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PubMedDate not supplied

Detection of rhinovirus in turbinate epithelial cells of chronic sinusitis.

BACKGROUND: In contrast to the well-established association of rhinovirus (RV) with acute sinusitis, little is known about the role of RV infections in the pathogenesis of chronic sinusitis. Therefore, we assayed the nasal cavity mucosae of chronic sinusitis patients lacking signs of acute viral infection for the presence of RV. METHODS: Nasal lavage fluids and turbinate epithelial cells from 39 sinusitis patients and 27 control subjects were tested. Turbinate epithelial cells were collected using a Rhino-probe mucosal curette. Picornavirus was assayed by an initial reverse-transcription polymerase chain reaction (PCR), and picornavirus-positive samples were assayed by nested reverse-transcription PCR to detect RV. RESULTS: All lavage fluids from both groups, as well as control epithelial cells, were negative for picornavirus. In contrast, 8 of 39 (21%) epithelial cell samples from sinusitis patients were positive for picornavirus. RV-specific nested-PCR revealed that all eight of these samples were positive for RV. CONCLUSION: The detection of RV in the turbinate epithelial cells of chronic sinusitis patients suggests that RV may be important in the pathogenesis of chronic sinusitis.

Adult↗
PubMedDate not supplied

Applications of in situ hybridization techniques in the diagnosis of chronic sinusitis.

The clinical significance of positive bacterial cultures in chronic sinusitis is often difficult to assess. Contaminants from surface colonization of the sinus mucosa may be difficult to distinguish from true intramucosal or bone involvement. Furthermore, tissue Gram stains are frequently unable to demonstrate the presence of bacteria in tissue despite endoscopic evidence of active sinusitis. In situ hybridization (ISH) techniques using bacterial rRNA probes were applied to evaluate the presence of intramucosal and intraosseous bacteria in chronic sinusitis surgical specimens. A total of 22 specimens of chronically inflamed human ethmoid bone were evaluated by ISH and by Gram stain. In three specimens, ISH identified bacterial rRNA within sinus mucosa and mucin. Notably, in these three ISH-positive specimens, Gram stain was negative in two. No specimen showed evidence of bacterial rRNA within bone. These preliminary results suggest that in situ hybridization may be a useful adjunct to current methods of detecting microorganisms within chronically infected sinus tissue.

Adult↗
PubMed2005

Comparison between polymerase chain reaction and fungal culture for the detection of fungi in patients with chronic sinusitis and normal controls.

CONCLUSION: PCR using panfungal gene primers is a more sensitive method for fungus detection than fungus culture, both in patients with chronic sinusitis and in normal controls. The presence of fungi alone, however, was insufficient to implicate them as pathogens in chronic sinusitis. OBJECTIVE: Previous findings have suggested that polymerase chain reaction (PCR)-based methods are more sensitive and reliable than conventional culture methods for the detection of fungal DNA. We therefore compared these methods in 82 patients with chronic sinusitis and 40 normal controls. MATERIAL AND METHODS: The noses of the subjects were irrigated with sterile saline, and the samples collected. The sediment from each irrigation was used for fungus culture and PCR analysis. RESULTS: PCR analysis using panfungal gene primers showed that 76/82 (92.5%) patients with chronic sinusitis and 39/40 (97.5%) normal controls were positive. In contrast, fungus cultures were positive in 19/82 (23.2%) patients with chronic sinusitis and 12/40 (30.0%) normal controls. We observed no significant between-group differences in the prevalence of fungus or in the fungal species detected.

Adolescent↗
PubMed1996

Do antral washouts have a place in the current management of chronic sinusitis?

Antral washouts have been widely used in the management of chronic sinusitis. With the advent of modern antibiotics and powerful topical nasal steroids, we sought to establish if a role remains for this procedure. One hundred and fourteen patients with chronic sinusitis were randomised into two groups. Patients in Group A received antral washouts followed by antibiotics and topical nasal steroids. Patients in the Group B received antibiotics and topical nasal steroids alone. In each group 51.6 per cent and 50 per cent of patients respectively improved with treatment. The outcome of treatment is also not influenced by endoscopic abnormality. The difference was not statistically significant (p = 0.86). The study indicates that half of patients with chronic sinusitis will improve with medical treatment but the addition of antral washout confers no additional benefits.

