Headache
Deep, in the back of the head, crown or behind the eyes; often long-lasting and may not respond well to painkillers.
CONDITION / CARRY
Sphenoiditis.
Sphenoiditis is an inflammation of the sphenoid sinus, which lies deep in the skull behind the nose. It often manifests itself only as a headache, so it is not noticed for a long time; chronic sphenoiditis is often treated with endoscopic surgery.
CONCEPTUAL VISUALIZATION- what is it
- Inflammation of the sphenoid sinus in the depth of the skull, near the optic nerves.
- The main feature
- Headache — in 61–64% of patients in large series.
- Why is it important?
- Optic nerves pass nearby, and a tumor sometimes hides under a similar picture on a CT scan.
- Who treats
- ENT surgeon; the operation is performed endoscopically, through the nose.
01 / WHAT IS ITWhat is
What is
sphenoiditis.
The sphenoid, or main, sinus is the deepest of the sacral sinuses. It is located behind the nasal cavity, in the center of the skull; the optic nerves, carotid arteries and pituitary gland pass nearby.
Due to this location, sphenoiditis is not like ordinary sinusitis: runny nose and congestion may be weak or absent, and the main complaint is headache. Sometimes the first manifestation is visual impairment or double vision.
Isolated darkening of the sphenoid sinus on CT is not always inflammation. In a summary of the data of 1133 patients, it was most often chronic rhinosinusitis without polyps, mucocele or fungal lesions, but tumors also occur. Therefore, such a find must be investigated.
This is general information. What exactly is wrong with you, the doctor will tell after the endoscopy and CT scan.
02 / SIGNSHow is
How is
sphenoiditis manifested.
The most frequent symptom is headache: in a series of 122 patients — 63.9%, in a series of 79 patients — 61%.
Deterioration of vision
The second most frequent complaint with lesions of the sphenoid sinus is a reason for an urgent examination.
Double or drooping of the eyelid
Signs of damage to the cranial nerves passing nearby.
Flowing mucus
Mucus on the back wall of the pharynx, unpleasant taste.
An accidental find
In 22.1% of patients, changes in the sinus were found accidentally on the image.
03 / REASONSWhat is
What is
behind sphenoiditis.
According to aggregated data, in 75% of cases, the cause of sphenoid sinus damage is infection or inflammation.
Chronic inflammation
Chronic rhinosinusitis is the most common cause of isolated sinus damage.
Chronic sinusitisMucocele
A cyst that fills and expands the sinus — about 20% of cases.
Sinus cystsFungal infection
A fungal ball in the sinus; with diabetes, complications occur more often.
Tumors
Benign or malignant tumors are less common: malignant tumors were found in approximately 7–10% of such patients.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
The sphenoid sinus borders the optic nerves and the cranial cavity. Complications do not happen to everyone, but need help on the same day.
103 immediately if:
- sudden deterioration of vision, double vision, drooping of the eyelid;
- severe headache with fever, vomiting, neck stiffness or confusion.
See an ENT doctor in the coming days if:
A headache in the depth of the head lasts for weeks and does not go away with ordinary painkillers, especially with a runny nose or runny nose. If you accidentally found changes in the sphenoid sinus on a CT scan, make an appointment without delay.
05 / DIAGNOSTICSHow the
How the
diagnosis is made.
- Nasal endoscopy
Examination of the area where the sphenoid sinus opens into the nose.
- CT scan of the sinuses
Mandatory: shows the lesion of the sinus, the condition of its walls and nearby bones.
- MRI if needed
It helps to differentiate between inflammation, mucocele, fungal infection and tumor.
- Ophthalmologist's examination
If there are complaints about vision or double vision.
06 / TREATMENTHow to treat
How to treat
sphenoiditis.
Chronic sphenoiditis often requires surgery: it both cures and provides material for research. An isolated lesion of the sphenoid sinus often requires timely intervention.
01
Endoscopic sphenoidotomy
Through the nose, without incisions on the face.
- The essence of the operation
- The surgeon expands the natural opening of the sphenoid sinus, removes the contents and the changed mucosa; the tissue is examined under a microscope.
- Security
- In a meta-analysis of 1133 patients, the frequency of surgical complications was 1.5%.
- Headache
- In a series of 21 patients, pain decreased on average from 8.24 to 2.67 points out of 10.
