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PubMedDate not supplied

Changing diagnostic and treatment strategies for chronic sinusitis.

Treating chronic sinusitis may at times require courses of antibiotics much more prolonged than those used in acute sinusitis, but not all patients with radiographic evidence of sinusitis require antibiotics. Chronic sinusitis and chronic asthma frequently occur together and may share a common pathogenesis. This article explores current knowledge about this common respiratory problem and presents an algorithm for its evaluation and treatment.

Adult↗
PubMed1998

Comparison of inflammatory cell profile and Th2 cytokine expression in the ethmoid sinuses, maxillary sinuses, and turbinates of atopic subjects with chronic sinusitis.

Chronic sinusitis is a common disease characterized by persistent inflammation of the sinus mucosa. This study was undertaken to investigate immunopathologic findings in biopsy specimens from the ethmoid sinuses, maxillary sinuses, and inferior nasal turbinates of 14 allergic subjects with chronic sinusitis. The composition of the inflammatory infiltrate in the three tissue sites was examined by immunocytochemistry with anti-CD3 (total T cells), anti-CD4 (helper T cells), anti-CD8 (suppressor T cells), anti-MBP (eosinophils), antitryptase (mast cells), and antichymase (mast cells) antibodies. These revealed a significant increase in the T-cell helper/suppressor ratio and eosinophils in the ethmoid sinus mucosa compared with those in the maxillary sinus mucosa and the inferior turbinate. Eosinophil numbers were also higher in the maxillary sinus than in the inferior turbinate. Mast cells were present in significantly higher numbers in the ethmoid sinus and inferior turbinate biopsy sections than in the maxillary sinus. With antisense, radiolabeled riboprobes, we used in situ hybridization to examine the expression of interleukin-4 and interleukin-5 transcripts. The density of cells expressing interleukin-4 transcripts was significantly higher in the inferior turbinate biopsy sections than in those from the ethmoid and maxillary sinuses. In addition, the number of interleukin-4 mRNA-positive cells was higher in the ethmoid than in the maxillary sinus mucosa. The density of interleukin-5 mRNA-positive cells was significantly higher in the ethmoid and maxillary sinuses than in the inferior turbinate. The results of this study indicate (1) a more intense inflammatory response in the ethmoid sinus than in the maxillary sinus and inferior turbinate in allergic chronic sinusitis and (2) different inflammatory responses in the upper airways that are dependent on the anatomic site. These findings have potential implications in the design of new therapeutic interventions for allergic chronic sinusitis.

Adolescent↗
PubMed1995

[Endoscopic sinus surgery for chronic sinusitis in children].

Anatomical features show maxillary sinus to be most commonly involved during childhood chronic sinusitis. Fifty-one cases who failed to respond to medications and irrigation were selected to undergo the middle meatal antrostomy under endoscopy. The majority of them had maxillary sinusitis. 10 cases had middle turbinate edema and polyps. 6 had ethmoiditis. After operations, signs of headache eliminated in 20 cases, nasal obstruction in 43 cases and yellowish discharge in 37 cases. The operative results were satisfactory. It is demonstrated that endoscopic sinus surgery is an ideal therapy for the treatment of childhood chronic maxillary sinusitis at present.

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↗
PubMed1999

[Endoscopic sinus surgery for unilateral chronic sinusitis].

Functional endoscopic sinus surgery has become an increasingly popular treatment for chronic sinusitis. This approach is aimed at re-establishment of ventilation and mucociliary clearance of the sinuses. However, some otolaryngologists believe that the Caldwell-Luc procedure should be routinely used for unilateral chronic sinusitis, because it is often associated with the maxillary sinus carcinomas. To evaluate the state of endoscopic sinus surgery for the diagnosis and treatment of unilateral chronic sinusitis, we analyzed the cases of 39 patients with unilateral chronic sinusitis who underwent endoscopic sinus procedures. These patients were unresponsive to appropriate antibiotic management for more than 6 months. Generally, endoscopic ethmoidectomy and antrostomy were performed with preservation of the middle turbinate. After the ostium was enlarged, the maxillary sinus was cleaned and carefully inspected for the presence of associated neoplasms using 30 and 70 degree endoscopes. Preoperative computed tomography (CT), postoperatve pathologic diagnosis, fiberscopic findings of the maxillary sinus, and symptomatic improvement were evaluated. Three patients had CT evidence of bone destruction of the lateral nasal wall. Pathological diagnosis demonstrated that three patients had maxillary sinus mycoses caused by Aspergillus species, one patient had inverted papilloma, and the other 35 patients had chronic sinusits. No associated malignancy was found. Eighty-one percent of the patients had almost normal endoscopic findings of the maxillary sinus by postoperative fiberscopic examination 4 to 8 months following surgery. With an average follow-up of 26 months, 88% of the patients were judged as having significantly improved in their presenting complaints of mucopurulent rhinorrhea, nasal obstruction, and facial pain. The results of this series suggest that endoscopic sinus surgery is an effective procedure for the diagnosis and treatment of unilateral chronic sinusitis.

