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PubMed1992

The diagnosis of sinusitis in infants and children: x-ray, computed tomography, and magnetic resonance imaging. Diagnostic imaging of pediatric sinusitis.

Plain film radiographic examination, the historical standard, is rapidly being supplanted by computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of sinusitis. In particular, many endoscopic surgeons consider CT to be a mandatory part of the preoperative evaluation. MRI is useful for cases complicated by orbital or intracranial extension. However, because of considerations of cost, the need for sedation, and for CT radiation exposure, conventional x-ray films will continue to play an important role in the diagnosis and management of medically treated sinus disease. Incidental sinus abnormalities in children without apparent symptoms are usually the result of resolving, uncomplicated upper respiratory tract infection. Opacification, moderate-to-severe mucosal thickening, or air fluid levels in patients with persistent symptoms indicate sinusitis. Sinus imaging in children, whatever the modality, is demanding both in obtaining technically adequate studies and interpreting findings. Poor-quality examinations usually overestimate the presence and severity of disease. Ideally, children should be referred to centers with expertise in pediatric ear, nose, and throat imaging.

Child, Preschool↗

PubMed2000

Application of YAMIK sinus catheter for patients with paranasal sinusitis with and without nasal allergy.

PURPOSE: YAMIK sinus catheter (YAMIK) has already been reported to be a useful therapeutic device for sinusitis cases. The purpose of this study was to compare the effectiveness of YAMIK in sinusitis cases with and without nasal allergy in order to contribute toward establishing its indication. METHODS: YAMIK was tried in 10 chronic sinusitis cases complicated with nasal allergy and 20 cases without nasal allergy. Clinical symptoms, endoscopic findings and pathological opacification in X-ray photographs were compared in these cases with and without nasal allergy. RESULTS: No significant differences were seen in the effectiveness of YAMIK between cases with and without nasal allergy. CONCLUSION: These findings suggest that YANIK is useful and applicable even in sinusitis cases complicated with nasal allergy.

Adolescent↗

PubMed2003

[Paranasal sinus surgery in chronic sinus disease and benign tumors indications, concepts and complications at a teaching institution].

BACKGROUND AND METHODS: The medical records of 635 patients that underwent paranasal sinus surgery for chronic sinus disease or benign tumors during a 6.5 year span were assessed retrospectively to evaluate the status of sinus surgery at a teaching institution. The parameters analyzed were indication for surgery, surgical approach, extent of the procedures and complications. RESULTS: The ratio between male and female patients was 2 : 1, with an average age of 44 (+/- 16) years. In 137 cases (21.5 %), revision surgery in patients previously treated at the University of Wuerzburg was necessary. In 80 cases (12.6 %), prior surgery had been performed elsewhere. The majority of the procedures (91.3 %) were carried out using endonasal techniques. External, transethmoid (6.5 %) or transmaxillar (2.2 %) approaches were chosen in 8.7 % of all cases, mainly when the preoperative diagnoses were mucoceles (65.2 %), benign tumors (40.9 %) or orbital complications (33.3 %). Surgery was assisted exclusively by the microscope in 78.7 %, solely by the endoscope in 15.9 % and with a combination of both optical tools in 5.4 % of all cases. The total rate of complications was 8.2 %. Minor complications were seen in 8.1 % of the endonasal and 4.9 % of the external transethmoid procedures. While no major complications occurred during endonasal or extranasal transmaxillar surgery, liquorrhoe was documented in three extranasal transethmoid procedures (7.3 %). Neither permanent impairment of vision, nor post-operative meningitis nor surgery-related mortality was observed in any case. CONCLUSION: The study gives an overview over the paranasal sinus surgeries performed at a teaching institution, independent of the experience of the surgeon. It confirms the results of previous investigations and indicates that endonasal sinus surgery is a reproducible and reliable procedure that can be safely applied at a teaching institution. The results also show that the indication for extranasal approaches is further reduced to the less invasive endonasal techniques.

