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PubMed1996

[A case of paranasal sinusitis-cavernous sinusitis with ophthalmoplegia externa].

A 15-year-old man was admitted because of diplopia and bilateral ptosis which occurred a few days after initial clinical signs, such as fever up, nausea, vomiting and headache. His pupils were anisocoric (Rt. phi 3.5 mm < Lt. phi 6.0 mm). In his left eye, light reflex was absent and its movements were limited in all directions. Brain MRI revealed the findings of paranasal sinusitis in bilateral ethmoidal and sphenoidal sinuses and swelling of bilateral cavernous sinus. Combination of intravenous antibiotic therapy and drainage improved his clinical symptoms and MRI findings. It was diagnosed as the inflammation originated in the sphenoid and ethmoid sinuses, which extended to the cavernous sinus and then involved III, IV, and VI cranial nerves. In conclusion, MRI was very useful to detect the cavernous sinusitis secondary to sphenoidal sinusitis.

Adolescent↗
PubMed1998

[Epidemiology of sinusitis seen in hospitalized patients. Apropos of 77 episodes of sinusitis among 72 patients between 1993 and 1996].

The 77 cases of sinusitis seen in 72 patients admitted to the Briançon Hospital between January 1, 1993, and June 30, 1996, were studied. One or both maxillary sinuses were involved in 96.8% of cases. Sinus aspiration was done in 95 cases. All aspirates were subjected to microbiological studies. Of the 45 aspirates that yielded positive cultures, 36 grew one or more pathogenic organisms. The most commonly isolated bacteria were Pseudomonas aeruginosa (n = 7), Streptococcus pneumoniae (n = 5), and Haemophilus influenzae (n = 5). Nosocomial sinusitis defined on a set of criteria including hospital stay duration at onset and an acute tempo of evolution contributed 32.5% of cases overall, 55.2% in the intensive care unit and 18.7% in all other departments combined. Nosocomial cases in the intensive care unit were associated with well-known risk factors, namely tracheal intubation with ventilation and presence of a nasogastric tube. Other study criteria included the type of organism recovered by culture and whether patients ventilated via a tracheal tube had the same organism in their sinus and tracheal tube aspirates. Some nonintensive care patients had none of the known risk factors for sinusitis; prompt diagnosis and treatment of these cases of sinusitis is important to avoid infectious complications, which are, however, less common than in intensive care patients.

Adolescent↗
PubMed1993

Nasal and paranasal sinus anomalies in children with chronic sinusitis.

Functional endoscopic sinus surgery (FESS) is being advocated to treat children with chronic sinusitis. The surgeon performing FESS needs an intimate understanding of the anatomy to adequately treat disease and avoid complications. One hundred thirty-six patients who had endoscopic sinus surgery were reviewed. Preoperative direct coronal computed tomography scans were available for review in 114 patients. Several nasal and paranasal sinus anomalies were uncovered during this evaluation. The most common was hypoplasia of the maxillary sinuses. All hypoplastic maxillary sinuses had diseased mucosa. Eleven patients were found to have a laterally deviated uncinate process and abnormal anatomy of the maxillary ostia. Other anomalies such as concha bullosa, Haller's cells, and paradoxic curvature of the middle turbinate were found, and their respective frequencies in this population were determined.

Adolescent↗
PubMed2004

Cytokine profile in paranasal effusions in patients with chronic sinusitis using the YAMIK sinus catheter with and without betamethasone.

