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At least 253 records · Page 14Linked to original sources
PubMed2004

Relationship between pediatric sinusitis and middle turbinate pneumatization--ethmoidal sinus pyocele thought to be caused by middle turbinate pneumatization.

OBJECTIVE: To investigate whether the presence of pediatric middle turbinate pneumatization causes narrowing of the ostiomeatal complex (OMC) and is associated with the development of paranasal sinusitis. METHODS: CT scans of 190 nasal sides of 95 children (1-15 years old) were analyzed for the presence of middle turbinate pneumatization and mucosal thickness in the paranasal sinus. RESULTS: Middle turbinate pneumatization was detected in nine (4.6%) of the nasal cavities. Only one of these sides was in a patient younger than 10 years of age, while the other eight sides were in patients at least 13 years old. In six of those nine sides with pneumatization, paranasal sinusitis was also found. However, the images showed that in five sides the middle turbinate pneumatization itself did not obstruct the OMC. In addition, the mean +/- standard deviation (S.D.) of the total score for the paranasal sinus opacification on the side which had the middle turbinate pneumatization was 5.67 +/- 2.95. The corresponding value for the 76 sides without pneumatization was 5.29 +/- 2.53, and the difference between these mean total scores was not statistically significant. However, in one side, the OMC was obstructed or narrowed due to the middle turbinate pneumatization, and an ethmoidal sinus pyocele formed on this side. CONCLUSION: A causal relationship was not found between middle turbinate pneumatization and the mechanism of development of paranasal sinusitis in children. However, in the event that the OMU becomes obstructed at some time, frequent cycles of improvement and aggravation of pediatric paranasal sinusitis may occur and lead to the development of a serious condition.

Adolescent↗
PubMed1999

IL-12 receptor beta2 and CD30 expression in paranasal sinus mucosa of patients with chronic sinusitis.

The aetiology of chronic sinusitis is still poorly understood. The expression of T-helper 1 (Th1) and T-helper 2 (Th2) cell markers, interleukin (IL)-12 receptor beta2 subunit (IL-12Rbeta2) messenger ribonucleic acid (mRNA) and CD30, respectively, were investigated in the paranasal sinus mucosa of patients with chronic sinusitis in an attempt to elucidate the involvement of Th1 and Th2 cells in this disease. Anterior ethmoidal mucosae were surgically obtained from two groups of patients with chronic sinusitis: those who had allergic rhinitis (allergic group, n=11) and those without allergy (nonallergic group, n=11). IL-12Rbeta2 mRNA was quantified by means of the reverse transcription polymerase chain reaction, and CD30-positive cells were examined immunohistochemically. Both IL-12Rbeta2 mRNA and CD30 were expressed in the sinus mucosa of the allergic and nonallergic groups. The proportion of mononuclear cells which were CD30-positive in the sinus mucosa was significantly greater in the allergic than in the nonallergic group. The expression levels of IL-12Rbeta2 mRNA were virtually equivalent in both groups. These results suggest a T-helper 2-dominated mucosal reaction in the allergic compared to the nonallergic group, and indicate T-helper 1 activity in the sinus mucosa of both groups. The ubiquity of T-helper 1 cells suggests that they play a role in maintaining local mucosal defences against foreign antigens, which continually enter the upper respiratory tract.

Chronic Disease↗
PubMed1998

[Chronic mycoses of the paranasal sinuses--value of endonasal paranasal sinus surgery].

BACKGROUND: Many host factors even in immunocompetent patients may have an influence on development of a fungal diseases within the paranasal sinuses. Fungal sinusitis can occur in an acute form or more often to a chronic type of the disease. These mainly relatively asymptomatic chronic forms and further divided into a chronic noninvasive, chronic allergic, and chronic invasive disease. Endonasal microsurgery has significantly changed the management of chronic fungal sinusitis and allows adequate removal of pathologic tissue even in advanced situations. The aim of this study was to analyze the efficacy of endonasal surgery in chronic fungal sinusitis. MATERIAL AND METHODS: In a retrospective study we assessed a group of 40 patients who had endonasal surgery for chronic fungal sinusitis. Patient records, CT and MRI scans, microbiology and histology as well as the postoperative clinical follow-up including endoscopic photo documentation were evaluated over a period of 5 years. All patients underwent endonasal surgery using endoscopic techniques. The microscopic was of additional help in a few cases with extended disease and multiple dehiscences of the skull base. RESULTS: Twenty-four patients had a chronic noninvasive of fungal sinusitis and 16 patients had a chronic invasive form. All these patients underwent endonasal surgery without external incision. The fungal disease was erradicated in 39 cases, and revision surgery was required in only one case in which involvement of the contralateral side was not initially detected. in two cases scar tissue in the middle meatus was later excised but without evidence of residual fungal disease. Only in 6 cases was antifungal chemotherapy required, where the disease had spread into surrounding tissue or the patient had severe symptoms. CONCLUSIONS: Endonasal microsurgical techniques are today the appropriate approach for managing chronic fungal sinus disease even in severe cases with radiologic evidence of expansion or invasion of surrounding tissue. Additional antifungal chemotherapy is only rarely indicated, specifically when the fungal disease invades surrounding tissue.

