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PubMedDate not supplied

Usefulness of patient symptoms and nasal endoscopy in the diagnosis of chronic sinusitis.

The diagnosis of chronic sinusitis can be difficult due to the variety and lack of specificity of presenting symptoms. Sinus CT scanning is presently considered the most sensitive and specific diagnostic method, but is expensive. In order to determine whether a combination of patient symptoms and nasal endoscopy could be used to predict which patients would have CT evidence of chronic sinusitis, we conducted a prospective study in which 92 consecutive patients referred for chronic sinusitis were required to fill out a questionnaire detailing their symptoms. Their responses were then correlated with subsequent findings on nasal endoscopy and CT scanning. Briefly, we found that patients with headache or facial pain as their chief complaint were less likely to have evidence of sinusitis than patients whose chief complaint was nasal obstruction or postnasal drip. Also, nasal endoscopy was shown to be moderately sensitive and highly specific in predicting results of CT scanning.

Chronic Disease↗
PubMed2004

The impact of sinus computed tomography on treatment decisions for chronic sinusitis.

OBJECTIVES: To determine the impact of sinus computed tomography (CT) on treatment decisions by otolaryngologists and to explore the factors leading to choice of surgical treatment for patients suspected of having chronic sinusitis. DESIGN: Prospective cohort study. SETTING: A tertiary academic medical center. PATIENTS: Questionnaires were administered to 3 otolaryngologists in a tertiary academic institution regarding diagnosis and treatment decisions in 27 patients suspected of having chronic sinusitis, before and after they reviewed sinus CT scans. MAIN OUTCOME MEASURES: The dichotomous decisions regarding surgical or nonsurgical treatment and the agreement of treatment decisions among surgeons were evaluated. The factors strongly influencing surgeons' treatment decisions regarding patients selected for surgery were also determined. RESULTS: The dichotomous treatment decisions were changed in one third of patients (9 of 27) after the sinus CT scans were reviewed. The agreement of treatment decisions among the 3 surgeons was markedly improved after they reviewed sinus CT scans. The factors favorably influencing surgical treatment were obstruction of the ostiomeatal complex on CT and concordance of CT abnormality with a patient's symptoms. Lund-Mackay stage, symptoms, and corticosteroid or antibiotic use were not significant predictors. CONCLUSIONS: Despite the common belief that treatment decisions for chronic sinusitis should be solely based on clinical grounds, with sinus CT providing only anatomic detail before surgery, our study indicates that the decision to perform surgery was altered by CT in a substantial portion of the patients. In our preliminary study, CT increased the tendency to elect surgical treatment by all 3 surgeons.

Adult↗
PubMedDate not supplied

Bacterial location in chronic sinusitis.

BACKGROUND: In chronic nonallergic sinusitis, it is often assumed that bacteria invade the sinus mucosa where the inflammatory condition begins and is maintained. However, the bacterial presence in a normal or moderately damaged epithelial layer has never been proved in biopsy studies. METHODS: In this study, mucosal samples from six consecutive patients with chronic sinusitis were examined. Transmission electron microscopy was used and the presence of bacterial invasion and formation of phagosomes containing bacteria as a marker of host response were studied. RESULTS: Phagocytosis of bacteria was observed in the sinus mucosa in samples from only one patient. In the other five patients, no signs of phagocytosis were seen. CONCLUSION: Based on these results, we concluded that in chronic sinusitis, bacterial invasion in sinus mucosa is not an obligatory phenomenon.

Bacteria↗
PubMedDate not supplied

Concordance of middle meatal swab and maxillary sinus aspirate in acute and chronic sinusitis: a meta-analysis.

