The ethmoid labyrinth is not differentiated. Ethmoid bone. Distinguish according to the location of inflammation

At the age of 2 years, the subjective symptoms of ethmoiditis (inflammation of the ethmoid sinus) are almost not detected, so the value of objective symptoms and research methods. Along with the general symptoms of ethmoiditis (inflammation of the ethmoid sinus) - fever, loss of appetite, indigestion - there are abundant discharge from the nose and difficulty in nasal breathing, then swelling and edema at the medial edge of the orbit. The edema of the upper eyelid increases, skin hyperemia and narrowing of the palpebral fissure are noted. With anterior rhinoscopy, a sharply edematous and hyperemic nasal mucosa is detected, and after anemia of the middle nasal passage, abundant mucopurulent discharge often appears. On radiographs, darkening of the ethmoid sinus is visible. Computed tomography shows inflammatory fluid in the cavity of the ethmoid sinus.

Acute ethmoiditis (inflammation of the ethmoid sinus) in young children is differentiated from acute osteomyelitis upper jaw, which usually proceeds more rapidly, with a pronounced increase in body temperature, more abundant purulent secretions from one side of the nose. On the 1st day of acute ethmoiditis (inflammation of the ethmoid sinus of the nose), a sharp swelling of the corresponding cheek and swelling of the eyelids appear. The nasolabial fold is smoothed out, the angle of the mouth is lowered, mobility upper lip limited. In the oral cavity on the alveolar process from the vestibule of the mouth and on the hard palate, small infiltrates appear, covered with a hyperemic mucous membrane. Infiltrates then turn into an abscess and often open spontaneously, after which fistulas usually remain with purulent discharge in the alveolar process, hard palate, and medial corner of the eye.

Treatment of acute inflammation of the ethmoid sinus, ethmoiditis

The main attention in the treatment of acute ethmoiditis (inflammation of the ethmoid sinus) is paid to improving the outflow of contents from the affected paranasal sinus and restoring nasal breathing. Actively and systematically produce anemia of the nasal mucosa. For this purpose, turundas moistened with a 0.1% solution of adrenaline are placed in the region of the middle nasal passage for 5-10 minutes. With abundant secretions, the pathological contents from the inflamed ethmoid sinus are sucked off and a 1% solution of protargol is instilled into the nasal cavity.

In the treatment of acute ethmoiditis (inflammation of the ethmoid sinus), antibiotic treatment and physiotherapy are carried out.

Acute respiratory viral diseases, colds and rhinitis (runny nose) are often accompanied by inflammation of the paranasal sinuses (sinuses). There are several of them. common name their inflammation is called sinusitis. But the inflammation of each individual sinus has its own unique name. In this article on vospalenia.ru, we will consider ethmoiditis.

What is it - ethmoiditis?

What is ethmoiditis (ethmoid sinusitis)? This is an inflammation of one of the paranasal sinuses, or rather, the cells of the ethmoid bone. It is often a secondary disease that develops against the background of inflammation of the upper respiratory tract. It ranks 5th in the prevalence of diseases that are treated with antibiotics.

According to the form of the flow, it happens:

1. Acute - a bright and sudden manifestation. It is more commonly seen in children and adolescents.
2. Chronic - a consequence of anatomical pathology or untreated acute ethmoiditis.

There are the following types of ethmoiditis:

1. Together with other departments:
   • Sinus ethmoiditis - inflammation of the ethmoid bone with maxillary sinuses.
   • Frontoethmoiditis is a lesion of the frontal sinus along with the ethmoid bone.
   • Rhinoethmoiditis - inflammation of the ethmoid bone together with the mucous membrane of the nasal cavity.
   • Sphenoethmoiditis - inflammation of the ethmoid labyrinth with the sphenoid sinus.
2. According to the nature of inflammation:

• catarrhal.
• Polypous.
• Edema-catarrhal.
• Purulent.

1. On the side of inflammation:

• Right hand.
• Left side.
• Bilateral.

go to top Reasons

The causes of ethmoiditis are the following factors:

• Penetration of the infection into the sinus.
• Complication of other diseases: measles, meningitis, frontal sinusitis, scarlet fever, rhinitis, influenza, encephalitis, sinusitis.
• Spread of infection from other organs through the blood, for example, with tonsillitis.
• Decreased immunity.
• Anatomic pathologies.
• Injuries of the nasal septum and face.
• allergic predisposition.

go to the top Symptoms and signs of ethmoiditis of the cells of the ethmoid bone

There are such symptoms and signs of ethmoiditis of the cells of the ethmoid bone:

• Pain. Localized in the bridge of the nose and fronto-orbital region. Accompanied by headaches, high fever, photophobia, blurred vision. AT chronic form there is insomnia, eye fatigue and swelling.
• A feeling of fullness in the nasal cavity due to the occurrence of pus and swelling of the cells. Nasal congestion.
• Difficulty breathing through the nose due to swelling of the mucous membrane. In children, there may be a complete absence of nasal breathing.
• Discharge from the nose, which characterizes the exudate that has accumulated in inflamed cells. They are mucous, purulent or bloody. At first they are scarce, and then they become plentiful.
• Partial or complete lack of smell.

These symptoms are characteristic of both acute and chronic forms. The following signs appear clearly only in the acute form of ethmoiditis, and in the chronic form they are weak and unexpressed:

• Elevated temperature.
• Regurgitation (in children) and vomiting.
• Malaise.
• Loss of appetite.
• Neurotoxicosis.
• Weakness.
• Intestinal disorders: as with colitis or proctitis, there is a violation of the stool.
• Renal failure.
• Tearing.
• Swelling of the eyelids, which are slightly or completely closed. It occurs as a result of the destruction of a part of the ethmoid bone and the penetration of exudate into the tissue of the orbit. Here there is a deviation, protrusion of the eyeball, decreased vision and pain with eye movements.
• The skin is hot and moist.

During remissions in chronic ethmoiditis, the symptoms are aggravated only in intoxication (weakness, fever, decreased performance, pain in the head).

go to top Etmoiditis in children

Etmoiditis is common in children (more often than in adults). This is due to the anatomical structure and low resistance of the body. It often develops against the background of colds in the winter, when children transmit the infection to each other. It can manifest itself both in newborns and in children of primary school age, and especially in adolescents.

go to top Etmoiditis in adults

Etmoiditis also occurs in adults often in winter, when they get colds and do not treat them. The presence of chronic diseases also provokes the transfer of infection to the cells of the ethmoid bone.

go to top Diagnostics

Diagnosis of ethmoiditis consists in a general examination based on the patient's complaints, according to which some manifestations of the disease are already visible, as well as in carrying out laboratory and instrumental procedures:

• Rhinoscopy.
• Blood analysis.
• X-ray of the nasal sinuses.
• Endoscopy.
• CT and MRI.
• Exclusion of dacryocystitis, periostitis of the nasal bones, osteomyelitis of the upper jaw.

go to top Treatment

Treatment of ethmoiditis consists in the passage of medical and physiotherapeutic procedures. How to treat inflammation of the cells of the ethmoid region of the nose? The ENT doctor prescribes the following course of medications:

• Antibiotics and antiviral drugs.
• Immunostimulating drugs. Immunomodulators.
• Vasoconstrictor drugs.
• Antipyretic drugs.
• Antihistamine medicines.
• Non-steroidal anti-inflammatory drugs.
• Painkillers.
  1. Galazolin.
  2. Xymelin.
  3. Oxymetazoline.
  4. Amoxicillin.
  5. Augmentin.
  6. Cefotaxime.
  7. Bioparox.
  8. Ceftriaxone.
  9. Rinofluimucil.
  10. Paracetamol.
  11. Aqua Maris.
  12. Sinuforte.

At home, the patient must adhere to the rules:

• Boost immunity.
• Ventilate the room and humidify the air.
• Follow the diet:
  1. Drink plenty of fluids.
  2. Eat vegetables, fruits, dairy products, nuts, meat, cereals, legumes.
  3. Eliminate alcohol, fatty, fried foods that cause allergies.
  4. Use decoctions of herbs, berries and fruits.

As physiotherapy and surgical intervention are used:

• Sinus catheter "Yamik" washing cells with antibiotics.
• Other types of washing
• Electrophoresis with antibiotics.
• Phonophoresis with hydrocortisone.
• Helium-neon laser.
• Endoscopic removal of exudate.
• Septoplasty.
• Resection.
• Polypotomy.

go to top Lifespan

Etmoiditis is easily and quickly treated. However, if the patient ignores the treatment of the disease, then it reduces the quality of life. How long do patients live? The disease itself does not affect life expectancy, but provokes several fatal complications:

• Empyema.
• Meningitis.
• Destruction of the ethmoid bone.
• Encephalitis.
• Phlegmon of the eye.
• Retrobulbar abscess.
• Arachnoiditis.
• brain abscess.

The ethmoid bone is an unpaired formation that forms facial department skulls. The bone has the shape of an irregular cube, it consists of a vertical and horizontal plate and a lattice labyrinth located on both sides of the vertical plate. It separates the nasal cavity from the cranial cavity. The ethmoid sinus refers to the pneumatic, inside such bones there are voids that are lined with mucous epithelium. It is in the numerous cells of the labyrinth that inflammation occurs with ethmoiditis.

The lattice plate has a rectangular shape, it is equipped with holes through which the fibers of the olfactory nerve and vessels pass. The vertical plate is an integral part of the nasal septum. It is worth noting that the cells of the ethmoidal labyrinth are in close contact with each other, because the infection spreads quickly. The labyrinth is referred to as the paranasal sinuses.

The lattice labyrinth performs the following functions:

• provides a reduction in the mass of the facial skull;
• acts as a buffer during impacts;
• isolates the nerve endings of the olfactory nerve.

Outside, the sinuses of the ethmoid bone are covered by the orbital plate. On the inside of the labyrinth there are shells, which are represented by bent bone plates, and it is between them that the upper nasal passage passes. The bone sections are in contact with all the paranasal sinuses, with the new cavity and the lacrimal bone. The horizontal plate provides contact with the frontal bone, contact with the sphenoid bone is provided by both plates. It is because of this that, against the background of ethmoiditis, inflammation of the maxillary, sphenoid or frontal cavities often manifests itself, depending on the location of the focus of inflammation in the sinus of the ethmoid bone.

The ethmoidal labyrinth is lined with a rather thin mucous membrane. It is quite loose and thin, and it is because of this that inflammation quickly spreads to the deeper layers. Severe edema occurs, and the mucous membrane becomes similar to polyposis formations. The epithelium is made up of goblet cells that produce mucus.

Inflammation in the ethmoid labyrinth (accumulation of mucus and pus)

Inflammation of the mucous membranes of the ethmoid bone is called ethmoiditis. With this pathology, all cells of the bone or some of its parts can become inflamed. It is worth noting that this is a fairly common disease, which often manifests itself in children, but can also occur in patients of mature age. To cope with inflammation without the use of antibacterial agents is almost impossible.

Basically, inflammation of the cells of the ethmoid labyrinth, like many types of sinusitis, is formed against the background of SARS or influenza. Otolaryngologists say that with any disease of a catarrhal nature, a lesion of the paranasal sinuses occurs. In 95% of patients diagnosed with acute respiratory viral infections, the diagnostic procedure of CT and MRI allows us to state sinusitis.

With ethmoiditis, the patient has noticeable swelling and swelling of the eyelids, while the eyes cannot open fully, in special cases they can be completely closed. There is an excessive susceptibility to light, both natural and artificial. At advanced stages, hemorrhages are noticeable on the mucous membranes of the eye. There is chemiosis of the conjunctiva. Any movement of the eyeballs is very painful, so the patient tries to keep his eyes closed.

Specific symptoms often appear if the disease occurs against the background of an existing infection. Psychologists say that the emotional state of the patient against the background of this pathology is greatly deteriorating, 25% of patients experience depressive states.

Causes

The causative agents of pathology in most cases are viruses, among which bacteria of the cocci group are distinguished in a special way. It is impossible to exclude cases in which cell damage occurs simultaneously under the influence of several infectious pathogens.

Ethmoiditis rarely occurs in patients as a primary disease, in most cases it develops against the background of other infections. Often, the infection penetrates to the sinus by the hematogenous route.

Among the factors that provide a predisposition to the occurrence of pathology, there are:

• anatomical features of the structure of the nasopharynx;
• proliferation of adenoids;
• facial trauma;
• allergic lesions;
• chronic respiratory diseases;
• immunodeficiency.

Microorganisms that have penetrated the mucous membrane of the cells quickly multiply and injure its cells. After they penetrate deep into the tissues, there are signs of inflammation. There is swelling of the mucous membranes, narrowing of the lumens of the excretory ducts. Such changes cause difficulty in the outflow of mucus from the labyrinth.

It is worth remembering that ethmoiditis in children often provokes complications in the form of an abscess, fistulas, empyema. If medical care is provided incorrectly or not in a timely manner, the risk of pus spreading into the tissues of the eye sockets and the cranial cavity increases several times.

Characteristic manifestations

Manifestations of acute ethmoiditis may look like this:

• severe headaches;
• painful manifestations in the zone of the inner edge of the orbit;
• difficulty breathing through the nose;
• absolute absence or decrease in smell;
• a sharp deterioration in the patient's condition;
• a significant increase in body temperature (38-40 degrees);
• flow of mucus and pus from the nose;
• tension of the eyelids, cyanosis of the skin of the eyelid;
• immobility of the eyeball;
• children have swelling of the orbit;
• gastrointestinal disturbances (nausea, vomiting).

Patients note that headaches, which are pressing in nature, with ethmoiditis are especially pronounced when making any head movements.

Do not forget that this pathology is especially dangerous for patients with reduced immunity and for young children. This is due to the fact that purulent contents can provoke partial bone destruction in them and cause pus to enter the orbit. Inflammation of the ethmoid labyrinth in newborns is extremely difficult: the temperature rises sharply, the baby becomes capricious, food refusal is possible. If treatment is not started in a timely manner, there are signs of neurotoxicosis and dehydration.

With ethmoiditis, pain manifests itself spontaneously and sharply. On the initial stage it is localized in the region of the nose. Headache is present throughout the day, this may be due to general intoxication of the patient's body and high body temperature. Pain in the bridge of the nose intensifies at night. In the chronic course of pathology, pain is usually less pronounced, but chronic fatigue in the eyes may occur.

