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PubMed1993

[Good results of endoscopic paranasal sinus surgery for chronic or recurrent sinusitis and for nasal polyps].

Endoscopic sinus surgery is being applied increasingly for chronic or recurrent sinusitis and nasal polyps. We investigated the results, which we classified as subjective results (i.e. the opinion of the patient) and objective results (i.e. the result as seen with nasal endoscopy). The subjective result was 'good' in 85% of 92 patients with chronic or recurrent sinusitis, the objective result in 77% of the treated sides, with a median follow-up of 46 months. In 90 patients with nasal polyps the percentages were 90% and 65% respectively, with a follow-up of 24 months. In 63% of 30 patients with chronic obstructive lung disease and nasal polyps the pulmonary function increased postoperatively (FEV1). In 4.2% of 1235 operated sides in 593 patients local complications were seen. These were mainly minor complications. Only in 0.3% serious complications as a orbital hematoma or a CSF leak were seen. Endoscopic sinus surgery has good results and little morbidity.

Adult↗
PubMed2006

A new strategy for direct measurement of sinus atrial conduction time by sinus node threshold determination in a rat-isolated atrium.

In this work we have searched for experimental evidence that would corroborate the idea that nodal threshold (NT) is the minimum electric field strength able to promote direct sinus node reset that, in turn, can be verified by a decrease in corrected sinus node recovery time (CSNRT). We have performed direct measurements of sinus node conduction time (SACT) and estimation of atrium sinus conduction time (ASCT). Stimulating pulses (pulse and train methods) generated a uniform electric field, with strength ranging from 1.5-fold to 5-fold the atrial threshold (AT), in the center of the perfusion chamber where isolated right atria were placed. The AT and NT were 67.4 and 192.7 mV cm(-1), respectively. The CSNRT values, obtained with stimulation strength below or above NT, were, respectively (ms; mean +/- standard error of mean) 38.1 +/- 0.42 and 25.2 +/- 0.30. In addition, we verified that NT corresponds to approximately 3-fold the AT; SACT was 1.34-fold ASCT and the overdrive suppression decreases with the increment of stimulation pulse strength. Therefore, by using a new and accurate approach for SNRT determination, we have provided additional experimental evidence for the development of alternative sinus node evaluation methods.

Animals↗
PubMed1991

Pediatric sinusitis. The role of endoscopic sinus surgery in cystic fibrosis and other forms of sinonasal disease.

Functional endoscopic sinus surgery has altered the surgical treatment of sinus disease in adults. We report our experience with functional endoscopic sinus surgery in the pediatric population. Functional endoscopic sinus surgery was safe and effective and compared favorably with traditional surgery with regard to operative time, blood loss, and parental opinion.

Adolescent↗
PubMed1997

Relationship between patient-based descriptions of sinusitis and paranasal sinus computed tomographic findings.

OBJECTIVE: To evaluate the relationship of paranasal sinus symptoms with coronal computed tomographic (CT) findings. DESIGN: Prospective comparison of patient-based symptoms with imaging findings. SETTING: Primary care and referral center office and hospital practices. PATIENTS: Of 586 consecutive patients referred by otolaryngologists and primary care physicians for CT of the paranasal sinuses, 221 (151 women and 70 men; age range, 13-82 years; mean age, 44 years) participated by completing the Sino-Nasal Outcome Test-20 (SNOT-20) clinical questionnaire immediately before undergoing CT. MAIN OUTCOME MEASURES: Radiologists blinded to the patients' responses scored the degree of mucosal thickening at each of 12 sites on CT scans using a staged scale of severity (0-2 points). Bivariate analysis was performed to assess the relationship between patients' symptoms and CT findings. RESULTS: The SNOT-20 scores ranged from 0 (normal) to 78 (mean, 34). The most commonly reported symptom was fatigue. The CT scores ranged from 0 (normal) to 24 (mean, 4.07). Seventy-five patients (34%) had normal findings on the CT scan. The maxillary sinus was the most commonly involved site (96 patients, or 43%). The SNOT-20 and CT scores failed to significantly correlate (r = 0.11, P < or = .09). When the subset of patients with "positive" or "very positive" CT scans were considered, no significant correlation was observed (r = 0.12, P < or = .16). For the 132 patients reporting facial pain, the mean CT score was lower than for patients without facial pain (3.78 vs 4.78, P = .21). CONCLUSION: Patient-based reports of paranasal sinus symptoms failed to correlate with findings on CT scans; therefore, CT should be reserved for delineating the anatomy and pattern of inflammatory paranasal disease prior to surgical intervention.

