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PubMed1982

Effects of Broncasma Berna on chronic sinusitis and nasal allergy.

Broncasma Berna is a polyvalent antigen vaccine containing eight types of bacteria or their autolysates which are commonly detected during infections of the upper respiratory tract and formed in clusters in the nasal and sinal cavities. This agent was administered to chronic sinusitis and nasal allergy patients; judgment of therapeutic effectiveness based on an independently developed scoring system showed the following results: markedly effective 2.5%, effective 42.5%, slightly effective 52.5% and ineffective 2.5%. No notable side-effects were observed. Although more study is required on such points as long term administration, posology, and application method especially Broncasma Berna aerosol nasal spray method, based on this study we can confirm that if the patient group is selected in a similar manner, the above reported therapeutic results can certainly be obtained. Broncasma Berna because of its non-specific desensitization effect has value as the drug of preference in treating nasal allergy cases where a specific antigen can not be found, and chronic sinusitis with a convoluted chronic course, especially where the involvement of infectious allergy is suspected.

Adolescent↗
PubMed1985

[Mucous membrane changes in the anterior ethmoid bone in chronic sinusitis and mycoses of the paranasal sinuses. An endoscopy, light and electron microscopy study. 2. Electron microscopy findings].

In the second part of this paper the findings of electron microscopical studies on ultrastructural changes of the cilia of the ethmoidal mucous membrane in patients with mycotic chronic sinusitis are presented. Many pathological variations of the normal 9 + 2 pattern can be demonstrated, along with compound cilia and central axis deviation beyond 25 degrees. This together with the endoscopical and lightmicroscopical findings results in conditions which are different from those in acute sinusitis. It may as well explain, why hardly a conservative therapy--aiming mostly for vasoconstriction and decrease of mucosal edema--is successful in chronic sinusitis. Endoscopical surgery of the diseased anterior ethmoid in most of the cases brings along cure of the dependent frontal and maxillary sinuses as well.

Chronic Disease↗
PubMed1997

Nitric oxide (NO) production in the upper airways is decreased in chronic sinusitis.

The nasal concentration of nitric oxide (NO) was measured by chemiluminescence in healthy volunteers 3-68 years of age, and in patients suffering from common cold and chronic sinusitis. The concentration of NO in healthy subjects, 233.2 +/- 66.8 ppb (mean +/- SD), was found to be relatively independent of age and body size. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic sinusitis, 96.4 +/- 72.8 ppb. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of NO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. The importance of NO for the mucociliary system was emphasized by the finding that the 2 patients with the lowest nasal concentration of NO were found to manifest functional and morphological changes of the mucociliary system that are typical of acquired mucociliary dysfunction.

Adolescent↗
PubMed2001

[Analysis of patients with middle lobe and lingular syndrome complicated with nontuberculous mycobacterosis, chronic sinusitis, or bronchopulmonary tuberculosis].

The clinical characteristics and chest CT scan findings in 77 cases of middle lobe and lingular syndrome, many of which were complicated with nontuberculous mycobacteriosis (21 cases, 27.3%), chronic sinusitis (16, 20.8%), or bronchopulmonary tuberculosis (11, 14.3%) are reported. Sixteen (76.2%) cases complicated with nontuberculous mycobacteriosis and 14 (87.5%) cases complicated with chronic sinusitis had granular shadows with dilated bronchi of both middle lobe and lingular in their chest CT scans. Granular shadows with a thickening of the bronchial wall or dilated bronchi were common characteristics of the chest CT scans of the patients with nontuberculous mycobacteriosis. However, cicatrization atelectasis of either middle lobe or lingular was the most common finding in patients with bronchopulmonary tuberculosis.

Adult↗
PubMed1997

Chronic sinusitis in children.

