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Results for “Chronic sinusitis”

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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↗
PubMedDate not supplied

Endonasal sinus surgery improves mucociliary transport in severe chronic sinusitis.

A total of 22 patients with extensive chronic sinusitis were examined before and 7.2 +/- 1.1 months after microscopic endonasal sinus surgery. Pre- and postoperative nasal mucociliary transport was measured using a modified saccharine test and ciliary beat frequency of nasal respiratory cells using video interference contrast microscopy. In patients suffering from chronic sinusitis, nasal ciliary beat frequency was significantly lower (8.0 +/- 1.8 Hz) than in normals (9.5 +/- 1.7 Hz p < 0.02). Following endonasal sinus surgery, ciliary beat frequency in patients with chronic sinusitis remained reduced (8.3 +/- 1.2 Hz). Nasal mucociliary transport time was significantly (p < 0.05) longer (20.9 +/- 9.4 minutes) in patients with chronic sinusitis than in normals (14.9 +/- 8.4 minutes). Nasal mucociliary transport improved significantly (p < 0.05) to 13.8 +/- 8.4 minutes in 17 of 22 patients without recurrent sinusitis and remained prolonged (20.6 +/- 7.7 minutes) in 5 of 22 patients with recurrent disease. These data suggest that ciliary beat frequency of nasal respiratory cells and nasal mucus transport are impaired in patients suffering from chronic sinusitis. After microscopic endonasal sinus surgery, impaired mucociliary transport is improved, and ciliary beat frequency remains lower than in normals.

Adult↗
PubMed1991

Maxillary sinus hypoplasia masquerading as chronic sinusitis.

Maxillary sinus hypoplasia is a common condition that may be misdiagnosed as chronic sinusitis. Although hypoplasia can usually be seen on conventional sinus films, computed tomography may be necessary, as in the cases described by the authors in this article.

Adult↗
PubMed2001

Endoscopic sinus surgery for the treatment of chronic sinusitis in geriatric patients.

Although endoscopic sinus surgery is a well-documented procedure for the treatment of chronic sinusitis in children and adults, no study has been conducted to specifically investigate its application in a geriatric population. We undertook to fill this void by analyzing the records of 1,112 patients who had undergone endoscopic sinus surgery for chronic sinusitis in our department between April 1988 and March 1998. We categorized these patients by age. There were 171 patients (15.4%) in the geriatric group (age: > or = 65 yr), 837 patients (75.3%) in the adult group (age: 17 to 64), and 104 patients (9.4%) in the pediatric group (age: < or = 16 yr). We found that the geriatric group experienced a disproportionately larger share of operative complications, but most of them were minor. Outcomes were similar in all three groups. We conclude that endoscopic sinus surgery is a safe and effective treatment for older patients with chronic sinusitis.

Adolescent↗
PubMed2002

Correlation of middle meatus and ethmoid sinus microbiology in patients with chronic sinusitis.

Empirical antibiotics constitute the cornerstone of medical therapy for chronic sinusitis due to difficulties of obtaining cultures from the paranasal sinuses. Indirect isolation of the pathogenic microorganisms outside the paranasal sinuses with a non-invasive method may enable administration of specific antibiotics. In this prospective study, we obtained cultures from the middle meatus and ethmoid sinuses of 193 sides from 127 patients who had undergone FESS for chronic sinusitis with a method that minimizes the risk of nasal contamination. The same bacterial species were isolated from both the ethmoid sinus and middle meatus in 59.3% of the cultures. There was no bacterial growth in either site in 32.3% of the cultures. The overall correlation rate of middle meatus and ethmoid sinus cultures was estimated to be 91.6%. In conclusion, middle meatal cultures can be used for the isolation of pathogenic microorganisms indirectly, while administration of specific antibiotics can be possible according to the results of these cultures.

Adolescent↗
PubMed1990

Endoscopic sinus surgery in children with chronic sinusitis: a pilot study.

This pilot study assessed the safety and preliminary data on the efficacy of endoscopic ethmoidectomy in children with chronic sinusitis. A total of 168 patients were evaluated for chronic sinusitis, and 31 were deemed appropriate candidates for ethmoidectomy. All patients were medical management failures. Twenty-six percent of the patients had asthma, 23% had some immune deficiency, 23% had allergies, and 2 patients (1%) had cystic fibrosis. All patients were followed for at least 1 year postoperatively. The only surgical complication was minor middle meatal scarring that developed in two patients. Overall, 71% of the patients were considered normal by their parents 1 year postoperatively. Of the 24 patients who did not have an underlying systemic disease (immune deficiency or cystic fibrosis) postoperatively, 80% were considered normal by their parents, 12% were improved but continued to have some symptoms, and 8% had unsatisfactory results. Seven children with underlying systemic disease had to undergo revision ethmoidectomy for persistent symptoms.

Child↗
PubMed2003

Molecular immunology and immunotherapy for chronic sinusitis.

