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PubMed1997

Medical and surgical management of chronic sinusitis.

The treatment of chronic sinusitis has four objectives: to control infection, to reduce tissue edema, to facilitate the drainage of sinus secretions and to maintain ostial permeability. Medical treatment includes antibiotics, decongestants, mucolytics, steroids and analgesics. Surgical treatment may be conservative, functional or radical. At present, "FESS" is the "Golden Standard". It is focused on the middle ostiomeatal complex and the ethmoid cells. The extent of the operation is adapted according to each case. In spite of standardization of the operative procedure, this type of surgery is risky. Most of the reported complications are minor. Major complications require an immediate aggressive medico-surgical treatment to minimize the sequelae. Precise and complete pre-operative evaluation, good preparation of the patient, meticulous and adapted surgical technique and experience acquired through a regular practice of this type of surgery play a major role to lower the risks of complications.

Administration, Topical↗
PubMed2001

[Clinico-immunological effectiveness of likopid in conservative treatment of patients with chronic tonsillitis and chronic sinusitis].

30 patients with chronic tonsillitis (CT) and 20 patients with chronic sinusitis (CS) received likopid (4 mg/day for 10 days). CT patients were additionally treated with tonsil lacunar lavage with dioxidine solution. Likopid was found effective in CT patients (good response--31%, partial response--59%). 9% did not respond to likopid. CS patients benefited less (good response--10%, partial response--50%). 40% were non-responders. In CT patients likopid demonstrated also an immunomodulating effect. Positive changes were observed in the counts of B-lymphocytes, T-lymphocytes, T-helpers, natural killers, level of serum IgG, titers of specific antibodies, functional activity of neutrophils. In CS this effect was less pronounced.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed2001

Antibiotic-resistant bacteria in pediatric chronic sinusitis.

BACKGROUND: Limited information exists on emerging bacterial resistance patterns in pediatric chronic sinusitis. METHODS: A retrospective review (1995 to 1998) of the aerobic microbiology of chronic sinusitis in children at a tertiary care children's hospital was conducted. One hundred nineteen children (mean age, 4.9 years) with maxillary sinusitis of >8 weeks duration and no known immunodeficiency or cystic fibrosis who underwent antral irrigation were included. RESULTS: One hundred sixty-one of 240 (67%) aerobic cultures were positive, yielding 274 isolates. Eighty-eight positive cultures were polymicrobial. The most frequent isolates were nontypable Haemophilus influenzae (24%), Streptococcus pneumoniae (19%), Moraxella catarrhalis (17%), coagulase-negative Staphylococcus (6%), alpha-streptococci (6%), diphtheroids (5%), Staphylococcus aureus (3%) and Neisseria spp. (3%). Rates of nonsusceptibility of Streptococcus pneumoniae were 64% for penicillin (24% high grade resistance), 40% for cefotaxime, 18% for clindamycin and 0% for vancomycin. Rates of nonsusceptibility of S. pneumoniae did not change significantly during the study period. Thirty-nine percent of H. influenzae isolates were beta-lactamase-positive and 44% were nonsusceptible to ampicillin (41% high grade resistance). Beta-lactamase positivity of H. influenzae decreased during the study period (P = 0.06). All M. catarrhalis isolates tested were beta-lactamase-positive. CONCLUSION: This study indicates that the aerobic pathogens in pediatric chronic sinusitis include bacteria typical of acute sinusitis as well as organisms more characteristic of chronic disease. Moreover it highlights the significant role of antibiotic-resistant aerobes, including multiply resistant S. pneumoniae, in pediatric chronic sinusitis.

Adolescent↗
PubMed2004

[Olfactory function and olfactory marker protein in patients with chronic sinusitis].

OBJECTIVE: To study the pathogenesis of dysosphresia in patients with chronic sinusitis, to discuss the expression and significance of olfaction marker protein in olfactory mucosa. METHODS: There were 55 cases with chronic sinusitis in the experimental group, and 11 cases in the control. All of them were first tested by subjective method, and then the olfactory marker protein in olfactory mucosa was examined by the method of immunohistochemistry. Tissue sections were observed under optical microscope. RESULTS: The ratio of dysosphresia in patients with chronic sinusitis was 50.9% (28/55), while by subjective olfactory test, it was 85.5% (47/55). The ratio of dysosphresia in control patients was 9.09% (1/11), by subjective olfactory test, it was 18.2% (2/11). Olfactory marker protein was identified in the olfactory cells and microvillar cells by histochemical and immunohistochemical technique (S-P method). CONCLUSIONS: The main cause of dysosphresia in patients with chronic sinusitis is the decrease, atrophy and degeneration of the olfactory cells, which lead to the failure of olfactus perception and recognition.

