Where is the sinus located and why does the disease “hid”
The sphenoid sinus is located deep in the skull, behind the ethmoidal labyrinth, and opens into the nasopharynx with a very narrow opening. Next to it pass the optic nerves, internal carotid arteries, pituitary gland and cavernous sinuses. Since the sinus is far from the facial bones, during inflammation there is no usual pain when pressing on the face, and the discharge does not flow out, but into the pharynx. Because of this, sphenoiditis is often considered a migraine, high blood pressure or chronic pharyngitis for a long time.
- Location at the base of the skull
- Narrow outlet into the nasopharynx
- Neighborhood with the optic nerves and carotid artery
- No pain when pressing on the face
- Drainage of discharge down the back of the throat
- Frequent misdiagnoses: migraine, pharyngitis
Causes and risk factors
Most often, inflammation begins as a complication of a viral infection of the upper respiratory tract: swelling of the mucous membrane blocks the already narrow anastomosis, the outflow is disrupted, and bacterial flora joins. Anatomical features contribute to this - a curved nasal septum, enlarged turbinates, polyps, as well as allergic rhinitis. Some variants are caused by fungi, especially in people with diabetes and reduced immunity. Less commonly, the cause is trauma, tumors of the base of the skull and dental procedures.
- Complication of ARVI
- Deviated nasal septum and enlarged turbinates
- Nasal polyps
- Allergic rhinitis
- Fungal infection of the sinus
- Diabetes mellitus and immunodeficiency
- Injuries and tumors of the base of the skull
Symptoms
The leading complaint is headache, which patients describe as a sensation in the center or depth of the head, in the back of the head, the crown of the head, and less often behind the eyes. It is dull, constant, intensifies in the heat, in a stuffy room, when bending over and in the afternoon. Characteristically, mucus or pus flows down the back wall of the throat, which causes coughing in the morning, soreness and an unpleasant odor. Possible decreased sense of smell, nasal congestion without heavy discharge, weakness and low temperature.
- Headache in the back of the head, crown or behind the eyes
- Increased pain in hot and stuffy rooms
- Drip of mucus down the back of the throat
- Unpleasant smell and taste
- Nasal congestion without excessive runny nose
- Decreased sense of smell
- Weakness, fatigue, low-grade fever
Diagnostics
Conventional anterior rhinoscopy does not give much, so the basis of the examination is endoscopy of the nasal cavity: the doctor examines the area of the anastomosis and can see a strip of pus flowing from the depths. The most informative method is computed tomography of the paranasal sinuses: it shows the condition of the sphenoid sinus, the thickness of the mucosa, the level of contents, bone changes and anatomical features. MRI is used if there is a suspicion that the process has spread into the cranial cavity or to a tumor. For purulent discharge, a culture is taken.
- Endoscopic examination of the nasal cavity
- CT scan of the paranasal sinuses is the main method
- MRI if complications are suspected
- Culture of discharge with sensitivity determination
- General blood test
- Examination by an ophthalmologist for visual disturbances
- Monitoring blood glucose if a fungal process is suspected
Treatment and prevention
In case of an acute bacterial process, the doctor prescribes an antibiotic, a short course of vasoconstrictors, rinsing the nasal cavity with saline solutions and topical glucocorticosteroids to reduce swelling of the anastomosis. Self-medication and heating are unacceptable, especially for headaches. If the outflow cannot be restored, the inflammation recurs or there is a fungal body, an endoscopic sphenotomy is performed - the natural anastomosis is expanded through the nose and the sinus is cleaned. For prevention, treatment of allergic rhinitis and correction of anatomical disorders are important.
- Antibacterial therapy as prescribed by a doctor
- Topical glucocorticosteroids
- Rinsing the nasal cavity with saline solutions
- Short course vasoconstrictor drops
- Endoscopic sphenotomy if treatment is ineffective
- Removal of the fungal body in mycetoma
- Treatment of allergic rhinitis and correction of the nasal septum
