Ethmoiditis. Causes, symptoms, signs, diagnosis and treatment of pathology. Inflammation of the ethmoid bone mucosa, its types, as well as its causes

Acute ethmoiditis(ethmoiditis acuta) - acute inflammation mucous membrane cells lattice labyrinth, occurs frequently and ranks second in frequency after inflammation of the maxillary sinuses. The cause of the disease is acute rhinitis, acute respiratory diseases, influenza, etc. Predisposing factors are the anatomical and topographic location of the excretory anastomosis of the cells of the ethmoidal labyrinth, the narrowness of the middle nasal meatus, curvature of the nasal septum, etc. Against this background, even slight swelling of the nasal mucosa causes difficulty in outflow from the ethmoidal cells. The anatomical proximity of the excretory anastomosis contributes to inflammation in the ethmoid cells in almost any inflammation of the paranasal sinus.

Clinic. As with any inflammatory process, acute ethmoiditis is characterized by general and local symptoms.

General symptoms characterized by an increase in body temperature (37-38 ° C), which lasts for 6-7 days, weakness, weakness. The patient may experience headaches varying intensity, most often localized in the root of the nose and orbit (pathognomic sign). These pain symptoms often depend on irritation of the sensitive endings of the branches trigeminal nerve.

Local symptoms: nasal congestion and difficulty in nasal breathing, mucous purulent discharge from the nasal cavity, decreased sense of smell of varying severity.

IN childhood and in weakened patients or in patients with highly virulent infection, part of the bone walls of the ethmoid cells is destroyed, swelling and hyperemia of the internal angle appear

orbit and adjacent parts of the upper and lower eyelids on the side of the disease. Here, a closed empyema (closed abscess) can form, from where pus can break into the tissue of the orbit, which is accompanied by outward deviation of the eyeball, exophthalmos, chemosis, pain when moving the eyeball, decreased vision, and increased intoxication.

Diagnostics based on characteristic complaints and anamnesis data. At anterior rhinoscopy swelling and hyperemia of the mucous membrane in the area of ​​the middle turbinate, mucopurulent discharge from under the middle turbinate or from the area of ​​the olfactory fissure with inflammation of the posterior ethmoid cells are noted. For a better examination, preliminary anemization of the mucous membrane in this area is performed. Endoscopic examination allows you to carefully examine the area of ​​exit of the natural openings of the ethmoid cells and differentiate purulent discharge from the anterior cells (anterior ethmoiditis) or posterior cells from the olfactory fissure (posterior ethmoiditis) (Fig. 2.32). On radiographs, especially with CT, darkening of the ethmoidal cells is visible. These data are most important for making a diagnosis.

Treatment. Acute ethmoiditis in the absence of complications is treated conservatively. Local treatment is aimed primarily at reducing swelling of the nasal mucosa and, therefore, improving

outflow from the affected paranasal sinuses. For this purpose, vasoconstrictor drugs are instilled into the nose. Applications to the area of ​​the middle nasal passage for 1-2 minutes of turunda soaked in an adrenaline solution work better. Effective combination drugs containing secretolytics, antibiotics and painkillers, in the form of endonasal sprays (rinofluimucil, isofra, polymexine with phenylephrine, etc.), physiotherapeutic procedures (UHF, therapeutic laser). The use of the YAMIK sinus catheter is effective, allowing aspiration of the contents and administration medicines into the paranasal sinuses on the affected side. For ethmoiditis, this method is especially effective.

General treatment indicated for elevated temperature reactions and intoxication of the body. Antibiotics are prescribed wide range actions (augmentin, sumamed, klacid, tsipromed, etc.), hyposensitizing drugs (diphenhydramine, gismanal, claritin), mucolytics, symptomatic treatment.

If complications occur (empyema, subperiosteal abscess, phlegmon of the orbital tissue, etc.), it is necessary surgical intervention- endonasal opening of the cells of the ethmoidal labyrinth, opening of an abscess of the eyelid or orbital tissue using external or endonasal endoscopic access.

