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Chronic ethmoiditis
Last reviewed: 05.07.2025
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Chronic ethmoiditis (chronic ethmoidal sinusitis, ethmoiditis chronica) is a chronic inflammation of the mucous membrane of the ethmoid sinus cells.
ICD-10 code
J32.2 Chronic ethmoid sinusitis.
What causes chronic ethmoiditis?
The causative agents of the disease are most often representatives of coccal microflora. In recent years, the formation of various types of aggressive associations characterized by increased virulence has been noted.
Pathogenesis of chronic ethmoiditis
The disease is more common in childhood. The natural outlet openings of the ethmoid sinus cells are located in the middle nasal passage and are part of the ostiomeatal complex. Even a small swelling of the mucous membrane of the nasal cavity spreads 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 inflammatory process involves the anastomoses of other paranasal sinuses of the anterior group.
Symptoms of chronic ethmoiditis
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 cerebrovascular accident. Headache is most often localized in the area of the root of the nose, often radiating to the eye socket on the corresponding side. Other local clinical signs are also expressed: nasal discharge and difficulty breathing associated with the development of edema and infiltration of the nasal mucosa with pathological exudate flowing from natural outlet openings. Due to the fact that isolated unilateral ethmoiditis is more common in children, and the bone structures of their paranasal sinuses have a looser structure compared to adults, the inflammatory process destroys part of the bone walls of the ethmoid bone, causing hyperemia and edema of the soft tissues of the inner corner of the eye. Further progression of purulent ethmoid sinusitis leads to the spread of the inflammatory process and the appearance of hyperemia and edema of the eyelid on the affected side. The absence 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.
Screening for chronic ethmoiditis
A method for mass non-invasive examination of a large contingent of people could be diaphanoscopy or fluorography of the paranasal sinuses (including the ethmoid sinuses).
Diagnosis of chronic ethmoiditis
At the stage of collecting anamnesis, it is important to obtain information about previous diseases of the respiratory tract, other paranasal sinuses, and acute respiratory viral infections. In case of ethmoiditis, parents should be carefully questioned about previous infectious diseases: flu, measles, scarlet fever.
Physical examination
On external examination, swelling and infiltration of the area of the inner corner of the eye are revealed, which can spread to the eyelids on the affected side. Palpation of the area of the root of the nose and the inner corner of the eye on the side of the inflamed sinus in the area of the inner part of the orbit is moderately painful.
Laboratory diagnostics of chronic ethmoiditis
In the absence of complications, general blood and urine tests are uninformative and can only indicate the presence of an inflammatory process.
Instrumental research
During anterior rhinoscopy, hyperemia and edema of the mucous membrane of the nasal cavity, a sharp narrowing of the general and closure of the lumen of the middle nasal passages are noted. After anemia of the mucous membrane of the nasal cavity and especially the middle nasal passage, purulent exudate may appear from under the middle nasal concha, which indicates a block of the ostiomeatal complex.
A non-invasive diagnostic method is diaphanoscopy, which can be used in children and pregnant women, but in the case of ethmoiditis, the value of this method is small.
The main method of instrumental diagnostics remains radiography, which is performed in a semi-axial projection in order to identify sinus darkening and assess its features. CT in axial and coronal projections is considered more reliable and informative.
The most accurate diagnostic method is endoscopy using optical endoscopes, which is performed after anemia of the mucous membrane, local application and infiltrative anesthesia. The method allows to specify 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 diagnostics should be carried out with dacryocystitis, periostitis of the nasal bones and osteomyelitis of the upper jaw. In dacryocystitis, both in adults and children, hyperemia and edema of soft tissues are found in the area of the inner corner of the eye, and a rounded protrusion, sharply painful on palpation, is found at the medial edge of the lower eyelid. Distinctive signs include lacrimation in the eye on the affected side.
Osteomyelitis of the maxilla, which occurs in infants, is characterized by soft tissue infiltration in the alveolar process and lower eyelid edema without hyperemia. Acute ethmoiditis with soft tissue changes in the inner corner of the eye develops most often in children over two years of age.
Periostitis of the nasal bones develops after an injury, but can also form as a complication of an infectious disease. It is characterized by a change in the shape of the external nose, severe spontaneous pain, significantly increasing with palpation.
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Indications for consultation with other specialists
If a child has ethmoiditis, a pediatrician consultation is mandatory. If there are doubts about the correctness of the diagnosis, an examination by a maxillofacial surgeon is recommended to exclude an odontogenic process. An examination by an ophthalmologist will help to exclude dacryocystitis.
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Treatment of chronic ethmoiditis
Treatment goals for chronic ethmoiditis
Restoration of drainage and aeration of the affected sinus, removal of pathological discharge from its lumen.
Indications for hospitalization
The presence of signs of ethmoiditis with changes in soft tissues in the area of the inner corner of the eye against the background of hyperthermia. Lack of effect from conservative treatment in an outpatient setting for 1-2 days.