The feeling of fullness in the nasal cavity is present in both acute and chronic course of the disease. A similar manifestation occurs due to the cellular structure of the bone and the formation of pus in the cells. Swelling of the mucous membrane and the production of pus increases due to the increased reproduction of pathogens. The cells of the labyrinth in this case are not filled with air, pus accumulates in them.

Nasal breathing is disturbed due to the fact that the edema passes to the mucous membranes of the nose, which thicken greatly, and this leads to a narrowing of the nasal passages. For this reason, the air circulates very poorly, in young children breathing through the nose becomes impossible. Difficulty in nasal breathing manifests itself very quickly - within a few hours from the moment the disease progresses.

Allocations with ethmoiditis can be purulent, mucous, they may contain blood blotches in case of damage to the vessels. At the beginning of the pathology, as a rule, they are insignificant, but with progression, the volume of pathogenic content production increases several times. If there is a lesion of the bone itself, then the discharge will acquire a putrid odor. The volume of secretions directly depends on the form of the lesion.

Characteristic symptoms of chronic pathology

Chronic ethmoiditis is caused by untimely and incorrect therapy of the disease in an acute form. The risk of its occurrence increases if the patient has a predisposition to diseases of the upper respiratory tract, and at the same time the protective function of the body is reduced. Pathology is characterized by alternating periods of exacerbation and remission.

Complaints of a patient with a similar diagnosis during an exacerbation are as follows:

• there is a compressive pain in the region of the nose, which becomes stronger when making head movements;
• mucus or pus is released from the nasal cavity;
• there are manifestations of intoxication of the body;
• there is swelling of the upper eyelid;
• sense of smell is reduced.

It is worth remembering that in the chronic course of the pathology, symptoms of intoxication of the body may be present at the time of remission. Most patients note a decrease in efficiency, fatigue, lethargy.

Diagnosis of ethmoiditis

Only an experienced otolaryngologist can make an accurate diagnosis. A preliminary diagnosis is made at the time of the initial examination based on the analysis of the patient's complaints and the study of the existing history. During the examination, the doctor may notice swelling of the area of ​​the medial angle of the eye, upper and lower eyelids. During rhinoscopy, swelling of the mucous membranes of the anterior nasal concha and the production of mucus and pus from it will be noticeable. At the time of palpation of the root of the nose, the patient will feel pain.

Endoscopic examination allows assessing the condition of the mucous membranes of the nose in the area of ​​​​the exit of the cells of the ethmoid labyrinth and accurately determine the location of the concentration of purulent masses. It is worth noting that both anterior and posterior cells can be affected. An X-ray examination is often used to make an accurate diagnosis. The picture shows blackout in any area of ​​the ethmoid bone.

How is the treatment

It is worth remembering that the doctor should select the means for the treatment of ethmoiditis after a complete examination of the patient. Self-medication in this case is unacceptable, because the risk of negative consequences for this disease is high.

In the treatment of pathology, the following drugs are often used:

1. Vasoconstrictors.
2. Painkillers.
3. Antibacterial drugs.
4. Antiallergic agents.
5. Washing the nasal cavity with saline.

Physiotherapeutic methods, such as electrophoresis and phonophoresis, are often used to treat ethmoiditis.

When drug treatment is ineffective, they resort to opening the cells of the lattice labyrinth. It is worth noting that doctors do not recommend the use of any folk remedies for therapy.

In the chronic course of the pathology, drug therapy does not bring results, therefore, in some cases, they resort to puncture, excision of the turbinates and opening of the cells of the labyrinth.

Preventive actions

The defeat of the ethmoid labyrinth, like many other pathologies, is easier to prevent than to cure.

1. To prevent the onset of the disease, it is extremely important to treat viral diseases in time.
2. Hypothermia should be avoided.
3. Complete cessation of smoking. Experts say that the disease in most situations occurs in smokers. It is also worth remembering that the chronicity of pathology in a smoker is possible even with the right therapy.
4. Raise protective functions organism.

Under the condition of correctly chosen therapy, the disease, as a rule, completely disappears, and the patient recovers completely. With the pathology of the labyrinth in adults, spontaneous recovery is possible, but it should be remembered that the course of antibiotic treatment cannot be interrupted. It is worth remembering that you need to contact a specialist at the first signs of pathology, this will help to avoid dangerous consequences.

Ethmoiditis is inflammation various etiologies mucous membrane of the cells of the ethmoid bone. With ethmoiditis, both all bone cells and its individual parts can become inflamed.

Etmoiditis in combination with other forms

sinusitis is a disease that is among the ten most popular diagnoses in outpatient practice. Inflammation of the mucous membrane of the paranasal sinuses affects about 15 percent of adults, in children this disease is much more common. This disease is in 5th place in the list of pathologies for the treatment of which are prescribed

antibiotics

So, for example, in the United States of America, about 6 billion dollars a year is spent on the purchase of drugs against this disease. In Russia, more than 10 million people suffer from this pathology every year. It should be noted that the above facts are much less than the real figures, because a large number of patients do not seek medical help with mild forms of the disease. In most cases, ethmoiditis, like other types of sinusitis, develop against the background of an acute viral respiratory infection (

). Experts say that with any type of acute cold, the paranasal sinuses are involved in the process. Conducted studies using diagnostic tools such as

CT scan

Magnetic resonance imaging

revealed signs of sinusitis in 95 percent of cases of acute respiratory disorders.

Ethmoiditis significantly impairs the quality of life of the patient, manifesting itself as somatic (

bodily

), and psychosomatic (

emotional

) way. Thus, according to studies, 26 percent of patients with sinusitis develop or exacerbate

depression

Interesting Facts In order to get rid of ethmoiditis, some people use unconventional, often absurd methods. So, one of the old Kalmyk methods recommends that a patient with this disease visit a bathhouse. Before you start bathing procedures, you should prepare your head by overlaying it with hellebore leaves (meadow perennial grass). The plant should be laid rolled up in a tube on partings made in the hair. Next, you need to wrap your head with a linen cloth and go into the steam room. The folk recipe promises that after performing these manipulations, mucus from the nose will begin to flow, and the patient's condition improves, and after a while the disease recedes. It should be noted that according to authoritative sources, with the help of folk remedies, it is possible to alleviate the patient's condition, but not completely rid him of ethmoiditis.

Anatomy of the ethmoid bone The ethmoid or ethmoidal bone is an unpaired bone that forms the facial region of the skull. It separates the nasal cavity from the cranial cavity. The ethmoid bone belongs to the so-called pneumatic or air bones. Inside such bones there are cavities lined with a mucous membrane that are filled with air. This greatly lightens the weight of the bone.

Inside the ethmoid bone there are numerous air cells, which become inflamed with ethmoiditis. The bone itself has the shape of an irregularly cube and consists of horizontal and vertical plates, as well as a lattice labyrinth, which is located on the sides of the vertical plate.

The horizontal or lattice plate has the shape of a rectangle. The plate itself, like a sieve, is perforated with small holes through which the fibers of the olfactory nerve pass. Together with the fibers of the olfactory nerve, vessels also pass through the holes. The vertical plate is involved in the structure of the nasal septum. Its upper part is called the cockscomb. This ridge goes into the cranial cavity. The lower part of the plate is part of the bony septum.

On the sides of the vertical plate are lattice labyrinths - right and left. These labyrinths consist of a mass of very small cells (

or bone cells

) that are in contact with each other. From the inside, these masses are covered with a mucous base, which is similar to the nasal mucosa. The anterior cells of the labyrinth communicate with the middle nasal passage, the middle and posterior cells with the upper nasal passage. All cells of the ethmoid bone form a complex called the ethmoid labyrinth. This labyrinth, along with the maxillary, frontal and sphenoid sinuses, belongs to the paranasal sinuses.

Functions of the lattice labyrinth:

• reduction in the mass of the bones of the facial skull;
• creation of a kind of "buffer" during impacts;
• isolation of the nerve endings of the olfactory nerve.

Outside, the cells of the labyrinth are covered with the orbital plate, which is the base of the medial wall of the orbit. On the inside of the labyrinth are two turbinates. The shells are represented by curved bone plates, between which the upper nasal passage is formed.

The ethmoid bone, in one way or another, is in contact with all the paranasal sinuses, as well as with the nasal passage and the lacrimal bone. So, it borders with the frontal bone through a horizontal plate, with the sphenoid bone through both plates, with the lacrimal bone with the help of cells. Such close proximity to other sinuses of the face provides a characteristic clinic of ethmoiditis. So, with inflammation of the ethmoid bone, as a rule, the frontal, maxillary and sphenoid sinuses are involved in the process. With inflammation of the anterior part of the ethmoid bone, the frontal sinuses are involved in the process, with inflammation of the posterior cells - the sphenoid sinus.

The mucous membrane of the ethmoid labyrinth is similar to the nasal mucosa, but is much thinner.

The mucous membrane consists of the following sections:

• pseudostratified epithelium;
• loose connective tissue;
• mucosal glands;
• perichondrium.

The epithelium of the sinuses is different great content goblet cells that produce mucus. In general, the mucosa is very loose and thin, which contributes to the rapid transition of the inflammatory process to the deeper layers. Due to its loose structure, edema easily occurs in it. In this case, the mucous membrane itself becomes similar to polyps.
Causes of ethmoiditis

There are acute and chronic ethmoiditis. Acute ethmoiditis usually occurs in children and adolescents. It is caused by various

bacteria

Chronic ethmoiditis develops against the background of untreated acute ethmoiditis.

Acute ethmoiditis The causes of acute ethmoiditis are:

1. Dissemination of the pathogen from the primary focus;

2. Complication of viral and other infections:

• measles;
• scarlet fever;
• flu.

3. Complication of frontal sinusitis, sinusitis and rhinitis.

Dissemination of the pathogen from the primary focus In eight out of ten cases, the cause of acute ethmoiditis in children is the spread of the pathogen from the primary focus with the bloodstream. The primary focus may be the lungs, tonsils. In newborns, acute ethmoiditis develops against the background of sepsis (generalized infection). The causative agent, in more than half of the cases, can not be identified. In other cases, they are staphylococcus aureus, streptococcus, and much less often pneumococcus.

The spread of an infectious agent usually occurs through the bloodstream. But also

infection

can spread with lymph flow or by contact.

Complication of viral and other infections In older children and adolescents, acute ethmoiditis develops against the background of viral and bacterial infections. So, acute ethmoiditis in children develops mainly against the background of scarlet fever. The source of this infection is hemolytic streptococcus group A. It, actively multiplying on the child's tonsils, is the cause of tonsillitis, a characteristic rash and other symptoms in scarlet fever. However, with the penetration of streptococci into the blood beyond the tonsils, severe septic forms of scarlet fever develop. Such forms are characterized by the secondary spread of the pathogen in internal organs, including in the sinuses.

With measles and influenza, ethmoiditis is much less common. As a rule, complications are associated with the general dysfunction of the nervous system, which is observed in viral diseases. Ethmoiditis can develop in conjunction with

encephalitis

meningitis

Complication of frontal sinusitis, sinusitis and rhinitis This variant of the development of ethmoiditis is the most common in adults. In this case, inflammation of the ethmoid labyrinth is combined with damage to other sinuses.

The forms of combined ethmoiditis are:

• sinusitis- inflammation maxillary sinus and lattice labyrinth;
• frontoethmoiditis- inflammation of the frontal sinus and ethmoid labyrinth;
• rhinoethmoiditis- inflammation of the nasal cavity and ethmoidal labyrinth;
• sphenoethmoiditis- inflammation of the sphenoid sinus and ethmoid labyrinth.

Such combined forms of ethmoiditis are due to the fact that the cells of the ethmoid labyrinth have direct contact with these sinuses. So, the anterior cells have common communications with the frontal and maxillary sinuses, and the posterior cellular structures of the labyrinth - with the sphenoid sinus. Therefore, the infection from these sinuses directly passes to the ethmoid labyrinth.

Infectious agents can be staphylococci, streptococci, moraxella, and Haemophilus influenzae. However, with sinusitis and frontal sinusitis, most often we are talking about microbial association, that is, several bacteria at once. The same microbial association penetrates into the ethmoid labyrinth, causing the development of ethmoiditis. The main route of penetration of these bacteria into the labyrinth is the rhinogenic mechanism. In this case, bacteria or viruses penetrate into the labyrinth of the ethmoid bone through the anastomoses between these sinuses.

Much less often, bacteria enter the bloodstream (

by hematogenous route

) or directly by contact as a result of a violation of the integrity of the bone (

traumatically

Chronic ethmoiditis

The cause of chronic ethmoiditis is a complication of untreated acute ethmoiditis. Chronic ethmoiditis develops 3 months after the onset of acute ethmoiditis. In this case, the infection initially affects only the anterior cellular structures. The difference between chronic ethmoiditis and acute is that the infectious process extends not only to the mucous membrane, but also to the bone. Then the bacteria or bacterial association, consisting of several types of bacteria, spreads to the posterior cells and intercellular septa.

Actively multiplying, bacteria initially affect the periosteum of the ethmoid bone. This is accompanied by the development of periostitis. Further, the inflammation passes to the ethmoid bone itself, with the development of osteitis. One of the most severe complications of this stage of the disease is bone destruction. So, with severe damage to the intercellular partitions, they can collapse. In this case, the purulent contents break into the sphenoid sinus, orbit or brain.

Predisposing factors

In addition to the immediate causes of ethmoiditis, there are factors that create favorable conditions for its development. The main factor is the reduction

immunity

So, against the background of reduced immunity, the conditionally pathogenic flora of the body is activated. Opportunistic pathogens are those microorganisms that are found in the body in small quantities and do not cause harm under normal conditions. So, normally, green streptococci, Neisseria, lactobacilli and others live in the oral cavity. Their number is negligible and does not threaten the body.

However, with a decrease in the protective properties of the body, the number of these bacteria increases. Their growth is out of control. Aggressive growth of opportunistic flora against the background of reduced immunity leads to the spread of infection first into the maxillary sinuses, and then into the labyrinths of the ethmoid bone.

Reduced immunity is also the cause of the development of chronic ethmoiditis. It causes the formation of microbial associations, which are very difficult for the body to cope with.

