Chronic etmoiditis

Chronic etmoiditis (chronic ethmoid sinusitis, ethmoiditis chronica) is a chronic inflammation of the mucous membrane of the cells of the latticular sinus.

ICD-10 code

J32.2 Chronic, ethmoidal sinusitis.

Epidemiology of chronic ethmoiditis

The disease is non-contagious, its occurrence does not depend on the place of residence.

[1], [2], [3], [4], [5], [6]

What causes chronic etmoiditis?

The causative agents of the disease are more often representatives of the coccal microflora. In recent years, the formation of various types of aggressive associations characterized by increased virulence is noted.

Pathogenesis of chronic ethmoiditis

The disease is more common in childhood. The natural outlets of the cells of the latticed sinuses are in the middle nasal passage and are part of the ostiomeatal complex. Even a small edema of the mucous membrane of the nasal cavity extends to the middle nasal passage, causing a sharp obstruction of the outflow, and then blockade of the ostiomeatal complex. Quite often, mainly in adults, the anastomoses of other paranasal sinuses of the anterior group are involved in the inflammatory process.

Symptoms of chronic etmoiditis

As with other types of sinusitis, exacerbation of ethmoiditis is manifested by general clinical signs in the form of febrile fever, general weakness, lethargy, diffuse headache as a consequence of cerebral circulation disorders. Headache is more often localized in the region of the root of the nose, often radiating to the orbit from the corresponding side. Other local clinical signs are also prominent: nasal discharge and difficulty breathing, associated with the development of edema and infiltration of the nasal mucosa pathological exudate flowing out of the natural outlets. Due to the fact that isolated unilateral etmoiditis is more common in children, and the bony structures of their paranasal sinuses have a looser structure than adults, the inflammatory process destroys some of the bone walls of the lattice, causing the appearance of hyperemia and edema of the soft tissues of the inner corner of the eye. Further progressing of purulent etmoid sinusitis leads to the spread of the inflammatory process and the appearance of hyperemia and edema of the eyelid on the side of the lesion. Lack of proper treatment can lead to the penetration of purulent contents under the skin of the inner corner of the eye or into the orbit.

Classification of chronic etmoiditis

Distinguish catarrhal, purulent and polypous-purulent chronic etmoiditis.

[7], [8],

Screening of chronic ethmoiditis

A method of mass non-invasive examination of a large contingent of people could be diaphanoscopy or fluorography of the paranasal sinuses (and the number of latticed ones).

Diagnosis of chronic etmoiditis

At the stage of collecting anamnesis, it is important to obtain information about previous diseases of the respiratory tract, other paranasal sinuses, acute respiratory infections. When etmoiditis should be carefully questioned parents about the transferred infectious diseases: flu, measles, scarlet fever.

[9], [10], [11]

Physical examination

At external examination, the edema and infiltration of the inner corner of the eye area that can spread to the eyelids on the side of the lesion are revealed. Palpation of the root of the nose and the inner corner of the eye from the side of the inflamed sinus in the interior of the orbit is moderately painful.

Laboratory diagnostics of chronic ethmoiditis

In the absence of complications, general blood tests of urine are poorly informative and can only indicate the presence of an inflammatory process.

Instrumental research

With anterior rhinoscopy, hyperemia and edema of the mucous membrane of the nasal cavity are marked, a sharp narrowing of the general and closing of the lumen of the middle nasal passages. After anemia of the mucous membrane of the nasal cavity and, in particular, the middle nasal passage, a suppurative exudate may appear from under the middle nasal concha, which indicates the block of the ostiomeatal complex.

A non-invasive method of diagnosis is diaphanoscopy, which can be used in children and pregnant women, but with etmoiditis, the value of this method is small.

The main method of instrumental diagnostics remains radiography, which is produced in a semi-axial projection in order to identify the darkness of the sinus, and to evaluate its features. More reliable and informative is considered CT in axial and coronary projections.

The most accurate method of diagnosis is endoscopy with the help of optical endoscopes, which is carried out after mucosal anemia, local application and infiltrative anesthesia. The method allows to clarify the localization and features of the inflammatory process by direct visual inspection of the structures of the ostiomeatal complex.

Differential diagnosis of chronic ethmoiditis

Differential diagnosis should be carried out with dacryocystitis, periostitis of the bones of the nose and osteomyelitis of the upper jaw. With dacryocystitis in both adults and children in the area of the inner corner of the eye, there is hyperemia and edema of the soft tissues, while in the medial edge of the lower eyelid there is a round protrusion that is sharply painful on palpation. Distinctive features are considered tearfulness in the eye on the side of the lesion.

For osteomyelitis of the upper jaw, which occurs in infants, infiltration of soft tissues in the region of the alveolar process and edema of the lower eyelid without hyperemia are characteristic. Acute etmoiditis with changes in soft tissues and the area of the inner corner of the eye develops most often in children older than two years.

Periostitis of the bones of the nose develops after an injury, but it can also form as a complication of an infectious disease. It is characterized by a change in the shape of the external nose, expressed by spontaneous pain, which is greatly enhanced by palpation.

[12]

Indications for consultation of other specialists

If there is ethmoiditis in the child, the pediatrician is obligatory. If there is any doubt about the correctness of the diagnosis, an examination of the maxillofacial surgeon is recommended to eliminate the odontogenic process. Inspection of the ophthalmologist will exclude dacryocystitis.