Adult↗
PubMed1983

Absence of respiratory sinus arrhythmia: a manifestation of the sick sinus syndrome.

The failure of changes in autonomic drive to affect heart rate is a common finding in patients with the sick sinus syndrome (SSS). The normal respiratory sinus arrhythmia is vagally mediated and should therefore be attenuated in SSS. This hypothesis was tested in a series of 32 symptomatic patients with SSS, mean age 68 years, and an age-matched control group of 75 normal subjects. The degree of sinus arrhythmia present in routine 12-lead electrocardiograms was quantitated as (1) the coefficient of variation (CV) of the R-R interval, and (2) the maximal R-R interval difference (delta R-Rmax). Mean CV was 2.7% in SSS compared to 3.8% in the control group (p less than 0.01). Mean delta R-Rmax was 72 ms in SSS and 140 ms in controls (p less than 0.01). Sixteen of 32 patients (50%) compared to only 4/75 (5%) control subjects had delta R-Rmax of less than 80 ms (p less than 0.01). Thus, SSS is frequently associated with a significant attenuation of sinus arrhythmia and the simple measurement of delta R-Rmax in standard ECG recordings provides useful diagnostic information.

Aged↗
PubMed1986

Electrophysiologic effects of ethmozin on sinus node function in patients with and without sinus node dysfunction.

To compare the effects of ethmozin on sinus node (SN) function in the presence (9 patients) and absence (17 patients) of SN dysfunction, sinus cycle length (SCL), maximal corrected sinus recovery time (CSRT), paced cycle length yielding peak SN suppression, and indirect sinoatrial SA conduction time (SACT) were determined before and after intravenous administration of ethmozin in the dose 2 mg/kg. The mean +/- SD SCL were significantly shortened in patients with normal SN and were not changed in patients with SN dysfunction after ethmozin administration. The mean maximal CSRT was 252 +/- 72 before and 284 +/- 86 ms after ethmozin administration in patients with normal SN function (p less than 0.05). In patients with SN dysfunction (p less than 0.1) the mean maximal CSRT was found to be 1016 +/- 434 before and 2170 +/- 1756 ms after ethmozin administration. The mean SACT was 158 +/- 41 before and 174 +/- 51 ms after drug administration in patients with normal SN (p less than 0.05). Four out of nine patients with SN dysfunction developed second degree SA exit block after ethmozin administration, whereas SACT increased significantly in the remaining group of patients (180 +/- 35 to 210 +/- 32 ms; p less than 0.05). The PR, PA, AH, and HV intervals significantly lengthened and the valves of QRS and QT were not changed after ethmozin administration in either group. The conclusion is drawn that ethmozin should be administered cautiously to patients with SN dysfunction, particularly to patients with SA exit block, sinus pauses, or secondary pauses (in particular, with bradycardia-tachycardia syndrome).

Adult↗
PubMed1982

[Concentrations of erythromycin and amoxicillin in tonsil and sinus tissues of patients with tonsillitis and sinusitis. A comparison (author's transl)].

Thirty male patients with chronic tonsillitis and 30 male patients with chronic Sinusitis maxillaris were pre-treated for four days with either 2 X 1 g erythromycin daily per os or 3 X 0.75 g amoxicillin daily per os in an open and randomised comparative study. MIC values for the relevant bacteria were determined beforehand. The intended tonsillectomy or radical operation was performed on the third day of pre-treatment, circa 1.5 h after the final administration of antibiotics. The tonsils or the sinus membrane were examined bacteriologically; the concentrations of erythromycin or amoxicillin were determined. At the same time, the concentration of the antibiotic administered was determined in the serum. The average concentration of erythromycin in the tonsil tissue was 1.24 micrograms/g; it was 1.21 micrograms/g in the sinus membrane. Amoxicillin was found at a concentration of 0.17 microgram/g in the tonsil tissue, and 0.1 microgram/g in the sinus membrane. While the levels of erythromycin in the tissue generally equalled or exceeded the MIC value for the pathogen in question, the levels of amoxicillin only reached the relevant MIC value for the given pathogen in a few cases since the concentration in the tissue was insufficient. The clinical tolerance of both antibiotics was good.