Symptoms of ethmoiditis Symptoms of ethmoiditis are:

• pain symptom;
• feeling of fullness in the nasal cavity;
• difficult nasal breathing;
• nasal discharge;
• decreased or complete absence of the sense of smell.

pain symptom

In acute ethmoiditis, pain occurs spontaneously and abruptly. Initially, it is localized in the region of the bridge of the nose, in the fronto-orbital region. Periodic pain in this place is accompanied by a constant headache. However, sometimes it can also occur paroxysmally in the form of paroxysms. Headache is present throughout the day and is due to general intoxication of the body, increased

temperature

The pain in the region of the nose increases mainly at night. Pain symptoms are accompanied by photophobia, impaired visual function.

In chronic ethmoiditis pain is very diverse. At night, constants predominate, dull pain in the root of the nose. The pain may radiate to the eye socket or forehead. With exacerbations of chronic ethmoiditis, the pain changes its permanent character to pulsating. In this case, there is rapid fatigue in the eyes. Pain in acute ethmoiditis and exacerbation of chronic is very strong, unbearable and is accompanied by painful

insomnia

They are associated with increasing swelling and swelling of the bone and, as a result, with its pressure on other structures.

Feeling of fullness in the nasal cavity

A feeling of fullness and fullness in the nasal cavity is present in both acute and chronic ethmoiditis. These sensations are due to swelling of the cellular structures of the ethmoid bone and the accumulation of pus in them. Pus and edema in the mucous membrane of the ethmoid bone develops due to the vital activity of pathogenic bacteria. During the infectious process, not only the mucous membrane is affected, but also its vessels. First of all, the permeability of the blood vessel wall changes. At the same time, it expands, and water penetrates from the vessel into the intercellular space. The fluid released from the bloodstream leads to swelling of the mucosa, or rather, to its edema. In addition, during the life of bacteria, the fluid becomes infected and pus is formed.

It turns out that the labyrinths are no longer filled with air, but instead of it, an inflammatory fluid accumulates in it. Because of this, the skin of the upper eyelid and bridge of the nose is often swollen. Pressing on this area is very painful. The feeling of fullness in the nasal cavity is constantly and greatly increased by night.

Difficult nasal breathing

Due to edema in the labyrinths of the ethmoid bone, nasal breathing deteriorates sharply. In this case, the edema passes to the nasal mucosa. Due to the loose structure of the respiratory mucosa, edema quickly develops in it, and the mucosa itself thickens very strongly. Thicker mucosa leads to narrowing of the nasal passages. Because of this, the air through them circulates very poorly.

In young children, due to the peculiarities of the structure of their turbinates, breathing through the nose may become impossible. It is known that in children physiologically the nasal passages are very narrow, and with developing edema, they can completely close. Difficulty in nasal breathing develops very quickly - a few hours after the onset of the disease.

Discharge from the nose

Nasal discharge with ethmoiditis can be different character. It can be mucous, purulent or even bloody issues. At the beginning of the disease, viscous, in a small amount of discharge are observed. As the disease progresses, the discharge becomes profuse, purulent and greenish color. Discharge from the nose is that purulent fluid that has accumulated in the labyrinths of the ethmoid bone. It is made up of inflammatory cells

leukocytes

), dead pathogenic microbes, which also gives a specific smell. From the anterior cells, the secretions flow into the nasal passages, with which they border.

If the bone itself with the periosteum was affected by the infectious process, then the discharge acquires a putrid odor. If the vessels of the mucous membrane are damaged, streaks with blood appear in the discharge from the nose.

The volume of secretions depends on the form of ethmoiditis. So, with sinusitis, the volume of secretions increases dramatically. Abundant purulent, greenish-colored discharge is observed. They create a feeling of constant fullness and pressure in the nasal cavity. Even after careful blowing, this feeling remains.

Decreased or complete absence of the sense of smell

This symptom is due to blockage of the olfactory fissure and damage to the fibers of the olfactory nerve. In the horizontal plate of the ethmoid bone there are many small holes. Through them, the fibers of the olfactory nerve come out, which is responsible for the function of smell. With inflammation of the labyrinths of the ethmoid bone, these holes are clogged with mucous or purulent (

depending on the stage of the disease

) content. Therefore, the sense of smell may decrease, and in severe cases and disappear altogether. In addition, there may be a perversion of the olfactory function. This may be due to the destruction of the ethmoid bone, which is accompanied by a fetid odor.

In addition to specific symptoms, ethmoiditis is also characterized by general symptoms of inflammation.

General symptoms of inflammation

These symptoms are most pronounced in acute ethmoiditis. In the chronic form, these symptoms are erased and do not represent the same diagnostic value as in the acute form.

Common symptoms of ethmoiditis are:

• elevated temperature;
• weakness and malaise;
• vomiting or regurgitation in young children;
• neurotoxicosis.

In the acute form of the disease, the disease begins suddenly and progresses rapidly. This happens most quickly in newborns. In a few hours, serous ethmoiditis turns into a purulent form. In adults, this can take anywhere from a few days to a few weeks.

The disease begins with a sharp rise in temperature to 39 - 40 degrees. In this case, vomiting, confusion and motor restlessness may be noted. Initially, breathing through the nose is free, but after a few hours it is already difficult. Simultaneously with difficulty breathing, discharge from the nose appears. Increased weakness, muscle pain.

All these symptoms are due to the action of specific bacterial toxins on the body. Toxins, depending on the type of pathological microorganism that produces it, have specificity for certain organs and tissues. Some toxins are tropic to the central nervous system. In this case, the phenomenon of neurotoxicosis prevails in the clinic of acute ethmoiditis. Growing painful and unbearable headache, at the height of which vomiting occurs. Initially, the patient is a little agitated, then he is lethargic, sleepy and lethargic.

If toxins are tropic to the gastrointestinal tract, then the symptoms of disorders prevail

intestines

stool disorder, frequent vomiting

). In septic forms, acute

kidney failure

Appearance of a patient with acute ethmoiditis

The patient has swelling and swelling of the eyelids (

top first, then bottom

). The eyes may be open or completely closed. The eye reacts to a light source with lacrimation. With advanced forms, the mucous membrane of the eye is red, it shows small hemorrhages. The conjunctiva of the eye is sharply edematous (

) and red. The patient tries to close his eyes, because the movements of the eyeballs are very painful.

Skin the patient because of the increased temperature warm, moist. If ethmoiditis has developed against the background of an already existing infection, then its specific symptoms also appear. For example, if ethmoiditis developed against the background of scarlet fever, then a small rash is visible on the patient's skin, the patient's tongue is crimson, and the nasolabial triangle against the background of red cheeks is sharply white.

Diagnosis of ethmoiditis

Diagnosis of ethmoiditis includes visits to an ENT doctor, laboratory and instrumental methods research.

Examination by an ENT doctor

A visit to an ENT doctor is a mandatory item in the diagnosis of ethmoiditis. At the appointment, the doctor collects anamnestic data of the patient, examines him visually, and also examines him for the presence of certain symptoms.

Disease history The doctor collects data on how the disease debuted and what preceded it. It reveals the presence of symptoms characteristic of ethmoiditis, namely, the presence of nasal discharge and a characteristic headache. Ethmoiditis is characterized by pain localized in the back of the nose, which can radiate to the orbit, as well as a feeling of fullness and fullness in the nasal cavity. To the general symptoms of ethmoiditis, having diagnostic value, refers to the acute onset of the disease, the presence of temperature.

Inspection The appearance of the patient can sometimes indirectly indicate ethmoiditis. So, the periorbital area (the area around the eyes) may be swollen, reddened. The conjunctiva of the eyes is also swollen and inflamed. At the beginning of the disease, only swelling and redness of the inner corner of the outer eyelid are revealed. In advanced stages, redness and swelling extends to the entire surface of the upper eyelid, and then to the lower one. At the same time, the eyelids are tense, painful, cyanotic. The palpebral fissure may be narrowed, and the movements of the eyeball are limited.

Pressure on the lacrimal bone causes pain, the intensity of which can be from mild to unbearable. Pressure on the bridge of the nose also provokes pain in the depth of the nose.

Rhinoscopy Rhinoscopy is a method of visualizing the nasal mucosa. There are anterior and posterior rhinoscopy. This method is the main one in the diagnosis of ethmoiditis.

Signs of ethmoiditis with rhinoscopy:

• swelling and redness of the mucosa;
• mucopurulent discharge;
• accumulations of pus in the upper and middle nasal passage;
• multiple polyps in the common nasal passage - with a polypous form of ethmoiditis;
• prolapse of the side wall of the nose until it comes into contact with the nasal septum;
• narrowing of the common nasal passage.

Laboratory tests There are no specific tests that would speak in favor of ethmoiditis. However, a general blood test may indicate the presence of an infection in the body, which is an indirect sign in favor of ethmoiditis. These signs are common to all infectious diseases, but in acute ethmoiditis they can be extremely pronounced.

Signs of inflammation in a general blood test for ethmoiditis are:

• leukocytosis - an increase in the number of leukocytes above 9 x 109 per liter;
• shift of the leukocyte formula to the left - an increase in the number of young forms of leukocytes (non-segmented) and a decrease in the number of old forms (segmented);
• an increase in the erythrocyte sedimentation rate (ESR) of more than 10 millimeters per hour.

Signs of inflammation for chronic ethmoiditis are:

• decrease in hemoglobin concentration less than 120 grams per liter;
• decrease in the number of red blood cells less than 3.7 x 1012 per liter.

X-ray signs

Radiological signs along with rhinoscopy are the main ones for the diagnosis of ethmoiditis.

Radiological signs of ethmoiditis are:

• darkened cells of the ethmoid bone (or "veiled" labyrinth);
• reduced density of adjacent sinuses (maxillary, frontal);
• sometimes signs of periostitis of the ethmoid bone

To clarify the diagnosis, the doctor may prescribe computer diagnostics or magnetic nuclear resonance. In addition to the above radiological signs, these two methods also reveal the accumulation of exudate in the cells of the ethmoid bone.
Treatment of ethmoiditis

Treatment of ethmoiditis, first of all, is aimed at destroying the infection that caused the disease. A similar treatment tactic remains in the chronic form of the disease, however, immuno-strengthening therapy is added here, aimed at restoring immunity.

Drugs for the treatment of ethmoiditis are:

• local vasoconstrictor drugs;
• antibiotics, preferably a wide range actions;
• painkillers;
• antipyretic drugs.

Nutrition and lifestyle with ethmoiditis

Ethmoiditis significantly reduces the quality of life of the patient, so the patient should adhere to a number of rules that will help minimize the manifestations of this disease. You should also follow a special diet aimed at normalizing the functionality of the body's defense systems.

The rules of lifestyle for ethmoiditis are:

• dieting;
• hardening of the body;
• increased immunity;
• fight against the manifestations of the disease;
• prevention and treatment of acute colds and other diseases that can provoke ethmoiditis.

Diet for ethmoiditis In the treatment of ethmoiditis, the patient is recommended to follow the principles of a balanced diet with enough vitamins. This will help to better resist the disease and prevent relapses (repeated exacerbations) in the future.

Vitamins and elements that contribute to the fight against this pathology are:

• calcium;
• zinc;
• vitamin C;
• vitamin A;
• vitamin E.

The effect of calcium in the treatment of ethmoiditis Calcium helps the body fight viruses and allergens, as it has anti-inflammatory and anti-allergic effects. Also, this mineral component normalizes the activity of the nervous system, which is especially important, because with ethmoiditis, patients experience increased irritability, a tendency to pessimism.

Foods rich in calcium include:

• dairy;
• white cabbage and cauliflower;
• broccoli;
• spinach;
• egg yolks;
• almond.

Zinc and its effect on the body Zinc normalizes the functioning of the immune system and helps to resist infections and viruses. In addition, zinc helps to remove toxins, which can reduce the symptoms of ethmoiditis.

Products that can help maintain the required balance of zinc in the body include:

• pork, lamb, beef;
• poultry meat (turkey and duck);
• pine nuts, peanuts;
• beans, peas;
• cereals (buckwheat, oatmeal, barley, wheat).

Vitamins A, E and C Vitamin C strengthens the immune system, A has an anti-infective effect, E has an anti-inflammatory effect. Therefore, the diet of a patient with ethmoiditis should include foods that contain these vitamins in sufficient quantities.

Products with a high content of these vitamins are:

• vitamin C- grapes, citrus fruits, bell pepper, onions, spinach, tomatoes;
• vitamin E- peanuts, cashews, walnuts, dried apricots, prunes, wild rose, salmon, pike perch;
• vitamin A- beef liver, fish oil, carrots, apricots, parsley.

Nutrition recommendations During the treatment of ethmoiditis, the forces of the body should be directed to combat the manifestations of this disease, and not to digest food. At the same time, a person needs to get food enough energy and nutrients. Therefore, the volume of servings should be small, and the amount of food consumed per day should be divided into 5-6 meals. You should refrain from eating before bedtime, because this can cause heartburn and inflammation of the mucous membranes. Patients with ethmoiditis should avoid allergen products that can cause swelling and inflammation of the mucous membranes. The traditional causative agents of allergies include milk, red caviar, chicken eggs. Foods with a high salt content can cause swelling, so it is better to refuse them. Alcoholic drinks and those that include caffeine are not recommended for this disease, because these substances greatly dry out the mucous membrane.
Hardening of the body

Systematic hardening measures will help increase the body's resistance and successfully resist the disease. Hardening improves a person's thermoregulatory abilities, so that the body quickly adapts to changing conditions. environment. In addition, hardening contributes to the development of such qualities as endurance, resistance to

Equilibrium. Hardening should begin at those moments when the body is healthy, and when performing procedures, a number of rules should be followed.

The norms for hardening the body are:

• gradualism- regardless of the type of procedure chosen, the duration of exposure to hardening factors (water, sun, fresh air) should initially be minimal. Subsequently, observing the reaction of the body, the dosage should be increased;
• regularity- when hardening, it is necessary to develop your own training regimen and stick to it. It should be borne in mind that the acquired skills for a course of procedures equal to 3-4 months are lost if you pause for 4-5 weeks;
• individuality– when drawing up a hardening program, it is necessary to take into account age and individual characteristics person. The best option is a preliminary consultation with a doctor;
• diversity- in order to exclude the addiction of the body and increase the effectiveness of hardening, it is necessary to alternate methods of exposure;
• correct load distribution- in order for the body to recover, it is necessary to evenly distribute the effects and allow the body to rest;
• safety- do not start hardening with radical methods.

