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PubMed2002

Polypoid mucosa with eosinophilia and glandular hyperplasia in chronic sinusitis: a histopathological and immunohistochemical study.

OBJECTIVE: To evaluate the histopathological and immunohistochemical characteristics of chronic sinusitis, with reference to the extent of sinus involvement. STUDY DESIGN: A nonrandomized, retrospective, controlled qualitative and quantitative study. METHODS: Twenty-nine adults with refractory chronic sinusitis underwent functional endoscopic sinus surgery. The score of computed tomography scans was used to determine the extent of disease. Six patients with normal sinus mucosae served as control subjects. Specimens underwent routine histological processing and hematoxylin-eosin and periodic acid-Schiff staining. Immunohistochemistry for T and B lymphocytes was applied. Low-magnification microscopy was designed to yield typical pathological features, and high magnification to count various inflammatory cells. RESULTS: Patients were divided into two groups according to their dominant pathological features: 16 had polypoid mucosa and eosinophilia, and 13 had glandular hyperplasia. The number of eosinophils, T and B lymphocytes in the lamina propria was significantly higher in patients with polypoid mucosa and eosinophilia, compared with those with glandular hyperplasia and with normal control subjects, whereas the difference between patients with glandular hyperplasia and control subjects was insignificant. Although the overall inflammatory reaction was relatively modest, nasal polyposis was more prevalent in patients with polypoid mucosa and eosinophilia; likewise, computed tomography revealed a significantly more extensive disease in these patients compared with the patients with glandular hyperplasia. CONCLUSION: Two pathophysiological pathways, inducing prolonged obstruction to the outflow of sinus secretion and ultimately causing chronic inflammation, are suggested: 1) swollen polypoid mucosa with activation of eosinophils that damage the epithelium and 2) continued increased mucus secretion originated from hyperplastic submucosal seromucous glands.

B-Lymphocytes↗
PubMed1993

Ciliary beating frequency in chronic sinusitis.

Ciliary beating frequency, one component of mucociliary function, was measured outside of the sinus in vitro with a photoelectric method in 150 patients with chronic sinusitis and in 26 control subjects. In the mucosal samples of 35 patients (23%), no ciliary activity was seen. Ciliary beating frequency in maxillary sinus mucosa of the rest of the 115 patients (77%) was, as an average, 16.6 +/- 3.0 Hz (range, 10.9 to 23.3 Hz) and it was 15.9 +/- 2.6 Hz (range, 13.2 to 22.8 Hz) for the control patients. No differences in ciliary beating frequency were found according to quality of sinus secretion, prevalent respiratory allergy, or mucosal thickness. However, in sinuses with purulent secretion, ciliary beating frequency was slightly better (P < .05) than in "empty" sinuses. The study suggests that in many cases of chronic sinusitis, the sinus mucosa still has a capacity to recure.

Adolescent↗
PubMed1989

Otitis media with effusion as a presenting symptom of chronic sinusitis.

Otitis media with effusion was the presenting symptom in 23 per cent of patients suffering from chronic sinusitis. The inter-relationship between chronic sinusitis and otitis media with effusion was studied in 29 patients. Endoscopic evaluation of intranasal structures including sinus ostia and Eustachian tube orifices was carried out. We further suggest that otitis media with effusion is not a separate entity but a presentation of sinus disease, predominantly of the ethmoid system. Patients with otitis media with effusion should be evaluated for sinusitis and vice versa. The value of careful nasendoscopy is demonstrated.

Adolescent↗
PubMed1994

Staging systems for chronic sinus disease.

A four-stage system is proposed for the classification of chronic hyperplastic rhinosinusitis. The system is comprehensive, simple to use, and has demonstrated extreme clinical usefulness. There is a linear correlation between recurrence rates and stage of disease. The system has virtually mandated treatment strategies for chronic sinusitis. Stage I disease is considered primarily medical, while Stages II, III and IV are surgical. The author's long-standing study is in agreement with Kennedy, Mackey and Lund in their view that radiographic assessment of extent of disease is the major determinant for staging and prognosis. This study, which began in 1988 and has been reported progressively since that time, has proven both useful and accurate for physicians using it, and more importantly has been a boon in explaining to patients the prognosis, needed treatment strategies, and potential outcomes in the treatment of their chronic sinusitis.

