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PubMedDate not supplied

Paranasal sinus radiology, Part 2B: ethmoidal sinuses.

The clinician must have a high level of suspicion in order to detect ethmoidal sinus disease. Survey plain film radiographic examination may provide information about gross changes in ethmoidal sinus transparency and the sinus walls. Conventional tomographic study will often aid evaluation of the ethmoidal sinus walls which may be obscured by overlying structures on plain films. Computerized tomography adds a new dimension to ethmoidal sinus study. By revealing not only bone changes but soft-tissue abnormality as well, more complete understanding of the disease process is gained. Computerized tomography is particularly useful in evaluating orbital structural change due to ethmoidal sinus abnormality.

Carcinoma↗
PubMedDate not supplied

Paranasal sinus radiology, Part 3A: sphenoidal sinus.

This article describes the complex anatomy of the sphenoid bone. The development and size of the sphenoidal sinuses are quite variable and complete analysis of the sinus walls requires several views. The essential plain film projections and use of tomography and CT scans are described. Sphenoidal sinus inflammatory disease produces changes similar to those already discussed in the articles in this series on the frontal sinus and the ethmoidal sinus. Illustrations of sphenoidal sinus inflammatory disease are provided.

Humans↗
PubMed1993

Cefotiam concentrations in the sinus fluid of patients with chronic sinusitis after administration of cefotiam hexetil.

Cefotiam hexetil is a prodrug of cefotiam. The concentrations of cefotiam in plasma and sinus secretions were determined in 18 patients (10 males, 8 females, aged 39.3 +/- 13.0 years) with chronic sinusitis. All patients received two 200 mg oral doses of cefotiam hexetil 12 h apart and were divided into four groups according to the time which elapsed between the last dose and collection of secretion samples. The last dose was given 2 h (group I), 3 h (group II), 4 h (group III) or 6 h (group IV) before sinus puncture. Cefotiam concentrations were measured by high-pressure liquid chromatography and microbiological assay, results being very similar with both methods. Mean concentrations of cefotiam with the standard deviation in sinus exudates were 1.04 +/- 0.60 mg/l at 2 h (n = 6), 1.04 +/- 0.33 mg/l at 3 h (n = 4), 0.75 +/- 0.74 mg/l at 4 h (n = 4) and < 0.10 mg/l at 6 h (n = 4). Mean sinus fluid concentrations were higher than mean plasma concentrations in all groups. These results suggest that cefotiam concentrations higher than the MICs for common pathogens are found in sinus secretions up to 4 h after oral administration of cefotiam hexetil.

Adult↗
PubMed1995

Maxillary sinus aspergillosis: diagnosis and differentiation of the pathogenesis based on computed tomography densitometry of sinus concretions.

PURPOSE: The efficacy of preoperative computed tomography (CT) densitometry in evaluating the origin of sinus concretions (SC) in sinus aspergillosis (SA) and its value for differentiation between a dental (endodontic) and an aerogenic pathogenesis were examined. PATIENTS AND METHODS: Thirty-two patients who demonstrated radiodense maxillary sinus concretions in standard radiography underwent an additional preoperative CT examination of the maxillary sinus and the SC. The density of the SC and the root canal filling materials was assessed. The SC were subdivided into organic (< 1,500 HU) and inorganic (> 1,500 HU) masses; this classification was useful in the differentiation between a dental and an aerogenic pathogenesis of SA. RESULTS: SA was diagnosed in 22 patients (68.8%). The SC of SA patients had a density of 2,566.5 +/- 713.6 HU, whereas those of patients without SA had a density of 1,159.9 +/- 1,008.4 HU (P < .01). A correlation between the density of inorganic SC and that of root filling materials was found (r = .78, P < .01). CONCLUSION: CT densitometry allows a classification of SC into two subgroups. The correlation between the density of root filling materials and that of radiodense sinus concretions seems to point to a "dental" origin of some concretions in SA. However, "organic" masses found in CT densitomentric examinations represent endogenous fungal products, which indicate an aerogenic pathogenesis of SA. Additional CT examinations of radiodense sinus concretions may thus be of some value for diagnosing SA and differentiating their pathogenesis.

