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PubMed1989

Chronic sinusitis and woodworking as risk factors for cancer of the maxillary sinus in northeast Japan.

In the period 1983 to 1985, 66 patients presented to six Japanese university hospitals with squamous cell carcinoma of the maxillary sinus. Using self-administered questionnaires, a case-control study was conducted to examine history of nasal diseases, occupational exposures, and other possible risk factors for this disease. For each patient, two controls were selected from the general population, matched to the patient by sex, age (+/- 5 years), and district of residence. A history of chronic sinusitis was associated with a 2.3-fold increase in risk (p = 0.05). A high relative risk was also observed in males with an occupational history of woodworking or joinery, particularly when these jobs involved sanding or lathing practices (RR = 7.5, p = 0.02). No association between cigarette smoking and maxillary sinus cancer was observed in this study and no evidence was found that indoor air pollution in the home is involved in cancer development.

Adult↗
PubMed1988

Benign Mucor colonization (fungus ball) associated with chronic sinusitis.

Mucormycosis of the nasal cavity and paranasal sinuses is an aggressive, life-threatening condition characterized by fulminant destruction of soft tissues and bone, vascular invasion, and thrombosis. Patients who have this infection generally are immunosuppressed or diabetic. The most effective treatment is immediate surgical debridement of all involved tissue, along with systemic antifungal agents. We identified four patients with chronic sinusitis in whom Mucor organisms were histologically confirmed within the sinus contents but not in the sinus mucosa. All four were successfully treated with conservative debridement. Our dilemma was determining appropriate treatment for this apparently less aggressive condition. We conclude that conservative debridement is the treatment of choice in the absence of tissue invasion, and that systemic antifungal therapy is probably unnecessary.

Adult↗
PubMed2005

Penetration of telithromycin into the nasal mucosa and ethmoid bone of patients undergoing rhinosurgery for chronic sinusitis.

OBJECTIVES: Telithromycin has a broad spectrum of activity against respiratory tract pathogens including penicillin- and macrolide-resistant streptococci. The aim of the study was to investigate the penetration of telithromycin into nasal tissue following a single oral dose of 800 mg. PATIENTS AND METHODS: A total of 29 patients undergoing rhinosurgery for chronic sinusitis were evaluated. Samples of blood, nasal mucus, nasal mucosa and ethmoid bone were collected during surgery in groups of 5-6 patients after 3, 6, 9, 15 and 24 h following a single oral dose of 800 mg telithromycin. Drug concentrations were determined by HPLC with fluorimetric detection. RESULTS: The highest telithromycin concentrations were observed after 3 h in plasma as well as in all tissues sampled. The mean plasma concentrations were 0.73 mg/L in the 3 h group and 0.02 mg/L in the 24 h group. The concomitant tissue concentrations were higher. The tissue penetration, expressed by the ratio of the area under the concentration-time curve in tissue versus plasma, was 1.0 for nasal mucus, 5.9 for nasal mucosa and 1.6 for ethmoid bone. CONCLUSIONS: Telithromycin achieved tissue concentrations that were generally above the MIC(90) for common pathogens in upper respiratory tract infections. These results indicate that telithromycin diffuses rapidly into the nasal tissues and achieves high and prolonged concentrations in nasal mucosa and ethmoid bone.

Adult↗
PubMed1999

Expression of interleukin (IL)-12 (p40) and IL-12 (beta 2) receptors in allergic rhinitis and chronic sinusitis.

