• Encephalitis.
• Phlegmon of the orbit.
• Retrobulbar abscess.
• Arachnoiditis.
• Brain abscess.

Ethmoid bone(os ethmoidak), unpaired, consists of 2 plates: ethmoidal, located horizontally, and perpendicular (Fig. 1, 2), as well as a ethmoid labyrinth. The labyrinth is a paired formation represented by a complex of air cells adjacent to the cribriform plate on each side. The cells communicate with each other and with the nasal cavity.

Rice. 1. Ethmoid bone:

a — topography of the ethmoid bone;

b — top and rear view: 1 — perpendicular plate; 2 - wings of the cock's comb; 3 - anterior cells of the ethmoid labyrinth; 4 - posterior and middle cells of the ethmoid labyrinth; 5 - orbital plate; 6 - cribriform plate; 7 - cockscomb;

c — bottom view: 1 — perpendicular plate; 2 - top turbinate; 3 - cribriform plate; 4 - middle turbinate; 5 - uncinate process; 6 - posterior cells of the ethmoid labyrinth; 7 - anterior cells of the ethmoid labyrinth;

d — view from the lateral surface: 1 — cockscomb; 2 - wings of the cock's comb; 3 - anterior cells of the ethmoid labyrinth; 4 - perpendicular plate; 5 - uncinate process; 6 - middle turbinate; 7 - orbital plate

Rice. 2. Participation of the ethmoid bone in the formation of the walls of the cranial cavity, orbits and nasal cavity

1 - ethmoid bone; 2 - cranial cavity; 3 - eye socket; 4 - maxillary sinus; 5 - nasal cavity

The ethmoid bone is located in the ethmoid notch of the frontal bone. The cribriform plate of the ethmoid bone is part of brain section skulls The remaining parts take part in education bone walls nasal cavity and medial walls of the orbits.

cribriform plate(lamina cribrosa) connects at the front and sides with frontal bone, behind - with the front edge sphenoid bone. The plate is riddled with many small lattice openings (foramina cribrosa) for branches of the olfactory nerves. From the cribriform plate to midline goes up cockscomb (crista galli), to which the anterior end of the falx cerebri is attached. Anterior to this ridge lies a paired process - cockscomb wing (ala cristae galli).

Perpendicular plate(lamina perpendicularis) irregular hexagonal shape, descends down, forming the anterior part of the bony septum of the nose.

Cells lattice labyrinth(labirintus ethmoidae) divided into three groups, vaguely delimited from each other: anterior, middle and posterior. On the lateral side they are covered with a very thin bone orbital plate (lamina orbitalis), facing the free surface into the orbital cavity. WITH inside only a small part of the ethmoid cells is covered with bone plates. Most of them remain open and are covered by neighboring bones: the frontal, lacrimal, sphenoid, palatine and maxilla.

The medial surface of the labyrinth limits top part nasal cavity and is equipped with 2 thin bone plates facing the nasal cavity - the upper and middle turbinates (conchae nasales superior et media), and uncinate process (processus uncinatus). There is a gap between the shells - superior nasal passage (meatus nasi superior). Sometimes found above and behind the upper shell highest nasal concha (concha nasalis suprema). The shells of the ethmoid bone have different shape and sizes, determining the different depths and lengths of the corresponding passages of the nasal cavity.

Ossification of the ethmoid bone begins with ethmoid plasticity and labyrinth at 5-6 months intrauterine development. At the end of the 1st year of life, ossification centers appear at the base of the cock's crest and in the perpendicular plate. The fusion of bone parts occurs at 5-6 years.

Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin

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

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

The pathoanatomical feature of acute ethmoiditis is that the loose stroma of the mucous membrane of the ethmoid bone cells 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 internal 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 locations, significant difficulty in nasal breathing. In the first days of the disease there are profuse serous lesions!

divisions from the corresponding half of the nose and mucopurulent or purulent in the future. The discharge is usually odorless. In childhood, swelling and hyperemia often appear in the area of ​​the internal angle of the orbit and adjacent parts of the upper and lower eyelids and conjunctivitis on the side of the disease. As a rule, hyposmia and anosmia are noted. 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 are usually irreversible.

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

hyperemia of the middle turbinate; the 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 area of ​​the inner wall of the orbits. From such an abscess, pus can break into the tissue of the orbit, which is accompanied by outward deviation of the eyeball, exophthalmos, severe pain in the orbit, headache, sudden increase in body temperature. Education purulent fistula at the inner corner of the orbit, it reduces inflammation, while the breakthrough of pus into the cranial cavity through the orbit sharply aggravates the condition.