Administration, Topical↗
PubMed1999

Intermittent sinus bigeminy as an expression of sinus parasystole: a case report.

A case of sinus parasystole is reported. The diagnosis of sinus parasystole is relatively difficult because there is no difference between the basic sinus P wave and the parasystolic wave. Sinus parasystole is diagnosed according to the following electrocardiographic criteria: (1) premature P waves having contour identical to P waves of basic beats; (2) intervals between premature P waves mathematically related. In the case reported, the coupling intervals during long phases of intermittent sinus bigeminy were nearly fixed, because there was little variability in the returning cycles, making the diagnosis of sinus parasystole difficult.

Aged↗
PubMed2000

Ventilator-associated sinusitis: microbiological results of sinus aspirates in patients on antibiotics.

BACKGROUND: The efficacy of systemic antibiotics on the treatment of ventilator-associated infectious maxillary sinusitis (VAIMS) is debated. The objective of this study was to determine the etiologic diagnosis of VAIMS in patients receiving antibiotics. METHODS: Patients mechanically ventilated for more than or equal to 72 h, who had persistent fever while on antibiotics for more than or equal to 48 h, underwent computed tomography scan followed by transnasal puncture of involved maxillary sinuses. VAIMS was defined as follows: fever greater than or equal to 38 degrees C, radiographic signs (air fluid level or opacification of maxillary sinuses on computed tomography scan), and a quantitative culture of sinus aspirate yielding more than or equal to 103 colony-forming units/ml. RESULTS: Twenty-four patients had radiographic signs of sinusitis. The mean +/- SD prior durations of mechanical ventilation and antibiotic exposure were 9.5 +/- 4.7 days and 6 +/- 4 days, respectively. Six unilateral and nine bilateral VAIMS were diagnosed in 15 patients. The median number of etiologic organisms per patient was two (range, one to four). The bacteriologic cultures yielded gram-positive bacteria (n = 21), gram-negative bacteria (n = 22), and yeasts (n = 5). Forty percent of causative agents were susceptible to the antibiotics prescribed. Seven patients with VAIMS developed 10 concomitant infections: ventilator-associated pneumonia (n = 5), urinary tract infection (n = 3), catheter infections (n = 2). In all cases of ventilator-associated pneumonia, the implicated agents were the causative agents of VAIMS. CONCLUSION: In VAIMS patients on antibiotics, quantitative cultures of sinus aspirates may contribute to establish the diagnosis. The frequent recovery of microorganisms susceptible to the antimicrobial treatment administered suggests that therapy of VAIMS with systemic antibiotics may not be sufficient.

Aged↗
PubMed2004

Cavernous sinus thrombosis complicating sinusitis.

BACKGROUND: Septic cavernous sinus thrombosis is a rare complication of paranasal sinusitis. OBJECTIVE: To familiarize the clinician with the pathogenesis, diagnosis, and appropriate management of septic cavernous sinus thrombosis. DESIGN: Case report and literature review. SETTING: Pediatric intensive care unit in a university hospital. PATIENT: We present a 12-yr-old female with a 1 wk history of an upper respiratory tract infection with worsening dyspnea, cough, and swelling of the left eye progressing to adult respiratory distress syndrome. Secondary to the need for significant mechanical ventilatory support, venovenous extracorporeal membrane oxygenation was initiated. Computed tomography scan of the head and neck with contrast revealed bilateral cavernous sinus thrombosis. After broad-spectrum intravenous antibiotics and aggressive supportive care in conjunction with surgical intervention (maxillary sinus lavage and right orbital exploration) and anticoagulation therapy, the patient recovered. Blood cultures were positive for Viridans streptococcus. At discharge 3 wks later, the patient had improved, but had right-eye blindness. CONCLUSIONS: The diagnosis of septic cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging; early diagnosis and surgical drainage of the underlying primary source of infection in conjunction with long-term intravenous antibiotic therapy are critical for an optimal clinical outcome.

