Edema of the mucosa of the latticed bone
[ethmoiditis; anat. (cellulae) ethmoidales latticed cells + -itis] - inflammation of the mucous membrane of the cells of the latticed bone; has bacterial (more often staphylococcal and streptococcal) or viral nature. Distinguish between acute and chronic etmoiditis.
Acute ethmoiditis can occur in patients with acute banalrhinitis, influenza, etc. Often acute or chronic inflammation of other paranasal sinuses leads to secondary damage to the trellis labyrinth. When the frontal and maxillary sinuses are inflamed, the anterior cells of the latticed bone are involved in the process, with the inflammation of the sphenoid sinus - the posterior cells. Inflammatory process quickly spreads to the deep layers of the mucous membrane. There is its edema and diffuse swelling, the lumens of cells of the latticed bone and their excretory ducts taper. This leads to a violation of drainage, and in childhood - the spread of the process to the bone. the formation of abscesses and fistulas.
The main clinical sign of acute E. - headache. pain in the root of the nose and nose. The predominant localization of pain at the root of the nose and the inner edge of the orbit is characteristic of hitting the posterior cells of the latticed bone. Often there is difficulty in nasal breathing, a violation of smell (hyposmia) or its absence (anosmia). The general condition of patients worsens, the body temperature rises to 37.5-38 °. In the first days of the disease, there are abundant serous discharge from the nose, usually without an odor, subsequently acquiring a serous-purulent or purulent character. Children often have swelling and hyperemia in the inner corner of the orbit and inner part of the upper and lower eyelid, a sharp increase in the middle nasal concha, mucopurulent or purulent discharge in the middle (with inflammation of the front cells of the trellis) or in the upper (with inflammation of the posterior cells ) nasal passage.
One of the complications of acute E. is the destruction of a part of the bone walls of the latticed labyrinth with the formation of empyema (Empyema), which in violation of the outflow of the separated quicklyincreases: this can lead to the breakthrough of pus in the fiber of the eye socket or (extremely rarely) into the cavity of the skull. The patient's condition deteriorates sharply, the body temperature rises, signs of ocular or intracranial complications appear. The spread of the inflammatory process from the anterior cells of the latticed labyrinth to the orbit causes the formation of phlegmon or a retrobulbar abscess in it; sharply increased pain, swollen eyelids. develops Exophthalmos , the eyeball is shifted to the outside. In the case of the spread of the process from the posterior cells of the latticed bone, the eye sight mainly causes visual impairment, narrowing the visual field, reducing visual acuity, the appearance of scotoma (Skotoma), etc. Intracranial complications are manifested by diffuse purulent meningitis, brain abscess, and arachnoiditis.
Diagnosis of acute E. is based mainly on the clinical signs and data of radiographic research. On radiographs and tomograms of the bones of the skull and paranasal sinuses, the darkening of the cells of the latticed bone is observed, often in combination with the dimming of adjacent sinuses (with their inflammation).
Treatment of acute E. is predominantly conservative. In the first days of the disease, the outflow of vasoconstrictive agents, which help to reduce the edema of the mucous membrane, is prescribed by anesthetics, antibiotics. a few days later, when the condition improves, - physiotherapy procedures. Surgical treatment of acute E. (opening of cells of the latticed labyrinth) is used only in cases of extremely serious condition of the patient and in the absence of the effect of conservative therapy, which is usually observed in acute empyema in children, as well as in the appearance of signs of ocular and intracranial complications. The operation of opening the cells of the latticed labyrinth can be performed by intranasal and vnenosovym methods. In the postoperative period, the opened cavity is washed with a warm sterile isotonic sodium chloride solution. The prognosis in case of uncomplicated course of E. with the timely and correct treatment is favorable.
Chronic etmoiditis is the result of the acute. It develops usually in solo with a reduced resistance of the body, with insufficiently affective treatment and concomitant chronic inflammation of other paranasal sinuses.
Clinical manifestations depend on the degreeactivity of the inflammatory process. Thus, during the period of remission, patients are periodically disturbed by pain in the root of the nose, headaches of indeterminate localization, discharge from the nose of a scant purulent character with an unpleasant odor. When the posterior cells of the latticed labyrinth are affected, the discharge (especially in the mornings) accumulates in the nasopharynx, with difficulty coughing up. The sense of smell. as a rule, is broken. In the rhinoscopy, polyposis growths are observed, sometimes granulation in the middle and upper parts of the nasal cavity, mucopurulent or purulent discharge under the middle nasal concha. As a rule, with chronic E, worsening of the general condition of the patient, increased fatigue are noted. irritability, weakness, decreased efficiency. In the period of exacerbation, chronic E. is characterized by the same manifestations as acute.
With chronic E. also sometimes develops the empyema of the latticed bone, which, however, unlike the empyema that complicates the course of acute E., can persist latently for a long time against the background of the patient's overall satisfactory state, manifested only by a disruption of nasal breathing and deformity of the nose or changes in the eyeball. It is also possible to develop intraocular and intracranial complications.
Treatment of chronic E. mostly operational. They produce polypotomy, partial resection of nasal conchaes, opening of cells of a latticed labyrinth. In the period of exacerbation, the treatment is conservative. The prognosis for uncomplicated flow of chronic E. is usually favorable. Prophylaxis of E. is the timely and rational treatment of diseases that contribute to its development.
Bibliography: A multivolume guide to otorhinolaryngology, ed. A.G. Likhachev, vol. 4, p. 7. M. 1963.
IIEthmoiditis (ethmoiditis; anatum cellulae ethmoidales lattice cells + -it)
inflammation of the mucous membrane of the cells of the latticed bone.
1. Small medical encyclopedia. - M. Medical encyclopedia. 1991-96 2. First aid. - M. The Great Russian Encyclopedia. 1994 3. Encyclopaedic dictionary of medical terms. - M. Soviet Encyclopedia. 1982-1984