Procedures for hardening the body, depending on the factor of influence on the body, can be divided into several groups. It is necessary to choose the appropriate option, focusing on the season, personal preferences and the patient's capabilities. You should also take into account the presence of certain diseases in which certain types of hardening measures are not allowed.

Factors that can be used to harden the body are:

• water;
• air;
• sun.

water hardening Hardening using cold water is one of the most effective ways to prevent diseases of the upper respiratory tract. Such procedures help the body get used to low temperatures, increasing its immunity. Also, water hardening normalizes the functioning of the nervous system, which allows a patient with ethmoiditis to more easily tolerate the manifestations of this disease.

Water hardening methods are the following procedures:

• rubdown;
• dousing (body, legs);
• walking in cold water;
• cold and hot shower;
• winter swimming.

Hardening should begin with the most gentle procedures (rubbing, dousing) in spring or summer. The water temperature must be at least 30 degrees. Subsequently, the temperature should be lowered to one that does not cause severe discomfort.

Washing with cold water Principle this method hardening consists in thoroughly rubbing the body with a sponge or towel soaked in cold water. The key requirement of this procedure is the speed of movements. After the body gets used to this type of hardening, one should proceed to dousing and other water procedures.

Pouring as a hardening method The best time for dousing is in the morning after sleep. The recommended room temperature is 18 - 20 degrees, water - 12 degrees (this value should be reached gradually, starting from 30 degrees). After a morning shower or bath, pour a bucket of water on the neck and shoulders and rub the skin with a dry towel. It is necessary to douche every other day, at least 2 times a week. When carrying out this procedure, it is necessary to observe systematic and regularity. Otherwise, dousing can be harmful, because without getting used to it, it is a serious stress for the body.

Washing the feet is a more gentle way of hardening, suitable for young children and the elderly. When carrying out this procedure, the feet must be immersed in cold water, and then rubbed quickly and strongly with a towel until a feeling of warmth appears. The duration of the first session is 1 minute, the water temperature is 28-30 degrees. Gradually reducing the value, you should bring the water temperature to 5 - 7 degrees, the duration of washing - up to 10 minutes.

Walking in the water This type of hardening can be implemented at home and is suitable for people with high sensitivity to cold. It can also be used to harden small children. It is necessary to pour several buckets of water at room temperature into the bath, so much that the amount of liquid reaches the level of the calves. The duration of the procedure should not exceed 1 - 2 minutes. Gradually, the amount of water in the bathroom must be increased to such an extent that it reaches the knees. The time spent in water should be increased to 5 - 6 minutes. After pouring some water into the bath, you should stand in it with your feet and start taking steps. After a few minutes, add cold water to the bath. When controlling the amount and temperature of water, as well as the duration of the procedures, it is necessary to focus on own feelings. After leaving the bath, intensive foot movements should be made in order to warm the limbs.

Cold and hot shower Hardening with a contrast shower combines thermal and mechanical effects on the body, therefore it is an effective way to prevent a large number of diseases of the upper respiratory tract.

The rules for conducting a contrast shower are:

• start off this species procedures are necessary with contrasting douches of the limbs (legs and arms), gradually increasing the area of ​​the body being doused;
• hot water exposure time - 1.5 minutes, cold - a few seconds;
• the duration of the contrast shower - 1 - 2 minutes;
• showering is not recommended after physical exertion;
• the optimal time for this type of hardening is morning, because the shower causes excitement and increases human activity;
• after a shower, it is necessary to intensively rub the body with a terry towel.

Swimming in winter Many experts believe that bathing in ice water activates all the vital systems of the body, which helps to resist a large number of diseases. A prerequisite for this type of hardening is a preliminary consultation with a doctor. It is better to do this type of swimming not alone, but in special winter swimming groups, where all participants are constantly monitored by medical personnel.

• pathologies of the cardiovascular system;
• hypertension (during an exacerbation);
• epilepsy;
• tendency to convulsions;
• kidney disease;
• inflammation of the bronchi, lungs;
• thyroid problems.

It is necessary to abandon winter swimming for those who have recently suffered a myocardial infarction. It is also undesirable to swim with ice water for the elderly and persons who are in a state of intoxication.

Aerotherapy (hardening of the body with air) Hardening with air is an effective method of dealing with ethmoiditis. It is necessary to start this type of body training with weakly acting procedures, gradually increasing the duration of air baths and lowering the air temperature. It is necessary to carry out hardening with air in a completely or partially naked form in the morning, when a large amount of ultraviolet rays is present in the air.

• warm - from 30 to 20 degrees;
• cool - from 20 to 14 degrees;
• cold - from 14 degrees and below.

It is necessary to start air hardening from warm baths, so the best time of the year to start is summer. You can increase the effectiveness of procedures by combining exposure to the air with physical activity (exercises, gymnastics, running).

Limitations during air quenching are:

• chills- when this sensation appears, it is necessary to get dressed and do exercises in order to warm up;
• physical exhaustion- it is necessary to harden the body, being in a cheerful mood;
• acute infectious diseases- exposure to cold air can exacerbate the disease.

hardening by the sun Sunlight is an effective means of treating and preventing ethmoiditis. Infrared rays, penetrating the skin to a depth of 4 centimeters, cause an increase in body temperature, thereby providing anti-inflammatory and vasodilating effects. Ultraviolet rays have a bactericidal property and increase the body's resistance to infections.

The rules for taking sun hardening baths are:

• it is necessary to start the procedures from the first summer days;
• it is necessary to increase the degree of exposure to sunlight moderately, otherwise skin burns can be provoked;
• the best place to take sunbathing is the bank of a river or lake;
• the area in which the procedures are carried out must be open to the sun and air movement;
• it is best to take baths in the morning, in a horizontal position, with your feet towards the sun;
• you need to wear a hat or panama on your head;
• baths should be taken half an hour after breakfast (between 7 and 10 am), finishing them at least 60 minutes before eating. In the evening, procedures can be carried out after 16 hours;
• The duration of the first session is 10 minutes. Next, every day you need to increase the time of exposure to sunlight by 5 - 10 minutes until reaching 2 hours;
• do not bring the body to severe overheating or allow excessive sweating. After sunbathing, take a shower or bath.

Hardening not recommended sunlight those who suffer from frequent migraines, kidney disease or heart disease. It is forbidden to stay in the sun with malignant tumors.
Improving the performance of the immune system

When immune function is suppressed, the body becomes susceptible to colds. Therefore, patients with ethmoiditis should pay attention to improving immunity. In addition to hardening the body, the functioning of the immune system improves the observance of a number of principles related to nutrition and lifestyle.

The rules, the observance of which helps to increase immunity, are:

• sweet restriction- According to the American Journal of Clinical Nutrition, 100 grams of sugar within five hours of consumption significantly reduces the effectiveness of white blood cells in fighting bacterial infections. Therefore, people with weak immunity should refrain from excessive consumption of sweet water, confectionery, sweets and other products containing sugar;
• drinking about 2 liters (8 glasses) of fluid per day– moisture helps to remove toxins from the body;
• struggle with extra pounds – overweight becomes the cause of hormonal disorders, which does not allow the immune system to fight infections and viruses;
• systematic moisturizing of the nasal mucosa- dry mucous is a favorable environment for the development of pathogens. To ensure a sufficient level of moisture in the air, it is necessary to install special devices in working and residential premises. The use of purchased aerosols or washing with saline solutions will help maintain the moisture of the mucosa;
• development of communication skills– neurophysiologist Barry Bitman and his colleagues conducted a study and proved that communication with loved ones, colleagues and relatives has a positive effect on the immune system;
• noise reduction- in the course of a scientific experiment, which was conducted at Cornell University, it was proved that increased noise levels inhibit the work of immune functions. Loud noises can cause a rise blood pressure, the development of heart disease and vascular disease, an increase in cholesterol levels;
• stress management- The American Psychological Association, in the course of a series of studies, has found that systematic or prolonged illnesses make a person's immunity very vulnerable. Therefore, one should develop resistance to stress by mastering special techniques for physical and mental relaxation.

Recipes for raising immunity Following the recommendations for the amount of drinking per day is an effective way to maintain the normal functionality of the immune system. You can increase the effect of drinking liquids by replacing water with herbal teas based on medicinal plants.

Orange peel tea To prepare a drink, 50 grams (10 tablespoons) of the mixture should be used per liter of boiling water. Orange syrup can be added to taste.

The components of tea are:

• orange peels (dry or fresh) - 1 part;
• black tea without impurities - 1 part;
• lemon peels (dry or fresh) - one second part.

Rosehip for raising immunity Rosehip is a source of vitamin C, so drinks based on it are recommended to improve the protective functions of the body. Freshly prepared decoction (100 grams of berries per liter of water) should be mixed with the same amount of hot tea. Add honey or sugar. You can drink tea without restrictions during the day.

Vitaminized tea The composition of the tea mixture includes such components as strawberry leaves, string and chamomile flowers. All ingredients should be taken in equal proportions in dry form, mixed and poured into a convenient storage container (glass or ceramic vessel). For 1 cup of boiling water, use 1 tablespoon of the collection.

Lifestyle with ethmoiditis For quick and effective treatment of this disease, the patient should give up a number of habits and follow a number of recommendations.

Rules that will help to quickly cope with the disease are:

• quitting smoking and staying in smoky rooms - tobacco smoke can cause swelling of the mucous membrane;
• prevention of severe hypothermia of the body;
• minimizing contact with people who have a cold;
• regular wet cleaning and ventilation of the premises;
• refusal to visit swimming pools, as chlorinated water can worsen the condition;
• when going outside, avoid getting wind in your face;
• before visiting public places, the nasal passages should be lubricated with an ointment that contains antiviral and anti-inflammatory substances.

Treatment of comorbidities To prevent this disease, it is necessary to promptly treat the underlying diseases against which ethmoiditis develops, and eliminate predisposing factors.

Pathologies that should be dealt with to prevent inflammation in the paranasal sinus include:

• viral diseases;
• bacterial lesions of the respiratory tract;
• dental diseases;
• deviated nasal septum;
• fungal infections.

Tips and recommendations for patients with ethmoiditis This disease significantly reduces the patient's quality of life. In addition to somatic manifestations (pain, swelling, nasal congestion), this pathology has a negative impact on the emotional state of a person. Ethmoiditis also adversely affects the overall vitality.

The worries that people experience during this illness are:

• increased fatigue;
• irritability;
• memory impairment;
• decrease in working capacity;
• problems with concentration;
• the predominance of bad mood.

Timely rest, healthy sleep, moderate physical exercise. Herbal teas based on plants that have a sedative effect (chamomile, mint, lemon balm) will help reduce irritability. In order for sleep to bring the maximum benefit, it is necessary to follow a number of rules. You should fall asleep 2 to 3 hours after eating, as a full stomach can cause poor sleep. In the room where the patient sleeps, all light sources should be eliminated at night - burning TV or computer lights, light from street lighting. Before resting, the room must be ventilated to enrich the air with oxygen. Refusal to watch programs and films of negative content will help ensure deep sleep. The implementation of this recommendation will also help fight bad mood during illness.

An effective way to deal with irritation is to direct negative energy in the right direction. Engaging in a process that requires involvement and attention will help get rid of anxiety or a desire to scandal (

Consequences of ethmoiditis

The consequences of ethmoiditis are reduced to numerous complications that occur if the disease is not treated.

Complications of ethmoiditis are:

• chronic ethmoiditis;
• destruction of the ethmoid bone with a breakthrough of pus into the orbit or cranial cavity;
• empyema (accumulation of pus) of the ethmoid bone.

Chronic ethmoiditis is the most common complication of acute ethmoiditis. Occurs predominantly in adults. Symptoms of chronic ethmoiditis are the same as in acute, however, their intensity is less pronounced. There is also a headache, pain in the nose. The main symptom is a feeling of fullness and pressure in the nasal cavity.

Chronic ethmoiditis, as a rule, is combined with other sinusitis (

sphenoiditis, sinusitis

). Very difficult to treat as bacteria become resistant (

sustainable

) to antibiotics. Chronic ethmoiditis develops against the background of other chronic diseases, reduced immunity, beriberi.

Ethmoid bone destruction

This complication is the most dangerous in ethmoiditis, since pus from the destroyed ethmoid labyrinth breaks into the cavity of the orbit, the skull. In this case, phlegmons are formed,

abscesses

Meningitis. If the anterior cells of the ethmoid bone are destroyed, then pus spreads behind the eye (

retrobulbarno

). This is accompanied by a sharp swelling of the eyelids, exophthalmos (

protrusion of the eyeball

), and the pain gets worse. If the posterior cells of the bone are destroyed, then vision deteriorates sharply - it falls

visual acuity

Fields of vision shrink.

Sometimes pathological exudate can break into the cranial cavity, and then the infection passes to the substance of the brain and its membranes. Meningitis and arachnoiditis develop. In this case, the patient's condition deteriorates sharply and requires resuscitation. Symptoms of acute dysfunction of the nervous system, intoxication are added to the symptoms of ethmoiditis.

Empyema (accumulation of pus) of the ethmoid bone

This complication is also very dangerous. With it, the intercellular partitions in the labyrinths are destroyed and pus accumulates. For a long time it can proceed latently, without exacerbations. However, later it manifests itself as a deformation of the bone structures of the nose, changes in the eyeball. In this case, the eyeball prominates (

speaks

) and deviates to the outside.

Ethmoiditis is an acute or chronic inflammation of the mucous membrane of the cells of the ethmoidal labyrinth. This labyrinth is one of the paranasal sinuses and is part of the ethmoid bone located deep in the skull at the base of the nose. It can occur as an independent disease, but more often it is accompanied by other sinusitis - sinusitis, frontal sinusitis, sphenoiditis. Children suffer from ethmoiditis more often preschool age however, it can be diagnosed in both neonates and adults. About what kind of disease it is, why it occurs and how it manifests itself, as well as the main methods of diagnosis and principles of treatment of ethmoiditis, we will talk in our article. So…

Etiology (causes) and mechanism of development of ethmoiditis

Paranasal sinuses. The ethmoid sinus is marked in green.