Adolescent↗
PubMed2005

[Relationship between allergic factors and chronic sinusitis with or without nasal polyps].

OBJECTIVE: To explore the effects of allergic factors in chronic sinusitis and nasal polyps. METHOD: Eosinophil in nasal secretions and allergen skin test of 1882 patients with chronic sinusitis and nasal polyps were examined before endoscopic sinus surgery. The occurrence ratios of allergic symptoms and syndromes were analyzed and compared with clinical stages of chronic sinusitis and nasal polyps. RESULTS: (1) Allergic symptoms (or syndromes) were presented in 60.4% (1137 cases) of patients in different degrees, 25.3% (477 cases) patients suffered from allergic rhinitis, 2.1% (39 cases) patients had asthma; (2) The morbidities of allergic rhinitis and asthma, the positive rates of eosinophil and allergen skin test, the occurrence rates of allergic symptoms were rising with the clinical stages in type I and type II, especially in type II stage 3; (3) There were 42.2% (795 cases) positive patients in allergen skin test, among them, 94% were sensitive to perennial allergens; (4) Allergic symptoms appeared in 26.3% (495 cases) patients, among them, 99.8% attacked perennially; (5) Of all patients, there were 38.9% (732 cases) had been operated cases before, among them 38.3% (280 cases) with allergy rhinitis. In chronic sinusitis with allergy rhinitis patients, 58.7% (477 cases) were suffered from operation. CONCLUSIONS: Allergic factors,especially perennial allergic rhinitis, are relative to clinical stages of chronic sinusitis and nasal polyps. Allergic rhinitis is an important factors in recurrence.

Adolescent↗
PubMed2005

Major secretory mucin expression in chronic sinusitis.

OBJECTIVE: The aim of this study was to investigate mucin expression in chronic sinusitis compared to that in normal nasal mucus. STUDY DESIGN AND SETTING: Sinus mucus samples were collected during functional endoscopic sinus surgery (FESS). The expression of 3 airway mucins, MUC2, MUC5AC, and MUC5B, was determined by ELISA. RESULTS: The 3 mucins are expressed in chronic sinusitis and in normal nasal mucus. MUC5AC and MUC5B represent a major component in sinus mucins while MUC5B and MUC2 predominated in normal nasal mucin. In sinus mucins, upregulation of MUC5AC was associated with downregulation of MUC2 and vice versa. This inverse relationship was strengthened in the presence of nasal polyps. CONCLUSION: At least 3 mucins are expressed at various levels in chronic sinusitis. An inverse relationship was identified between expression of MUC5AC and MUC2. Large prospective studies are required to unravel the complexities of sinus mucus in chronic sinusitis. SIGNIFICANCE: Mucins may be used as markers for assessment of disease severity and may also help as prognostic indicators following medical or surgical treatment.

Adolescent↗
PubMedDate not supplied

What is the bacteriology of chronic sinusitis in adults?

PURPOSE: Recent advances in imaging and endoscopy has increased our awareness of chronic sinusitis. The teaching has been that chronic sinusitis is mainly caused by anaerobes; however, recent studies have found that the role of anaerobes is small, especially in children. MATERIALS AND METHODS: A prospective study was conducted on 76 adults who failed medical treatment for chronic sinusitis and were scheduled for endoscopic sinus surgery. Specimens were obtained on all 76 patients at the time of surgery and were sent for aerobic and anaerobic cultures. RESULTS: Anaerobic organisms were isolated in 7.6% of the cases, and aerobes were isolated in 76.3% of the patients. The most common aerobic organism was the Staphylococcus species, whereby resistance to the most commonly used antibiotics was 21.7%. CONCLUSION: All past studies on the bacteriology in adults were made before the era of endoscopic sinus surgery and the newer-generation antibiotics. According to our results, it seems there is a change in trend in the bacteriology of chronic sinusitis in adults.

Adult↗
PubMed1992

Chronic sinusitis: an update.

