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PubMedDate not supplied

A comparison of imaging techniques in patients with chronic sinusitis (X-ray, MRI, A-mode ultrasound).

Thirty-five patients age 9 to 67 were evaluated for chronic sinusitis by history, physical and laboratory examination, and imaging techniques (X-ray, magnetic resonance imaging (MRI) and flexible rhinoscopy). MRI was the most predictive. To establish the diagnosis of sinusitis, it was more sensitive than plain X-ray for intrasinus disease. Findings of edema, erythema, and drainage on flexible rhinoscopy were consistent with chronic sinusitis and were confirmed by MRI and sinus X-rays in 41% of the cases. Nasal smears for polymorphonuclear cells and eosinophils were suggestive of a diagnosis of chronic sinusitis, but other laboratory tests (CBC, sedimentation rate, quantitative immunoglobulins, total IgEs) were of very limited value in the diagnosis of chronic sinusitis.

Adolescent↗
PubMed1990

[Management of chronic sinusitis in children].

The managements and the results of therapy for children with chronic sinusitis were reported. During the period of 1980 to 1988, 190 patients, aged 3 to 15, were examined at our outpatient clinic. The pathologic conditions of the maxillary sinus were examined by the contrast x-ray study (X-MFT). The mild, moderate and severe lesions in the maxillary sinus evaluated by X-MFT were 22%, 44; and 34%, respectively. Sixty-two per cent of ethmoid sinus was opacified in occipito-frontal view. The degree of patency of the maxillary ostium was evaluated by an application of the constant pressure to the maxillary sinus. Almost all maxillary ostia of these patients were patent. Nasal mucociliary clearance was reduced in 37% of the patients examined after the saccharin method. Antral lavages were performed once in a week for the therapy of 72% of children with chronic sinusitis. The efficacy of this modality was evaluated by the above mentioned items. The maxillary and ethmoid lesions, and nasal mucociliary transit time were significantly improved by the modality after 25 months in average. These results indicate that the antral lavage is an useful therapy for chronic sinusitis in children.

Adolescent↗
PubMed1997

Inflammatory mechanisms in chronic sinusitis.

Apart from ventilatory and bacteriologic aspects, understanding the pathomechanisms of inflammation in chronic sinusitis and nasal polyposis seems crucial for further success in disease treatment. New insights into inflammatory processes became recently possible by investigating the pattern of cytokines and chemokines as well as adhesion molecules in different acute and chronic sinus diseases. The proinflammatory cytokines interleukin (IL)-1 beta, IL-6 and especially the neutrophil-chemoattractant IL-8 play a dominant role in acute sinusitis, as was shown before for viral and allergic rhinitis. In contrast, IL-3 protein dominates the cytokine profile in chronic sinusitis, giving support to a variety of inflammatory cells. The most striking finding was the increased synthesis of IL-5 protein in bilateral nasal polyposis, whereas IL-5 was not found in controls or antrochoanal polyps. As this cytokine is known to enhance eosinophil activation and survival, our data point to IL-5 as a key protein in the pathomechanism of tissue eosinophilia in nasal polyposis. The investigation of cytokine patterns may furthermore help to differentiate between sinusitis subgroups, e.g. in the classification of sinus diseases.

Acute Disease↗
PubMed2005

[Effect of nasal endoscopy-assisted adenoidectomy on the development of pediatric chronic sinusitis and otitis media with effusion].

OBJECTIVE: To discuss the effect of nasal endoscopy-assisted adenoidectomy with debrided on the development of pediatric chronic sinusitis and otitis media with effusion. METHOD: Fifteen cases of hypertrophied adenoid with pediatric chronic sinusitis and/or otitis media with effusion were treated with nasal endoscopy-assisted adenoidectomy and medicines followed. RESULT: No remainder of adenoid was left, no complication occurred and snoring disappeared in all patients. Pediatric chronic sinusitis and/or otitis media with effusion recovered with medicines after adenoidectomy. CONCLUSION: Nasal endoscopy-assisted adenoidectomy with debrided was an minimally invasive and effective treatment for hypertrophied adenoid, as well as contributed to the development of pediatric chronic sinusitis and otitis media with effusion.

Adenoidectomy↗
PubMed2002

Effect of new macrolides on the expression of adhesion molecules on neutrophils in chronic sinusitis.