Administration, Oral↗
PubMed1998

Cavernous sinus syndrome caused by a primary paranasal sinus non-Hodgkin's lymphoma.

Although uncommon, non-Hodgkin's lymphomas occasionally arise from the nose and paranasal sinuses. Rarely, they may invade into the cavernous sinus and produce signs and symptoms that characteristically include unilateral ophthalmoplegia, sensation loss in the distribution of the ophthalmic and other divisions of the trigeminal nerve, sympathetic nerve paralysis and proptosis. In this report, we present a case of cavernous sinus syndrome (CSS) caused by infiltration of non-Hodgkin's lymphoma from the adjacent paranasal sinuses and address issues regarding its diagnosis and treatment.

Aged↗
PubMedDate not supplied

The treatment of chronic sinusitis in six cats by ethmoid conchal curettage and autogenous fat graft sinus ablation.

Six cats with chronic recurrent rhinitis and frontal sinusitis were treated by surgical ablation of their frontal sinuses by the implantation of autogenous fat grafts and curettage of the remaining ethmoid conchae. Deep nasal bacterial cultures and skull radiographs were performed before surgery. Excellent results were achieved in four of six cats and there was significant improvement in two of six cats. Median follow-up time was 15 months. Subcutaneous emphysema over the temporal area was managed by needle aspiration and bandaging. Frontal sinus ablation with autogenous fat graft in combination with ethmoid conchal curettage appears to be an effective treatment for chronic sinusitis in cats.

Adipose Tissue↗
PubMed1975

Antibiotic concentrations in maxillary sinus secretions and in the sinus mucosa.

In maxillary sinusitis, the blood circulation is supposed to be impaired in the oedematous sinus mucosa, and in such cases the transport of antibiotics into the maxillary sinus should be reduced. To prove the accuracy of this assumption a comparison has been made between the concentrations of penicillin and doxycycline (Vibramycin, Pfizer) in sinus mucosa and secretions and the serum concentrations in patients under treatment with these antibiotics. Measureable concentrations of penicillin (greater than 0.2 mug/ml) were reached in the secretions only if the serum concentration was high (greater than 4-5 mug/ml). In contrast, measurable concentrations of doxycycline were achieved in both mucosa and secretions in all patients treated with this antibiotic. This must depend on the fact that doxycycline, due to its optimal lipid solubility, was able to penetrate poorly vascularized tissue. In most cases, the concentrations of doxycycline far exceeded the minimum inhibitory concentrations of the isolated organisms, and in some cases the local concentrations were higher than those found in the serum. The clinical response to doxycycline was good and correlated well to the laboratory data.

Doxycycline↗
PubMedDate not supplied

Frontal sinus septectomy for chronic unilateral sinusitis.

Frontal sinus trephination with removal of the intersinus septum has been found to be an effective therapy in selected cases of chronic unilateral frontal sinusitis; in addition, it may be combined with unilateral duct reconstruction in the treatment of chronic bilateral sinusitis. It may also be performed as a prophylactic measure when nasofrontal duct injury occurs during unilateral nasal or maxillary sinus surgery. The authors' experience with the procedure in 20 cases is described.

Adult↗
PubMed1992

Relationship of chronic ethmoidal sinusitis, maxillary sinusitis, and ostial permeability controlled by sinusomanometry: statistical study.

Three hundred sixty-seven successive patients suffering from chronic maxillary sinusitis (CMS) were thoroughly examined by means of maxillary sinusoscopy, a CT scan of the facial sinuses, and sinusomanometry (SMM). Ninety-eight cases of unilateral CMS, 269 cases of bilateral CMS, and 444 chronic ethmoidal sinusitis (CES) cases were evaluated. According to SMM, the maxillary ostia were divided into two groups: 1. maxillary ostium patency (MOP) group and 2. the maxillary ostium nonpatency (MONP) group. The unilateral and bilateral pathologies were separately analyzed so as to minimize the effects of general or systemic causes on the results. MONP is, in both bilateral and unilateral groups, significantly linked with the presence of ethmoidal sinusitis (P < 10(-6); P = .026), while the correlation between MOP and the ethmoid status does not appear to be significant in either group. Thus, there seems to be a close relationship between CES and maxillary ostial dyspermeability in cases of CMS.

Belgium↗
PubMed2002

Endoscopic sinus surgery in cases of cholesterol granuloma of the maxillary sinus.

