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PubMed1994

Unilateral choanal atresia masquerading as chronic sinusitis.

Choanal atresia is a congenital anomaly usually diagnosed at birth. This case involves bilateral choanal atresia in a newborn with respiratory difficulties in whom there is an inability to pass a #8 French catheter through the nose. In contrast, unilateral choanal atresia causes a variable degree of nasal obstruction that may delay the diagnosis. We report a case of unilateral choanal atresia in a 9-year-old boy diagnosed as having chronic sinusitis with allergic rhinitus. Initial interpretation of a computerized, tomographic (CT) examination confirmed the diagnosis of chronic sinusitis. The definitive diagnosis, however, was made by endoscopic evaluation. A review is presented of the epidemiology, clinical presentation, differential diagnosis, and contemporary surgical management for unilateral choanal atresia.

Child↗

PubMed1990

[A case of multiple inflammatory tracheo-bronchial polyps associated with chronic sinusitis].

A 57 year-old woman was aware of breath odor and visited to our hospital. There were no abnormal findings in her physical examination and chest X-ray. Multiple polyps in the trachea and both main bronchi were discovered by fiberoptic bronchoscopy. They were 0.1-0.5 cm in diameter. In a histological examination, squamous metaplastic epithelial cells and numerous inflammatory cells infiltrating subepithelially were seen. No malignant cells were found. The patient had suffered from chronic sinusitis for 15 years, and it was suggested that the development of tracheo-bronchial polyps was associated with chronic sinusitis.

Bronchial Neoplasms↗

PubMed2002

Comparison of the efficacy and tolerability of amoxycillin/clavulanic acid 875 mg b.i.d. with cefuroxime 500 mg b.i.d. in the treatment of chronic and acute exacerbation of chronic sinusitis in adults.

The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125 mg b.i.d. for 14 days) were compared with that of cefuroxime axetil (500 mg b.i.d. for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis. Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%). In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroxime-treated patients cured (95% confidence interval; -18% to +15%). However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group. A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea. Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime). AMX/CA 875/125 mg b.i.d. for 14 days is as effective and well tolerated as cefuroxime axetil 500 mg b.i.d. for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate.

Administration, Oral↗

PubMed1993

Effect of S-carboxymethylcysteine on ciliary activity in chronic sinusitis.

This study was designed to investigate the possible pharmacological effect of S-carboxy-methylcysteine (S-CMC) on the ciliary activity, using an in vitro experimental system after removing mucus. Ciliary activity from healthy rabbit maxillary sinus and from healthy human nasal mucosa demonstrated no significant change in RPMI 1640 containing S-CMC. On the other hand, the effect of S-CMC on the reduced ciliary activity from patients with chronic sinusitis was quite varied among the cases examined. S-CMC demonstrated no stimulatory effect on the beating activity of cilia that have a baseline activity of less than 400 beats/min. However, S-CMC was able to enhance the beating activity of cilia that demonstrated a baseline activity of more than 400 beats/min. S-CMC at 0.5% induced a larger ciliostimulatory effect than 0.05% S-CMC. In conclusion, our study has clearly demonstrated that S-CMC could directly enhance ciliary activity of chronic sinusitis in the absence of significant organic change of ciliated cells.

Animals↗

PubMed2004

Preoperative imaging of chronic sinusitis by multislice computed tomography.

The aim of this study was to evaluate whether multislice CT enables quality improvement and dose reduction in the imaging of the paranasal sinuses, especially when using secondary reconstructions. We compared the imaging quality of direct CT scans and secondary reconstructions of single-slice CT (SSCT) as a criterion standard with multislice CT (MSCT) of the paranasal sinuses in 80 patients suspected of having chronic sinusitis. Coronary secondary reconstructions were calculated from all transversal CT data sets. Coronary reconstructions of transversal MSCT showed a significantly better image quality compared with coronary reconstructions of SSCT. Because of the absence of dental metal artifacts, coronary reconstructions of MSCT were superior even to direct coronary images of SSCT. MSCT offered a superior examination quality compared to SSCT. A halving of radiation dosage can be reached by eliminating one examination plane.

Adolescent↗

PubMed2001

[Endoscopic surgery of chronic sinusitis].