Recently, the YAMIK sinus catheter (YAMIK) has been reported to be a useful therapeutic device in the treatment of sinusitis. The present study was conducted to compare its delivery of either a normal saline (NS) or a betamethasone solution (0.4 mg/ml) into the paranasal sinuses of 25 patients (39 sides) with chronic sinusitis. The following parameters were evaluated: (1) subjective nasal clinical symptoms (nasal discharge, nasal obstruction, postnasal drip and headache), (2) X-ray photographs (ethmoid and maxillary sinuses) and (3) cytokine levels (IL-1beta, IL-8 and TNF-alpha) by enzyme-linked immunosorbent assay. The total nasal symptom scores significantly decreased after the first therapy, and the total X-ray photograph scores significantly decreased after therapy with either NS or the betamethasone solution. In both NS and betamethasone patients, the levels of IL-1beta and IL-8 had significantly decreased by the 3rd and 2nd weeks after therapy, respectively. In contrast, the TNF-alpha level decreased after the first therapy with betamethasone solution and remained unchanged after therapy with NS. These findings suggest that evacuation of the pathological effusions in sinuses may exert a beneficial effect by reducing the levels of IL-1beta and IL-8, and we speculate that removal of pathological effusions from the sinuses may provide treatment through different mechanisms than those that occur in treatment with betamethasone.

Adult↗
PubMed2003

[Video-assisted endoscopic sinus revision for treatment of chronic, unilateral odontogenic maxillary sinusitis].

BACKGROUND: The proportion of dental causes of maxillary sinusitis is estimated between 10% and 40%. The mechanisms are manifold and originate from the close relation of the side teeth and the maxillary sinus. In the past, the transantral approach was commonly used by maxillofacial surgeons as their first choice. PATIENTS AND METHODS: Between 01/1999 and 10/2001 38 patients underwent endoscopic surgery controlled via the fossa canina. Apart from the mandatory treatment of the dental focus and the mucosal pathologies, a fenestration to the middle meatus of the nose was performed in 7 cases. RESULTS AND CONCLUSION: The dental medical history, OPG, CT scans in coronary plane, endoscopic findings, and histology showed the commonly "silent" course of dental sinusitis. Typical findings in CT scans are unilateral basal maxillary opacities adjacent to the molar and premolar teeth. In 20% of the cases there was also a blockade of the infundibulum. All patients were reexamined 6-12 months postoperatively. The patients are free of symptoms, but sometimes suffer from headaches. An exact diagnosis and the clear separation of rhinogenic causes are vital points for the therapy of dental sinusitis. In cases of unilateral sinusitis, a comprehensive investigation by the maxillofacial surgeon should be recommended. Video-assisted endoscopic sinus revision is preferable to the transantral approach and is especially suitable for the treatment of mucosal retention cysts, the removal of foreign bodies, endoscopically controlled resections of apical roots, elevations of the sinus floor, and dental implants. If the ethmoidal infundibulum and maxillary ostium are open, no fenestration is needed. In cases of blockade, fenestration to the middle nose canal is indicated.

Bicuspid↗
PubMed1991

Postextrasystolic sinoatrial exit block in human sick sinus syndrome: demonstration by direct recording of sinus node electrograms.

Ten patients with sick sinus syndrome having repetitive sinus node electrograms during long postpacing pauses were studied during programmed atrial stimulation. Sinus node activity was recorded using a percutaneous catheter electrode. A sinus node electrogram was recorded before the return atrial beat in seven patients; it was similar to the sinus node electrogram observed during postpacing pauses and is clearly identified because sinoatrial conduction time was markedly prolonged following the atrial extra beat. Complete sinoatrial exit block occurred in four patients. (1) Sinus node electrograms were thus validated both during postpacing pauses and during programmed atrial stimulation in most patients with sick sinus syndrome. (2) Sinoatrial conduction time was markedly prolonged after one extrasystole, accounting for supracompensatory atrial return cycles. (3) If it were cumulative following multiple extrasystoles, this effect could constitute the electrophysiologic link between an abnormal response during programmed atrial stimulation and the complete sinoatrial block recorded during the pauses that follow rapid atrial pacing.

Cardiac Catheterization↗
PubMed1976

Electrophysiologic effects of atropine on sinus node and atrium in patients with sinus nodal dysfunction.