Anti-Bacterial Agents↗
PubMed1997

Microbiology of chronic maxillary sinusitis: comparison between specimens obtained by sinus endoscopy and by surgical drainage.

The aerobic and anaerobic microbiology of sinus aspirates obtained during surgery was compared with culture of samples obtained by endoscopy. Six patients with chronic maxillary sinusitis were evaluated. Polymicrobial flora was found in all specimens (two-to-five isolates/sample). A total of 24 isolates (18 anaerobic, five aerobic and one micro-aerophilic) was obtained from sinus aspirates, and 25 isolates (16 anaerobic and nine aerobic) were found in endoscopic specimens. The predominant organisms were Prevotella spp., Fusobacterium nucleatum, Peptostreptococcus spp. and Staphylococcus spp. Concordance in the type and concentration of organisms was found in all cases. Sixteen of the 18 anaerobes isolated from sinus aspirates were also found in the concomitant endoscopic sample. Five aerobic isolates were found in both sinus aspirates and endoscopic samples and their concentration was similar. However, four aerobic gram-positive bacteria (<10(4) cfu/sample) were found only in endoscopy samples. This pilot study demonstrates the usefulness of endoscopic aspiration in the isolation of bacteria from chronically infected maxillary sinuses.

Adult↗
PubMed1990

Pacing for carotid sinus syndrome and sick sinus syndrome.

The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia less than 50 beats/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal episodes per patient (2.9 +/- 2 vs 1.8 +/- 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.

Aged↗
PubMedDate not supplied

A CT study of the course of growth of the maxillary sinus: normal subjects and subjects with chronic sinusitis.

We measured the maxillary sinus volume of normal children and those with bilateral chronic sinusitis by coronal CT scan of the paranasal sinus, and compared the results with findings previously obtained from adult patients. The distribution of mean maxillary sinus volume by age group from 4-9 to 70-79 years exhibited a monomodal pattern with a peak in the 20s in both the normal group and the surgical therapy group. The maxillary sinus volumes of children aged 10-15 years and adults tended to be smaller in the surgical therapy group than in the normal group; this tendency was more prominent in the adult group. These findings appear to support the hypothesis that the ethmoid infundibulum and middle meatus are narrowed by inflammation of the ostiomeatal complex and by various bony anatomic variations in the nasal cavity, leading to impaired pneumatization of the maxillary sinus.

Adolescent↗
PubMed1991

Sinus aspergillosis and allergic fungal sinusitis.

Aspergillosis of the sinonasal tract has four basic clinicopathologic presentations depending on the mucosal or extramucosal involvement by the fungus. Two are saprophytic (aspergilloma and allergic Aspergillus sinusitis) and two are infectious (chronic indolent and invasive fulminant sinusitis). Tissue-invasive and angioinvasive aspergillosis can be a rapidly lethal disease, particularly in the immune-compromised host. The allergic form of paranasal sinus aspergillosis is presumed to be initiated by hyperreactivity to fungal antigens. Not all allergic fungal sinusitis is associated with Aspergillus species, and culture confirmation is necessary to distinguish the fungal agent. Surgical removal of the offending fungus is the mainstay of therapy in all forms of sinonasal aspergillosis and other fungal sinusitis. Antifungal agents and steroids complement surgical removal, depending on the form of the sinusitis.

Antigens, Fungal↗
PubMed2005

Effect of treatment on maxillary sinus and nasal nitric oxide concentrations in patients with nosocomial maxillary sinusitis.