Adult↗
PubMed1983

Reduced ciliary action in chronic sinusitis.

In chronic sinusitis, the disturbance of mucociliary transport explicitly represents the pathology of the mucous membrane. It was established by a photo-electric method that in this disease, mucociliary transport is disturbed as the result of not only change in secretory function but also a decrease in the frequency of ciliary beating. In the in vitro experiment using mucous membrane samples from 10 cases of chronic sinusitis, the frequency of ciliary beating was lowered slightly to about 409 +/- 84 beats per minute at 30 degrees C. In the most active phase of action, human cilia in sinusitis beat about 720 times per minute at 30 degrees C in vitro. The ciliary actions of the mucous membrane in human chronic sinusitis were classified into three types: 1) gathering type, 2) bifocal type, and 3) scattering type.

Animals↗
PubMed1996

CD4+ lymphocytes are increased in the sinus mucosa of children with chronic sinusitis.

OBJECTIVES: To quantitate lymphocyte subtypes in sinus tissues harvested from children with chronic sinusitis and coexisting asthma, allergies, and cystic fibrosis during functional endoscopic sinus surgery and compare them with those in normal adult sphenoid sinus mucosa. DESIGN: Immunohistochemical staining of surgical specimens with monoclonal antibodies against CD4 and CD8 surface antigens. SETTING: Tertiary medical center. PATIENTS: Thirty-two children who underwent functional endoscopic sinus surgery for chronic sinusitis refractory to medical treatment (median age, 8 years; range, 2-13 years) were divided into 3 groups: 10 with asthma, 15 without asthma, and 7 with cystic fibrosis. Sphenoid sinus mucosa obtained from 10 adults (median age, 70 years) undergoing transsphenoidal hypophysectomy was used as control tissue. MAIN OUTCOME MEASURES: Numbers of CD4+ and CD8+ cells in the lamina propria and epithelium of surgical specimens. RESULTS: Significantly more CD4+ cells were in the sinus mucosa of patients with chronic sinusitis than in the normal sinus mucosa (P < .01), but there was no significant difference in the number of CD8+ cells (P = 4). Patients with chronic sinusitis with asthma, without asthma, and with cystic fibrosis all had increased numbers of CD4+ cells compared with sphenoid mucosa, with the difference reaching statistical significance only in the subgroup with chronic sinusitis without asthma (P < .001). The numbers of CD4+ cells were higher in patients with chronic sinusitis than in the sphenoid mucosa irrespective of allergic status. Significantly more CD4+ than CD8+ cells were in tissues from the patients with chronic sinusitis irrespective of concomitant diseases or allergic status. CD4+ and CD8+ cells were more numerous in the apical portion of the submucosa (immediately beneath the epithelium) than in the basal portion both in patients with chronic sinusitis and in normal sphenoid tissue. CONCLUSIONS: Children with chronic sinusitis have predominance of CD4+ cells in the sinus mucosa as compared with normal sphenoid tissue. This contrasts with published results in adults with chromic sinusitis, in whom CD8+ cells predominate in nasal polyps and the submucosa, possibly reflecting a difference in the immunologic response of children and adults.

Adolescent↗
PubMed1998

[Exploration of evaluating way of curative effect in transnasal endoscopic sinus surgery for treating chronic sinusitis].

OBJECTIVE: To explore the evaluating way of curative effect in transnasal endoscopic sinus surgery for treating chronic sinusitis. METHODS: 725 cases who suffered from chronic sinusitis and undergone the endoscopic sinus surgery in 1991-1995 were analyzed according to the index that set up by ourselves. RESULTS: The difference of properties, limits and extents of pathological changes in sinuses affected directly the surgical result. CONCLUSION: It is very important to build up a staging system and a criterion of treating effect on chronic sinusitis for appraising properly the endoscopic sinus surgery.

Adolescent↗
PubMedDate not supplied

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis.

PURPOSE: To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. PATIENTS AND METHODS: The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. RESULTS: Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. CONCLUSIONS: This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Adult↗
PubMed1994

Localization of IL-1 beta mRNA and cell adhesion molecules in the maxillary sinus mucosa of patients with chronic sinusitis.