Electrophysiologic studies were conducted in 21 patients with sinus nodal dysfunction before and after intravenous administration of 1 to 2 mg of atropine. The mean sinus cycle length (+/- standard error of the mean) was 1,171 +/- 35 msec before and 806 +/- 29 msec after administration of atropine (P less than 0.001). Mean sinus nodal recovery time determined at a aced rate of 130/min and maximal recovery time were, respectively, 1,426 +/- 75 and 1,690 +/- 100 msec before and 1,169 +/- 90 and 1,311 +/- 111 msec after atropine (P less than 0.001 and less than 0.001). Mean calculated sinoatrial conduction time, measured in 16 patients, was 113 +/- 8 msec before and 105 +/- 9.7 msec after atropine (difference not significant). Mean atrial effective refractory period, measured at an equivalent driven cycle length, was 262 +/- 11.1 msec before and 256 +/- 10.3 msec after atropine (not significant). Mean atrial functional refractory period was 302 +/- 12.5 msec before and 295 +/- 11.3 msec after atropine (not significant). The shortening of sinus cycle length and sinus recovery time with atropine was similar to that noted in patients without sinus nodal dysfunction. In contrast, atropine had insignificant effects on sinoatrial conduction and atrial refractoriness in this group whereas it shortens both in normal subjects. This finding may reflect altered perinodal and atrial electrophysiologic properties in patients with sinus node disease.

Adult↗
PubMed1986

Differential effects of autonomic blockade on sinus and atrioventricular nodal function in normals and in intrinsic sinus node dysfunction.

The effect of pharmacologic total autonomic blockade on sinus and atrioventricular nodes was studied in 10 normals and 21 patients with sick sinus syndrome with abnormal intrinsic corrected sinus node recovery time. In normals the intrinsic heart rate (113.3 +/- 11.6 beats/min) was higher than the resting heart rate (87.3 +/- 12 beats/min; P less than 0.001). The AH interval at an identical paced rate decreased from 119 +/- 36 msec to 93 +/- 17.6 msec after autonomic blockade (P less than 0.05). Mean atrial paced cycle length at AH Wenckebach block was not different during control and after drugs (319 +/- 46 msec vs. 311.5 +/- 39 msec; P = NS). Although sinus cycle length shortened in all cases after autonomic blockade, paced cycle length at AH Wenckebach increased (4) or remained unchanged (3) in 7 cases. Maximum normal "intrinsic" paced cycle length at AH Wenckebach was 390 msec (mean +/- 2 SD). In sick sinus syndrome, resting heart rate (66.3 +/- 18.8 beats/min) and intrinsic heart rate (74.6 +/- 16.4 beats/min) were similar (P = NS); AH at identical paced rate: control 136.6 +/- 54 msec, after drugs 130.5 +/- 35 msec (P = NS); cycle length at AH Wenckebach: control 380.5 +/- 73 msec, after autonomic blockade 383 +/- 49 msec (P = NS). Two of 3 cases with abnormal atrioventricular nodal response to atrial pacing during control normalized after autonomic blockade; 9/21 (42.8%) cases developed AH Wenckebach at cycle length greater than 390 msec after autonomic blockade. The data suggest that the autonomic nervous system has differential effects on sinus and atrioventricular nodes. Patients with sick sinus syndrome frequently have abnormalities of "intrinsic" atrioventricular nodal conduction unmasked by autonomic blockade.

Adolescent↗
PubMed2004

Sinus slowing caused by adenosine-5'-triphosphate in patients with and without sick sinus syndrome under various autonomic states.

