Chronic Frontitis - Diagnosis

At the stage of assessing the anamnesis, it is important to collect information about previous diseases, acute respiratory viral infections, sinusitis and exacerbations of frontal sinusitis, and treatment features, including surgery.

Among the complaints, one can immediately highlight the local headache typical for frontal sinusitis, pain in the area of the eyebrows, specify its nature and intensity, the side of the lesion, the presence of irradiation to the temple or crown; the appearance and consistency of the discharge, the time and features of its entry into the nasal cavity or nasopharynx

Physical examination

Palpation and percussion of the walls of the frontal sinuses allow us to determine the presence of pain and the area of its distribution.

Laboratory research

In the absence of complications of the disease, general blood and urine tests are uninformative. This also applies to the determination of the cellular composition of the discharge using rhinocytograms.

Instrumental research

During anterior rhinoscopy, a “stripe of pus” may be detected in the form of exudate descending from the anterior part of the middle nasal meatus.

The leading method of examination remains radiography. Roentgenoscopy in the semi-axial projection gives an idea of the shape, size, condition and relationships of the sinuses, in the frontal-nasal projection - specifies the positions of other formations of the facial skeleton, according to S. Wein (modification of the posterior axial) - reveals pathology in the area of the walls of the frontal sinuses on each side and their topography, the presence of exudate in the lumen of one of them. According to the lateral projection, they judge the condition of the deep sections of the sinus, the thickness of the bone walls and superciliary arches, the presence or absence of the frontal sinus in general. Their polypvd can be diagnosed by unevenness, spotting, partial darkening of the sinuses. A non-invasive method for diagnosing frontal sinusitis (in pregnant women and children) is diaphanoscolia or diaphanography, especially effective when using fiber optics or very bright diodes.

A new and accurate method of additional diagnostics of frontal sinusitis is ENDOSCOPY (sinusoscopy, sinoscopy) - a surgical method that allows to clarify the nature and characteristics of the inflammatory process using direct visual examination.

Other methods of frontal sinusitis diagnostics, specifying the features of the inflammatory process, are ultrasound echolocation (ultrasonography), using the analysis of the reflected ultrasound signal from the sinus structures, thermography (thermal imaging) - contact or remote registration of infrared radiation of the skin surface of the anterior walls of the frontal sinuses, giving certain information about the presence of inflammation in their lumen. Laser Doppler flowmetry is also used - a study of blood flow in the mucous membrane of the nasal cavity and paranasal sinuses; direct joulemetry, based on the registration of changes in the electrochemical properties of fluid in the inflammation focus by the totality of biochemical components of protein. For the same purpose, the frequency-phase method of eddy sinusoscopy is used - a study of the emerging eddy currents, the density of which depends on the electrically conductive properties of the area under study. In instrumental diagnostics of chronic frontal sinusitis, these methods can only be considered in combination with others.

Radio- and scintigraphy using radioisotopes is a technique based on the natural ability of leukocytes labeled with a radiopharmaceutical to migrate to the area of inflammation. It is used to identify intracranial complications of frontal sinusitis and diagnose latent forms of the disease,

Surgical diagnostic methods include biopsy, performed through a trephine canal to examine individual areas of the mucous membrane of the frontal sinus, and resistometry, which evaluates the speed of air passage through the frontal-nasal canal.

Differential diagnosis of chronic frontal sinusitis

In differential diagnostics of frontal sinusitis and neuralgia of the first branch of the trigeminal nerve, it should be taken into account that in the latter case, the pain occurs in attacks, gradually increases, and then decreases in intensity. Neuralgia is characterized by the presence of a pain point corresponding to the place where the nerve passes, while frontal sinusitis has diffuse pain. Neuralgic pain tends to radiate along the branches of the trigeminal nerve and decrease when pressing on the pain point.

In patients with frontal sinusitis, in contrast to those with neuralgia, sensitivity to local thermal effects is increased; cold brings them relief. In addition, pressure on the anterior-superior angle of the orbit and percussion of the anterior wall of the frontal sinus in patients with frontal sinusitis causes increased pain.

It is necessary to conduct differential diagnostics with Charlin's symptom - neuralgia of the nasociliary nerve, which manifests itself as severe pain in the inner corner of the eye and the bridge of the nose, irritation of the conjunctiva and corneal erosion.

A headache in the forehead is the most important symptom of frontal sinusitis. To assess it, it is important to specify the intensity, nature, irradiation, time of appearance and disappearance. Palpation and percussion of the anterior walls of the frontal sinuses help to identify the characteristics of the local pain symptom. The following classification is proposed for assessing the local pain symptom according to its severity:

• I degree - spontaneous local pain in the area of the eyebrow is absent, pain appears during palpation and percussion of the anterior wall of the inflamed frontal sinus;
• Grade II - spontaneous local pain in the frontal region of moderate intensity, intensifies with palpation and percussion of the anterior wall of the frontal sinus;
• Grade III - constant spontaneous local headache in the area above the eyebrows or frequent attacks of pain that sharply intensify upon palpation and, especially, upon percussion of the anterior wall of the frontal sinus;
• IV degree - pronounced local pain symptom. Percussion and palpation are impossible due to severe pain, which is assessed as a hyperreaction to touch.

A pronounced local pain symptom is a constant or paroxysmal headache in the area of the superciliary arch or moderate local pain that intensifies with palpation of the sinus wall. The effect of parenteral administration of analgesics may be absent or temporary, with a resumption of a pain attack after the end of the effect of the drugs.

Indications for consultation with other specialists

Consultations with an ophthalmologist and neurologist are advisable before surgery and are mandatory if signs of complications or an atypical course of the postoperative period appear.

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