The main causative agents of this disease are ARVI viruses - influenza, parainfluenza, adenovirus and rhinovirus infections, bacteria (mainly from the group of cocci - staphylo- and streptococci), as well as pathogenic fungi. There are frequent cases of the so-called mixed infection: when several infectious agents are determined at once in the material taken from the affected cells of the ethmoid labyrinth.

Ethmoiditis rarely develops initially - in children of preschool, school age and adults, it is usually a complication of other infectious diseases of the ENT organs: rhinitis, sinusitis, in newborns - against the background of intrauterine, skin or umbilical sepsis.

Infection in the ethmoid sinus spreads more often by hematogenous (with blood flow), less often by contact.

Factors predisposing to the development of ethmoiditis are:

• structural features of the nasopharynx (excessively narrow outlet openings of the cells of the ethmoid labyrinth, narrow middle nasal passage);
• adenoid vegetations;
• traumatic injuries of the face (for example, a broken nose or a deviated septum);
• allergic diseases of the nasopharynx (allergic rhinitis, sinusitis);
• chronic infectious processes in the nasopharynx (chronic pharyngitis, rhinitis, sinusitis, etc.);
• congenital and acquired immunodeficiencies.

The inflammatory process from nearby organs extends to the cells of the ethmoid labyrinth: in case of inflammation of the maxillary and frontal sinuses, the anterior cells are primarily affected, and in the case of inflammation of the mucous membrane of the sphenoid sinus, the posterior cells. Microorganisms, once on the mucous membrane of the cells, multiply and damage its cells, penetrating deep into the tissues - signs of inflammation appear (the mucous membrane is edematous, hyperemic, the gaps of the cells and their excretory ducts are significantly narrowed). These changes lead to a violation of the outflow of fluid from the ethmoid labyrinth, and in children, they also contribute to the transition of the pathological process to the bone with its subsequent destruction, resulting in purulent complications of ethmoiditis - abscesses, fistulas, empyema. If left untreated, the pus can spread into the tissues of the eye socket or the cranial cavity, also causing life-threatening complications.

Classification of ethmoiditis

As mentioned above, according to the nature of the course, acute and chronic ethmoiditis are distinguished.

Depending on the morphological features of the disease and the nature of the discharge, the following types of it are determined:

• catarrhal;
• purulent;
• edematous-catarrhal;
• polyposis.

The last 2 species are characteristic of the chronic form of the disease.

Depending on the side of the lesion, inflammation of the mucous cells of the ethmoid labyrinth can be:

• left-sided;
• right-handed;
• bilateral.

Clinical signs of ethmoiditis

The disease of the acute form occurs suddenly and is characterized by pronounced symptoms.

One of the symptoms of ethmoiditis is nasal congestion.

Adult patients complain of intense pressing headaches with predominant localization in the region of the base of the nose and orbit, aggravated by tilting the head forward and down. In addition, patients are concerned about difficulty in nasal breathing, a feeling of nasal congestion, mucous, mucopurulent or purulent discharge from the nose, decreased sense of smell or its complete absence. In addition to local symptoms, patients note the presence of signs of general intoxication of the body: an increase in body temperature to subfebrile, less often febrile, numbers, general weakness, reduced performance, poor appetite and sleep.

In adult patients with reduced immunity and in pediatric patients, part of the bone may be destroyed by purulent masses and their penetration into the tissues of the orbit. Manifestations of this are hyperemia and swelling of the inner corner of the eye, the medial part of the upper and lower eyelids, the deviation of the eyeball outward, its protrusion (exophthalmos), pain during eye movement, decreased visual acuity.

In newborns, ethmoiditis is much more severe than in other patients. The disease begins with a sharp rise in temperature to febrile numbers. The child is restless, refuses to eat, does not digest the food eaten - vomiting and regurgitation appear. With untimely assistance, signs of dehydration and neurotoxicosis develop. In addition, bright eye symptoms are revealed: the eyelids are hyperemic or cyanotic, sharply edematous, infiltrated; the palpebral fissure is tightly closed; the eyeball is motionless, protruding.

Chronic ethmoiditis develops with untimely and inadequate treatment of the acute form of the disease, with frequent infections of the upper respiratory tract, and also against the background of a decrease in the body's immune status.

Chronic ethmoiditis, as a rule, proceeds latently, with alternating periods of exacerbation and remission. During an exacerbation, the patient may complain of:

• a feeling of heaviness or moderate pain of a pressing nature in the region of the root of the nose and bridge of the nose, aggravated by tilting the head forward and down;
• profuse mucous or mucopurulent discharge from the nose;
• decreased sense of smell;
• swelling of the upper eyelid and forward displacement of the eyeball;
• soreness at the medial angle of the eye and in the region of the root of the nose;
• symptoms of intoxication: fever to subfebrile numbers, lethargy, weakness, fatigue.

As for the symptoms of intoxication, they do not leave the patient even during the remission of the disease. In addition, these symptoms gradually worsen, become more pronounced and, in some cases, significantly reduce the quality of life. Another remission is characterized by non-intense pains of indeterminate localization, poor serous-purulent discharge or purulent nature and impaired sense of smell of varying degrees.

Complications of ethmoiditis

With the spread of purulent masses to nearby organs, the following complications may develop:

• with damage to the orbit - retrobulbar abscess, empyema or phlegmon of the orbit;
• with damage to intracranial structures - arachnoiditis (inflammation of the arachnoid membrane of the brain), meningitis (inflammation of the pia mater), brain abscess.

Diagnosis of ethmoiditis

An otorhinolaryngologist can diagnose this disease. A preliminary diagnosis is established on the basis of the patient's complaints, the history of the disease (under what conditions it arose) and life (presence of concomitant pathology that affects the immune status of the body), the results of a physical examination.

During an external examination, the doctor can detect infiltration and swelling of the medial (inner) corner of the eye, upper and lower eyelids.

When conducting anterior rhinoscopy (examination of the nasal cavity), hyperemia and swelling of the mucous membrane of the middle nasal concha and a mucopurulent discharge from under it are noticeable.

Palpation in the region of the root of the nose and the medial angle of the eye, the patient will note moderate pain.

The study of the nasal cavity with the help of an endoscope allows you to reliably determine the state of the mucous membrane of the exit area of ​​the cells of the ethmoid labyrinth and determine the source of purulent masses - the anterior or posterior cells. In chronic ethmoiditis, this research method can determine polyposis growths of various sizes around the outlet openings of the cells of the ethmoid labyrinth.

Crucial in the diagnosis of ethmoiditis belongs to the x-ray examination of the paranasal sinuses - the picture will determine the darkening in the area of ​​the cells of the ethmoid bone. Computed tomography will also be highly informative in this case.

Differential diagnosis of ethmoiditis

The main diseases with which ethmoiditis should be differentiated are periostitis of the nasal bones, osteomyelitis of the upper jaw and dacryocystitis.

Periostitis of the nasal bones is an inflammation of the periosteum, or periosteum, as a result of injury or as a complication of an infectious disease. Signs of this disease are deformity of the external nose, intense pain, which increases sharply during palpation examination.

Osteomyelitis of the maxilla is a disease commonly diagnosed in children. younger age. It is manifested by swelling and infiltration of the soft tissues of the face in the region of the alveolar process of the upper jaw and swelling of the lower eyelid. There is no redness of the eyelid and tissues above the upper jaw.

Dacryocystitis is an inflammation of the lacrimal sac located between the bridge of the nose and the inner corner of the eyelids, resulting from a violation of the patency of the nasolacrimal duct. This disease is diagnosed in both adults and children. Its characteristic signs are palpation painful protrusion of a rounded shape in the region of the inner edge of the lower eyelid, the impossibility of isolating a tear on the side of the lesion, as well as swelling and redness of the soft tissues in the region of the medial corner of the eye.

Treatment of ethmoiditis

To completely get rid of ethmoiditis and avoid the development of complications of the disease, it is necessary to begin complex treatment immediately after the diagnosis is made.

The principles of treatment of acute and exacerbation of chronic ethmoiditis are similar to each other.

First of all, it is necessary to restore the outflow of fluid from the lattice labyrinth and normalize air exchange in its cells. To do this, it is necessary to reduce the swelling of the mucosa, which is achieved by using vasoconstrictor nasal drops (xylometazoline, oxymetazoline), special combined drugs(polymyxin with phenylephrine, Rinofluimucil), cotton-gauze turundas soaked in a solution of adrenaline, installed in the nasal cavity from the affected side. Also, for this purpose, antihistamines should be prescribed - Tsetrin, Aleron, Erius, etc.

If the bacterial nature of the disease is proven, then tableted or, in a hospital, injectable forms of antibiotics are indicated. It is advisable to choose a drug based on the sensitivity of the pathogen to it, but if the latter is not reliably determined, then broad-spectrum antibiotics are used - Augmentin, Zinnat, Cefix, etc.

In addition, the patient is shown washing with solutions of antibacterial substances of the paranasal sinuses. This procedure is best carried out with the help of a special device - the YAMIK sinus catheter. During the procedure, the inflammatory fluid is aspirated from the cells and treated with a medicinal substance. Washing is carried out until the cloudy liquid from the sinus is replaced by a transparent one.

If the disease is accompanied by a severe pain syndrome, non-steroidal anti-inflammatory drugs are used - based on paracetamol (Panadol, Cefecon) and ibuprofen (Brufen, Ibuprom, Nurofen). They also normalize elevated body temperature and reduce inflammation.

In order to improve the immune status of the body as a whole, the appointment of vitamin-mineral complexes (Duovit, Multitabs, Vitrum, etc.) and immunomodulatory drugs (Echinacea compositum, Immunal, Ribomunil, etc.) is indicated.

When the inflammation begins to subside, you can add physiotherapy to the main treatment. The following methods can be used:

• electrophoresis with an antibiotic;
• phonophoresis with hydrocortisone;
• UHF on the sinus area;
• helium-neon laser on the nasal mucosa.

In the absence of the effect of conservative therapy, as well as with the development of various complications of the disease, surgical intervention becomes necessary. More often than not, they use endoscopic methods: with a flexible endoscope, they penetrate into the cavity of the ethmoid bone through the nasal passage and, under the control of vision, do all the necessary manipulations there. After operations performed according to this technique, patients recover quickly and in the postoperative period they have less purulent complications.

Less often, in especially severe cases, open access to the lattice labyrinth is used.

With chronic ethmoiditis to surgical treatment come up much more frequently. This is due to the need to eliminate the causes that led to the chronicity of the process or aggravate the course of the disease. In this case, septoplasty, polypotomy, partial resection of hyperplastic areas of the middle or inferior turbinates, etc. can be performed. These operations are also often performed using endoscopes through endonasal access.

Prevention of ethmoiditis

Since ethmoiditis is a disease caused by a wide variety of microorganisms, there are no measures for its specific prevention. To prevent the development of ethmoiditis, it is necessary to prevent the occurrence of diseases that can provoke it, or, if the disease has already developed, to start adequate treatment in time.

In addition, the immune system should be supported by periodic intake of vitamin-mineral complexes and immunomodulating agents, especially in the autumn-winter period.

Ethmoiditis prognosis

In most cases of acute ethmoiditis, subject to timely diagnosis and rational treatment, the disease passes without a trace - the person recovers completely.

The prognosis for chronic ethmoiditis is less encouraging. Full recovery is almost impossible; only the introduction of the disease into the stage of stable remission is possible, and then under the condition of complex treatment and prevention of diseases that cause an exacerbation of the inflammatory process in the ethmoid labyrinth.

Ethmoiditis is an inflammation of the ethmoid sinus (ethmoid sinus). Often, inflammation of the ethmoid sinus is referred to by the generalized term "sinusitis", which should be understood as inflammation of any of the four pairs of paranasal sinuses.

The paranasal sinuses (in addition to the ethmoid) also include –

The ethmoid sinus is paired (Fig. 1). Each ethmoid sinus consists of many small cavities in the bone (microsinuses), filled with air and lined from the inside with a mucous membrane. The sinus has an oblong shape and is elongated in the anterior-posterior direction.

Etmoiditis: photo, diagram

An important anatomical feature of the ethmoidal sinus is

the microsinuses of the anterior part of the sinus (located closer to the surface of the face) communicate through a small opening with the middle nasal passage; microsinuses of the posterior part of the sinus, located closer to the base of the skull and sphenoid sinus, have communication with the superior nasal passage.

Accordingly, with inflammation of the anterior part of the sinus, inflammatory exudate and pus will drain into the middle nasal passage, and with inflammation of the posterior part of the sinus, into the upper nasal passage. All this will be seen by the ENT doctor when examining the nasal passages. This is important for the diagnosis and determination by the doctor of the treatment strategy for ethmoiditis. In general, ethmoiditis is an extremely dangerous disease, and if not treated in time, it can result in an orbital abscess, brain abscess, sepsis ...

Etmoiditis: causes

As we said above: the sinuses of the ethmoid sinus are lined from the inside with a mucous membrane, and communicate with the nasal passages through small openings. This mucous membrane has a large number of glands that produce mucus, and its surface layer is covered with ciliated ciliated epithelium (the cilia of which move, which contributes to the removal of mucus from the sinuses into the nasal passages).

This active transport mechanism(plus ventilation of the sinuses through the holes) and ensure the health of the sinuses. If the output of mucus from the sinuses is blocked, then it accumulates there, and this just contributes to the development of infection and subsequent suppuration.

Factors that can cause sinus inflammation:

1. Acute respiratory viral infections (SARS and influenza) –
   the virus dramatically increases the production of mucus in the sinuses and nasal passages, and also causes the development of swelling of the mucous membranes of the nose and sinuses. Swelling of the mucous membranes leads to the closure of the holes through which the mucus from the sinuses enters the nasal cavity. In addition, viral toxins block the motor activity of the ciliated epithelium of the mucous membrane, which also disrupts the removal of mucus from the sinuses.

   At the initial stage, inflammation in the sinuses is of a serous nature, i.e. pus in the sinuses is not detected. But gradually in the closed space of the sinuses (in the absence of their ventilation and the presence a large number mucus) develops a bacterial infection, which leads to the formation of pus in the sinuses.

2. Chronic inflammatory diseases of the nose (chronic rhinitis) –
   chronic inflammation of the nasal passages is usually bacterial in nature. Pathogenic bacteria and their toxins also contribute to swelling of the nasal and sinus mucosa, lead to nasal congestion, increase mucus production in the nose and sinuses.