Adult↗

PubMed1983

Pathologic findings in allergic aspergillus sinusitis. A newly recognized form of sinusitis.

The pathologic findings are described in seven cases of allergic aspergillus sinusitis, a newly recognized form of sinusitis. Grossly, the sinuses are filled with firm, white-tan mucoid material. Microscopically this material consists of mucin-containing numerous eosinophils, sloughed respiratory epithelial cells, cellular debris, Charcot-Leyden crystals, and scattered fungal hyphae resembling aspergillus species. This histologic appearance is identical to mucoid impaction occurring in bronchi in allergic bronchopulmonary aspergillosis. Allergic aspergillus sinusitis and allergic bronchopulmonary aspergillosis may represent different manifestations of aspergillus hypersensitivity in the respiratory tract. Implications for treatment of allergic aspergillus sinusitis and a possible relationship between it and allergic bronchopulmonary aspergillosis are discussed.

Aspergillosis↗

PubMed1997

Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses.

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow-up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow-up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses.

Adult↗

PubMed1988

Macroscopic purulence, leukocyte counts, and bacterial morphotypes in relation to culture findings for sinus secretions in acute maxillary sinusitis.

Macroscopic purulence, leukocyte counts, and bacterial morphotypes in Gram-stained smears were investigated in 335 sinus secretions (240 aspirates and 95 injection aspirates) obtained by puncture in 234 young patients with acute maxillary sinusitis. Over 90% of the 147 aspirates macroscopically classified as purulent also contained high numbers of leukocytes (greater than 20 per oil immersion field). A total of 82% of the 147 macroscopically purulent aspirates and 79% of the 156 aspirates containing high numbers of leukocytes yielded presumed sinus pathogens by culture in quantities of greater than 10(3) CFU/ml. Streptococcus pneumoniae or Streptococcus pyogenes was associated relatively more often (92 or 87%, respectively) with high numbers of leukocytes than Haemophilus influenzae, which was not infrequently (29%) recovered from the less purulent aspirates. When a bacterial morphotype was seen in the Gram-stained smear, a corresponding sinus pathogen was isolated in quantities of greater than 10(3) CFU/ml in 92% of aspirates. Other bacterial species (most often staphylococci) were usually isolated in low numbers and were almost never seen in the smear, suggesting nasal contamination. The 95 injection aspirates behaved, to a large extent, like diluted aspirates, with the exception that there was a higher frequency of probable nasal contamination. Macroscopic purulence, high leukocyte counts, and bacterial morphotypes seen in Gram-stained smears each predicted well the isolation of a presumed sinus pathogen and in some cases supported the significance of an otherwise doubtful culture finding. However, the macroscopic appearance of the secretion should not be used to screen samples for culture, because in several cases H. influenzae grew from nonpurulent samples as well.

Acute Disease↗

PubMed1991

The impact of screening sinus CT on the planning of functional endoscopic sinus surgery.

The clinical and radiologic records of 500 sequential patients who underwent screening sinus CT as a prelude to possible functional endoscopic sinus surgery (FESS) were reviewed in order to answer three clinical-radiologic questions: (1) Can distinct radiologic patterns of inflammatory disease be identified on screening sinus CT (SSCT)? (2) If so, what are these radiologic patterns? (3) How do the findings seen on SSCT influence the endoscopic surgical plan? Five basic radiologic patterns of sinonasal inflammatory disease were identified among the 500-member patient population. These were based on known patterns of mucociliary drainage correlated with obstructive patterns observed on the CT scans. These radiologic patterns included: (1) infundibular (129 of 500 or 26%), (2) ostiomeatal unit (126 of 500 or 25%), (3) sphenoethmoidal recess (32 of 500 or 6%), (4) sinonasal polyposis (49 of 500 or 10%), and (5) sporadia (unclassifiable) (121 of 500 or 24%) patterns. Normal SSCT was seen in 133 of the 500 patients (27%). Although the ostiomeatal unit is the central feature in sinonasal inflammatory disease, obstruction of the infundibulum alone or of the sphenoethmoidal recess can cause unique inflammatory patterns of disease that require tailored FESS. The identification of sinonasal polyposis raises a different set of FESS considerations. The sporadic pattern of inflammatory disease, when identified, creates unique FESS challenges, depending on the specific sinus or sinuses involved. Assignment of these patterns to the individual case also assists in patient management by grouping patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess) surgical groups.

