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PubMed2001

[A comparative observation preoperatively and postoperatively of nasal mucosa in chronic sinusitis treated with endoscopic sinus surgery].

OBJECTIVES: To study morphologic and functional mucosal changes both preoperatively and postoperatively in chronic sinusitis (CS) treated with endoscopic sinus surgery (ESS). METHODS: 1. Saccharin test and light microscopic examination of nasal mucosa were taken preoperatively and postoperatively in 32 cases with CS and in 28 normal subjects as control. 2. Scanning and transmission electron microscopy were performed to exam preoperatively and postoperatively the nasal mucosa in 10 cases with CS and in 2 normal cases as control. RESULTS: 1. The preoperative saccharin test time (STT) in patients with CS was significantly longer than that in the controls (P < 0.001), and the postoperative STT became significantly shorter than that in preoperative one(P < 0.001). 2. The pathological changes of nasal mucosa, such as infiltration in inflammatory cells, edema, polypoid formations and pathologic glands were observed preoperatively. The infiltration in inflammatory cells, edema and polypoid formations were significantly released (P < 0.01) at four months after operation, and there was no significant difference comparing with the controls (P > 0.05). However, the pathologic glands were not reduced even after four months postoperatively. 3. The examination of electron microscopy demonstrated that the ultrastructure of nasal mucosa was impaired preoperatively and almost completely recovered at four months postoperatively. CONCLUSIONS: The normal structure and clearance function of nasal mucosa in patients with CS was impaired preoperatively, and the impaired structure and mucociliary clearing function of nasal mucosa were greatly improved after ESS and almost completely recovered at four months postoperatively. The pathologic glands and secretive function of nasal mucosa may need longer period for recovering.

Adolescent↗
PubMed2002

Cytokine profile of chronic sinusitis in patients with cystic fibrosis.

BACKGROUND: The inflammatory-cell and cytokine profiles of chronic sinusitis (CS) are well documented in the literature. In contrast, little is known about the pathogenesis of this condition in patients with cystic fibrosis (CF). OBJECTIVE: To determine whether patients with CF have inflammatory-cell and cytokine profiles that differ from other patients with CS. METHODS: Patients with CF (n = 7) and adults with CS (n = 7) undergoing functional endoscopic sinus surgery were recruited for the study. Patients with no allergies or sinus disease (n = 6) were used as controls. Using immunohistochemical analysis, we assessed sinus mucosal specimens for the presence of T lymphocytes, eosinophils, macrophages, and neutrophils. Using in situ hybridization, we assessed the expression of interleukin (IL) 4, IL-5, IL-8, IL-10, and interferon gamma. RESULTS: There was a higher number of neutrophils, macrophages, and cells expressing messenger RNA for interferon gamma and IL-8 in patients with CF than in patients with CS or in controls (P<.01). The number of eosinophils and cells expressing messenger RNA for IL-4, IL-5, and IL-10 was higher in patients with CS than in those with CF and controls (P<.01). CONCLUSIONS: Sinus disease in patients with CF presents different inflammatory-cell and cytokine profiles than that seen in other patients with CS. These results may explain the difference in response to treatment in the CF group.

Adult↗
PubMed1991

[Conventional X-ray versus CT in diagnosis of chronic sinusitis in children].

The interpretation of conventional radiographic views for sinusitis in children has given rise to considerable controversy. Thirty-three children (66 sides of sinuses) aged from 4 to 15 years who were suspected of having chronic sinusitis were studied to determine the accuracy of conventional X-ray examination, comparing the results with those of CT. Coronal CT was taken after conventional X-ray examination (Waters and occipito-frontal views), and the time interval between these two examinations was 0 to 14 days (average 5.1 days). The rate of correspondence in diagnosis of sinus pathology between conventional X-ray views and CT was 74.3% in the maxillary sinus and 40.9% in the ethmoid. The rate of overestimation with conventional X-ray views was 24.2% in the maxillary sinus and 56.1% in the ethmoid, while that of underestimation was 1.5% and 3.0% in the maxillary and the ethmoid sinus respectively. The incidence of false positives according to conventional X-ray views was 8.0% in the maxillary sinus and 33.3% in the ethmoid. Our results indicate that Waters view is sufficient to diagnose maxillary sinus pathology in children. However, additional radiologic examinations, such as CT, are necessary in investigating the pathologic conditions of the ethmoid sinus, since diagnostic significance of occipito-frontal view for ethmoid pathology is doubtful in children. A routine preoperative CT is recommended, which allows a detailed evaluation of pathologic changes and anatomical relations of the ethmoid before embarking a surgical intervention for the ethmoid sinus in children.