Between 1984 and 2000 the author has performed endoscopic sinus surgery (ESS) in 1072 patients with chronic sinusitis resistant to medical therapy. In 201 patient (19%) the operation was limited to the maxillary sinus and in 871 patients (81%) multiple cavities were involved. Ethmoidectomy was performed for 749 patients (70%) of which polyposis was found in 315 (29%), bilateral in (87%). History of previous sinus surgery was found in 399 patients (37%). This retrospective study with a long-term follow-up (average 8.6 years) analyzes the objective and subjective result in 212 patients after ESS for pansinusal polyposis. Subjective success rates were noted in 92% of patients after 1 year; in 78% after 5 years and in 82% 8.6 years after ESS. The best results were obtained in nasal breathing which was significantly improved in 91% of patients, the poorest results were noted in olfaction which was improved in 60% of cases. Objectively, the endoscopic findings were normal in 86% of cases after 1 year; in 81.6% after 5 years and in 79.2% 8.6 years after ESS. 26 patients (12.2%) underwent revision surgery. In 100 patients (47%) the polyposis was massive, associated with allergy in 82 cases (39%), asthma in 67 patients (31%), Aspirin sensitivity in 24 patients (11.1%) and Samter's syndrome in 19 patients (9%). In 1072 patients major complications occurred in 4 cases (0.4%). On case of delayed hemorrhage required cautery of the sphenopalatine artery and transfusions. Three other cases of CSF leak were repaired during ESS without sequel.

Adolescent↗

PubMed2003

[Study of pathological morphology in chronic sinusitis].

OBJECTIVE: To study the pathological characteristics and regularity of chronic sinusitis (CS) in different clinical types, tc estimate the reliability and feasibility of CS classification on the pathologic basis. METHODS: HE, Van Gieson's, alcian blue-periodic acid-schiff(AB-PAS) staining was used to observe the changes of epithelium, to measure the thickness of basement membrane and the area of mucous glands. The ultrastructural changes of pseudostratified ciliated columnar epithelium were observed under transmission electron microscope (TEM) and scanning electron microscope (SEM). RESULTS: The epithelial fiber tissue was increased, the basement membrane was thickened, and the mucous glands were obviously increased in CS under the light microscope. Subepithelial fibrosis and thickened basement membrane were most obviously seen in type III of CS and the hyperplasia of mucous glands was most distinct in type II. Under the TEM, abnormal structure of cilia, decrease of ciliated cells, increase of goblet cells were detected in all three CS types. Under the SEM, the cilia of every types showed the ingravescenced process of pathological changes from slight cilium disorder, disorientation, to desquamation of most cilia and replacement of microvilli. CONCLUSION: There is significant distinction of mucous membrane structure among three types. The Chinese classification of CS has pathological basis, it represents the occurrence, development and regularity of CS, and it can be used as basis in further study, communication and evaluation for surgical effect of CS.

Adolescent↗

PubMed2001

The anti-inflammatory effect of erythromycin and its derivatives, with special reference to nasal polyposis and chronic sinusitis.

Macrolides have been used for decades as an important chemotherapeutic agent in the treatment of infectious diseases. In the last 10 years there has also been increasing interest in the interaction between macrolide antibiotics and the immune system. The aim of this review is to focus on the anti-inflammatory action of erythromycin and its derivatives in the treatment of chronic sinusitis and nasal polyps. Systematic clinical investigations have been few and to the author's knowledge there have been no placebo-controlled studies. However there have been, especially from Japan, a number of clinical reports stating that long-term, low-dose macrolide antibiotics are effective in treating chronic sinusitis incurable by surgery or glucocorticosteroid treatment, with an improvement in symptoms varying between 60% and 80% in different studies. In animal studies macrolides have increased mucociliary transport, reduced goblet cell secretion and accelerated apoptosis of neutrophils, all factors that may reduce the symptoms of chronic inflammation. There is also increasing evidence in vitro of the anti-inflammatory effects of macrolides. Several studies have shown macrolides to inhibit interleukin gene expression for IL-6 and IL-8 and also to inhibit the expression of intercellular adhesion molecule essential for the recruitment of inflammatory cells. There is also evidence in vitro, as well as clinical experience, showing that macrolides reduce the virulence and tissue damage caused by chronic bacterial colonization without eradicating the bacteria. The benefit of long-term, low-dose macrolide treatment seems to be that it is, in selected cases, effective when steroids fail. The exact mechanism of action is not known, but it probably involves downregulation of the local host immune response as well as a downgrading of the virulence of the colonizing bacteria. In the future, placebo-controlled studies should be performed to establish the efficacy of macrolides if this treatment is to be accepted as evidence-based medicine.