In children, sinusitis is a common, generally uncomplicated, and self limiting disease which drops with age. The diagnosis is difficult because of relatively non specific signs and symptoms that overlap with viral upper respiratory infection and allergy. Plain paranasal sinus radiographs are not adequate, in determining the extent of involvement in recurrent or chronic sinusitis and so CT scan has become the standard. Viral illness appears to be the most common predisposing factor. Immune defects (mainly IG2 and IGA) may exist in a significant percentage of children. The role of allergy seems less important. With advances in the genetic field of cystic fibrosis, genetic factors are advocated in chronic or recurrent sinusitis. The most common bacterial pathogens in pediatric sinusitis patients are SP (Streptococcus Pneumoniae), HI (Hemophilus Influenza) and MC (Moraxella Catarrhalis). Other less frequent bacterial species include group A streptococcus, group C streptococcus, streptococcus viridans, peptostreptococcus, moraxella species and Eikenella corrodens. Respiratory anaerobes are not common. Antibiotics resistant to the action of the beta-lactamase are the cornerstone in medical treatment. In recurrent acute sinusitis prophylactic antimicrobials may be helpful. The indication for surgery remains controversial. To date, we have no prospective studies comparing surgical to medical therapy in order to guide us in deciding surgical indication. It is therefore recommended to follow a conservative track and to limit surgical procedures in children with suppurative complications, nasal obstruction from polyposis or refractory sinusitis aggravating chronic pulmonary disease such as asthma.

Anti-Bacterial Agents↗
PubMed1996

Effect of new macrolide roxithromycin upon nasal polyps associated with chronic sinusitis.

We often observe shrinkage of nasal polyps with low-dose long-term macrolide treatment, which was recently developed in Japan for the treatment of intractable chronic sinusitis. In order to assess the efficacy of this treatment for nasal polyps, we administered the new macrolide roxithromycin (RXM) (1 tablet: 150 mg a day) for at least 8 weeks to 20 patients with nasal polyps associated with chronic sinusitis. It was competent in controlling nasal polyp with the overall incidence of improvement being 52%. The combination of RXM with azelastine (1 mg twice/day), an inhibitor of mediator release, was examined in 20 other patients. It augmented the rate of improvement to 68%, but the increase was not significant. The incidence of improvement increased with time after the start of medication in both groups. Smaller polyps were more likely to decrease in size, but some larger polyps also markedly decreased in size. Associated allergic conditions and the extent of eosinophilic infiltration had no relation to the treatment result. We speculate that the mechanism of effectiveness of RXM is through its suppressive potency in cytokine production from inflammatory cells.

Adult↗
PubMed2025

Mendelian randomization and FinnGen analysis of the causal relationship between 473 gut microbiota species and chronic sinusitis.

OBJECTIVE: To investigate the causal associations between Gut Microbiota (GM) and Chronic Sinusitis (CRS) using Mendelian Randomization (MR). METHODS: Genome-Wide Association Study (GWAS) summary statistics for 473&#x2009;GM taxa were obtained from MiBioGen consortium. CRS data (22,099 cases vs. 371,520 controls) were sourced from the FinnGen R12 cohort. Causal effects were estimated via Inverse Variance-Weighted (IVW), MR-Egger, weighted median, and Bayesian-weighted MR methods. Sensitivity analyses (heterogeneity and horizontal pleiotropy tests) were performed to validate robustness. RESULTS: IVW analysis identified 20&#x2009;GM taxa significantly associated with CRS risk (p&#x2009;<&#x2009;0.05). Of these, 7 taxa (e.g., Francisellales, Roseibacillus, Merdibacter massiliensis) exhibited risk-increasing effects, while 13 taxa (e.g., Firmicutes I, Succinivibrionaceae) showed protective effects. Sensitivity analyses confirmed the absence of significant heterogeneity (Cochran's Q p&#x2009;>&#x2009;0.05) or pleiotropy (MR-Egger intercept p&#x2009;>&#x2009;0.05). Bayesian-weighted MR validated 18 causal relationships (posterior probability > 95%), except for RUG420 sp900317985 and UBA7703 (non-significant). CONCLUSIONS: This MR study provides genetic evidence supporting causal roles of specific GM taxa in CRS pathogenesis. These findings highlight the gut-sinus axis as a potential therapeutic target and underscore the utility of large-scale biobanks (e.g., FinnGen) in advancing precision medicine. LEVEL OF EVIDENCE: Level 5. Mendelian Randomized (MR) studies are second only to randomized controlled trials in terms of the level of evidence.