BACKGROUND: The medical management of acute and chronic sinusitis is a therapeutic challenge. The use of endoscopic middle meatal cultures as a noninvasive method to determine the bacteriology of the maxillary sinus has not accurately been established. The aim of this study was to review the literature that compares cultures obtained by endoscopic middle meatal swabs with those obtained from maxillary sinus aspirates (MSAs). METHODS: We reviewed studies published between January 1966 and October 2003 that were identified from searches of multiple databases, bibliographies, and original articles. Studies were included for analysis if they compared the results of endoscopic middle meatal cultures to aspirate cultures. All clinical variables and test performances were independently extracted by two reviewers. RESULTS: Middle meatal culture had a per isolate accuracy of 82% (95% confidence interval, 0.64, 0.92) compared with MSA (excluding coagulase negative staphylococcus and fungal cultures). CONCLUSION: Endoscopic middle meatal cultures have a high concordance with MSAs.

Acute Disease↗
PubMedDate not supplied

Increased expression of IL-4, IL-5, IFN-gamma, IL-6, IL-8, and TGF-beta mRNAs in maxillary mucosa of patients with chronic sinusitis.

This study aimed to investigate expression of various cytokine mRNAs, including IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa of patients with chronic sinusitis. Maxillary sinus mucosae of six patients with chronic sinusitis and turbinate mucosae of six healthy subjects were obtained. We performed RT-PCR and Southern blot to examine gene expression of the cytokines IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma in maxillary sinus mucosa and compared the results with cytokine gene expressions in normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed more frequently in maxillary sinus mucosa from patients with chronic sinusitis than in normal turbinate mucosa. All the maxillary sinus mucosa specimens revealed relatively higher mean density ratio for each cytokine investigated than did normal turbinate mucosa. IL-6, IL-8, TGF-beta, IL-4, IL-5, and IFN-gamma mRNAs were expressed simultaneously in maxillary sinus mucosa of chronic sinusitis. These cytokines may be responsible for recruitment of inflammatory cells and for mucosal thickening in chronic sinusitis, and thus chronicity of the disease.

Adult↗
PubMedDate not supplied

Blood flow in the rabbit sinus mucosa during experimentally induced chronic sinusitis. Measurement with a diffusible and with a non-diffusible tracer.

Chronic sinusitis was induced in New Zealand White rabbits. Access to the sinus cavity in question was obtained through a hole drilled in the dorsum of the nose, and for induction of sinusitis either cotton wool together with a suspension of 10(8) Streptococcus pneumoniae was introduced, or this method was combined with blocking of the sinus ostium with methacrylate. In 9 rabbits (weight range 3.6-5.0 kg), blood flow was determined 5 weeks-9 months after the induction of sinusitis, at a point in time when heavy inflammatory signs were present. The blood flow was determined both with radioactively labelled microspheres 16 +/- 1.5 micron in diameter and with Rb86Cl. Cardiac output as determined with the microsphere method was 127 +/- 28 ml X min-1 X 1 000 g-1. The blood flow in the sinus mucosa was 0.60 +/- 0.16 ml X min-1 X g-1 with the microsphere method and 0.51 +/- 0.20 ml X min-1 X g-1 with use of Rb86Cl. These values did not differ significantly from the corresponding values found previously in healthy rabbits.

Animals↗
PubMed1993

Nasal and paranasal sinus anomalies in children with chronic sinusitis.

Functional endoscopic sinus surgery (FESS) is being advocated to treat children with chronic sinusitis. The surgeon performing FESS needs an intimate understanding of the anatomy to adequately treat disease and avoid complications. One hundred thirty-six patients who had endoscopic sinus surgery were reviewed. Preoperative direct coronal computed tomography scans were available for review in 114 patients. Several nasal and paranasal sinus anomalies were uncovered during this evaluation. The most common was hypoplasia of the maxillary sinuses. All hypoplastic maxillary sinuses had diseased mucosa. Eleven patients were found to have a laterally deviated uncinate process and abnormal anatomy of the maxillary ostia. Other anomalies such as concha bullosa, Haller's cells, and paradoxic curvature of the middle turbinate were found, and their respective frequencies in this population were determined.