Chronic ethmoiditis(ethmoiditis chronica) - chronic inflammation of the mucous membrane of the cells of the ethmoid labyrinth. As a rule, it is a continuation of undiagnosed or undertreated acute ethmoiditis. Occupying a central position in relation to other sinuses, chronic ethmoiditis is often a combined process or a secondary complication of inflammation of other sinuses.

The formation of chronic ethmoiditis is also facilitated by frequent acute infectious diseases, reducing the body's resistance, the presence adenoid vegetation, curvature of the nasal septum, etc.

In most cases, there are catarrhal-serous, purulent or hyperplastic forms of chronic ethmoiditis, which are characterized by significant thickening and hyperplasia of the mucous membrane, polypous metaplasia of the mucosa in the area of ​​the middle nasal passage, which is clearly visible during endoscopic examination. The cause of polypous degeneration of the mucous membrane is considered to be prolonged irritation by its pathological discharge, local allergic reactions. Polyps are often multiple, of various sizes, and can sometimes obstruct the entire nasal cavity and even come out through the vestibule of the nasal cavity. In some cases, polyps put pressure on the walls of the nose for a long time and even cause their external deformation.

Pathomorphology. Polyps are edematous inflammatory formations of the mucous membrane. Diffuse infiltration of tissue by neutrophils occurs, other cells (eosinophils, mast cells, plasma cells) are also found, focal metaplasia of multirow columnar epithelium into stratified squamous epithelium occurs.

Clinic. General symptoms are mild and depend on the activity of the process. Chronic ethmoiditis often occurs latently. During the period of relapse, the patient is bothered by nasal discharge of mucous or purulent in nature, headache - more often in the area of ​​the root of the nose, a feeling of heaviness - in the area of ​​​​the bridge of the nose, increasing when the head is tilted. The sense of smell is usually varying degrees violated. With a complicated course of chronic ethmoiditis, the process can spread to the orbit, then swelling is observed upper eyelid, smoothing of the upper inner corner of the eye, the eyeball moves forward. On palpation, pain occurs in the root of the nose and at the inner corner of the eye (periostitis). The infection can penetrate into the tissue of the eyelid and through the venous channels (phlebitis). These and other complications are accompanied by a significant general reaction and intoxication of the body.

Diagnostics. Rhinoscopy reveals swelling of the mucous membrane of the middle turbinate and middle nasal passage, mucopurulent or purulent discharge from under the middle turbinate or from the upper nasal passage in the olfactory fissure. With the help of endoscopes, it is possible to differentiate the source of pus: under the middle turbinate - anterior ethmoiditis, in the upper nasal passage or on back wall nasopharynx - posterior ethmoiditis. The long course of ethmoiditis is characterized by such hyperplasia of the middle turbinate that it comes into contact with the nasal septum, blocking the ostiomeatal complex. Single or multiple polypous formations of various sizes around the excretory openings of the ethmoidal labyrinth cells are characteristic. X-rays of the paranasal sinuses or CT scans reveal darkening on the corresponding side of the cells of the ethmoidal labyrinth. The significance of these data is especially great since there is no other method, such as puncture, to examine the contents inside the cells of the ethmoid labyrinth.

Treatment. In case of uncomplicated course of chronic ethmoiditis, first conservative treatment, broad-spectrum antibiotics are prescribed. To reduce swelling of the mucous membrane and the free outflow of contents from the inflamed sinuses, various vasoconstrictor drugs are used in the form of drops and aerosols (sanorin, galazolin, xymelin, tizin). Combination preparations containing an antibiotic are effective vasoconstrictor and analgesic: rhinofluimucil in the form of an aerosol, polydex with phenylephrine, isofra, bioparox, etc. Physiotherapeutic procedures are used: UHF on the sinus area 5-7 times (in the absence of polyps), endonasal electrophoresis with 2% calcium chloride solution, 1% solution Diphenhydramine rum or hydrocortisone phonophoresis 7-10 times. Good effect allows the use of the YAMIK sinus catheter. In pediatric practice, the diastolic method is widely used - thickening and rarefaction of air in the nasal cavity with suction of contents from the sinuses.