Acute Disease↗

PubMed2002

Dural arteriovenous fistula involving the superior sagittal sinus following sinus thrombosis--case report.

A 57-year-old woman presented with a dural arteriovenous fistula (AVF) involving the superior sagittal sinus (SSS) based upon serial radiological examinations. Her chief complaints were headache and vomiting. Cerebral angiography and magnetic resonance (MR) venography revealed the sinus thrombosis involving the SSS, the bilateral transverse sinuses (TSs), and the right sigmoid sinus. Her symptoms disappeared after anticoagulant therapy. Follow-up MR venography revealed almost complete recanalization of the occluded sinuses, followed by restenosis of the SSS and the left TS and occlusion of the right TS without symptoms. She developed transient right hemiparesis 13 months after the initial onset. Cerebral angiography revealed a dural AVF involving the SSS with cortical reflux into the left frontoparietal region. The dural AVF was occluded by transarterial and transvenous embolization. Her symptom disappeared during the follow-up period.

Anticoagulants↗

PubMedDate not supplied

Maxillary sinus involution after endoscopic sinus surgery in a child: a case report.

Studies in animal models have suggested that functional endoscopic sinus surgery may affect facial skeletal growth in children, although reviews of large clinical series do not support this observation. This is a case report of a 12 year old male referred to the senior author (SBL) several months after undergoing bilateral functional endoscopic sinus surgery. The preoperative computed tomograms of the paranasal sinuses were normal with symmetrical well-developed paranasal sinuses. Postoperative computed tomography revealed nearly total involution of the osseous skeleton of the left maxillary sinus. This is the first clinical report of alterations in the facial skeleton of a child secondary to iatrogenic trauma directed at the osteomeatal complex. The case and related literature are reviewed in detail.

Child↗

PubMedDate not supplied

Bacteriology of ethmoid sinus in chronic sinusitis.

This study was designed to study the bacteriology of the ethmoid sinus in chronic sinusitis with a new sampling method to decrease nasal contamination. The anterior nose was disinfected with povidone-iodine solution. Then, the sample of ethmoid sinus was obtained with a cotton-tip stick through a cannula that was put into the ethmoid cavity after removing ethmoid bulla. Thirty-nine patients of chronic sinusitis were included with a total of 69 specimens. Fifty-eight bacterial isolates were recovered. The cultural rate was 60.9%. The most frequently isolated bacteria were Streptococcus viridans, Klebsiella pneumoniae, Proteus mirabilis, and Hemophilus parainfluenzae. Conversely, only three isolates of Staphylococcus epidermidis were obtained. The results show that the new sampling method used in this study could decrease the chance of nasal contamination and might, at the same time, make the study of the bacteriology of the ethmoid sinus more accurate.

Adolescent↗

PubMedDate not supplied

Endoscopic sinus surgery: modern therapy for sinus disease.

This article describes the procedures of functional endoscopic sinus surgery (FES). The types of patients who are potential candidates for the surgery are discussed and case examples given. The primary rationale for functional endoscopic sinus surgery is its physiological basis in restoring mucocilliary clearance of the paranasal sinuses. Accurate preoperative assessment using telescopic examination in the office and coronal CT scans of the sinus provide the surgeon with precise anatomical information which is used at the time of surgery. The surgery is minimally invasive resulting in significantly less morbidity than with traditional sinus operations. Overall success rates are approximately 85%.

Acute Disease↗

PubMed1996

[Lymphoid follicle formation in sinus mucosa of chronic sinusitis].

