Etmoidit

Description:

Etmoidit  [ethmoiditis; annate. (cellulae) of ethmoidales trellised cells + - itis] - an inflammation of a mucous membrane of cells of a sievebone; has bacterial (more often staphylococcal and streptococcal) or the virus nature. Distinguish acute and chronic etmoidit.

Etmoidit's symptoms:

Acute etmoidit can arise at patients with acute banal rhinitis, flu, etc. Often acute or chronic inflammation of other okolonosovy bosoms leads to secondary defeat of a trellised labyrinth. At an inflammation of frontal and maxillary bosoms front cells of a sievebone are involved in process, at an inflammation of a wedge-shaped bosom - back cells. Inflammatory process quickly extends to deep layers of a mucous membrane. There is its hypostasis and diffusion swelling, gleams of cells of a sievebone and their output channels are narrowed. It leads to drainage disturbance, and at children's age - to distribution of process on a bone, to formation of abscesses and fistulas.

The main symptom of an acute etmoidit - a headache, pain in the field of a root of a nose and a nose bridge. Preferential localization of pain at a root of a nose and an inner edge of an eye-socket is characteristic of defeat of back cells of a sievebone. Difficulty of nasal breath, disturbance of sense of smell are often observed (hyposmia) or its absence (anosmia). The general condition of patients worsens, body temperature increases to 37,5-38 °. In the first days of a disease plentiful serous allocations from a nose, usually inodorous, in the subsequent gaining serous and purulent or purulent character are noted. At children hypostasis and a hyperemia in the field of an internal corner of an eye-socket and internal department of an upper and lower eyelid, sharp increase in an average nasal sink, a mucopurulent or purulent discharge on average (are quite often observed at an inflammation of front cells of a sievebone) or in upper (at an inflammation of back cells) the nasal course.

At primary acute etmoidit of change of the general state are most expressed. The disease begins with sharp temperature increase to 39-40 °C, concern, vomiting, vomiting, parenteral dyspepsia, bystry increase of the phenomena of toxicosis, an eksikoz and neurotoxicosis.

Secondary etmoidit proceeds much heavier and progresses quicker, than primary. Complications arise for the 2-3rd day of a disease.

Condition of patients, as a rule, very heavy, the phenomena of septic process at multiple metastatic suppurative focuses (the omphalitis, a pyoderma, acute purulent etmoidit, osteomyelitis of an upper jaw, pneumonia, staphylococcal destruction of lungs, pyelonephritis), are expressed toxicosis and эксикоз, parenteral dyspepsia.

The bright orbital symptomatology comes to light: intense dense and painful infiltration a century, a hyperemia and a cyanotic shade of their skin, densely close palpebral fissure, хемоз conjunctivas, a sharp exophthalmos and an immovability of an eyeglobe, a sharp prolapse of a lateral wall of a nasal cavity with narrowing of the general nasal course and disturbance of nasal breath. Owing to osteomiyelitichesky process of a trellised labyrinth and a lateral wall of a nasal cavity purulent discharges in the nasal courses are found. At children of chest age the purulent form of a disease proceeds less hard, than at newborns, and arises less often.

One of complications of an acute etmoidit is destruction of a part of bone walls of a trellised labyrinth with formation of an empyema which at disturbance of the outflow separated quickly increases: at the same time there can be a break of pus in cellulose of an eye-socket or is (extremely rare) in a head cavity. The condition of the patient sharply worsens, raises body temperature, signs of orbital or intracranial complications appear. Distribution of inflammatory process from front cells of a trellised labyrinth on an eye-socket causes formation in it of phlegmon or retrobulbar abscess; sharply pains amplify, eyelids swell, the exophthalmos develops, the eyeglobe is displaced knaruzh. In case of distribution of process of back cells of a sievebone on an eye-socket there are generally vision disorders - narrowing of a field of vision, decrease in visual acuity, emergence of scotoma, etc. Intracranial complications are shown by diffuse purulent meningitis, brain abscess, an arachnoiditis.

Chronic etmoidit is result of acute. It develops usually at solo with reduced body resistance, at insufficiently affective treatment and the accompanying chronic inflammation of other okolonosovy bosoms.

Symptoms of a chronic etmoidit depend on a degree of activity of inflammatory process. So, during remission of patients pains in the field of a nose root, headaches of uncertain localization, allocation from a nose scanty purulent character with an unpleasant smell periodically disturb. At defeat of back cells of a trellised labyrinth the discharge (especially in the mornings) accumulates in a nasopharynx, is hardly expectorated. Sense of smell is, as a rule, broken. At a rinoskopiya find polypostural growths, sometimes granulations on average and upper departments of a nasal cavity, a mucopurulent or purulent discharge under an average nasal sink. As a rule, at a chronic etmoidit deterioration in the general condition of the patient, increased fatigue, irritability, weakness, decrease in working capacity are noted. In the period of an aggravation chronic to an etmoidita it is characterized by the same manifestations, as acute.

At a chronic etmoidit the empyema of a sievebone which, however, unlike the empyema complicating a current of an acute etmoidit can latentno proceed a long time against the background of the general satisfactory condition of the patient also sometimes develops, being shown only by disturbance of nasal breath and deformation of a nose or changes of an eyeglobe. Perhaps also development of intra orbital and intracranial complications.

Etmoidit's reasons:

Emergence of an etmoidit is promoted by narrowness of output openings of cells of a trellised labyrinth, and also average nasal course and adenoid growths. More often children of preschool age are ill an acute etmoidit. Chronic etmoidita occur at the people weakened, having frequent viral diseases of a nasopharynx.

At newborns and babies etmoidit usually arises separately, preferential hematogenous way for the second time against the background of sepsis (pre-natal, umbilical, skin) as a metastatic suppurative focus and proceeds most hard.

At children of more advanced age is after formation of maxillary and frontal bosoms acute etmoidit is combined with their defeat and is defined as gaymoroetmoidit or frontoetmoidit.

The contributing moment is the narrowness of the average nasal course and output openings. At easily arising hypostasis of a mucous membrane outflow separated from a bosom quickly is at a loss and stops.

Etmoidit's treatment:

Treatment of an acute etmoidit preferential conservative. In the first days of a disease provide outflow separated by means of introduction to a nasal cavity of the vasoconstrictors promoting reduction of hypostasis of a mucous membrane appoint anesthetics, antibiotics, several days later, at improvement of a state, - physiotherapeutic procedures. Operational treatment acute E. (opening of cells of a trellised labyrinth) apply only in cases of critical condition of the patient and in the absence of effect of conservative therapy that is usually observed at an acute empyema at children, and also at emergence of signs of orbital and intracranial complications. Operation of opening of cells of a trellised labyrinth can be executed intranasal and extra nasal by methods. In the postoperative period the opened cavity is washed out warm sterile isotonic solution of sodium of chloride. The forecast in case of an uncomplicated current E. at timely and correct treatment favorable.

Treatment of a chronic etmoidit preferential operational. Make a polipotomiya, a partial conchotomy, opening of cells of a trellised labyrinth. In the period of an aggravation treatment conservative.