If there is no effect, conservative therapy is combined with various surgical methods: corrective intranasal operations; septoplasty, nasal polypotomy, partial or total opening of the ethmoidal cells, partial resection of hyperplastic areas of the middle turbinate, marginal (sparing) resection or vasotomy of the inferior turbinate, etc.

Many patients after polypotomy experience repeated relapses of polyps, so in postoperative period Prescribe local corticosteroid therapy for 3-5 months. (flixonase, aldecine, nozanex, etc.), correction immune status. It is advisable to perform intranasal operations using optical systems- rigid and flexible endoscopes, microscopes and microinstruments, which significantly improves the technique of endonasal surgery.

Endonasal opening of the cells of the ethmoidal labyrinth and polypotomy is performed under local topical anesthesia using 5% cocaine solution, 2% dicaine solution or 10% lidocaine solution. Premedication is required in advance intramuscular injection- 2% solution of promedol, 0.1% solution of atropine and tavegil, as well as anemization surgical field using adrenaline. In the surgical chair, the patient is in a semi-sitting position. The first step is to perform polypotomy with a loop or fenestrated nasal forceps and create access to the ethmoidal labyrinth. To penetrate the area of ​​the ethmoid cells, it is necessary to expand the middle nasal meatus by displacing (fracture) medially the middle turbinate or resection of its hyperplastic anterior end. After achieving good visibility of the middle nasal passage, the anterior and middle cells of the ethmoidal labyrinth are partially opened in front using nasal pincers, a conchotome or a Hartmann instrument. When the posterior ethmoidal cells are affected, they penetrate through the basal plate of the middle turbinate into the posterior cells, thus opening the entire ethmoidal labyrinth to the sphenoid sinus, turning it into one common cavity with good conditions drainage and aeration.

Etiology and pathogenesis

The causes of chronic inflammation of the cells of the ethmoid labyrinth are the same as those of the other sinuses. Almost always chronic ethmoiditis is observed in combination with chronic diseases others paranasal sinuses, which is explained by the central position of the lattice labyrinth and its immediate proximity to the latter. A predisposing factor to the transition of acute to chronic ethmoiditis are previous general diseases, as well as hereditary and constitutional factors.

Symptoms

Subjective symptoms are often mild. Headache localized in the area of ​​the nose, less often at the inner corner of the orbit. Impaired nasal breathing and discharge, which can be profuse in the edematous-catarrhal form of chronic ethmoiditis, often worry patients. In purulent forms, the scanty discharge may dry into crusts.

Complaints of copious discharge, which is expectorated from the nasopharynx, especially in the morning, are characteristic of damage to the posterior cells of the ethmoid labyrinth. With this localization of the lesion, a violation of the sense of smell is often observed, which may be due to the transition of inflammation to the mucous membrane of the olfactory area. Hyposmia can also be expressed to a lesser extent with inflammation of the anterior cells of the ethmoidal labyrinth.

Rhinoscopic picture in chronic ethmoiditis can be varied. At catarrhal forms inflammation, thickening of the mucous membrane is accompanied by the development of granulations and the formation of polyps. Polyps are often multiple, since the initial site of their growth is often the edematous-hypertrophied mucous membrane around the numerous outlet openings of the ethmoid cells.

In some cases, they perform not only the middle nasal passage, but also the entire nasal cavity. The addition of a secondary infection entails the formation of pus in the cells, which flows into the nasal cavity. Purely purulent forms of ethmoiditis are less common. With open empyema (usually with damage to individual ethmoid cells), you can often see crusts or a strip of pus located under the middle concha, and if the posterior cells of the ethmoid labyrinth are affected, above it, around the excretory openings.

Sometimes pus is released after polyps are removed. Closed empyema can be latent for a long time: only an atypical expansion (swelling) at the anterior end of the ethmoidal labyrinth gives reason to suspect the formation of a pyocele that has developed from an empyema. This kind of limited swelling and pus-filled cells are usually found in the area of ​​the bulla ethmoidalis, in the thickness of the anterior end of the middle concha; they are often accidentally discovered during polypotomy or probing. When pus breaks out from the empyema through outer wall In the ethmoid labyrinth, swelling forms, and then a fistula forms at the inner corner of the orbit, slightly above the lacrimal fossa.