Interleukin-1 beta (IL-1 beta) is a predominant cytokine in retained paranasal sinus fluid of chronic sinusitis where infiltration by polymorphonuclear neutrophils (PMNs) of nasal and paranasal mucosa is characteristic. The authors investigated the localization of IL-1 beta messenger RNA (mRNA) in the maxillary sinus mucosa of patients with chronic sinusitis, using digoxigenin-labeled oligonucleotide probes. IL-1 beta mRNA was detected in some extravascular PMNs and small numbers of mononuclear leukocytes but was not detected in other tissue cells or intravascular leukocytes. The expression and distribution of the cell adhesion molecules, intercellular adhesion molecule-1 (ICAM-1) and endothelial-leukocyte adhesion molecule-1 (ELAM-1), were also studied in cultured human mucosal microvascular endothelial cells and in the maxillary sinus mucosa in chronic sinusitis by immunohistochemistry using monoclonal antibodies against these cell adhesion molecules. Only ICAM-1 was expressed on cultured human mucosal microvascular endothelial cells without IL-1 beta stimulation. With IL-1 beta activation of these cells, ELAM-1 was expressed strongly and the expression of ICAM-1 was enhanced. In the maxillary sinus mucosa, ICAM-1 was strongly and universally expressed on endothelial cells of all small vessels, whereas ELAM-1 was expressed only in the subepithelial region. These findings suggest that IL-1 beta, one of mediators in chronic sinusitis, is produced by PMNs, induces the expression of ICAM-1 and ELAM-1 on endothelial cells, and, thereby, stimulates PMN infiltration in chronic sinusitis.

Adult↗
PubMed2000

Outcome analysis of endoscopic sinus surgery for chronic sinusitis in patients having Samter's triad.

A study was conducted to assess outcome analysis in acetylsalicylic acid (ASA) triad patients after endoscopic sinus surgery (ESS). The control group consisted of patients with chronic sinusitis, with or without asthma, who had also undergone ESS. The study group contained 18 patients with the classic triad who were compared with 22 controls. The study was conducted in retrospective fashion highlighting clinical presentation, radiologic evaluation, surgical findings, and recurrence rate of nasal polyps. Although both groups had a relatively similar age of onset of symptoms, the symptomatic picture was different in the two groups. Radiologic evaluation of the nose and paranasal sinuses revealed more extensive involvement of the sinuses in ASA triad patients. Furthermore, ASA triad patients underwent a greater number of repeat operations. This review suggests that ASA triad patients respond less well to surgical intervention and that other treatment modalities should perhaps be explored.

Adult↗
PubMed2000

[Study on endoscopic sinus surgery management of chronic sinusitis with nasal polyps].

Endoscopic sinus surgery is commonly used to treat chronic sinusitis. Subjects were 79 chronic sinusitis patients--50 men and 29 women aged 17 to 79 years (average: 50.6 years) undergoing endoscopic sinus surgery in our department from January 1993 to December 1997. Mean follow-up was 17.5 months. We evaluated preoperative staging of chronic sinusitis based on Kennedy staging. Most were stage 3. This type of staging was not effective in predicting nasal polyp relapse. We found that cases with diffuse polyposis and associated disease such as bronchial asthma or aspirin-induced asthma tended to experience a polyp relapse. Our results suggest that postoperative treatment is important in maintaining patency of the ostiomeatal complex, nasal polyp or edematous mucosa relapse must be treated early in on in occurrence.

Adolescent↗
PubMed1981

[Transnasal, endoscopical sinus surgery for chronic sinusitis. I. A biomechanical concept of the endonasal mucosa surgery (author's transl)].

Transnasal, endoscopical operations are recommended for the surgical treatment of chronic sinusitis. They are based on a bio-mechanical concept of recovery of the diseased mucosa, initiated by the restoration of ventilation and drainage to the paranasal cavities. These interventions, e.g. endonasal maxillary sinus operation and endonasal total ethmoidectomy, intend to remove narrow straits within the pneumatic system ("isthmus surgery"), but to preserve the lining mucosa. Flanking measures are necessary, in order to rule out etiologic cofactors of the sinusitis (septoplasty, conchotomy, tonsillectomy). Special instrumentation and the development of the surgical suction-irrigation-endoscope were prerequisite for this type of rhino-surgery, which also requires intimate knowledge of the topographical anatomy.

Biomechanical Phenomena↗
PubMedDate not supplied

[Clinical-radiologic correlation in chronic sinusitis].