Treatment of chronic etmoiditis

The goals of treatment of chronic ethmoiditis

Restoring the drainage and aeration of the affected sinus, removing from its lumen the pathological separable.

Indications for hospitalization

The presence of signs of etmoiditis with changes in soft tissues in the inner corner of the eye on the background of hyperthermia. Absence of the effect of conservative treatment in outpatient conditions for 1-2 days.

Non-pharmacological treatment of chronic ethmoiditis

Physiotherapeutic treatment: electrophoresis with antibiotics on the anterior wall of the sinus, phonophoresis of hydrocortisone, including in combination with oxytetracycline. Ultrasonic high-frequency influence on the sinus area, radiation of the therapeutic helium-neon laser on the mucosa of the nasal cavity and symmetrical biologically active points located in the centers of the base of the nares.

Drug treatment of chronic ethmoiditis

Chronic ztmoiditis in the absence of complications are treated only conservatively. Before receiving the results of the microbiological examination of the isolate, antibiotics of a wide range of action, amoxicillin, including in combination with claudiadic acid, cephaloridine, cefotaxime, cefazolin, roxithromycin, etc., can be used. By results of inoculation, antibiotics of directed action should be prescribed; if the detachment is absent or can not be obtained, the treatment is started. One of the drugs of choice in anti-inflammatory therapy can be used fenspiride. At the same time, hyposensitizing therapy is carried out with mebhydroline, chloropyramine, ebastin, etc. Prescribe vasoconstrictive drops in the nose (decongestate), at the beginning of treatment - mild action (ephedrine solution, dimethindene in combination with phenylephrine): in the absence of effect for 6-7 days, treatment with imidazole drugs (nafazolin, xylometazoline, oxymetabolia, etc.). Effective is the use of immunomodulators (preparations of the thymic group of all generations, azoximer).

Anemizatsnu mucous membrane of the anterior, the department of the middle nasal passage is carried out with the help of vasoconstrictive drugs (solutions of epinephrine, oxymetazoline, naphazoline, xylometazoline, etc.).

Washing of the nasal cavity or nasal shower with the use of antimicrobial drugs: in children it is better to use lactoglobulin against opportunistic bacteria and salmonella - a purified lyophilized fraction of the complex Jg colostrum of pre-immunized cows (25 mg of the drug in dilution with 50 ml of a warm 0.9% solution of sodium chloride) 1-2 times a day. A patient in a sitting position with a head tilted to the shoulder in one of the half of the nose is injected with an olive, which surrounds the lumen of the nostrils, a blood transfusion system filled with medicinal solution is attached. Adjust the rate of infusion (20-40 drops per minute), while the fluid enters the nasal cavity and is released through the other half. Upon completion of the infusion, half the dose of the drug is changed to the position of the patient's head on the opposite side, and the olive is placed on the other side.

Moving of medicines (according to Proetz) is produced in the same way as in the treatment of exacerbation of chronic sinusitis.

With the help of the YAMIK catheter, a negative pressure is created in the nasal cavity, which allows aspirating the pathological contents from the paranasal sinuses of one half of the nose, and their lumen is filled with a drug or contrast agent.

[13], [14], [15], [16], [17]

Surgical treatment of chronic ethmoiditis

In some cases, the maxillary sinus is punctured with Kulikovsky's needle in order to create a drug depot in it in an attempt to affect the inflammatory focus in the cells of the grating sinus bordering it.

Endonasal dissection of cells of the sinus is performed only in the absence of the effect of conservative treatment and the increase in edema, hyperemia and infiltration of soft tissues of the inner corner of the eye. The intervention is performed under local anesthesia, beginning with resection of the part of the anterior end of the middle nasal conch to expand the lumen of the middle nasal passage. Conduct the redress of the middle nasal concha, displacing it medially, and then successively open the cells of the sinus sinus. This leads to an increase in the average nasal passage and better drainage and aeration of the inflamed sinus sinus. Extranasal autopsy is performed only in the presence of complications of the disease.

Further management

After the course of conservative treatment, vasoconstrictive soft-acting drugs are prescribed for 4-5 days. After an extra-aqueal opening of the sinus sinusitis, it is recommended to spray the topical glucocorticoids (fluticasone, mometasone) once a day in both halves of the nose and wash the cavity with a warm 0.9% solution of sodium chloride 1-2 times a day for 2 weeks. Required is a gentle regime. If signs of inflammation persist, long-term use of the anti-inflammatory drug fenspiride is possible.

Approximate terms of incapacity for treatment of exacerbation of chronic etmoiditis without signs of complications in the case of conservative treatment in the inpatient condition are 5-6 days, with extranasal intervention - for 2 4 days more.

Information for Patient

• Beware of drafts.
• Vaccinate with anti-influenza serum.
• At the first signs of an acute cold, acute respiratory viral infection or flu, consult a specialist.
• Carry out a thorough treatment of acute sinusitis.
• At the recommendation of the attending physician to perform a surgical sanation of the nasal cavity for the restoration of nasal breathing and normal anatomy of the structures of the nasal cavity.

How to prevent chronic etmoiditis?

Chronic etmoiditis can be prevented if the timely and rapid treatment of acute respiratory viral infections, rhinitis, influenza, measles, scarlet fever and other infectious diseases.

What is the prognosis of chronic etmoiditis?

The forecast is favorable if the above rules are observed.