Adolescent↗
PubMed1993

Cefotiam concentrations in the sinus fluid of patients with chronic sinusitis after administration of cefotiam hexetil.

Cefotiam hexetil is a prodrug of cefotiam. The concentrations of cefotiam in plasma and sinus secretions were determined in 18 patients (10 males, 8 females, aged 39.3 +/- 13.0 years) with chronic sinusitis. All patients received two 200 mg oral doses of cefotiam hexetil 12 h apart and were divided into four groups according to the time which elapsed between the last dose and collection of secretion samples. The last dose was given 2 h (group I), 3 h (group II), 4 h (group III) or 6 h (group IV) before sinus puncture. Cefotiam concentrations were measured by high-pressure liquid chromatography and microbiological assay, results being very similar with both methods. Mean concentrations of cefotiam with the standard deviation in sinus exudates were 1.04 +/- 0.60 mg/l at 2 h (n = 6), 1.04 +/- 0.33 mg/l at 3 h (n = 4), 0.75 +/- 0.74 mg/l at 4 h (n = 4) and < 0.10 mg/l at 6 h (n = 4). Mean sinus fluid concentrations were higher than mean plasma concentrations in all groups. These results suggest that cefotiam concentrations higher than the MICs for common pathogens are found in sinus secretions up to 4 h after oral administration of cefotiam hexetil.

Adult↗
PubMedDate not supplied

The correlation between ciliary ultrastructure and ciliary beat frequency in experimental chronic sinusitis.

Ciliary ultrastructural abnormalities secondary to chronic sinusitis may cause abnormal mucociliary transport clearance. We examined the relationship between anatomic abnormalities of ciliary ultrastructure secondary to chronic sinusitis and ciliary beat frequency (CBF) before and after middle meatal antrostomy (MMA) in rabbits. Ultrastructural abnormalities of cilia included absence of axoneme membrane, blebs of the axoneme membrane, compound cilia, and ciliary orientation. Two groups of rabbits were studied: Uninfected (group A control, n = 3) and infected (group B, n = 10); 10(8) CFU S. pneumoniae were used to infect the animals in group B after sinus ostial occlusion and chronic sinusitis developed. After 6 weeks with infection, 6 of 10 group B animals underwent MMA and were restudied 6 weeks later. Uninfected animals had mean CBF = 11.75 Hz. Animals with chronic sinusitis had mean CBF = 8.5 Hz (p < 0.05). Six weeks after MMA, mean CBF = 11.82 Hz. This was not different from control. There were significant changes in ciliary ultrastructure when uninfected and infected rabbits were compared. These changes were reversed with MMA. Changes in ciliary ultrastructure correlated significantly with changes in CBF for all animals. Abnormalities in ciliary ultrastructure may account for the abnormal mucociliary transport clearance seen in chronic sinusitis in rabbits.

Animals↗
PubMed1994

Use of nasal cytology in the diagnosis of occult chronic sinusitis in asthmatic children.

BACKGROUND: Chronic sinusitis, in contrast to acute sinusitis, often presents with nonspecific symptoms that may be confused with other disease entities. Due to the cost of computerized tomography and the difficulty in interpreting sinus radiographs in certain children, a search for a simpler screening tool for chronic sinusitis in children was undertaken. OBJECTIVE: This study was undertaken to provide a quantitative comparison between the methods of wax paper blow and Rhinoprobe scraping for nasal cytology in screening for chronic sinusitis while minimizing selection bias. METHODS: Twenty serially selected patients (13 males and seven females) with a mean age of 11 years (range 6-16) were enrolled. Nasal cytology was obtained via two methods: scraping of the turbinate with a Rhinoprobe (Synbiotics Inc.,) and wax paper blow. RESULTS: The results showed that > or = 5 neutrophils per high power field on Rhinoprobe cytology significantly correlated with radiographic sinusitis (P < .05 by Chi-square and P < .056 by Fisher's exact test). The sensitivity and specificity for > or = 5 neutrophils per high power field were 100% and 53%, respectively. Counts of other nasal cells, such as eosinophils, bacteria, and epithelial cells, did not yield significant correlations with radiographic sinusitis. CONCLUSIONS: We feel that the Rhinoprobe, with criteria of > or = 5 neutrophils per high power field, may be useful as a screen for occult chronic sinusitis in childhood asthma. Confirmation of sinusitis via X-ray is still necessary if neutrophils are present on Rhinoprobe nasal cytology.