INTRODUCTION: Chronic sinusitis is a pathology that has been increasing in incidence in world population. The Mexican Institute of Social Security (IMSS) reports 91 cases per year per 100,000 people. In the last decades, much has been advanced concerning knowledge of the physiology of paranasal sinuses and thus of the pathogenesis of sinusitis; this has led to developing of functional endoscopic sinus surgery. To perform this kind of surgery, it is mandatory to have computerized tomography, and the necessity of clinical-radiologic correlation has been recognized to attain better diagnosis and treatment. OBJECTIVE: To determine clinical-radiologic correlation of chronic sinusitis in adult patients. MATERIALS AND METHODS: Correlational, transverse, convenience-assigned blind study from January to July 2002 in the Department of Otolaryngology, Hospital de Especialidades at the Centro Médico Nacional Siglo XXI in Mexico City. Kendall test was applied to a group of 31 patients. RESULTS: Nasal obstruction was found in 87%, mucopurulent rhinorrea in 55%, mucosal edema in 74%, and polyps in 42%. Most frequently paranasal sinus affected by sinusitis was maxillary sinus in 97% and least affected was frontal, in 58%. Of tomographic findings, most frequent was obstruction of ostiomeatal complex in 84%. There was no statistical significance (p > 0.05) in clinical-radiologic. DISCUSSION: No correlation was found between signs and symptoms evaluated with tomographic findings, as reported by other authors.

Adult↗
PubMed1998

Monocyte chemotactic protein expression in allergy and non-allergy-associated chronic sinusitis.

OBJECTIVE: Chronic sinusitis (CS) is characterized by inflammatory mucosal thickening and polyp formation with a predominantly eosinophilic infiltrate. Chemokines are a novel group of inflammatory mediators capable of attracting specific inflammatory cell populations. Monocyte chemotactic proteins (MCP) are a subfamily of chemokines (MCP-1, MCP-2, MCP-3, and MCP-4) that share a number of functional properties including chemotactic activity for eosinophils. The purpose of this study was to investigate the expression of the MCP family of chemokines in allergy and non-allergy-associated chronic sinusitis using the technique of immunocytochemistry. METHOD: We examined the expression of MCP-1, MCP-3, and MCP-4 in biopsies from the ethmoid sinuses of patients with CS and normal controls. RESULTS: MCPs were localized to the epithelial cells and a subset of inflammatory cells within the mucosa. The expression of both MCP-3 and MCP-4 immunoreactivity were significantly increased in patients with both allergy and non-allergy-associated CS compared to normal controls (p < .001). There was no significant difference in the expression of MCP-1 in nasal biopsies from individuals with CS and normals. The level of expression of MCP-3 and MCP-4 correlated with eosinophil (p < .001) and CD4-positive T-cell infiltrate (p < .001) but not with CD8-positive T-cell infiltration. CONCLUSIONS: Our data suggest biologic redundancy in the expression of eosinophil chemoattractants in CS and a potential role for MCP-3 and MCP-4, but not MCP-1, in the pathophysiology of this disorder. Further, chemokines may be a common link between the eosinophilia of allergy-associated and non-allergy-associated CS, a finding that may have therapeutic implications.

Adult↗
PubMedDate not supplied

Endoscopically guided cultures in chronic sinusitis.

In chronic sinusitis, culture-directed antibiotics are often recommended as a cornerstone of treatment. The significance of Gram-negative rods (GNRs), coagulase-negative Staphylococci (SCN), and Staphylococcus aureus has been controversial. In an effort to determine host factors which correlate with culture results, 507 endoscopically-guided cultures are reviewed from 265 patients. A history of asthma, allergic rhinitis, prior sinus surgery, and the concurrent use of antibiotics, steroids, and irrigations were some of the host factors compared by X2. The results were compared to a control group of 50 cultures from healthy volunteers. SCN, S. aureus, P. aeruginosa, and Streptococcus were the most common isolates. GNRs were present in 27% of cultures and were more common in patients who had prior sinus surgery or were using irrigations. P. aeruginosa was more common in patients taking systemic steroids. SCN occurred with the same incidence in patients and control subjects but was more prevalent in cultures obtained intraoperatively and in patients taking systemic steroids. No identifiable host factor was associated with S. aureus. S. aureus occurred at similar rates in patients and control subjects but grew heavily in patients and exhibited only light growth in controls. Topical nasal steroids appear to have no statistically significant effect on bacterial cultures. Findings from this study further our understanding of chronic sinusitis and may help guide practitioners in the treatment of this disease.

Adolescent↗
PubMed2002

[Microcirculation evaluation of the maxillary sinus mucosa in patients with chronic sinusitis].

OBJECTIVE: To evaluate the microcirculation change in the maxillary sinus mucosa of patients with chronic sinusitis. METHOD: The microcirculation blood flow in the maxillary sinus mucosa of 20 patients with chronic sinusitis and 10 healthy controls was evaluated by means of nasal endoscopy-guided laser Doppler flowmetry. RESULT: The microcirculation blood flow were significantly reduced in the maxillary sinus mucosa of patients with chronic sinusitis (including type I and type II) compared with healthy controls(P<0.05, P<0.01). There were no significantly difference between the two types of chronic sinusitis. CONCLUSION: The microcirculation blood flow were reduced in the maxillary sinus mucosa of patients with chronic sinusitis.

Adult↗