Adolescent↗
PubMed1992

[Surgical treatments of adult chronic sinusitis--a study by questionnaire from 434 hospitals in Japan].

Information concerning surgical treatment of adult patients with chronic sinusitis was obtained through questionnaires from 434 hospitals in Japan. The hospitals were authorized for an in-service otorhinolaryngological training institute by the Oto-Rhino-Laryngological Society of Japan. The questionnaires were sent to the hospitals in December, 1989, and answers were obtained from 370 hospitals within 2 months, an 85.3% response rate. The following results were obtained. In 96.2% of the hospitals, permaxillary sinus surgery was performed on patients whose maxillary and ethmoid lesions were severe. With moderate lesions of both the maxillary and ethmoid sinuses, permaxillary sinus surgery and endonasal sinus surgery were performed in 76.0% and 24.9%, respectively. Application of an endoscope for sinus surgery was reported by 89 hospitals. In January, 1990, a further survey was sent to the 89 hospitals where endoscopic sinus surgery was performed. Questionnaire responses were obtained from 75 hospitals. Rigid endoscope was used most frequently and operative microscope was also used. Endoscopy was applied to all of the sinus surgery procedures in 21.6%, and to a portion of the procedures in 74.3% of the hospitals. About 50% of the hospitals performed endoscopic surgery in fewer than 30% of sinus surgery cases. When questioned as whether endoscopic surgery had been successful, 42.6% said yes, 10.7% said no, and 42.6% were unsure.

Adult↗
PubMed1999

[Concepts for measuring quality of life in patients with chronic sinusitis].

BACKGROUND: In 1997, Benninger developed the Rhinosinusitis Disability Index (RSBI) for patients who suffered from chronic sinusitis. Its content related validity and construct related validity were established, as were its sensitivity and reliability. The aim of our study is to introduce a concept to measure quality of life in these patients according to circumstances prevalent in Germany. METHODS: The questionnaire (Rhinusitis-Beeinträchtigungs-Index, RSBI) contains 30 questions that describe the 5 aspects of quality of life. Moreover we used a standardized data sheet to acquire further information about history and diagnostic results. Using this method it is possible to specificity more precisely the patients current complaints and condition. Evaluation is possible according to complex of questions as well as simple items. The influence of treatment on quality of life can be measured as the sum of the specific scores and is expressed comprehensively in the total score. The concept of the study includes a prospective inquiry as well as before and after surgical intervention. CONCLUSION: A disadvantage of the American RSDI is that the clinical symptoms are not described in a detailed catalogue which allows the correlation of the clinical factors. Therefore we added a detailed questionnaire concerning the clinical symptoms and the individual treatment of the patient (RSBI). That permits comprehensive analysis of quality of life as it relates to different aspects of disease and different strategies in treatment.

Chronic Disease↗
PubMed1999

Effect of biochemical components on rheologic properties of nasal mucus in chronic sinusitis.