Adult↗
PubMed2003

Electron microscopy assessment of the recovery of sinus mucosa after sinus surgery.

OBJECTIVES: To determine the level of injury to the maxillary sinus mucosa due to chronic infection and the capacity of sinus mucosa to recover after sinus surgery. MATERIAL AND METHODS: Scanning and transmission electron microscopy (SEM and TEM, respectively) were used for examination of maxillary sinus mucosa at the time of endoscopic sinus surgery and 6 months postoperatively. RESULTS: SEM showed non-ciliated cells, metaplasia, ciliary disorientation, abundant goblet cells, microvilli and compound cilia perioperatively. Six months postoperatively the numbers of non-ciliated cells and microvilli had increased but the degree of metaplasia and disorientation and the number of compound cilia had decreased. Perioperative TEM revealed metaplasia, disorientation, tubulus anomalies, compound cilia and one patient with short dynein arms. CONCLUSIONS: As a result of this study we conclude that sinus mucosa repairs slowly after surgery. There are still many pathological findings in the mucosa 6 months postoperatively and some of these findings may even be irreversible. Patients need frequent follow-up after their operation and we suggest that a follow-up time for sinus surgery patients of at least 1 year should be allowed before final evaluation of the operation and its outcomes is made.

Adolescent↗
PubMed1996

Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorticotropin-secreting adenomas.

Bilateral simultaneous venous sampling of ACTH from the inferior petrosal sinus is a reliable test for diagnosing Cushing's disease, but is not reliable for lateralizing ACTH-secreting pituitary adenomas. We reviewed 23 consecutive patients with Cushing's disease who underwent venous angiography of the cavernous and inferior petrosal sinuses followed by bilateral simultaneous venous sampling of ACTH in the inferior petrosal and cavernous sinuses. Venous drainage was bilaterally symmetric in 14 patients (61%) and asymmetric in 9 (39%). The most common asymmetric pattern (6 patients) was for blood from both cavernous sinuses to drain into the right inferior petrosal sinus, with no significant drainage into the left. Cavernous sinus sampling in 21 patients correctly lateralized the tumor in 12 cases of symmetric venous drainage, but in only 3 cases of asymmetric drainage. Inferior petrosal sinus sampling in all 23 patients correctly lateralized the tumor in 12 cases of symmetric drainage, but in only four cases of asymmetric drainage. Overall, venous sampling correctly lateralized 70% of the tumors. Incorrect lateralization in cases of asymmetric venous drainage is probably attributable to shunting of blood toward the side of dominant venous drainage. Our findings illustrate the need for venography in all patients undergoing venous sampling of ACTH because an understanding of the venous drainage patterns is essential to correctly interpret venous sampling data and warn physicians that the lateralization data may be incorrect or unreliable.

Adenoma↗
PubMed2003

Ultrastructural ciliary changes of maxillary sinus mucosa following functional endoscopic sinus surgery: an image analysis quantitative study.

This was a study of the effect of functional endoscopic sinus surgery (FESS) on the ciliary regeneration of maxillary sinus mucosa in patients with chronic maxillary sinusitis, using objective quantitative methods. Twenty specimens from the mucosa of both the superolateral wall and the ostium of the maxillary sinus were sampled during FESS and then six to 12 months later. They were light examined first by light microscopy and then by scanning electron microscopy in combination with image analysis software in order to study the cilia under higher magnification and to calculate proportion of the field that was ciliated. Samples were taken and studied at Cairo University hospital. This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration and could return towards normal with the improvement of ventilation and drainage of the maxillary sinus following FESS. There were no significant changes in the degree of glandular hyperplasia, goblet cells or pathological glands after surgery.

Adolescent↗
PubMed1991

Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery.

Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the "background" prevalence of these findings are needed to determine their clinical relevance. A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbinate, Haller's cells, and pneumatization of the uncinate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons. Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus-like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region. Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus CT scans.

Adult↗
PubMed1995

Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: a comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer.

To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae. The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 x 1.5 cm) was placed within the sinus after re-establishing ostial patency. The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3. The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3. The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3. The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.

Ampicillin↗
PubMedDate not supplied

Experimental acute sinusitis in rabbits. Energy metabolism in sinus mucosa and secretion.

In previous studies, sinus secretions have been analysed concerning pO2, pCO2 and pH. In this study the energy metabolism in the maxillary sinus mucosa and secretion was studied in 33 New Zealand White rabbits. In freeze-dried samples, glucose and lactate were analysed by enzymatic assays and ATP by HPLC. In the purulent sinusitis, lactate concentration in the mucosa was 5.67 mmol X kg-1 w.w. and significantly higher than in the control sinus. Also in the non-purulent sinusitis, lactate was increased in the mucosa. The lactate concentrations in the secretion were 9.8 and 8.4 mmol X kg-1 w.w. in purulent and non-purulent secretions respectively and are probably the result of a diffusion from the mucosal cells and of leukocyte metabolism. A reduced ATP content, with increases in ADP and AMP, in the sinus mucosa of the purulent sinusitis suggests a relative energy depletion which could result in impaired epithelial function.

Adenine Nucleotides↗
PubMed1991

Penetration of administered IgG into the maxillary sinus and long-term clinical effects of intravenous immunoglobulin replacement therapy on sinusitis in primary hypogammaglobulinaemia.

The influence of long-term intravenous immunoglobulin (i.v. IgG) replacement therapy on the clinical course of chronic sinusitis in patients with primary hypogammaglobulinaemia has not previously been reported. We have analysed the efficacy of i.v. IgG therapy and the penetration of administered i.v. IgG into the maxillary sinus. Seventeen patients with primary hypogammaglobulinaemia received i.v. IgG replacement therapy to maintain pre-infusion serum IgG concentrations above 4 g/l for periods of 12 to 58 (mean 36.7) months. Cases with established chronic sinusitis prior to therapy did not have symptomatic or radiological improvement at this dose, although no sinusitis developed de-novo in the 3 previously unaffected patients. The administered IgG penetrated into maxillary sinus antral lavage fluid in 3 patients from whom secretions were obtained at antroscopy. This indicates that poor clinical responses are not due to lack of penetration of antibodies to the required sites of action. Larger doses of i.v. IgG may be more effective in this situation, but the addition of antibiotics at high dosage may be a more economical therapeutic alternative. These findings highlight the importance of diagnosis of hypogammaglobulinaemia by measurement of serum IgG concentrations in patients who suffer from recurrent sinusitis, as the early institution of i.v. IgG therapy may prevent the development of sinusitis refractory to i.v. IgG therapy.

Adolescent↗
PubMed1993

[Combined-macro-micro endoscopic technique as the most advantageous endonasal sinus surgery especially for severe sinusitis: theory and surgical technique].

Functional endonasal sinus surgery (FESS) is becoming the procedure of choice for the surgical treatment of chronic sinusitis. The operation has been made possible by the introduction of the endoscope to sinus surgery. The endoscope allows a more detailed observation of ethmoid lesions, and provides direct visual access to the paranasal region which is not visible through the anterior nares. A technique which involves the exclusive use of endoscopy, endoscopic sinus surgery, presents several problems however, especially in cases of polyposis or those with excessive bleeding. For ideal sinus surgery, tools must guarantee the greatest possible safety, ease, and accuracy. None of the currently available tools is independently able to fully satisfy all three of these requirements, not even the endoscope. The anatomical region being operated on determines which of these three requirements is most critical in each phase of the surgery. Ease is most important in the nasal cavity, which has no exceptionally dangerous regions to be operated on. The quickest and simplest operation is most expedient for minimizing blood loss in severe polyposis. To achieve this objective, macroscopic manipulation using a headlamp is most suitable. There is no need to use the endoscope or microscope to remove polyps in the nasal cavity. Because almost all of the risks in sinus surgery are encountered in the ethmoid region, operation in this area demands the safest method. For example if the ethmoid cavity is filled with massive polyps, it is sometimes difficult to endoscopically detect whether orbital fat has broken into the ethmoid. To discriminate between fat and a polypoid lesion or to distinguish dura from mucoperiost during surgery, the microscope is clearly the superior tool. In region where dead angles prevent accurate manipulation, use of the endoscope is essential. To optimize success in sinus surgery using the currently available tools, the author describes a combined macro-micro-endoscopic technique (COMMET) which effectively combines use of the headlamp, the microscope, and the endoscope according to the demands of each anatomical region.