   All this leads to the formation of pus in the sinuses. Also, sluggish chronic inflammation can lead to the formation of polyps in the sinuses and nasal passages.

3. allergic rhinitis –
   also occurs in allergic rhinitis sharp increase mucus production and swelling of the mucous membranes. As a result, at first, serous ethmoiditis may occur in the ethmoid sinuses, in which there are no signs purulent infection. But over time (if the outflow of mucus from the sinuses is not established), a bacterial infection may join, and ethmoiditis may turn into purulent.
4. Factors contributing to the development of ethmoiditis –
   → deviated septum,
   → adenoids, polyps in the nasal passages,
   → active and passive smoking,
   → chronic inflammatory diseases of the nose, tonsils…

Etmoiditis: symptoms

Ethmoiditis can have an acute and chronic course. Acute ethmoiditis occurs, as a rule, against the background of SARS and influenza, or allergic rhinitis. Acute ethmoiditis is characterized by severe symptoms. Chronic ethmoiditis, in turn, has sluggish symptoms; with it, very often in the nasal passages and the sinuses themselves, you can see the formation of polyps ..

The main symptoms that patients may complain about –

• headache (mainly in the area between the eyes),
• pain in the nose bridge and inner corners of the eyes,
• swelling of the eyelids (especially in the morning after waking up),
• prolonged runny nose (more than 7-10 days),
• mucous or mucopurulent discharge from the nose,
• runoff of mucus, pus on the back of the throat (if the posterior microsinuses of the ethmoid sinus are affected).

Photo of a patient with purulent right-sided ethmoiditis (if the serous process turns into a purulent one, then the eyelids can no longer just swell, but their redness and swelling appear):

More general symptoms observed in ethmoiditis –

• swelling of the face,
• headache, fatigue, fever,
• sore throat, cough,
• bad breath,
• decreased sense of taste and smell.

Important: the ethmoid sinuses are separated by very thin bone walls from the orbits, therefore, when the inflammation changes from serous to purulent, more serious symptoms may appear: loss of vision, double vision, redness of the eyes and eyelids, protrusion of the eyes forward. It should also be taken into account that inflammation of the anterior part of the ethmoid sinus usually occurs simultaneously with the defeat of the maxillary and frontal sinuses, and the posterior ones - with inflammation of the sphenoid sinus.

How is ethmoiditis diagnosed?

As a rule, inflammation of the ethmoid sinuses is diagnosed by an ENT doctor based on the patient's complaints and the results of an examination of your nasal passages. The doctor will check the patency of your nasal passages, the presence of swelling of the mucous membrane, polyps or purulent discharge in the nasal passages, the presence of adenoids. However, the absence of purulent exudate from the ethmoid sinuses cannot indicate the mandatory absence of ethmoiditis, because in conditions of severe edema of the mucosa, the sinuses can be completely blocked.

Additional research methods –
1) Computed tomography (CT) will allow you to determine the degree of inflammation of the ethmoid sinus, the presence of polyps, pus in it. Especially, it is important to carry it out if the patient has symptoms that indicate the spread of infection in the eye sockets or other paranasal sinuses.
2) X-ray examination is possible, but unlike CT, it is very little informative in this pathology.
3) Ideally, if your doctor notices a lot of nasal discharge, they will take a sample of the mucus for microbiological testing. This will determine the nature of ethmoiditis (viral, bacterial or allergic). If the cause is an allergy, then many eosinophils will be found in the mucus.

Etmoiditis: treatment

Treatment may be conservative and/or surgical. The choice of treatment tactics will depend on your symptoms, the cause that caused the development of ethmoiditis, and the nature of the inflammatory process (serous, purulent or polypous).

1. Treatment of acute ethmoiditis -

Etmoiditis treatment, as a rule, is conservative, but this is only in situations where suppuration of the ethmoid sinus has not yet occurred. the main objective conservative therapy is the restoration of the patency of the nasal passages, the removal of mucosal edema in order to restore the outflow of mucus and inflammatory exudate from the sinuses into the nasal cavity.

Nasal drops and sprays + ibuprofen-based systemic anti-inflammatory drugs can be used for this. Also, the patient should regularly rinse his nose with saline solutions on his own, try to sleep with his head elevated, because..

Drops to reduce nasal congestion –
it must be borne in mind that traditional vasoconstrictor drops from the common cold can be used for sinusitis for no more than 2-3 days, tk. addiction quickly develops to them and they only begin to exacerbate inflammation. To relieve nasal congestion and mucosal edema with ethmoiditis, it is optimal to use -

Drugs that stimulate the discharge of mucus from the sinuses –
There are several herbal preparations that can enhance the function of the ciliated epithelium of the mucous membrane. This leads to an acceleration of the evacuation of mucus and pus from the sinuses into the lumen of the nasal passages through the openings between them.

Treatment of acute ethmoiditis of an allergic nature –
in acute ethmoiditis of an allergic nature, treatment consists in avoiding contact with allergens, conducting desensitizing therapy with antihistamines, corticosteroids, anti-allergic nasal sprays with low concentrations of glucocorticoids (for example, Nasonex spray), and the use of calcium preparations.

Surgical treatment of acute ethmoiditis –
in case of development anxiety symptoms such as: exophthalmos, limitation of eyeball mobility, loss of visual acuity - an urgent start of intensive care is necessary, including, among other things, intravenous administration antibiotics. In the absence of positive dynamics with such therapy (and even more so with worsening symptoms), urgent surgical intervention is necessary. The operation can be performed endoscopically (from inside the nose), as well as external access through an incision in the corner of the palpebral fissure.

2. Treatment of chronic ethmoiditis -

In chronic ethmoiditis (both catal and purulent) in the sinuses and nasal passages, as a rule, polyps are formed, the presence of which requires their mandatory surgical removal.

Antibiotics for ethmoiditis -

As we wrote above: acute sinusitis most often develops against the background of SARS and influenza, and antibiotics, as you know, do not work on viruses. Drinking antibiotics for acute frontal sinusitis makes sense only in the case of a bacterial infection and the development of purulent inflammation, but this does not happen immediately.

If there are indications for taking antibiotics, then the drug of first choice is Amoxicillin in combination with Clavulanic acid. Preparations that contain such a combination: "Augmentin", "Amoxiclav". If the patient is allergic to antibiotics of the penicillin group, then it is better to use -

• antibiotics of the fluoroquinolone group (for example, "Ciprofloxacin"),
• or macrolides ("Clarithromycin", Azithromycin).

Antibiotics for frontal sinusitis are prescribed for about 10-14 days. However, after 5 days from the start of administration, it is necessary to evaluate the effectiveness of therapy. If significant improvement is not achieved, then it is best to prescribe a more potent antibiotic.

Complications with ethmoiditis -

The most common complications are: intracranial meningitis, thrombophlebitis of the veins of the head, orbital abscess, brain abscess. If complications are suspected, urgent hospitalization is needed, because. loss of time can lead to loss of health and even death of the patient. We hope that our article on the topic: Ethmoiditis symptoms treatment in adults - turned out to be useful to you!

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Definition

Ethmoiditis- inflammation of the cells of the ethmoid labyrinth (cells of the ethmoid bone), a type of sinusitis.

The lattice labyrinth is located between the orbits, from which it is separated by thin walls of a paper plate. Its roof, a perforated plate, is part of the anterior cranial fossa.

By virtue of its location, the lattice plays a prominent role in the pathology of the nose. Due to the close proximity to frontal sinus, as well as to the maxillary cavity, the lattice is often involved in the disease of these sinuses. The anatomical features of its structure explain the peculiarity of the pathological processes developing here, as well as the difficulties of dealing with them. As in other sinuses, the inflammation of the lattice cells is either acute or chronic.

The reasons

Inflammation of the lattice cells (ethmoiditis) is characterized by moments common to inflammation of all sinuses. Depending on the nature of the inflammation, the process is limited to one mucosa or it also affects the bone tissue, as, for example, in tuberculosis, syphilis. In addition to the usual pathogens, ethmoiditis b. fusiformis, Leffler's bacillus and gonococcus.

In acute inflammation, the mucous lattice, which is characterized by a looser stroma, the deep layer of which is the periosteum, easily swells, thickens, narrowing the lumen of cells filled with exudate. The reaction of the mucosa to prolonged irritation differs in some features. It is expressed in the formation of limited or diffuse thickenings, elastic, soft consistency, taking the form of tumors on the leg (nasal polyps).

Symptoms

Ethmoiditis, especially chronic, usually proceeds latently, and is also often a companion of the disease of the other sinus. Therefore, its symptoms are characterized by extreme poverty, the absence of characteristic signs. The patient complains of nasal congestion due to the presence of polyps or crusts in it. This circumstance leads, in turn, to the development of anosmia, especially when the process is localized in back cages. Headache is noted in acute ethmoiditis and exacerbation of chronic. In some acute cases, there is pain with pressure on the inner edge of the orbit in the region of the lacrimal bone, as well as when the probe touches the middle shell.

Acute and exacerbated chronic ethmoiditis can lead to the development of orbital and intracranial complications.

Diagnostics

Recognition inflammatory diseases The gratings are based on the data of rhinoscopy, probing and radiography. Significant difficulties sometimes have to be overcome in cases where the only symptom of the disease is purulent discharge coming from the middle nasal passage. The probing of the lattice cells, due to the inconsistency of its structure, is associated with significant difficulties. Can provide an X-ray screen that facilitates orientation; also orients the radiograph in the anteroposterior plane when the probe is inserted.

The diagnosis often has to be made “on suspicion”, based on the existing extensions of the anterior lattice and polypous changes in the mucosa. The same must be said about the empyema formed from the fusion of individual cells of the lattice into one cavity containing pus. Its thinned front wall is elastic when touched by a probe; sometimes you can catch crepitus, like the one that is characteristic of a mature mucocele; in fact, we are dealing with a pyocele that developed from an empyema. This kind of limited purulent foci can be located in the bulla ethmoidalis, in the region of the semilunar fissure. Their recognition is impossible and they are detected by chance, during surgery, for example, when removing the polypous mucosa, or during the development of complications outside the lattice, the source of which they are.

Prevention

The diversity of the structure of the ethmoid labyrinth, as well as the peculiarities of its tissue reactions, often make treatment difficult. Acute inflammations are often eliminated under the influence of already given conservative methods of treatment. Only in cases of a rapidly flowing process that threatens the development of complications, it becomes necessary to resort to surgical intervention.

The situation is different in chronic ethmoiditis, which usually forces one to resort to one or another surgical technique.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Gums of maxilla (C03.0), Malignant neoplasm of paranasal sinuses (C31), Nasal cavity (C30.0), Hard palate (C05.0)

Oncology

general information

Short description

Recommended
Expert Council
RSE on REM "Republican Center
health development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 30, 2015
Protocol #14

Cancer of the nasal cavity, paranasal sinuses and cells of the ethmoid labyrinth- This is a malignant tumor more often of an epithelial nature 73.2%, affecting the upper respiratory tract to the nasopharynx, as well as the maxillary, frontal, main sinuses and cells of the ethmoid labyrinth, 26.8% connective tissue.

Malignant neoplasms of the nasal cavity and paranasal sinuses (PNS), upper jaw is 1-3% among malignant tumors of the head and neck, 75-95% of patients are admitted to the clinic with III-IV stage of the disease. There are 58 histological types of cancer, but squamous cell carcinoma is the most common, accounting for 54.8-92.8%, according to various authors, cancer from the minor salivary glands is observed in 5.7-20% of cases. Among connective tissue tumors, the most common is esthesioneuroblastoma 61.9%, less often rhabdomyosarcoma 14.3%. Melanoma of the nasal cavity is rare in 10.4%, characterized by a less aggressive course in comparison with localizations in other organs (UD-A).

Neoplasms in the nasal cavity and paranasal sinuses develop against the background of chronic hyperplastic processes, the previous diseases are:
polyposis rhinosinusitis with glandular fibrous polyp;
pleomorphic adenoma of the minor salivary gland in the palate;
polyposis rhinosinusitis with inverted or transitional cell papilloma on the background of metaplasia and
Severe epithelial dysplasia (DTS);
· chronic ulcer, perforation of the nasal septum and leukoplakia;
chronic hyperplastic sinusitis with DTS;
Pigmentary nevus, radicular or follicular cyst;
post-radiation damage to tissues;
fibromatosis;
chronic frontal sinusitis in combination with trauma;
hemangioma;
osteoblastoclastoma;
squamous papilloma.

According to A.U. Minkin (UD-A), background processes precede cancer in 56.7% of cases, granulations and polyps under the influence of constant purulent secretions turn into cancer. contribute to the development of pathological conditions adverse factors external environment, exposure (inhalation) of carcinogenic substances of a physical and chemical nature, especially in a group of people associated with hazardous production, cauterization or removal of polyposis neoplasms.

Protocol name: Malignant tumors of the nasal cavity and paranasal sinuses, cells of the ethmoid bone

Protocol code:

Code(s) ICD-10:
C30.0 - Malignant neoplasms of the nasal cavity;
C 31 - Malignant neoplasms of the paranasal sinuses;
C03.0 - Malignant neoplasms of the gums of the upper jaw;
C05.0 - Malignant neoplasms of the hard palate.

Abbreviations used in the protocol:

Classification

ClassificationTNMcancer of the nasal cavity, paranasal sinusesand cells of the ethmoid labyrinth.

(UD-A).
T - primary tumor:
TX - insufficient data to evaluate the primary tumor;
TO - primary tumor is not determined;
Tis - preinvasive carcinoma (carcinoma in situ).

Maxillary sinus:
T1 the tumor is limited to the mucous membrane without erosion or destruction of the bone;
T2 a tumor that erodes or destroys internal structures, including the hard palate and / or middle nasal passage;
T3 the tumor extends to any of the following structures: subcutaneous tissue of the cheek, posterior wall; maxillary sinus, lower or medial wall of the orbit, ethmoid cells, pterygopalatine fossa;
T4a the tumor extends to any of the following structures: anterior orbit, cheek skin, pterygoid plates, infratemporal fossa. Lattice plate, main or frontal sinuses;
T4b Tumor invades any of the following structures: apex of orbit, dura meninges, brain, middle cranial fossa, cranial nerves, except at the point of division trigeminal nerve in the upper jaw (the second branch of the trigeminal nerve), the nasopharynx.