Diagnostics. Based on the symptoms described. X-ray examination, and, if necessary, ophthalmological and neurological examination, an examination by an infectious disease specialist will help clarify the diagnosis. Studying the discharge for 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 case of acute ethmoiditis, it is conservative, and in case of beginning or developed complications, it is surgical. Infusion of vasoconstrictor drops into the nose and applications of the same are prescribed. drugs under the middle concha, UHF or microwave on the area of ​​the ethmoid labyrinth. At elevated body temperatures, antibacterial drugs are indicated orally, and in severe cases - parenterally. After receiving the results of a microflora study of the discharge, it is necessary to clarify the choice of antibiotic. If a closed empyema or orbital complication occurs, the cells of the ethmoidal labyrinth and the abscess in the orbit should be opened.

Chronic inflammation of the ethmoidal labyrinth cells

Chronic inflammation of the cells of the ethmoidal labyrinth (chronic ethmoiditis) usually begins after an acute illness; often, acute and chronic inflammation of the maxillary, frontal and sphenoid sinuses leads to secondary damage to the cells of the ethmoidal labyrinth, since they occupy 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, most often the maxillary sinus.

In most cases, catarrhal-serous, catarrhal-purulent and hyperplastic forms of chronic ethmoiditis occur, which are characterized by significant thickening of the mucous membrane and the formation of polypous growths. The cause of polypous degeneration of the mucous membrane is considered to be prolonged irritation by its pathological discharge; Another reason may be a local allergic reaction. Sometimes polyps are single, but more often they are multiple. Typically, each has a relatively thin stem, and the shape depends on the surrounding contours of the nose. Rarely, polypous changes are presented not as individual polyps, but as a continuous polypous area of ​​the mucous membrane. . |

In cases where there are multiple polyps, they can put pressure on the walls of the nose and even cause external deformation. In children early age polypous 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 disrupted by the type of delamination and chaotic displacement of fibers by a wall of liquid; diffuse infiltration of tissues by neutrophils occurs; Other cells (eosinophils, mast cells) are also found. The surface of the polyps is covered with columnar ciliated epithelium, which in some places metaplasias 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.

Rhinoscopy reveals catarrhal changes in the new area of ​​the middle sections of the nose; under the middle concha there is a mucous or mucopurulent discharge. Polypozn! formations are also localized in the middle and upper sections of the 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 filling the entire nasal cavity, or many small ones; in most cases, with ethmoiditis, multiple small polyps are found, which is explained by their formation around the numerous outlet openings from the cells of the ethmoid bone.

In chronic ethmoiditis, empyema can also form; Moreover, even closed empyemas can occur latently for a long time. In such cases, only external deformation of the nose or eye socket, as well as a sharp disturbance in nasal breathing, can be a reason for their recognition. The general condition of patients remains satisfactory, but irritability, increased fatigue, and general weakness may be noted. During the period of exacerbation, symptoms of acute inflammation appear; in this case, medical history and rhinoscopic picture can help 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 ethmoidal labyrinth, partial resection of the nasal turbinates, etc.).

Endonasal opening of the ethmoidal labyrinth cells is performed under local application anesthesia. To penetrate the ethmoid cell zone, it is necessary to expand the middle meatus, this is achieved by removing the anterior end and medially displacing the middle turbinate (or partially removing it). After achieving good visibility of the middle nasal meatus, the middle and partially anterior cells of the ethmoid bone are opened with nasal forceps, double curettes and a conchotome; in this case, the nasal cavity expands due to 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 some of the dead cells of the ethmoid bone, which leads to the improvement of the rest under the influence of conservative treatment. In rare cases, there is still a need to open all ethmoid cells, including the rear ones; To do 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 epithelium lining the cells of the ethmoid bone.

The ethmoid bone (from the Latin os ethmoidale) lies between the nasal cavity and the cranial cavity, consists of bone cells lined with ciliated epithelium - the mucous membrane.

Due to its central position, the proximity of the excretory ducts of other sinuses, inflammation of the mucous lining of the ethmoid bone leads to,. When inflamed, the loose and thin mucous membrane of the cells quickly swells, becomes gelatinous, and serves as the basis for the formation.

The anterior cells of the ethmoid bone come close to the frontal sinus and, when inflamed, cause blockage of the frontal sinus. Another feature of the ethmoid bone is that branches of the trigeminal nerve pass through it - the ophthalmic nerve and the maxillary nerve.

Most often, ethmoiditis is accompanied by sinusitis or frontal sinusitis; the symptoms and approaches to the treatment of these diseases are similar.

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

• spicy;
• chronic.

They are distinguished by localization of inflammation:

• right-sided– inflammation affects the cells of the ethmoid bone on the right side;
• left-handed– the affected cells are on the left;
• double-sided– all cells of the ethmoid bone are affected.

Causes

The cause of ethmoiditis can be ordinary, frequent respiratory diseases. Ethmoiditis is caused by bacterial microfungal and viral infections.

In adults and children, symptoms of ethmoiditis occur against the background of reduced immunity and inflammation of other paranasal sinuses; treatment in this case is aimed at eliminating concomitant diseases.