The effect of biochemical components on the viscoelasticity of nasal mucus from 24 patients with chronic sinusitis (CS) was investigated by multiple stepwise regression analysis. The dynamic viscosity (eta') and the elastic modulus (G') of nasal mucus were determined with an oscillating sphere magnetic rheometer at oscillatory frequencies of 1 and 10 Hz. The eta' and G' values of mucus determined at 1 Hz were 1.6 +/- 1.5 Pa/s and 31.8 +/- 31.0 Pa, respectively, and these values were much higher than optimal viscoelasticity for mucociliary transport. The concentrations of fucose, N-acetyl neuraminic acid, albumin, IgG, secretory-IgA, and lysozyme were measured in the same mucus samples. The multiple regression analysis showed that the concentration of fucose, a marker of mucous glycoproteins, was the most important determinant of eta' and G'. The analysis also revealed that the level of IgG was the next important determinant. The coefficients of multiple determination for fucose and IgG were 0.732 and 0.733 when the response variables were eta' and G', respectively. The results indicate that locally produced mucous glycoproteins may largely contribute to the high viscoelasticity of nasal mucus in CS.

Adolescent↗
PubMed1992

Microbiology of acute and chronic sinusitis in children.

To determine the bacteriologic cause of acute sinusitis, a sample of sinus secretions must be obtained from one of the paranasal sinuses without contamination by normal respiratory or oral flora that colonize mucosal surfaces. When maxillary sinus aspiration is performed on children who have signs and symptoms of acute sinusitis, bacteria are recovered in high density from 70%. In patients with acute, subacute, or chronic sinusitis who are generally well except for persistent respiratory symptoms, of nasal discharge or cough or both, the usual bacterial isolates are Streptococcus pneumoniae, Haemophilus influenzae, an Moraxella catarrhalis. In contrast, anaerobic organisms and staphylococci should be suspected in patients who have very long-standing symptoms or in those whose symptoms are so severe or complicated that sinus surgery is undertaken.

Acute Disease↗
PubMed1999

Abnormal expression of the cystic fibrosis transmembrane regulator in chronic sinusitis in cystic fibrosis and non-cystic fibrosis patients.

Cystic fibrosis (CF) patients commonly suffer from chronic sinusitis. Mutations of a single gene, the cystic fibrosis transmembrane conductance regulator (CFTR) gene, have been associated with CF. Functional CFTR protein is localized to the apical cell membrane, while dysfunctional CFTR is commonly found in the cytoplasm. We undertook a preliminary immunocytochemical study of CFTR subcellular localization in CF and non-CF pediatric and adult patients using a newly developed murine monoclonal antibody, TAM. Immunostaining was evaluated for subcellular localization (cytoplasmic versus membranous) and for epithelial layer (basal versus luminal). Analysis of the predominant CFTR distribution patterns demonstrated significant differences in adult versus pediatric groups independent of whether the latter were CF or non-CF (p<.0001 and p<.008, respectively), and no significant difference between the 2 pediatric groups (p = .70). This suggests that the pathophysiology of pediatric sinusitis differs from that of adult sinusitis at the level of secretion production.

Adolescent↗
PubMed2005

Comparison of traditional Chinese acupuncture, minimal acupuncture at non-acupoints and conventional treatment for chronic sinusitis.

OBJECTIVES: To compare traditional Chinese acupuncture, minimal acupuncture at non-acupoints and conventional treatment for chronic sinusitis. DESIGN: A three-armed single blind randomised controlled study. SETTING: In an outpatient specialist clinic, we recruited 65 patients with symptoms of sinusitis >3 months and signs of sinusitis on computed tomography (CT). INTERVENTIONS: We randomised patients to one of three study arms: (1) 2-4 weeks of medication with antibiotics, corticosteroids, 0.9% sodium chloride solution, and local decongestants (n=21), (2) 10 treatments with traditional Chinese acupuncture (n=25), or (3) 10 treatments with minimal acupuncture at non-acupoints (n=19). OUTCOME MEASURES: Change in sinus soft tissue swelling on CT, symptoms of sinusitis, and health-related quality of life (HRQoL), using the two component summary scales of the Short Form 36 and a rating scale. RESULTS: In the conventional treatment group, sinus soft tissue swelling was reduced over 4 weeks (p=0.04), and HRQoL improved over 12 weeks (p=0.01-0.05). Pairwise comparisons of changes in total symptom score between the groups showed signs of a difference between conventional medication and sham over 4 weeks (p=0.06). CONCLUSION: Sinus soft tissue swelling was reduced in the conventional treatment group over 4 weeks, and HRQoL improved over 12 weeks. Only a non-significant difference in symptom score change over 4 and 12 weeks was shown between conventional medication and traditional Chinese acupuncture.

