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PubMed1994

Normalization of maxillary sinus mucosa after FESS. A prospective study of chronic sinusitis with nasal polyps.

To observe the normalization of antral mucosa after FESS, 71 patients suffering from chronic sinusitis with nasal polyps were enrolled in this study. Pre-operative profiles including history, allergy skin test, and saccharin time test were done. Endoscopic findings of the antral mucosa were divided into 3 groups: polyposis, oedema, and thickening. The time sequence required for normalization of the mucosa was observed through the antromeatal opening. A patient's history of more than seven years, a saccharin time longer than 36 min, and polyposis of antral mucosa are ominous signs for recovery. The most frequent endoscopic finding of maxillary sinusitis is oedema and many of the sinus units (42%) gained complete recovery during the third month. Pre-operative profiles and endoscopic findings during surgery can serve as a reference of recovery time and treatment modality.

Chronic Disease↗
PubMed2006

Does gastroesophageal reflux contribute to the development of chronic sinusitis? A review of the evidence.

Although recent studies suggest that gastroesophageal reflux disease (GERD) may contribute to a variety of ear, nose and throat and pulmonary diseases, the cause-and-effect relationship for the vast majority remains far from proven. In this article, the evidence supporting a possible causal association between GERD and chronic sinusitis has been reviewed. The evidence would suggest that: (i) a higher prevalence of GERD and a different esophagopharyngeal distribution of the gastric refluxate occurs in patients with chronic sinusitis unresponsive to conventional medical and surgical therapy compared to the general population; (ii) a biologically plausible pathogenetic mechanism exists whereby GERD may result in chronic sinusitis; and (iii) clinical manifestations of chronic sinusitis respond variably to antireflux therapy. While these findings suggest that GERD may contribute to the pathogenesis of chronic sinusitis in some patients, it is apparent that the quality of the evidence supporting each of these three lines of evidence is low and therefore does not conclusively establish a cause-and-effect relationship. A number of unresolved issues regarding prevalence, pathophysiological mechanism, diagnosis and treatment exist that deserve further investigation in order to solidify the relationship between GERD and chronic sinusitis. In conclusion, given the possible relationship between GERD and chronic sinusitis, until more convincing data are available, it may be prudent to investigate for GERD as a potential cofactor or initiating factor in patients with chronic sinusitis when no other etiology exists, or in those whose symptoms are unresponsive to conventional therapies.

Algorithms↗
PubMed1996

[Proliferating cell nuclear antigen (PCNA) immunolocalization in human nasal epithelium with chronic sinusitis detected by confocal laser scanning microscopy].

This study examines the immunohistological localization of proliferating cell nuclear antigen in the nasal and paranasal sinus epithelium from a group of patients undergoing sinus surgery for chronic sinusitis. PCNA immunoreactivity as determined by fluorescence intensity and the density of labeled cells as assessed by confocal laser scanning microscopy. The control group consisted of seven specimens taken from patients with post operative maxillary cyst and optic nerve canal fracture. In this group, most of the labeled cells were located on the basal cell layers with a few on the intermediate cell layers. The average labeled cell densities were 57.3 cells/mm2 on the basal cell layers and 15.9 cells/mm2 on the intermediate cell layer. The sinusitis group consisted of eleven patients. In contrast with the control group, the sinusitis epithelium displayed a significantly high proportion of goblet and intermediate cells positively stained for PCNA. The average densities were 84.9 cells/mm2 on the basal cell layers and 133.1 cells/mm2 on the intermediate cell layers in this group, the latter being nearly ten fold greater than that in the control group. Epithelial PCNA expression was correlated with the degree of inflammatory cell infiltration assessed by serial sections for each sample. A positive correlation was observed between these two factors (R = 0.63, Pearson). We believe that epithelial cell turnover is accelerated in chronic rhinosinusitis due to continuous exposure to various pathogens and host immune interventions. In those cases, goblet and intermediate cells would play the major role in enhanced epithelial proliferation.