BACKGROUND: Interleukin (IL)-12 is a relatively new and structurally distinct TH1-associated cytokine produced by B cells and macrophages, which may play a suppressive role in the development of allergic sinonasal mucosal responses. OBJECTIVE: We investigated the expression of IL-12 (inducible p40 subunit) and its receptor (IL-12R beta2 subunit) in tissue biopsies of naturally exposed patients with allergy-associated (ACS) and nonallergy-associated chronic sinusitis (NCS) and compared it with controls. We also examined IL-12 and IL-12R expression in biopsies from a ragweed allergen challenge model. In the allergen challenge model, the effect of pretreatment with topical corticosteroids on IL-12 and IL-12R expression was assessed. METHODS: To detect IL-12 and IL-12R mRNA, we employed the technique of in situ hybridization using digoxigenin-labelled riboprobes. RESULTS: In both ACS and NCS subjects there was decreased expression of IL-12 as compared with control (P < 0.05). IL-12R (beta2) expression was decreased in ACS subjects as compared with control (P < 0.05), however, there was no significant difference found between NCS subjects and control. In the allergen challenge subjects, there was a significant decrease in IL-12 expression following challenge (P < 0.05). This effect was abrogated by pretreatment of the subjects with topical corticosteroids. However, IL-12R (beta2) expression showed no change following allergen challenge while pretreatment with topical corticosteroids resulted in increased expression of the (beta2) receptor after allergen challenge (P < 0.05). CONCLUSION: Our data suggest that IL-12 plays a role in the in vivo suppression of the allergic inflammatory response and that the control of this suppression may be exerted largely via the IL-12 (beta2) receptor.

Adult↗
PubMed2003

Prognostic staging system and therapeutic effectiveness for recurrent or chronic sinusitis in children.

OBJECTIVE: We sought to assess the clinical status of pediatric sinusitis patients after a minimum of 2 years follow-up and to evaluate relative treatment effectiveness. Study design We conducted a medical record review of 308 patients, with a 2-year follow-up questionnaire. RESULTS: Overall, 55% of children were "much improved." A 4-stage prognostic system was developed and used to compare results in 133 patients who had not responded to medical treatment and who had positive sinus computed tomography scans. Endoscopic sinus surgery (ESS) had no apparent advantages in stages I and IV, but in stages II and III, rates of "much improved" for ESS versus medical therapy were 79% versus 54% and 68% versus 42%, respectively. CONCLUSION: These results suggest that ESS may be particularly effective for patients from intermediate prognostic stages. SIGNIFICANCE: This type of prognostic staging and evaluation of treatment effectiveness is necessary and important in chronic sinusitis, where randomized trials are unlikely to be performed.

Child, Preschool↗
PubMed2001

Analysis of human papillomavirus in schneiderian papillomas as compared to chronic sinusitis and normal nasal mucosa.

Schneiderian papillomas (SPs) are tumours arising from the surface epithelium (schneiderian epithelium) of the nasal cavity and paranasal sinuses. Evidence points toward a viral etiology, specifically human papillomavirus (HPV). Although substantial data indicate HPV as a likely etiology, little is known about the role of HPV in benign nasal pathologies or in normal nasal mucosa. The objective of this study was to characterize the relationship between HPV and SP, chronic sinusitis (CS), and normal nasal mucosa. A case-control study was undertaken, matching patients with SP to patients with CS. Patients with normal nasal mucosa served as a control group. All patients had their tissues analyzed for the presence of various HPV subtypes using line blot assay. A total of 168 patients were identified (74 SP, 74 CS, 20 control). Of these, 70 (41.7%) had detectable deoxyribonucleic acid and 9 of 70 (12.9%) had detectable HPV of subtypes 6, 11, and 16. None had detectable HPV type 18. Significant differences were detected in the presence of HPV in the CS, SP, and control groups, as well as in the presence of low- versus high-risk subtypes among investigation and control groups. Significant differences exist in HPV infectivity among SP, benign nasal pathologies such as CS, and normal nasal mucosa. Human papillomavirus plays an important role, at least in part, in the development of SP, with types 6, 11, and 16 being more pivotal than other types. Line blot assay is a useful technique in identifying HPV in SP.

Case-Control Studies↗
PubMed1993

Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis.