Nasal cavity and ethmoid cells:
T1 the tumor is located within one part of the nasal cavity or cells of the ethmoid bone with or without destruction of the bone;
T2 tumor spreads to two parts of the same organ or to an adjacent compartment within the nasoethmoid complex with or without bone invasion;
T3 the tumor extends to the medial or inferior wall of the orbit, maxillary sinus, palate, or lamina cribrosa;
T4a the tumor extends to any of the following structures: anterior orbit, skin of the nose or cheek, pterygoid plates of the sphenoid bone, frontal or sphenoid sinus, minimal invasion into the anterior cranial fossa;
T4b the tumor has spread to any of the following: orbital apex, dura mater, brain, middle cranial fossa, cranial nerves other than the maxillary division of the trigeminal nerve (second branch of the trigeminal nerve), nasopharynx, or clivus.

Regional lymph nodes:
Regional lymph nodes for the nose and paranasal sinuses are the submandibular, submental and deep cervical lymph nodes located along the neurovascular bundle of the neck. However, malignant tumors of the nasal cavity and paranasal sinuses metastasize relatively rarely.

N - regional lymph nodes:
NH- insufficient data to assess the state of regional lymph nodes;
N0- there are no signs of metastatic lesions of regional lymph nodes;
N1- metastases in one lymph node on the side of the lesion up to 3 cm or less in the largest dimension;
N2- metastases in one or more lymph nodes on the side of the lesion up to 6 cm in the largest dimension or metastases in the lymph nodes of the neck on both sides, or on the opposite side up to 6 cm in the largest dimension;
N2a- metastases in one lymph node on the side of the lesion 3.1 - 6 cm in the largest dimension;
N2b- metastases in several lymph nodes on the side of the lesion up to 6 cm in the largest dimension;
N2с- metastases in the lymph nodes on both sides or on the opposite side up to 6 cm in the largest dimension;
N3- metastasis in the lymph node more than 6 cm in the greatest dimension.

M - distant metastases:
MX - insufficient data to determine distant metastases;
М0- no signs of distant metastases;
M1- There are distant metastases.

Histopathological differentiation G:
GH- the degree of differentiation cannot be established;
G1- high degree of differentiation;
G2- average degree of differentiation;
G3- low degree of differentiation;
G4- undifferentiated tumors.

R-classification:
The presence or absence of a residual tumor after treatment is indicated by the symbol R. The definitions of the R-classification apply to all tumor sites of the head and neck. These definitions are as follows:
RX- the presence of a residual tumor is not determined;
R0- there is no residual tumor;
R1- microscopic residual tumor;
R2- macroscopic residual tumor.
Grouping by stages:

Diagnostics

The list of basic and additional diagnostic measures:
The main (mandatory) diagnostic examinations carried out at the outpatient level:
a thorough history taking;
oropharyngoscopy;
anterior and posterior rhinoscopy;
a) CT or MRI of the paranasal sinuses, maxilla, cells of the ethmoid labyrinth, eyes, base of the skull
b) puncture of the maxillary sinus with a cytological examination of the punctate or washing fluid;
c) fibroscopic examination;
Tumor biopsy and smears-imprints;
puncture biopsy.

Additional diagnostic examinations performed at the outpatient level:
fibrobronchoscopy;
fibrogastroduodenoscopy;
· angiography / spirography;
CT or MRI of the chest;
CT or MRI abdominal cavity;
· PET;

x-ray of the chest in two projections.

The minimum list of examinations that must be carried out when referring to planned hospitalization : according to the internal regulations of the hospital, taking into account current order authorized body in the field of healthcare.

The main (mandatory) diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations are carried out that were not performed at the outpatient level):
UAC;
· OAM;
biochemical blood test (total protein, ALT, AST, total bilirubin, glucose, urea, creatinine);
· coagulogram;
ECG;
x-ray of the chest;

Additional diagnostic examinations performed at the inpatient level (in case of emergency hospitalization, diagnostic examinations are performed that were not performed at the outpatient level):
· CT and/or MRI from the base of the skull to the collarbone;
CT scan of the chest with contrast (in the presence of metastases in the lungs);
Ultrasound of the abdominal cavity and retroperitoneal space;
Echocardiography (after consultation with a cardiologist according to indications);
UDZG (with vascular lesions).

Diagnostic measures taken at the stage of emergency care: not carried out

Diagnostic criteria for making a diagnosis:
Complaints and anamnesis:
Complaints:
Difficulty in nasal breathing
Bleeding from the nose
Abundant mucous discharge from the nasal cavity;
The appearance of a tumor formation in the lumen of the nasal cavity;
· headache;
fetid odor;
facial deformity;
· exophthalmos;
Bone defect of the hard palate and alveolar process of the upper jaw.
Anamnesis:
I - II stage - complaints of difficulty in nasal breathing, bleeding from the nose, copious mucous discharge from the nasal cavity, the appearance of a tumor formation in the lumen of the nasal cavity, possibly headaches.
On CT or radiography, it is determined - an additional tumor formation in the nasal cavity, or in one of the paranasal sinuses, in the second stage, destruction of the bone tissue is possible;
IIIstage - complaints of difficulty in nasal breathing, bleeding from the nose, profuse mucous discharge from the nasal cavity, fetid odor, facial deformity, a tumor formation in the lumen of the nasal cavity, headaches, possibly exophthalmos.
On CT or radiography, it is determined - an additional tumor formation occupying the nasal cavity, extending to the medial wall or lower wall of the orbit, maxillary sinus, palate or cribriform plate;
IVstage - complaints about the absence of nasal breathing, bleeding from the nose, profuse mucous discharge from the nasal cavity, fetid odor, facial deformity, tumor formation in the projection of the maxillary sinus, a tumor formation in the lumen of the nasal cavity, headaches, possibly exophthalmos.
On CT or radiography, it is determined - an additional tumor formation occupying the nasal cavity extending to any of the following structures: the anterior parts of the orbit, the skin of the nose or cheeks, the pterygoid plates of the sphenoid bone, the frontal or sphenoid sinus, minimal germination in the anterior cranial fossa, the apex of the orbit, solid meninges, brain, middle cranial fossa, cranial nerves.

Physical examination:
External examination of the face, symmetry and configuration of the face (asymmetry of the face due to tumor deformation of soft tissues, organ, germination and infiltration of the tumor, violation of the functional activity of the organ);
Anterior and posterior rhinoscopy with the determination of nasal breathing (the presence and prevalence of a tumor process in the nasal cavity or nasopharynx, impaired nasal breathing due to stenosis of the lumen of the nasal cavity or nasopharynx by a tumor);
Oropharyngoscopy with determination of mouth opening restriction (presence and prevalence of a tumor process in the oral cavity, oropharynx, restriction of mouth opening due to trismus as a result of the spread of the tumor to the surrounding soft tissues);
Palpation examination of the lymph nodes of the submandibular region, neck on both sides (for the presence or absence of regional metastases in the lymph nodes).

Laboratory research:
Cytology: includes a puncture biopsy of a tumor of the nasal cavity, maxillary sinus, lymph node, making smears-prints from the tumor and cytological examination tumors to determine the morphological structure of the tumor;
Histology: includes biopsy tumor tissue from the nasal cavity, maxillary sinus, lymph node in order to determine the morphological structure of the tumor and its degree of malignancy (histological differentiation G).
Laboratory indicators at various stages of the disease may be within the normal range.

Instrumental research:
CT or MRI of the paranasal sinuses, upper jaw, cells of the ethmoid labyrinth, eyes, base of the skull (to determine the localization of the tumor process and its spread to adjacent organs and tissues or other concomitant diseases, regression of the tumor process). Detection of darkening of the cavity, destruction of the bone, etc. is the basis for a more in-depth study;
puncture of the maxillary sinus with a cytological examination of the punctate or washing fluid (to determine the morphological structure of the tumor);
Fibroscopic examination (presence of a tumor process, biopsy of tumor tissue);
Ultrasound of the neck and abdominal organs (to exclude the presence of regional, distant metastases and concomitant diseases);
X-ray of the chest (to exclude distant metastases in the mediastinum or other concomitant diseases);
Puncture biopsy of a tumor of the nasal cavity, maxillary sinus, lymph node with a cytological examination of a punctate or washing fluid, making smears-imprints from the tumor and cytological examination of the tumor to determine the morphological structure of the tumor;
biopsy of tumor tissue from the nasal cavity, maxillary sinus, lymph node in order to determine the morphological structure of the tumor and its degree of malignancy (histological differentiation G);
Intraoperative diagnostics includes: a biopsy of the tumor tissue, making smears-imprints from the tumor and an urgent histological examination of the removed tissue.
· fibrobronchoscopy (to exclude and the presence of a tumor in the mediastinum and biopsy of the tumor);
fibrogastroduodenoscopy (to exclude and presence of a tumor in the gastrointestinal tract, tumor biopsy, the presence of concomitant diseases);
· angiography / spirography (to exclude the germination of the tumor in the main vessels);
CT or MRI, chest, abdominal, PET ((to exclude distant metastases in the mediastinum, in the abdominal cavity, or other concomitant diseases, regression of the tumor process, distant metastases.

Indications for consultation of narrow specialists:
consultation with a cardiologist (patients aged 50 years and older, as well as patients younger than 50 years old in the presence of a cardiac history or pathological changes in the ECG);
consultation of a neurologist (for previous strokes, craniocerebral brain injury, meningitis;)
consultation of a gastroenterologist (in the presence of an erosive or peptic ulcer of the gastrointestinal tract in history);
consultation of an abdominal oncologist (in the presence of metastases and tumors in the abdominal organs);
consultation of a neurosurgeon (in the presence of metastases to the brain, spine);
consultation of a thoracic surgeon (in the presence of metastases in the lungs and other concomitant diseases);
consultation with an ophthalmologist (with a local widespread tumor process in the eye, visual impairment);
consultation of a psychologist (with carcinophobia and the presence of psychological illness);
consultation of an infectious disease specialist (in the presence and previously transferred infectious disease);
Consultation with a phthisiatrician (in the presence and previously transferred tuberculosis);
Consultation with an endocrinologist (in the presence and detection of an endocrine disease).

Differential Diagnosis

Table #1 . Differential Diagnosis:

Treatment

Treatment goals:
elimination of the tumor focus and metastases;
Achievement of complete or partial regression, stabilization of the tumor process.

Treatment tactics:
General principles of treatment:
Multidisciplinary approach.
The initial assessment and development of a treatment plan for a patient requires a multidisciplinary team (MDT) of physicians with experience in the treatment of this patient population. Also, the introduction and prevention of the consequences of radical surgery, RT and CT should be carried out by specialists who know these diseases - this is a surgeon-oncologist of head and neck tumors, a radiologist and a chemotherapist.
Accompanying illnesses.
These include the presence of an intercurrent disease (in addition to malignancy) that may affect the diagnosis, treatment, and prognosis of the patient. Documentation of comorbidities is especially important in oncology to prevent misdiagnosis of poor outcomes in cancer treatment. It is known that comorbidities are a strong independent predictor of mortality in this group of patients and they also affect the cost of treatment and quality of life.
The quality of life.
Malignant tumors disrupt basic physiological functions (ie chew, swallow, breathe) and unique human characteristics (eg appearance and voice). Health status describes individual, physical, emotional and social capabilities and limitations. Functions and general status refers to how well an individual is able to perform important roles, tasks, or activities. The concept of “quality of life” is different because the main emphasis is on the value (as determined by the patient) that the individual assigns to his state of health and functions.

Principles of surgical treatment.
Grade:
All patients should be evaluated by a head and neck cancer surgeon prior to treatment to ensure that:
· consider the adequacy of biopsy material, staging and imaging to determine the extent of the tumor, exclude the presence of a synchronous primary tumor, assess the current functional status and the possibility for potential surgical treatment if the primary treatment was non-surgical;
· participate in multidisciplinary team discussions on patient treatment options to maximize survival and maintain form and function;
· develop a long-term follow-up plan that will include adequate examination of the teeth, nutrition and healthy lifestyle, as well as interventions and any other additional studies that are necessary for complete rehabilitation;
For patients undergoing elective surgery, it is necessary to work out the surgical intervention, margins and reconstruction plan for resection of a clinically detectable tumor with tumor-free surgical margins. Surgery should not be modified based on pre-treatment clinical response, unless tumor progression necessitates more extensive surgery to cover the tumor at the time of definitive resection.

Treatment of cancer of the nasal cavity, paranasal sinuses, cells of the ethmoid labyrinth, depending on the stage:
Stages I-II(T1-2 N0). Combined treatment: Surgical intervention with various accesses with postoperative remote radiation therapy in SOD 70 Gy per focus. In poorly differentiated tumors - irradiation of the area of ​​regional metastases on the side of the tumor in SOD 64 Gy, neoadjuvant courses of polychemotherapy followed by surgical treatment, anti-relapse courses of polychemotherapy in the postoperative period (UD - A);

Stage III (T1-2 N1 M0). Combined treatment: preoperative chemotherapy, external beam radiation therapy in SOD 50-70 Gy to the primary focus + external access surgery. Zones of regional metastasis on the side of the tumor are irradiated in SOD 40-64 Gy. In case of insufficient effectiveness of radiation treatment - radical cervical dissection. In the postoperative period, anti-relapse adjuvant courses of polychemotherapy (UD - A);

III-IVA stages (T3-4a N0-3 M0). Option 1: Complex treatment - surgical intervention with various approaches with postoperative remote radiation therapy in SOD 70 Gy to the main focus and adjuvant courses of chemotherapy (UD - A);
Option II: If there are contraindications to surgery and the patient refuses surgery, neoadjuvant courses of polychemotherapy, external beam radiation therapy in SOD 40-70 Gy per focus and 64 Gy per zone of regional lymph nodes on the side of the lesion (N0) (LE - A), (LE - AT);
Option III: Neoadjuvant intra-arterial polychemotherapy and radiation therapy on the main focus SOD 50-70Gy. (UD - B);
Option IV: Preoperative radiation therapy against the background of radiomodifying properties + operation with various accesses, postoperative courses of polychemotherapy (UD - A), (UD - B);

IVBstage Palliative radiotherapy or chemotherapy in the setting of OOD (LE-A), (LE-B)
At various stages of the disease, external beam, 3D-conformal irradiation, intensity-modulated radiation therapy (IMRT) can be used during radiotherapy. When conducting conservative specialized chemoradiotherapy, progression of the tumor process is noted, then surgical treatment is performed.