STUDY OBJECTIVES: In maxillary nosocomial sinusitis (MNS) related to severe sepsis, nitric oxide (NO) concentration in the maxillary sinuses is drastically reduced secondarily to a downregulation of type-2 NO synthase. NO plays a major role in nonspecific immune defense of sinuses. We therefore aimed to study maxillary NO concentration during the treatment of MNS with drainage, daily lavage, and removal of any nasally introduced tube. PATIENTS AND METHODS: Nine patients were studied during the first 4 days of treatment of MNS. We measured the concentration of NO gas in the maxillary sinus and in the nasal cavity, and the NO metabolite levels (nitrites/nitrates [NOx]) in the sinus lavages. MEASUREMENTS AND RESULTS: Maxillary NO concentration (median [25 to 75 percentile]) increased from 70 parts per billion (ppb) [40 to 100 ppb] to 2,050 ppb (1,700 to 3,000 ppb) after 4 days of treatment of MNS (p < 0.0001). In the meantime, nasal NO increased from a median of 100 ppb (98 to 148 ppb) to 180 ppb (180 to 188 ppb) [p < 0.001]. At any time, there was a correlation between maxillary NO (logarithmic value) and nasal NO (r2 = 0.57, p < 0.0001). NOx levels remained stable in the lavages. CONCLUSIONS: We conclude that the treatment of the sinusitis with drainage, daily lavage, and removal of the gastric tube lead to a spectacular increase of maxillary and nasal NO concentrations.

Adult↗
PubMedDate not supplied

Development of the paranasal sinuses in children with sinus disease.

In a previous report, the authors defined the normal development of the paranasal sinuses. Landmarks and dimensions relevant to functional endoscopic sinus surgery were measured on the computed-tomography images of 145 children who were free of significant sinusitis. The present study compares those normal values to the same measurements in 235 cases of sinus disease. No significant difference was found between normal and diseased groups in any of the 10 dimensions originally reported or in six derived measures. There appears to be no association between sinus disease and any of these dimensions. The previously reported norms are applicable to cases of pediatric sinus disease.

Adolescent↗
PubMedDate not supplied

Blood flow in the rabbit sinus mucosa during experimentally induced chronic sinusitis. Measurement with a diffusible and with a non-diffusible tracer.

Chronic sinusitis was induced in New Zealand White rabbits. Access to the sinus cavity in question was obtained through a hole drilled in the dorsum of the nose, and for induction of sinusitis either cotton wool together with a suspension of 10(8) Streptococcus pneumoniae was introduced, or this method was combined with blocking of the sinus ostium with methacrylate. In 9 rabbits (weight range 3.6-5.0 kg), blood flow was determined 5 weeks-9 months after the induction of sinusitis, at a point in time when heavy inflammatory signs were present. The blood flow was determined both with radioactively labelled microspheres 16 +/- 1.5 micron in diameter and with Rb86Cl. Cardiac output as determined with the microsphere method was 127 +/- 28 ml X min-1 X 1 000 g-1. The blood flow in the sinus mucosa was 0.60 +/- 0.16 ml X min-1 X g-1 with the microsphere method and 0.51 +/- 0.20 ml X min-1 X g-1 with use of Rb86Cl. These values did not differ significantly from the corresponding values found previously in healthy rabbits.

Animals↗
PubMed1994

Radiologic assessment of diseased mucosa of the maxillary sinus after functional endoscopic sinus surgery.

We attempted to evaluate postoperative mucosal changes and symptomatic improvement in 99 patients who underwent functional endoscopic sinus surgery from September 1991 through August 1992. The patients were divided into 2-, 4-, 6-, and 12-month postoperative groups. Thickness of the maxillary sinus mucosa measured at the midpoint of the lateral sinus wall on a follow-up ostiomeatal unit computed tomogram (OMU CT) was compared with that of preoperative OMU CT. Postoperative endoscopic findings of the maxillary sinus and changes in presenting symptoms such as rhinorrhea, nasal obstruction, facial pain, headache, anosmia, epiphora, and referred otalgia were analyzed. Improvement in the diseased mucosa of the maxillary sinus, as evaluated on OMU CT, was observed in 69.7% of the patients, and such mucosal changes did not differ significantly among 2-, 4-, 6-, and 12-month follow-up groups. However, apparent mucosal changes exceeding marginal improvement was observed in 32.3% of the patients. The overall symptomatic improvement rate was 57.9% and improvement in endoscopic findings was observed in 46.3% of the patients. Although there was some discrepancy between radiologic and symptomatic improvement rates, symptomatic improvement was significantly related with radiologic improvement. It is suggested that removal of obstructive lesion in the ostiomeatal area might be beneficial in a seemingly early symptomatic improvement, but complete healing of the maxillary sinus mucosa as assessed by OMU CT might take longer than 12 months.