A dramatic increase in the incidence of methicillin-resistant Staphylococcus aureus at a teaching hospital was documented to be due to three factors: a hospital-wide outbreak of 32 cases caused by an epidemic strain, an increase in the number of nosocomial cases caused by several other strains, and an increase in the number of patients admitted carrying strains acquired at other institutions. Case patients with the epidemic strain were significantly more likely than control patients to have had previous exposure to a respiratory therapist (P = .005) who had chronic sinusitis due to the epidemic strain. The plasmid DNA of isolates from the implicated respiratory therapist and affected patients yielded the same patterns on restriction endonuclease digestion. Implementation of general control measures and eradication of the respiratory therapist's sinusitis and nasal carriage terminated the epidemic. Establishing the importance of the infected health care worker by epidemiological methods led to control of the outbreak without the institution of wide-scale culture of specimens from personnel and the environment or other expensive and labor-intensive measures.

Aged↗
PubMed1988

A clinical and pathologic study of chronic sinusitis: the role of the eosinophil.

Evidence exists that the eosinophil plays an important role in mediating injury to bronchial epithelium in chronic asthma. Here, the role of the eosinophil in chronic inflammatory disease of the paranasal sinuses was studied with tissue from patients who underwent surgery for chronic sinusitis. Paranasal tissue from patients with chronic asthma and/or allergic rhinitis was extensively infiltrated with eosinophils. Immunofluorescent studies demonstrated a striking association between the presence of extracellular deposition of major basic protein and damage to sinus mucosa. The histopathology of paranasal respiratory epithelium appeared similar to that described in bronchial asthma. These findings suggest that the eosinophil acts as an effector cell in chronic inflammatory disease of paranasal respiratory epithelium. Thus, sinus disease in patients with asthma may be due to the same mechanisms that cause damage to bronchial epithelium.

Adolescent↗
PubMed2005

Chronic sinusitis in children and adults: role of bacteria and antimicrobial management.

The nasopharynx serves as the reservoir for anaerobic bacteria as well as pathogenic bacteria that can cause respiratory infections including sinusitis. Some of these organisms possess the ability to interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may result from the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus. Anaerobes were identified in chronic sinusitis in adults and children whenever techniques for their cultivation were employed. The predominant isolates were pigmented Prevotella, Fusobacterium, and Peptostreptococcus spp. The choice of antimicrobial agent in chronic sinusitis should provide coverage for the usual pathogens in acute sinusitis as well as beta-lactamase-producing aerobic and anaerobic organisms.

Adult↗
PubMedDate not supplied

Endonasal microendoscopic pansinusoperation in chronic sinusitis. II. Results and complications.

PURPOSE: We evaluated the long-term results and complications of endonasal pansinusoperation in chronic polypoid sinusitis. PATIENTS AND METHODS: In a retrospective study, 170 patients were followed-up for 20 months to 10 years after bilateral endonasal microendoscopic pansinus surgery or ethmoidectomy. The follow-up consisted of a standardized questionnaire and clinical examination with the flexible endoscope. RESULTS: We found that 85.6% of the ethmoid cell systems, 69.4% of maxillary sinuses, and 37.5% of frontal sinuses could be visualized endoscopically. The ethmoid mucosa was normal in 56% and thickened in 19%. Recurrent polyps were found in 25%. The evaluation--as per the graduation of results defined by us as a combination of examination findings and subjective assessment of the operative result--resulted in an operative success of 92%. Two studies dealing with the frequency of complications showed injury to the dura in 2.3% to 2.55% and periorbital injury without permanent sequelae in 1.4% to 3.4%. Because of two cases of bleeding from the internal carotid artery, the problems of vascular complications in particular will be thoroughly discussed. CONCLUSION: More than 90% of patients with chronic polypoid sinusitis gain long-term satisfying results after endonasal ethmoidectomy with microscope and endoscope. For minimizing the risk of injury of the optic nerve or the internal carotid artery preoperative, computed tomography is necessary. A special training program is recommended.

Chronic Disease↗
PubMed1999

Antibacterial management of acute and chronic sinusitis.