Chronic Disease↗
PubMed1999

Complementary therapeutic practices in patients with chronic sinusitis.

Understanding patient use of alternative and complementary modalities to treat chronic health conditions is an important component to providing holistic care. This study sought to identify traditional and complementary therapies used by patients with chronic sinusitis. Eighty-one percent of patients with chronic sinusitis engaged in physical exercise to relieve symptoms. Additional complementary therapies utilized included herbal therapy (32%), chiropractic therapy (16%), biofeedback (13%), acupuncture (11%), and chelation therapy (7%). Medications were commonly used by patients (60%), especially those with severe symptoms. By recognizing and incorporating effective complementary therapies into care for chronic sinusitis, nurse practitioners may help patients to improve their clinical outcomes.

Adult↗
PubMed2002

Comparative evaluation of functional endoscopic sinus surgery and conventional surgery in the management of chronic sinusitis.

Fifty patients with signs and symptoms of chronic sinusitis and refractory to medical treatment constituted this study. They were divided at random into two groups of 25 patients each. Group A (study group) patients were subjected to functional endoscopic sinus surgery (FESS) and group B (control group) patients were treated by conventional surgery. The age of the patients varied from 16-55 years (mean 29.1). Out of 25 patients in the study group, 19(76%) had complete relief of symptoms, 4(16%) had partial relief of symptoms and 2(8%) had no relief of symptoms in the follow-up period of 15-33 months (mean 19.2 months). Out of 25 patients in the control group, 15(60%) had complete relief of symptoms, 4(16%) had partial relief of symptoms and 6(24%) had no relief of symptoms in the follow-up period of 15-33 months (mean 19.2 months). The results of this series revealed that FESS had the combined advantages of precise, atraumatic removal of the disease with minimal morbidity and at the same time retaining the physiological function of the nose and paranasal sinuses.

Adult↗
PubMedDate not supplied

Bacteriology of chronic sinusitis after ampicillin therapy.

The bacteriologies of the maxillary and ethmoid sinuses were studied in 74 chronic sinusitis patients who took ampicillin (500 mg every 6 hours) for 2 weeks preoperatively. The specimens from one ipsilateral maxillary and ethmoid sinuses were obtained when undergoing functional endoscopic sinus surgery. In 74 specimens of the maxillary sinus, 38 bacterial isolates were recovered. The culture rate was 46.0%. On the other hand, 34 bacterial isolates were taken from the ethmoid sinus specimens. The culture rate was 41.9%. As compared with a previous group who did not take any antibiotic preoperatively, the culture rate significantly decreased in the maxillary as well as the ethmoid sinus specimens. Not surprisingly, a significantly decreased sensitivity to ampicillin was also found in the recovered bacteria from both the maxillary sinus (23.7%) and ethmoid sinus (5.9%) specimens. These results demonstrate that antibiotic therapy with ampicillin could eradicate most sensitive bacteria in chronic sinusitis. However, persistence of resistant bacteria was demonstrated.

Adolescent↗
PubMed1998

The effect of endoscopic sinus surgery on mucociliary clearance in patients with chronic sinusitis.

The saccharin test was used to measure mucociliary clearance in 50 patients with symptoms of chronic sinusitis. Samples of the nasal mucosa were also examined under transmission electron microscopy before and after functional endoscopic sinus surgery (FESS). Before surgery, the mean saccharin clearance (ST) was 37.0 +/- 15.7 min, with nasal mucosa exhibiting ciliary loss as well as other ultrastructural changes. Three months after surgery, the mean ST had improved to 20.3 +/- 7.5 min and significant regeneration of cilia was observed. It was therefore concluded that FESS had successfully corrected mucociliary dysfunction in these patients.

Adolescent↗
PubMed1997

Antioxidant levels in the nasal mucosa of patients with chronic sinusitis and healthy controls.

