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PubMed1998

Economic implications of chronic sinusitis.

An approach to cost analysis useful in understanding the economic implications of surgical intervention on chronic sinusitis is break-even time analysis. The break-even time is the time until cost savings associated with improved health status after surgery equal the up-front costs of the operation itself. Data from 100 consecutive patients undergoing sinus operation were obtained by survey before surgery and at quarterly intervals for 1 year with statistically validated outcome measures (Medical Outcome Study Short Form 36-Item Health Survey, Chronic Sinusitis Survey). Direct and indirect costs were obtained or derived for this cohort. The cost of sinus medications, including over-the-counter remedies, nasal steroid sprays, and antibiotics, averaged $1220 per patient per year before surgery and $629 after surgery (p < 0.0001), which is a 48% reduction. Surgical costs averaged $6490 per patient. Economic modeling predicted a break-even time of approximately 7 years assuming a 3% surgical revision rate per year, a 3% decrease in sickness-related disability, and a 5% discount rate. The model was sensitive to changes in the total cost of operation, the surgical revision rate, and the anticipated disability benefit. We conclude that significant direct and indirect medical cost savings may be achieved after surgical intervention for chronic sinusitis and these savings eventually break even with the total cost of surgery itself.

Absenteeism↗
PubMed2000

[Bacteriological analysis of chronic sinusitis in school-age children (36 cases report)].

OBJECTIVE: To research the bacteriological characters of chronic sinusitis in school-age children and to provide basis for clinical treatment. METHOD: The purrent discharges taken from middle meatus of 36 patients were cultured for bacteria and the antimicrobial suscepility was determined. RESULT: The positive rate of bacteria culture was 83.3%, the compound infection rate was 36.1%. Aerobic bacteria were present in 76.7%, anaerobic bacteria were present in 55.6%. The result of antimicrobial susceptibility test was scattered. CONCLUSION: Infection rate of anaerobic bacteria was high in chronic sinusitis in school-age children and result of antimicrobial susceptibility was scattered. It was important to have anti-anaerobic treatment in chronic sinusitis in school-age children and to take an antimicrobial susceptibility test before medical treatment.

Adolescent↗
PubMed2001

[Ultrastructure changes of the olfactory epithelium of the patients suffering from dysosmia caused by the chronic sinusitis].

OBJECTIVE: To observe the ultrastructural changes of olfactory epithelium (OE) in patients suffering from dysosmia caused by chronic sinusitis. METHODS: The specimens of olfactory epithelium were obtained from 35 patients operated for chronic sinusitis accompanied by dysosmia. According to the results of light microscope (LM) examination, the OE was divided into three groups by the types of pathological changes: normal, atrophic and respiratory epithelium metaplasia(REM). Transmission electron microscope was used to observe the ultrastructural changes of each group. RESULTS: Under the LM, the surface ultrastructure of the OE showed some abnormal changes: (1) surface microvillus of the supporting cells disappeared; (2) olfactory vesicle changed their shape due to vacuolization; (3) disappearance of canaliculus structure in the olfactory vesicle; (4) the olfactory cilia changed the shape or reduced; some of the reduced cilia underwent metaplasia. The ultrastructural changes of atrophic OE included: (1) minor and moderate atrophy: the organelles and the membrane-limited electron dense vesicles on the upper section of the supporting cells obviously decreased or disappeared, even underwent vacuolization. The basic cell degenerated; (2) serious atrophy: the turbidity of the cell structure, even double cell structure, the nuclei of the cell aggregated as the plaque and vesiculose change or karyopyknosis. As for the cytoplasm, there were the dilation of the ERs, turgidity of the mitochondrion, the disarrangement, diminution and vacuolization. Fasciculate cilia were distributed separately in the REM group. CONCLUSION: There is a positive relationship between the atrophy degree and the degree of the abnormal ultrastructural changes of the OE. The ultrastructural changes of OE in patients suffering from dysosmia caused by chronic sinusitis may provide reference for assessment of the treatment of dysosmia.

Adult↗
PubMed2001

[Analysis of the reason that patients with chronic sinusitis having a negative CT manifestation].