Cholesterol granuloma is usually associated with middle ear disease and is very rare in the paranasal sinuses. We report a case of cholesterol granuloma originating in the maxillary sinus of a 52-year-old female. Endoscopic sinus surgery was performed on the left maxillary sinus, and the cholesterol granuloma was successfully removed by the middle meatal antrostomy. Light microscopic examination showed granulomatous tissue with typical cholesterol clefts, multinucleated foreign body giant cells, small areas of hemorrhage, hemosiderin-laden macrophages and plasma cells. We also describe the details of the endoscopic surgical techniques employed in the treatment of this disorder.

Cholesterol↗
PubMedDate not supplied

Blood flow in the rabbit maxillary sinus mucosa during experimentally induced acute sinusitis.

The blood flow in the maxillary sinus mucosa was studied in 35 New Zealand White rabbits. The blood flow measurements were made by two methods, one with use of Rb86Cl and the other with 15 microns Sn113-labelled microspheres. With the Rb86Cl method the blood flow of the infected sinus mucosa was about 0.8 ml x min-1 x g-1 when correction was made for radioactivity in the secretion. The radioactivity found in the secretion probably reflects an increase both in vascular and mucosal permeability and in blood flow. When microspheres labelled with Sn113 were used, the mean mucosal blood flow in the presence of sinusitis was found to be 0.83 +/- 0.56 ml x min-1 x g-1. This blood flow was significantly higher than on the control side. In a control series, mere blocking of the ostium did not significantly alter the blood flow in the sinus mucosa.

Animals↗
PubMed1991

Chronic maxillary sinusitis. Energy metabolism in sinus mucosa and secretion.

The energy metabolism in maxillary sinus mucosa and secretion from 41 patients with, in most cases, recurrent or chronic sinusitis was studied and compared with that in mucosal samples from patients with no previous history of sinus abnormality or infection. In freeze-dried samples, glucose and lactate were measured by enzymatic assays and adenine nucleotides by HPLC. In chronic sinusitis the lactate concentration in the mucosa was increased, probably as a result of increased glycolysis or of impaired diffusion within the mucosa. The lactate concentrations in purulent and non-purulent secretions were 16.3 and 1.1 mmol x kg-1 w.w., respectively. The higher concentration in the purulent secretion was due mainly to leucocyte metabolism. The adenine nucleotide contents in the mucosa were similar in all groups studied. Anaerobic bacteria were isolated only in secretions with a high lactate concentration.

Adenine Nucleotides↗
PubMed1992

Lactic acid isomers and fatty acids in sinus secretion: a longitudinal study of bacterial and leukocyte metabolism in experimental sinusitis.

Concentrations of the two optic isomers of lactate (D- and L-form) as well as glucose, succinate, acetate, butyrate, isovalerate and valerate were examined in purulent sinus secretions. The samples were obtained from rabbit maxillary sinuses, experimentally infected with Streptococcus pneumoniae or Bacteroides fragilis. More soluble acids such as acetate displayed relatively low levels in the secretion, despite a high microbial production. A substantial increase in D-lactate concentration was found in secretions only the first day after induction of pneumococcal sinusitis, and not in bacteroides sinusitis. L-lactate levels were particularly high in secretions of a marked purulent character, and this isomer can be considered as indicator of anaerobic glycolysis in the leukocytes. Less diffusible fatty acids such as butyrate and isovalerate accumulated in the secretion, in spite of a relatively lower production rate, and are thus more reliable indicators of bacterial metabolism.

Animals↗
PubMed1981

Bacampicillin in acute maxillary sinusitis: concentration in sinus secretion and clinical effect. A randomized, double-blind study of two dosage regimens.

The clinical effect and the penetration of ampicillin into sinus secretion after oral administration of bacampicillin was studied in 47 patients with acute maxillary sinusitis allocated at random in treatment with 400 mg bacampicillin 3 times or 1200 mg twice daily. The overall clinical effect was similar and was assessed as "good" in 23/25 patients treated with 400 mg doses and in 19/22 treated with 1200 mg. Adverse reactions were reported by 4 patients. The concentrations of ampicillin obtained in sinus secretion were proportional to the dose given. The highest values after 400 mg bacampicillin were approximately 0.6 mg/l and after 1200 mg about 2 mg/l. Both dosages are applicable to treatment of acute maxillary sinusitis.

Acute Disease↗