Adolescent↗
PubMed1984

[Endoscopy of the maxillary sinus. Diagnostic and therapeutic value in chronic sinusitis].

Sinus endoscopy is now well established as an essential exploratory procedure for the study of rhinosinus affections. By direct endocavitary observation, after identification and evacuation of possible secretions, it enables the anatomical and functional state of the mucosa to be studied, as well as that of the ostial region. For the maxillary sinus, the most easily accessible, direct endoscopic examination has become indispensable for a precise diagnosis of any chronic inflammatory or infections process, when associated with cyto-bacteriologic, colorimetric, manometric and possibly histologic investigations, completing clinical and radiologic findings when necessary. Endoscopy can also often act as the primary therapeutic gesture, its evacuating and aerating properties relieving ostial dyspermeability, the principal cause of chronic maxillary sinusitis. Diagnostic and therapeutic features in this particularly frequent affection are discussed with respect to the use of endoscopy.

Adolescent↗
PubMed1995

[Improvement of olfactory disturbance by endoscopic endonasal surgery for chronic sinusitis].

Olfactory disturbance is the one of the most important symptoms of chronic sinusitis. In the present study, we followed up the postoperative clinical course of olfactory disturbance in patients who underwent surgery for chronic sinusitis. Ninety patients with severe olfactory disturbance or anosmia who underwent endoscopic endonasal surgery for chronic sinusitis with severe olfactory disturbance or anosmia in the preceding three-year period were enrolled in this study. We obtained a high postoperative improvement rate of 78.8%. We compared and examined our cases' postoperative clinical course concerning their olfactory disturbance and various factors in other patients before and after surgery, and obtained the following results: a) Young patients, 30 years old or under at the time of surgery, showed significantly higher rates of improvement than patients who were 50 years old or more at the time of surgery. b) Even though revision surgery was performed, the improvement rates were almost the same as after the initial surgery. c) Although the Alinamin intravenous olfaction test is regarded as an olfaction threshold test, we have seen quite a few cases in which improvement was achieved despite the absence of a preoperative response to the Alinamin intravenous olfaction test. d) There was no clear correlation between the presence of preoperative lesions of the ethmoid sinus and the olfactory cleft and the improvement rates. e) The cases with unsatisfactory results concerning the paranasal sinuses and nasal cavity--those accompanied by postoperative adhesions of the olfactory cleft, recurrence of polyps, etc.,--showed significantly lower improvement rates than cases with satisfactory postoperative results. During surgery in patients with severe olfactory disturbance, we conclude that it is particularly important to adequately clean the lesions of the olfactory cleft and the anterior and posterior ethmoid sinus endoscopically. This ensures leaving clear the olfactory cleft.

Adult↗
PubMedDate not supplied

[Chronic sinusitis in children. Current role of diagnostic imaging].

A retrospective study of a large series of patients (5,100 cases of radiologically confirmed rhino-sinusitis) was carried out to assess the efficacy of traditional radiology in the diagnosis of chronic sinusitis and the specific role of more recent imaging techniques. Traditional radiography, often limited to the naso-occipital projection (lack of collaboration), allows a reliable examination only of maxillary sinus. "Typical" findings of chronic sinusitis have been identified as "polipoid" thickening of the mucous membrane and localised parietal opacity. Both maxillary sinuses are involved in approximately 91% of cases, with ethmoidal involvement in 53%. Thickened mucosal walls and retention cysts may be obscured by inflammatory exudate: the air space is reduced and the sinus appears cloudy or opaque (acute reinflammation). The overall frequency of chronic sinusitis is 11.1% (67% in the 8-14 age range, 29% in the 5-8 age range and 4% in the 2-5 age range). Complications are rare (4 cases). Whereas echotomography provides limited and inconstant findings, CT and MRI are indicated in case of isolated opacity of a maxillary sinus, persistent after treatment: the former allows a detailed study of the bone, the latter enables to obtain a better tissue characterization. MRI often allows the differential diagnosis between inflammatory diseases and malignant tumors.