Animals↗

PubMed1999

Alterations of nasal mucociliary transport in patients with hypertrophy of the inferior turbinates, deviations of the nasal septum and chronic sinusitis.

Mucociliary transport (MCT) represents the first barrier of the nasal fossae and paranasal sinuses against various biological and physical insults. We studied the nasal MCT time using a mixture of vegetable charcoal powder and 3% saccharin in three groups of patients suffering from hypertrophy of the inferior turbinates, deviations of the nasal septum or chronic sinusitis. The mean values of the nasal MCT in the first two groups were practically identical to the normal ones. In contrast, significantly delayed times were found in patients with chronic sinusitis (P < 0.01). Findings indicate that this delay is determined by an increase in viscoelasticity of the mucus following the acute release of mediators of inflammation, together with a reduction in the periciliary stratum, which slows down the metachronous wave of the MCT.

Adolescent↗

PubMed1994

[Efficacy and tolerance of cefotiam hexetil in the super-infected chronic sinusitis. A randomized, double-blind study in comparison with cefixime].

Efficacy and safety of a new oral third generation Cephalosporin, Cefotiam Hexetil (CTM) 200 mg bid were compared with those of Cefixime (CX) 200 mg bid over 10 day duration of treatment. One hundred and twenty two ambulatory adults suffering from chronic sinusitis were randomized by ENT specialists in this multicentre prospective double blind, doubled dummy study. Sinusitis diagnosis evocated in front of fascial pain, purulent nasal discharge and/or obstruction was confirmed with sinus X-ray. Use of antibiotics or corticosteroids concomitantly or 15 days prior inclusion represented one of the major exclusion criterion. One hundred and seventy one patients were evaluated for efficacy analysis (62 and 59 respectively in CTM and CX groups). Regarding demographic data, clinical and radiological signs, the two populations were comparable at inclusion excepted for sex and weight (female: 73% in CTM group versus 47% in CX group). The overall clinical success rate at the end of treatment (cure+improvement) was not significantly different between the two groups (CTM: 82% versus CX: 80%). The incidence of adverse events was less frequent in the CTM group (14.5% versus 19%). In conclusion, CTM 200 mg bid is as efficacious and as well tolerated as CX 200 mg bid in the treatment of chronic sinusitis in adults.

Anti-Infective Agents↗

PubMed2006

Differentiation of chronic sinus diseases by measurement of inflammatory mediators.

BACKGROUND: Chronic rhinosinusitis (CRS) clinically is a heterogeneous group of sinus diseases, which may cover different disease entities, or may represent a disease continuum. Studying inflammatory cells and mediators in clearly defined disease subgroups may lead to a better differentiation of chronic sinus diseases. METHODS: Sinonasal mucosal tissue from 10 nasal polyp (NP) patients, 13 cystic fibrosis patients (CF-NP), eight CRS subjects without polyps, and nine control patients were stained for CD3, CD25, CD68, CD20, myeloperoxidase (MPO), CD138 and tissue homogenates were assayed for eotaxin, interleukin (IL)-1beta, IL-2sRalpha, IL-5, interferon (IFN)-gamma, IL-8, transforming growth factor (TGF)-beta1, tumor necrosis factor-alpha, and MPO by enzyme-linked immunosorbent assay or UNICAP system. RESULTS: Nasal polyp and CF-NP showed increased numbers and activation of T cells, while only NP displayed an increase in plasma cells. Nasal polyp had significantly higher levels of eosinophilic markers [eosinophils, eotaxin, and eosinophil cationic protein (ECP)] compared with CRS, controls and CF-NP. Chronic rhinosinusitis was characterized by a Th1 polarization with high levels of IFN-gamma and TGF-beta, while NP showed a Th2 polarization with high IL-5 and immunoglobulin (Ig) E concentrations. Nasal polyp and CF-NP were discriminated by edema from CRS and controls, with CF-NP displaying a very prominent neutrophilic inflammation. CONCLUSION: Based on cellular and mediator profiles, we suggest that CRS, NP, and CF-NP are distinct disease entities within the group of chronic sinus diseases.