BACKGROUND: Imbalances between oxidant formation and antioxidative defense are associated with the pathogenesis of several chronic inflammatory disorders of the respiratory tract. Therefore, a role of oxidative stress in chronic upper airway tract infections can be anticipated. OBJECTIVE: To determine if patients with chronic sinusitis demonstrate a reduced antioxidative tissue status. DESIGN: The levels of 3 biologically important antioxidants, reduced glutathione and oxidized glutathione, uric acid, and vitamin E, were determined biochemically in mucosal biopsy specimens from the uncinate process of patients with chronic sinusitis and healthy controls. SUBJECTS: Inflamed mucosa samples were obtained from 9 patients with chronic sinusitis during functional endoscopic sinus surgery. Normal mucosa samples were collected from 10 healthy controls during surgery for nasal obstruction. RESULTS: The data (presented as mean +/- SD) show a significant reduction (P < or = .05) of reduced glutathione levels (0.3 +/- 0.1 mumol/g wet weight) and uric acid levels (2.7 +/- 0.4 mumol/g wet weight) in mucosa samples obtained from patients with chronic sinusitis compared with healthy controls (0.6 +/- 0.2 and 3.4 +/- 0.6 mumol/g wet weight, respectively). No difference was found in oxidized glutathione (24 +/- 8 vs 25 +/- 15 nmol/g wet weight) and vitamin E (20.5 +/- 7.9 vs 22.5 +/- 6.9 nmol/g wet weight) levels between both groups. CONCLUSIONS: Decreased levels of both reduced glutathione and uric acid in patients with chronic sinusitis lead to a diminished antioxidant defense, which may be associated with the pathogenesis of upper respiratory tract disorders. The vitamin E level seems less important. This finding may offer perspectives for pharmacotherapeutic intervention with antioxidants.

Case-Control Studies↗
PubMed2002

The role of interleukin-12, and tissue antioxidants in chronic sinusitis.

BACKGROUND: The role of cytokines and reactive oxygen species formation in the pathogenesis of chronic sinusitis is still not fully understood. This work was designed to determine if patients with chronic sinusitis demonstrate altered levels of serum IL-12 and/or tissue antioxidants. SUBJECTS AND METHODS: Mucosal biopsy specimens from the uncinate process of patients with chronic sinusitis were obtained from 52 patients using functional endoscopic sinus surgery. Normal mucosa samples were collected from 20 healthy controls. Patients' group was further classified according to computerized tomography findings into mild and severe subgroups. Serum IL-12 was estimated using enzyme immunoassay (EIA). The levels of tissue uric acid, and reduced glutathione were determined biochemically, alpha-tocopherol was measured by HPLC. Superoxide dismutase (SOD) activity was determined by spectrophotometry. RESULTS: A significant decrease in serum IL-12, tissue alpha-tocopherol and SOD in patient group was demonstrated (p < 0.05). Tissue uric acid and reduced glutathione showed primary increase in mild subgroup followed by significant drop in severe subgroup (p < 0.05). Negative significant correlation was observed between glutathione, uric acid, and SOD, and the severity of the disease (p < 0.05) independent of the cellularity of the biopsy. CONCLUSION: The presented data suggests a possible role of IL-12, and tissue antioxidants in development and progression of chronic sinusitis. Adjuvant antioxidant treatment may have role in achieving better prognosis of the disease.

Antioxidants↗
PubMedDate not supplied

Interleukin-8 gene expression in chronic sinusitis.

