CONDITION / CARRY

Chronic frontal sinusitis and ethmoiditis.

Chronic frontal sinusitis is an inflammation of the frontal sinuses, and ethmoiditis is an inflammation of the ethmoid sinuses lying between the eyes; often they are combined. If washing and sprays do not help, the sinuses are opened endoscopically through the nose.

Discuss your case How it is treated in the clinic ↓

CONCEPTUAL VISUALIZATION

BRIEFLY

what is it: Prolonged, more than 12 weeks, inflammation of the frontal and ethmoid sinuses.
Main signs: Pressure in the forehead and between the eyes, congestion, discharge, weaker sense of smell.
When operating: If symptoms persist despite treatment with sprays and washes.
Who treats: ENT surgeon; operations are performed endoscopically, through the nose.

01 / WHAT IS IT

What is
frontal sinusitis and ethmoiditis.

The frontal sinuses are located in the bone above the eyebrows, the lattice sinuses are dozens of small cells between the eyes. Mucus from the frontal sinus flows into the nose through a narrow channel - the frontal pocket, which passes through lattice cells.

Therefore, inflammation of the ethmoid sinuses easily blocks the outflow from the frontal sinuses, and they become inflamed together. The structure of this area is very different in people, from simple to complex - this is the main thing that the surgeon evaluates before the operation.

Acute ethmoiditis is the earliest form of sinusitis in children; it is he who often gives complications to the eye socket. The chronic form in adults is usually part of chronic rhinosinusitis.

This is general information. How to treat you, the doctor will tell you after the endoscopy and CT scan.

02 / SIGNS

How
inflammation manifests itself.

The symptoms are similar to other forms of chronic rhinosinusitis, but the pain is more often localized in the forehead and between the eyes.

Pressure in the forehead

Heaviness above the eyebrows, aggravated by bending forward.

Pain between the eyes

Pressing pain in the bridge of the nose is typical for ethmoiditis.

Congestion and discharge

The nose does not breathe well, mucus flows from the nose or down the back wall of the pharynx.

Smell

Odors are felt weaker, especially if there are polyps.

Polyps in the nose

03 / REASONS

Why inflammation
becomes chronic.

The key is a narrow frontal pocket: if it is narrowed by swelling, polyps, or structural features, the frontal sinus is not ventilated.

Chronic rhinosinusitis

Inflammation is rarely limited to one sinus - more often several are affected.

Chronic sinusitis

Polyps

Lattice cell polyps block the outflow.

Polyposis rhinosinusitis

Anatomy

Additional cells around the forehead pocket narrow it.

Previous operations

Cicatricial narrowing of the frontal sinus opening after surgery is associated with persistence of symptoms.

04 / SEEK MEDICAL ADVICE

When to seek urgent medical care?

The frontal and ethmoid sinuses border the eye socket and the skull cavity. Complications are rare, but can threaten vision and life; intracranial complications are sometimes manifested only by a severe headache and fever.

103 immediately if:

swelling and redness of the eyelids, bulging of the eye, pain when moving the eyes, double or impaired vision;
severe headache with fever, vomiting, neck stiffness or confusion;
swelling on the forehead above the sinus.

See an ENT doctor in the coming days if:

Pain in the forehead with temperature and purulent discharge does not go away in a few days or worsens. If the pressure in the forehead, congestion and discharge last for months, make an appointment for a scheduled consultation.

05 / DIAGNOSTICS

How the
diagnosis is made.

Nasal endoscopy
Inspection of the site of outflow from the frontal and ethmoid sinuses, search for polyps and pus.
CT scan of the sinuses
Shows the affected sinuses and the structure of the frontal pocket - the scope of the operation is planned for it.
Additional examinations
If necessary, asthma and allergy assessment, in case of complications, a CT scan of the eye socket and head.

06 / TREATMENT

How to treat
frontal sinusitis and ethmoiditis.

The basis is rinsing and nasal sprays as prescribed by the doctor. If symptoms persist, endoscopic surgery helps.

Ethmoidotomy

Opening of lattice cells.

Volume: According to a meta-analysis of 46 studies, a more complete opening of the sinuses gives a better result, and a full ethmoidotomy reduces symptoms more than a partial one; the frequency of complications did not differ.

Frontotomy

Expansion of the frontal pocket through the nose.

Basic operation: In a study of 109 patients, the opening of the frontal sinus remained open in 92%, symptoms completely disappeared in 78%.
Quality of life: In a prospective study of 60 patients, the opening was passable in 90% of the sinuses, and the quality of life was significantly improved, particularly in patients with asthma and polyps.
Advanced operations: In complicated and repeated cases, the hole is expanded more (Draf IIb, Draf III). In a review of 1205 patients after Draf III, symptoms improved significantly in 86.5%.

