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PubMed2000

[Endoscopic sinus surgery for extracranial complications of sinusitis].

Orbital subperiosteal abscess (SPA) and Pott's puffy tumor (PPT) are the major extracranial complications of acute sinusitis. These complications are aggravated by the close anatomic relationships between the nasal sinuses and the orbits and frontal bone. Furthermore, the rich diploic venous drainage of the region enhances the spread of the infection. Between 1992 and 1997, 16 patients (mean age 12 years, range 2-15, 10 of them males), 11 of them with SPA and 4 with PPT were operated on by the senior author by means of endoscopic sinus surgery (ESS). Indications for operation included: CT findings of abscess formation and lack of clinical improvement after 48 hours of i.v. antibiotic therapy. Clinical resolution of symptoms was achieved in all and there were no operative or postoperative complications. We emphasize and explain the advantages of ESS over external approaches in surgery for extracranial complications of acute sinusitis by several facts: the technique treats the source of the disease, clinical success rate is high, morbidity is low, and facial distortion and poor cosmetic results completely avoided.

Abscess↗
PubMed2000

Sinusitis-induced enophthalmos: the silent sinus syndrome.

Enophthalmos caused by inadequate maxillary sinus function was first reported in 1964. Since this initial report, scattered case reports and, more recently, reviews have appeared in the literature detailing the pathophysiology, clinical findings, and management of this process. We present a classic case of the asymptomatic development of enophthalmos caused by maxillary sinus hypoventilation: the silent sinus syndrome. In addition, this case included findings in the ethmoid sinuses that suggested their contribution to this disorder, which by our review of the literature has not been well described.

Chronic Disease↗
PubMed1998

[Ostium of maxillary sinus in endoscopic sinus surgery].

OBJECTIVE: To determine the clinical significance and operative method of maxillary sinus ostium in the treatment of chronic sinusitis and nasal polyps. METHODS: Fifty-six patients (112 sides) undergone endoscopic sinus surgery were studied. RESULTS: The patency rates of the maxillary ostia in patients with enlarged and unchanged maxillary ostia were 92.9% and 80.4% respectively. Fifty-one patients (64 sides) undergone Caldwell-Luc operations were retrospectively studied. The patency rate of inferior antrostomy was 40.6%. CT scans of the sinuses of 38 cases with unilateral sinisitis or nasal polyps were reviewed. The scaled values of the maxillary hiatus on CT images showed no difference between the normal group and the diseased group. Pneumatization and proliferation of middle turbinate and bent uncinate process were the most common anatomic variation in the diseased group. CONCLUSION: The results suggest that management of anatomic variations surrounding the ostia is very important in the treatment of maxillary ostium.

Adolescent↗
PubMed1975

[The effect of various antibiotics on the mixed flora of the maxillary sinus in sinusitis(author's transl)].

The effect of four frequently used antibiotics on the germs of the sinus maxillaris was studied. For this purpose germs of the sinus max. rinsing fluid, got from 127 patients, were cultured under nearly the same physical and chemical conditions which can be expected in the sinus itself. Each antibiotic substance was studied with three different comcentrations in the culture medium. By extrapolation of the linear regression between some characteristical parameters of the culture absorbancy development and the concentration, the inhibitory concentration can be estimated. The efficacy decreases in the following order: Doxycyclin greater than Gentamycin greater than Ampicillin greater than Lincomycin. An inhibitory concentration results, if the antibiotics are instilled in the sinus itself. The general side effects can be neglected but not at all the local ones. Investigations in this direction are still going on. As a preliminary report, 700 instillations of Lincomycin turned out with no incident.

Administration, Topical↗
PubMed2003

[Sinus radiography and low-dose CT in the diagnosis of acute sinusitis. ].

