Chronic frontal sinusitis: symptoms

Frontite is a disease of the whole body, so it has common and local clinical manifestations. To general, hyperthermia is included as a manifestation of intoxication and diffuse headache as a consequence of cerebral blood and liquor circulation disorders. Often noted general weakness, dizziness and other vegetative disorders. Local clinical manifestations are represented by local headache, nasal discharge, difficulty in nasal breathing.

The leading and the earliest clinical sign of a frontitis is a local spontaneous headache in the superciliary on the side of the affected frontal sinus, with a chronic process they have a diffuse character.

In recent years, reports of a decrease in the reliability of leading clinical signs of a frontitis, including a local headache, for diagnosis have become more frequent. The disappearance of it does not always indicate a recovery - it may be absent with a good outflow of the contents despite a purulent lesion of the sinus.

Pain is of a complex nature and is not only a consequence of mechanical stimulation of the endings of the trigeminal nerve. The so-called vacuum or morning pain arises due to a decrease in pressure in the lumen of the sinus due to oxygen re-sorption, an increase in mechanical pressure with accumulation of the pulsation to be separated in the cavity, painful pulsation as a result of excessive pulse stretching of the arteries and exposure to metabolic products of microorganisms. Pain has a reflex character with a projection of stimulation in the corresponding area of Zakharyin-Ged - the superciliary.

With an exacerbation of the chronic frontitis, there is a bursting pain in the frontal region, intensified by the movement of the eyeballs and head inclinations forward, a feeling of heaviness behind the eye. The greatest intensity achieves in the morning, which is associated with filling the lumen of the sinus with pathological contents and deterioration of its drainage in the horizontal position. Irradiation of pain in the temporomandibular or temporal region on the side of the lesion is possible. Sensations can be spontaneous or appear with light percussion of the anterior wall of the frontal sinus,

In patients with chronic gonorrhea outside of exacerbation, the intensity of pain is reduced, does not differ in constancy and clear localization. An important sign of an exacerbation is a feeling of "tide" in the superciliary region at rest or when the head is tilted. The intensity of pain changes during the day, which is associated with a change in the outflow of contents from the sinuses, depending on the position of the head. A one-sided chronic frontitis is characterized by a dull pressing pain in the forehead region, which increases in the evening, after a physical strain or a prolonged inclination of the head. Irradiation can be in a healthy superciliary, parietal and temporal-parietal areas. The pain is permanent, sometimes manifested by a sensation of pulsation.

The next most frequent local symptom of the frontitis is the allocation of the pathological contents of the sinus from the nose to the side of the lesion. More abundant secretions are noted in the morning, which is associated with a change in the position of the body and the outflow of the contents accumulated in the bosom through natural paths.

The third leading clinical sign of chronic frontalitis is the difficulty of nasal breathing associated with swelling and infiltration of the nasal mucosa as a result of irritation with its pathological discharge from the frontal-nasal canal.

There may be a decrease or absence of smell. Significantly less photophobia, lacrimation and decreased vision associated with the involvement of the eyeball and / or optic nerve in the inflammatory process.

Subjective symptoms are reduced to sensations of fullness and bursting in the corresponding half of the frontal region and in the depth of the nose, to unilateral disruption of nasal breathing and smell, to a sensation of pressure in the eyeball on the side of the lesion, to constant discharge from the nose of mucopurulent, caseous or putrefactive, subjective and objective kakosmii with putrefactive form of the disease, photophobia, lacrimation, especially in the presence of secondary dacryocystitis, deterioration of vision on the side of the affected sinus. A painful syndrome is typical: stubborn constant blunt pains in the projection of the frontal sinus, periodically exacerbated in the form of paroxysms with irradiation into the eye, crown, temporal and retromaxillar region (involvement of the pterygoid node).

Objective symptoms: hyperemia and edema of the soft tissues of the eye on the side of the lesion, puffiness in the area of the lacrimal lake and teardrop, the flow of tears along the nasolabial fold, swelling and hyperemia of the nasal mucosa, dermatitis, impetigo, eczema in the area of the anterior nose and upper lip caused by permanent the outflow of mucopurulent discharge from the nose, often the furuncle of the vestibule of the nose.

When percussion of the frontal hillock and pressing on the supraorbital opening (the place of the exit of the supraorbital nerve) pain arises. Pressing the finger in the area of the outer-lower corner of the orbit determines the pain point of Ewing - the projection of the attachment of the lower oblique muscle of the eye.

With endoscopy of the nose, pronounced puffiness and hyperemia of the mucous membrane of the middle third of the nasal cavity on the side of the affected frontal sinus, increased average nasal concha, the presence of thick purulent discharge, the number of which increases after lubrication of the middle nasal passage with adrenaline solution is determined. The discharge appears in the anterior part of the middle nasal passage and drains but the inferior nasal shell anteriorly. In the area of the middle nasal shell, the phenomenon of the double shell, often described by the German otorhinolaryngologist Kaufman, is often described.

In the presence of concomitant chronic sinusitis, Frenkel's symptom can be detected: when the head is tilted forward and the crown is down in the nasal cavity, a large amount of purulent discharge appears. If, after their removal by puncture and washing of the maxillary sinus, the purulent discharge reappears at the normal (orthopedic) position of the head, this indicates a chronic suppurative inflammation of the frontal sinus. In contrast to chronic purulent sinusitis, in which purulent discharge flows into the nasopharynx, with a chronic front, these discharges drain into the anterior sections of the nasal cavity, which is associated with the location of the drainage holes of the maxillary sinus and the frontal sinus.

Evolution of the chronic frontitis. Chronic frontitis in the absence of effective treatment gradually disrupts both the local and general condition of the patient. Developing in the frontal sinus granulation, polyps, mucocele type formations, caseous and cholesteatom "compositions" steadily lead to the destruction of the sinus bone walls, the formation of fistulas, most often in the orbit. With the destruction of the posterior (medullary) wall, severe intra-cranial complications arise prognostically.

The prognosis is generally favorable, but in many ways it depends on timely and effective treatment. The prognosis is sharply aggravated when intracranial complications occur, especially when deep, peripheral cerebral abscesses occur.

[1], [2], [3], [4]