OBJECTIVE: To explore the reason why the CT manifestation of the patients with chronic nasosinusitis is negative. METHOD: To analyze the clinical and CT manifestation of the patients with chronic sinusitis having a negative CT manifestation. RESULT: Pathological changes were found in all 8 patients during the course of endoscopic sinus surgery, such as pus storing in the sinus cavity, mucous swelling polypoidly, small polyps formation and so on. CONCLUSION: The reasons that the patients with chronic sinusitis having a negative CT manifestation are, 1. CT scan can only give a static one-off image, 2. partial volume effect, 3. maybe result from the location of CT scan and the resolving power of tomograph, 4. maybe attribute to the pathological classify of chronic sinusitis.

Adolescent↗
PubMed2005

[Effects of irrigating solution of Sihuang on morphology and function of nasal mucosa following surgery for chronic sinusitis and nasal polyps].

OBJECTIVE: To investigate the effect of the irrigating solution of Sihuang (ISSH) given after endoscopic surgery for chronic sinusitis and nasal polyps. METHODS: ISSH was used to irrigate the operated sinus cavity for 4 weeks in 109 patients with chronic sinusitis and/or polyps treated by endoscopic surgery, and 0.9%; normal saline (NS) was given in the same manner in another 109 patients receiving ISSH for similar problems, and the effects of the irrigating solutions was compared. Before and 3 months after the surgery, respectively, 32 patients with sinusitis were selected from each group for saccharin test. The mucosa in the ostiomeatal complex region was examined by electron microscopy in 6 patients before, two weeks and one month after surgery, respectively. RESULTS: The total effective rate was not significantly different between the two groups, but the postoperative morphological and functional recovery of the nasal mucosa occurred earlier in ISSH than in NS group (P<0.05). The level of SIgA was similar between the two groups before treatment (P>0.05), whereas after ISSH treatment, the SIgA level was significantly elevated in the treated group. Mucociliary transport rate was similar between ISSH and NS groups before the surgery (3.14+/-1.05 mm/min vs 3.31+/-1.09 mm/min, P>0.05), but 3 month after the surgery, the mucociliary transport rate increased to 6.09+/-2.63 mm/min in ISSH group and 5.04+/-1.22 mm/min in NS group, showing significant difference between them. Under electron microscope, the cilia of the epithelial cells were found exfoliated preoperatively but regularly arranged after the surgery, presenting the "9+2" architecture of the microtubule. CONCLUSION: ISSH used after operation can improve the therapeutic effect of endoscopic surgery for chronic sinusitis and/or nasal polyps.

Adolescent↗
PubMed2000

Clinical outcomes in patients with chronic sinusitis.

Although sinusitis is one of the most common chronic illnesses in this country, relatively little is known about the effect of this disease or its treatment on quality of life. In a series of studies utilizing both disease-specific and general health instruments, patients with chronic sinusitis were found to have significant decrements in several subscales of general health, including bodily pain and social functioning (P<.05), compared with the general US population. Surgery for sinus disease was shown to result in significant reduction in both symptoms and medication usage (P<.05) after 12 months. These same outcome instruments can be used by health care providers to document clinical outcomes in similar populations of patients with chronic sinusitis.

Chronic Disease↗
PubMed1999

[Anatomic variations of the ostiomeatal complex and their correlation with chronic sinusitis: CT evaluation].

OBJECTIVE: To explore the relationship between anatomic variations in the ostiomeatal complex (OMC) and chronic sinusitis. METHODS: Coronal plane CT scans of the paranasal sinuses showing the ostiomeatal complex including the middle turbinate, uncinate, ethmoid bulla, agger nasi and Haller cell were analyzed in 297 individuals (594 sides). Statistical analyses were carried out with SPSS 5.0. RESULTS: There were 81.14% of OMC noted to have at least one variation. The anatomic variations included paradoxical curvature of the middle turbinate (13.97%), the pneumatized middle turbinate (34.85%), uncinate hyperplasia(19.36%), deviation of uncinate (45.27%), large ethmoidal bulla (30.30%), large agger nasi (0.70%) and Haller cell (1.00%). The correlation between variations and chronic sinusitis was significant (P < 0.01). CONCLUSION: The occurrence of OMC variation is common. The variations may be one of the causes of chronic sinusitis. Therefore, properly handling the variations was important in the endoscopic sinus surgery.