Adult↗

PubMed2004

Chronic sinusitis: symptoms versus CT scan findings.

PURPOSE OF REVIEW: The association between symptoms of chronic rhinosinusitis and findings on a sinus CT scan remains controversial. Although the 1997 Task Force on Rhinosinusitis definition of chronic rhinosinusitis includes only symptoms and signs, many clinicians use CT scans for diagnosis and assessment of disease severity. RECENT FINDINGS: Two prospective studies evaluated associations between symptoms and CT scan findings. One study compared the diagnosis of chronic sinusitis with findings using a validated CT staging system; the CT findings were poorly predictive of the presence or absence of chronic sinusitis. The other study used a nonvalidated assessment of symptoms and several measurements from CT scans and identified a few significant associations. SUMMARY: There are few recent studies explicitly addressing symptom severity and CT scan findings in chronic sinusitis. Most studies conclude that there is little correlation between CT findings and symptoms but that both are important in the evaluation of sinusitis.

Chronic Disease↗

PubMed1998

Human nasal ciliary-beat frequency in normal and chronic sinusitis subjects.

OBJECTIVE: Ciliary-beat frequency (CBF) is an important factor influencing mucociliary flow in the respiratory tract. A significant correlation exists between CBF and mucus transport time (MTT), which suggests that CBF is the main factor in nasal mucociliary clearance in healthy individuals. Mucociliary clearance is influenced by the temperature of the inspired air and decreases at temperatures below 33 degrees C. It is unknown whether CBF varies in different sites within the nasal chamber and exactly how CBF is altered in disease states such as chronic sinusitis (CS) and nasal polyposis (NP). Our study was conducted in an attempt to answer these questions. METHOD: CBF was measured in nasal biopsies from eight normal control subjects: 6 CS and 8 NP patients. Biopsies from the regions of the maxillary, ethmoid, frontal, and sphenoid sinus ostia were also obtained. The material was analyzed using a computerized image-processing system. RESULTS: Our data demonstrated a significant decrease in CBF at 22 degrees C compared to at 35 degrees C for all sinus biopsies (p < .05). We found no statistical difference between the CBF of biopsies from the regions of the various sinus ostia. A comparison between the patients with CS and normal controls again revealed no significant difference in CBF, a finding which contradicts previously published reports. Surprisingly, an increase in CBF was observed in NP patients compared to control and CS patients (p < .05). CONCLUSIONS: We conclude that our technique is a viable model for studying sinonasal CBF in the human. Our data suggest that a mechanism other than decreased CBF may account for the decreased mucociliary clearance observed in chronic sinusitis.

Adult↗

PubMed1994

Surgical treatment of sinusitis.

Chronic sinusitis has become more widely recognized recently because of the improved diagnostic tools that are now available. The advent of the nasal endoscopes and computed tomography scans have revolutionized our understanding of chronic sinus disease and have led to new surgical techniques. Functional endoscopic sinus surgery (FESS), a new surgical approach to chronic sinus disease, seems to have promising results in the treatment of chronic sinusitis as compared to prior traditional techniques.

Chronic Disease↗

PubMed2000

Medical management of pediatric chronic sinusitis.

Pediatric sinusitis can be a challenging disease to treat, whether by a primary care physician or an otolaryngologist. When initial appropriate therapy fails to resolve the disorder, frustration may develop on the part of the patient, the family, and the physician. In addition to treatment with appropriate antibiotics for a sufficient length of time, other associated conditions that can exacerbate the condition must be considered and addressed as necessary. These may include viral upper respiratory infections, allergic rhinitis, immune deficiencies, asthma, and gastroesophageal reflux disease. Unless all associated conditions have been optimized, treatment of chronic sinusitis will often be unsuccessful. Recognition that there may be another factor contributing to the patient's continuing illness should prompt appropriate evaluation and occasionally referral to appropriate specialists. Except for the unusual pediatric patient with a truly anatomic disorder or an underlying chronic illness such as cystic fibrosis, proper medical management will almost always resolve chronic sinusitis.

Anti-Bacterial Agents↗

PubMed1992

Investigation into allergic response in patients with chronic sinusitis.