An accurate history is essential to the diagnosis of chronic sinusitis. Patients classically present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, postnasal drip, ear pain or blockage, and fatigue. The headache in chronic sinusitis is usually worse in the morning and following head movement. Purulent nasal discharge, spiking fever, an elevated white blood cell count, and intense, brief headache associated with nausea and vomiting are uncommon. Palpation, transillumination of the sinuses and anterior rhinoscopy are of minimal value in making the diagnosis. Fiberoptic nasopharyngoscopy can be used to identify the source of sinus discharge and the cause of obstruction. Although plain sinus radiographs are useful in diagnosing and monitoring acute sinusitis, they are of limited value in confirming chronic sinusitis. The sinuses are better imaged with computed tomographic scanning. Prolonged antibiotic therapy, in combination with decongestants and steroids, is usually effective for chronic sinusitis. In recalcitrant cases, sinus surgery may be necessary.

Anti-Bacterial Agents↗
PubMedDate not supplied

Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitis.

UNLABELLED: Gastroesophagopharyngeal reflux (GEPR) has been suggested as a cause of pediatric sinusitis. However, its contribution to the pathogenesis of chronic sinusitis in adults has not been systematically investigated. We evaluated the prevalence of GEPR in 11 CT confirmed chronic sinusitis patients (51 +/- 4 years) who had not responded to conventional therapy, and 11 normal healthy controls (44 +/- 7 years). A 3-site ambulatory esophagopharyngeal pH monitoring technique (probe location: 2 cm proximal, 3-4 cm distal to UES and 5 cm proximal to LES high pressure zones) was used. A pharyngeal pH drop was accepted as a true reflux event only if it was coincident with or preceded by esophageal pH declines of a similar or larger magnitude. Studies were performed while subjects were on a uniform 2500 calorie diet (provided). RESULTS: Ambulatory pH monitoring documented GEPR in seven of 11 patients (1-12 episodes) and two of 11 normal volunteers (1,2 episodes) (p < 0.05). A total of 34 nonbelch related pharyngeal acid reflux events were identified in patients, but none was associated with coughing. In both groups, all pharyngeal acid events occurred in the upright position. Compared to normal controls prevalence of pharyngeal reflux of gastric acid is significantly higher in patients with chronic sinusitis unresponsive to conventional therapy and suggests a different esophagopharyngeal distribution pattern of gastric refluxate in this patient group; these findings suggest that GEPR may contribute to the pathogenesis of chronic sinusitis in some adult patients.

Adult↗
PubMed2003

[Exploring of surgery solution for chronic sinusitis treatment and application of partial middle turbinectomy].

OBJECTIVE: To explore the effective surgery solution for chronic sinusitis treatments and the effect of partial middle turbinectomy which excise the head of middle turbinate in treating chronic sinusitis. METHOD: The chronic sinusitis patients were divided into three groups due to its cause and its specific ill state, each group was treated with suitable surgery solution. RESULT: Thirty-nine were cured and 4 improved of 43 sides in the first group. 69 were cured, 10 improved and 2 ineffective in 81 sides for the second group. 17 were cured, 9 improved and 5 ineffective in 31 sides for the third group. The collective statistics showed that 80.6% were cured and the total effective rate were 95.5%. CONCLUSION: Different surgery solutions can be chosen in the treatment of chronic sinusitis based on its cause and its specific ill state, and partial middle turbinectomy have important effect.

Adolescent↗
PubMed1995

Bacteriology of chronic otitis media, chronic sinusitis, and paranasal mucopyocele in Japan.

A bacteriologic study of cases of chronic otitis media, chronic sinusitis, and paranasal mucopyocele diagnosed at Gifu University Hospital was performed between 1989 and 1992. Bacteria were isolated from all of 13 samples of discharge from the ears of patients with chronic otitis media, all of 14 mucosal biopsy specimens from patients with chronic sinusitis, 8 of 10 aspirate samples from patients with chronic sinusitis, and 9 of 15 aspirates samples from patients with mucopyocele. Cultures often yielded polymicrobial growth, with an average of 3.1, 3.8, and 4.2 species per positive specimen from chronic otitis media, chronic sinusitis, and mucopyocele, respectively. The most commonly encountered anaerobes were Peptostreptococcus, Propionibacterium, and Prevotella species; the most common aerobes were Staphylococcus and Streptococcus species. One strain of Prevotella melaninogenica highly resistant to ampicillin and two strains of Peptostreptococcus resistant to cefaclor were found.