Adolescent↗
PubMedDate not supplied

Cytokines in nasal polyposis, acute and chronic sinusitis.

Cytokines are potent biologic factors involved in the regulation of inflammation, immune defense, and wound healing. Recently, growing interest has developed in the role of cytokines in chronic sinusitis and nasal polyposis. In the present study, we investigated the cytokine profile of different types of rhinosinusitis in order to evaluate whether a specific form of rhinosinusitis is associated with the expression of a certain cytokine profile. Sinus mucosa from patients with acute sinusitis (n = 10), chronic sinusitis (n = 7), antrochoanal polyp (n = 10), nasal polyps (n = 8) and controls of turbinate mucosa (n = 7) were sampled. The cytokine protein content (IL-1 beta, IL-3, IL-4, IL-5, IL-6, IL-8, IL-13, GM-CSF, interferon-gamma) of tissue homogenates was measured using ELISA technique. In acute sinusitis, the synthesis of proinflammatory cytokines and of the neutrophil chemokine IL-8 and IL-3 appeared to be upregulated. Chronic sinusitis mucosa demonstrated no significantly increased concentrations of the measured cytokines. In bilateral nasal polyposis, but not in antrochoanal polyps, the eosinophil related cytokine IL-5 was strongly upregulated. From these findings, it appears that specific cytokine patterns are found in different forms of sinusitis, and that IL-5 may represent the most important cytokine responsible for tissue eosinophilia in nasal polyposis.

Acute Disease↗
PubMed1999

Inhibitory effect of erythromycin on interleukin-8 secretion from exudative cells in the nasal discharge of patients with chronic sinusitis.

OBJECTIVES: The mechanism of the efficacy of long-term low-dose macrolide therapy for chronic sinusitis is not fully understood. The authors studied the inhibitory effect of erythromycin on interleukin-8 (IL-8) secretion from exudative cells in the nasal discharge of patients with chronic sinusitis. STUDY DESIGN AND METHODS: Exudative cells in the nasal discharge were isolated from six patients with nonallergic chronic sinusitis. The cells, more than 90% of which were neutrophils, were incubated with or without erythromycin in the presence of 10 micrograms/mL of lipopolysaccharide. The IL-8 concentrations in the culture supernatants were measured by enzyme-linked immunoassay. RESULTS: The amount of secreted IL-8 in the absence of erythromycin was 682 +/- 226 pg/10(6) cells/24 h. The IL-8 secretion was significantly reduced to 66 +/- 15% and 46 +/- 13% of the control in the presence of 10(-6) and 10(-5) M of erythromycin, respectively. CONCLUSION: Erythromycin may act as a biologic modulator that inhibits IL-8 secretion from exudative cells and thereby blocks the vicious circle of neutrophil recruitment and IL-8 generation in the inflammatory site in chronic sinusitis.

Anti-Bacterial Agents↗
PubMed2002

Presence of cysteinyl leukotrienes in asthmatic patients with chronic sinusitis.

