Acute frontal sinusitis.



Let us review briefly the anatomy of the frontal sinus. You will recall that it is located in the frontal bone between the two compact layers of the bone, one sinus on each side of the middle line of the head, and that it is lined by the mucous membrane which is continuous with the lining membrane of the nasal passages, through the ductus naso-frontalis, which has its ostium underneath the middle turbinate.

Etiology.—One of the principal causes of frontal sinusitis is some obstruction of the ductus naso-frontalis, which interferes with the outflow of secretions, such as a swelling of the anterior part of the middle turbinate or a deviation of the septum, which acts as a mechanical barrier, and increases the severity of the sinusitis when the inflammation of the mucous membrane is on the same side as the deviation. We may have a simple serous inflammation or a purulent inflammation, when pyogenic bacteria are present. In cases of the serious or acute catarrhal inflammation of the sinus, we may have oedema of the lining mucous membrane, which may be so extensive as to obliterate the caliber of the tube, or we may have polypoid growths as the cause of the obstruction. In the acute purulent sinusitis we have the superficial layers of the mucous membrane involved, while in the chronic form we find the pathology extending into the deeper layers. If the section is thick we find it retained in the sinus, lint if thin it may drain through the ductus naso-frontalis to the under surface of the middle turbinate.

Symptoms.—The pain is generally over the frontal sinus and is of a dull, heavy or pressure pain in character, assuming at times a throbbing pain. There is a history of an acute cold and on inspection we find an inflammation of the nasal mucous membrane, with a secretion in the middle nasal fossa with more or less occlusion of the nares and tenderness on pressure over the sinus with a neuralgic pain. The pain generally begins in the morning after the patient has been on his feet from one to three hours. Motion, such as sneezing, coughing or blowing the nose increases the pain. The eye on the affected side may be inflamed and painful. The secretion varies from a thin, watery serous nature to a mucoid, muco-purulent or purulent.

Treatment.—The object of the treatment is drainage and alleviation of the inflammation. Probing of the canal and sinus is to be discouraged. The mucous membrane around and under the middle turbinate is thoroughly cocainized with a 2 to 4 per cent. solution. Adrenalin may be used in connection with the cocaine solution. After the tissues are shrunken apply a 2 per cent. solution of silver nitrate underneath the middle turbinate and around the ostium of the ductus naso-frontalis. The middle passage is then packed with a pledget of cotton which has been thoroughly covered with an ungentum of salicylic acid (20 grs. salicylic acid C. P. to the ounce of white petrolatum). This application is to be left in place for two hours and then removed by the patient. This treatment is to be repeated every day until a cure is brought about. The patient is given a spray of menthol and camphor in liquid petrolatum to spray into the nose every two to four hours. If you have a middle turbinate or a deviated septum that is causing a mechanic obstruction, these conditions should be corrected as soon as the acute inflammation has subsided. The indicated remedy as gelsemium, bryonia. etc., may be given internally to help alleviate the sinusitis.

Transillumination is of little benefit as an aid in making a diagnosis. Suction and heat hell) to remove the secretion and lessen the pain.

National Eclectic Medical Association Quarterly, Vol. 26, 1934-35, was edited by Theodore Davis Adlerman, M.D.