Adolescent↗
PubMed1999

RinoFlow nasal wash and sinus system as a mechanism to deliver medications to the paranasal sinuses: results of a radiolabeled pilot study.

Direct delivery of medication to the sinuses with standard nebulizers is difficult to achieve. The nasal inhalation of aerosolized medications is dependent on the size of the particles and the pressure with which they are delivered; when the particles are too small or the pressure is too low, the drug cannot reach the sinuses. The ability of topical medications to treat sinus disorders can be improved if the medication could be delivered directly to the sinuses. We tested the ability of the RinoFlow nasal aerosol delivery device to deposit aerosol directly to the paranasal sinuses. Five normal, healthy subjects used the device to administer technetium Tc 99m nasally. Nuclear scanning was used to detect deposition in the frontal and maxillary sinuses. Three subjects underwent additional testing after administration of a nasal decongestant. Three of the five subjects showed some evidence of direct delivery to the sinuses, although deposition was not uniform or complete. Pretreatment with a decongestant had no apparent effect on subsequent technetium delivery. We conclude that the results of this study are promising and that further study is warranted.

Administration, Inhalation↗
PubMed1999

Cavernous sinus and inferior petrosal sinus flow signal on three-dimensional time-of-flight MR angiography.

BACKGROUND AND PURPOSE: Venous flow signal in the cavernous sinus and inferior petrosal sinus has been shown on MR angiograms in patients with carotid cavernous fistula (CCF). We, however, identified flow signal in some patients without symptoms and signs of CCF. This review was performed to determine the frequency of such normal venous flow depiction at MR angiography. METHODS: Twenty-five 3D time-of-flight (TOF) MR angiograms obtained on two different imaging units (scanners A and B) were reviewed with attention to presence of venous flow signal in the cavernous sinus or inferior petrosal sinus or both. Twenty-five additional MR angiograms were reviewed in patients who had also had cerebral arteriography to document absence of CCF where venous MR angiographic signal was detected, as well as to gain insight into venous flow patterns that might contribute to MR angiographic venous flow signal. Differences in scanning technique parameters were reviewed. RESULTS: Nine (36%) of the 25 MR angiograms obtained on scanner A but only one (4%) of the 25 obtained on scanner B showed flow signal in the cavernous or inferior petrosal sinus or both in the absence of signs of CCF. On review of 25 patients who had both MR angiography and arteriography, three patients with venous signal at MR angiography failed to exhibit CCF at arteriography. CONCLUSION: Identification of normal cavernous sinus or inferior petrosal sinus venous signal on 3D TOF MR angiograms may occur frequently, and is probably dependent on technical factors that vary among scanners. The exact factors most responsible, however, were not elucidated by this preliminary review.

Aged↗
PubMed2001

Maxillary sinus elevation: the effect of macrolacerations and microlacerations of the sinus membrane as determined by endoscopy.

The authors evaluated the health of the maxillary sinus in a group of 18 patients who had undergone sinus lift surgery for implantation purposes, using computed tomography and endoscopic imaging as a means of diagnosis. The study was performed after a mean interval of 31 months. All sinus lift operations were carried out using the lateral flap technique. The authors evaluated graft characteristics and intraoperative and postoperative complications and compared the results with computed tomography and endoscopic images. Endoscopy of a maxillary sinus that underwent microlaceration of the mucosa during sinus lifting showed a situation compatible with healthy conditions. In cases complicated by macrolaceration, the endoscopic picture was typical of sinusitis, even where clinical conditions of this type were not present. In the absence of intraoperative complications, the endoscopic appearance of sinus mucosa appears to improve when autologous graft material is used.

Adult↗
PubMed2002

Correlation of middle meatus and ethmoid sinus microbiology in patients with chronic sinusitis.

Empirical antibiotics constitute the cornerstone of medical therapy for chronic sinusitis due to difficulties of obtaining cultures from the paranasal sinuses. Indirect isolation of the pathogenic microorganisms outside the paranasal sinuses with a non-invasive method may enable administration of specific antibiotics. In this prospective study, we obtained cultures from the middle meatus and ethmoid sinuses of 193 sides from 127 patients who had undergone FESS for chronic sinusitis with a method that minimizes the risk of nasal contamination. The same bacterial species were isolated from both the ethmoid sinus and middle meatus in 59.3% of the cultures. There was no bacterial growth in either site in 32.3% of the cultures. The overall correlation rate of middle meatus and ethmoid sinus cultures was estimated to be 91.6%. In conclusion, middle meatal cultures can be used for the isolation of pathogenic microorganisms indirectly, while administration of specific antibiotics can be possible according to the results of these cultures.

