Acute inflammation of the ethmoid labyrinth (acute rhinoethmoiditis): causes, symptoms, diagnosis, treatment

The front cells closely contact and share common messages with the frontal sinus and maxillary sinus, and the posterior cells with the sphenoid sinus, therefore inflammation of the anterior cells is often associated with inflammation of the frontal sinus or maxillary sinus, and inflammation of the posterior cells with the sphenoid sinus. With these associations often appear such names as gaymeroetmoidit, frontoetmoiditis, etmoidosfenoiditis. And although these names do not appear in the official nomenclature of diseases, they, in essence, reflect the localization of the pathological process and determine the tactics of treatment.

Acute rhinoetmoiditis also has another name - acute anterior ethmoid rhinosinusitis, reflecting the anatomical localization of the inflammatory process of a rhinogenic nature, affecting the anterior cells of the latticed bone. Etiology, pathogenesis and pathoanatomical changes in this disease are the same as in acute maxillary sinusitis.

Symptoms of acute rhinoethmoiditis are divided into local and general.

Local symptoms are characterized by the following symptoms:

• sensation of fullness and expansion in the depth of the nasal cavity and in the fronto-orbital area, caused by swelling and infiltration of the mucosa of the anterior cells of the latticed bone, filling them with exudate, and also with the emerging osteoperiostitis of their walls; the patient usually notices that the skin and soft tissues in the area of the internal commissure of the eyelids of one or both eyes and the base of the nose pyramid are thickened, pasty, somewhat hyperemic and sensitive when touching;
• spontaneous pains of a neuralgic nature in the frontal-orbital-nasal region, accompanied by diffuse cephalgia, which turn into pulsating paroxysms; these pains are worse at night, accompanied by photophobia, increased fatigue of the visual function, increased visual tension;
• obstruction of the nasal passages leads to a severe obstruction of nasal breathing;
• discharge from the nose, first serous, then mucopurulent with blood veins, abundant, creating a feeling of fullness in the deep sections of the nose, even after a blow-out; the patient has a constant sensation of a foreign body in the depth of the nose, itching and burning, which cause his fits of unrestrained sneezing;
• hyposmia and anosmia are caused not only by the obstruction of the olfactory gap, but also by the damage to the receptors of the olfactory organ.

With anterior rhinoscopy, pronounced edema appears in the area of the olfactory cleft, which completely covers it and sharply contrasts with the opposite side with unilateral damage to the anterior cells of the latticed bone. The average nasal shell is often enlarged, covering its mucous membrane edematous, hyperemic and painful when touching. Often, the average shell has the appearance of a double formation due to the fact that the top and the infundibulae region ethmoidale crawls the edematous mucous membrane in the form of a pillow, named after the author who described this Kaufmann's cushion.

In the upper and middle nasal passages, mucopurulent discharge is determined. For a more precise definition of the site of their exit, it is necessary to perform an effective anemization of the Mucous membrane of the upper part of the nasal cavity and the middle nasal passage with anterior rhinoscopy. On the same side, the edema of the eyelids, the skin of the inner commissure of the eye, the area of the CML, the sclera hyperemia, especially severe cases of chemosis, sharp pain in palpation of the tear bone at the root of the nose (the painful point of Grunwald) are determined. When palpation of eyeballs through closed eyelids on the side of the lesion, the pain of the eye, irradiating to the upper parts of the nasal cavity, is determined.

The clinical course of acute rhinoemoideitis is characterized by the following criteria:

• etiological and pathogenetic - rhinopathic, maxillo-odontopathic, barotraumatic, mechano-traumatic, etc .;
• pathomorphological - catarrhal, secretory-serous, purulent, infectious-inflammatory, allergic, ulcerative-necrotic, osteitic, etc .;
• microbiological - pyogenic microbiota, viruses, specific microbiota;
• symptomatic - according to the prevailing sign (the gynecological form, hyperthermic, anosmic, neuralgic, etc.);
• in terms of severity - super-sharp with pronounced general symptoms and involvement in the inflammatory process of neighboring tissues and organs (more often observed in children), acute, subacute (more often observed in the elderly);
• on complications - intraorbital, intracranial, optohyazmalnye, etc .;
• by age - rhinoethmoiditis of children, adults and old people.

Many of these criteria are associated with one another to one degree or another, determining the general picture of acute rhinoethmoiditis, which can evolve in the following directions:

• spontaneous recovery is most characteristic of catarrhal rhinoemoiditis, which go along with the banal rhinitis that initiates them; spontaneous recovery can occur under appropriate conditions and with purulent rhinoemoitis, for this it is necessary that the causes that caused the inflammatory process in the latticed bone be eliminated, and the general resistance of the organism to the infection was sufficient to overcome it; However, most often in the absence of the necessary treatment, rhinoemoideita passes into a chronic stage with a protracted clinical course;
• recovery as a result of appropriate treatment;
• transition to chronic ethmoiditis, which is facilitated by a variety of heteropathogenic factors (recurrent rhinoemoiditis, chronic foci of infection, frequent colds, immunodeficiency states, a number of risk factors, etc.).

The prognosis of rhinoemoideitis is favorable, with cautious forms - cautious, since in the case of orbital complications there may be disturbances associated with the organ of vision, and intracranial (leptomeningitis, sub- and extradural abscesses, etc.) can be life-threatening. With respect to the sense of smell, rhinoetmoiditis, caused by a banal microbiota, is favorable. With viral etiology, as a rule, persistent anosmia occurs.

The diagnosis is made on the basis of anamnesis, characteristic patient complaints and objective examination data, including radiography of the paranasal sinuses. The presence of rhinoemoideitis is indicated by two most characteristic symptoms: mucopurulent discharge, localized mainly in the upper parts of the nasal cavity, and characteristic pain and localization and irradiation. On radiographs, usually produced in the nasolabial and lateral projections, it is usually determined by the shading of the cells of the latticed bone, often combined with a decrease in the transparency of the maxillary sinus.

Differential diagnosis is made with regard to exacerbation of chronic etmoiditis and acute inflammation of other paranasal sinuses, for which clinical and diagnostic features are characteristic. Do not overlook the possibility of having spontaneous prosopalgia due to the essential trigeminal neuralgia.

Treatment of rhinoetmoiditis is mainly non-operative, based on the same principles and methods as treatment of acute sinusitis. First of all, all funds should be aimed at reducing the swelling of the nasal mucosa, especially in the middle nasal passage and in the upper parts of the nasal cavity to restore the drainage function of the cells of the latticed bone. To do this, use the same medication and manipulations, which are described above for acute sinusitis, excluding the puncture of the maxillary sinus. However, when combined rhinogaimeroetmoiditis and the presence of pathological contents in the maxillary sinus, measures for restoring the aeration and drainage of the affected sinus are shown, not excluding its puncture. To improve the drainage of the cells of the trellis, medial lux of the middle nasal cone is permissible.

Surgical treatment with rhinoethmoiditis is indicated only with complicated osteonecrotic forms of this disease, the appearance of signs of meningitis, sinus thrombosis, and brain abscess. With rhinoemoiditis, the opening of the cells of the trellis is always made from external access. Surgical intervention with rhinoethmoiditis is carried out under general anesthesia, a powerful cover of antibiotics with the establishment of a wide drainage of the postoperative cavity and the introduction of appropriate bactericidal solutions into the carry.