Asthma↗
PubMed1997

IL-4 and IL-13 expression in chronic sinusitis: relationship with cellular infiltrate and effect of topical corticosteroid treatment.

OBJECTIVE: Chronic sinusitis with allergy (ACS) and without allergy (NCS) are inflammatory diseases with considerable morbidity. The present study was undertaken to investigate, by in situ hybridization, the expression of IL-13 and IL-4 mRNA in sinus biopsy sections. METHOD: Specimens were obtained from subjects with NCS (n = 12), ACS (n = 13), ACS on steroid therapy (n = 11), and normal controls (n = 11). The composition of the inflammatory infiltrate was also examined in all cases. RESULTS: The number of cells expressing IL-4 and IL-13 transcripts was significantly higher in subjects with ACS compared to normal controls. In contrast, the numbers of IL-13 but not IL-4 mRNA-positive cells were increased in the NCS subjects compared to the normal controls. IL-4 and IL-13 mRNA expression was suppressed in ACS subjects on topical steroid therapy compared to untreated patients. There was no significant difference in the numbers of eosinophils between the ACS subjects treated with steroids and those who were not treated, but the steroid-treated patients demonstrated significantly higher numbers of CD8+ cells in the sinus mucosa. Increased numbers of CD8+ cells were also observed in subjects with NCS compared with ACS subjects and normal controls. CONCLUSIONS: These results demonstrate that increased IL-13 expression is an important feature of allergic and nonallergic patients with chronic sinusitis. Furthermore, our data indicate that IL-13 and IL-4 are under differential regulation in NCS subjects.

Adolescent↗
PubMedDate not supplied

Septal deviation and chronic sinus disease.

The introduction of computerized tomography in the identification of sinonasal pathology and associated anatomic variants has contributed to a greater understanding of the factors leading to ostiomeatal complex (OMC) obstruction and chronic sinus disease. The OMC and paranasal sinus regions were prospectively evaluated in 150 consecutive patients as a function of the degree of nasal septal deviation and compared with matched controls. These data were correlated with paranasal sinus disease, lateral nasal wall findings, and middle turbinate abnormalities. An increased incidence and severity of bilateral chronic sinus disease was present with increasing septal deviations (p < 0.05). Similarly, patients with increasing nasal septum deviations were noted to have a higher incidence of OMC obstruction (p < 0.05). Ostiomeatal complex obstruction in the direction of septal angulation was associated with nasal septal deformity; however, contralateral OMC obstruction was associated with middle turbinate and lateral nasal wall abnormalities (p < 0.05). The evaluation of the degree of septal angulation has helped better understand the factors contributing to chronic sinus disease and OMC obstruction.

Adolescent↗
PubMed2000

[Treatment of patients with chronic sinusitis by endoscopic and Caldwell-Luc approaches].

OBJECTIVE: To investigate the clinical effect of surgical procedures on patients with chronic sinusitis. METHOD: 104 patients with chronic sinusitis were treated by endoscopic and Caldwell-Luc's approaches. The lesions were cleared away completely. RESULT: The clinical cure rate was 96.1% after 6-12 months (average 9 months) follow up. CONCLUSION: It suggests that patients with severe maxillary sinus diseases might be cured by endoscopic and Caldwell-Luc's procedure.

Adolescent↗
PubMed1994

Study of the efficacy and safety of ciprofloxacin in the treatment of chronic sinusitis.

