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, sphenoidal sinusitis typically presents with a unique set of symptoms, including:
- Permanent retro-orbital headache
- Radiation of pain to the vertex
- Simulation of pain caused by intracranial hypertension
- Purulent discharge on the posterior pharyngeal wall
The headache associated with sphenoiditis can be severe and persistent, often worsening at night or in the early morning 1. Other symptoms that may accompany sphenoiditis include postnasal drip, facial pain, visual disturbances, and occasionally fever if there is significant infection. Diagnosis of sphenoiditis can be challenging due to its deep location in the skull and the similarity of its symptoms to other conditions like migraine or tension headaches. Imaging studies such as CT scans of the sinuses are typically required for diagnosis, and treatment may involve antibiotics, nasal corticosteroids, and nasal saline irrigations 1.
From the Research
Presenting Symptoms of Sphenoiditis
- The most common presenting symptom of sphenoiditis is headache, as reported in multiple studies 2, 3, 4, 5, 6
- Other presenting symptoms include visual symptoms, such as diplopia, and cranial nerves palsies 2, 3
- The headache pattern is often non-specific and can be similar to migraine headaches, making diagnosis challenging 4
- In some cases, sphenoiditis can present with postnasal drainage or orbital symptoms 3
Diagnosis and Treatment
- Diagnosis of sphenoiditis is made through a combination of history, nasal endoscopy, and radiological examination, including computed tomography (CT) and/or magnetic resonance imaging (MRI) 3, 5, 6
- Treatment typically involves antibiotic therapy and surgical drainage, often performed through an endoscopic approach 2, 3
- Prompt and aggressive medical treatment is advised to reduce the risk of serious complications, such as permanent cranial neuropathies or intracranial spread 5