After surgery

Control: Careful examinations with endoscopy help keep the opening open; narrowing may require repeat surgery.

07 / AT THE VALIKHNOVSKY CLINIC

How do we
treat it.

Chronic frontal sinusitis and ethmoiditis at Dr. Valikhnovsky's Institute of Surgery are operated in the "New Nose" direction - endoscopically, through the nostrils.

DIRECTION TO THE CLINIC A new nose Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors. Go to direction

What do we do in this condition

Endoscopic ethmoidotomy — opening of lattice cells.
Endoscopic frontotomy — expansion of the outflow path from the frontal sinus.
Revision of the ostiomeatal complex — restoration of outflow from the sinuses to the nose.

Rostislav Valikhnovsky

Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.

About the doctor ORCID

How is the treatment in us

ConsultationTalk about complaints and preliminary treatment, endoscopy of the nose.
CT scan of the sinusesAssessment of the structure of the frontal pocket and planning of the scope of the operation.
PlanWhich sinuses to open and to what extent.
OperationEndoscopically, through the nostrils.
ControlControl examinations with endoscopy; the doctor will explain what is possible and what should be avoided after the operation.

Discuss your case to call

08 / QUESTIONS AND ANSWERS

Frequently asked
questions.

Short answers. What is right for you, the doctor will tell you during the consultation.

How does frontal sinusitis differ from sinusitis?

Another sinus is affected: with frontal sinusitis, the frontal above the eyebrows, with sinusitis, the maxillary sinus below the eyes. Often they ignite together.

Is chronic frontal sinusitis dangerous?

Usually not, but the frontal and ethmoid sinuses border the eye socket and brain. Swelling of the eyelids, impaired vision, severe headache with temperature - a reason to call 103.

Can frontal sinusitis be cured without surgery?

Symptoms can often be controlled by washing and spraying. Surgery is offered if they do not help.

How is frontal sinus surgery performed?

Endoscopically, through the nostrils: the surgeon expands the frontal pocket to re-ventilate the sinus. Incisions on the forehead are not required.

Can the hole close again?

Yes, that's why follow-up examinations are important. After extended Draf III surgery in a review of 1,205 patients, reoperation was required in 12.6%.

Does asthma or smoking affect the outcome of surgery?

In a study of 109 patients after frontal sinus surgery, asthma, allergies, and smoking did not appear to affect outcome. It is more important that the new hole remains wide.

What is ethmoiditis in children?

Acute ethmoiditis is the earliest form of sinusitis in children and often causes complications for the eye socket. Swelling of the eyelid in a child with a runny nose requires immediate examination.

09 / SOURCES

Sources

10 sources · reviews, guidelines and studiesShowCollapse

Safety and Efficacy of the Draf IIb Procedure: A Systematic ReviewOtolaryngology–Head and Neck Surgery, 2021doi:10.1177/01945998211004237 ↗
Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta-analysisLaryngoscope, 2018doi:10.1002/lary.26794 ↗
Long-term results after primary frontal sinus surgeryInternational Forum of Allergy & Rhinology, 2012doi:10.1002/alr.21015 ↗
Endoscopic Management of Chronic Frontal Sinusitis: Prospective Quality of Life AnalysisAnnals of Otology, Rhinology & Laryngology, 2015doi:10.1177/0003489415573959 ↗
The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS)International Forum of Allergy & Rhinology, 2016doi:10.1002/alr.21738 ↗
Extent of Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-AnalysisCurrent Allergy and Asthma Reports, 2024doi:10.1007/s11882-024-01175-5 ↗
Orbital complication of acute ethmoiditis: A Tunisian paediatric cross sectional studyAmerican Journal of Otolaryngology, 2020doi:10.1016/j.amjoto.2019.102320 ↗
Orbital complications of acute bacterial rhinosinusitis in the pediatric population: A systematic review and meta-analysisInternational Journal of Pediatric Otorhinolaryngology, 2020doi:10.1016/j.ijporl.2020.110078 ↗
Orbital Complications of Acute Rhinosinusitis in Adulthood: Predictors of Outcome and ManagementLaryngoscope, 2026doi:10.1002/lary.70309 ↗
Intracranial Suppurative Complications of SinusitisScandinavian Journal of Surgery, 2016doi:10.1177/1457496915622129 ↗

The figures on the page are from these sources.

VALIKHNOVSKI SURGERY PARTNERS

Pressure in the forehead
doesn't go away?

Describe the complaints and what was treated, or send a CT scan. The doctor will tell which sinuses are affected and whether surgery is needed.

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