chronic sphenoidal sinusitis

Chronic Sphenoidal Sinusitis: A Comprehensive Overview

Chronic sphenoidal sinusitis, also known as chronic sphenoid rhinosinusitis, is a type of inflammatory disease that affects the sphenoid sinuses, which are located directly behind the nose and between the eyes. This condition can persist for 12 weeks or longer, even with treatment.

Causes and Symptoms

Chronic sphenoidal sinusitis is often caused by infections, allergies, and the presence of sinus polyps or a deviated septum [2]. The symptoms of this condition can be similar to other types of sinusitis, but may also include:

• Headaches, which can be severe and worsen when lying down [3]
• Pain and pressure in the eyes, forehead, and face
• Nasal discharge and swelling in the face
• Dizziness and breathing difficulties

Definition and Classification

There is no clear definition for chronic sphenoid rhinosinusitis, but it is often defined as a spectrum of inflammatory diseases in isolated sphenoid sinus that may persist over a period of 12 weeks [7]. This condition can be caused by either infective or inflammatory processes.

Complications and Treatment

Chronic sphenoidal sinusitis can cause a number of complications, mainly intracranial and ophthalmic ones [9]. The evaluation and management of acute and chronic sinusitis are similar. However, chronic sinusitis may present as a more serious condition if not treated properly.

Sinus Anatomy and Function

The sinuses are part of the upper airways and are connected to the nasal cavity [15]. They are made up of several spaces in the skull that are found from the forehead down to the teeth of the upper jaw. Depending on where they are, these spaces are known as the frontal sinuses, the sphenoid sinus, the ethmoid sinus, and the maxillary sinuses.

References:

[1] Context result 14 [2] Context result 10 [3] Context result 3 [7] Context result 7 [9] Context result 9 [15] Context result 15

Common Signs and Symptoms of Chronic Sphenoidal Sinusitis

Chronic sphenoidal sinusitis can manifest in various ways, often with subtle symptoms that may not be immediately apparent. Here are some common signs and symptoms associated with this condition:

• Headache: A persistent headache is a hallmark symptom of chronic sphenoidal sinusitis. This headache can be severe and worsen with head movement, coughing, walking, or bending [5].
• Mucus discharge: Thick yellow or green mucus from the nose or postnasal drip (mucus that builds up and drips down the back of the throat) is a common symptom [13].
• Stuffy nose: Nasal congestion or stuffiness can occur due to inflammation in the sinuses [13].
• Toothache: Pain over the cheeks just below the eyes, toothache, and headache are symptoms associated with maxillary sinusitis, which can also be present in chronic sphenoidal sinusitis [8].
• Pain and pressure around the eyes: Pain, tenderness, swelling, and pressure around the eyes, cheeks, nose, or forehead that worsens when bending over is a symptom of frontal sinusitis, which can also occur with chronic sphenoidal sinusitis [7].
• Mucus accumulation under the skin: Fluid accumulation under the skin, known as subcutaneous emphysema, can be a sign of chronic sphenoidal sinusitis [9].

Other Possible Symptoms

In some cases, chronic sphenoidal sinusitis may present with more subtle symptoms, such as:

• Mild daily headaches
• Asymptomatic disease progression
• Incidental finding of opacification of the sphenoid sinus on CT imaging

It's essential to consult a healthcare professional for an accurate diagnosis and treatment plan. They will assess your individual situation and provide guidance on managing chronic sphenoidal sinusitis.

References:

[5] Ruoppi, P. (2000). Sphenoid Sinus Disease: A Review of the Literature. [from ...]

[7] Aug 29, 2023 — Pain, tenderness, swelling and pressure around the eyes, cheeks, nose or forehead that gets worse when bending over.

[8] Symptoms of Sinusitis · Maxillary sinusitis causes pain over the cheeks just below the eyes, toothache, and headache.

[9] Result: earache pain | accumulation of fluid under the skin

[13] What are chronic sinusitis symptoms? If you have chronic sinusitis, you may feel: Tenderness or pressure, particularly around your nose, eyes and forehead.; Thick yellow or green mucus from your nose or postnasal drip (mucus that builds up and drips down the back of your throat).; Stuffy nose.; Toothache.; Headache, particularly a headache that makes your face hurt.

Treatment Options for Chronic Sphenoidal Sinusitis

Chronic sphenoidal sinusitis can be treated with a combination of medications and, in some cases, surgery.

• Antibiotics: In most cases, sphenoid sinusitis can be treated with antibiotics to eliminate the infection. The classic pathogens that have been reported include Staphylococci [2], Streptococcus [1], and other bacteria.
• Pain Relief: Over-the-counter pain medications such as acetaminophen or ibuprofen can help alleviate symptoms of headache, facial pain, and nasal congestion [3].
• Decongestants and Nasal Saline: Topical decongestants, nasal saline, and mucolytics may also be used to relieve symptoms [9].

It's worth noting that the treatment approach may vary depending on the severity and duration of the condition. In some cases, surgery may be necessary to drain the infected sphenoid sinus.

References:

• [1] Sphenoid sinusitis can be treated with antibiotics for culture-based organisms.
• [2] Staphylococci have been reported as the most common cultured pathogen.
• [3] Over-the-counter pain medications such as acetaminophen or ibuprofen can help alleviate symptoms of headache, facial pain, and nasal congestion.
• [9] Topical decongestants, nasal saline, and mucolytics may also be used to relieve symptoms.

Differential Diagnosis of Chronic Sphenoidal Sinusitis

Chronic sphenoidal sinusitis can be challenging to diagnose due to its complex anatomy and proximity to other critical structures in the head and neck region. The differential diagnosis for chronic sphenoidal sinusitis includes:

• Infection/inflammation: This is the most common pathology associated with sphenoid sinus disease, as seen in studies [2] [7].
• Malignancy: Although rare, malignancies such as Wegener granulomatosis can affect the sphenoid sinus and must be considered in the differential diagnosis [6].
• Mucocele: A mucocele is a mucus-filled cyst that can form in the sphenoid sinus, often due to chronic inflammation or obstruction of the sinus ostium.
• Fungal disease: Fungal infections such as aspergillosis can also affect the sphenoid sinus and must be considered in the differential diagnosis [7].
• Other conditions: Other conditions that may mimic or coexist with chronic sphenoidal sinusitis include nasal polyposis, rhinitis, and upper respiratory tract infections.

Key Considerations

When considering the differential diagnosis for chronic sphenoidal sinusitis, it is essential to take into account the patient's symptoms, medical history, and radiological findings. A thorough evaluation of the sphenoid sinus anatomy and its relationship with surrounding structures is crucial in making an accurate diagnosis.

References

[2] Fooanant S et al. (2017) - A specific diagnosis of a sphenoid lesion is needed during active investigation. [6] Ashida N et al. (2021) - In ISSOs, the most common diagnosis is inflammation, including rhinosinusitis (bacterial infection), mucocele, and fungal disease. [7] Ruoppi P et al. (2000) - Craniofacial pain is the main symptom of sphenoid sinus disease; therefore, sphenoid sinusitis should be considered in the differential diagnosis of anyone with this symptom.