Diagnosis placed on the basis of the patient’s complaints and objective data, including data x-ray examination, sometimes including . In some cases it is necessary differential diagnosis chronic purulent ethmoiditis from purulent forms of the runny nose. The appearance of purulent discharge in the areas of the excretory openings after cleaning and anemization of the middle nasal passage indicates damage to the anterior cells of the ethmoidal labyrinth, and the presence of pus above the middle concha in the upper nasal passage is characteristic of damage to the posterior cells of the ethmoidal labyrinth or the main sinus.

With closed empyema of individual cells, diagnosis is often difficult. In these cases, X-ray examination is especially valuable, which reveals the darkening of the cells of the ethmoid labyrinth, as well as the condition of the other paranasal sinuses.

Treatment can be carried out conservatively, but in combination with minor intranasal surgical interventions aimed at improving the outflow of secretions (resection of the anterior end of the middle turbinate, polypotomy, resection of the nasal septum). Intranasal methods surgical intervention indicated for uncomplicated ethmoiditis, they are aimed at opening all the cells of the ethmoidal labyrinth, which is usually not always possible and necessitates repeated interventions. External opening of the cells of the ethmoidal labyrinth is used in complicated cases, as well as in the presence of a fistula and tumors of the ethmoidal labyrinth.

“Handbook of otorhinolaryngology”, A.G. Likhachev

• Which doctors should you contact if you have ethmoidal sinusitis (ethmoiditis)

What is ethmoidal sinusitis (ethmoiditis)

Ethmoiditis- inflammation of the mucous membrane of the ethmoid bone cells; has a bacterial (usually staphylococcal and streptococcal) or viral nature. There are acute and chronic ethmoiditis.

What causes ethmoidal sinusitis (ethmoiditis)

The occurrence of ethmoiditis is facilitated by the narrowness of the excretory openings of the cells of the ethmoidal labyrinth, as well as the middle nasal meatus and adenoid growths. Children often suffer from acute ethmoiditis preschool age. Chronic ethmoiditis occurs in weakened people who suffer from frequent viral diseases nasopharynx.

In newborns and infants ethmoiditis usually occurs in isolation, predominantly hematogenously, secondary to sepsis (intrauterine, umbilical, skin) as a metastatic purulent focus and has the most severe course.

In older children, after the formation of the maxillary and frontal sinuses acute ethmoiditis is combined with their lesions and is defined as sinusitis or frontoethmoiditis.

A predisposing factor is the narrowness of the middle nasal meatus and excretory openings. When swelling of the mucous membrane occurs easily, the outflow of discharge from the sinus quickly becomes difficult and stops.

Symptoms of Ethmoid sinusitis (ethmoiditis)

Acute ethmoiditis may occur in patients with acute trivial rhinitis, influenza, etc. Often acute or chronic inflammation of other paranasal sinuses leads to secondary lesion lattice labyrinth. For inflammation of the frontal and maxillary sinuses The anterior cells of the ethmoid bone are involved in the process, and with inflammation of the sphenoid sinus - the posterior cells. The inflammatory process quickly spreads to the deep layers of the mucous membrane. Its edema and diffuse swelling occurs, the lumens of the cells of the ethmoid bone and their excretory ducts narrow. This leads to disruption of drainage, and in childhood - the spread of the process to the bone, the formation of abscesses and fistulas.

The main symptom of acute ethmoiditis- headache, pain in the root of the nose and bridge of the nose. The predominant localization of pain at the root of the nose and the inner edge of the orbit is characteristic of damage to the posterior cells of the ethmoid bone. Difficulty in nasal breathing, impaired sense of smell (hyposmia) or absence of smell (anosmia) are often observed. The general condition of patients worsens, body temperature rises to 37.5-38°. In the first days of the disease, there is abundant serous discharge from the nose, usually odorless, which subsequently acquires a serous-purulent or purulent character. Children often experience swelling and hyperemia in the area of ​​the inner corner of the orbit and the inner part of the upper and lower eyelids, a sharp increase in the middle turbinate, mucopurulent or purulent discharge in the middle (with inflammation of the anterior cells of the ethmoid bone) or in the upper (with inflammation of the posterior cells ) nasal passage.