Humans↗
PubMed2005

What is the relationship between chronic sinus disease and isolated nasal septal deviation?

OBJECTIVE: The aim of this retrospective study is to examine the role of isolated nasal septal deviation (NSD) in the pathogenesis of chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: The interaction between isolated NSD and chronic sinus disease were retrospectively evaluated in 1452 patients. Out of 1452 patients, 152 patients were included in the study. Patients with anatomical variants other than NSD were excluded from the study. Patients with NSD were enrolled in the study group and patients without NSD were enrolled in the control group. RESULTS: There was no statistically significant difference between NSD group and non-NSD group with respect to the CRS. CONCLUSIONS: The mild to moderate degree of NSD was not a risk factor for chronic sinus disease. Only gross deviation of the nasal septum itself is a risk factor for the development of CRS. SIGNIFICANCE: Excluding the subjects with ostiomeatal anatomic variations has differentiated this study from the previously reported researches (isolated NSD).

Adolescent↗
PubMedDate not supplied

[use of a Staphylococcus bacterial vaccine in pediatric patients with chronic sinusitis].

INTRODUCTION: The antigenic extracts of bacterial vaccine (Staphylococcus aureus) they increase the phagocitosis, the immunoglobulins concentrations and they help in the immunologic response. OBJECTIVE: To determine the effectiveness of the bacterial vaccine in patient pediatric with chronic sinusitis. MATERIAL AND METHOD: Through a prospective, observational, descriptive and logitudinal study 50 patients were studied with clinical and radiological diagnosis of chronic sinusitis in the period of May from 1997 to July of 1998; they talked to three outlines of antibiotics, they were made studies of cytology hematic, of snot, perspired pharyngeal and immunoglobulin determination and x-rays of breasts paranasals. The extract of 0.1 ml was applied twice up to 0.5 ml per week, subcutaneous trial during eight months, with pursuit of six months and control of cytology hematic, as well as immunoglobulin determination. RESULTS: 82% (41) of the patients they improved and nine (18%) they persisted with symptoms, of these five required the antimicrobials prescription, three tonsillectomi. There was an immunoglobulin increment, mainly of the IgA and IgG in 38 (76%) patient.

Child↗
PubMed2000

Involvement of inferior turbinate mucosa in chronic sinusitis--localization of T-cell subset.

BACKGROUND: In chronic sinusitis (CS), different subsets of leukocytes are involved in development of persistent inflammation of the nasal mucosa. The localization and differentiation of these infiltrating lymphocytes may help us to understand the inflammatory interactions in the epithelium, lamina propria, and seromucous glands of the nasal mucosa in CS. METHODS: We examined frozen sections of inferior turbinates from 14 patients with nonallergic CS and 10 normal nonallergic controls. We used the avidin-biotin-peroxidase (ABC) technique with monoclonal antibodies against CD3 (total T cells), CD4 (T-helper/inducer cells), CD8 (T-suppressor/cytotoxic cells), CD22 (B cells), CD56 (natural killer cells), elastase (neutrophil granulocytes), eosinophil cationic protein (eosinophil granulocytes), and CD68 (macrophages). RESULTS: We found significant increases (P < 0.05) of CD3, CD4, and CD8 T cells and B cells in the nasal mucosa of patients with CS. The number of CD68 cells and eosinophils showed no significant rise. CONCLUSIONS: The different types of leukocytes play a key role in the defense of the respiratory tract. The analysis of the distribution of cells in the epithelium, mucosa, and glands of the inferior turbinate confirmed that nonallergic CS is, in fact, chronic, bacterial rhinosinusitis involving the inferior turbinates, and that the pathomechanism is therefore different from that of nasal polyposis.

Adolescent↗
PubMed2003

Results of Caldwell-Luc after failed endoscopic middle meatus antrostomy in patients with chronic sinusitis.

