Acute ethmoiditis: signs, diagnosis, treatment of children and adults

The term "acute ethmoiditis" refers to a pathological process, the course of which is accompanied by inflammation of the mucous epithelium lining the cells of the ethmoid bone. The disease refers to sinusitis. It can occur in both adults and children. A doctor should be consulted if the first signs of ethmoiditis occur. This is due to the fact that the pathological focus is located very close to the brain, as well as to the branches of the trigeminal tree. The latter is responsible for the innervation of facial tissues.

Pathogenesis

The ethmoid bone (its other name is ethmoidal) refers to pneumatic structures. It forms the facial section of the skull, separating its cavity from the nose. Inside the ethmoid bone there are several cavities that are lined with mucous membranes and filled with air. It is these cells that are involved in the pathological process.

The mechanism of development of acute ethmoiditis:

• Under the influence of various provoking factors, inflammation spreads from adjacent organs. Pathogens, having penetrated the cells of the mucosa, begin to destroy them.
• Against the background of the course of inflammation, the outflow of biological fluid from the trellis maze is disturbed. In children, bone structures are often involved in the pathological process, followed by their destruction.

Ignoring the pathology leads to the development of dangerous complications. In the absence of treatment, purulent foci begin to form. Then the exudate moves into the cavity of the skull or eye socket, creating a threat to the patient's life.

The following code is assigned to acute ethmoiditis in ICD-10 - J01.2.

Etiology

The disease can have both acute and chronic forms. In the first case, the main cause of the development of the disease is the active activity of viruses and bacteria. With untimely treatment, the disease becomes chronic.

Causes of acute ethmoiditis in children and adults:

• Dissemination of the pathogen from the primary focus. In 80% of cases, the pathogen moves into the ethmoid bone with a blood stream. As a rule, tonsils or lungs act as the primary focus. In newborns, acute ethmoiditis is a consequence of sepsis. In most cases, based on the diagnostic results, it is impossible to identify the pathogen. Less commonly, it is detected immediately. Most often, pathogens are streptococci and staphylococci, as well as pneumococci. The infection can spread not only with blood but also with lymphatic fluid.
• Complications of infections (measles, flu, scarlet fever). Most often, acute ethmoiditis is a consequence of these diseases in adolescents. As a rule, pathology develops against the background of scarlet fever. The causative agent of this disease is streptococcus. Against the background of the active vital activity of the pathogen, tonsillitis, rash and other symptoms characteristic of scarlet fever appear. Under the influence of any provoking factor, pathogens can move into the bloodstream and beyond the tonsils. With influenza and measles, acute ethmoiditis in adults and children is less often diagnosed. In most cases, the complication is associated with impaired functioning of the nervous system, which is typical for viral pathologies, for example, meningitis and encephalitis.
• Complication of sinusitis, frontal sinusitis and rhinitis. This option for the development of the disease is most common among adults. In this case, acute ethmoiditis has a combined character. In other words, the ethmoidal sinus and, for example, the frontal or maxillary sinus, nasal cavity, etc., become inflamed at the same time. This is due to the fact that the ethmoid bone is in close proximity to these zones. Most often, with acute ethmoiditis in adults, staphilo- and streptococci, moraxella and hemophilic bacillus are found in the body. Often, all of these pathogens are immediately identified. The main route of their penetration into the ethmoid bone is rhinogenic. In isolated cases, bacteria enter it with a blood stream.

Chronic ethmoiditis develops if the acute form of the disease has not been completely cured. As a rule, the transition of pathology to a new stage occurs 3 months after the onset of the development of the disease. In this case, the infectious agent initially affects only the anterior sections of the cellular structures. Then, the rear sections are also involved in the pathological process. The difference between the chronic form and the acute one is that its course is accompanied by damage to the bone structures. When they are destroyed, purulent contents can enter the eye sockets, the brain and the sphenoid sinus.

Classification

There are several types of disease, depending on its morphological features. Types of pathology:

• Catarrhal. The most common type of disease. He is also the most dangerous. This is due to its extremely rapid progression.
• Purulent. The course of the pathological process is accompanied by the formation and accumulation of exudate. Acute purulent ethmoiditis is dangerous because fluid can burst into the orbits and brain.
• Edema-catarrhal. As a rule, it develops against the background of the active life of viruses.
• Polypous. It is characterized by a significant thickening of the mucous membrane. Subsequently, polyps begin to form on it.

Catarrhal and purulent ethmoiditis are acute forms of the disease. Polyposis and edematous-catarrhal - chronic.

The disease is also classified according to lesion. Ethmoiditis can be:

• Left-handed.
• Right-handed.
• Two way.