The effect of the treatment is assessed according to WHO criteria:
· full effect- disappearance of all lesions for a period of at least 4 weeks;
· partial effect- greater than or equal to 50% reduction of all or individual tumors in the absence of progression of other foci;
· stabilization- (unchanged) less than 50% decrease or less than 25% increase in the absence of new lesions;
· progression- an increase in the size of one or more tumors by more than 25% or the appearance of new lesions.

Treatment of relapses of the disease.
Local relapses are treated surgically and in combination. For unresectable relapses and distant metastases, palliative chemotherapy or radiation therapy is performed. Regional lymphatic metastases are treated surgically(radical cervical lymph node dissection) (LE - A).
In the presence of a residual tumor, a radical surgical intervention is performed, followed by postoperative radiation therapy in SOD 70 Gy (ROD 2 Gy) to the area of ​​the primary tumor focus (preferred option). It is also possible to conduct radiation or simultaneous chemotherapy. If a residual tumor is not detected during clinical and instrumental examination, radiation therapy is performed on the bed of the removed tumor according to a radical program. Reoperation followed by postoperative radiotherapy (LE-A) is a treatment option.

conformal radiation therapy.
Conformal irradiation (3D-conformal irradiation) is understood as such irradiation when the shape of the irradiated volume is as close as possible to the shape of the tumor. That is, on the one hand, all parts of the tumor, which may have an irregular shape, fall into the irradiated volume, and on the other hand, the irradiation of the tissues surrounding the tumor is minimized ("selectivity"). Due to this, less radiation complications develop from the healthy tissues surrounding the tumor (radiation "burn" of the skin, local swelling of the brain, with irradiation of the spinal cord - a decrease in radiation exposure to the spine).

Intensity Modulated Radiation Therapy (IMRT).
This is a modern innovative method of radiation therapy, the essence of which is that the radiation, depending on the data obtained during computed tomography, is modulated in its intensity. The advantage of this method of irradiation is that it allows you to accurately determine the dose of radiation that is directed to a particular area of ​​the tumor. Before this type of radiation therapy, computed tomography is performed to accurately determine the contours and shape of the tumor and its relationship to surrounding tissues. The data obtained using CT allows you to adjust the radiation beam and direct a large dose to the tumor tissue.

Radiation and chemotherapy treatment depends on factors related to the characteristics of the tumor and the general condition of the patient. The main goals of therapy are the cure of the tumor, the preservation or restoration of organ functions, and the reduction of treatment complications. A successful treatment outcome usually requires a multidisciplinary approach. Chemotherapy and radiation treatment should be well organized and supervised by chemotherapists and radiologists who have knowledge of the treatment and complications in this patient population.
The patient's ability to tolerate an optimal treatment program is an important factor making a decision to carry it out.
The choice of treatment strategy is mainly carried out between surgical treatment, radiation therapy and combined methods.
The surgical method is acceptable only in the treatment of stage I tumors, which can be radically removed with a good functional outcome. In other cases, stage I-II cancer is treated with the radiation method and in combination. Patients with advanced cancer always require combined or complex treatment. An integral part of the treatment of these patients are extended resections with the performance of reconstructive and restorative operations. The use of neoadjuvant chemotherapy in a number of localizations or simultaneous chemotherapy and radiation treatment makes it possible to increase the number of organ-preserving interventions and transfer some of the initially unresectable tumors to a resectable state.

Non-drug treatment:
The patient's regimen during conservative treatment- general. In the early postoperative period- bed or semi-bed (depending on the volume of the operation and concomitant pathology). In the postoperative period - ward.
Diet table - No. 15, after surgical treatment - No. 1.

Medical treatment:
Chemotherapy is the medical treatment of malignant cancerous tumors aimed at destroying or slowing down the growth cancer cells with the help of special preparations, cytostatics. Treatment of cancer with chemotherapy occurs systematically according to a certain scheme, which is selected individually. As a rule, tumor chemotherapy regimens consist of several courses of taking certain combinations of drugs with pauses between doses to restore damaged body tissues.
There are several types of chemotherapy, which differ in purpose of appointment:
neoadjuvant chemotherapy of tumors is prescribed before surgery, in order to reduce the inoperable tumor for surgery, as well as to identify the sensitivity of cancer cells to drugs for further prescription after surgery;
· adjuvant chemotherapy is prescribed after surgical treatment to prevent metastasis and reduce the risk of recurrence;
· therapeutic chemotherapy is prescribed to reduce metastatic cancerous tumors.
Depending on the location and type of tumor, chemotherapy is prescribed according to different schemes and has its own characteristics.

Indications for chemotherapy:
Cytologically or histologically verified MN of the nasal cavity, PPN and cells of the ethmoid labyrinth;

metastases in regional lymph nodes;
tumor recurrence;
Satisfactory blood picture in the patient: normal performance hemoglobin and hematocrit, absolute
the number of granulocytes - more than 200, platelets - more than 100,000;
Preserved function of the liver, kidneys, respiratory system and SSS;
the possibility of transferring an inoperable tumor process into an operable one;

Improving long-term results of treatment with unfavorable histological types of tumor (poorly differentiated, undifferentiated).

Contraindications to chemotherapy:
Contraindications to chemotherapy can be divided into two groups:
absolute;
relative.

Absolute contraindications:
hyperthermia >38 degrees;
disease in the stage of decompensation (cardiovascular system, respiratory system, liver, kidneys);
the presence of acute infectious diseases;
mental illness;
The ineffectiveness of this type of treatment, confirmed by one or more specialists;

Severe condition of the patient on the Karnovsky scale of 50% or less.

· pregnancy;
intoxication of the body;


cachexia.

Below are diagrams of the most commonly used polychemotherapy regimens for cancer of the nasal cavity, PPN, and ethmoid cells. They can be used in both neoadjuvant (induction) chemotherapy and adjuvant polychemotherapy, followed by surgery or radiation therapy, as well as in recurrent or metastatic tumors.
The main combinations used in induction polychemotherapy today are cisplatin with fluorouracil (PF) and docetaxel with cisplatin and fluorouracil (DPF). This combination of chemotherapy drugs has become the "gold standard" when comparing the effectiveness of the use of different chemotherapy drugs in the treatment of squamous cell carcinoma heads and necks for all large multicenter studies. The latter regimen seems to be the most effective, but also the most toxic, but at the same time providing higher rates of survival and locoregional control compared to the traditional PF regimen as induction polychemotherapy (UD-A).
Of the targeted drugs, cetuximab (UD-A) has now entered clinical practice.
According to recent data, the only combination of chemotherapy drugs that not only increases the number of complete and partial regressions, but also the life expectancy of patients with relapses and distant metastases of squamous cell carcinoma of the head and neck, is a regimen using cetuximab, cisplatin and fluorouracil (UD-A).

Table No. 2. The activity of drugs in mono mode in recurrent / metastatic squamous cell carcinoma (modified according to V.A. (Murphy) (UD-A):

Drugs (active substances) used in the treatment

Hospitalization

Indications for hospitalization:
Indications for planned hospitalization: morphologically verified cancer of the nasal cavity and paranasal sinuses, subject to specialized treatment with II clinical group.

Indications for emergency hospitalization: morphologically verified cancer of the nasal cavity or paranasal sinuses with bleeding or pain in clinical group II.

Prevention

Preventive actions:
Early start of treatment, its continuity, complex nature, taking into account the individuality of the patient, the return of the patient to active work.
The use of drugs that allow you to restore the immune system after antitumor treatment (antioxidants, multivitamin complexes), a complete diet rich in vitamins, proteins, giving up bad habits (smoking, drinking alcohol), preventing viral infections and concomitant diseases, regular preventive examinations by an oncologist, regular diagnostic procedures(radiography of the lungs, ultrasound of the liver, kidneys, lymph nodes of the neck) .

Information

Sources and literature

1. Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
   1. List of used literature: 1. A.I. Paches. Tumors of the head and neck. Clinical guide. Fifth edition. Moscow 2013 from 322-339; 2. D.Kh. Savkhatov. Issues of timely diagnosis of malignant neoplasms of the upper respiratory tract. Almaty 1999 p.8; 3.A.U.Minkin. Ecological aspects and ways to solve the problem of early detection and organ-preserving treatment of malignant tumors of the upper jaw and paranasal sinuses. Materials of the scientific-practical conference "Diagnosis and treatment of malignant tumors of the nasal cavity and paranasal sinuses" 06/07/2011. Siberian journal of oncology 2001; 6(48); 4.NCCN Clinical Practice Guidelines in Oncology: head and neck. Available at Accessed March 2011; 5. Bonner JA, Harari PM, Giralt J, et al. Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head and neck: A phase III study of high dose radiation therapy with or without cetuximab (abstract). ASCO Annual Meeting Proceedings (post-meeting edition). J Clin Oncol 2004;22:5507; 6. Greene FL, Page DL, Fleming ID, et al (eds). AJCC Cancer Staging Manual, Sixth Edition Springer-Verlag: New York 2002; 7 Colasanto JM, Prasad P, Nash MA, et al. Nutritional support of patients undergoing radiation therapy for head and neck cancer. Oncology 2005;19:371-382; 8. Medical clinical guidelines of the European Society of Medical Oncologists (ESMO. Moscow, 2006); 9. Piccirillo JF, Lacy PD, Basu A, et al. Development of a new head and neck cancer-specific comorbidity index. Arch Otolaryngol Head Neck Surg 2002;128:1172-1179; 10.American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 11. Murphy B. A Carcinoma of the head and neck. In: Handbook of cancer chemotherapy. Skeel R. T., Khleif S. N. (eds). 8th Edition. Lippincott Williams & Wilkins. 2011: 69-63; 12. Guidelines for chemotherapy of tumor diseases. Edited by N.I. Perevodchikova, V.A. Gorbunova. 4th edition, expanded and enlarged. Practical medicine. Moscow 2015; 13. Foratiere A.A., Goepfert H., Maor M. et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med.2003; 349:2091-2098; 14 Blanchard P., Bourhis J., Lacas B. et al. Taxan-Fluorouracil as induction chemotherapy in locally advanced head and neck cancers: an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol. 2013; 31(23): 2854-2860; 15. Vermorken J.B., Mesia., Rivera F. et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008; 359(11): 1116-1127; 16. Foratiere A.A., Goepferi H., Maor M. et al. Concurrent chemotherapy and radiotherapy for organ preservationin advanced laryngeal cancer. N Engl J Med. 2003; 349:2091-2098; 17. Bonner J.A., Harari P.M., Giralt J. et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N. Engl. J. Med. 2006; 354(6): 567-578; 18.American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 19. Adilbaev G.B., Kim G.G., Kaybarov M.E., Mukhambetov M.M., Sadykov S.S. The role of neoadjuvant polychemotherapy and radiotherapy with radiomodification in the complex treatment of cancer of the maxillary sinus // V congress of oncologists and radiologists of the CIS, May 14-16, Tashkent 2008. P. 149; 20. Konstantinova M.M. Chemotherapy for squamous cell carcinoma of the head and neck. St. Petersburg Medical Academy of Postgraduate Education. Practical Oncology T.4, No. 1-2003, p. 25; 21. Adilbaev G.B., Kim G.G., Mukhambetova G.A. Ways to improve the results of complex treatment of locally advanced cancer of the maxillary sinus. N. N. Blokhin RAMS, 2009 v. 20, No. 2 (app. 1), p. 54, Proceedings of the Eurasian Congress on Head and Neck Tumors, 2009, Minsk, Belarus; 22. Vdovina S.N., Andreev V.G., Pankratov V.A., Rozhnov V.A. .Combined treatment of malignant tumors of the nasal cavity and paranasal sinuses using preoperative radiation therapy against the background of radiomodifying properties.//Siberian Journal of Oncology No. 1, 2006, p. 25; 23. Molotkova N. G. Radiation and combined treatment of malignant tumors of the upper jaw and nasal cavity. Abstract. Dissertation for the degree of kmn; Obninsk. 1996 24. Sdvizhkov A.M., Finkelshtern M.R., Pankin I.V., Borisov V.A., Gurov S.N. Intra-arterial regional chemotherapy in the complex treatment of patients with malignant tumors of the nasal cavity, paranasal sinuses and oral cavity. Siberian journal of oncology №1 2006 pp 113; 25. Kropotov M.A. General principles of treatment of patients with primary head and neck cancer. RONTS im. N.N. Blokhin RAMS Moscow. Practical Oncology T4, No. 1-2003; 26.Posner M.R., Hershor D.M., Blajman C.R. et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007; 357(17): 1705-1715. 27. Kholtoev U.T. Features of the clinic and treatment of patients with malignant tumors of the upper jaw with invasion into the orbit. Abstract. Dissertation for the degree of kmn. Moscow. 2002

Information

List of protocol developers with qualification data:

1.

Adilbaev Galym Bazenovich - Doctor of Medical Sciences, Professor, "RSE on REM Kazakh Research Institute of Oncology and Radiology", head of the center;
2. Akhmetov Daniyar Nurtasovich - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", oncologist;
3. Tumanova Asel Kadyrbekovna - candidate medical sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the department of day hospital chemotherapy -1.
4. Savkhatova Akmaral Dospolovna - RSE on REM "Kazakh Scientific Research Institute of Oncology and Radiology", head of the day hospital department.
5. Makhyshova Aida Turarbekovna - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", researcher.
6. Tabarov Adlet Berikbolovich - clinical pharmacologist, RSE on REM "Hospital of the Medical Center Administration of the President of the Republic of Kazakhstan", head of the innovation management department.

Indication of no conflict of interest: No

Reviewers: Yesentayeva Suriya Ertugyrovna - Doctor of Medical Sciences, Head of the Course of Oncology, Mammology, National Educational Institution "Kazakhstan - Russian Medical University"

Indication of the conditions for revising the protocol: Revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Attachment 1
Assessment of the general condition of the patient using the Karnofsky index

Mobile application "Doctor.kz"

Attached files

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