Adenosine infusion can potentially be used as a diagnostic test for sick sinus syndrome (SSS) based on its negative chronotropic effects. Whether autonomic tone underlies adenosine's negative chronotropic effects remains unknown. This study was to investigate the bradycardiac response of sinus node to ATP in patients with and without clinical SSS by measuring atrial cycle length (ACL) before and after bolus of ATP in different states of autonomic tone. The negative chronotropic effect of ATP was assessed by comparing the mean ACL before ATP administration with the longest ACL after a bolus of ATP infusion (Delta ACL). Our results showed that Delta ACL in patients with SSS were significantly greater than that without SSS (P<.001) in all 4 states, and IHR in patients with SSS were significantly lower than calculated IHR (P<.0001). Moreover, there was no significant difference in Delta ACL between the 4 states in patients with SSS (P = .99). However, Delta ACL was significantly greater during isoproterenol infusion and after propranolol administration in patients without sinus node dysfunction, comparing with baseline state (P<.01), but not after combination of atropine (P = .33). Our results indicate that the negative chronotropic effect of ATP on sinus node is much more dramatic in patients with SSS, in which the intrinsic disease of sinus node is responsible for the abnormal adenosine-mediated sinus arrest, and this effect is influenced by autonomic tone in patients without sinus node dysfunction but not in patients with SSS.

Adenosine Triphosphate↗
PubMed2005

The use of autologous fibrin glue for closing sinus membrane perforations during sinus lifts.

Sinus lift procedures depend greatly on fragile structures and anatomical variations. These procedures may cause sinus membrane perforations, which can lead to graft infection and early failure. The aim of this study was to assess the efficacy of autologous fibrin glue in the management of large perforations of the maxillary sinus membrane occurring during sinus lifts. After elevating the sinus membrane in the bilateral maxillary sinuses of 6 adult female mongrel dogs, a laceration (about 2.0 cm in length) was made in the membrane and either repaired with autologous fibrin glue or covered with a bioabsorbable collagen membrane as a control. Wounded areas were biopsied 2 weeks after the operation. Wounds repaired with autologous fibrin glue showed newly formed continuous epithelium across the previous perforation site. However, extensive fibrosis, inflammatory infiltration, and absent epithelium were observed in wounds treated with the collagen membrane control. Our results support the clinical use of autologous fibrin glue for repairing sinus membrane perforations.

Animals↗
PubMed2006

The effects of exposing dental implants to the maxillary sinus cavity on sinus complications.

OBJECTIVE: The aim of this study was to investigate whether dental implant exposure to the maxillary sinus cavity increases the risk of maxillary sinus complications. STUDY DESIGN: An implant was placed bilaterally in the maxillary sinus of 8 adult female mongrel dogs in a way that it penetrated the bone and mucous membrane of the maxillary sinus floor to the extent of 2 mm, 4 mm, or 8 mm. The implants were left in place for 6 months. RESULTS: Radiographic and histologic examinations did not show any signs of pathologic findings in the maxillary sinus of the 8 dogs. CONCLUSION: This study indicates that implant protrusion into the maxillary sinus cavity is not related to the development of sinus complications in canines.

Animals↗
PubMed2004

Effectiveness of immunotherapy for recurring sinusitis associated with allergic rhinitis as assessed by the Sinusitis Outcomes Questionnaire.

BACKGROUND: Outcomes measurement is a proficient method for determining the effectiveness of medical therapy. Currently, there are no easy-to-use and inexpensive questionnaires available to evaluate the impact of immunotherapy in the treatment of sinusitis by allergists, given the research constraints of a private practice setting. OBJECTIVE: To measure the effectiveness of immunotherapy in the overall treatment of atopic patients with associated sinusitis in a private practice setting. METHODS: A total of 114 patients with a history of rhinitis and sinusitis and positive radiographic evidence of sinus disease were consecutively chosen from 3 private practices nationwide and surveyed for global symptoms and specific symptoms related to the nose, sinuses, eyes, and chest with the Sinusitis Outcomes Questionnaire (SOQ). Their medical history, including prior treatment, was evaluated. This questionnaire was administered twice in one sitting, with the first a recall of symptoms before starting immunotherapy and the second an evaluation of current symptoms. RESULTS: The data revealed that 99% believed immunotherapy worked, with 1% unsure. Patients experienced a 72% decrease in days lost from work or school and a 26% reduction in the use of medications per year. There was a mean reduction of 51% in the overall symptom score of the patients after receiving immunotherapy. CONCLUSIONS: This study demonstrates that the user-friendly SOQ can be effectively and inexpensively used in a private practice setting and suggests that immunotherapy is an effective treatment for patients with sinus disease and allergic rhinitis.

