2023-11-12 21:45:05
Sphenoidal sinusitis, also called sphenoiditis, refers to uncommon inflammation of the sphenoid sinuses, located at the back of the nose, just above the nostril wings. Much less known than maxillary, ethmoidal or frontal sinusitis, it can cause symptoms that are just as disabling and get seriously complicated. How to recognize it, prevent it and take care of it? Answers from Professor Justin Michel, ENT doctor, head and neck surgeon and member of the French Society of Oto-Rhino-Laryngology and Face and Neck Surgery (SFORL).
Definition: what is sphenoid sinusitis?
Sphenoid sinusitis is a viral, bacterial or fungal infection sphenoid sinuses, small cavities filled with nitric oxide (No), grafted very deep into the sphenoid bone of the skull, between the eyes. “These usually sterile sinuses are lined by respiratory mucosa and communicate with the nasal cavities through narrow openings at the level of the sphenoid ostium,” specifies the expert. And to alert: “Their proximity to sensitive structures such as the carotid artery, optic nerves, and frontal lobe of the brain makes inflammation of these sinuses of particular concern.”
What are the sphenoid sinuses used for?
“We do not know exactly the role of the sinuses,” replies Professor Michel, “and we also do not know why they contain nitric oxide or why they are located in their location. » Two main theories emerge, explains the expert… First hypothesis: the sinuses would lighten the facial area and would have favored the transition to bipedalism. Second hypothesis: the sinuses act as thermal buffers and protect the eyes and the brain from variations in air temperature.
© Ameli.fr
Pain at the top of the head, stuffy nose, fever, fatigue… What symptoms should alert you?
The symptoms of sphenoid sinusitis can be varied. They include in particular:
- a congestion nasale,
- a posterior rhinorrhea,
- of the persistent headaches,
- a pain behind the eyes,
- of the pain at the top of the head,
- a feeling of pressure in the nose,
- of the visual disturbances more or less important,
- a possible fever, above 38.5°C,
- etc.
“Persistent pain at the top of the head or behind the eyes should really alert you,” says Professor Michel. It is generally increased when patients tilt their heads forward and resists analgesics,” he notes.
Is sphenoid sinusitis contagious?
Sphenoid sinusitis itself is not a contagious disease : it is not transmitted directly from one person to another. However, infections likely to cause sphenoid sinusitis can be contagious… This is particularly the case with colds or the flu!
The viruses that cause these viral infections are spread in particular through droplets that remain suspended in the air. when an infected person coughs or sneezes. Healthy people who then find themselves exposed to these droplets can therefore be contaminated and in turn develop a cold or flu responsible for a potential infection of the sphenoid sinuses.
It is therefore essential to take steps to prevent the spread of respiratory infectionssuch as frequent hand washing and avoiding close contact with sick people!
What causes sphenoid sinusitis?
The causes of sphenoidal sinusitis are generally the same as those of maxillary, frontal or ethmoid sinusitis, indicates Professor Michel.
Sphenoidal sinusitis can therefore be linked to a nasal infection of viral, bacterial or fungal origin (linked to a small fungus, aspergillus), but also to an allergy involving recurrent rhinitis. Of the nasal polyps or some anatomical abnormalities that obstruct drainage of the sphenoid sinuses.
Furthermore, smoking, certain diseases impacting the immune system or even diving can increase the risks.
As for why the sphenoid sinuses are affected, and not the maxillary, frontal or ethmoidal sinuses… “It’s Russian roulette, bad luck », recognizes the doctor.
Sphenoiditis: what are the possible complications?
The risk of complications is higher in cases of sphenoiditis, due to the location of the sphenoid sinuses… Even more so if the condition is not diagnosed and treated correctly. Among the most common complications associated with sphenoid sinusitis:
- visual disturbancesfor example a reduction in visual acuity, paralysis of the oculomotor nerves, or even eyelid edema;
- and serious neurological complicationssuch as meningitis or an intracerebral abscess.
In rare cases, the infection can cause blood clots to form in the veins that drain blood from the brain, causing cerebral venous thrombosis. Of the bone infections may also require surgery. And even rarer, the infection can sometimes spread to the entire body, we then speak of sepsis.
Regardless, these complications are relatively rare and most cases of sphenoid sinusitis are managed successfully.
Treatment is quickly initiated, often before a sinus scan is performed, to prevent any complications. In certain cases, sphenoid sinus surgery is also considered, underlines Professor Michel.
Can this type of sinusitis be prevented?
Prevention of sphenoid sinusitis involves appropriate management of underlying conditions such as allergies and rapid treatment. It also involves simple actions: regular blowing and nose washing. “Good nasal hygiene is essential in the event of illness, this helps reduce the viral load and bacterial overgrowth in the nose,” assures the doctor. It is also possible to make wet inhalations or resort to a air humidifier.
Diagnosis: how do you know if you have sphenoid sinusitis?
The diagnosis of such sinusitis obviously involves a questioning and physical examination accurate. Then comes the time to nasal endoscopy : the doctor uses an endoscope (a rigid or flexible tube with a tiny camera and a light source at the end) which he inserts into the patient’s nose. “This allows us to note – or not – the presence of a polyp or other anomaly which would guide our diagnosis,” notes Professor Michel. And added: “when we suspect sphenoidal, ethmoidal or frontal sinusitis, we first prescribe a sinus scanthen possibly an MRI, as a third intention.
Please note: medical imaging should not delay treatment ! “If we suspect sphenoid sinusitis but there is no slot available for a CT scan before three weeks, we begin treatment and prescribe a follow-up CT scan to monitor the evolution of the situation,” warns our expert .
Treatment: how to treat this condition of the sphenoid sinuses?
Treatment for sphenoid sinusitis depends on the severity of the symptoms and the underlying cause. Therapeutic options include antibiotics for bacterial infections, corticosteroids to reduce inflammation, and in some cases, endoscopic surgery to clear blockages or drain the sinuses. As noted above, the vast majority of people experiencing sphenoid sinusitis respond well to treatment !
Which antibiotic for sphenoid sinusitis? For how long ?
We generally prescribe the amoxicillin/clavulanic acid combination for a period of one to two weeks. Of the fluoroquinolones (levofloxacin or moxifloxacin) may also be prescribed. This should calm the harmful symptoms. But if these symptoms persist after 48 hours, surgery is necessary.
In adults, painkillers help relieve pain. Of the vasoconstrictors local can also help you regain some comfort (to be taken for a maximum of 5 days).
How is surgery to empty the sinuses performed?
Sphenoid sinus surgery is recommended when conventional medical treatments are not effective enough, or when sphenoid sinusitis is caused by anatomical problems such as nasal polyps or a deviated nasal septum. It can be carried out under local or general anesthesiadepending on the complexity of the procedure and the needs of the patients.
The procedure itself consists of aspirating the purulent contents of the sphenoid sinuses under nasal endoscopy, through an orifice made specifically in the sinus. Inflamed or infected tissues are thus eliminated to restore normal sinus function. If there is an obstruction, the surgeon can widen the sinus passages to improve drainage, reducing the risk of recurrent infections.
Endoscopic checks under local anesthesia will be necessary in the weeks following the operationwarns the expert.
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