Sinusitis is a common disorder in both children and adults. It is responsible for significant absenteeism from school and work. Up to 10% of upper respiratory infections in children are complicated by acute sinusitis. Since antibacterial therapy is most often empirically chosen to treat the disorder, knowledge of the typical etiologic agents as well as awareness of the antibacterial susceptibility profiles in a given community are of paramount importance. The need for consistently bactericidal antibacterials, the recognition of the importance of nontypable Hemophilus influenzae unresponsive to first-generation cephalosporins, tetracyline-resistant Gram-positive cocci, and the increasing emergence of beta-lactamase-positive respiratory pathogens such as H. influenzae and Moraxella catarrhalis, now mandate the use of newer therapeutic agents for acute and chronic sinusitis.

Absenteeism↗
PubMed1986

Microbial flora of nose and paranasal sinuses in chronic maxillary sinusitis.

Nasal secretions, maxillary sinus aspirates and specimens of the maxillary sinus mucosa were collected in 44 patients aged between 25 and 60 affected by mono- or bilateral chronic maxillary sinusitis, in order to establish the best sampling technique for microbiological purposes, the most frequently involved bacteria and the physiopathological mechanism underlying chronic maxillary disease. The sinusal mucosa resulted to be the most reliable sample as it reduces contamination and microbial variability. Anaerobic bacteria were isolated in nasal swab (15.6%), in maxillary sinus aspirates (30.4%) and in maxillary sinus mucosa (36.4%) of maxillary sinusitis patients. In controls anaerobic bacteria were isolated only in one nasal swab (2.3%), while they could not be isolated in maxillary sinus aspirates and in maxillary sinus mucosa. The presence of anaerobic bacteria in chronic maxillary sinusitis patients and their absence in controls seem to confirm that anaerobic microorganisms represent the main pathogenetic agents of chronic maxillary sinusitis. The possible physiopathological mechanisms underlying chronic maxillary sinus disease are finally discussed.

Adolescent↗
PubMed2002

Hydrocephalus, situs inversus, chronic sinusitis, and male infertility in DNA polymerase lambda-deficient mice: possible implication for the pathogenesis of immotile cilia syndrome.

A growing number of DNA polymerases have been identified, although their physiological function and relation to human disease remain mostly unknown. DNA polymerase lambda (Pol lambda; also known as Pol beta2) has recently been identified as a member of the X family of DNA polymerases and shares 32% amino acid sequence identity with DNA Pol beta within the polymerase domain. With the use of homologous recombination, we generated Pol lambda(-/-) mice. Pol lambda(-/-) mice develop hydrocephalus with marked dilation of the lateral ventricles and exhibit a high rate of mortality after birth, although embryonic development appears normal. Pol lambda(-/-) mice also show situs inversus totalis and chronic suppurative sinusitis. The surviving male, but not female, Pol lambda(-/-) mice are sterile as a result of spermatozoal immobility. Microinjection of sperm from male Pol lambda(-/-) mice into oocytes gives rise to normal offspring, suggesting that the meiotic process is not impaired. Ultrastructural analysis reveals that inner dynein arms of cilia from both the ependymal cell layer and respiratory epithelium are defective, which may underlie the pathogenesis of hydrocephalus, situs inversus totalis, chronic sinusitis, and male infertility. Sensitivity of Pol lambda(-/-) cells to various kinds of DNA damage is indistinguishable from that of Pol lambda(+/+) cells. Collectively, Pol lambda(-/-) mice may provide a useful model for clarifying the pathogenesis of immotile cilia syndrome.

Animals↗
PubMed1995

[A study of ceftriaxone concentration in serum and tissue of patients with chronic sinusitis].

After an intravenous drip infusion of 1 g or 2 g of ceftriaxone (CTRX), its concentrations in serum and tissue were determined using the bioassay for 18 surgical patients with chronic paranasal sinusitis. 1. The serum levels observed at 75-105, 135-165, 195-225 minutes after an intravenous drip infusion of 1 g, averaged 98 +/- 38, 92 +/- 13 and 73 +/- 13 micrograms/ml, respectively. 2. The tissue levels at 75-105, 135-165, 195-225 minutes after an intravenous drip infusion of 1 g, averaged 27 +/- 13, 27 +/- 7 and 25 +/- 9 micrograms/g. 3. CTRX appears to be a useful drug for the treatment of chronic paranasal sinusitis.

Adult↗