Adolescent↗
PubMed2001

Heating of air in the nasal airways in patients with chronic sinus disease before and after sinus surgery.

The main goal of this study was to determine the influence of sinus surgery on the heating of inspired air in the nose. Intranasal temperature values of 22 patients with chronic sinus disease were measured after inspiration at different locations in the nasal cavity. Measurements were done before and 6-8 weeks after sinus surgery. The patients were compared to 22 healthy control subjects. Nasal airway temperature did not differ between the two study groups at any location in the nasal cavity. Nasal decongestion was without significant influence on temperature values in the patients and the volunteers. There was no significant difference of nasal airway temperature before and after sinus surgery. Even after sinus surgery the main area of heating of inspired air seemed to be the anterior part of the nose. Sinus surgery in patients with chronic sinus disease does not seem to influence heating of air in the nasal cavity.

Adult↗
PubMed2003

High density endocardial mapping of shifts in the site of earliest depolarization during sinus rhythm and sinus tachycardia.

Previous mapping studies of sinus rhythm suggest faster rates arise from more cranial sites within the lateral right atrium. In the intact, beating heart, mapping has been limited to epicardial plaques or single endocardial catheters. The present study was designed to examine shifts in the site of the earliest endocardial depolarization during sinus rhythm and sinus tachycardia using high density activation mapping. Noncontact mapping of the right atrium during sinus rhythm was performed on ten anesthetized swine. Recordings were made during sinus rhythm, phenylephrine infusion, and isoproterenol infusion. The hearts were then excised and the histological sinus node identified. The mean minimum and maximum cycle lengths recorded were 355 +/- 43 and 717 +/- 108 ms. A median of three (range two to five) sites of earliest endocardial depolarization were documented in each animal. With increasing heart rate the site of earliest endocardial depolarization remained stationary until a sudden shift in a cranial or caudal direction, often to sites beyond the histological sinoatrial node. The endocardial shift was unpredictable with considerable variation between animals; however, faster rates arose from more cranial sites (r = 0.46, P = 0.023). There was no difference in the mean cycle length of sinus rhythm originating from specific positions on the terminal crest (r = 0.44, P = 0.17). Cranial sites displayed a more diffuse pattern of early depolarization than caudal sites. In the porcine heart the relationship between heart rate and site of earliest endocardial depolarization shows considerable variation between individual animals. These findings may have implications for clinical mapping and ablation procedures.

Animals↗
PubMed1984

Electrophysiological effects of ethmozin on sinus nodal function in patients with and without sinus node dysfunction.

The electrophysiological effects of intravenously administered ethmozin (1 mg kg-1) on sinus node function were examined in 32 patients. Based on their clinical data and the results of the initial study, patients were subdivided into group A (n = 12), those with sick sinus syndrome and sinus node recovery time (SNRT) greater than 1500 ms, and group B (n = 20), those without overt sinus node dysfunction and a normal SNRT. The mean sinus cycle length did not change significantly in either group after ethmozin . SNRT was prolonged by ethmozin in group A whereas in group B the increase of SNRT was not significant. Corrected SNRT increased after ethmozin in both subgroups but with a much more pronounced increase in group A. Sinoatrial conduction time was not significantly changed in any group. The lengthening of SNRT in the majority of patients with sick sinus syndrome implies that ethmozin might prolong post-tachycardia pauses in these patients. This drug should therefore be administered cautiously to persons with signs indicative of dysfunction of the sinus node.

Adolescent↗
PubMed1999

Bone density measurements of the paranasal sinuses on plastinated whole-organ sections: anatomic data to prevent complications in endoscopic sinus surgery.