Background. Although CT is considered the method of choice in the evaluation of inflammatory sinus disease, plain film radiography is still used, as repetitive CT examinations may impart a considerable radiation dose to the lens. We designed a new low-dose CT examination and compared this and plain film radiography to standard-dose CT. Methods and materials. The new CT low-dose protocol consisted of ten coronal scans at 40 mAs and 1 mm collimation. 47 patients referred for acute sinusitis were examined with plain film radiography, low-dose and standard-dose CT on the same day. The latter was used as "the gold standard". Results. The sensitivity of plain film radiography was low (< 50 %) except for the maxillary sinus (80 %). The overall sensitivity of low-dose CT was 95 % and the specificity 97 %. Effective dose and lens dose of low-dose CT were 3 % and 2 % respectively compared to standard-dose CT. Corresponding values for conventional radiography were 13 % and 2 %. Interpretation. Low-dose CT had image quality comparable to standard-dose CT and a dose to the eye lens equal to plain film radiography. Low-dose CT should be the method of choice in patients referred for acute sinusitis.

Acute Disease↗
PubMed2003

[Factors that affect the improvement of olfactory function after endoscopic sinus surgery in patients suffering from chronic sinusitis and/or nasal polyps].

OBJECTIVE: To investigate the factors related to the improvement of olfaction after endoscopic sinus surgery (ESS) in chronic sinusitis and/or nasal polyps patients. METHOD: Fourteen patients suffering from chronic sinusitis and/or nasal polyps were accompanied with olfactory dysfunction. At 6 months after the ESS, measurement of olfaction showed that 27 patients' olfaction had improved. The effective rate is 61.36%. Using a logistic regression model, we analyzed the factors such as gender, disease stage, disease site, allergy, duration of olfactory dysfunction and follow-up. RESULT: Contrary to gender, disease site and duration of olfactory dysfunction, disease stage, allergy and follow-up had a significant effect on the improvement of olfaction. CONCLUSION: In order to improve the olfaction of the patients with chronic sinusitis and/or nasal polyps, it is important to treat positively with allergic rhinitis on a basis of the ESS. Follow-up should be emphasized further.

Adult↗
PubMed2003

[Occipital sinus as a potential differential diagnosis in patients suspect of dural sinus thrombosis--a case report].

INTRODUCTIONS: The diagnosis of dural sinus thrombosis despite of using modern imaging techniques still remains a difficult problem. For satisfactory interpretation of CT and MR scans it is indispensably important the knowledge of anatomical variations and possible imaging artifacts. One of the relatively rare developmental variations--giving chance for making false positive diagnosis--is the occipital sinus with hypoplasia or agenesis of transverse sinus. CASE REPORTS CONCLUSION: The incidence, the anatomical classification, the importance and the possibility of differentiation from sinus thrombosis are reviewed based on case reports of four patients.

Adult↗
PubMed2006

A comparison between functional and radical sinus surgery in an experimental model of maxillary sinusitis.

PURPOSE OF THE STUDY: To compare functional and radical surgery in a maxillary sinusitis' treatment during in vivo experiments in rabbits. METHODS: An experimental chronic maxillary sinusitis was induced in 21 New Zealand white rabbits by inducing mucosal trauma combined with an injection of Streptococcus pneumoniae, and a maxillary sinus ostium occlusion during 28 days. Functional surgery (FS) by reopening the natural ostium and radical surgery (RS) by reopening the natural ostium were performed in association with removal of the sinus mucosa. They were macroscopically and histologically evaluated 15 days, 1 month and 2 months after the surgery. RESULTS: FS had diminished chronic inflammatory criteria (lymphoid and plasma cells) faster that RS ([15 days (p = 0.016)]; [1 month (p = 0.03)]; [2 months (p = 0.03)]). Mucosa fibrosis was more important after RS ([15 days (p = 0.016)]; [1 month (p = 0.03)]; [2 months (p = 0.016)]). CONCLUSION: FS accelerates healing with less fibrosis that RS in pathological mucosa altered by a chronic inflammation.

Animals↗
PubMed1989

[Therapeutic approach in chronic maxillary sinusitis. Apropos of 469 patients and 640 sinuses].

