Features of the treatment of chronic ethmoiditis: what is important to know

Chronic ethmoiditis in most cases is the result of insufficiently effectively treated acute ethmoiditis. Since the lattice labyrinth occupies the "central" position among all the paranasal sinuses, ethmoiditis is highly likely to develop as a secondary disease against the background of inflammation of other nasal sinuses. The transition of acute inflammation of the mucous membrane of the ethmoid labyrinth to chronic can be facilitated by factors such as deformities of the nasal septum, the presence of adenoid vegetations, weakening of the body's immunity, and so on. The treatment of chronic ethmoiditis is a much more complex process, which has its own characteristics, which are described by estet-portal.com.

Pathological features of the course of chronic ethmoiditis

Before talking about the treatment of chronic ethmoiditis, it is necessary to understand the pathomorphological features of its course. In most cases, there are such forms of this disease as catarrhal-serous, purulent and hyperplastic. A characteristic feature of these forms of chronic ethmoiditis is polypous metaplasia of the mucous membrane in the region of the middle nasal passage, which develops as a result of its prolonged irritation with pathological discharge. In most cases, there are multiple polyps of various sizes that obstruct the nasal passages. Thus, the mechanisms of acute and chronic ethmoiditis are significantly different, which determines the peculiarities of the treatment of chronic ethmoiditis.

Methods of conservative treatment of chronic ethmoiditis

Conservative treatment of chronic ethmoiditis may be sufficient to cure the patient only in the case of an uncomplicated course of the disease. First of all, the patient is prescribed antibiotic therapy with the use of broad-spectrum antibacterial drugs. In order to reduce the swelling of the mucous membrane and restore the outflow from the paranasal sinuses, the use of vasoconstrictor drugs in the form of various aerosols or drops is recommended. Combined preparations containing analgesics, antibacterial and vasoconstrictive drugs are highly effective. As an additional therapy, physiotherapy procedures are used: UHF, endonasal electrophoresis, and so on.

Stages of surgical treatment of chronic ethmoiditis

In the absence of the desired effect of conservative methods of treatment, as well as in the event of complications, surgical treatment of chronic ethmoiditis is recommended. Endonasal opening of the cells of the cribriform labyrinth with polypotomy is performed under local anesthesia in several stages:

1. At the first stage, using a special loop or fenestrated nasal forceps, polyps are removed, thus creating  access to the ethmoid labyrinth.
2. By breaking the middle turbinate or removing its hyperplastic anterior end, the middle nasal passage is expanded.
3. Sequentially, the anterior and middle cells of the ethmoidal labyrinth are partially opened from the front using a conchotome, nasal forceps or a Hartmann instrument.
4. If the posterior cells of the ethmoid labyrinth are also affected, by penetrating through the basal  the plate of the middle nasal concha is opened by the entire ethmoid labyrinth & nbsp; to the sphenoid sinus, thus creating conditions for sufficient drainage of the nasal passages.

Important features of the treatment of chronic ethmoiditis

In order to achieve the most effective treatment and achieve complete recovery of the patient, it is necessary to take into account the following features of the treatment of chronic ethmoiditis:

• a partial opening of the affected cells of the ethmoid labyrinth is performed, since this is often enough to achieve normal sanitation of the sinus against the background of conservative treatment;
• it is recommended to perform surgical intervention under the control of optical systems, since endonasal endoscopic surgery allows complete rehabilitation of the pathological focus under visual control;
• to prevent recurrence after polypotomy, which occurs quite often, it is recommended that patients in the postoperative period be prescribed glucocorticosteroids for 3-5 months, as well as immunomodulators;
• it is necessary to treat the process of penetration of the instrument through the sieve plate of the ethmoid bone into the cranial cavity very carefully, as this can lead to serious complications. Knowing all the topographic features of the structure of the ethmoid bone will help to avoid this.