To elucidate the mechanisms involved in the action of new macrolides on chronic sinusitis, we examined the effects of clarithromycin (CAM) and roxiythromycin (RXM) on the expression of adhesion molecules (L-selectin and Mac-1) on peripheral blood neutrophils of individuals with chronic sinusitis. The administration of CAM and RXM slightly inhibited the down-regulation of L-selectin expression on neutrophils induced by interleukin (IL)-8 stimulation. Furthermore, the administration of CAM strongly inhibited the IL-8-induced up-regulation of Mac-1 expression on neutrophils. These observations suggest that the new macrolides such as CAM and RXM may affect the functions of neutrophils in chronic sinusitis by modulating the expression of L-selectin and Mac-1 molecules on neutrophils, thereby attenuating the adhesion of neutrophils.

Adolescent↗
PubMed2002

[Therapeutic effect of roxithromycin on chronic sinusitis with nasal -- polyps clinical, computed tomography, and electron microscopy analysis].

To evaluate the therapeutic effect of Roxithromycin (RXM), we studied 56 chronic sinusitis patients with nasal polyps using computed tomography (CT) and electron microscopy in addition to conventional clinical assessment. The paranasal sinus of subjects was observed clinically before and after daily administration of RXM at 300 mg for 3 months all underwent allergy testing for possible complications of allergic rhinitis based on subjective symptoms and objective findings. Improvement after RXM treatment was seen in 50.3% based on subjective symptoms and 59.1% based on objective findings. Overall improvement was seen in 53.6%. In 41 cases (73.2%) of all patients with chronic sinusitis and complications of allergic rhinitis, no significant difference was seen between patients with and without complications (53.7% in those with complications and 53.3% in those without). In CT analysis the paranasal sinus in 51.8% of all posttreated patients showed obvious improvement. In electron microscopy in chronic sinusitis patients with complications of allergic rhinitis, pretreated ethmoidal sinus tissues showed high mucous epithelial cell apoptosis in addition to common histological lesions, while posttreatment patients showed only eosinophil apoptosis in the interstitium and no apoptotic epithelial cells. We divided ethmoidal sinus lesions in patients without complications into 3 types and evaluated them as follows: In type 1, pretreated ethmoidal sinus tissues showed plasma cell infiltration and posttreatment cell apoptosis. In type 2, pretreated tissues showed lymphocyte and plasma cell infiltration and posttreated showed only some lymphocytes and no plasma cells. In type 3, proliferation of fibroblasts, most of which showed apoptosis, was seen in addition to apoptotic epithelial cells before treatment, while after treatment, these lesions remained with some apoptotic bodies phagocytosed by macrophages. In type 3 patients relapsed after surgery. Our findings indicate that RXM treatment had a significant therapeutic effect on chronic sinusitis with nasal polyps with and without complications of allergic rhinitis. We clarify the morphological mechanism of therapeutic effect of RXM on each type of ethmoidal sinus lesion divided by light and electron microscopy.

Adult↗
PubMed1998

Changes in nasal epithelium in patients with severe chronic sinusitis: a clinicopathologic and electron microscopic study.

OBJECTIVE: Defective ciliary ultrastructure and impaired mucociliary clearance play an important role in the development of respiratory disease and sinusitis. Changes in the ciliary ultrastructure of the sinonasal epithelium have been documented in patients with primary ciliary dyskinesia. However, secondary ciliary dyskinesias and epithelial cytopathologic changes have been underappreciated as a consequence of respiratory dysfunction and chronic sinusitis. STUDY DESIGN: Thirty-two patients with severe chronic sinusitis were evaluated for ciliary and epithelial abnormalities. MATERIALS AND METHODS: Fourteen patients (44%) were children who underwent full allergy, sweat, and immunologic workups. Eighteen patients (56%) were adults who had severe refractory sinusitis and had failed previous sinus surgery. All patients underwent nasal epithelium biopsies of the middle turbinate and evaluation by light and transmission electron microscopy. RESULTS: Ciliated cells were found in 23 patients (72%) with 9 patients (28%) having no cilia. Foci of normal ciliated epithelium were found in only 19% of the patients, often in epithelial invaginations. Variable numbers (usually a minor population) of cilia in 20 cases (87%) exhibited ultrastructural defects including compound cilia and microtubule and dynein arm defects. All of the patients showed variable loss of differentiated epithelial cells ranging from denuded epithelium to basal cell hyperplasia often associated with squamous metaplasia, secondary to chronic sinonasal disease. The lamina propria was often edematous with dilated capillaries, plasma cells, lymphocytes, and hyperplastic seromucous glands. CONCLUSIONS: This study demonstrates that ciliary dyskinesias are primarily the result rather than the cause of chronic sinusitis. Patients with chronic sinusitis of uncertain origin exhibit a prominent loss of differentiated epithelial cells, as well as ciliary defects, most of which are likely to be secondary to the chronic disease process. These changes slow down mucociliary clearance and lead to a vicious cycle leading to chronicity.