Adolescent↗
PubMed2003

[Study of bleeding during surgery of chronic sinusitis and nasal polyp influenced by preoperative treatment].

OBJECTIVE: To explore the method of reducing bleeding during endoscopic sinus surgery for chronic sinusitis and nasal polyp. METHODS: Bleeding during surgery and the effective rate of two groups patients with chronic sinusitis and nasal polyp were compared (68 cases in group A with preoperative treatment, 30 cases in group B without preoperative treatment). RESULTS: The effective rate between group A(91.2%) and group B (80%) is of significant difference (F = 8.617, P = 0.026); The volume of bleeding during surgery between group A that is (53.2 +/- 41.8) ml and group B that is (97.2 +/- 59.0) ml is of significant difference (F = 27.946, P = 0.002). CONCLUSIONS: Controlling the inflammatory reaction of chronic sinusitis and nasal polyp by preoperative treatment is the most important factor to reduce bleeding while undergoing endoscopic sinus surgery. However, the followings are also important factors to reduce bleeding in endoscopic sinus surgery, such as adequate use of vasoconstrictor in the middle nasal meatus during surgery, the use of deliberate hypotension during surgery, controlling the high risk factors by preoperative treatment and reducing trauma during surgery, etc.

Adolescent↗
PubMed1999

[A study on the concentration of eosinophil cationic protein in chronic sinusitis].

The relationship between eosinophil and chronic sinusitis was investigated by measuring the concentration of eosinophil cationic protein (ECP). In addition to the blood, a cytological brush was inserted into middle meatus to scrape the nasal membrane, and the concentration of ECP in the collected specimen was measured. There was a moderate degree of correlation between the blood eosinophil count and the ECP concentration in the blood (r = 0.543, p < 0.01). On the other hand, there was high degree of correlation between the number of EG2-positive cells and ECP of the nasal membrane in the middle meatus (r = 0.805, p < 0.001), reflecting the amount of ECP in the nasal mucous membrane. The ECP in 10 control group subjects and 14 patients with severe chronic sinusitis and nasal polyps was significantly lower than that in 14 patients with severe chronic sinusitis and asthma (p < 0.01). The ECP concentration of the nasal membrane in the middle meatus was significantly lower in patients showing a good postoperative course compared with patients showing a poor postoperative course following Endoscopic Sinus Surgery (p < 0.01). These findings suggest that eosinophils are closely related to the pathology and clinical course of chronic sinusitis, and that the ECP concentration of the nasal membrane in the middle meatus reflects the pathology of chronic sinusitis. The ECP concentration thus has potential as a prognostic indicator for chronic sinusitis.

Adult↗
PubMed1987

The opacified maxillary sinus: CT findings in chronic sinusitis and malignant tumors.

To distinguish opacification owing to inflammatory conditions (sinusitis) from that caused by nasomaxillary malignancy, computed tomography scans in 24 proved cases of sinusitis or tumor were reviewed for features related to sinus size, wall thickness, and character of bone erosion. An anatomic system was defined for classifying lesions according to the surface and type of bony involvement. In 12 cases of chronic maxillary sinusitis, the involved sinus was usually small and thick walled. The nasal surface of the involved sinus usually was eroded; often the orbital surface was eroded. The erosion was, however, short, irregular, and in the region of a normal dehiscence (semilunar hiatus or infraorbital canal) in all cases. The infratemporal surface was never eroded. In 12 cases of nasomaxillary neoplasia, the sinus was enlarged, one or more walls of the involved sinus being thinned and expanded. Bone erosion was present in all cases; erosion of the infratemporal surface was specific for neoplasia and significant as the usual site of recurrence.

