The sphenoid sinuses, home to ASS, are located on the sides of the sphenoid bone that divides the sinus into two unequal cavities. ASS is not a normal donkey! ASS is acute sphenoid sinusitis. Toddlers never get ASS because they do not have cavities where it can hide and create turbulence. The sphenoid sinus fully develops by the eighth year only. In adults, ASS may occur owing to blocked ostium. Inflammation or structural problems may plug the ostium, causing headaches-sinus.

ASS always triggers headaches. Based on location, these headaches-sinus can be of three types: temporal, occipital and frontal. The patients may also experience a combination of these. The headaches-sinus are curable provided the infection is detected in time and treated properly.

The symptoms include dull pain in the orbit and around it, blur vision or loss of vision and / or unilateral visual impairment. ASS causes deep, persistent pain over the head or behind the nose or eyes. This pain may increase with bending forward. The pain may reach to the mastoid region. In posterior rhinoscopy, postnasal discharge may be spotted.  Pus may be identified on the posterior wall or roof of nasopharynx. Alternatively, pus may secrete over posterior part of the middle turbinate.

On an X-ray, sphenoid sinus may appear opaque. A physician may be able to see the fluid level on the X-ray. To get a clear picture of the fluid level, an x-ray of the sphenoid sinus is taken in lateral view. Radiographic scans like MRI and CT also aid in diagnosis.

Diagnosing ASS is difficult because the sphenoid sinus is located posteriorly. The diagnosis is delayed until complications appear. The infection may spread to nearby structures and cause hypopituitarism, meningitis, subdural abscess, orbital cellulites and ocular palsies. A neurological emergency, ASS may produce severe headaches. If meningeal and cavernous sinus are infected, patient may die. Neoplasms or mucoceles of the sphenoid sinus may resemble to ASS, so physicians must differentiate between the two conditions.

Staphylococcus aureus “produces” ASS. However, ASS rarely occurs in isolation. It is generally accompanied by pansinusitis, which means it develops with other types of sinusitis. For instance, ASS accompanies infection of one of the ethmoid sinuses.

If ASS does not respond to an antimicrobial treatment, transnasal puncture of the sphenoid sinus is required to drain the sinus. During severe cases, the infection is likely to spread into the optic canal, orbital apex and optic nerve and cause acute loss of vision and retrobulbar optic neuritis.