02
The result
- No relapse
- In a series of 79 patients after surgery, there was no relapse in 89.8%; in 10.2%, the hole closed again and required a repeat operation.
- Vision
- In a series of 13 patients with inflammatory lesions and reduced vision after surgery, vision improved in 87.5%; worse if the vision was very low or there was double vision.
- Timeliness
- With fungal sphenoiditis, complications in one series were 40%, most often - loss of vision; therefore it is not worth delaying.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Sphenoiditis at Dr. Valikhnovsky's Institute of Surgery is 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 sphenoidotomy — expansion of the opening of the sphenoid sinus and removal of pathological contents.
- Endoscopic septoplasty — if the curved septum prevents access to the sinus.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
How is the treatment in us
- ConsultationTalk about pain and vision, endoscopy of the nose.
- ExaminationCT scan of the sinuses, if necessary, MRI and examination by an ophthalmologist.
- PlanThe scope and urgency of the operation depends on the symptoms and findings.
- OperationEndoscopically, through the nostrils; the tissue is sent for histology.
- ControlExaminations with endoscopy, so that the opening of the sinus remains open.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Why is sphenoiditis difficult to recognize?
Because runny nose and congestion can be weak, and the main complaint is a headache. In a review of 71 cases of acute sphenoiditis in children, the diagnosis was not suspected at the first visit in 54.0%.
Is sphenoiditis dangerous for vision?
Maybe: the optic nerves pass nearby. In the case of sudden deterioration of vision or double vision, help is needed on the same day.
Can sphenoiditis be cured without surgery?
Acute sphenoiditis is usually treated conservatively, but complications may require surgery. Chronic often requires endoscopic sphenoidotomy.
How safe is the operation?
In a meta-analysis of 1133 patients, surgical complications were 1.5%. It is done through the nose, without incisions on the face.
Can sphenoiditis return?
Yes: in a series of 79 patients, sinus opening reoccluded in 10.2% and reoperation was required. Therefore, control examinations are required after the operation.
Does sphenoiditis happen in children?
So, acute isolated sphenoiditis is also described in children. In the review of 71 cases, headache was present in almost all of them, temperature in half, and intracranial complications in 16.9%; most children recover completely with timely treatment.
Why explore deleted?
Isolated darkening of the sphenoid sinus sometimes turns out to be a tumor - therefore, the entire removed content is examined.
Sources
10 sources · reviews, guidelines and studiesShowCollapse
- Isolated sphenoid sinus opacifications: a systematic review and meta-analysisInternational Forum of Allergy & Rhinology, 2017doi:10.1002/alr.22023 ↗
- Isolated sphenoid sinus opacification: A systematic reviewAmerican Journal of Otolaryngology, 2017doi:10.1016/j.amjoto.2017.01.014 ↗
- Sphenoid Sinus Diseases: A Review of 1,442 PatientsInternational Journal of Otolaryngology, 2017doi:10.1155/2017/9650910 ↗
- Results of transnasal transostial sphenoidotomy in 79 cases of chronic sphenoid sinusitisEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2016doi:10.1016/j.anorl.2016.02.002 ↗
- Isolated sphenoid sinus disease: An overlooked cause of headacheJournal of Cranio-Maxillofacial Surgery, 2015doi:10.1016/j.jcms.2015.08.025 ↗
- Modified sphenoidotomy for isolated sphenoid sinus disease: A series of 117 casesScience Progress, 2023doi:10.1177/00368504231189538 ↗
- Visual Acuity Impairment from Inflammatory Isolated Sphenoid Sinus DiseaseIn Vivo, 2024doi:10.21873/invivo.13651 ↗
- Complications of Isolated Fungal Sphenoiditis: Patient Clinical CharacteristicsORL, 2020doi:10.1159/000503902 ↗
- Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literatureInternational Journal of Pediatric Otorhinolaryngology, 2021doi:10.1016/j.ijporl.2020.110492 ↗
- Chronic sphenoid rhinosinusitis: management challengeJournal of Asthma and Allergy, 2016doi:10.2147/JAA.S93023 ↗
The figures on the page are from these sources.
Headache,
that does not go away?
Describe how long the headache has been and whether there are any vision complaints, or send a CT scan. The doctor will tell you if it is related to the sinus.