Adolescent↗
PubMed1999

Analysis of HLA antigens in Japanese patients with chronic sinusitis.

OBJECTIVES: Genetic factors likely play a role in the etiology of chronic sinusitis and this disease is often associated with diffuse panbronchiolitis, which is strongly associated with HLA B54 antigen. The purpose of this study is to examine whether genetic factors are involved in the pathogenesis of chronic sinusitis. STUDY DESIGN: Eighty-two Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells in plain X-ray films. METHODS: Both class I and class II HLA antigens were analyzed by conventional microcytotoxicity assays in these patients and 176 healthy control subjects. RESULTS: In class I antigens, B54 antigen significantly increased in the patient group (antigen frequency = 29.3%, relative risk = 3.23, corrected P value = .037) compared with normal control group (antigen frequency = 11.4%). For class II antigens, no antigens were significantly increased. CONCLUSION: These data indicate that certain genetic factors play a role in the etiology of chronic sinusitis.

Adolescent↗
PubMed2000

Is there a correlation between radiographic and histologic findings in chronic sinusitis?

OBJECTIVE: To determine if the degree of radiologic changes noted on computed tomography (CT) scan correlate with the severity of histologic changes. DESIGN: Retrospective analysis. SETTING: Academic tertiary care centre. METHODS: Sixty consecutive patients undergoing endoscopic sinus surgery for chronic sinusitis, with complete data obtained for 131 sinuses. MAIN OUTCOME MEASURES: Paranasal sinus CT scans and pathologic reports were examined. Respective findings were graded as mild, moderate, or severe, and the results were analyzed for agreement. CT scan grading was based on the extent of sinus opacification and pathologic grading was determined by the number of inflammatory cells found in the sinus mucosa. RESULTS: Of the 51 ethmoid sinuses, agreement between the radiographic and histologic grading occurred in 32 or 62.7%. In the maxillary group, a 57.1% (24 of 42) correlation was noted. Of the 20 frontal sinuses, agreement occurred in 8 or 40%, whereas a 22.2% (4 of 18) correlation was present in the sphenoid group. CONCLUSION: This study suggests that the severity of sinus disease based on preoperative CT scan does not correlate with the histologic degree of disease.

Chronic Disease↗
PubMed1995

Techniques for outcomes research in chronic sinusitis.

Accurate assessment of patient outcome after sinus surgery requires the collection of valid and reliable data. Symptom-based surveys were administered in a prospective manner to 104 patients with chronic sinusitis. Test-retest reliability for the Chronic Sinusitis Survey based on duration of symptoms (0.86, P < .0001) was superior to that for a similar survey based on severity of symptoms (0.57, P < .0001). Results of the Chronic Sinusitis Survey also correlated significantly with subscales of a general health assessment in the extent to which chronic sinusitis limits physical activity (0.40, P < .01), interferes with work or other activities (0.36, P < .01), and affects patient perception of bodily pain (0.46, P < .001). The Chronic Sinusitis Survey is an efficient and reliable method to follow health status and health-related quality of life outcomes in patients with chronic sinusitis.

Activities of Daily Living↗
PubMed2001

Bacteriology of chronic sinusitis after amoxicillin-clavulanate potassium therapy.

The bacteriology of chronic sinusitis was studied after amoxicillin-clavulanate potassium therapy. Patients with chronic sinusitis were randomly divided into 2 groups. In the study group, 90 patients were given a 2-week course of amoxicillin-clavulanate potassium before functional endoscopic sinus surgery. In the control group, 113 patients did not take any antibiotics within 2 weeks before the surgery. Swab specimens were taken from the maxillary and ethmoid sinuses during surgery and sent for aerobic and anaerobic culture. In the study group, the culture rates of maxillary and ethmoid sinuses were 45.6% and 28.9%, respectively. In the control group, the culture rates of maxillary and ethmoid sinuses were 53.1% and 34.5%, respectively. The culture rates between the control group and the study group were not significantly different, either for the maxillary sinus or the ethmoid sinus. This showed that treatment with amoxicillin-clavulanate potassium did not change the bacteriology of chronic sinusitis.