Adolescent↗
PubMed1990

The microbiology of chronic sinus disease in children with respiratory allergy.

Chronic maxillary sinusitis is common in children with respiratory allergy and is associated with increased morbidity. The bacteriology of chronic sinus disease in these children has not been adequately evaluated. Between May 1987 and January 1988, 12 children (aged 3 to 9 years), all with documented respiratory allergy and chronic respiratory symptoms consistent with chronic sinusitis (greater than 30 days), were fully evaluated. History, physical examination, complete blood count, nasal smear, and Waters x-ray were done. All patients had opacification of one or both maxillary sinuses, failed to respond to multiple courses of antibiotics, and subsequently underwent maxillary sinus aspiration and irrigation. Specimens were cultured for aerobic and anaerobic organisms with standard technique, and sensitivities were obtained. Culture results revealed a single organism (Moraxella [Branhamella] catarrhalis) in five patients, one patient yielded M. catarrhalis plus Streptococcus species, three were negative, and three patients grew multiple organisms (two with multiple aerobic streptococcal species and one patient with aerobic streptococci and Peptostreptococcus). All children received appropriate culture-directed antimicrobial therapy. Sequential biweekly follow-up revealed progressive radiographic clearing and significant symptomatic improvement. M. catarrhalis is a common pathogen, whereas anaerobic organisms are unusual as a cause of chronic maxillary sinusitis in allergic children. Some children, despite negative cultures, may benefit from maxillary sinus irrigation.

Child↗
PubMed1994

[Sense of smell before and after endonasal surgery in chronic sinusitis with polyps].

Although olfactory dysfunction is a common clinical symptom in patients with chronic sinusitis, there are few written reports about the nature, frequency and therapeutic accessibility of the various dysosmias. We analysed pre- and postoperative olfactory function in 78 patients suffering from chronic sinusitis with nasal polyposis. Using a squeeze bottle technique we were able to detect preoperative hyposmia and/or dysfunction of olfactory discrimination in 40% and anosmia in 36%. Only 22% of these patients complained spontaneously of disabilities in smell. Endoscopic surgery improved hyposmias and anosmias in 71% and preoperative dysfunctions of olfactory discrimination in 61%. Postoperative thresholds for 2-phenylethanol and dimethyldisulfide worsened in 9% of all patients. Postoperative olfactory discrimination deteriorated in 11%. Preoperative and postoperative olfactory functions were not predictable in individual cases when nasal polyposis was limited. However, mechanical blockage of the nasal airway was just one of many other pathophysiological factors causing olfactory loss in patients with chronic sinusitis.

Adolescent↗
PubMed2001

Efficacy of a stepwise protocol that includes intravenous antibiotic therapy for the management of chronic sinusitis in children and adolescents.

BACKGROUND: Recent concern regarding interference with facial skeletal growth and the risk of complications after endoscopic sinus surgery (ESS) has led to interest in exploring other treatment options for the management of chronic sinusitis in children. OBJECTIVE: To present the use of a stepwise protocol that includes intravenous (IV) antibiotic therapy as a therapeutic alternative to pediatric ESS. DESIGN: Retrospective analysis of pediatric patients with chronic sinusitis treated from January 1, 1993, to July 1, 1998, with a stepwise protocol that includes the use of IV antibiotics. SETTING: Academic tertiary care children's hospital. PATIENTS: Seventy patients, aged 10 months to 15 years, with the diagnosis of chronic sinusitis as defined by symptomatic disease for at least 12 weeks. All patients had persistent symptoms and radiographic evidence of sinus disease by computed tomographic scan after a minimum 3- to 4-week course of oral antibiotics. INTERVENTIONS: Patients were treated with maxillary sinus aspiration and irrigation with selective adenoidectomy, followed by a 1- to 4-week course of a culture-directed IV antibiotic. Most patients also underwent placement of a long-arm IV catheter. OUTCOME MEASURES: Medical charts were reviewed for clinical response to IV antibiotics, complications from IV antibiotic therapy, need for ESS, and recurrent episodes of sinusitis. RESULTS: Of the 70 patients studied, 62 (89%) had complete resolution of symptoms following IV therapy with selective adenoidectomy. Eight patients (11%) failed IV therapy and required ESS. Thirty-seven patients (53%) underwent concurrent adenoidectomy. Patients treated with concurrent adenoidectomy had equivocal response rates compared with patients treated with IV antibiotic therapy alone. Follow-up data were available for 52 patients (range, 6-62 months; mean, 25 months). All recurrent episodes resolved with oral antibiotic therapy. Complications from IV therapy included superficial thrombophlebitis in 6 patients (9%) and dislodgement of a catheter guidewire during placement in 1 patient (1%), requiring venotomy. Antibiotic-related complications also occurred in 3 patients (4%) and included serum sickness, pseudomembranous colitis, and drug fevers. CONCLUSION: A stepwise protocol that includes IV antibiotic therapy is a safe and efficacious mode of therapy for the management of chronic sinusitis in children and adolescents and may be a reasonable alternative to pediatric ESS.

