Sphenoiditis is an inflammation of the mucous membrane of the sphenoid sinus that develops against a background of a viral or bacterial infection.
Sphenoiditis is not common and is traditionally associated with a disease of the ethmoid labyrinth – its posterior cells.
Acute sphenoiditis occurs with acute rhinitis, influenza and other infectious diseases, often in combination with inflammation of the cells of the ethmoid labyrinth. It proceeds according to the type of catarrhal or purulent inflammation. Manifested by discharge from the nose, headache, localized in the occipital, less often in the frontal, parietal or temporal region, impaired sense of smell, increased body temperature, weakness. Acute sphenoiditis can be complicated by the spread of the inflammatory process to the region of the orbit, into the cranial cavity with the development of damage to the optic nerve, meningitis, brain abscess, etc.
Chronic sphenoiditis may be the result of improper treatment of acute sphenoiditis. The transition of acute sphenoiditis to chronic is associated with frequently recurring acute inflammations, especially under unfavorable conditions for the outflow of pathological secretions from the sphenoid sinus. The cause of chronic sphenoiditis can also be damage to the bone walls of the sphenoid sinus in a number of diseases (tuberculosis, syphilis, benign / malignant tumors). The inflammatory process proceeds in isolation or with damage to the posterior cells of the ethmoid labyrinth.
The most common symptoms of chronic sphenoiditis are headache localized in the parietal and sometimes in the occipital region, and the patient feels an unpleasant odor due to the fact that the aperture of the sphenoid sinus opens in the olfactory region of the nose. An important sign of chronic sphenoiditis is the flow of secretions along the anterior wall of the sphenoid sinus along the arch of the nasopharynx and posterior pharyngeal wall. The inflammatory process can spread into the cranial cavity, others within the nasal sinuses, into the orbit and also lead to the development of complications.
The diagnosis of “acute / chronic sphenoiditis” is established by an otolaryngologist based on the clinical picture and the results of rhinoscopy. Treatment of sphenoiditis is focused on reducing the swelling of the mucous membrane of the sphenoid sinus and improving the outflow of secretions. With severe intoxication, antibiotic therapy is indicated (after laboratory tests for the susceptibility of pathogens to antibiotics). To reduce edema and swelling of the mucous membrane, vasoconstrictor nasal drops (short-term), secretolytic and secretion-stimulating products are recommended. Physiotherapeutic methods play a certain role in the treatment. These procedures are carried out by an otolaryngologist in a medical institution.
Headache complaints. Most often it is localized in the region of the crown, in the depths of the head and occiput, the orbit. With chronic lesions, pain is felt in the crown region, and with large sinus volumes, it can also spread to the back of the head. With rhinoscopy, the accumulation of discharge in the olfactory gap is determined. It is not often visible strips of pus flowing down the roof of the nasopharynx and the back wall of the pharynx. With unilateral sphenoiditis, unilateral lateral pharyngitis is observed. Sometimes patients complain of a rapid decrease in vision, which is associated with the involvement of the optic chiasm in the process. Chronic sphenoiditis can also occur with mild symptoms. X-ray examination is of great importance in the diagnosis of sphenoiditis.
X-ray examination is of great importance in the diagnosis of sphenoiditis. The diagnosis is established on the basis of the clinical picture and the results of rhinoscopy. Of decisive importance is the darkening of the sphenoid sinuses and the ethmoid labyrinth on radiographs and tomograms made in several projections.
Treatment is focused on reducing the swelling of the mucous membrane and ensuring the outflow of discharge from the sinuses. Frequent lubrication of the mucous membrane of the nasal cavity with vasoconstrictor preparations (0.1% solutions of adrenaline, galazolin, naphthyzinum) is shown to ensure the outflow of discharge from the sinuses. With a protracted process, probing and washing the sphenoid sinus with antibiotic solutions is recommended.
The prognosis is often favorable. Sometimes surgery is indicated (for example, resection of the posterior end of the middle shell). With progressive deterioration of vision, intracranial complications, the sphenoid sinus is opened through the anterior wall.