Adolescent↗
PubMed1991

Microbiology of chronic sinusitis in children.

To better understand the factors involved in chronic sinusitis in childhood, we cultured the sinuses, middle meatus, and nasopharynx in 39 children requiring surgical intervention. Sixty-nine percent of these patients had other medical problems, including asthma (49%) and immunologic compromise (18%). We cultured coagulase-negative staphylococcus in 18 patients, Streptococcus viridans in 14 patients, normal flora in 10 patients, Staphylococcus aureus in nine patients, group D streptococcus in five patients, Corynebacterium in five patients, Haemophilus influenzae in three patients, Neisseria in three patients, and Streptococcus pneumoniae, group A streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella oxytoca, Propionibacterium acnes, Actinomyces, and an anaerobic gram-negative bacillus in one patient each. Cultures yielded no growth in nine patients. A strong association between cultures of the middle meatus obtained ipsilaterally and cultures of the maxillary (83%) and ethmoid sinuses (80%) occurred. A poor correlation was found between cultures of the nasopharynx and maxillary (45%) and ethmoid sinuses (49%). All seven patients who had both maxillary and ethmoid sinus cultures showed the same organisms in both sinuses. Only 41% of organisms were found on both sides when procedures were performed bilaterally. Cultures of the middle meatus appear to be sensitive and specific for organisms within sinuses. The presence of predominantly nonvirulent organisms in low titers suggests that additional factors other than bacterial overgrowth contribute to the pathogenesis of chronic sinusitis in children.

Adolescent↗
PubMed1989

[A study on collagenase production of nasal polyp-derived fibroblasts stimulated by nasal secretions of chronic sinusitis].

The collagenase produced by mesenchymal cells has been thought to have a great importance in the pathophysiology of connective tissue metabolism and prolongation of chronic inflammation. The factors, such as IL-1 and PMN factor, released by inflammatory cells have been known to induce mesenchymal cells to produce collagenase. In the present study, the collagenase activity of the nasal secretions were estimated using FITC-labelled collagens as substrates. The factor, enhancing the fibroblasts to produce collagenase, was also isolated from nasal secretions and partially characterized. The fibroblasts used in the present study were cultured with explant of the sections of nasal polyp obtained from a patient with chronic sinusitis. The collagenase activity in nasal secretions from patients with chronic sinusitis was high, whereas that of allergic nasal secretions was extremely low. Furthermore, the collagenase productions of nasal polyp-derived fibroblasts were enhanced by the extracts of nasal secretions from patients with chronic sinusitis. Crude extracts of nasal secretions were fractionated by ammonium sulfate precipitation. The active materials precipitated by 50% to 80% ammonium sulfate were further purified by Sephadex G-75 gel chromatography. The molecular weight determination of the active fraction checked by HPLC utilizing for TSK 2,000 SW gel column indicates 20,000 daltons for the active materials. However, the collagenase production of human microvascular endothelial cells derived from nasal mucosa was not enhanced by this factor. Although either the origin or the nature was not confirmed, the factor was considered to relate to the prolongation of chronic inflammation in the nasal and paranasal sinus pathology. Analysis of these factors will expected to establish methods for new therapeutics in chronic inflammation.

Cells, Cultured↗
PubMed1990

Chronic sinusitis and the yellow nail syndrome.

Diagnosing syndromes that include chronic sinusitis can expedite the management of both conditions. Yellow nail syndrome is usually described as the combination of yellow nails, lymphoedema and often respiratory manifestations such as chronic sinusitis, bronchiectasis and pleural effusions. The pathology responsible for the syndrome is believed to be lymphatic hypoplasia. Diagnosis of yellow nail syndrome is clinical not requiring any specialized tests. In the two cases described, the respiratory tract manifestations required the most active investigation and management. The significance of this syndrome to the otolaryngologist is discussed.