Adenoidectomy↗
PubMedDate not supplied

Medical treatment of chronic sinusitis in the immunocompetent and immunosuppressed patient: a review.

Chronic sinusitis may arise from a variety of causes. Failure of mucociliary transport, nasal obstruction, and breakdown of the mucosal barrier are important mechanisms that may contribute to irreversible tissue pathologic changes in the paranasal sinuses. Diagnosis is usually made radiographically using plain films, polytomography, or computerized tomography. Medical treatment attacks underlying causes such as allergy or viscous mucus secretions. In addition to antibiotic therapy, management of the underlying medical problems, general prophylactic measures, immunologic reconstitution of specific immune deficiencies, and vaccine therapy when combined with surgical therapy are likely to help improve survival of the immunosuppressed patient with chronic sinusitis.

Anti-Bacterial Agents↗
PubMed2002

Bacteriology of chronic sinusitis: the bulla ethmoidalis content.

OBJECTIVE: To study the microbiology of the bulla ethmoidalis of patients who suffered from chronic sinusitis. DESIGN: A prospective study performed at the Saint-Luc universitary clinic (University of Louvain) from June 1999 to December 2000. MATERIAL AND METHODS: Seventy seven patients underwent functional endoscopic endonasal surgery during this period for chronic sinusitis refractory to standard medical treatment. All the patients presented symptoms for more than 3 months. After Povidone-Iodine disinfection, samples were taken into the bulla ethmoidalis after its opening with an endoscopic endonasal control. Samples were transferred to the microbiology laboratory using a thioglycolate medium for aerobic and anaerobic cultures. RESULTS: One hundred forty eight samples were studied. Culture rate was 73.6%. Thirty nine samples remained sterile. In the 109 culture positive specimens, 135 bacterial isolates were recovered. The main results are: Staphylococcus coagulase negative: 31, Staphylococcus aureus: 22, Streptococcus sp: 20, other Gram positive Cocci: 5, Haemophilus influenzae: 4, non-fermentative Gram negative bacilli: 6, Enterobacteriaceae: 45, anaerobic bacteria: 2. CONCLUSION: Enterobacteriaceae or enteric gram negative bacilli were frequently encountered in the bulla ethmoidalis of patients suffering from chronic sinusitis. This report suggests that endoscopically guided culture obtained from the ethmoid sinus may accurate our understanding of the microbiology of chronic ethmoidal sinusitis and underline the importance of Enterobacteriaceae in this disease.

Adult↗
PubMed1995

Evaluation of leukocyte chemotactic function in patients with chronic sinusitis.

In this study the chemotactic activities of neutrophils and monocytes were evaluated in patients with chronic sinusitis as compared to a control group. Leukocyte chemotaxis was measured with a micropore filter method in blood samples taken from 26 patients with chronic sinusitis and 10 volunteers. A statistically significant impairment of leukocyte chemotaxis capacity in patients with chronic sinusitis was found. It is concluded that a functional disorder of leukocytes may play a role in the progression of the disease into a chronic state.

Adolescent↗
PubMed1980

Retro-orbital hematoma and proptosis associated with chronic sinus disease.

Sudden unilateral proptosis occurred in a patient with a history of chronic sinusitis. The radiologic description of chronic sinusitis associated with the computerized tomography scan picture of a retro-orbital mass justified surgical exploration and evacuation of a hematoma. The proximity of the orbital cavity and the sinuses, plus their common venous drainage system, can account for this disease.