Thus, acute and chronic ethmoiditis can take various forms. Cells can be involved in the pathological process both on one or both sides.

Clinical manifestations

The signs of the disease and their severity directly depend on the form of the disease. The following symptoms are common:

• Painful sensations. They appear abruptly, without any precursors. Initially, the pain is localized in the fronto-orbital zone. Often it is accompanied by migraine attacks. Pain in the bridge of the nose bothers you all day. Its severity is enhanced at night. A person also suffers from photophobia and impaired visual function. One of the symptoms of chronic ethmoiditis is also pain. It is permanent and often radiates to the forehead or eye sockets. The intensity of the pain increases significantly at night. It becomes painful, unbearable and does not allow a person to sleep. Then there is pain in the eyes.
• Feeling of fullness in the nose. It is characteristic of both acute and chronic ethmoiditis. Cellular structures swell, purulent exudate accumulates in them. That is why it seems to the patient that his nose is filled with something and is about to burst. In addition, with an infectious lesion, vessels are also involved in the pathological process. They expand and water flows out of them into the intercellular space. The fluid that has left the bed contributes to swelling of the mucosa. In addition, sooner or later, the water becomes infected. As a result, pathological fluid accumulates in the labyrinths, the air leaves them. If you press on the upper eyelid or nose bridge, you can feel significant pain.
• Impaired nasal breathing. Its deterioration is due to the presence of edema. The mucous membrane thickens, so that the nasal passages narrow. As a result, air circulation is disturbed. In children, nasal breathing becomes completely impossible due to anatomical features.
• Discharge other than normal. Purulent, mucous, and even bloody fluids may leak from the nose. At an early stage of the development of the disease, the discharge is scarce and viscous. Over time, they become abundant and turn green. It is with this liquid that the labyrinths of the ethmoid bone are filled. Allocations have an unpleasant specific smell.
• Violation of smell. In the horizontal plate of the ethmoid bone there are many small holes through which the fibers of the olfactory nerve pass. Against the background of the inflammatory process, they are clogged with a pathological secret. The result is a violation or complete lack of smell.
• General weakness.
• Elevated body temperature.
• Vomiting after eating in young children.

Catarrhal ethmoiditis is characterized by profuse lacrimation. In addition, the patient has the following signs of intoxication: dizziness, migraine, nausea, weakness, aches throughout the body, redness of the sclera of the eye.

Acute purulent ethmoiditis in both a child and an adult begins with an increase in body temperature to critical values. In addition, there is severe pain in the nose, eyes and teeth. The patient is concerned about signs of intoxication and excessive lacrimation.

Diagnostics

If you experience the first alarming symptoms, you must consult an ENT specialist. During the initial appointment, the doctor must provide all the information regarding the available clinical manifestations and their severity. Immediately after the interview, the ENT proceeds to the examination. Edematous and reddened areas around the eyes, pain when pressing on the eyelids and nose bridge are the main signs of acute bilateral ethmoiditis.

To confirm the diagnosis, the doctor prescribes a comprehensive examination to the patient, including:

• Rhinoscopy During it, the otorhinolaryngologist examines the mucous membrane of the patient’s nose with special tools.
• General blood analysis. The following indicators are clinically significant: the number of red blood cells and white blood cells, ESR, hemoglobin concentration.
• X-ray examination.

If necessary, the doctor may additionally prescribe CT or MRI.

Adult Treatment

Therapeutic measures should be carried out immediately immediately after diagnosis. This is due to the high risk of developing dangerous complications. Information on how to treat ethmoiditis is also provided by an otorhinolaryngologist.

The principles of treatment of acute and chronic forms are the same. Initially, it is necessary to normalize the process of air exchange in the cells of the trellis labyrinth, restoring the outflow of fluid from it. To do this, get rid of swelling of the mucous membrane. For this purpose, doctors prescribe vasoconstrictors (Tizin Xilo, Rinonorm), combined preparations (Rinofluimucil), an adrenaline solution (they moisten cotton swabs and are introduced into the nasal passages), and medicines with an antihistamine effect (Cetrin, “ Suprastin "," Erius ").

If the disease is bacterial in nature, antibiotic administration or administration is indicated. The doctor selects the drug based on the sensitivity of the pathogen to the active component. If the pathogen is not defined, broad-spectrum antibiotics are prescribed (Cefix, Zinnat, Augmentin).

The patient also needs to rinse the paranasal sinuses with antibacterial solutions using a sinus catheter. This device allows you to remove pathological fluid from the cells and treat them with a drug. It is necessary to rinse the sinuses until the resulting secret becomes transparent.

