What happens in the lattice maze
The ethmoid bone consists of many small cells, lined with mucous membrane and communicating with the nasal cavity through very narrow openings. In case of a viral infection or allergy, the mucous membrane swells, the outflow from the cells stops, mucus accumulates inside, to which bacterial flora quickly attaches. The walls of the cells are thin, and the orbit and the anterior cranial fossa are adjacent to them above and to the sides. That is why inflammation from here spreads more easily to neighboring structures than from other sinuses.
- Acute ethmoiditis - up to three to four weeks
- Subacute - up to three months
- Chronic - longer than three months or with frequent exacerbations
- Polypous form when combined with nasal polyps
- Isolated ethmoiditis is rare; more often than not, several sinuses are affected
Causes and risk factors
The trigger point is almost always a viral infection of the upper respiratory tract. If a runny nose persists for more than ten days or gets worse again after improvement, the likelihood of bacterial sinusitis increases dramatically. Anything that interferes with normal nasal ventilation contributes to the disease: a deviated septum, enlarged adenoids in children, polyps, allergic rhinitis, frequent use of vasoconstrictor drops. In young children, ethmoiditis can develop already on the second or third day of acute respiratory viral infection.
- Protracted ARVI
- Allergic rhinitis
- Adenoids and chronic tonsillitis in children
- Deviated nasal septum
- Nasal polyps
- Abuse of vasoconstrictor drops
- Smoking and air pollution
Symptoms
The main distinguishing symptom is pain and a feeling of fullness in the depths of the nose, at the bridge of the nose and the inner corner of the eye; it intensifies when tilting the head and applying pressure. The nose is stuffy, mucus often flows down the back wall of the throat rather than coming out, which causes obsessive coughing, especially in the mornings and at night. The sense of smell decreases or disappears. In young children, fever, refusal to eat, anxiety and swelling of the eyelids come to the fore.
- Pressing pain at the root of the nose and between the eyes
- Persistent nasal congestion
- Drip of mucus down the back of the throat
- Decreased or loss of sense of smell
- Fever and weakness
- Swelling of the eyelids in the morning, especially in children
- Headache that gets worse when bending over
Diagnostics
The ENT doctor examines the nasal cavity, assesses swelling and the presence of pus in the middle meatus; Endoscopy makes the examination much more accurate than conventional rhinoscopy. X-rays of the ethmoidal cells are not very informative due to their small size, so if the course is prolonged, a complication is suspected, or before surgery, a computed tomography scan of the sinuses is prescribed - it shows each cell. A complete blood count helps assess the activity of inflammation. In case of swelling of the eyelids, an examination by an ophthalmologist is required.
- Examination and endoscopy of the nasal cavity
- Computed tomography of the paranasal sinuses
- General blood test
- Smear with culture if treatment is ineffective
- Examination by an ophthalmologist for eye symptoms
- Assessment of allergic background during relapses
Treatment and prevention
Mild forms are treated conservatively: regular nasal rinsing with saline solutions, intranasal glucocorticoids to relieve swelling, a short course of vasoconstrictor drops no longer than five to seven days. An antibiotic is prescribed by a doctor for signs of bacterial inflammation, and the course cannot be interrupted prematurely. Sinus lavage procedures are performed by an ENT doctor. In case of chronic course, polyps or the threat of complications, an endoscopic ethmoidotomy is performed - through the nose, without incisions on the face, with restoration of outflow from the cells.
- Rinse your nose with saline solution several times a day
- Intranasal hormonal sprays as prescribed by a doctor
- Short course vasoconstrictor drops
- Antibiotic only as prescribed by a doctor
- Sinus lavage procedures in the ENT doctor’s office
- Endoscopic surgery for chronic or complicated forms
- Treatment of allergic rhinitis and adenoids for prevention