PURPOSE: Interleukin-8 (IL-8), a monocyte-derived and macrophage-derived cytokine, displays potent chemotactic activating properties toward neutrophils and thus may contribute to the pathogenesis of chronic sinusitis. The object of this investigation was to show the expression of the IL-8 gene in chronic sinusitis by Northern blot analysis and a reverse transcription-polymerase chain reaction (RT-PCR). MATERIALS AND METHODS: For Northern blot analysis, RNAs were extracted from maxillary mucosa and nasal polyps from two patients with chronic sinusitis, respectively, and from the inferior turbinate of a nasal allergy patient. For RT-PCR, RNAs were extracted from 11 patients with chronic sinusitis, 8 patients with allergic rhinitis, and 4 patients with hypertrophic rhinitis. RESULTS: Whereas IL-8 mRNA was expressed in the maxillary mucosa, IL-8 transcript was not detected in the inferior turbinate by Northern blot analysis. IL-8 transcripts were detected in 45% of chronic sinusitis RNAs (5/11) and in 50% of allergic rhinitis RNAs (5/10) by RT-PCR. CONCLUSION: These data suggest IL-8 may contribute to neutrophil involvement in chronic sinusitis.

Adolescent↗
PubMed2002

Role of anaerobes in chronic sinusitis: Will polymerase chain reaction solve the debate.

BACKGROUND: Bacteriology of chronic sinusitis continues to be a matter of debate, particularly the role of anaerobes. Some authors suggest that anaerobes play a significant role whereas others suggest a minimal role. Those who suggest a significant role argue that standard culture techniques are the culprits. OBJECTIVE: The purpose of this study was to use polymerase chain reaction (PCR) on sinus specimens for the presence of anaerobes and to compare them with standard culture techniques. METHODS: Sixty-four samples were obtained in a sterile fashion during sinus surgery and were sent for standard anaerobic cultures as well as anaerobic PCR analysis. RESULTS: Anaerobic bacteria were demonstrated in 5% of culture specimens, which is similar to recently published data. PCR identified anaerobic bacteria in 19% of the specimens (P = 0.01). CONCLUSION: PCR analysis of surgical samples obtained during endoscopic sinus surgery for chronic sinusitis identified a significantly higher incidence of anaerobes (x4) compared with standard anaerobic culture technique.

Adolescent↗
PubMed2005

[Correlative study of nuclear factor-kappa B activity and cytokine expression in chronic sinusitis].

OBJECTIVE: To investigate the correlation between nuclear factor-kappa B (NF-kappaB) activity and cytokine expression in nasal mucosa of chronic sinusitis. METHODS: IL-5, IL-6 and IL-8 levels in nasal mucosa were assayed by the method of ELISA in 52 cases of chronic sinusitis [concomitant with allergic rhinitis (AR group), without allergic rhinitis (NAR group)] and 12 normal subjects. Semi-quantitative RT-PCR and immunohistochemical staining were used to examine P50 and P65 subunits of NF-KB expressions and activation in nasal mucosa. The correlation between activities of NF-KB P50 and P65 subunits and cytokine expression was evaluated. RESULTS: IL-5, IL-6 and IL-8 levels in both AR and NAR groups were significantly increased (all P < 0.01 for AR group; P < 0.05, 0.05, 0.01, respectively, for NAR group, as compared with normal group), and the levels were much higher in AR group than that in NAR group (P < 0.01, 0.05, 0.01, respectively). The levels of P50 and P65 mRNA in both AR and NAR groups were enhanced (all P < 0.01 for AR group; all P < 0.01 for NAR group, as compared with normal group), and AR group had markedly greater P50 and P65 mRNA levels in comparison with NAR group (both P < 0.05). Immunohistochemical study revealed that nucleus-present rates of P50 and P65 in both AR and NAR groups were significantly higher than those of control group (all P < 0.01), and they were much greater in AR group as compared with NAR group (all P < 0.01). Pearson correlation analysis demonstrated that P50 and P65 nucleus-present rates were closely correlated with IL-6 and IL-8 levels, but not IL-5. The correlation coefficient was 0. 49 for P50 and IL-6, 0. 54 for P50 and IL-8, 0. 61 for P65 and IL-6, and 0.66 for P65 and IL-8 (all P < 0.01). CONCLUSIONS: Activation of P50 and P65 subunits of NF-kappaB might be one of the mechanisms for induction of IL-6 and IL-8 expression in chronic sinusitis. Concomitance of allergic rhinitis with chronic sinusitis further increased activities of NF-kappaB subunits, and further elevated IL-6 and IL-8 expression. IL-5 expression was independent of NF-kappaB pathway in chronic sinusitis.