Acupuncture↗
PubMed2000

Aerobic and anaerobic bacteriology of concurrent chronic otitis media with effusion and chronic sinusitis in children.

OBJECTIVE: To correlate the aerobic and anaerobic microbiologic findings of concurrent chronic otitis media with effusion and chronic maxillary sinusitis. METHODS: Cultures were obtained from 32 children with concurrent chronic otitis media with effusion and maxillary sinusitis who underwent tympanostomy tube placement. RESULTS: A total of 42 isolates, 24 aerobic and 18 anaerobic, were recovered from 30 patients; 27 were isolated from both sites, 4 from the ear only, and 11 from the sinus only. The most common isolates were Haemophilus influenzae (9 isolates), Streptococcus pneumoniae (n = 7), Prevotella species (n = 8), and Peptostreptococcus species (n = 6). Microbiological concordance between the ear and sinus was found in 22 (69%) of culture-positive patients. CONCLUSION: The concordance in recovery of organisms in more than two thirds of the patients illustrates the common bacterial etiology between chronic otitis media with effusion and chronic sinusitis in children.

Bacteria, Aerobic↗
PubMed2004

[Microbiology of acute exacerbation chronic sinusitis in adults].

The bacterial flora taken by sinus puncture from 115 patients with uni and bilateral acute exacerbation of chronic maxillary sinusitis was analyzed. Germ-free culture was obtained in 49 cases (40%) and in 69 cases (60%) bacteria were isolated from all sinus aspirates. Microbiological evaluation shows, that in majority of cases (90%) of acute exacerbation of chronic sinusitis there were pathogenic bacteria namely aerobic and anaerobic. The most frequent pathogens isolated from the aspirates were; Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Streptococcus pneumoniae, Staphylococcus hominis, Propionibacterium acnes i Candida albicans. The culture analysis proves that one or more pathogens can be the etiological factor. In the majority of cases (64%) the sinusitis is caused by monoculture.

Acute Disease↗
PubMedDate not supplied

Studies on the maxillary ostial function in cases with maxillary pain, intrasinusal cysts and chronic sinusitis.

The maxillary ostial function, measured as pressure transmission capacity, ostial airway resistance, equivalent ostial diameter during nasal breathing and with a constant artificial air-flow of 16.7 cm3 X S-1 into the sinus, was compared in three groups of patients. One group consisted of 7 sinuses in 6 patients with maxillary pain but without any signs of sinusitis; a second group of 6 sinuses in 6 patients with intramaxillary cysts; and a third group of 6 sinuses in 5 patients with chronic maxillary sinusitis. No impairment of the ostial function was found in groups one and two. In the third group an increased airway resistance of the ostia and small equivalent ostial diameters were found in both sitting and recumbent positions. With the pressure recording technique, the ostium can be judged as patent, non-patent, or partially obstructed, but no further grading can be done. With the pressure-flow technique the ostial function can be evaluated as ostial resistance or equivalent ostial diameters under 'physiological conditions' when the ostium is patent. With a constant artificial air-flow into the sinus the equivalent ostial diameter can be estimated even in non-patent ostia but the equivalent ostial diameters obtained do not always reflect the true functional state of the ostium.

Adult↗
PubMed1989

The diagnosis and treatment of recurrent and chronic sinusitis in children.

Pediatricians, allergists, family practitioners and otolaryngologists are all very aware of the increasing problem of recurrent and chronic sinusitis in children. This article details the diagnosis and management of the disease process and outlines steps for its future management.

Anti-Bacterial Agents↗
PubMed2000

Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis.