OBJECTIVE/HYPOTHESIS: Although anatomic data regarding the gross anatomy of the paranasal sinuses are available, severe complications of endonasal sinus surgery (ESS) are frequently reported. To understand and to avoid these complications, density of bony walls of the paranasal sinuses were studied in this report. Special attention was given to the analysis of the bone density in regions where minor and major complications occur in ESS. METHODS: Thirty cadaver heads were embedded in epoxy resin. The plastic blocks were sectioned with a diamond-coated wire saw into 1.0-mm thick, parallel slices in axial, coronal, and sagittal planes for 10 specimens each. The slices were x-rayed and scanned with a computerized image analyzing system. For each specimen the bone density in 12 regions of interest was measured. RESULTS: Besides the macroscopic examination of the plastinated specimens, a bone density analysis based on x-ray films is presented. Lowest bone density was found at the lateral wall of the sphenoid sinus (3.31 +/- 0.99 mm aluminum [Al]); highest density was measured at the roof of the sphenoid sinus (12.91 +/- 1.75 mm Al). Overall bone density in female specimens was 0.41 mm Al (mean) lower than in male specimens. CONCLUSIONS: This study is the first to use plastinated whole-organ serial sections and bone density images for the analysis of potential complications in ESS. The illustration of regions with minor and major bone density of the paranasal sinuses and the ethmoid floor as presented in this study may help the novice sinus surgeon to minimize the risks of ESS and to avoid severe complications.

Absorptiometry, Photon↗
PubMed1998

Dural arteriovenous malformations of the transverse/sigmoid sinus acquired from dominant sinus occlusion by a tumor: report of two cases.

OBJECTIVE AND IMPORTANCE: Debate continues regarding the pathogenesis of dural arteriovenous malformations (dAVMs). The prevailing theory is that dAVMs are acquired lesions that occur after thrombosis of the dural venous sinus. CLINICAL PRESENTATION: We report unique cases of two patients having different tumors (one meningioma and one glomus jugulare paraganglioma) that occluded the ipsilateral transverse and sigmoid sinuses, respectively, and were associated with dAVMs. In each patient, the occluded venous sinus was the dominant sinus. CONCLUSION: Our experience with these patients supports the hypothesis that dAVMs are acquired and induced lesions that may occur after sinus occlusion. We suggest that the occlusion of the dominant transverse/ sigmoid sinus is a major contributing factor to the development of dAVMs because of the inability of the contralateral (nondominant) sinus to handle the venous flow from the obstructed (dominant) side.

Arteriovenous Fistula↗
PubMed2000

Endovascular treatment of a grade IV transverse sinus dural arteriovenous fistula by sinus recanalization, angioplasty, and stent placement: technical case report.

OBJECTIVE AND IMPORTANCE: The frequent association of dural arteriovenous fistulae (DAVFs) and dural sinus thrombosis may render the treatment of these complex lesions difficult. We report a case of DAVF eradicated by recanalization of the chronically thrombosed transverse sinus (TS) and sigmoid sinus followed by balloon angioplasty and stent deployment at the site of the fistula. CLINICAL PRESENTATION: A 52-year-old man presented with a Type IV DAVF of the left TS with widespread white matter changes secondary to venous hypertension. Arterial feeders arose from the left internal carotid, external carotid, and vertebral arteries. The distal segment of the left TS, the left sigmoid sinus, and the proximal segment of the right TS were occluded. Reverse flow was observed in the deep venous system and in the superior sagittal sinus. INTERVENTION: Endovascular access was gained through the left internal jugular vein. Mechanical recanalization of the thrombosed left TS and sigmoid sinus was followed by balloon angioplasty and placement of six overlapping stents extending from the TS to the proximal internal jugular vein. Angiograms performed after surgery showed resaturation of antegrade venous drainage as well as complete eradication of the fistulous connections. The patient was discharged with an improving clinical CONCLUSION: Recanalization of a chronically occluded dural venous sinus through a jugular approach is feasible. In addition to eradicating cerebral venous hypertension by reestablishing antegrade venous drainage, balloon angioplasty and stent deployment at the DAVF site produced complete closure of the fistula. This may prove to be a new therapeutic strategy for management of DAVF.

Angiography, Digital Subtraction↗