Between 1982 and 1987 we treated 469 patients who accounted for a total of 640 involved sinuses. These patients suffered from various stages of chronic sinusitis. Endoscopy of the maxillary sinuses enabled us to collect important information regarding the state of the mucosa and secretions, to collect bacteriological samples and to inspect the ostium and take pressure measurements. There was an 80% success rate in cases of sinusitis treated by drainage. In our opinion the indication for inferior meatotomy is as an extraction procedure and is not of value for aeration drainages. Nevertheless, out of a total of 141 inferior meatotomies performed, 80% remained patent after a mean follow up period of 3 years.

Chronic Disease↗
PubMed1987

[Sinusal-dental tomography and dental origin of chronic sinusitis].

Always frequent and often misleading, chronic sinusitis are multifactorial. Consequently, the role of teeth apical infection is largely underestimated. The difficulties of interpretation of the sinus radiographic imaging are well established, particularly in the study of the dental with sinus border. The clinical circumstances in which the responsibility of teeth can be involved, are studied. Diagnosis insufficiency are frequent, and inadequate procedures can be undertaken. The particular conditions to obtain good polycyclicidal tomographs pictures are described and demonstrated. In special cases, with the eventual contribution of the bacterial-sensitivity evaluation, these sinusal-dental tomographs allow a relevant diagnosis.

Chronic Disease↗
PubMed1985

[Mucous membrane changes in the anterior ethmoid bone in chronic sinusitis and mycoses of the paranasal sinuses. An endoscopy, light and electron microscopy study. 2. Electron microscopy findings].

In the second part of this paper the findings of electron microscopical studies on ultrastructural changes of the cilia of the ethmoidal mucous membrane in patients with mycotic chronic sinusitis are presented. Many pathological variations of the normal 9 + 2 pattern can be demonstrated, along with compound cilia and central axis deviation beyond 25 degrees. This together with the endoscopical and lightmicroscopical findings results in conditions which are different from those in acute sinusitis. It may as well explain, why hardly a conservative therapy--aiming mostly for vasoconstriction and decrease of mucosal edema--is successful in chronic sinusitis. Endoscopical surgery of the diseased anterior ethmoid in most of the cases brings along cure of the dependent frontal and maxillary sinuses as well.

Chronic Disease↗
PubMed1994

[Diagnostic value of computer tomography of paranasal sinuses in qualifying for functional endoscopic sinus surgery (FESS)].

Functional endoscopic sinus surgery (FESS) introduced in the recent years by Messerklinger, Stammberger and Kennedy gained undisputable reputation as method of choice in treatment of nose and nasal sinus diseases. The introduction of this method was possible, among others, due to precise radiological diagnostics (CT). Traditional radiological examinations of nasal sinus do not allow for detailed diagnostics and analysis of anatomic anomalies such as: dehiscention in vicinity of carotic artery or ophtalmic nerve which have basic significance while establishing surgical risk. The paper presents 20 cases of nasal sinus CT of patients qualified for functional endoscopic surgery comparative analysis with traditional radiograms were performed.

Endoscopy↗
PubMed1993

Results and prognostic factors in the radical sinus operation for chronic sinusitis.

Radical surgical procedures of the maxillary sinus with or without involvement of the ethmoid, sphenoid and frontal sinuses were performed in 382 adult patients in the Department of Otorhinolaryngology. Tokai University Hospital in the 8-year period from 1984 to 1991. Of 382 patients, the postoperative symptomatology was studied in 189 patients by mcans of questionnaires. The postoperative results were finally analyzed in 63 patients whose subjective symptoms and objective findings were completely recorded. The follow-up period was over 3 months and subjective postoperative improvement was achieved in 83% and objective postoperative improvement in 75%; the overall improvement rate was 73%. In an analysis of results of the radical surgical operation, it appeared that poor results were closely related to the following factors: (1) maxillary sinus mucosa with cellular infiltration or edematous changes; (2) multiplicity of bacterial species including Gram-negative rods isolated from maxillary sinus secretion; (3) poor mucociliary clearance function; and (4) unsatisfactory postoperative treatment.

Adolescent↗
PubMed1996

Recanalization of the falcine sinus after venous sinus thrombosis.