While the presence of mucosa-associated lymphoid tissue (MALT) in the human upper respiratory mucosa is still being debated, it is known that lymphoid follicles (LFs) are present in the mucosa of patients with chronic sinusitis. In the present study, we investigated LFs in chronic sinusitis mucosa samples for the first time immunohistochemically to reveal the frequency and process of lymphoid follicle formation. Forty maxillary sinus mucosa samples from 27 surgical cases were examined. Of the 31 samples, 15 (48.4%) contained primary and/or secondary LFs, 27 (87.1%) contained lymphocyte aggregates (LAs), and 27 (87.1%) contained high endothelial venules (HEVs) located in the LAs and around the LFs. In the inflammatory site above the lesion of the LAs or LFs, respectively, intraepithelial lymphocyte infiltration and a non-ciliated structure or lympho epithelium were seen. In the first phase of diffuse lymphocyte infiltration, CD8+ T cells (suppressor/cytotoxic) were the predominant cells observed in a spreading pattern under the epithelium. In the next phase, while OPD4+ T cells (helper/inducer) were infiltrating, L26+ B cells were gradually aggregating to form lymphocyte clusters (LCs). S-100+ antigen-presenting cells and DRC+ follicular dendritic cells (FDCs) had already appeared during lymphocyte aggregation to promote lymphoid follicle formation. The region of LFs was morphologically divided into the lympho epithelium (LE), the sublympho epithelial area (SLA), the parafollicular area (PFA), and the follicular area (FA). The LE was invaded focally by L26+ B cells and sporadically by UCHL1+ T cells. In the SLA, L26+ B cells and small numbers of OPD4+ T cells were dominant. In the PFA, both OPD4+ and CD8+ T cells were present. The FA consisted of B cells, FDCs, and a few OPD4+ T cells in germinal centers (GCs). In the GCs, we observed VLA-4+ lymphocytes, VCAM-1+ FDCs, IgM+ B cells, and a few IgA+ B cells. On the basis of this study, LFs with lympho epithelium and HEVs are considered prevalent pathological findings in the mucosa humans with chronic sinusitis. Immunohistochemical study revealed the infiltration patterns of T and B lymphocyte subpopulations and FDCs, which clarified the process of LAs, LCs and LFs. This study confirms that LFs are immunologically activated areas that produce plasma cells and are supported by the cellular interaction between FDCs and B cells in their GCs. These MALTs in chronic sinusitis play an important role in mucosal immunity and persistent local inflammation.

Antibodies, Monoclonal↗

PubMed1998

[The valuation of paranasal sinus coronal CT scanning in endoscopy sinus surgery].

We applied coronal CT scanning of paranasal sinus to 260 patients with chronic sinusitis before they were performed endoscopy sinus surgery. The correct diagnostic rate was 99.2% in our study. The positive findings of CT were compared with that from normal person. By analyzing, we consider that coronal CT scanning can clearly reveal various anatomic variation for all sinuses, also, it is valuable in evaluating the difficulties of endoscopic sinus surgery and preventing dangerous operative complications.

Adolescent↗

PubMed2002

Microbiology of the ethmoid sinus following endoscopic sinus surgery.

We prospectively studied the native microbiology of the ethmoid sinus following endoscopic sinus surgery in 113 patients (mean age: 41.3 yr). After each patient had regained complete mucosalization (minimum follow-up: 6 wk), we obtained a bacterial swab of the ethmoid sinus and submitted it for culture and sensitivity analysis. We then compiled data on sensitivity patterns and the number and type of bacteria isolated. Of the 113 patients, 67 (59.3%) had positive cultures, 26 (23.0%) had sterile cultures, and 20 (17.7%) had normal flora. Multiple bacteria were isolated in 31 of the 113 patients (27.4%). The most common isolates were gram-positive cocci, and the most common bacteria were staphylococcal species. A significant degree (42.9%) of beta-lactamase resistance was exhibited. We conclude that the ethmoid sinus is not microbiologically sterile following endoscopic sinus surgery.

