ETMOIDYT (ethmoiditis; Greek eth-mos a sieve, a sieve + eidos a look + - itis) — an inflammation of a mucous membrane of cells of a sievebone.
Distinguish acute and chronic etmoidit.
Acute etmoidit can arise at patients with acute rhinitis (see), flu (see) and others inf. diseases. Often acute and chronic inflammation of other adnexal bosoms of a nose (see) leads to secondary defeat of a trellised labyrinth as it holds central position in relation to these bosoms. At an inflammation of frontal and Highmore's bosoms front cells of a sievebone are involved in process, at an inflammation of a wedge-shaped bosom — back cells. Quite often E. develops at injury of bones of a facial skull. Inflammatory process quickly extends to deep layers of a mucous membrane. There is its hypostasis and diffusion swelling, gleams of cells of a sievebone and their output channels are narrowed that leads to disturbance of drainage. It promotes distribution of process on a bone, to formation of abscesses and fistulas.
Main wedge, sign acute
E. — a headache, pain in the field of a root of a nose and a nose bridge. Preferential localization of pain at a root of a nose and an inner edge of an eye-socket is characteristic of defeat of back cells of a sievebone. Often sick are disturbed by difficulty of nasal breath, disturbance of sense of smell (hypoosmium) or its absence (anosmia). The general condition of patients worsens, body temperature increases to 37,5 — 38 °. In the first days of a disease plentiful serous allocations from a nose, usually inodorous, in the subsequent — serous and purulent or purulent are noted.
At children hypostasis and a hyperemia in the field of an internal corner of an eye-socket and internal department of a top and bottom century are quite often observed. At a rinoskopiya find sharp increase and hypostasis of an average nasal sink, a mucopurulent or purulent discharge on average (at an inflammation of front cells of a sievebone) or in upper (at an inflammation of back cells) the nasal course.
One of complications acute E. destruction of a part of bone walls of a trellised labyrinth with formation of an empyema is, edges quickly increases at disturbance of the outflow separated; at the same time there can be a break of pus in cellulose of an eye-socket or a head cavity. The condition of the patient sharply worsens, raises body temperature, signs of orbital or intracranial complications appear. An inflammation of front cells of a trellised labyrinth, extending to an eye-socket, causes formation in it of phlegmon or retrobulbar abscess; sharply pain in an eye amplifies, the headache, develops an exophthalmos (see), the century swelled, the eyeglobe is displaced knaruzh. In case of distribution of process of back cells of a sievebone on an eye-socket there are generally vision disorders — narrowing of a field of vision, decrease in visual acuity, increase in scotoma (see), etc. Intracranial complications at acute E. are extremely rare. Carry diffuse purulent meningitis to them (see), abscess of a brain (see the Brain, diseases), an arachnoiditis (see).
Diagnosis acute E. the hl is based. obr. on a wedge, signs and data rentgenol. researches. On roentgenograms and tomograms of a skull and adnexal nasal cavities find blackout of cells of a sievebone, it is frequent in combination with blackout of the next adnexal bosoms at their inflammation (see fig. 4 to St. Paranasal sinuses, t. 21, Art. 58).
Treatment acute E. preferential conservative. Apply the same methods and means, as well as at treatment of an acute frontal sinusitis. In the first days of a disease provide outflow of separated, appoint anesthetics, antibiotics, and several days later, at improvement of a state — physiotherapeutic procedures (see the Frontal sinusitis). Operational treatment acute E. (opening of cells of a trellised labyrinth) apply only in cases of critical condition of the patient and in the absence of effect of conservative therapy, usually at an acute empyema at children, and also at emergence of signs of orbital and intracranial complications.
Operation of opening of cells of a trellised labyrinth can be executed intranasal and extra nasal by methods. Intranasal opening of cells of a trellised labyrinth carry out under local application anesthesia 5% solution of cocaine with addition of 3% of solution of ephedrine. For penetration into a zone of a sievebone expand the average nasal course by removal of the front end of an average nasal sink and shift it in the medial direction. By means of special curettes and a conchotome open and delete bone walls of cells of a trellised labyrinth. The operations which are carried out by an extra nasal method are shown in the presence of fistula or impossibility of intranasal opening of cells because of narrowness of the nasal courses, napr, at children. At the same time use the same accesses, as during the opening of a frontal sinus (see the Frontal sinusitis): through the lower orbital wall open the front cells of a sievebone adjacent to a bottom of a frontal sinus, and if necessary — and back. At chronic
E., often combined with an inflammation of a frontal sinus, apply the frontal and trellised trepanation offered by A. F. Ivanov. In need of simultaneous opening of several bosoms carry out Moore's operation (see Moore operation).
In the postoperative period wash out the opened cavity warm sterile isotonic solution of sodium of chloride through a cannula with rubber drenazhy.
The forecast in case of an uncomplicated current E. at timely and correct treatment favorable.
Chronic etmoi-d and t. At patients with reduced body resistance, at insufficiently effective treatment and accompanying hron. inflammation of other adnexal bosoms of a nose acute E. can pass into chronic.
At chronic E. clinical manifestations depend on a degree of activity of inflammatory process. During remission at patients periodically arise pain in the field of a root of a nose, a headache of uncertain localization, allocation from a nose more often purulent, scanty, with off-flavor. During the involvement in process of back cells of a trellised labyrinth the discharge accumulates in a nasopharynx, especially in the mornings, is hardly expectorated. Sense of smell is, as a rule, broken. At a rinoskopiya find on-lipoznye growths, sometimes granulations on average and upper departments of a nasal cavity, a mucopurulent or purulent discharge under an average nasal sink. As a rule, at chronic E. deterioration in the general condition of the patient, increased fatigue, irritability, weakness, decrease in working capacity is noted. In the period of an aggravation chronic E. it is characterized by the same manifestations, as well as acute.
At chronic E. sometimes the empyema of a sievebone, edge unlike the empyema complicating a current acute E develops., the long time latentno against the background of the general satisfactory condition of the patient can proceed. At the same time sharp disturbance of nasal breath and deformation in a nose or an eye-socket can be observed. Perhaps also development of intra eyes-nichnykh and intracranial complications.
Treatment chronic E. preferential operational. Make a polipotomiya, a partial conchotomy, opening of cells of a trellised labyrinth, in the period of an aggravation hron. etmoidita treatment conservative.
The forecast at an uncomplicated current chronic E., as a rule, favorable.
Bibliography: Ivanov A. F. Vnutrino-
sovy surgery of adnexal nasal cavities, Kiev, 1914; Likhachev A. G. and Goldman I. I. Chronic allergic rinosinuita, M., 1967; The Multivolume guide to otorhinolaryngology, under the editorship of A. G. Likhachev, t. 4, page 7, M., 1963; Tarasov D. I. and
Piskunov G. 3. Puncture of cells of a trellised labyrinth, Vestn. otorino-lar., No. 5, page 56, 1978. A. G. Likhachev.