OBJECTIVES/HYPOTHESIS: The Caldwell-Luc operation for treatment of medically refractory chronic maxillary sinusitis has largely been replaced by functional endoscopic sinus surgery. Despite this change, the Caldwell-Luc procedure still has well documented indications including treatment of both failed endoscopic middle meatus antrostomy and irreversible mucosal changes. The purpose of the study was to review the authors' experience and results of Caldwell-Luc procedure after failed endoscopic middle meatus antrostomy in patients clinically deemed to have irreversible mucosal changes. STUDY DESIGN: Retrospective review of preoperative and postoperative results of patients who underwent Caldwell-Luc procedure for refractory chronic maxillary sinusitis after failed endoscopic middle meatus antrostomy. METHODS: The preoperative and postoperative clinical course of patients treated with Caldwell-Luc procedure performed by a single surgeon between 1996 and 2001 were reviewed. Only patients with a history of chronic sinusitis after failed maximal medical therapy, no prior Caldwell-Luc procedure, prior endoscopic middle meatus antrostomy, and at least 6 months of follow-up were included. Outcome measurements including documented endoscopic examinations and the need for repeat surgery, and postoperative computed tomography scan results were evaluated to assess treatment success. RESULTS: The study involved 11 men and 26 women who underwent 50 Caldwell-Luc procedures. Caldwell-Luc procedure was performed bilaterally in 13 patients. The average number of prior endoscopic middle meatus antrostomies before Caldwell-Luc procedure was 2. Of all patients, 92% responded to surgical treatment as demonstrated by an endoscopic examination or computed tomography scan revealing a disease-free maxillary sinus. Repeat Caldwell-Luc procedure was required in 8.0% (n = 3) because of continued sinusitis. Two of the three cases with repeat Caldwell-Luc procedures demonstrated clinical improvement during follow-up. Average follow-up was 23.5 months. CONCLUSION: Caldwell-Luc procedure seems to be highly effective in the management of medically refractory chronic sinusitis after failed endoscopic middle meatus antrostomy. Caldwell-Luc procedure should remain in the otolaryngologist's surgical repertoire for these selected cases.

Chronic Disease↗
PubMed2005

[Comparison and improvement in the methods of establishing animals model of experimental chronic sinusitis in rabbits].

OBJECTIVE: To compare and improve the methods of establishing animal model of experimental chronic sinusitis in rabbits . METHODS: Sixty-six New Zealand white rabbits were divided into seven groups: control group, sham-operation group I, sham-operation group II, bacteria inoculation group, ostia-blocked group, ostia-blocked and bacteria inoculation group, incomplete ostium blocked and set-cotton group. The animals were examined by the methods of histology and bacteriology after 42 days. RESULTS: The positive rate of chronic inflammation in ostium blocked group was 80%, inoculated staphylococcus group was 100%, incomplete ostium blocked and set-cotton group was 100%, and the other groups were 0%. All infected sinuses displayed signs of moderate or severe chronic inflammation. The cultivated bacteria were mainly opportunistic pathogens. The probability of having abscess in maxillary sinus was high in ostia-blocked and bacteria inoculation group. CONCLUSIONS: The method of incomplete ostium blockage and set cotton can establish stable chronic sinusitis model, it is a simple and perfect method.

Animals↗
PubMed1996

Positive identification in situ of mRNA expression of IL-6, and IL-12, and the chemotactic cytokine RANTES in patients with chronic sinusitis and polypoid disease. Clinical relevance and relation to allergy.

Interleukins 6 (IL-6) and 12 (IL-12), and the chemoattractant chemokine RANTES were studied in ethmoidal mucosa, using reverse transcriptase polymerase chain reaction. The 49 patients had chronic sinusitis or nasal/paranasal polyposis, and some also allergy. To the best of our knowledge, this is the first study that demonstrates RANTES and IL-12 on mRNA level in human sinonasal mucosa in situ. mRNA for IL-6, IL-12 and RANTES were detected in 2, 8 and 6 patients with chronic sinusitis, respectively, and in mucosa from patients with polyposis a positive expression was observed in 4, 14 and 10 cases. There were no statistically significant differences. Analysing the entire group of 49 patients, disregarding type of mucosal disease, the number of patients with positive RANTES was significantly higher than that for IL-6. Similarly, IL-12 positivity was more frequently expressed than IL-6. mRNA for IL-6 was expressed in only 2 of the allergic patients. The cytokine production studied thus seems to be unrelated to the clinically defined entities. There is thus a local production in human diseased sinonasal mucosa of RANTES, as well as of IL-6 and IL-12. The local production of RANTES is an important prerequisite for recruitment and migration of inflammatory cells into the tissue. IL-12 is a co-stimulator of antigen-specific responses of established T helper 1 (Th1) clones, and regulates the responsiveness of the clones to a number of T cell growth factors. The study supports a shift towards Th1 cells in these disease entities.