Adult↗

PubMed2005

Anatomical variations of the lateral nasal wall and paranasal sinuses: A CT study for endoscopic sinus surgery (ESS) in Thai patients.

Computerized tomography (CT) of the paranasal sinuses is usually required prior to endoscopic sinus surgery. CT demonstrates both the extent of disease(s) and the anatomical variations that may predispose to rhinosinusitis and nearby vital structures that iatrogenic damage can be avoided. The authors retrospectively reviewed 88 CT scans of paranasal sinuses and orbits, performed at Srinagarind Hospital between January 1995 and February 1997. Only adult patients were included. The study showed the presence of frontal sinuses in 88% of cases (95%CI 82.3-92.5%), agger nasi cells in 92% (95%CI 87-95.6%), concha bullosa in 34% (95%CI27.1-41.6%), Haller's cell in 24% (95%CI 17.8-30.9%), Onodi cell in 25% (95%CI 19.8-32.1%), dehiscence of the internal carotid artery in 10.2% (95%CI 6.2-15.7%) and the optic canal in the sphenoid sinus in 18.2% (95%CI 12.8-24.7%). The most common olfactory fossa was type II. Haller's cell was a coincident finding not a risk factor for maxillary rhinosinusitis. Concha bullosa was a non-statistically significant, risk factor for maxillary rhinosinustis.

Adolescent↗

PubMedDate not supplied

[Thrombophlebitis of left cavernous sinus secondary to acute right sphenoid sinusitis].

Isolated sphenoid sinusitis is a rare, potentially destructive entity. Presenting symptoms are often vague and non-specific therefore the diagnosis is made late when complications have had already occurred. The most frequent complications of sinusitis are the neurological ones--being serious life--threatening conditions. We report a case of isolate right sphenoid sinusitis with concurrent thrombophlebitis of left cavernous sinus. Accordingly, we review the salient clinical features of this illness, with emphasis on the importance of a high index of suspicion, the potentially rapid and fatal course of the disease process and the aspects of the diagnosis and treatment. We also reviewed the predisposing factors of complications of sphenoid sinusitis.

Adrenal Cortex Hormones↗

PubMedDate not supplied

The association of carotid artery stenosis with carotid sinus hypersensitivity. Transitory cerebral ischaemic attack provoked by carotid sinus reflex.

The association of internal carotid stenosis with the carotid sinus syndrome represents a special clinical entity. Transitory cerebral ischaemic attack (TIA) will usually be manifested by activation of carotid sinus reflex. Eighteen patients were observed suffering from both carotid sinus hypersensitivity and TIA. The patients had had TIA's for many years. Unilateral internal carotid stenosis was detected in 15 cases, while 3 patients had bilateral carotid stenosis. On carotid sinus stimulation, syncope appeared and a TIA could be provoked. The mean duration of the syncopic attack was 5500 ms and was based on sinus arrest in 14 cases and on third degree AV block in 4 cases. In all patients carotid artery disobliteration was performed; in 14 patients pacemaker implantation was necessary, while 4 patients could be treated by atropine medication. The development of a TIA could be abolished in every patient and 14 patients remained totally symptom free.

Adult↗

PubMed1979

[Endonasal sinus surgery with endoscopic control for recurrent sinusitis in children (author's transl)].

Since 1976, 35 transnasal operations of the maxillary sinus with endoscopic control were performed in children as treatment for chronic sinusitis. After luxation of the inferior turbinate, a mucosal flap was developed to expose the lateral bony nasal wall. A sinus fenestra was then created to allow endoscopic control of the antrum during the operation. Gross pathological alterations of the mucosa were removed while most of the lining mucosa was preserved for recovery. 30 of the 35 children were followed from 4--18 months after surgery. 28 were without any discomfort. Although X-ray studies in many of the patients revealed mucosal swelling four weeks after surgery, the maxillary sinuses were well aerated 8 weeks after operation. Transnasal sinusotomy under endoscopic control is considered to be the treatment of choice for chronic sinusitis in adults and can now also be considered to be the treatment for similar disease in children.

Adolescent↗