Over a 12-month period, 56 patients with acute exacerbations of chronic sinusitis were included in this study. The mean age of the patients was 48.6 +/- 10.1 years. The period between the onset of sinus symptoms and inclusion in the study was 10.1 +/- 12.1 years and the exacerbation had lasted 2.4 +/- 4.4 months. Patients were given 500 mg ciprofloxacin twice daily for 9 days. Bacteriological specimens taken at inclusion were positive in 53.6% of cases, 25 Gram-positive and 16 Gram-negative pathogens being isolated. At the end of the treatment, rhinorrhoea, which was the main criterion for evaluation of the efficacy of treatment, had disappeared in 46/54 (85%) patients who were examined. Of the 30 patients whose sinusitis was confirmed by bacteriological test, the bacteria were eradicated in 90% of cases. At the end of a 4-week follow-up period after the end of treatment, the clinical success rate was 74.5%, the partial success rate 21.2% and the failure rate 4.3%. There were no bacteriological recurrences. Ten adverse events were observed in seven patients and in four (7%) of these treatment had to be withdrawn. This study showed ciprofloxacin to be an effective and well tolerated treatment for exacerbations of chronic sinusitis treated in non-hospital practice.

Adult↗
PubMed1997

Effects of long-term low-dose macrolide administration on neutrophil recruitment and IL-8 in the nasal discharge of chronic sinusitis patients.

Effects of long-term low-dose macrolide administration were studied in patients with chronic sinusitis. Twelve patients with non-allergic chronic sinusitis were orally given 150 mg roxithromycin once a day without other treatments. The patients underwent computed tomography before and after the treatment, and paranasal sinus aeration was analyzed quantitatively. The number of neutrophils in the nasal smear was semiquantitatively assessed on a grading scale, and the IL-8 concentration in the nasal discharge was measured by enzyme immunoassay. The aeration of all four sinuses significantly improved, and recruited neutrophils and the IL-8 level in the nasal discharge were simultaneously reduced after the treatment. These findings suggest that long-term low-dose roxithromycin administration inhibits the positive feedback mechanism of neutrophil recruitment and IL-8 production by the recruited neutrophils, which is considered to be an essential cause of the prolongation of sinusitis.

Administration, Oral↗
PubMed1983

Functional and morphological pathology of chronic sinusitis mucous membrane.

The previous paper (Part I) in our study described how a decrease in the frequency of ciliary beating was responsible for the deceleration of mucociliary transport in chronic sinusitis. In the present work, it was examined whether or not the reduction in ciliary beating frequency is associated with morphological changes in the mucosal epithelium. As a result, a very close correlation was found between them: the more severe the morphological changes, the more the beating frequency was reduced. The morphological changes of the mucosal epithelium in chronic sinusitis were swelling of the ciliary membrane, formation of compound cilia, dropping of epithelial cells, and metaplasia of a squamous epithelium. On the basis of these observations on ciliary beating and the fine structure of the mucosal epithelium, the severity of pathological change of the mucous membrane in chronic sinusitis was graded.

Chronic Disease↗
PubMedDate not supplied

Chronic sinusitis in children.

Clinical practice guidelines for the management of acute sinusitis in children have been published by the American Academy of Pediatrics. Of note is that in this document, a brief discussion of chronic disease concluded that the pathogenesis and management are essentially unknown. Although there are insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of the literature and clinical experience of experts who manage pediatric chronic sinusitis is presented in an effort to develop specific recommendations and to offer practical treatment options. Factors associated with chronic sinusitis should be addressed individually and include recurrent viral upper respiratory infections, allergic and nonallergic rhinitis, ciliary dyskinesia, cystic fibrosis, immunodeficiency, and anatomic abnormalities. Bacteriology includes the 3 pathogens associated with acute disease i.e., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis but with chronic sinusitis also includes Staphylococcus aureus, anaerobic bacteria, and fungi. Medical interventions discussed include endoscopic sinus surgery, saline nasal irrigation, intranasal decongestant therapy, intranasal steroids, and oral antibiotics. Clinical ranking without regard to side effects and cost suggests that endoscopic sinus surgery and antral irrigation have the highest probability of substantial symptom improvement. Other issues discussed include identification and management of gastroesophageal reflux disease (GERD), allergy, and immune deficiency.