Chronic Disease↗
PubMed1994

Serum immunoglobulins and IgG subclass levels in adults with chronic sinusitis: evidence for decreased IgG3 levels.

Serum immunoglobulin class and IgG subclasses were measured in 30 adult patients with chronic sinusitis documented by CT scans of the paranasal sinuses. Results were compared to 30 age-and-sex matched patients with chronic rhinitis who had normal sinus CT scans, and a matched group of asymptomatic, healthy subjects. None of the patients was taking oral corticosteroids and none had ever received allergen immunotherapy. IgA deficiency was present in 3% (2/60) of the patients with chronic rhinitis or sinusitis and IgG deficiency was seen in another two (3%). None of the normals had low IgA or IgG. Low levels of IgG1 or IgG3 were found in some patients in all three groups, while none had low IgG2 levels. Serum levels of IgG, IgA, IgM, IgG1, IgG2, and IgG4 were not significantly different between the groups. Mean serum IgG3 levels, however, were significantly lower in the chronic sinusitis group than the chronic rhinitis group (P < .003) or the normals (P < .0005). The incidence of below normal levels of IgG3 was also more frequent in chronic sinusitis than in chronic rhinitis (P < .04) or normals (P < .002). Patients in the chronic sinusitis group had a high incidence of asthma (57%) and atopy (45%) but there was no difference in immunoglobulin class or IgG subclass levels in matched asthmatics compared with nonasthmatic patients with chronic sinusitis. Atopic patients with chronic sinusitis had a higher frequency of IgG3 subclass deficiency than nonatopics (P = .04). Normalization of low immunoglobulin class or IgG subclass levels that coincided with clinical improvement was documented in two patients with sinusitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

[Early results of the treatment of chronic sinusitis with functional endoscopic sinus surgery].

In recent years FESS has become a gold standard in the treatment of chronic sinusitis. The results of the treatment depends to a high degree on the thorough preoperative assessment and qualification for surgery, as well as applied criteria reported for success. The aim of the study was to evaluate the early results of FESS in patient with chronic sinusitis after 3 to 12 month of follow up focusing attention on some prognostic factors. In the group 52 patients who underwent FESS in 2003 due to chronic sinusitis particular attention to standardization of pre and postoperative evaluation was paid. Meticulous analysis of the data from SNAQ 11 (sino nasal assessment questionnaire) questionnaire for subjective complaints evaluation, and assessment of the extent of disease according to Friedman, Kennedy and Levine scale revealed no correlation between extent of disease and results of treatment. It was demonstrated, that there is the statistically significant correlation between extent of sinus disease on CT scans and the duration of disease. It applies to the first tree years of disease.

Chronic Disease↗
PubMed1996

Efficacy of long-term administration of clarithromycin in the treatment of intractable chronic sinusitis.

Long-term erythromycin therapy has been reported as effective in the treatment of various chronic respiratory diseases, including chronic sinusitis. We investigated the clinical efficacy of long-term administration of the erythromycin derivative clarithromycin (CAM) in intractable cases of chronic sinusitis. Forty-five adult patients were treated with dosages of 400 mg/day for 8 to 12 weeks. The results were as follows. i) Improvement of symptoms and rhinoscopic findings was noted in 71.1% of the patients. ii) For periods of up to 12 weeks, clinical efficacy depended upon the duration of treatment. Administration for more than 12 weeks might further improve clinical results. iii) No significant side effects were noted during the course of CAM treatment. On the whole, CAM was at least as effective as erythromycin in the treatment of chronic sinusitis.

Adolescent↗
PubMed1986

Possible mechanisms of reduction of nasal mucociliary clearance in chronic sinusitis.

Nasal mucus was collected from 38 patients with chronic sinusitis. Following this collection, nasal mucociliary clearance (ST) was measured by the saccharin granule technique. Nasal mucus was used for in vitro frog palate clearance studies and then compared with the in vivo ST. The mucociliary transport rate of nasal mucus on mucus-depleted frog palate (MTR on frog palate) was 5.93 +/- 1.04 mm/min in the patients whose ST was within normal range (group A), and was 5.54 +/- 1.94 mm/min in the patients whose ST was above the normal range (group B). Significant differences were not observed in MTR on frog palate between groups A and B and no significant correlation was noted between ST and MTR. These results suggest that factors other than the rheological properties of nasal mucus control nasal mucociliary clearance in patients with chronic sinusitis.

Adolescent↗