At primary acute ethmoiditis changes general condition most pronounced. The disease begins with sharp increase temperature up to 39-40 °C, anxiety, regurgitation, vomiting, parenteral dyspepsia, rapid increase in toxicosis, exicosis and neurotoxicosis.

Secondary ethmoiditis is much more severe and progresses faster than the primary one. Complications arise already on the 2-3rd day of the disease.

The condition of patients, as a rule, is very serious, the phenomena of a septic process are pronounced with multiple metastatic purulent foci (omphalitis, pyoderma, acute purulent ethmoiditis, osteomyelitis upper jaw, pneumonia, staphylococcal destruction of the lungs, pyelonephritis), toxicosis and exicosis, parenteral dyspepsia.

Vivid orbital symptoms are revealed: tense, dense and painful infiltration of the eyelids, hyperemia and bluish tint of their skin, tightly closed palpebral fissure, chemosis of the conjunctiva, sharp exophthalmos and immobility of the eyeball, sharp prolapse of the lateral wall of the nasal cavity with a narrowing of the common nasal passage and impaired nasal breathing. Due to the osteomyelitic process of the ethmoid labyrinth and the lateral wall of the nasal cavity, purulent discharge is found in the nasal passages. In children infancy purulent form The disease is less severe than in newborns and occurs less frequently.

One of complications of acute ethmoiditis is the destruction of part of the bone walls of the ethmoid labyrinth with the formation of empyema, which, if the outflow of secretions is disrupted, quickly increases: in this case, a breakthrough of pus can occur into the tissue of the orbit or (extremely rarely) into the cranial cavity. The patient's condition sharply worsens, body temperature rises, signs of orbital or intracranial complications. Spreading inflammatory process from the anterior cells of the ethmoid labyrinth to the orbit causes the formation of phlegmon or retrobulbar abscess in it; The pain sharply intensifies, the eyelids swell, exophthalmos develops, and the eyeball shifts outward. If the process spreads from the posterior cells of the ethmoid bone to the orbit, visual impairment mainly occurs - a narrowing of the visual field, decreased visual acuity, the appearance of scotoma, etc. Intracranial complications are manifested by diffuse purulent meningitis, brain abscess, arachnoiditis.

Chronic ethmoiditis is the result of an acute It usually develops in solo individuals with reduced body resistance, with insufficiently effective treatment and concomitant chronic inflammation other paranasal sinuses.

Symptoms of chronic ethmoiditis depend on the degree of activity of the inflammatory process. Thus, during the period of remission, patients are periodically bothered by pain in the root of the nose, headaches of uncertain localization, scanty purulent nasal discharge with unpleasant smell. When the posterior cells of the ethmoidal labyrinth are affected, the discharge (especially in the morning) accumulates in the nasopharynx and is difficult to expectorate. The sense of smell is usually impaired. Rhinoscopy reveals polypous growths, sometimes granulations in the middle and upper sections nasal cavity, mucopurulent or purulent discharge under the middle turbinate. As a rule, with chronic ethmoiditis there is a deterioration in the general condition of the patient, increased fatigue, irritability, weakness, decreased performance. During the period of exacerbation, chronic ethmoiditis is characterized by the same manifestations as acute.

In chronic ethmoiditis, empyema of the ethmoid bone also sometimes develops, which, however, unlike empyema, which complicates the course of acute ethmoiditis, can long time occur latently against the background of the general satisfactory condition of the patient, manifesting itself only in impaired nasal breathing and deformation of the nose or changes in the eyeball. The development of intraorbital and intracranial complications is also possible.