Adult↗
PubMed2000

Chronic sinusitis.

Sinusitis is a very common chronic illness with a substantial health care impact. This review focuses on factors contributing to sinusitis pathogenesis and chronicity, including anatomic factors, disturbances in mucociliary clearance, microbial pathogens, and inflammatory factors. A distinction is made between "infectious" and "noninfectious" types of inflammation in chronic sinusitis. The inflammatory characteristics of noninfectious inflammation are reviewed primarily in the context of chronic hyperplastic sinusitis with nasal polyposis. Key features of this type of inflammation include the presence of chronic inflammatory cells, large numbers of eosinophils, and IL-5-producing T lymphocytes. Allergic fungal sinusitis is discussed as a special type of chronic sinusitis. Published studies on the outcomes of medical management are reviewed. Finally, algorithms for medical management of chronic sinusitis and allergic fungal sinusitis are presented.

Chronic Disease↗
PubMedDate not supplied

Characteristics of tissue plasminogen activator from paranasal mucous membrane in chronic sinusitis.

Tissue extract of paranasal mucous membrane from patients with chronic sinusitis was found to show a large lysis area on plasminogen-rich fibrin plates, but not on plasminogen-free fibrin plates. This indicates the existence of tissue plasminogen activator in the tissue extract. Further studies by the gel filtration technique showed that two plasminogen activators of different molecular weights were present in the tissue extract. The existence of tissue plasminogen activator with a low molecular weight has not previously been reported. This activator is labile at neutral pH at 37 degrees C, but stable on fibrin under the above conditions. The molecular weight of this compound is lower than that of cytochrome c. It may be a compound which is proteolytically modified by proteases, ie, trypsin-like enzymes, existing in the paranasal mucous membrane tissue of patients with chronic sinusitis.

Chronic Disease↗
PubMed2006

A study of the link between gastric reflux and chronic sinusitis in adults.

Much discussion is taking place regarding the role of gastric reflux disease in the development and maintenance of chronic sinus disease. We studied 31 patients in a large urban private practice who had recalcitrant chronic sinusitis despite aggressive medical and surgical therapy. After we obtained information on the severity of each patient's sinus disease, we performed either double- or triple-catheter probe pH testing to assess the presence of reflux disease. Of the 30 patients who were successfully tested (1 patient did not tolerate probe testing), 25 demonstrated reflux disease, including 2 whose reflux reached the level of the nasopharynx. These 25 patients were placed on a proton-pump inhibitor (PPI) regimen and reassessed at least 1 month later. At follow-up, 14 of 15 evaluable patients demonstrated at least some improvement in their sinus symptoms, including 7 who experienced either a complete or almost-complete resolution of symptoms. The improvements in sinus symptoms corresponded with improvements in reflux symptoms. These findings suggest that antireflux therapy might play a role in the treatment of recalcitrant chronic sinus disease.

Adult↗
PubMedDate not supplied

Benefits of antibiotic prophylaxis in children with chronic sinusitis: assessment of outcome predictors.

Eighty-six children with chronic sinusitis, documented by x-ray with symptoms and signs for more than 12 weeks, were evaluated for atopy and B-cell immune abnormalities. Twenty-nine percent (25/86) of the patients had some B-cell abnormality of immunoglobulin isotype, IgG subclass, and/or hyporesponsiveness to pneumococcal polysaccharide (PPS) vaccine (Pneumovax). Eleven of 17 patients who were hyporesponsive to PPS vaccine had normal immunoglobulin isotypes and IgG subclasses. Twenty-six of these 86 children were followed prospectively for > or = 1 year on prophylactic antibiotics. The 12-month period before the use of prophylactic antibiotics was taken as the control period for each child for comparison. Nineteen of 26 (74%) children had a good outcome (greater than a 50% reduction in the number of exacerbations of sinusitis during a 12-month period compared with the previous year) on prophylactic antibiotics with a reduction in exacerbations of sinusitis from 9.8 per year to 2.7 episodes per year. In contrast, 7/26 had a poor outcome (p < .0001) on prophylactic antibiotics (from 12.6 per year to 8.7 per year on prophylactic antibiotics). There were no significant differences in age, gender, atopy, or presence of a B-cell immune abnormality in the good versus the poor outcome groups to prophylactic antibiotic therapy. Treatment outcome correlated inversely with the number of sinus infections before prophylactic antibiotics, p = .036. Underlying B-cell immune abnormalities could not be correlated with intervention outcome on prophylactic antibiotics. The use of prophylactic antibiotics was an effective treatment modality in children with chronic sinusitis, even in patients with selective immune abnormalities.