Adjuvants, Immunologic↗
PubMed2003

Chronic sinusitis: defective T-cells responding to superantigens, treated by reduction of fungi in the nose and air.

In this study, the author used endoscopic sinus photography to study the effects of reduction of fungi in the nose, and in environmental air, on the sinus mucosa of 639 patients diagnosed with chronic rhinosinusitis. Sinus mucosal photographs were taken before and after reduction of fungal load in the nose and air, to determine if there was an optimum environmental air fungal load associated with sinus mucosal recovery to normal appearance. Systemic symptoms associated with fungal exposure, which resolved when fungus was removed from the patient and the environmental air and reappeared with recurrent environmental fungal exposure, are also discussed and are termed systemic fungal symptoms. Interventions consisted of nasal fungal load reduction with normal saline nasal irrigations and antimicrobial nasal sprays, and environmental air fungal load reduction with high-efficiency particulate air (HEPA) filtration in combination with ionizers or evaporation of a solution of botanical extract. Main outcome measures were obtained with environmental air 1-hr gravity-plate fungal colony counts, laser air particle counts, and endoscopic sinus photography. Blood levels of immunoglobulins IgG and IgE for 7 common molds were also determined. After intervention, 94% of patients who used antimicrobial nasal sprays and who reduced their environmental fungal air count to 0-4 colonies per 1-hr agar gravity-plate exposure (n = 365) exhibited normal sinus mucosa by endoscopic exam. Environmental air fungal counts that exceeded 4 colonies resulted in sinus mucosal abnormalities ranging from edema, to pus and/or nasal polyps at higher counts. Neutralization of allergy, and/or surgery, were used as appropriate following implementation of environmental measures. On the basis of these observations, as well as detailed clinical experience and a review of the current literature, the author hypothesizes that the pathogenesis of chronic rhinosinusitis, allergic fungal sinusitis, and systemic fungal symptoms is a genetic defect at the variable beta chain helper T-cell receptor (TCR Vbeta) site which requires the presence of an antigen (fungus). Chronic sinusitis patients who have recurring exposure to environmental air that contains fungal concentrations in excess of 4 colonies per 1-hr agar plate exposure appear to have an increased risk of persistent chronic sinusitis and/or systemic symptoms, regardless of the medical treatment provided.

Adolescent↗
PubMed2000

Effects of clarithromycin on rheological properties of nasal mucus in patients with chronic sinusitis.

Macrolide antibiotics have a variety of actions along with antimicrobial action. To determine the effects of oral administration of clarithromycin (CAM) on rheological properties, we measured the spinability, dynamic viscoelasticity, and solid composition of human nasal mucus from 18 patients with chronic sinusitis before and after administration of CAM for 4 weeks. After administration of CAM, the spinability and percent solid composition of nasal mucus increased from 26.5 +/- 12.2 mm to 40.2 +/- 18.7 mm and 7.86% +/- 3.47% to 13.90% +/- 3.67% (p < .05), respectively, whereas the ratio of the viscosity to the elasticity (eta'/G') of nasal mucus after the administration of CAM decreased in all of the mucus samples. These results suggest that treatment with CAM may modulate the rheological properties of nasal mucus in patients with chronic sinusitis.

Adolescent↗
PubMed1991

Immunologic aspects of chronic sinusitis.

The role of immunological defence mechanisms in the development of acute recurrent or chronic sinusitis is obviously of considerable importance but the incidence of such immune problems is unknown. To elucidate this situation, a prospective study of 47 patients with chronic rhino-sinusitis were examined for abnormalities of serum immunoglobulins, both major class and subclasses. Deficiencies of minor IgG subclasses may be obscured by only measuring the major IgG class and should be specifically sought in clinically suspicious cases. The clinical and therapeutic implications are considered.

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↗