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Ethmoid Sinusitis

Ethmoid Sinusitides

Ethmoid sinusitis is a term describing infection of the ethmoid sinus and is one of the variants of sinusitis. Having in mind its anatomical location, eye-related symptoms such as retroorbital pain and swelling are used as a distinguishing feature. The diagnosis is made primarily on clinical grounds supported by imaging studies, mainly in the form of computed tomography.


Presentation

After the maxillary sinus, the ethmoid sinus is most commonly affected by infectious pathogens (including bacteria but also viruses and fungi), but it is not uncommon for more than one sinus to be involved [1] [2]. The ethmoid sinus lines the medial wall of the orbit and drains into the middle nasal meatus, which is why typical features of sinusitis - nasal obstruction, rhinorrhea (either serous or purulent), malaise and fever in more severe cases - are often present in patients suffering from ethmoid sinusitis [1] [3]. In many individuals, a preexisting infection of the upper respiratory tract is frequently reported, with symptoms of cough, a sore throat, rhinorrhea and a posterior pharyngeal drip [4]. Having in mind the anatomical proximity of the ethmoid sinus to the eye apparatus, the distinguishing feature of this condition is the concomitant presence of pain between the orbits (or behind the eyes), as well as swelling and tenderness in that area [1] [4]. Headaches are also a common manifestation of sinusitis. Symptoms may last from days to weeks, or even months, depending on the type of sinusitis and is an important clinical finding that can determine the course of treatment. Based on the duration of symptoms, acute (< 30 days), subacute (30-90 days) chronic (> 90 days) or recurrent (multiple episodes during the year) forms of sinusitis are described [1] [4]. Although more severe complications of sinusitis are rare, most notable in terms of ethmoid sinusitis are preseptal or orbital cellulitis, osteomyelitis, subperiosteal orbital abscess and dissemination of microorganisms into the central nervous system (CNS), as well as pseudodacryocystitis and nasolacrimal duct obstruction [4] [5].

Anosmia
  • When she continued to complain of progressive headaches, right-sided epiphora, and anosmia, limited computed tomography (CT) of the paranasal sinuses was obtained (figure 1).[go.galegroup.com]
  • Box 2: Symptoms Associated with the Diagnosis of Chronic Sinusitis Facial pain or pressure Facial congestion or fullness Nasal obstruction or blockage Nasal discharge, purulence, or postnasal drip Hyposmia or anosmia Headache Fever Halitosis Fatigue Dental[clevelandclinicmeded.com]
Hyposmia
  • […] sinusitis cause similar symptoms, including Yellow or green pus discharged from the nose Pressure and pain in the face Congestion and blockage in the nose Tenderness (pain when touched) and swelling over the affected sinus Reduced ability to smell (hyposmia[merckmanuals.com]
  • Box 2: Symptoms Associated with the Diagnosis of Chronic Sinusitis Facial pain or pressure Facial congestion or fullness Nasal obstruction or blockage Nasal discharge, purulence, or postnasal drip Hyposmia or anosmia Headache Fever Halitosis Fatigue Dental[clevelandclinicmeded.com]
Diplopia
  • Diplopia can occur if an extraocular muscle, usually the medial rectus, is injured. Atrophic rhinitis has also been reported. [19] More worrisome are the rare, but unfortunate, reports of blindness due to resection of the optic nerve.[emedicine.medscape.com]
  • Sphenoid and posterior ethmoid mucoceles are less frequent and may present with orbital involvement resulting in decreased vision, exophthalmos, diplopia or with the superior orbital fissure syndrome consisting of ocular palsies and decreased forehead[skullbaseinstitute.com]
  • Orbital floor repair may be helpful in cases with diplopia, severe cosmetic deformity or those with little improvement following endoscopic surgery. 3 Most certainly an acquired condition, SSS should be distinguished from maxillary sinus hypoplasia, which[appliedradiology.com]
Unilateral Proptosis
  • This article presents a case of bilateral ethmoid sinusitis with unilateral proptosis as a presenting sign of an unsuspected prostate carcinoma. A 59-year-old Hispanic male presented to his primary care physician with nasal congestion and rhinitis.[ncbi.nlm.nih.gov]
  • proptosis as an initial manifestation of metastatic prostate carcinoma. ( 7861473 ) Fortson J.K....Moseley D.L. 1994 15 Radiological case of the month.[malacards.org]
Unilateral Proptosis
  • This article presents a case of bilateral ethmoid sinusitis with unilateral proptosis as a presenting sign of an unsuspected prostate carcinoma. A 59-year-old Hispanic male presented to his primary care physician with nasal congestion and rhinitis.[ncbi.nlm.nih.gov]
  • proptosis as an initial manifestation of metastatic prostate carcinoma. ( 7861473 ) Fortson J.K....Moseley D.L. 1994 15 Radiological case of the month.[malacards.org]
Frontal Headache
  • Maxillary sinusitis may cause pain in the maxillary area of the face, toothache, and frontal headache. Frontal sinusitis causes frontal pain and headache. Ethmoid sinusitis causes pain behind the eyes and frontal headache.[webhealthcentre.com]
  • Frontal headaches and purulent nasal drainage have been present intermittently for years. He received multiple courses of oral antibiotics, nasal steroids, and decongestants, with only temporary relief.[aafp.org]
  • Osteoma in frontal sinus Osteoma This is a patient who had been having brain MRI for the past 1,5 yrs for frontal headaches. On the MRI (not shown) it looked as if the patient had a little mucosal disease of the frontal sinus.[radiologyassistant.nl]
  • Look for: Suspicion of intracranial spread - severe frontal headache, frontal swelling, symptoms or signs of meningitis or focal neurological signs. Suspicion of spread to the orbit - see separate article Orbital and Preseptal Cellulitis .[patient.info]

