Chronic frontal sinusitis: diagnosis
Last reviewed: 23.04.2024
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At the stage of assessing anamnesis, it is important to collect information on previous diseases, ARVI, sinusitis and exacerbation of the frontitis, features of treatment, including surgical.
Among the complaints, one can immediately identify typical local headaches, pain in the region of the eyebrows, clarify its nature and intensity, the side of the lesion, the presence of irradiation in the temple or the crown; appearance and consistency of the discharge, time and peculiarities of its entry into the nasal cavity or nasopharynx
Physical examination
Palpation and percussion of frontal sinus walls allow to establish the presence of pain and the area of its spread.
Laboratory research
In the absence of complications of the disease, general blood and urine tests are not informative. This also applies to the determination of the cellular composition of the rhinocytograms to be separated.
Instrumental research
During anterior rhinoscopy, a "pus patch symptom" can be identified as an exudate coming down from the anterior part of the middle nasal passage.
The leading method of research remains radiography. Radiography in the semi-axial projection gives an idea of the shape, size, condition and interrelation of the sinuses, in the frontal-nasal - it clarifies the positions of other facial skeleton formations, according to S.Wein (modification of the posterior axial) - reveals the pathology in the frontal sinus walls of each side and their topography , the presence of exudate in the lumen of one of them. On the lateral projection judged the state of the deep sinus, the thickness of the bone walls and the superciliary arches, the presence or absence of the frontal sinus in general. Their polypend can be diagnosed by unevenness, patchiness, partial dimming of the sinuses. A non-invasive method for diagnosis of the frontitis (in pregnant women and children) is diafanoscoli or diaphanography, especially effective when using fiber optics or very bright diodes.
A new and accurate method for additional diagnosis of the frontitis is ENDOSCOPY (sinusoscopy, sinoscopy) - a surgical method that allows you to clarify the nature and characteristics of the inflammatory process with the help of a direct visual inspection.
Other methods of diagnosing the frontitis, 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 the infrared radiation of the dermal frontal sinus wall, giving definite information about the presence inflammation in their lumen. They also use laser Doppler flowmetry - a study of blood flow in the mucosa of the nasal cavity and paranasal sinuses; direct joulemetry, based on recording changes in the electrochemical properties of fluid in the focus of inflammation on the totality of the biochemical components of the protein. For the same purpose, the frequency-phase method of vortex sinusoscopy is used-the study of emerging eddy currents whose density depends on the electrical conducting properties of the region under investigation. In the instrumental diagnosis of chronic frontalitis, these methods can only be considered in conjunction with others.
Radio and scintigraphy using radioisotopes is a technique based on the natural ability of leukocytes labeled with radiopharmaceuticals to migrate to the inflammation zone. It is used to detect intracranial complications of the frontitis and diagnosis of latent forms of the disease,
Surgical diagnostic methods are biopsy performed through the trepanation channel for the examination of individual sections of the mucous membrane of the frontal sinus, and resistometry, which estimates the rate of passage of air through the frontal-nasal canal.
Differential diagnosis of chronic frontitis
When differential diagnosis of the frontitis and neuralgia of the first branch of the trigeminal nerve should be taken into account that in the latter case the pain arises from attacks, gradually increases, then decreases in its intensity. For neuralgia is characterized by the presence of a pain point corresponding to the passage of the nerve, while the front pain is spilled. Neuralgic pain tends to irradiate along the branches of the trigeminal nerve and decrease with pressure on the painful point.
In patients with gonaditis, in contrast to those with neuralgia, sensitivity to local thermal effects is increased, and the cold brings relief. In addition, pressing on the anteroposterior angle of the orbit and percussion of the anterior wall of the frontal sinus in patients with the frontitis causes an increase in pain.
It is necessary to carry out differential diagnostics with the symptom Charlin - the neuralgia of the nasociliary nerve, which is manifested by severe pain in the inner corner of the eye and the back of the nose, irritation of the conjunctiva and erosion of the cornea
Headache in the forehead region is the most important sign of the frontitis, its clarification is important clarification, intensity, character, irradiation, time of appearance and disappearance. Identification of the local pain symptom is facilitated by palpation and percussion of the anterior walls of the frontal sinuses. To assess the local pain symptom, the following classification is proposed according to the degree of its severity:
- I degree - spontaneous local pain in the region of the superciliary absent soreness occurs when palpation and percussion of the anterior wall of the inflamed frontal sinus;
- II degree - spontaneous local pain in the frontal region of moderate intensity, is enhanced by palpation and percussion of the anterior wall of the frontal sinus;
- III degree - a constant spontaneous local headache in the area of the eyebrow or frequent attacks of pain, sharply increasing during palpation and, especially, percussion of the anterior wall of the frontal sinus;
- IV degree - a pronounced localized pain symptom. Percussion and palpation are impossible due to severe pain, which is regarded as a hyper-reaction to a touch.
An expressed local pain symptom is a permanent or paroxysmal headache in the region of the brow or moderate local pain, which is enhanced by palpation of the sinus wall. The effect of parenteral administration of analgesics may be absent or temporary, with the resumption of a painful attack after the end of the action of drugs.
Indications for consultation of other specialists
Consultations of the oculist and neurologist are desirable before surgical intervention and are obligatory at occurrence of signs of complications or an atypical current of the postoperative period.
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