Acute and chronic sphenoiditis: what is this, causes, symptoms, complications, diagnostics, treatment, prevention

Sphenoiditis is one of the severe forms of inflammation in the paranasal sinuses., its symptoms do not cause a person to temporarily lose his ability to work, treatment requires antibiotics.

Among the group of sinusitis (inflammation of the paranasal sinuses) sphenoiditis occurs in approximately 12% of the total number of clinical cases. The pathognomonic picture is very poor, signs can only appear during special tests. More often it turns out to be random during a survey radiography of the facial bones of the skull.

Acute sphenoiditis is practically diagnosed, mainly established chronic inflammatory process, which can be transferred with successful treatment to a phase of long-term remission. It is impossible to completely cure this disease..

The main or sphenoid paranasal sinus is affected. Inside it is a mucosa, giving off a specific secret, moisturizing the air, passing through the nasal passages. Minor signs allow treatment at home, but under constant medical supervision.

The pathogenesis of the disease and the development of the inflammatory process

The pathogenesis of the disease is based on the penetration of pathogens into the cavity of the main or wedge-shaped additional sinus.. The development of the inflammatory process begins with swelling of the mucosa, what can be manifested by a feeling of pressure in the area under the eye sockets. Severe swelling disrupts the process of capillary blood supply. This aggravates the outflow of blood with released toxins and poisons.. Accumulating in the sphenoid sinus, they quickly lead to scarring and narrowing of the outlets.. This hinders the flow of mucous secretions..

The sphenoid sinus is located inside the front of the skull on both sides of the nasal septum. It borders on the carotid arteries, skull base and ophthalmic nerves. All these formations can partially suffer from pathological processes occurring inside the main sinus., that leaves its mark on the clinical picture of the disease. Look at the photo below, what does the sphenoid sinus look like and where is it located, in the cavity of which acute and chronic sphenoiditis can develop:

Infections can cause all forms of coccal microflora. It's staphylococcus, streptokokk, enterococcus, pneumococcus and meningococcus. Less often, Moraxella catarrhalis and Haemophilus influenzae are determined in crops.. Around 5% cases, the primary cause of the inflammatory response is respiratory viruses and fungal microflora.

Established, that with any infectious disease in the nasal passages and nasopharynx, a latent inflammatory process occurs in the cavity of the sphenoid sinus. However, in the absence of interference with the outflow of mucous secretion, sphenoiditis does not form.. The immune system quickly neutralizes all microorganisms and the mucous membranes are cleared on their own.

There are risk factors, in the presence of which the likelihood of developing acute and chronic sphenoiditis increases dramatically:

• chronic rhinitis of bacterial etiology;
• high degree of sensitization of the body with manifestations of reflex allergic rhinitis;
• narrow exits from the sphenoid sinus and anatomical changes in the sost;
• foreign objects in the paranasal sinuses, including cystic changes;
• upper deviated septum, related to the ethmoid bone;
• congenital deformities of the sphenoid sinus or their abnormal development in infancy.

Acute sphenoiditis lasts no longer than 14 days. If during this period the restoration of the mucosa does not occur, she's starting to thicken. Chronic sphenoiditis is formed, the treatment of which requires long-term rehabilitation therapy.

The clinical picture: symptoms and signs of sphenoiditis

The clinical picture in acute conditions of sphenoiditis is erased due to the imposition of symptoms of an acute respiratory disease., being the leading cause of infection. Typical symptoms of sphenoiditis can manifest as nasal congestion, feeling of pressure around the nose, increase in body temperature. Secondary signs in a chronic condition are based on obstruction of the outflow of mucous secretions.. Here come to the fore:

• headache is concentrated in the temporal and occipital part of the skull;
• discharge of a purulent secret with an unpleasant putrid odor from the nose;
• frequent sneezing with discharge of mucus and irritation of the mucous membranes of the upper parts of the nose;
• change in smell, inability to recognize certain groups of odors;
• intracranial hypertension;
• feeling of pressure on the eyes;
• decreased immune resistance to various infections, transmitted by airborne droplets;
• chronic fatigue, muscle aches, general malaise, periodic rise in body temperature to subfebrile numbers in the evening.