Workup

A meticulous patient history and a thorough physical examination are mandatory steps in achieving a diagnosis of ethmoid sinusitis, principally because clinical criteria are most important when it comes to infection of the paranasal sinuses [1] [2] [4] [6]. Identifying the onset and type of symptoms is detrimental in assessing which sinus is affected, although signs of rhinorrhea, cough, pain and headaches are sufficient to make a presumptive diagnosis of a paranasal infection. Physical findings include dullness (or absence) of light on transillumination exam, whereas detection of serous or mucopurulent discharge is also a notable observation [1] [2]. Clinical suspicion should be supported by imaging studies, which are necessary to confirm ethmoid sinusitis, with plain radiography often employed as the initial method. The occipitomental view is favored for visualization of the ethmoid cells, and an air-fluid level is considered as a diagnostic hallmark [3] [4]. Computed tomography (CT), however, is superior compared to plain X-rays, and is recommended whenever possible [3] [4] [6]. A detailed microbiological investigation is also a mandatory step in the workup. Cultivation of secretions obtained through nasal swabs is detrimental in confirming bacterial etiology, causative agents predominantly being haemophilus influenza, streptococcus pneumoniae, and gram-negative bacilli [7]. On the other hand, rhinovirus, influenza virus, and parainfluenza virus are notable viral agents [4].

Chlamydia Trachomatis
  • No anaerobes, viruses, or Chlamydia trachomatis organisms were identified. Results of this study showed organism isolation frequencies different from those found in other studies of chronic sinusitis reported in the literature.[ncbi.nlm.nih.gov]

Treatment

  • Treatment The treatment for ethmoid sinusitis might require various measures that ranges from home treatment to surgery in severe cases.[firstaidsaskatoon.ca]
  • Since there are numerous causes of ethmoid sinusitis the doctor will choose the most suitable treatment modality. The treatment is generally conservative and majority of patients are prescribed certain medications.[ic.steadyhealth.com]
  • Treatment of chronic ethmoid sinusitis (ethmoiditis) Conservative treatment is often not given proper effect, providing only a temporary subsidence of the inflammatory process and creating a false premise for discontinuation of treatment.[minclinic.ru]
  • Treatments for ethmoid sinusitis can require a varied approach that ranges from at-home treatments to surgery in the most severe circumstances. Over-the-counter treatments Over-the-counter pain relievers can help ease ethmoid sinusitis discomfort.[healthline.com]