Diagnosis of ethmoid sinusitis (ethmoiditis)

Diagnosis of acute ethmoiditis is based mainly on clinical signs and X-ray data. X-rays and tomograms of the bones of the skull and paranasal sinuses reveal darkening of the cells of the ethmoid bone, often in combination with darkening of the adjacent sinuses (when they are inflamed).

The seasonality of the disease should be borne in mind, since acute ethmoiditis is mainly observed in the autumn-winter period and is regarded as acute respiratory disease, and intraorbital complications - as a manifestation adenovirus infection, allergic edema eyelid, conjunctivitis, stye, dacryocystitis, eyelid abscess or insect bites.

Differential diagnosis. Acute ethmoiditis must be differentiated from osteomyelitis of the upper jaw, dental damage, dacryocystitis, suppuration congenital cyst dorsum of the nose, erysipelas.

Treatment of ethmoid sinusitis (ethmoiditis)

Treatment of acute ethmoiditis mostly conservative. In the first days of the disease, the outflow of secretions is ensured by introducing vasoconstrictors into the nasal cavity, helping to reduce swelling of the mucous membrane, painkillers and antibiotics are prescribed, and after a few days, when the condition improves, physiotherapeutic procedures are prescribed. Surgical treatment acute E. (opening the cells of the ethmoidal labyrinth) is used only in cases of extreme serious condition patient and in the absence of effect from conservative therapy, which is usually observed in acute empyema in children, as well as when signs of orbital and intracranial complications appear. The operation of opening the cells of the ethmoidal labyrinth can be performed using intranasal and extranasal methods. In the postoperative period, the opened cavity is washed with warm sterile isotonic sodium chloride solution. Forecast in case of uncomplicated course of E. with timely and proper treatment favorable.

Treatment of chronic ethmoiditis predominantly operational. Polypotomy, partial resection of the nasal turbinates, and opening of the cells of the ethmoid labyrinth are performed. During an exacerbation, treatment is conservative.

Forecast with an uncomplicated course of chronic ethmoiditis, as a rule, favorable.

Prevention of ethmoidal sinusitis (ethmoiditis)

Prevention of ethmoiditis is to timely and rational treatment diseases that contribute to its development.

The ethmoid bone is an unpaired formation that forms facial section skulls The bone has the shape of an irregular cube; it consists of a vertical and horizontal plate and a lattice labyrinth located on both sides of the vertical plate. She delimits nasal cavity from the cranial cavity. The ethmoid sinus is a pneumatic sinus; inside such bones there are voids that are lined with mucous epithelium. It is in the numerous cells of the labyrinth that inflammation occurs in ethmoiditis.

The grid plate has rectangular shape, it is equipped with openings through which the fibers of the olfactory nerve and blood vessels pass. The vertical plate is an integral part of the nasal septum. It is worth noting that the cells of the ethmoid labyrinth are in close contact with each other, so the infection spreads quickly. The labyrinth is classified as the paranasal sinuses.

The lattice labyrinth performs the following functions:

• provides a reduction in the mass of the facial skull;
• acts as a buffer during impacts;
• isolates nerve endings olfactory nerve.

The outside of the ethmoid sinuses is covered by the orbital plate. On inside In the labyrinth there are shells, which are represented by bent bone plates, and it is between them that the upper nasal passage passes. The bone sections are in contact with all the paranasal sinuses, with the new cavity and the lacrimal bone. The horizontal plate provides contact with the frontal bone, and both plates provide contact with the sphenoid bone. It is because of this that against the background of ethmoiditis, inflammation of the maxillary, sphenoid or frontal cavities often appears, depending on the location of the source of inflammation in the ethmoid sinus.

The ethmoid labyrinth is lined with a fairly thin mucous membrane. It is quite loose and thin, and it is because of this that inflammation quickly spreads to the deeper layers. Severe swelling occurs, and the mucous membrane becomes similar to polypous formations. The epithelium consists of goblet cells that produce mucus.

