SINUSES, DISEASES OF. Ethmoiditis.
Definition.—This term is used by some authors to designate inflammation of the middle turbinated body in connection with ordinary chronic rhinitis, while others appear to restrict its use to in flammation beginning within the eth moidal labyrinth. It is evident that two processes, perhaps radically different, are concerned here, each of which has been associated with the term ethmoiditis. In the first place, in chronic rhinitis, under some circumstances, the inflammation of the mucosa of the middle turbinated bone extends by contiguity to the sub jacent bone, producing a sort of fungous osteitis, with more or less suppuration, dry caries, or osseous hypertrophy; fur ther extension by continuity involves the ethmoidal cells; so that there is in creased production of granulation-tissue and pus, which latter may become pent up. This process, thoroughly ingrafted upon the ethmoid, may play a very prominent part in settling up antral or frontal-sinus disease, and also in the for mation of mucus polypi. The other con ception of ethmoiditis has reference to the endogenous production of suppura tion, such as occurs in all the other sinuses. Here we understand that the process starts from within the labyrinth, through invasion of the labyrinth dur ing a special rhinitis, or influenza, etc.; the accidental presence of pyogenic germs in the labyrinth roused to activity by repeated attacks of severe coryza, and finally infection of the labyrinth by pus from one of the other sinuses. The process once established within the sinus, it may readily extend through its wall and attack the middle turbinated bone.
While both varieties of etiological factors are competent to cause eth moiditis, the fact that suppuration of the ethmoidal cells is much more com mon than suppuration of any of the other sinuses would seem to prove that its great frequency here is due to the fact that the ethmoidal cells are particu larly liable to inflammatory action be cause of their relation to the middle tur binated bone.
Symptoms.—The superficial form of ethmoiditis is simply one of the phe nomena of chronic hypertrophic rhinitis with enlargement of the middle turbi nate body. The symptoms of this af
fection belong, therefore, to chronic rhinitis, and also, in part, to intranasal mucous polypi. As far as the affection is a purulent one, the symptoms consist of a unilateral purulent discharge, or in some cases of the escape of a large quan tity of pus after removing some portion of the middle turbinated body.
In cases of suppuration of any of the sinuses acute exacerbations are common: so that such symptoms as tenderness, localized pain; neuralgias of the cheek, eve, and forehead; nasal obstruction, to gether with unilateral discharge of pus, will at once call the attention of the ob server to the probability of sinous sup puration. It remains to determine from which cavity the pus emanates. But, since it is true that very frequently two or more of the sinuses on the same side are involved, it will readily be seen how difficult such a task is. It is of very little value to note the exact point through which the pus enters the nostril in determining which sinus is affected, because the middle turbinated blocks the middle meatus in so many different ways that pus may easily appear to ema nate from the antrum when actually it lows down from the ethmoidal cells,— and the reverse is also true. Of much more importance in diagnosing an eth moiditis is it to note whether the middle turbinated bone is enlarged and con gested; and whether fungoid granula tions or polypi have developed. We should not expect that a suppurating process of the ethmoidal cells be present if the middle turbinated bone is normal in appearance.
As regards the of eth moidal and antral suppuration, we be lieve that involvement of the ethmoidal cells is by far the most common of sinus suppurations, and that, very frequently, the test of transillumination shows the antrum to be the seat of empyema when this cavity is only a receptacle for the pus which flows down over the outer wall from the ethmoidal cells above. This test is useful not only in diagnosing antral disease, but the electric light in the mouth frequently presents a shadow on the side of the nose where there is a suppurating ethmoiditis, or where the middle turbinated bone is largely hyper trophied.