Adolescent↗
PubMed2004

Nasopharyngeal pH monitoring in chronic sinusitis patients using a novel four channel probe.

OBJECTIVE: To determine the prevalence of acid reflux into the nasopharynx in patients with chronic sinusitis. STUDY DESIGN: Prospective study of patients presenting to a specialist rhinology practice with chronic sinusitis. METHODS: Forty patients with chronic sinusitis underwent ambulatory 24 hour pH testing. The mean age of the patients was 56.3 years (25 Female, 15 Male). The studies were performed using a specially developed bifurcated 4 channel pH probe, incorporating 2 circumferential sensors positioned at the naso- and hypo-pharynx, and 2 unidirectional sensors positioned at the proximal and distal esophagus. RESULTS: The circumferential band sensors yielded a stable recording largely free of artefact allowing meaningful recordings to be obtained from thirty-seven patients. Twelve patients (32.4%) were diagnosed with gastroesophageal reflux. A total of 809 reflux episodes were recorded. Of these, 596 (73.7%) reached the distal esophagus, with 187 (23.1%) and 24 (3.0%) reaching the proximal esophagus and hypopharynx respectively. Only 2 episodes (0.2%) were recorded in the nasopharynx. This occurred in 2 of 37 patients (5%). CONCLUSIONS: Acid reflux into the nasopharynx is a rare event in patients with chronic sinusitis even though a significant proportion (32.4%) have abnormal 24 hour pH studies. It is likely that alternative mechanisms other than direct acid contact are involved in the pathogenesis of chronic sinusitis.

Adult↗
PubMed2001

Immunoglobulin classes, complement factors and circulating immune complexes in chronic sinusitis patients.

Serum concentrations of immunoglobulin classes (IgG, IgA and IgM), complement factor B (FB), 4th complement factor (C4) and circulating immune complexes (CIC) were determined in 34 Nigerians with chronic sinusitis and 37 apparently healthy age and sex matched controls by single radial immunodiffusion and polyethylene glycol precipitation methods, respectively. The mean serum IgG, IgA, C4, FB and CIC were significantly reduced in chronic sinusitis patients compared with the controls. The mean serum levels of IgG, IgM, C4 and FB were higher in male chronic sinusitis patients compared with female patients. In contrast the mean serum level of IgA was significantly reduced in chronic sinusitis patients. Only IgG and IgA showed significant correlation with the duration of chronic sinusitis. These findings in Nigerian patients suggest immuno-deficiency as one of the causes of chronic sinusitis in Nigerians, therefore routine serum immunoglobulin evaluation is recommended and if found deficient immunoglobulin replacement therapy is advocated for the treatment of such chronic sinusitis.

Adolescent↗
PubMedDate not supplied

Antimicrobial resistance in bacterial chronic sinusitis.

Recent reports describe the emergence of antimicrobial resistant bacteria in acute sinusitis and an increased incidence of enteric gram negative bacilli in chronic sinusitis. The objective of this cross sectional study is to identify the emergent resistance patterns in bacterial chronic sinusitis. Specifically, this article seeks to characterize the bacteriology of outpatient chronic sinusitis, then to compare the antimicrobial susceptibilities of the bacterial isolates with standard culture data from a tertiary care center. Between March and August, 1994, 113 new outpatients presented with chronic sinusitis at a major teaching institution. Of these patients 34 underwent endoscopically guided aerobic culture of the paranasal sinuses and nasal cavities. Of the 48 total cultures, there were 43 positive cultures yielding 72 isolates. Thirty-eight cultures had two or fewer isolates; four cultures had three plus isolates, and one culture grew out normal flora. The most frequently isolated organisms were coagulase negative Staphylococcus (SCN), 20 (28%); Pseudomonas aeruginosa, 12 (17%); and Staphylococcus aureus, 9 (13%). Within the limited sample size for each isolate, Staphylococcus coagulase negative, Pseudomonas, and Pneumococcus demonstrated higher antimicrobial resistance compared to the medical center's corresponding nonurinary isolates. Additionally, three of six patients with Pseudomonal aeruginosa (50%) had a quinolone resistant strain. These preliminary data suggest that both an increased incidence of antimicrobial resistance and of enteric gram negative bacilli may exist in these outpatient, tertiary care center patients with chronic bacterial sinusitis.

Adolescent↗