Chronic Frontitis - Symptoms

Frontitis is a disease of the whole organism, therefore it has general and local clinical manifestations. General manifestations include hyperthermia as a manifestation of intoxication and diffuse headache as a consequence of impaired cerebral blood and cerebrospinal fluid circulation. General weakness, dizziness and other vegetative disorders are often noted. Local clinical manifestations are represented by local headache, nasal discharge, difficulty in nasal breathing.

The leading and earliest clinical sign of frontal sinusitis is a local spontaneous headache in the superciliary region on the side of the affected frontal sinus; in chronic cases, it has a diffuse character.

In recent years, there have been increasing reports of a decrease in the reliability of the leading clinical signs of frontal sinusitis, including local headache, for diagnosis. Its disappearance does not always indicate recovery - it may be absent with good drainage of the contents despite purulent damage to the sinus.

The pain has a complex nature and is not only a consequence of mechanical irritation of the trigeminal nerve endings. The so-called vacuum or morning pain occurs due to a decrease in pressure in the sinus lumen due to oxygen resorption, an increase in mechanical pressure during the accumulation of secretions in the cavity, painful pulsation as a result of excessive pulse stretching of the arteries and the impact of microorganism metabolic products. The pain is reflexive in nature with irritation projected into the corresponding Zakharyin-Geda area - the superciliary arch.

During exacerbation of chronic frontal sinusitis, there is a bursting pain in the frontal region, which intensifies with movement of the eyeballs and forward tilts of the head, a feeling of heaviness behind the eye. The pain reaches its greatest intensity in the morning, which is associated with the filling of the sinus lumen with pathological contents and deterioration of its drainage in a horizontal position. Irradiation of pain to the temporoparietal or temporal regions on the affected side is possible. Sensations can be spontaneous or appear with light percussion of the anterior wall of the frontal sinus,

In patients with chronic frontal sinusitis, the intensity of pain is reduced outside of an exacerbation, is not constant and is not clearly localized. An important sign of exacerbation is considered to be a feeling of a "rush" in the superciliary region at rest or when tilting the head. The intensity of pain changes during the day, which is associated with a change in the conditions of the outflow of contents from the sinuses depending on the position of the head. Unilateral chronic frontal sinusitis is characterized by a dull pressing pain in the forehead, which intensifies in the evening, after physical exertion or a prolonged tilt of the head. Irradiation may be to the healthy superciliary region, the parietal and temporo-parietal regions. The pain is constant, sometimes manifested by a feeling of pulsation.

The next most frequent leading local symptom of frontal sinusitis is the discharge of pathological contents of the sinus on the affected side from the nose. More abundant discharge is observed in the morning hours, which is associated with a change in body position and the outflow of accumulated contents in the sinus through natural pathways.

The third leading clinical sign of chronic frontal sinusitis is difficulty in nasal breathing, associated with swelling and infiltration of the mucous membrane of the nasal passages as a result of irritation by pathological discharge from the frontal-nasal canal.

A decrease or absence of smell may be observed. Much less frequently, photophobia, lacrimation and decreased vision associated with the involvement of the eyeball and/or optic nerve in the inflammatory process.

Subjective symptoms include sensations of fullness and distension in the corresponding half of the frontal region and deep in the nose, unilateral impairment of nasal breathing and olfaction, sensation of pressure in the eyeball on the affected side, constant mucopurulent, caseous or putrefactive-bloody nasal discharge, subjective and objective cacosmia in the putrefactive form of the disease, photophobia, lacrimation, especially in the presence of secondary dacryocystitis, and visual impairment on the side of the affected sinus. A characteristic pain syndrome is: bursting constant dull pain in the projection of the frontal sinus, periodically aggravated in the form of paroxysms with irradiation to the eye, crown, temporal and retromaxillary region (involvement of the pterygopalatine ganglion).

Objective symptoms: hyperemia and swelling of the soft tissues of the eye on the affected side, swelling in the area of the lacrimal lake and lacrimal caruncle, tear flow along the nasolabial fold, swelling and hyperemia of the nasal mucosa, dermatitis, impetigo, eczema in the area of the nasal vestibule and upper lip, caused by the constant discharge of mucopurulent discharge from the nose, often a furuncle of the nasal vestibule.

Percussion of the frontal tubercle and pressure on the supraorbital foramen (the exit point of the supraorbital nerve) causes pain. Pressing with a finger in the area of the outer-lower angle of the orbit reveals Ewing's pain point - the projection of the attachment of the inferior oblique muscle of the eye.

Endoscopy of the nose reveals marked swelling and hyperemia of the mucous membrane of the middle third of the nasal cavity on the side of the affected frontal sinus, an enlarged middle turbinate, and the presence of thick purulent discharge, the amount of which increases after lubricating the middle nasal passage with an adrenaline solution. The discharge appears in the anterior part of the middle nasal passage and flows down the lower turbinate forward. In the area of the middle turbinate, the phenomenon of a double turbinate is often detected, described, as already noted above, by the German otolaryngologist Kaufman.

In the presence of concomitant chronic sinusitis, the Frenkel symptom may be detected: when the head is tilted forward and the crown down, a large amount of purulent discharge appears in the nasal cavity. If, after their removal by puncture and rinsing of the maxillary sinus, purulent discharge reappears in a normal (orthograde) position of the head, this indicates the presence of chronic purulent inflammation of the frontal sinus. Unlike chronic purulent sinusitis, in which purulent discharge flows into the nasopharynx, with chronic frontal sinusitis these discharges flow into the anterior parts of the nasal cavity, which is associated with the location of the drainage openings of the maxillary sinus and frontal sinus.

Evolution of chronic frontal sinusitis. Chronic frontal sinusitis, if not effectively treated, gradually disrupts both the local and general condition of the patient. Granulations, polyps, mucocele-type formations, caseation and cholesteatoma "compositions" developing in the frontal sinus steadily lead to the destruction of the sinus bone walls, the formation of fistulas, most often in the orbital area. When the posterior (cerebral) wall is destroyed, serious intracranial complications arise, in terms of prognosis.

The prognosis is generally favorable, but it largely depends on timely and effective treatment. The prognosis is greatly aggravated by the occurrence of intracranial complications, especially by the occurrence of deep, periventricular abscesses of the brain.

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