The development of chronic sinusitis is a complex multifactorial process characterized by inflammation of nasal and sinus mucosa. Many studies have shown that the composition of the inflammatory substrate in chronic sinusitis is similar to that seen in allergic rhinitis and in the late-phase response to antigen challenge. Mononuclear cells, consisting of T and B lymphocytes and activated eosinophils, are prominent in the sinus mucosa of patients with chronic sinusitis, especially in atopic patients. Cellular recruitment and activation of the inflammatory infiltrate have been largely attributed to the effects of T(H)2 cytokines (namely interleukin -4, IL-5, IL-13, and granulocyte-macrophage colony-stimulating factor). Current treatment of allergic chronic sinusitis consists of nasal corticosteroids and immunotherapy. A subgroup of steroid-insensitive patients demonstrates an overexpression of a variant of the glucocorticoid receptor (GR). Despite these advances, the management and treatment of chronic sinusitis is often fraught with failures and remains a frustrating task for both physician and patient.

Chemokines↗
PubMed2002

Current views on the molecular biology of chronic sinusitis.

The development of chronic sinusitis is a multifactorial process primarily related to allergen exposure, genetic predisposition, and persistent infections. Like allergic rhinitis, the inflammatory substrate in chronic sinusitis is highlighted by the abundance of mononuclear inflammatory cells, eosinophils, and T helper type 2 (Th2) cytokines. Corticosteroids are the most potent agents available for relieving the symptoms of chronic sinusitis, and they act by inhibiting the synthesis of Th2 cytokines and other inflammatory mediators. The mechanisms of corticosteroid insensitivity in chronic sinusitis and other inflammatory conditions are poorly understood. Microbial products and abnormalities in cytokine expression and corticosteroid receptors have been suggested as potential mechanisms of corticosteroid resistance. The purpose of this article is to review our current knowledge of the pathogenesis of chronic sinusitis and highlight recent advances in the molecular biology of the inflammatory process underlying this condition. The issue of corticosteroid insensitivity in chronic sinusitis will also be addressed.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Efficacy of endoscopic sinus surgery in the management of patients with asthma and chronic sinusitis.

An association between chronic sinusitis and asthma has been noted for many years, although the precise nature of the relationship is poorly understood. Earlier studies, using traditional surgical techniques, have demonstrated subjective improvement in asthmatic complaints. Reports demonstrating improvement following endoscopic sinus surgery for chronic sinusitis are rare. To report our experience with endoscopic sinus surgery and asthmatics, we reviewed the charts of 75 consecutive patients with asthma and chronic sinusitis who underwent endoscopic sinus surgery between 1994 and 1996. Study criteria included the following: chronic sinusitis, one year preoperative and one year postoperative follow-up from endoscopic sinus surgery, and asthma requiring inhaled steroids and oral prednisone for control. Many patients required prednisone bursts for control of asthma. Number of days and total dose of oral prednisone were used as objective measures of asthma control. Number of weeks of antibiotics was used as a relative measure of sinusitis. Fourteen of the 15 patients meeting study criteria decreased their postoperative prednisone requirement by total number of days (preoperative 84 versus postoperative 63 days [p < 0.0001]). Postoperatively, patients required an average of 1300 mg less oral prednisone (p < 0.033). Antibiotic use also decreased, with an average use of antibiotic nine weeks preoperatively versus seven weeks postoperatively (p < 0.045). This study provides corroborative objective evidence that, at least in the short term, endoscopic sinus surgery is efficacious in the management of patients with chronic sinusitis and asthma.

Adolescent↗
PubMed2004

Localization of T cells and subtypes in the paranasal sinus and turbinate mucosa in patients with chronic sinusitis.

The aim of this study was to quantitate total T lymphocytes (total CD3+ cells) and T-lymphocyte subtypes (CD4+ [T helper] and CD8+ [T suppressor] cells) in patients with chronic sinusitis who were treated with functional endoscopic sinus surgery (FESS) and to investigate the pathophysiology of persistent inflammation in chronic sinusitis. This prospective study was conducted in study and control groups. The study group consisted of 32 patients (20 male, 12 female) with chronic sinusitis who underwent FESS. The control group consisted of 8 nonsinusitis patients (5 male, 3 female) who underwent septoplasty. Specimens from the study group were excised from five regions: the uncinate process, maxillary and ethmoid sinuses, and middle and inferior turbinates. The specimens were examined with x10 magnification by light microscopy, and the slides with a severe inflammatory process were included. Punch biopsy of the control group was taken from the inferior turbinate with patients' written approval. The surgical specimens from the study and control groups were examined with an immunohistochemical staining technique with monoclonal antibodies against CD3, CD4, and CD8 surface antigens of T lymphocytes. In every specimen, the numbers of CD3+, CD4+, and CD8+ cells were calculated in 3 to 4 high magnification field on light microscopy, and the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and deep paraglandular layer of the mucosa was determined. Statistical analysis by Kruskal-Wallis analysis of variance and the Mann-Whitney U test with Bonferroni correction revealed that the CD3 epithelial layer value of the inferior turbinate (p = .030) and the CD4 deep layer value of the middle turbinate (p = .048) were significantly higher than the corresponding values of the control group. In the epithelial (p = .018) and subepithelial (p = .012) layers of the uncinate process group, in the epithelial (p = .050) and subepithelial (p = .012) layers of the ethmoid sinus group, and in the subepithelial (p = .018) and deep paraglandular (p = .012) layers of the middle turbinate group, the difference between the CD4+ and CD8+ cell counts was found to be statistically significant by the Wilcoxon signed rank test. The number of CD4+ cells was higher than the number of CD8+ cells. In conclusion, T cells play a role in the pathophysiology of chronic sinusitis. CD4+ T helper cells, in particular, are predominant at the initiation and regulation of inflammation. The uncinate process, ethmoid sinus, and middle and inferior turbinates have the main roles by T cells and subtypes in the defense system in chronic sinusitis.