Adolescent↗
PubMed1997

Bacteriological evaluation of 194 adult patients with acute frontal sinusitis and findings of simultaneous maxillary sinusitis.

In a prospective study bacteriological findings from frontal and maxillary sinus secretes were analyzed. Frontal sinus trephination was performed to 103 and maxillary irrigation to 192 patients. Main pathogens in the frontal as well as in the maxillary sinus secretes were Haemophilus influenzae and Streptococcus pneumoniae. beta-lactamase production of H. influenzae was found in 17% of frontal and in 16% of maxillary sinus samples. Bacteriological findings were supported by the staining results. The portion of anaerobic pathogens in cultures were poor, though Bacteroides fragilis antigen was detected in 8 frontal and 6 maxillary sinus samples. The acute frontal sinusitis should be treated with respective antibiotics. Complications seem not to develop in the acute phase and the disease can primarily be treated conservatively. It should however be controlled properly to avoid prolonged disease and late complications.

Acute Disease↗
PubMed1996

[Patency of the ostium of the frontal sinus after endoscopic endonasal surgery for chronic sinusitis].

We examined the patency of the ostium of the frontal sinus after endoscopic endonasal surgery for chronic sinusitis. This study involved one hundred and seventy-two nasal sides of ninety cases who underwent surgery in this unit in the preceding three-year period by the designated three surgeons. All patients were followed up for more than one year after surgery. We obtained a high postoperative patent rate of 90.1%. However, communication between the frontal and ethmoidal sinus could not be confirmed in 9.9% of the cases due to the presence of polyp or adhesion in the middle meatus. Cases with preoperative severe lesion of the frontal sinus showed significantly lower rates of patent than cases with preoperative mild and/or no lesion. In cases where the opening of the ostium could not be sufficiently widened during surgery because the size around the ostium was already small, lower patent rates resulted. However, even in such cases, scraping or curetting of the surrounding bone should be avoided, because it may cause postoperative narrowing of the ostium due to new bone formation. Cases with unsatisfactory results caused by pathological changes in the middle meatus showed significantly lower patent rates than cases with satisfactory postoperative results. It is recommended that accurate cleaning of the ethmoid sinus and adequate postoperative treatment be considered important. Endoscopic endonasal opening of the ostium of the frontal sinus is shown to be a safe and reliable procedure, which can be performed with clear visualization.

Adolescent↗
PubMed2003

[The correlation between computed tomography findings of the paranasal sinuses and the symptoms of acute sinusitis].

OBJECTIVES: We investigated the relationship between symptoms, coronal paranasal computed tomography (CT) findings and anatomic variations in patients with acute sinusitis. PATIENTS AND METHODS: The study included 44 patients (23 females, 21 males; mean age 35 years; range 21 to 74 years) whose diagnosis was acute sinusitis by history and physical examination. A comprehensive inquiry into the symptoms was made and coronal paranasal CT scans were obtained in all the patients. Correlations were sought between symptom scores, CT scores, and anatomic variations. RESULTS: No correlations were found between anatomic variations and CT scores. Total symptom scores did not correlate with CT scores. A statistically significant correlation existed only between headache and CT scores. The most commonly affected sinuses were maxillary sinuses (73%), followed by posterior ethmoidal sinuses (60%). CONCLUSION: Our data suggest that routine CT evaluations are superfluous in acute sinusitis.

Acute Disease↗