Ethmoiditis: symptoms, causes, complications

What is ethmoiditis?

Ethmoiditis is a inflammation of ethmoid cells, located between the eyes, at the level of the upper part of each nasal cavity. For the record, the sinuses are bones forming an air hollow allowing to warm and humidify the inhaled air before reaching the lungs. The sinuses exist in pairs and develop gradually with age, with the exception of the ethmoid sinuses, which are present from birth:

• The maxillary sinuses (under the cheekbones) are formed from 3 or 4 years old;
• The frontal sinuses appear between 5 and 10 years;
• The sphenoid sinuses develop from 10 years.

“Ethmoiditis affects more children and toddlers than adults, because the ethmoid sinuses are the first to develop, explains Doctor Wissame El Bakkouri, ENT doctor and face and neck surgeon. In adults, it is rather maxillary sinusitis, rarer in children, in whom the maxillary sinuses are not very developed.”

What are the causes of ethmoiditis in children?

Ethmoiditis is caused by a badly progressing cold. “Inflammation has a bacterial origin, although it begins with a viral cold. The bacteria mainly responsible are, in order of frequency, Haemophilus influenzae, Streptococcus pneumoniae and Staphylococcus Aureus“, says Dr. El Bakkouri.

What are the causes of ethmoiditis in adults?

Inflammation of the ethmoid sinuses is very rare in adults. “A barrier is present between the orbit and the ethmoid sinus. Therefore, the germ hardly passes. However, this barrier is very fragile and permeable in young children. The infection, if it affects adults, affects immunocompromised or diabetic patients. In adults, ethmoiditis has mainly a dental causebut dental germs rather lead to maxillary, frontal sinusitis, or even affects all of the sinuses.”

What are the symptoms of ethmoiditis?

One of the main symptoms of ethmoiditis is edema at the inner angle of the eye: the upper eyelid is red and swollen. The eye is sensitive and painful. Other symptoms of ethmoiditis include high fever (over 38.5°C), characteristic of bacterial infection, and a deterioration in the general condition of the child (dejection, exhaustion, weakness, fatigue). Ethmoiditis can occur in 24 hours in a succession of stages: the upper eyelid swells, reddens at the inner angle first, the eye closes, fever appears. “Often these symptoms worry parents, who go to the emergency room. When the child comes to the emergency room, we try to see his pupil, but often we can’t see the inside of the eye. due to edema. Initially, the cold concept still figure. Moreover, during the scan, we find that the sinuses are full of secretions, which confirms the ENT cause”says the surgeon.

What are the potential complications ?

The sinus lying next to the eye, infection can spread into the eye socket, the cavity containing the eyeball, with damage to the fat, the oculomotor muscles and the optic nerve. “If the infection passes from the sinus to the orbit, orbital complications may occur and end abscess in orbit. The optic nerve is compressed, which can lead to blindness, a rather rare complication, but irreversible”. Other complications of ethmoiditis can occur, such as paralysis of eye movements (ophthalmoplegia).

Often, in first intention, the doctor prescribes a antibiotic treatment. A control clinical examination is necessary 48 hours after the first consultation. Doctor Wissame El Bakkouri recommends that parents go to the emergency room if the eye does not deflate after 3 or 4 doses of antibiotics. “If the swelling does not decrease, the condition is worsening behind the eyelids and in the eye. However, behind a swollen eyelid, there may be an eye in pain. In the hospital, the treatment of ethmoiditis is based first on the intravenous intake of antibiotic drugs to fight against bacteria, such as PENICILLIN. “Antibiotics adapted to the collected germ can be administered by secondarily intravenously. If hospitalization and antibiotics aren’t enough and symptoms get worse, it often means the infection becomes an abscess (pus in the orbital cone). The surgical operation is then envisaged: a scanner is carried out in order to know precisely the place which it is necessary to operate. The surgery is performed under General anaesthesia. We operate through the nose to open the ethmoid or we make an incision on the eyelid to drain the pus. Nursing care is then carried out to clean and wash the wound with Betadine“, details the surgeon of the face and the neck. After, the child is placed under hospital monitoring for at least 5 days, while continuing treatment with intravenous antibiotics. A relay by oral antibiotics is prescribed when returning home. In any case, the saline nose washes are recommended.

Thank you to Doctor Wissame El Bakkouri, ENT doctor and face and neck surgeon at the Rothschild Foundation Hospital.