Sphenoiditis can be unilateral (more common in congenital and acquired deformities of the sphenoid sinus) and bilateral. Secondary signs of the disease may include visual disturbances, persistent migraine headaches, discharge of purulent mucus from the nose, Ozen (smelly runny nose). Approximately 10% patients are at risk of developing meningitis, especially when seeding for meningococcal infection.

In chronic sphenoiditis, symptoms can only be expressed in a constant headache of unspecified origin.. Patients can treat cervical osteochondrosis for years, vertebral artery syndrome and other neurological conditions without benefiting.

Diagnosis of sphenoiditis

An x-ray is used for diagnosis.. Sometimes a contrast agent is used to assess the condition of the internal cavities of the sphenoid sinus. The most reliable, but inaccessible means of clinical diagnostics is computed tomography.

Already during the primary rhinoscopy, the doctor will be able to see the swelling of the nasal mucosa in that place, where do the fistulas of the sphenoid sinus exit. When pressed, a small portion of a purulent or mucous concentrated secret may stand out, talking about congestion.

Principles of treatment of sphenoiditis at home

The principles of modern therapy offer the patient an exclusively conservative treatment. Under its influence, it is possible to bring the chronic inflammatory process into the phase of long-term stable remission.. Usually, treatment of sphenoiditis at home includes the following aspects:

• conducting bacteriological culture in order to identify pathogenic microflora and its sensitivity in different groups of antibacterial and antimicrobial agents;
• appointment of an antibacterial, antiviral or antifungal etiotropic therapy;
• the use of antihistamines to relieve swelling of the mucosa;
• hormonal drops with a vasoconstrictor effect, as well as mucolytics contribute to the release of the sphenoid sinus from the exudate accumulated there.

Among the most effective antibiotics in the clinical practice of an otolaryngologist, one can single out “AUGMENTIN”, “Amoksiklav”, “Cefodox”, “Flemoxin” Soljutab”, “Zinnat” and etc. In addition, drugs are prescribed, stimulating the immune system and providing protection against viral infection. It “Lavomax”, “Amiksin”, “Ingaverin”, “Kagocel”, “Arʙidol”, “Rimantadine” and others. All of them provide increased production of interferons.. This speeds up the process of sanitation of the cavity of the sphenoid cavity.

Probing the main sinus and washing with disinfectant solutions with antibiotics gives good results.. This procedure can be performed by an otolaryngologist on an outpatient basis..

To improve the outflow of mucous secretion, an epinephrine solution or vasoconstrictor drops based on xylometazoline are instilled into the nose. ("Naftizin", "Sanorin", "Naftizin"). In severe cases, the use of nasal drops with a hormonal component is indicated. ("Nazonex").

Besides, it is necessary to increase the level of the immune defense of the human body. Patients with chronic sphenoiditis are shown courses of treatment with Wobenzym in spring and autumn. You can also take 2 per year “Polyoxidony” and “Echinacea extract”.

Surgery to treat sphenoiditis

Surgical methods for the treatment of chronic sphenoiditis are used only in those cases, when conservative therapy does not give a positive result within 2-3 months. More often during the operation, sanitation of the internal cavity of the sphenoid sinus and stenting are performed. (extension) flow, through which the mucous secretion flows out of it. The duration of the surgery is 20 – 30 minutes, performed using local anesthesia. The update period is 7-10 days.

Can there be complications after surgery for the treatment of sphenoiditis?

The quality of the operation using endoscopic equipment depends on the level of training of the ENT doctor in the field of anatomy of the nasal cavity and ENT surgery. With a successful operation, recovery takes about 2-3 weeks. There is a risk of serious consequences, if endoscopic ENT surgery was unsuccessful: damage to large vessels, opening of the cranial fossa (meningitis, etc.. P.), eye socket damage.

Sources

• Medscape
• Levinson J., Rossi IR., Kuan EC., Tajudeen BA. Chronic Sphenoiditis With Deep Neck Space Extension: Case Report With Review of the Literature and Postulated Mechanisms for Extracranial Extension. // Ear Nose Throat J – 2021 – Vol – NNULL – p.145561321989453; PMID:33470832
• Shellman Z., Coates M., Kara N. Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery. // Laryngoscope – 2021 – Volume 131 – N4 – p.E1086-E1087; PMID:32990341