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Sphenoid sinusitis is the least common sinus condition (only 3% of sinusitis cases).

The sphenoid sinus is at the very back part of the nose and sits just beneath the base of the brain (neurosurgeons will often go through the sphenoid sinus to get easier access the brain for pituitary gland operations called trans-sphenoidal hypophysectomy).

The big problem with sphenoid sinusitis is that infection of the sinus may cause a bad, dull, non-descript, vague headache that will not go away.

The difficulty in making the diagnosis is that it is not considered as classic sinus symptoms such as a runny nose are often not there.

A CT scan of the paranasal sinuses can tell if significant sphenoid sinus infection is present.

The headache may be made worse by changes in posture, walking, stooping down or prolonged standing

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Treatment of Sphenoid Sinusitis

The entry to the sinus is via a small hole in the upper middle front wall of the sphenoid sinus called the ostium.

If the entry to the ostium is blocked by inflammation of nasal lining (rhinitis), then decongestants and anti-inflammatory nasal spray (like flixotide) may help the sinus to drain.
More often, by the time isolated sphenoid sinusitis has been diagnosed, these have been tried on several occasions, and some sort of surgery is likely to be recommended by your ENT surgeon.

The usual surgery, in modern practice, is FESS - Functional Endoscopic Sinus Surgery. I am not an ENT specialist, so will not make too much comment.

However, you should know that FESS involves passing a fine endoscope up the nose. The surgeon tries to get the fine tube into the sinus to drain it, and take samples for laboratory analysis.

Patient satisfaction with FESS is usually high. FESS requires a lot of skill, and when operating on the sphenoid sinus there are several critical structures just through the wall - internal carotid arteries, the cavernous venous sinus, abducens nerve, optic nerve and the pituitary gland.

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