Thrombosis of the straight and transverse sinuses associated with a large hemorrhagic venous infarct developed in an infant with large chronic subdural fluid collections after drainage of the subdurals. CT and MR studies obtained before and after the onset of venous sinus thrombosis showed interval widening of a segment of the posterior falx between the vein of Galen and the superior sagittal sinus. MR angiography confirmed a recanalized falcine sinus.

Battered Child Syndrome↗
PubMed1997

[Influence of naso-sinusal anatomic variants on recurrent, persistent or chronic sinusitis. X-ray computed tomographic evaluation in 112 patients].

Using CT scan, we studied the influence of the most important sinonasal anatomic variants on 112 patients, aged more than 16 years, suffering from recurrent, persistent or chronic sinusitis. The series was characterized by the absence of: multifocal sinusitis, polyposis, dental or mycotic sinusitis, traumatic, tumour, actinic or prior surgery. We compared our results with those of the literature. Our findings confirmed the association between recurrent, persistent or chronic sinusitis, and ipsilateral septal ridges or spurs (33%), unusual ipsilateral deflexions of uncinate process (31%), and contralateral septal watch glass like deviation (42%). We found no correlation for the other studied variants (concha bullosa, paradoxical curve of middle turbinate, pneumatised uncinate process, hypertrophic ethmoid bulla, Haller cell and accessory maxillary ostium).

Adult↗
PubMed1987

Effect of amiodarone on sinus node function in patients with sick sinus syndrome.

The effect of amiodarone on sinus node function has been studied in 9 patients with symptomatic sick sinus node as documented by Holter-ECG. All patients had programmable dual-chamber pacemakers. Sinus node activity was assessed by intermittently inhibiting the pacemakers before and after four weeks of oral amiodarone treatment. Sinus node function was not altered by amiodarone in 5 patients but was severely depressed in 4 patients. Thus, it is concluded that amiodarone cannot be used safely in all patients with the tachybrady syndrome for the treatment of symptomatic tachyarrhythmias without concomitant pacing.

Aged↗
PubMed1981

Clinical and electrophysiologic characteristics of sinoatrial entrance block evaluated by direct sinus node electrography: prevalence, relation to antegrade sinoatrial conduction time, and relevance to sinus node disease.

When AV conduction is normal, the absence of VA conduction is not abnormal. Analogous information about retrograde sinoatrial conduction is not available. Although the premature atrial stimulas (PAS) technique can demonstrate the presence of sinoatrial entrance block (SAEB), both its prevalence and its relationship to antegrade SA conduction are unknown. Using PAS, we determined the incidence of SAEB in 59 patients with known or suspected dysrrhythmias or conduction defects to be 6.8%. Using catheter recorded sinus node electrograms (SNE), we then directly measured sinoatrial conduction time (SACT) in three patients with SAEB. Antegrade SACT was normal in two and prolonged in one. Only the latter had sinus node dysfunction recognized by ECG and/or conventional sinus node testing. We conclude that SAEB occurs infrequently, may occur when antegrade SACT is normal, is probably analogous to behavior at the AV node, and should not be used as an indicator of sick sinus syndrome.

Adolescent↗
PubMed1975

"Paradoxical" prolongation of sinus nodal recovery time after atropine in the sick sinus syndrome.

A case of symptomatic sick sinus syndrome is presented with confirmation of sinus nodal dysfunction established by functional testing. The validity of such provocative testing and the criteria for abnormality are discussed. A newly recognized, seemingly "paradoxical" and potentially detrimental effect of atropine noted in this patient is examined. Despite an increase in sinus rate and an improvement in sinoatrial conduction time after administration of atropine, a markedly prolonged sinus recovery time after rapid atrial pacing occurred, and atrial quiescence for more than 10 seconds was seen. Possible electrophysiologic mechanisms for this phenomenon, such as decreased atriosinus entrance block, concealed sinoatrial reentry or enhanced intranodal depolarization, are discussed and potential clinic correlates are made.

Arrhythmia, Sinus↗