In children, inflammation of the mucous membranes of the cells is more common. Swelling of the mucous membrane due to a runny nose, respiratory disease, flu, can lead to illness. The cause of ethmoiditis in newborns is most often umbilical and skin sepsis. The disease is very severe, with high fever.

In adults and older children, ethmoiditis easily spreads to other paranasal sinuses and is combined with sinusitis or sinusitis. In these cases, the disease is diagnosed as frontoethmoiditis, maxillary ethmoiditis.

Features of ethmoiditis in children

The number of bone cells in a newborn is 2-3, with age their number increases and reaches 10-15. Ethmoiditis is observed in children from a very early age, this is due to the narrowness of the excretory ducts from the cells of the ethmoid labyrinth.

A slight swelling of the mucous epithelium lining the cells and the outlet openings of the cells is sufficient to stop the outflow of discharged contents from the ethmoid sinus.

Ethmoiditis in young children easily spreads to the bone and periosteum, causing the formation of abscesses and fistulas. The proximity of the ethmoid bone to the orbit poses a threat to the health of the eye; the abscess provokes phlegmon of the orbital tissue and intraorbital complications.

Symptoms of acute ethmoiditis

The main symptoms of ethmoiditis are heaviness at the base of the nose, congestion of the nasal passages, secretion of yellow-green mucus and pus, accompanied by frequent painful headaches.

The disease is characterized by an acute increase in temperature, deterioration of general condition, a feeling of weakness and fatigue. The pain is localized at the root of the nose and in the eye sockets. The intensity of pain is determined by the degree of irritation of the nerve endings of the branches of the trigeminal nerve passing through the ethmoid bone.

The skin of the inside of the eye socket and base of the nose is thickened and sensitive to touch. There are throbbing pains in the forehead, base of the nose, and orbit. The pain intensifies at night, in the daytime there is rapid fatigue during visual work, photophobia.

In children, elderly people, and people with weakened immune systems, part of the bone walls of the cells is destroyed, and inflammation also affects the soft tissues of the inner corner of the orbit. The process spreads to the surrounding tissues, causing the formation of numerous foci, causing orbital and intracranial complications, osteomyelitis of the upper jaw, affecting the bronchopulmonary system.

In the orbital area, an abscess forms, and when it ruptures, fistulas and orbital phlegmon are formed.

The abscess causes pain when moving the eyes, displaces the eyeballs outward, and impairs vision. In the orbital area, symptoms manifest as swelling of the eyelids, displacement of the eyeball outward, and increased pain in the orbit.

Nasal mucus discharge contains pus and blood. Even after thoroughly blowing his nose, the patient still has a feeling of stuffiness in the depths of the nasal passages. Constant irritation leads to paroxysmal frequency. Noted.

The area of ​​the lacrimal sac swells, the sclera of the eyes turn red, and when palpating the lacrimal bone located at the root of the nose, the sufferer of ethmoiditis feels pain.

Symptoms of ethmoiditis in young children may include lack of appetite and vomiting.

Ethmoiditis occurs much more acutely in children than in adults; this phenomenon is associated with the low resistance of the child’s body to infectious agents.

Symptoms of chronic ethmoiditis

Undiagnosed, undertreated ethmoiditis passes into the chronic stage. The disease is often a complication of inflammation of the maxillary sinus, frontal sinusitis, and chronic runny nose.

Symptoms of chronic ethmoiditis appear 2 months after the acute form.

WITH contribute to the transition of the disease from an acute to a chronic form; defects in the structure of the nasal septum. The causes of chronic inflammation can be frequent respiratory diseases, the presence of polyps, and adenoids.

The general condition worsens, the patient quickly gets tired, becomes irritable, and his ability to work decreases.

Often chronic ethmoiditis occurs for a long time in a latent form. The patient's state of health in the periods between relapses is satisfactory.

With exacerbation of chronic ethmoiditis, the following are observed:

• purulent nasal discharge;
• drainage of pus and mucus along the wall of the nasopharynx, especially a lot of discharge accumulates in the morning, the patient has difficulty coughing it up;
• heaviness in the bridge of the nose, increasing when the head is tilted;
• headache;
• swelling of the upper eyelid;
• pain when moving the eyes.

Swelling of the eyelid and pain in the right orbit indicate right-sided ethmoiditis; with severe symptoms on the left, left-sided ethmoiditis. All cells of the ethmoid bone can be involved in the inflammatory process, in this case they speak of bilateral ethmoiditis.

Endoscopic examination at the stage of chronic ethmoiditis reveals pronounced thickening of the mucous membrane - hyperplastic ethmoiditis. In this form of the disease, the mucous membrane of the middle concha grows so much that it closes with the nasal septum.

