From the Guidelines
The most common presenting symptom of sphenoiditis is a permanent retro-orbital headache, radiating to the vertex, which may simulate the pain caused by intracranial hypertension. This symptom is highlighted in the French guidelines for the treatment of upper and lower respiratory tract infections 1. According to these guidelines, sphenoiditis presents with a distinct set of symptoms, including:
- Permanent retro-orbital headache
- Radiation of pain to the vertex
- Simulation of pain caused by intracranial hypertension
- Possible purulent discharge on the posterior pharyngeal wall
The unique location of the sphenoid sinus at the base of the skull, near critical structures like the optic nerve and cranial nerves, contributes to the characteristic headache symptom. Diagnosis of sphenoiditis often requires imaging studies like CT scans, as the symptoms may mimic other conditions like migraine or cluster headaches. The guidelines also recommend first-line antibiotic therapy, including amoxicillin-clavulanate, second and third generation cephalosporins, or fluoroquinolones active against pneumococci, such as levofloxacin or moxifloxacin, for the treatment of sphenoiditis 1.
From the Research
Presenting Symptoms of Sphenoiditis
- The most common presenting symptom of sphenoiditis is headache, as reported in two studies 2, 3.
- In the study by 2, headache was the main presenting symptom in five out of ten patients.
- Another study 3 found that all 21 patients with isolated sphenoid sinus disease had headache with various localizations, with the most common location being the vertex (24%).
- Other presenting symptoms of sphenoiditis include diplopia 2 and postnasal drainage 2.
Diagnosis and Treatment
- The diagnosis of sphenoiditis is typically accomplished by history, nasal endoscopy, and radiological examination (computed tomography and/or magnetic resonance imaging) 2.
- Treatment of sphenoiditis usually involves medical treatment with intravenous or oral antibiotics, and endoscopic sinusotomy may be performed in some cases 2.
- Endoscopic sphenoidotomy has been shown to be an effective and less traumatic approach for treating isolated sphenoid sinus disease 2, 3.