Adolescent↗
PubMedDate not supplied

Bacteriology of chronic maxillary sinusitis and normal maxillary sinuses: using culture and multiplex polymerase chain reaction.

BACKGROUND: Although many investigations have been performed on bacteriology of chronic sinusitis and normal sinuses, there still is much discussion. Also a new bacterial agent, Alloiococcus otitidis determined in the nasopharynx and middle ear specimens can be thought as a causative agent of sinusitis. METHODS: The bacteriology of chronic maxillary sinusitis and maxillary sinuses with normal radiogram and endoscopic findings were studied by culture methods for aerobic and anaerobic bacteria. Multiplex polymerase chain reaction (PCR) was used to investigate four bacteria in study and control groups. There were 27 specimens in the study group and 28 specimens in the control group. RESULTS: In the study group, the bacteria commonly isolated were Staphylococcus aureus (11.1%), alpha-hemolytic streptococci (11.1%), Streptococcus pneumoniae (11.1%), Haemophilus influenzae (7.4%), coagulase-negative staphylococci (7.4%), and anaerobes (33.3%). Coagulase-negative staphylococci (14.3%), alpha-hemolytic streptococci (10.7%), and anaerobes (35.7%) were isolated also in the control group. PCR was used to investigate S. pneumoniae, H. influenzae, Moraxella catarrhalis, and A. otitidis in the study and control groups. None of these bacteria was determined in the control group whereas detection rates of these bacteria in the study group were 11.1, 11.1, 3.7, and 7.4%, respectively. It should be considered that PCR yielded faint amplification band for A. otitidis. CONCLUSION: Using multiplex PCR can help to increase detection rates of bacterial etiology. Healthy sinuses are not sterile. A. otitidis may be one of the pathogens causing sinusitis.

Adult↗
PubMedDate not supplied

Nasal airflow, mucociliary clearance, and sinus functioning during viral colds: effects of allergic rhinitis and susceptibility to recurrent sinusitis.

BACKGROUND: The aim was to compare nasal airflow and mucociliary clearance (MCC) and their association with paranasal sinus functioning during acute natural colds and convalescence in allergic and sinusitis-susceptible patients and healthy controls. METHODS: Nine allergic subjects, 16 sinusitis-susceptible subjects, and 20 healthy controls were examined during days 2-4 of acute colds and 3 weeks later by taking viral specimens, recording symptoms, performing rhinomanometry and dyed saccharin tests, and evaluating sinus functioning with computed tomography (CT). RESULTS: Viral etiology of the cold was identified in 31 (69%) subjects. Nasal airflow was decreased and MCC time prolonged during the cold compared to convalescence. A higher proportion of the allergic subjects, but not of the sinusitis-susceptible subjects, compared to the control subjects tended to have abnormal nasal airflow and MCC values. Abnormal nasal airflow and MCC values associated significantly with higher ipsilateral paranasal sinus CT scores. CONCLUSION: Abnormal nasal airflow and MCC rates seem to be associated with impaired functioning of paranasal sinuses during viral colds and tend to be more common in allergic subjects.

Adult↗
PubMed1986

[The value of maxillary sinus irrigation in children with maxillary sinusitis using the Waters film].

Eighty children with chronic sinusitis receiving a conservative treatment were followed. They found that without any further therapy the Waters view of 30 children became normal. The usefulness of irrigation of the maxillary sinus was studied in the other 50 children. In one group of 25 children a sinus endoscopy and sinus irrigation was performed. In a control group of another 25 children no further treatment was performed. A comparison between the Waters view and sinus endoscopy is also included in the study. The authors found little difference in the treatment results in the two groups. Furthermore, when the Waters view is normal, then exists little chance of finding a pathological mucous membrane during sinus endoscopy. In doubt the clinical picture is most important. The control of the roentgenogram should be performed one month after the first one. Antroscopy is better for the diagnosis but in view of its traumatic aspect and the finding that it does not result in a better therapeutic response, the authors advise sinus irrigation only in problematic cases.

Anti-Bacterial Agents↗