We attempted to investigate the role of nasal allergy in sinusitis to elucidate whether it results from an immediate-type allergic reaction of the sinus mucosa or from allergic edema-induced sinus ostial obstruction. Forty-two patients with chronic sinusitis were selected for allergen skin tests, measurements of serum total and specific IgE, and sinus tissue-specific IgE. The data were then correlated to examinations of nasal mucosal scrapings and histopathology of the sinus mucosa. We found that serum levels of total IgE and house dust mite-specific IgE antibodies were significantly higher in patients (n = 12) allergic to house dust than in the nonatopics (n = 30; p less than 0.0001). There was no difference in the sinus tissue-specific IgE antibody. Eosinophils and basophilic cells in epithelial scrapings from the inferior turbinates, assessed by Hansel staining, were high in 66.7% and 50% of the atopic patients, respectively, and 36.7% and 26.7% of the nonatopics, respectively. The rates were influenced by the existence of infection and nasal polyps. The increase in eosinophils, mast cells and plasma cells, assessed by histopathologic examination, were not prevalent in the sinus mucosa of atopic patients. It is concluded that nasal allergy may be a predisposing factor to sinusitis and that the pathologic change of the sinus mucosa is mainly secondary, due to sinus ostial obstruction.

Adult↗

PubMed2006

[Investigation of GR mRNA quantu expression in chronic sinusitis and nasal polyps].

OBJECTIVE: To detect the expression of the glucocorticoid receptor-alpha/beta (GR-alpha/beta) mRNA in nasal polyp and normal nasal mucosa and investigate the significance of receptor-alpha/beta in GC-insensitive and GC-sensitive patients. METHODS: The expression of GR-alpha/beta mRNA in 40 samples of nasal polyp and 30 normal nasal mucosa was examined by using Fluorescent quantitative PCR. RESULTS: Forty cases were screened from the 80 cases after follow-up, including 26 cases of GC-sensitive and 14 cases of GC-insensitive. the levels of GR-beta mRNA in group of GC-insensitive [(5.72 +/- 0.58) x 10(2) copy/microg] were significantly higher than that of GC-sensitive [(4.82 +/- 0.28) x 10(2) copy/microg, t = -6.65, P < 0.01] and normal nasal mucosa [(4.44 +/- 0.35) x 10(2) copy/microg, t = -9.19, P < 0.01]. There was difference between group of GC-insensitive and other two groups of GC-sensitive and normal nasal mucosa (P < 0.01). The ratio of GR-alpha/GR-beta showed significant difference between the group of GC-sensitive (829.42 +/- 67.36) and that of GC-insensitive (535.70 +/- 89. 00, t = 11.74, P < 0.01). CONCLUSIONS: The high expression of GR-beta mRNA and low expression of GR-alpha mRNA in nasal polyp show the status of "insensitive" in chronic sinusitis and nasal polyp. The GR-beta may play an important role in evaluating the effect of glucocorticoid in chronic sinusitis and nasal polyps.

Adult↗

PubMed2005

[The bacteria isolated from middle nasal meatus and ethmoid sinus of chronic naso sinusitis patients and their correlationship].

OBJECTIVE: To explore the bacteria isolated from middle nasal meatus and ethmoid sinuses of chronic naso sinusitis patients and their correlationship. METHOD: Patients with chronic naso sinusitis were selected to performed the functional nose endoscopy in order to obtain the sample with disinfection cotton. All the samples were cultured aerobically and anaerobically, separately. RESULT: In 120 samples of chronic naso sinusitis patients, 2 section of 18 samples (15%) showed the same kinds of bacteria culture positive; and 2 section of 9 samples showed different kinds of bacteria, 24 samples showed culture positive only in the samples from middle nasal meatus; and 12 samples showed culture positive only in the samples from ethmoid sinuses. The positive rate of isolation was 42.5% in middle nasal meatus and 32.5% in ethmoid sinuses. The positive rate of aerobe was 39.2% in middle nasal meatus, and 22.5% in ethmoid sinuses. The positive rate of anaerobe was 12.5% in middle nasal meatus and in ethmoid sinuses. CONCLUSION: The positive rate of isolation was not high in the sample with disinfection cotton of chronic naso sinusitis patients. The correlationship of bacterium between the middle nasal meatus and ethmoid sinuses is little.

Adolescent↗