Adult↗
PubMed2001

Fosfomycin nebulizer therapy to chronic sinusitis.

OBJECTIVE: effects of Fosfomycin (FOM) nebulizer therapy were studied in patients with chronic sinusitis. METHODS: about 28 patients with chronic sinusitis were administered 2 ml of FOM sodium (3% w/v) by nebulizer three times per week for 4 weeks. Levels of IL-1 beta, IL-6, IL-8, and TNF-alpha in nasal lavage were also measured before and at the end of treatment. RESULTS: the overall efficacy of this treatment on the basis of both subjective and objective symptoms, was 'excellent' for 28.6%, 'good' for 10.7%, 'fair' for 39.4%, and yield 'no change' for 21.4% of the patients. Both IL-1 beta and IL-6 concentrations were significantly decreased after treatment. Although the IL-8 level did not significantly decrease, it seems to be related to the overall efficacy. TNF-alpha was not detected in all of the samples. CONCLUSION: FOM nebulization therapy is highly effective in treatment for chronic sinusitis, and efficacy may be due to an immunomodulatory mechanism, as well as its bactericidal effect.

Adolescent↗
PubMed2004

Evidence of bacterial biofilms in human chronic sinusitis.

The purpose of this study was to evaluate whether bacterial biofilms exist on the sinus mucosa surfaces of human subjects with recalcitrant chronic sinusitis. Scanning electron microscopy was used to evaluate patients with continued symptoms of chronic sinusitis despite prior appropriate medical and surgical management. Morphologic structures that confirm the presence of bacterial biofilms were identified on the sinus mucosa of patients infected with Pseudomonas aeruginosa, a known biofilm former. The presence of bacterial biofilms may explain the recalcitrant nature of some forms of chronic sinusitis.

Biofilms↗
PubMed2003

Bacteriologic findings in patients with chronic sinusitis.

We studied the bacteriology of maxillary sinus aspirates obtained from patients diagnosed with chronic sinusitis. We recovered 659 strains from 510 aspirates; of these, 572 (86.8%) were aerobes and 87 (13.2%) were anaerobes. Aerobes only were recovered from 310 of the 510 specimens (60.8%) and anaerobes only from 31 (6.1%). Among the 572 aerobic bacteria, the most prevalent organisms were Streptococcus viridans (158 strains [27.6%]), Streptococcus pneumoniae (67 [11.7%]), Corynebacterium species (66 [11.5%]), Staphylococcus aureus (54 [9.4%]), Moraxella catarrhalis (38 [6.6%]), Hemophilus parainfluenzae (33 [5.8%]), and group C beta-hemolytic streptococci (26 [4.5%]). Among the 87 recovered anaerobes were species of Peptostreptococcus (32 strains [36.8%]), Prevotella (22 [25.3%]), Actinomyces (13 [14.9%]), Propionibacterium (11 [12.6%]), Fusobacterium (8 [9.2%]), and Veillonella (1 [1.1%]). Beta-lactamase production was detected in 115 of the 572 aerobic strains (20.1%) and in 10 of the 87 anaerobic strains (11.5%). We found that the prevalence and type of organisms we identified in chronic sinusitis did not differ substantially from those reported in previous studies. Our study is one of the more extensive reports on the type and prevalence of pathogens in chronic sinusitis that has been published to date.

Adolescent↗
PubMed2002

Morpho-functional evaluation of osteomeatal complex in chronic sinusitis by coronal CT.