Adrenal Cortex Hormones↗
PubMed1992

Nasal mucociliary transport of chronic sinusitis in children.

Nasal mucociliary function is one of the most important and indispensable mechanisms of the respiratory tract, providing protection against the atmospheric environment. We previously found mucociliary dysfunction in the noses of adult patients suffering from chronic sinusitis. In this study, using the saccharin method, we determined nasal mucociliary function in normal children and in children with chronic sinusitis. The mean (+/- SD) value of saccharin transit time in the nose was 28.2 +/- 19.9 minutes in patients with chronic sinusitis, this being significantly slower than that in the control group of children. The incidence of abnormally slow nasal mucociliary transport time (> 30 minutes) in patients was significantly higher than in controls of the same age. Mucociliary dysfunction may initiate a vicious cycle of self-mediated inflammation and may be important in recovery from chronic respiratory inflammation.

Adolescent↗
PubMed2003

Pulmonary aspiration of nasal secretions in patients with chronic sinusitis and asthma.

BACKGROUND: The role of silent aspiration of nasal secretions in the pathogenesis of asthma has often been questioned. OBJECTIVE: To investigate the presence of pulmonary aspiration of nasal secretions during sleep in patients with chronic sinusitis and asthma and in healthy controls. DESIGN: Prospective, controlled trial. SUBJECTS: The study included 13 patients with chronic sinusitis and asthma and 12 healthy controls. The diagnoses were based on history, physical examination findings, radiologic assessments, and pulmonary function test results. INTERVENTIONS: A radioactive tracer was prepared by diluting 10 mCi of technetium 99m-labeled macroaggregated albumin in 10 mL of physiologic saline. At 10 PM, just before the patients went to sleep, the solution was sprayed into their nostrils. The subjects were examined with a gamma camera to obtain views of the thorax at 8 AM the following morning. The average counts of the lungs and background and the actual lung counts (average lung count minus average background count) were determined. RESULTS: The average counts of the lungs were significantly greater than the average counts of the background in both the sinusitis-asthma group (P =.001) and the control group (P =.002). The difference in the actual counts of the lungs was not significant between the 2 groups (P =.79). CONCLUSIONS: The nasal secretions were aspirated into the lungs both in patients with sinusitis and asthma and in healthy adults during sleep, and the relative amounts that were aspirated did not differ significantly between the 2 groups (P =.79). The amount of the aspirated material alone is probably not responsible for the pathogenesis of asthma in patients with chronic sinusitis.

Asthma↗
PubMed1998

Interleukin-6 expression in chronic sinusitis: colocalization of gene transcripts to eosinophils, macrophages, T lymphocytes, and mast cells.

Chronic sinusitis in allergic (ACS) and nonallergic (NCS) patients is characterized by persistent inflammation and subepithelial fibrosis of the sinus mucosa. The inflammatory infiltrate is rich in T lymphocytes, monocyte/macrophages, plasma cells, and eosinophils. Th2-type cytokines are thought to regulate inflammatory cell recruitment, activation, survival, and the release of tissue-damaging mediators. Interleukin-6 is a proinflammatory Th2-type cytokine that stimulates fibroblast proliferation and collagen synthesis. Expression of interleukin-6 has been reported in pulmonary fibrosis and a number of other conditions associated with fibrotic tissue changes. In vitro studies have indicated that interleukin-6 is produced by macrophages, T cells, eosinophils, mast cells, and other cell types. Here we examined interleukin-6 messenger RNA and immunoreactivity in the sinus epithelium and subepithelium of subjects with ACS and NCS by in situ hybridization and immunocytochemistry, performed on sinus biopsy and polyp sections obtained from patients. Nasal turbinate biopsy specimens from normal volunteers were used as controls. Interleukin-6 messenger RNA and immunoreactivity were expressed by a significantly greater proportion of epithelial and subepithelial cells in ACS and NCS subjects than in normal controls. There was no difference in epithelial or subepithelial interleukin-6 expression between ACS and NCS patients. Colocalization studies revealed that macrophages, T cells, eosinophils, and mast cells are sources of interleukin-6 messenger RNA in ACS and NCS. The numbers of interleukin-6 messenger RNA-positive cells coexpressing immunoreactivity for the mast-cell marker were significantly greater in ACS than in NCS subjects. The results of this study suggest a role for interleukin-6 in the inflammatory response of chronic sinusitis.