INTRODUCTION: The association between asthma and sinusitis has long been recognized. Numerous studies point to a complex, yet undeniable relationship between asthma and chronic sinusitis and rhinitis. There have also been extensive attempts to characterize the inflammatory mechanisms of both disorders. Increasingly, the cysteinyl leukotrienes, a potent group of inflammatory mediators, have gained attention as important contributors to the manifestation of both disorders. Leukotriene production has been shown to be upregulated in the bronchial tissue of asthmatics. Our study sought to determine if leukotriene production was increased in the sinus mucosa of asthmatics with chronic sinusitis. STUDY DESIGN: Prospective study. METHODS: Nasal polyp tissue was evaluated from 27 consecutive patients undergoing elective polypectomy. The presence of asthma was determined by patient history, their medical record, and use of asthma medication. Sinus tissue was extracted during the course of endoscopic surgery. Cysteinyl leukotrienes (CysLT) were quantified by a sensitive competitive enzyme immunoassay, and the levels of CysLT were compared in the group with and without asthma. RESULTS: Cysteinyl leukotrienes were detected in 23 of 27 patients. The average level of LTC4 in non-asthmatic patients was 25.6 picograms (pg)/g. The average amount of LTC4 in asthmatic patients with sinusitis was 19.2 pg/g. There was no significant difference between the two groups (P =.64). CONCLUSIONS: The presence of asthma does not correlate with increased levels of leukotrienes in the sinus mucosa of patients with chronic sinusitis.

Asthma↗
PubMed2005

Validity of a new health-related quality of life instrument for patients with chronic sinusitis.

OBJECTIVE/HYPOTHESIS: To assess the validity and responsiveness of a new health-related quality of life (HRQL) instrument for patients with chronic sinusitis. STUDY DESIGN: Prospective case series. METHODS: Patients with chronic sinusitis undergoing endoscopic sinus surgery were assessed in two otolaryngology practices affiliated with an academic hospital. Patient-reported HRQL was assessed using a new instrument (includes symptom frequency, bothersomeness, and impact scales), the Chronic Sinusitis Survey (CSS), and the generic SF-12 at baseline and 3 months postsurgery. The psychometric properties of the new instrument were assessed including reliability, validity, responsiveness, and interpretability. RESULTS: Among 50 enrolled patients, 49 underwent surgery and 39 (80%) completed 3-month follow-up. Internal consistency was high for the symptom impact scale. The symptom frequency and, especially, bothersomeness scales had lower internal consistency and were comparable with the CSS. Correlation analyses support the construct validity of the new measure compared with the CSS and SF-12. The responsiveness of the new instrument was excellent and similar to or better than the CSS. The mean score change was linearly related to the patient's global self-assessment, although the CSS symptom and total score better discriminated patients with major or moderate degrees of improvement. CONCLUSIONS: This study demonstrates the validity and responsiveness of a new rhinosinusitis-specific HRQL instrument, the Rhinosinusitis Quality of Life survey, in patients with chronic sinusitis. The instrument's symptom frequency, bothersomeness, and impact scales compare favorably with a previously validated disease-specific and a generic HRQL measure. If validated in other patient populations, this disease-specific instrument may be useful in assessing severity and outcomes of treatment for sinusitis.

Chronic Disease↗
PubMed2005

The role of nasal cavity disinfection in the bacteriology of chronic sinusitis.

OBJECTIVES: Several factors may influence the results of bacteriological studies in chronic rhinosinusitis. We investigated the potential role of nasal cavity disinfection in the bacteriology of the bulla ethmoidalis in patients suffering from chronic sinusitis. MATERIAL AND METHODS: Bacteriology of the bulla ethmoidalis was studied in 176 consecutive adult patients presenting a chronic sinusitis refractory to standard medical treatment who underwent functional endoscopic sinus surgery. Two different techniques were used: (A) a technique with nasal vestibule and facial disinfection with chlorhexedin (N = 89 patients and 165 samples) vs. (B) a technique with facial, nasal vestibule and nasal cavity disinfection with a povidone-iodine solution followed by a cleansing of the nasal cavity (N = 87 patients and 166 samples). RESULTS: Culture rate was 89.6% (183 bacterial isolates) for technique (A) vs 76.5% (164 bacterial isolates) for technique (B) (p < 0.001). Major bacteria encountered in the (A) group and in the (B) group were respectively: Coagulase Negative Staphylococcus: 77 vs 40 isolates (p < 0.001); Coagulase positive Staphylococcus: 44 vs 30 isolates (p = 0.061); Streptococcus pneumoniae: 4 vs 5 isolates; Others: Streptococcus sp.: 12 vs 16 isolates; Haemophilus influenzae: 8 vs 6 isolates; Enterobacteriacea: 33 vs 53 isolates (p = 0.013) and others Gram Negative Bacilli: 3 vs 7 isolates. CONCLUSIONS: The standard (A) technique to study the bacteriology of the bulla ethmoidalis in patients with chronic sinusitis yielded a higher percentage of positive culture and of bacterial isolates than a more advanced (B) technique. This is mainly due to the higher percentage of contaminant bacteria such as Coagulase Negative Staphylococcus recovered with the standard technique. Enterobacteriacea and others Gram Negative Bacilli were more often encountered into the bulla ethmoidalis with the technique where disinfection of the nasal cavity was performed.