OBJECTIVE: To explore the possible role of gastroesophageal reflux (GER) in children with chronic sinus disease (CSD). DESIGN: A descriptive prevalence study of the frequency of GER and nasopharyngeal reflux in children with CSD. SETTING: Pediatric otolaryngology and gastroenterology outpatient clinics of a regional medical center. PATIENTS AND OTHER PARTICIPANTS: Consecutive children aged 2 to 18 years referred for evaluation of CSD from December 1, 1996, through April 30, 1998. INTERVENTIONS: Participants underwent 24-hour monitoring with dual pH probes, and participants (or their parents) completed questionnaires before treatment and at specific intervals after treatment. MAIN OUTCOME MEASURES: Prevalence of GER and nasopharyngeal reflux in children with CSD, and the response of sinusitis to treatment in those diagnosed with GER. RESULTS: Nineteen (63%) of 30 patients demonstrated esophageal reflux, which is well above the expected prevalence of GER in the healthy general population. Six (32%) of these 19 patients demonstrated nasopharyngeal reflux. Fifteen (79%) of 19 patients improved after treatment for GER. CONCLUSIONS: The children in this population had a prevalence of GER that was significantly higher than expected. Furthermore, most children with GER demonstrated improvement of sinus disease after treatment of GER. We recommend that children with CSD refractory to aggressive medical management be evaluated for GER and, if GER is present, be treated accordingly, before sinus surgery is considered.

Adolescent↗
PubMed2004

Surgical management of chronic sinusitis in children.

OBJECTIVES/HYPOTHESIS: The objective was to compare three common surgical modalities in children for the treatment of chronic sinusitis that is refractory to medical management. STUDY DESIGN: Prospective nonrandomized study in a pediatric otolaryngology tertiary service. METHODS: Two hundred two children who satisfied criteria for surgery and were referred over a 10-year period were studied. Children were divided into three surgical groups. Group 1 had both endoscopic sinus surgery and adenoidectomy, group 2 had endoscopic sinus surgery alone, and group 3 had adenoidectomy. After a follow-up period of 12 months, improvement of symptoms was assessed. RESULTS: One hundred eighty-three children had adequate follow-up. Eighty seven percent of children in group 1 had improved symptoms, compared with 75% in group 2 and 52% in group 3 (P < .0001). Multivariate analysis showed that surgical procedure was a predictor of success. Asthma, smoke exposure, and age were independent predictors of success. CONCLUSION: Children who fail medical therapy benefit from surgery. Following certain criteria, one can chose between adenoidectomy alone or endoscopic sinus surgery with adenoidectomy to optimize surgical treatment of these children.

Adenoidectomy↗
PubMed1989

Immunohistological characteristics of nasal polyps. A comparison with healthy mucosa and chronic sinusitis.

Immunohistological investigations were performed on a series of samples from 37 patients with nasal polyps, 22 with chronic sinusitis, and 15 controls with healthy nasal and sinusal mucosa. Mean numbers of plasma- and mast cells were not different in the various groups. Immunoglobulin isotypes were always predominantly IgA and IgM; IgE were scarce. Deposited immune complexes were always absent. A statistically significant difference, however, was observed in the number of eosinophils within the mucosa. Patients with nasal polyps had up to ten times more eosinophils per surface unit than patients with sinusitis or healthy mucosa.

Adolescent↗
PubMedDate not supplied

Chronic sinusitis complicating sinus lift surgery.

Sinusitis has been reported as a complication of sinus lift surgery with antral bone augmentation. The procedure involves the creation of a submucoperiosteal pocket in the floor of the maxillary sinus for placement of a graft consisting of autogenous, allogenic, or alloplastic material. This can result in inadvertent tearing of the mucoperiosteal flap with extrusion of graft material into the antrum. Obstruction of the sinus outflow tract by mucosal edema and particulate graft material may result in sinusitis. We will discuss the clinical presentation and management of 14 cases of chronic sinusitis following sinus lift surgery with alloplastic hydroxyapatite (HA) augmentation of the maxillary antrum.

Adult↗