Adult↗
PubMed2004

Macrophage mannose receptor in chronic sinus disease.

BACKGROUND: The role of infectious agents in the onset and maintenance of chronic sinus disease is still not fully understood. Macrophage mannose receptor (MMR), an innate pattern recognizing receptor, capable of phagocytosis of invaders and signal transduction for proinflammatory mechanisms, might be of importance in immune interactions in chronic sinus disease. OBJECTIVE: We examined the MMR in sinonasal airway mucosa to evaluate its possible role in chronic rhinosinusitis (CS) and nasal polyposis (NPs). METHODS: Surgical samples from patients with sinonasal disease were investigated with real-time RT-PCR for quantification of MMR mRNA expression, and the presence and location of MMR-positive cells was analysed by immunohistochemistry. RESULTS: Quantification of MMR mRNA showed a statistically significant higher expression in NPs compared to CS without NP and controls. Immunohistochemistry revealed expression of MMR in all tissue samples; however, in NP we found an enhanced positive cellular staining including cell aggregates. CONCLUSIONS: We could demonstrate for the first time that the expression of MMR is significantly upregulated in NP compared to patients with CS without NP or turbinate tissue of controls. Macrophages expressing MMR, accumulated in cell aggregates in NPs, play a possible key role in pathogen-macrophage interaction in NP disease.

Adult↗
PubMedDate not supplied

Treatment of chronic sinusitis with open drainage and cefaclor.

A prospective study of 50 adult patients with chronic sinusitis was undertaken. Forty patients were treated with the Caldwell-Luc operation and postoperative cefaclor, and 10 underwent nasal antrostomy and treatment with cefaclor. Approximately 85% of the 40 patients had resolution of symptoms with this treatment. The microbiology of chronic sinusitis was studied through aerobic and anaerobic cultures of sinus secretions obtained at surgery. Staphylococcus aureus (coagulase-negative) and Propionibacterium sp were found to be the most common pathogens. The radiologic results of Caldwell-Luc surgery were studied through comparison of preoperative and postoperative radiographs in 33 of these patients. An air-fluid level is the only radiographic sign of consistent diagnostic significance in the postoperative radiograph.

Adult↗
PubMed1981

Endonasal findings using a fiberoptic telescope in postoperative cases of chronic sinusitis.

It is the purpose of this study to investigate the healing process in chronic sinusitis by means of a fiberoptic telescope. The patients were divided into 3 groups, in which various combinations of operative techniques were used. Group 1:53 patients with moderate chronic sinusitis. In this group endonasal ethmoidectomy and endonasal exposure of the sphenoidal sinus were performed. Group 2:73 patients with moderate or severe sinusitis. In this group a Caldwell-Luc operation was added to the operations which were used in group I. Group 3:8 patients, in which only endonasal ethmoidectomy was performed. In most cases, the maxillary sinus was cured, but in some of the cases the drainage opening was closed at an early stage. The epithelization of the ethmoidal sinus is mostly completed in about one month after the surgical operation. Adhesions between middle turbinate and lateral wall were seen regularly. Hypertrophic scars were observed in the posterior ethmoid, the ethmoidal roof and the lamina papyracea. We classified the healing process into 4 types. All postoperative infections were treated by antibiotics. Adhesions and scar tissue formations were treated endoscopically.

Chronic Disease↗