In the presence of severe pain, doctors prescribe NSAIDs (Cefecon, Paracetamol, Nurofen, Ibuprofen). The active components of these funds also normalize body temperature and stop the inflammatory process.

An important step in the treatment of both unilateral and bilateral acute ethmoiditis is the adjustment of the immune status. In order to strengthen the body's defenses, doctors prescribe vitamin complexes (Vitrum, Duovit). Less commonly shown is the administration of immunomodulators.

Immediately after stopping the inflammatory process, physiotherapeutic treatment is indicated. The most effective procedures: electrophonophoresis, UHF, exposure to a helium-neon laser.

If conservative therapy is ineffective or in the presence of serious complications, the doctor decides whether surgery is appropriate. During surgical treatment, pathological areas are removed. Intervention can be carried out both in an open way and with the help of endoscopic equipment.

Treatment in children

The principles of therapy are the same as in adults. To ensure the outflow of pathological fluid, vasoconstrictive drops in the nose are prescribed. With bacterial etmoiditis, antibiotic administration is indicated. It is recommended to rinse the nose using the “cuckoo” method; the procedure is performed by an ENT specialist in a clinic.

If the child suffers from excessive lacrimation and photophobia, antihistamines are indicated. In rare cases, sinuses are punctured and purulent secretions are pumped out using a special tube.

Alternative methods of treatment

In order to increase the effectiveness of medications, it is allowed to turn to alternative medicine. It is important to remember that the use of alternative methods cannot be considered as the main treatment for ethmoiditis. In addition, you must first obtain the permission of a doctor.

The most effective recipes:

• Take 2-3 medium aloe leaves. Grind the plant thoroughly to a state of gruel. Using gauze, squeeze juice from raw materials. Then take one small head of onion. Chop it. Using gauze, squeeze juice out of the resulting slurry. Mix both liquids in one container. Add 10 g of honey. Mix the ingredients thoroughly. With the resulting agent, bury the nose several times a day for 3 days.
• Grind separately carrots and beets. Squeeze the juice from the resulting gruel. Mix both liquids. Add 5 g of honey slightly warmed in a water bath. Instill the nose with the resulting product several times a day.
• Chop one medium-sized onion. Squeeze the juice from the resulting slurry with gauze. Mix the liquid with 10 g of slightly warmed honey. Add 50 ml of warm water. Mix the ingredients thoroughly. Rinse your nose with the product three times a day.
• Take a few chamomile flowers. Dry and grind the raw materials. 10 g of flowers pour 250 ml of boiling water. Allow the product to infuse for an hour. Strain. With the resulting infusion, irrigate the nasal passages up to 5 times a day.
• Regarding bilateral ethmoiditis, ordinary laundry soap has worked well. It can only be used to treat adults. Algorithm for preparing a medicinal product: take 10 g of laundry soap, grate it, transfer to a saucepan. Add 60 ml of milk and 10 g of honey to the same container. Mix the ingredients thoroughly. Strain the product in a water bath for about 15 minutes. Cool. With the resulting agent, bury the nose three times a day. The duration of treatment is 5 days.

If signs of an allergic reaction occur, treatment of ethmoiditis with alternative methods must be stopped.

Forecast and Prevention

The outcome of the disease directly depends on the timeliness of going to the doctor. After a well-conducted treatment, the pathology recedes completely. In chronic etmoiditis, it is important to achieve the onset of persistent remission. It is also possible only if timely stopping the acute process with medicines.

Ignoring the pathology leads to the following consequences:

• Retrobulbar abscess in the orbits.
• Exophthalmos.
• Displacement of the eyeball.
• Visual impairment.
• Destruction of the ethmoid bone.
• A breakthrough of purulent contents into the orbits or cranial cavity.
• Fistula formation.
• Arachnoiditis.
• Spilled purulent meningitis.

In order to prevent the development of complications, it is important not to delay treatment. Specific preventive measures do not exist. It is only necessary to treat diseases in a timely manner, the course of which can provoke the occurrence of ethmoiditis.

Finally

Acute ethmoiditis in adults and children is a pathological condition characterized by inflammation of the mucous epithelium lining the cavity of the ethmoid labyrinth. As a rule, the disease is secondary. In other words, the provoking agent penetrates into the ethmoid bone from another focus of the pathology. The main symptom of the disease is pain, which is localized in the forehead, orbits and nose. It is due to the development of the inflammatory process and the accumulation of pathological secretions in the sinuses. Many patients also complain of a feeling of fullness in the nose and a significant deterioration in well-being. Treatment of pathology involves the administration or administration of antibiotics, NSAIDs, antihistamines. You also need to instill the nose with vasoconstrictors. In ICD-10, acute ethmoiditis is assigned the code J01.2.