Adolescent↗
PubMed2003

Expression of epidermal growth factor receptor and its ligands in chronic sinusitis.

The epidermal growth factor receptor (EGF-R) system plays a crucial role in mucus production in vitro and in rats. However, the role of the EGF-R system in humans is not known. We compared the localization of EGF-R and its ligands (epidermal growth factor and transforming growth factor alpha) in the epithelia of sinuses with chronic sinusitis and in those of healthy controls. Immunohistochemical techniques were employed to identify the presence of EGF-R and its ligands in the sinus mucosa. We found EGF-R in goblet cells, basal cells, and submucosal gland cells, but not in ciliated cells. Immunoreactivity for both epidermal growth factor and transforming growth factor alpha was found in the epithelial cells and inflammatory cells and in some submucosal gland cells. There was stronger staining of EGF-R and its ligand proteins in chronic sinusitis specimens than in controls. The interrelated localization of EGF-R and its ligands suggests a role in mucus production in the epithelium of the sinus mucosa.

Adult↗
PubMed2001

Quantitative analysis of mucin and lectin in maxillary sinus fluids in patients with acute and chronic sinusitis.

OBJECTIVES: Sinusitis is characterized by quantitative and qualitative changes in mucus biosynthesis that contribute to sinus disease. In general, patients with acute sinusitis complain of purulent rhinorrhea, whereas those with chronic sinusitis complain of mucoid or mucopurulent rhinorrhea Locally produced mucin largely contributes to the high viscoelasticity of mucus in sinusitis. In this study, the authors attempt to quantify the concentrations of mucin and lectin in the maxillary sinus fluids from these patients. STUDY DESIGN: To assess the concentrations of mucin and lectin in aspirates of 11 acutely and 11 chronically inflamed maxillary sinuses, the concentration of mucin was measured by enzyme-linked immunosorbent assay (ELISA) and that of lectin by sandwiched enzyme-linked lectin assay (ELLA). RESULTS: The concentrations of mucin and lectin that were measured using monoclonal antibodies (HCS 4, HCS 14, and HCS 18) and Ulex europaeus agglutinin-1 (UEA-1) in chronic sinusitis were higher than those in acute sinusitis. The concentration of total protein in chronic sinusitis was lower than that in acute sinusitis. Each mucin and lectin versus total protein ratio in chronic sinusitis was higher than that in acute sinusitis. CONCLUSIONS: These data suggest that hypersecretion in chronic sinusitis may result from locally increased mucin production. Comprehension of this mechanism may be a strategy to prevent the viscous cycle of paranasal sinus fluids in chronic sinusitis.

Acute Disease↗
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↗
PubMed2006

Reliability, validity and responsiveness of a Norwegian version of the Chronic Sinusitis Survey.

BACKGROUND: The Chronic Sinusitis Survey (CSS) is a valid, disease-specific questionnaire for assessing health status and treatment effectiveness in chronic rhinosinusitis. In the present study, we developed a Norwegian version of the CSS and assessed its psychometric properties. METHODS: In the pooled data set of 65 patients from a trial of treatment for chronic sinusitis with long-standing symptoms and signs of sinusitis on computed tomography (CT), we assessed the reliability, validity and responsiveness of the CSS. RESULTS: Test-retest reliability of the two CSS scales and the total scale ranged 0.87-0.92, while internal consistency reliability ranged 0.31-0.55. CSS subscale scores were associated with other items on sinusitis symptoms, and with the Mental health and Bodily pain scale of the SF-36. There was little association of the CSS scale scores with sinus CT findings. The patients with chronic sinusitis had worse scores on all three CSS scales than a healthy reference population (n = 42) (p < 0.001). The CSS sinus symptoms subscale and the total scale were sensitive to improvement in global symptoms during 12 weeks. CONCLUSION: The Norwegian version of the CSS had acceptable test-retest reliability, but lower internal consistency reliability than the accepted standard criteria. The results support the construct validity of the measure and the sinusitis symptoms subscale and the total scales were responsive to change. This supports the use of the questionnaire in interventions for chronic sinusitis, but points at problems with the internal consistency reliability.

Journal Article↗