Ethmoiditis is an inflammation that occurs in the ethmoid labyrinth

Inflammation in the ethmoid labyrinth (accumulation of mucus and pus)

Inflammation of the mucous membranes of the ethmoid bone is called ethmoiditis. With this pathology, all bone cells or some parts of it can become inflamed. It is worth noting that this is a fairly common disease, which often manifests itself in children, but can also occur in mature patients. Cope with inflammation without using antibacterial agents almost impossible.

Basically, inflammation of the cells of the ethmoid labyrinth, like many types of sinusitis, occurs against the background of ARVI or influenza. Otolaryngologists say that with any cold-related disease, damage to the paranasal sinuses occurs. In 95% of patients diagnosed with ARVI diagnostic procedure CT and MRI can diagnose sinusitis.

With ethmoiditis, the patient has noticeable swelling and puffiness of the eyelids, while the eyes cannot open fully, in special occasions they can be completely closed. There is an excessive sensitivity to light, both natural and artificial. On advanced stages Hemorrhages are noticeable on the mucous membranes of the eye. Chemiosis of the conjunctiva occurs. Any movements eyeballs are very painful, so the patient tries to keep his eyes closed.

Specific symptoms often appear when the disease occurs against the background of an existing infection. Psychologists say that emotional condition The patient's condition worsens significantly due to this pathology, and 25% of patients develop depressive states.

Causes

The causative agents of the pathology in most cases are viruses, among which bacteria of the coccus group are particularly distinguished. We cannot exclude cases in which cell damage occurs simultaneously under the influence of several infectious pathogens.

Ethmoiditis occurs quite rarely in patients with primary disease, in most cases it develops against the background of other infections. Often the infection penetrates the sinus through the hematogenous route.

Among the factors that provide a predisposition to the occurrence of pathology are:

• anatomical features of the structure of the nasopharynx;
• proliferation of adenoids;
• facial injuries;
• allergic lesions;
• chronic respiratory diseases;
• immunodeficiency.

Microorganisms that penetrate the mucous membrane of the cells quickly multiply and injure its cells. After they penetrate deep into the tissues, signs of inflammation appear. Swelling of the mucous membranes appears, the lumens of the excretory ducts narrow. Such changes cause difficulty in the outflow of mucus from the labyrinth.

It is worth remembering that it often provokes complications in the form of an abscess, fistulas, and empyema. If health care If performed incorrectly or not in a timely manner, the risk of pus spreading into the tissue of the eye sockets and the cranial cavity increases several times.

Characteristic manifestations

Manifestations of acute ethmoiditis may look like this:

• severe headaches;
• painful manifestations in the area of ​​the inner edge of the orbit;
• difficulty breathing through the nose;
• absolute absence or decreased sense of smell;
• a sharp deterioration in the patient's condition;
• significant increase in body temperature (38-40 degrees);
• flow of mucus and pus from the nose;
• eyelid tension, bluish skin of the eyelid;
• immobility of the eyeball;
• children experience swelling of the orbit;
• Gastrointestinal disorders (nausea, vomiting).

Patients note that headaches of a pressing nature with ethmoiditis are especially severe when making any movements with the head.

Do not forget that this pathology is especially dangerous for patients with reduced immunity and for children early age. This is due to the fact that purulent contents can provoke partial destruction of the bone in them and cause pus to penetrate into the orbit. Inflammation of the ethmoid labyrinth in newborns is extremely difficult: the temperature rises sharply, the baby becomes capricious, and food refusal is possible. If treatment is not started in a timely manner, signs of neurotoxicosis and dehydration occur.

With ethmoiditis, pain manifests itself spontaneously and sharply. On initial stage it is localized in the area of ​​the bridge of the nose. Headache is present throughout the day; this may be due to general intoxication of the patient’s body and high temperature bodies. Painful sensations in the area of ​​the bridge of the nose intensifies at night. At chronic course pain pathologies are usually less pronounced, but may occur chronic fatigue In eyes.

A feeling of fullness in the nasal cavity is present in both acute and chronic course of the disease. This manifestation occurs due to the cellular structure of the bone and the formation of pus in the cells. Swelling of the mucous membrane and the production of pus increases due to increased reproduction pathogens. In this case, the labyrinth cells are not filled with air; pus accumulates in them.