Prognosis

  • Our highly skilled head and neck surgeons work closely with radiation therapists, medical oncologists, oral and maxillofacial surgeons, radiologists and pathologists to discuss the patient’s staging, treatment, and prognosis.[nyee.edu]
  • Prognosis Prognosis for sinus infections is usually excellent, although some individuals may find that they are particularly prone to contracting such infections after a cold. Fungal sinusitis, however, has a relatively high death rate.[medical-dictionary.thefreedictionary.com]
  • Treatment and Prognosis The treatment may be either medical or surgical. The initial treatment involves administration of appropriate antibiotics along with an analgesic and an anti-histaminic.[webhealthcentre.com]
  • Prognosis The prognosis for acute sinusitis is very good. Most cases will go away within one to two weeks, often without antibiotics.[womenshealthmag.com]

Etiology

  • Review the microbiology of chronic rhinosinusitis and test the hypothesis that bacterial infections are not the predominant etiology for chronic rhinosinusitis.[ncbi.nlm.nih.gov]
  • Uncovering the etiology of chronic sinusitis can be more difficult.[arizonasinus.com]
  • It may complicate preseptal cellulitis (irrespective of the underlying etiology) or be the presenting symptom.[em-consulte.com]
  • […] bacteria to enter the sinus, causing irritation, infection and fluid-related pressure pain. sinusitis ENT Infection and/or inflammation of paranasal sinuses, often caused by blocked drainage of fluid or purulent material, linked to swelling of nasal mucosa Etiology[medical-dictionary.thefreedictionary.com]
  • The microbial etiology and antimicrobial therapy of adults with acute community acquired sinusitis: a fifteen year experience at the university of Virginia and review of other selected studies. J Allergy Clin Immunol 1992;90:457-61. [ Links ] 5.[scielo.br]

Epidemiology

  • There is no epidemiological study in Brazil, but it is most likely similar to the American 2 one.[scielo.br]
  • Epidemiology Although this is less common than acute sinusitis, it remains a reasonably common entity in itself, accounting for about 25 cases per 10,000 person-years in an average UK GP practice [ 2 ] .[patient.info]
  • Assess the effect of the pneumococcal conjugate vaccine on the epidemiology of acute bacterial sinusitis. 10. Develop new bacterial and viral vaccines to reduce the incidence of acute bacterial sinusitis.[pediatrics.aappublications.org]
Sex distribution
Age distribution

Pathophysiology

  • […] and chronic bronchitis, exacerbation of these diseases affects more than 90 million people—nearly one in three Americans. 5 The socioeconomic impact of this translates to more than 5.8 billion dollars spent on the treatment of sinusitis. 6 Back to Top Pathophysiology[clevelandclinicmeded.com]
  • It can occur as a result of a variety of causes of inflammation, the pathophysiology being that this leads to sinus cavity obstruction and subsequent infection (acute sinusitis) and chronic inflammation (chronic disease).[patient.info]

Prevention

  • This condition can be prevented by taking a few precautionary and preventive measures. Sinusitis can be prevented or its frequency can be reduced to a great extent by avoiding the potential allergens and irritants, and by using a humidifier.[buzzle.com]
  • Keeping your nasal passages clear can help prevent sinusitis. These methods may also be helpful for allergy sufferers.[healthline.com]
  • Prevention Prevention involves the usual standards of good hygiene to cut down on the number of colds an individual catches.[medical-dictionary.thefreedictionary.com]
  • PTFE nozzle at the distal portion acts as a limiter, preventing advancement of the needle beyond the ethmoid sinus.[minclinic.ru]

References

Article

  1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011
  2. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
  3. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
  4. Masood A, Moumoulidis I, Panesar J. Acute rhinosinusitis in adults: an update on current management. Postgraduate Medical Journal. 2007;83(980):402-408.
  5. Yazici B, Yazici Z. Pseudodacryocystitis and nasolacrimal duct obstruction secondary to ethmoiditis. Ophthal Plast Reconstr Surg. 2010;26(5):381-383.
  6. Crovetto-Martínez R, Martin-Arregui FJ, Zabala-López-de-Maturana A, Tudela-Cabello K, Crovetto-de la Torre MA. Frequency of the odontogenic maxillary sinusitis extended to the anterior ethmoid sinus and response to surgical treatment. Med Oral Patol Oral Cir Bucal. 2014;19(4):e409-e413.
  7. Brook I. Bacteriology of Acute and Chronic Ethmoid Sinusitis. J Clin Microbiol. 2005;43(7):3479-3480.

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Last updated: 2018-06-22 07:27