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

The anterior cells are in close contact and have common communications 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 the above associations, such names as maxillary ethmoiditis, frontoethmoiditis, ethmoidosphenoiditis often appear. 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 treatment tactics.

Acute rhinoethmoiditis has another name - acute anterior ethmoidal rhinosinusitis, reflecting the anatomical localization of the inflammatory process of a rhinogenic nature, affecting the anterior cells of the ethmoid bone. The etiology, pathogenesis and pathological changes in this disease are the same as in acute sinusitis.

Symptoms of acute rhinoethmoiditis are divided into local and general.

Local symptoms are characterized by the following signs:

• a feeling of fullness and distension in the depths of the nasal cavity and in the fronto-orbital region, caused by edema and infiltration of the mucous membrane of the anterior cells of the ethmoid bone, filling them with exudate, as well as the resulting 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 nasal pyramid are thickened, pasty, somewhat hyperemic and sensitive to touch;
• spontaneous pain of a neuralgic nature in the frontal-orbital-nasal region, accompanied by diffuse cephalgia, turning into pulsating paroxysms; these pains intensify at night, are accompanied by photophobia, increased fatigue of the visual function, and intensify with visual strain;
• obstruction of the nasal passages leads to severe difficulty in nasal breathing;
• nasal discharge, initially serous, then mucopurulent with streaks of blood, profuse, creating a feeling of fullness in the deep parts of the nose even after blowing the nose; the patient experiences a constant sensation of a foreign body deep in the nose, itching and burning, which cause him to have attacks of uncontrollable sneezing;
• Hyposmia and anosmia are caused not only by obstruction of the olfactory cleft, but also by damage to the receptors of the olfactory organ.

Anterior rhinoscopy reveals marked edema in the olfactory cleft area, which completely covers it and sharply contrasts with the opposite side in case of unilateral damage to the anterior ethmoid cells. The middle nasal concha is often enlarged, the mucous membrane covering it is edematous, hyperemic and painful to the touch. Often the middle concha looks like a double formation due to the fact that from above and in the area of the infundibulae ethmoidale, an edematous mucous membrane creeps in the form of a cushion, which was named after the author who described this formation - Kaufmann's cushion.

Mucopurulent discharge is detected in the upper and middle nasal passages. For a more precise determination of the place of their exit, it is necessary to perform effective anemization of the mucous membrane of the upper nasal cavity and middle nasal passage during anterior rhinoscopy. On the same side, edema of the eyelids, skin of the inner commissure of the eye, the area of the middle nasal passage, hyperemia of the sclera, in especially severe cases chemosis, and sharp pain upon palpation of the lacrimal bone at the root of the nose (Grunwald's painful point) are determined. When palpating the eyeballs through closed eyelids on the affected side, pain in the eye is determined, radiating to the upper parts of the nasal cavity.

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

• etiological and pathogenetic - rhinopathic, maxillodontopathic, barotraumatic, mechanotraumatic, etc.;
• pathomorphological - catarrhal, secretory-serous, purulent, infectious-inflammatory, allergic, ulcerative-necrotic, osteotic, etc.;
• microbiological - pyogenic microbiota, viruses, specific microbiota;
• symptomatic - according to the predominant feature (hypersecretory form, hyperthermic, anosmic, neuralgic, etc.);
• by severity - hyperacute with pronounced general symptoms and involvement of adjacent tissues and organs in the inflammatory process (more often observed in children), acute, subacute (more often observed in the elderly);
• by complications - intraorbital, intracranial, optochiasmal, etc.;
• by age - rhinoethmoiditis in children, mature adults and the elderly.

Many of the above criteria are associated with each other to varying degrees, defining the overall picture of acute rhinoethmoiditis, which can evolve in the following directions:

• Spontaneous recovery is most typical of catarrhal rhinoethmoiditis, which occurs together with the common cold that initiates it; spontaneous recovery can also occur under appropriate conditions with purulent rhinoethmoiditis, for this it is necessary that the causes that caused the inflammatory process in the ethmoid bone are eliminated, and the general resistance of the body to infection is sufficient to overcome it; however, most often, in the absence of the necessary treatment, rhinoethmoiditis 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 many heteropathogenic factors (recurrent rhinoethmoiditis, chronic foci of infection, frequent colds, immunodeficiency states, a number of risk factors, etc.).

The prognosis of rhinoethmoiditis is favorable, in complicated forms - cautious, since orbital complications may cause disorders associated with the organ of vision, and intracranial (leptomeningitis, sub- and extradural abscesses, etc.) may be life-threatening. In terms of olfaction, rhinoethmoiditis caused by banal microbiota is favorable. In viral etiology, persistent anosmia usually occurs.

The diagnosis is established based on the anamnesis, characteristic complaints of the patient and the data of an objective examination, including radiography of the paranasal sinuses. The presence of rhinoethmoiditis is indicated by two most characteristic symptoms: mucopurulent discharge, localized mainly in the upper parts of the nasal cavity, and pain characteristic in localization and irradiation. Radiographs, usually made in the nasomental and lateral projections, usually reveal shadowing of the ethmoid bone cells, often combined with a decrease in the transparency of the maxillary sinus.

Differential diagnostics are performed in relation to exacerbation of chronic ethmoiditis and acute inflammation of other paranasal sinuses, which are characterized by their own clinical and diagnostic features. The possibility of spontaneous prosopalgia caused by essential neuralgia of the trigeminal nerve should not be overlooked.

Treatment of rhinoethmoiditis is mainly non-surgical, based on the same principles and methods as the treatment of acute sinusitis. First of all, all means should be aimed at reducing the swelling of the nasal mucosa, especially in the area of the middle nasal passage and in the upper parts of the nasal cavity to restore the drainage function of the ethmoid cells. For this, the same medications and manipulations are used that are described above for acute sinusitis, excluding puncture of the maxillary sinus. However, in combined rhinoethmoiditis and the presence of pathological contents in the maxillary sinus, measures are indicated to restore aeration and drainage of the affected sinus, not excluding its puncture. To improve the drainage of the ethmoid cells, medial luxation of the middle turbinate is permissible.

Surgical treatment of rhinoethmoiditis is indicated only in complicated osteonecrotic forms of this disease, the appearance of signs of meningitis, sinus thrombosis, brain abscess. In rhinoethmoiditis, the opening of the ethmoid bone cells is always performed from an external approach. Surgical intervention in rhinoethmoiditis is performed under general anesthesia, powerful antibiotic coverage with the establishment of wide drainage of the postoperative cavity and the introduction of appropriate bactericidal solutions into it.