Degenerative changes in the mucosa lead to the appearance of polyps. Prolonged swelling and inflammation cause polyposis - the phenomenon of multiple formation of polyps.

So many polyps form that they fill the entire nasal cavity and come out. This form of the disease is defined as polypous ethmoiditis. At this stage, there is a deformation of the nasal septum caused by polyposis.

Diagnosis of ethmoiditis

The best method for assessing the condition of the ethmoid sinuses in ethmoiditis is computed tomography. A detailed examination allows you to identify the first signs of the disease.

Magnetic resonance imaging (MRI) is the preferred tool for detecting acute ethmoiditis. This method has a high resolution, which makes it possible to diagnose sinusitis caused by a fungal infection.

X-ray studies are used in the diagnosis of adults. The radiograph shows shadowing of the ethmoid bone cells.

Effective methods are:

• rhinoscopy– the examination is performed using a nasal dilator and a nasopharyngeal speculum.
• endoscopic examination using a probe equipped with an optical system.

Treatment of acute ethmoiditis

Acute ethmoiditis is treated mainly with medications. All therapeutic measures are aimed at reducing swelling of the mucous membrane of the ethmoid bone cells and improving drainage function.

It is especially effective in the treatment of ethmoiditis. Using a sinus catheter, the cells of the ethmoid bone are cleared of pus using a non-surgical method, washed with medicinal substances, suppressing the activity of pathogenic bacteria and eliminating inflammation of the mucous membrane.

Antibiotics of a wide range of action effectively cope with bacterial infections - cypromed, amoxicillin, cefazolin, augmentin, clacid, roxithromycin, cephaloridin, sumamed.

Among the anti-inflammatory drugs, the drugs of choice are chloropyramine, ebastine, and fenspiride. Nasal congestion is relieved by dimetindene, naphazoline, and ephedrine solution.

Treatment with the new generation drug Sinuforte has a good effect. The remedy belongs to homeopathic preparations and is prescribed for individual intolerance to traditional medications.

Allergic ethmoiditis

The disease occurs quite often and is accompanied by paroxysmal sneezing and impaired nasal breathing. Rhinoscopy reveals the filling of the nasal passages with foamy mucus.

Mucus analysis shows a high content of eosinophils, indicating an allergic reaction. The key to success in the treatment of allergic ethmoiditis is the identification and elimination of the allergen.

Symptomatic treatment of allergic ethmoiditis is carried out with antihistamines, corticosteroids, calcium compounds, and vitamin complexes.

Treatment of chronic ethmoiditis

Treatment with complex agents isofra, rhinofluimucil, polydex, bioparox effectively eliminates the symptoms of chronic ethmoiditis.

They include:

• vasoconstrictor;
• antibiotic;
• pain reliever.

Physiotherapeutic procedures give good results:

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

A good result in the treatment of chronic ethmoiditis is observed when treated with the YAMIK method.

Surgery

Surgical intervention is resorted to in cases of complications caused by the spread of the inflammatory process to the periosteum and bone tissue. The opening of the ethmoid bone cells is carried out under anesthesia from an external approach.

To provide access to the ethmoid bone, the middle meatus is widened. Then the cells of the ethmoid bone are opened. The number of cells of the ethmoid bone and their location are individual for each person; the number of destroyed cells depends on the stage of the disease. During the operation, the affected cells are removed.

Modern endoscopic techniques allow surgery to be performed under video control using an endoscope and a medical microscope.

Treatment of ethmoiditis with folk remedies

Treatment with antibiotics, vasoconstrictors and anti-inflammatory drugs, on the recommendation of a doctor, can be supplemented with folk recipes. At home, ethmoiditis is treated by rinsing the nasal sinuses with a decoction of chamomile, strong brew of well-filtered black tea, and sage.

Traditional methods of treating ethmoiditis include washing wild rosemary, string, and fireweed with a heated solution. It is useful to rinse your nose with a solution of table salt; this method is also used in traditional medicine.

Complications

The main complications are observed from the orbit and ethmoid bone.

Noted:

• optic neuritis;
• empyema - destruction of the bone cells of the ethmoid bone;
• phlegmon of the orbital tissue.

Complications of ethmoiditis can include visual impairment - the appearance of visual field defects, decreased acuity, narrowing of the visual field.

Chronic ethmoiditis causes intracranial complications such as purulent meningitis, inflammation of the arachnoid membrane of the brain (arachnoiditis), and brain abscess. If the course of the disease is unfavorable, sepsis is possible.

With viral ethmoiditis, a complete loss of smell is observed.

Prevention of ethmoiditis

Quitting smoking, restoring the immune system, and timely treatment of colds and infectious diseases will help prevent the disease.

Forecast

With adequate treatment, the prognosis is favorable.

In adults, spontaneous recovery is possible with ethmoiditis, but in most cases, special treatment is required for complete disappearance of symptoms. The prognosis is cautious in case of complications.