Adult↗
PubMed1997

Efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children.

OBJECTIVE: To determine the efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children. DESIGN: Retrospective case series. SETTING: Tertiary care center. PATIENTS: Symptoms of chronic sinusitis were studied in 48 consecutive patients who underwent adenoidectomy or adenotonsillectomy between October 1993 and May 1995. Children with cystic fibrosis or those who underwent concurrent endoscopic sinus surgery were excluded. Patient ages ranged from 1 to 12 years. Four patients were unavailable for follow-up and did not complete the study. MAIN OUTCOME MEASURES: Patients' charts were reviewed for the presence of preoperative symptoms, including rhinorrhea, nasal congestion, headache, postnasal drainage, cough, halitosis, and irritability. Also recorded were mouth breathing, fevers, and frequent antibiotic use. Telephone interviews with the patients' caregivers were conducted to collect information following the surgery regarding the presence of the same symptoms as well as an estimate of overall improvement. Follow-up ranged from 5 months to 2 years. RESULTS: The most frequently reported symptoms before surgery were rhinorrhea, nasal congestion, mouth breathing, and frequent antibiotic use (35, 37, 34, and 38 patients, respectively). These numbers decreased following surgery to 18, 20, 11, and 10 patients, respectively. The average number of symptoms experienced by each patient decreased from 5.3 to 2.9. Complete or near symptom resolution was reported in 25 (58%) of 43 patients. Some improvement was reported in another 9 patients (21%). Minimal or no improvement was reported in 9 patients (21%). To date, only 3 patients have gone on to have endoscopic sinus surgery. CONCLUSION: In the majority of cases, symptoms of chronic sinusitis in children are relieved by adenoidectomy.

Adenoidectomy↗
PubMed2005

[A clinical observation on the effect of irrigating solution of Shuang Huang Lian on ESS for chronic sinusitis].

OBJECTIVE: To investigate the effect of irrigating solution of Shuang Huang Lian on ESS for chronic sinusitis. METHOD: In 201 cases with chronic sinusitis (type II) treated by ESS From August 2001 to August 2004, the Shuang Huang Lian Liquid and 0.9% N.S. were respectively used in 101 cases and 100 cases to irrigate the operated sinus cavity, then a comparison was made between the two groups about the irrigating solution with above six months followed up. RESULT: The total effective ratio in group Shuang Huang Lian was significantly higher than that in group of 0.9% N.S. (P < 0.05). CONCLUSION: Irrigating solution of Shuang Huang Lian used after operation can improve the therapeutic effect of ESS for chronic sinusitis.

Adolescent↗
PubMed1998

[Lysozyme and lactoferrin in human uncinate process mucosa during chronic sinusitis].