The objective was to determine whether or not there exists a clinical-radiological correlation in chronic sinusitis of anterior paranasal sinus and to quantitatively evaluate the importance of osteomeatal complex structures and anatomic variants in chronic sinusitis etiopathology. We analyzed 208 nasal fossae with high-resolution and low-irradiation coronal computed tomography. The following inclusion criteria we established: one case control and one control group. We considered any chronic thickness of sinusal mucosal as a radiological indicator of chronic sinusitis. We evaluated the mucosal thickness of internal, external, superior and inferior maxillary walls, the addition of four maxillary walls and the maximal mucosal thickness in frontal sinus and anterior ethmoidal cells. We also obtained 15 parameters of osteomeatal complex structures and anatomical variants in each nasal fossa, and we correlated them statistically with chronic sinusitis radiological indicators. Uncinate process length is the only anatomic element from which we have been able to obtain a statistically significant cut point between case and control groups, but only with a sensitivity of 51.6%, specificity of 71.2%, positive predictive value of 74.2%, and negative predictive value of 47.9%. No association of radiological parameters exists that can explain chronic sinusitis.

Adult↗
PubMedDate not supplied

Bacteriology of chronic sinusitis in relation to middle meatal secretion.

BACKGROUND: The bacteriology of chronic sinusitis has been studied widely, but some factors may affect the results, such as sample sources and sampling techniques. However, whether the presence of secretion in the middle meatus affects the culture result has been studied rarely. METHODS: When patients with chronic sinusitis underwent functional endoscopic sinus surgery, swab specimens were taken from the ipsilateral middle meatuses and ethmoid sinuses under endoscopic guidance. While taking specimens from the middle meatuses, we observed the presence of secretions in the middle meatuses. The severity of chronic sinusitis was evaluated by preoperative computed tomography, which was scored by the Lund-Mackay system. The scores of the frontal, anterior ethmoid, maxillary sinus, and ostiomeatal complex were cumulated. RESULTS: Between March 2001 and February 2004, 210 pairs of specimens were collected. The secretion was present in 82 middle meatuses and was absent in the other 128 middle meatuses. The culture rates of middle meatus and ethmoid sinus specimens were 70.7 and 51.2%, respectively, for patients with secretions in the middle meatuses and 53.1 and 44.5%, respectively, for patients without secretions in the middle meatuses. The culture rate was significantly different for middle meatus specimens (p = 0.011) and the mean cumulated computed tomography score also was significantly higher in patients with secretions in the middle meatuses than in patients without secretions in the middle meatuses (p < 0.001). CONCLUSION: The results of this study suggest that the presence of secretion in the middle meatus indicates more severe disease in the anterior group of paranasal sinuses.

Adolescent↗
PubMed1983

Mucociliary clearance in chronic sinusitis: related human nasal clearance and in vitro bullfrog palate clearance.

Nasal mucociliary clearance was measured in both healthy subjects and patients with chronic sinusitis using saccharin granule technique. Nasal mucociliary transit time (ST) was significantly slower in the patients with chronic sinusitis compared with that in controls (p less than 0.005). Nasal mucus collected from each nasal cavity was used for in vitro bullfrog palate clearance studies and compared to the in vivo nasal ST. Mucociliary clearance rate (MTR) on frog palate was 12.5 +/- 2.5 mm/min in the mucus from control subjects, 6.1 +/- 1.5 mm/min in the mucus from the patients. The difference was statistically significant (p less than 0.005). The MTR on frog palate in the patients whose nasal ST was within normal range was significantly slower than that in controls (p less than 0.005), but not significantly different from that in the patients whose nasal ST was over the normal range. These results suggest that the nasal mucous properties which decreased the mucociliary clearance on frog palate did not contribute to the mucociliary clearance of the patients who had a normal one. No significant correlation existed between MTR on frog palate and nasal ST in both control and chronic sinusitis. In chronic sinusitis patients, decelerated nasal ST was recovered significantly by normal saline nebulization compared with the value before the nebulization (p less than 0.01). None of the significant change of ST was observed in control before and after the nebulization.

Adolescent↗