Nasal breathing is disrupted due to the fact that the swelling spreads to the mucous membranes of the nose, which become very thick, which leads to a narrowing of the nasal passages. For this reason, the air circulates very poorly; in young children, breathing through the nose becomes impossible. Difficulty in nasal breathing manifests itself very quickly - within a few hours from the moment the disease progresses.

Discharge from ethmoiditis can be purulent, mucous, and may contain blood in it in case of vascular damage. At the beginning of the pathology, as a rule, they are insignificant, but as they progress, the volume of production of pathogenic contents increases several times. If there is damage to the bone itself, the discharge will acquire a putrid odor. The volume of discharge directly depends on the shape of the lesion.

Characteristic symptoms of chronic pathology

Chronic ethmoiditis is caused by untimely and improper treatment of the disease in acute form. The risk of its occurrence increases if the patient has a predisposition to diseases of the ENT organs, and at the same time his protective function of the body is reduced. The pathology is characterized by alternating periods of exacerbation and remission.

The complaints of a patient with a similar diagnosis during an exacerbation are as follows:

• a compressive pain appears in the bridge of the nose, which becomes stronger when moving the head;
• mucus or pus is released from the nasal cavity;
• there are manifestations of intoxication of the body;
• swelling of the upper eyelid occurs;
• the sense of smell decreases.

It is worth remembering that in the chronic course of the pathology, symptoms of intoxication of the body may be present even at the time of remission. Most patients note decreased performance, fatigue, and lethargy.

Diagnosis of ethmoiditis

Put accurate diagnosis Only an experienced otolaryngologist can. A preliminary diagnosis is made at the moment initial examination based on an analysis of the patient’s complaints and a study of the existing medical history. During the examination, the doctor may notice swelling in the area of ​​the medial corner of the eye, upper and lower eyelids. During rhinoscopy, swelling of the mucous membranes of the anterior turbinate and the production of mucus and pus from it will be noticeable. When palpating the root of the nose, the patient will feel pain.

An endoscopic examination allows one to assess the condition of the nasal mucous membranes in the area where the cells of the ethmoidal labyrinth exit and accurately determine the location of the concentration of purulent masses. It is worth noting that both anterior and posterior cells can be affected. To make an accurate diagnosis, they are often used x-ray examination. The image shows darkening in any area of ​​the ethmoid bone.

How does the treatment work?

It is worth remembering that the doctor should select drugs for the treatment of ethmoiditis after full examination patient. Self-medication in this case is unacceptable, because the risk of negative consequences with this disease is large.

The following medications are often used in the treatment of pathology:

1. Vasoconstrictors.
2. Painkillers.
3. Antibacterial drugs.
4. Antiallergic drugs.
5. Rinse the nasal cavity with saline solution.

Physiotherapeutic methods, such as electrophoresis and phonophoresis, are often used to treat ethmoiditis.

When drug treatment turns out to be ineffective, they resort to opening the cells of the ethmoid labyrinth. It is worth noting that doctors do not recommend using any folk remedies for therapy.

In case of chronic pathology drug therapy does not bring results, therefore in some cases they resort to puncture, excision of the nasal turbinates and opening of the cells of the labyrinth.

Preventive actions

Damage to the ethmoidal labyrinth, like many other pathologies, is easier to prevent than to cure.

1. To prevent the occurrence of the disease, it is extremely important to treat viral diseases in a timely manner.
2. Hypothermia should be avoided.
3. Complete smoking cessation. Experts say that the disease in most situations occurs in smokers. It is also worth remembering that chronic pathology in a smoker is possible even with properly selected therapy.
4. Promotion protective functions body.

With the right therapy, the disease usually disappears completely and the patient makes a full recovery. With pathology of the labyrinth in adults, spontaneous recovery is possible, but it should be remembered that the course of antibiotic treatment cannot be interrupted. It is worth remembering that you need to contact a specialist at the first signs of pathology, this will help to avoid dangerous consequences.