Anti-Bacterial Agents↗
PubMed1984

[Personal experience with sinus endoscopy. Apropos of 120 cases of chronic sinusitis].

One hundred and twenty adults have benefitted from a full staging of their chronic maxillary sinusitis. The authors detail the place of endoscopy in the assessment and management of the different clinical presentations. The endoscopy will be useful only if a systematic examination is performed, of nose and paranasal cavities, both optically and manometrically. Nature and severity of the disease can be evaluated by summarizing of the patient findings of story, clinical, radiological examinations and biological data. Endoscopy constitutes nor a valuable diagnostic tool, nor a therapeutic approach, conducting conservative treatment and avoiding some radical surgery.

Adolescent↗
PubMed1983

[Clinical experience with cefotiam infusions in chronic sinusitis and otitis media].

Clinical efficacy and safety of cefotiam were studied. Twelve patients with chronic sinusitis and 14 patients with chronic otitis media were intravenously given cefotiam in daily doses of 2 g for 7 to 10 days. In chronic sinusitis, clinical responses were excellent in 6 patients, good in 3 and fair in 3, the rate of satisfactory clinical responses (excellent and good) being 75%. In chronic otitis media, the responses were excellent in 5, good in 4 and fair in 5, the rate of satisfactory clinical responses being 65%. As for side effects, eruption and abdominal pain were observed in 1 patient.

Adolescent↗
PubMedDate not supplied

Endoscopic surgery for mycotic and chronic recurring sinusitis.

Chronic sinusitis and its complications are often caused or perpetuated by fungi. In Europe and North America Aspergillus species are the most common contaminants of the sinuses, with relatively few cases of mycoses caused by Mucor, Candida, Penicillium, Cladosporium, and Fusarium reported in the literature. Although Aspergillus and Mucor are mainly saprophytic, they may cause severe, potentially lethal complications. Consequently, therapy should include complete removal of the mycotic masses and prevention of reinfection. In nearly all cases in our experience, fungal diseases of the maxillary sinuses are secondary diseases, the pathologic conditions for which are created by chronic recurring sinusitis. Nasal endoscopy has shown that in most cases of recurring sinusitis, infection spreads from the nose into the larger sinuses, mostly from an infected anterior ethmoid. Maxillary and frontal sinuses are fully dependent on the pathophysiologic conditions in the anterior ethmoid because their ventilation and drainage pass through its complicated system of fissures and clefts into the middle nasal meatus. Endoscopic endonasal surgery of the diseased ethmoid is therefore an important element in our treatment schedule. Stenotic and/or chronically infected areas of the anterior ethmoid are identified by conventional or computed tomography. These areas then undergo endonasal operation under the guidance of rigid endoscopes. Diseased mucosa is removed, narrow or stenotic areas are widened, and the natural maxillary sinus ostium is enlarged. In many cases it is possible to remove all mycotic masses through this new window. Fenestration into the inferior nasal meatus is unnecessary with this method, and the sinus mucosa is usually left untouched. For follow-up treatment, instillations of antimycotic or antibiotic ointments are used. Even in cases of massive mucosal changes, the dependent sinuses, such as the frontal or maxillary sinuses, usually heal spontaneously after this procedure without having been treated directly. More than 140 patients with mycotic sinusitis, 48 of whom were studied and followed up for this paper, were treated by us during the last 8 years. The endoscopic surgical technique we have developed is described in detail.

Adult↗