Non-drug treatment of chronic ethmoiditis
Physiotherapeutic treatment: electrophoresis with antibiotics on the anterior wall of the sinus, phonophoresis of hydrocortisone, including in combination with oxytetracycline. Ultrasound high-frequency exposure to the sinus area, radiation of a therapeutic helium-neon laser on the mucous membrane of the nasal cavity and symmetrical biologically active points located in the centers of the base of the nostrils.
Drug treatment of chronic ethmoiditis
Chronic ethmoiditis in the absence of complications is treated only conservatively. Until the results of the microbiological examination of the discharge are obtained, broad-spectrum antibiotics can be used - amoxicillin, including in combination with claudan acid, cephaloridine, cefotaxime, cefazolin, roxithromycin, etc. Based on the results of the culture, targeted antibiotics should be prescribed; if the discharge is absent or cannot be obtained, the treatment is continued. Fenspiride can be used as one of the drugs of choice in anti-inflammatory therapy. At the same time, hyposensitizing therapy is carried out with mebhydrolin, chloropyramine, ebastine, etc. Vasoconstrictor nasal drops (decongestants) are prescribed, at the beginning of treatment - mild action (ephedrine solution, dimethindene in combination with phenylephrine): if there is no effect within 6-7 days, treatment is carried out with imidazole drugs (naphazoline, xylometazoline, oxymetabolins, etc.). The use of immunomodulators (thymic group drugs of all generations, azoximer) is effective.
Anemia of the mucous membrane of the anterior and middle nasal passage is carried out using vasoconstrictor drugs (solutions of epinephrine, oxymetazoline, naphazoline, xylometazoline, etc.).
Nasal lavage or nasal douche using antimicrobial drugs: in children, it is better to use lactoglobulin against opportunistic bacteria and salmonella - purified lyophilized fraction of the Jg complex of colostrum from pre-immunized cows (25 mg of the drug diluted with 50 ml of warm 0.9% sodium chloride solution) 1-2 times a day. With the patient in a sitting position with his head tilted to the shoulder, an olive is inserted into one half of the nose, obturating the lumen of the nostril, a blood transfusion system filled with a medicinal solution is attached. The infusion rate is regulated (20-40 drops per minute), with the liquid entering the nasal cavity and excreted through the other half. Upon completion of the infusion of half the dose of the drug, the position of the patient's head is changed to the opposite, and the olive is installed on the other side.
The movement of drugs (according to Proetz) is carried out in the same way as in the treatment of exacerbation of chronic sinusitis.
Using a YAMIK catheter, negative pressure is created in the nasal cavity, which allows pathological contents to be aspirated from the paranasal sinuses of one half of the nose, and their lumen to be filled with a medicinal product or contrast agent.
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Surgical treatment of chronic ethmoiditis
In some cases, a puncture of the maxillary sinus is performed with a Kulikovsky needle in order to create a depot of the drug in it in an attempt to affect the inflammatory focus in the cells of the adjacent ethmoid sinus.
Endonasal opening of the ethmoid sinus cells is performed only if conservative treatment is ineffective and there is increasing edema, hyperemia, and infiltration of the soft tissues of the inner corner of the eye. The intervention is performed under local anesthesia, starting with resection of a portion of the anterior end of the middle turbinate to widen the lumen of the middle nasal passage. Redressing of the middle turbinate is performed, shifting it medially, and then the cells of the ethmoid sinus are sequentially opened. This leads to widening of the middle nasal passage and better drainage and aeration of the inflamed ethmoid sinus. Extranasal opening is performed only if there are complications of the disease.
Further management
After a course of conservative treatment, vasoconstrictors of mild action are prescribed for 4-5 days. After extravasal opening of the ethmoid sinus, it is recommended to spray topical glucocorticoids (fluticasone, mometasone) once a day in both halves of the nose and rinse its cavity with warm 0.9% sodium chloride solution 1-2 times a day for 2 weeks. A gentle regimen is mandatory. If signs of inflammation persist, long-term use of the anti-inflammatory drug fenspiride is possible.
Approximate periods of incapacity for work during treatment of exacerbation of chronic ethmoiditis without signs of complications in case of conservative treatment in a hospital setting are 5-6 days, with extranasal intervention - 2-4 days longer.
Information for the patient
- Beware of drafts.
- Carry out vaccination with anti-influenza serum.
- At the first signs of acute rhinitis, acute respiratory viral infection or flu, consult a specialist.
- Conduct careful treatment of acute sinusitis.
- If recommended by the attending physician, perform surgical sanitation of the nasal cavity to restore nasal breathing and normal anatomy of the nasal cavity structures.
Drugs
How to prevent chronic ethmoiditis?
Chronic ethmoiditis can be prevented by timely and prompt treatment of acute respiratory viral infections, rhinitis, flu, measles, scarlet fever and other infectious diseases.
What is the prognosis for chronic ethmoiditis?
The prognosis is favorable if the specified rules are followed.