OBJECTIVE: To study the local protective role of lysozyme(LZ) and lactoferrin(LF) in the uncinate process mucosa during chronic sinusitis. METHODS: Expression of LZ and LF was determined in 17 samples from normal subjects and 70 samples from chronic sinusitis patients with ABC immunohistochemical method. According to the presence or absence of nasal polyps, patients were divided into two groups. RESULTS: Serous cells of submucosal glands displayed a strongly positive staining reaction to both LZ and LF in the normal uncinate process mucosa and mucosa from patients with chronic sinusitis. A positive though weak staining for LZ could also be found frequently within mucous cells of submucosal mixed glands and occasionally within goblet cells. In the mucosa from patients without nasal polyps, the staining reaction to LZ appeared to be intensified in goblet cells when compared with normal controls (P < 0.05). In patients with nasal polyps, the staining reaction to LZ appeared to be intensified in submucosal glands when compared with normal controls (P < 0.01) and patients without nasal polyps (P < 0.05). For LF, the staining reaction from patients with nasal polyps was stronger than that in normal controls (P < 0.01). The epithial cells stained negatively for LZ and LF. CONCLUSIONS: It suggests that the observed increase in LZ and LF secreting activity of goblet cells and submucosal mixed glands may play a part role in the defense mechanism of uncinate process mucosa during the course of chronic sinusitis.

Adolescent↗
PubMed1997

Reduced sialylation of glycoproteins in nasal glands of patients with chronic sinusitis.

This study was conducted to investigate the sialylations of glycoproteins in the nasal glands of patients with chronic sinusitis. Sialic acids were detected using lectin histochemistry, and the mRNA of sialyltransferase was evaluated by in situ hybridization histochemistry. Sambucus nigra agglutinin (SNA), which recognizes terminal sialic acids, strongly stained the glandular mucous cells of normal subjects, but not those of patients with chronic sinusitis. In situ hybridization histochemistry showed that the expression of alpha2,6 sialyltransferase mRNA was decreased in the secretory cells of patients with chronic sinusitis. Our present results suggest that a reduction in sialyltransferase activity at the mRNA level in the nasal glands may lead to the persistence of chronic sinusitis.

Adolescent↗
PubMed2001

Cystic fibrosis gene mutations deltaF508 and 394delTT in patients with chronic sinusitis in Finland.

Previous studies have shown that cystic fibrosis (CF) gene mutations are linked to several severe chronic infections. Chronic sinusitis is one condition that may well be influenced by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. We studied two prevalent CF mutations (AF508 and 394delTT) in a population with a low incidence of CF. The carrier frequency of the CF mutations in the Finnish population is approximately 1 in 80. We examined DNA specimens from 127 chronic sinusitis patients and found one patient who was heterozygous for 394delTT gene mutation. None of the DNA specimens had any AF508 mutation. This study shows that in a population with a low incidence of CF there was no abnormal carrier distribution of the two most common CF gene mutations in a group of chronic sinusitis patients. Routine screening of sinusitis patients for CF mutations provides no additional information on the etiology of chronic sinusitis.

Adult↗
PubMed1994

Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia.

OBJECTIVE: To develop a technique for evaluating the severity of chronic sinus disease and to examine the correlation with allergy, asthma, and eosinophilia. DESIGN: A survey of 104 patients undergoing surgery for chronic sinusitis. SETTING: A university hospital ear, nose, and throat clinic. PATIENTS: A referral population of adult patients being scheduled for endoscopic sinus surgery was eligible; 104 completed questionnaires and agreed to participate. MAIN OUTCOME MEASURES: Computed tomographic scans were reviewed and scored for extent of disease. Serum samples were assayed for total IgE and specific IgE antibodies to common inhalant allergens. Peripheral blood samples were analyzed for total eosinophil count. Surgical biopsy specimens were examined for eosinophilia and cultured for bacteria and fungi. RESULTS: Extensive disease was present in 39% of subjects and correlated well with asthma, specific IgE antibodies, and eosinophilia, but not with elevated total IgE. Among patients with peripheral eosinophilia, 87% had extensive disease. All cultures grew aerobic bacteria; anaerobes and fungi were uncommon. CONCLUSIONS: We present a system for quantitation of disease extent using computed tomographic scans of patients with chronic sinusitis. The well-accepted associations of chronic sinusitis with asthma and allergy appear to be restricted to the group with extensive disease. The presence of peripheral eosinophilia in patients with sinusitis indicates a high likelihood of extensive disease.

Adult↗