Chronic ethmoid sinusitis (ethmoiditis)
The formation of chronic ethmoid sinusitis (chronic ethmoiditis) is contribute acute infections, changing the reactivity, and predispose to secondary diseases that causes the impaired nasal breathing (adenoid proliferation, etc.). If acute ethmoiditis usually detect a monopathogenic flora, when chronic ethmoiditis — polypathogenic flora, often in combination with various saprophytes. In purulent forms of inflammation were more frequently found staphylococci, streptococci, pneumococci, and microflora, vegetating in the upper respiratory tract.
Chronic ethmoid sinusitis (chronic ethmoiditis) in children in some cases occurs almost asymptomatic. Because of the diversity of manifestations is hardto recognize it. It is almost always combined with lesions of other sinus, can be single or double-sided, proceeds mainly on the type of edematous-catarrhal inflammation, rarely purulent. A characteristic feature of chronic ethmoid sinusitis (chronic ethmoiditis) — polypoid process development in sinus.
In chronic ethmoid sinusitis (chronic ethmoiditis) reveals mucosal edema, prismatic multi-row epithelium focal metaplasia into stratified squamous. Blood vessels are usually enlarged and congested, with symptoms of swelling and proliferation. Inflammatory cell infiltration is diffuse, polymorphous. Number of mucosal glands varies considerably, their status is rather mixed picture. Standing finding in chronic ethmoid sinusitis (chronic ethmoiditis) is the focal sclerosis of the mucous membrane. Often there are changes in ethmoid sinus osseous tissue — the phenomenon of chronic osteomyelitis and focal fibrosis of the bone marrow.
Symptoms of chronic ethmoid sinusitis (ethmoiditis)
Chronic ethmoid sinusitis (chronic ethmoiditis) often proceeds latently. Some patients notice a dull or squeezing pain in the root of the nose. In some cases only with rhinoscopy can detect moderate mucous or muco-purulent discharge. With the defeat of the anterior and middle groups of cells discharges localized in the allocation of the middle and lower nose section, and at the back group diseases — on the top of his department and the nasopharynx. With scanty discharge on the mucous membrane formed crust. Long duration of chronic ethmoid sinusitis (chronic ethmoiditis) is characterized by local hyperplasia of the middle turbinate. In debilitated patients chronic ethmoid sinusitis (chronic ethmoiditis) are often observed on the background of allergies or immune deficiency.
Diagnosis of chronic ethmoid sinusitis (ethmoiditis)
Diagnostics of chronic ethmoid sinusitis (chronic ethmoiditis) is based on the subjective and objective data, including a puncture and radiological methods, paranasal sinuses computed tomography (CT) scan.
Treatment of chronic ethmoid sinusitis (ethmoiditis)
Conservative treatment is often not given proper effect, providing only a temporary subsidence of the inflammatory process and creating a false premise for discontinuation of treatment.
For the puncture of the ethmoid sinus apply 2 sets of needles of a certain shape and appropriate dimensions. One is used for the puncture of certain groups of cells for diagnostic purposes, another set of holes in the distal portion, arranged in a certain order, provides lavage of the maximum number of the ethmoid sinus cells. PTFE nozzle at the distal portion acts as a limiter, preventing advancement of the needle beyond the ethmoid sinus.
The indications for puncture are the presence of edematous-catarrhal and purulent forms of chronic ethmoid sinusitis (chronic ethmoiditis), the inefficiency of conservative treatment. With a marked hypertrophy of the middle turbinates also idicated the puncture of the ethmoid sinus, that is aimed for clarifying the state of its drainage system. Before the puncture ethmoid sinuses radiography is carried out, take into consideration the main parameters, characteristic for each age group. Guidance for the puncture is the point of attachment of the front end of the middle turbinate to the lateral wall of the nose.
Analgesia of the mucous membrane of the middle nasal passage to produce a 3% solution of cocaine or lidocaine 2% solution. As you move the needle parallel to the position of the middle turbinate there is a slight resistance when piercing individual cells of the ethmoid sinus. After attaching the syringe to the proximal part of the needle produce content aspiration, and then wash out the sinus with sterile saline solution. In some cases, into the sinus injected drainage tube and fix it with adhesive tape at the entrance to the nose.
After bacteriological examination and determination of the sensitivity of microorganisms to antibiotics, into the sinus introduce various antiseptics and antibiotics. In the absence of the effect from the puncture in chronic ethmoid sinusitis (chronic ethmoiditis) produce surgical intervention, aimed at improving the outflow from the affected sinus drainage and restore its function.