Swelling of the mucous cells of the trellis labyrinth
Acute ethmoiditis</ i>(ethmoiditis acuta) - acute inflammation of the mucous membrane cells of the latticed labyrinth, often occurs and ranks second infrequency after inflammation of the maxillary sinuses. The cause of the disease are acute rhinitis, acute respiratory disease, influenza, etc.. Contributing factors are the anatomical topographical location pin anastomoses cells trellis labyrinth narrow middle nasal passage, deviation of the nasal septum, and others. Against this backdrop, even a slight swelling of the mucosa of the nasal cavity of the shell causes difficulty outflow from the lattice cells. The anatomical proximity of excretory anastomoses promotes inflammation in the latticed cells, in practice, with inflammation in any paranasal sinus.
Clinic. As with any inflammatory process, acute etmoiditis 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, with weakness, with shattering. The patient may be troubled by headaches of varying intensity, most often with localization in the root of the nose and orbit (a pathological symptom). These painful symptoms often depend on the irritation of the sensitive endings of the branches of the trigeminal nerve.
Local symptoms: congestion in the nose and difficulty in nasal breathing, mucopurulent discharge from the nasal cavity, a decrease in the 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 latticed cells is destroyed, there is edema and hyperemia of the internal angle
eye sockets and adjacent sections of the upper and lowercentury on the side of the disease. It can form a closed empyema (closed abscess), where pus can break into the fiber of the orbit, which is accompanied by a deviation to the outside of the eyeball, exophthalmos, chemosis, pain in the movement of the eyeball, decreased vision, increased intoxication.
Diagnostics is based on the characteristic complaints, the given anamnesis. When anterior rhinoscopy there is swelling and hyperemia of the mucosashells in the area of the middle nasal concha, mucopurulent discharge from under the middle nasal concha or from the area of the olfactory gap during inflammation of the posterior trellised cells. For a better inspection, preliminary mucosal anemia is carried out in this area.Endoscopic examination allows you to carefully consider the output areanatural openings of the lattice cells and differentiate the purulent discharge from the anterior cells (anterior ethmoiditis) or the posterior cells from the olfactory gap (posterior etmitoid) (Figure 2.32). On radiographs, especially with CT, a darkening of the latticed cells is seen. These data are the most important for establishing a diagnosis.
Treatment. Acute etmoiditis in the absence of complications are treated conservatively. Local treatment is primarily aimed at reducing the swelling of the nasal mucosa and, consequently, improving
outflow from the affected paranasal sinuses. For this purpose, the vasoconstrictive preparations are buried in the nose. It is better to apply applications in the area of the middle nasal passage for 1-2 minutes of turunda, impregnated with adrenaline solution. Combination preparations containing secretolitics, antibiotics and pain medications are effective in the form of endonasal sprays (rhinofluucimil, isophra, polymexin with phenylephrine, etc.), physiotherapeutic procedures (UHF, therapeutic laser). The use of the sinus catheter "Yamik", which allows the aspiration of the contents and the introduction of medicinal preparations into the paranasal sinuses on the side of the lesion, is effective. When etmoidite this method is especially effective.
General treatment is indicated with increasedtemperature reaction and intoxication of the body. Antibiotics of a wide spectrum of action are prescribed (augmentin, sumamed, klatsid, tsipromed, etc.), hyposensitizing drugs (diphenhydramine, gismanal, claritin), mucolytics, symptomatic treatment.
When complications arise (empyema, subperiosteal abscess, cellulose phlegmon, etc.), it is necessarysurgical intervention - endonasal opening of cells of the latticed labyrinth, opening of the eyelid abscess or ophthalmic gland by external or endonasal access.