Chronic Disease↗
PubMed2004

[Observation of maxillary mucosa restoration after the endoscopic sinus surgery operation of chronic sinusitis and nasal polyps].

OBJECTIVE: To understand the restoration process of the mucosa through the continual endoscopic, microscopic, transmission electron microscopic and scanning electron microscopic observation of the nasal mucosa after endoscopic sinus surgery (ESS). This restoration process of mucosa can be used to appraise the effectiveness of the operation. METHODS: Thirty-one cases (53 sides) with chronic nasal sinusitis and nasal polyps were selected randomly, which had been undergone ESS operation during January to December, 2001. Biopsy of posterior frontanelle of the maxillary sinus were performed to observe the mucosa changes before the ESS and at 2-3 weeks, 8-11 weeks and 13-16 weeks after the ESS, respectively. RESULTS: Epithelia shedding, proliferation, squamous metaplasia, glandular and fibrous tissue proliferation and lymphocytes infiltration were observed in all cases before the ESS. The microtubule abnormal and mitochondria diminishing and expanding existed in all cases. The morphological changes were not significant within 2-3 weeks after the ESS compared to the changes before the ESS. Eight-eleven weeks after the ESS, the nasal cavity turned clean and smooth. The number of pillar cells increased and the cilia swelling, short cilia, and many pillar cells with microvillus were seen. The number of goblet cells increased. Pathological glandular and fibrous proliferation were seen in all cases (53 sides). The operated cavity was clean and covered completely by epithelia (50 sides) 13-16 weeks after ESS. The length of cilia increased and arrangement of the cilia line was in the same direction. The structure of microtubules was clear. The mitochondria was elongated and became dense (49 sides). The pathological repairing was at work (3 sides). CONCLUSIONS: After the ESS, the recovery of the mucus needs 3 months. Some pathological changes are irreversible and the cilia pathological change is related with its restoration. The more cilia reserved and timely local cleaned after ESS, the more helpful to the restoration of the cilia morphology and function. The effective of ESS can be evaluated through the histological-morphological changes. timely local cleaned after ESS, the more helpful to the restoration of the cilia morphology and function. The effective of ESS can be evaluated through the histological-morphological changes.

Adolescent↗
PubMed1993

The microbiology of acute and chronic sinusitis and otitis media:a review.

There exists no real controversy about the role of aerobic bacteria in acute sinusitis and in acute otitis media. The "infernal trio" Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are by far the most common pathogens in these acute infections. On the contrary, there is still much debate about the normal flora of the paranasal sinuses and the middle ear, although there are some reports of the presence of anaerobes and aerobes in the majority of the normal paranasal sinuses. In chronic sinusitis bacteriological cultures show a greater variation than those in acute sinusitis. Nonetheless, it is demonstrated in most studies that besides the "infernal trio" additional bacteria are present, including anaerobes and gram negative bacteria. In otitis media with effusion (OME) we find the same bacteria as in acute otitis media (AOM) and a pathologic flora in the nasopharynx seems to be important for both AOM and OME. In chronic otitis cultures are nearly always positive and reveal Pseudomonas species, Klebsiella pneumoniae, Staphylococcus aureus, Proteus species and anaerobes.

Acute Disease↗
PubMed2000

Does the severity of sinus computed tomography findings predict outcome in chronic sinusitis?

OBJECTIVES: We studied the association between the severity of pretreatment CT scan findings and the improvement in symptoms of chronic sinusitis after treatment. METHODS: We analyzed data from an ongoing prospective, nonrandomized clinical outcomes study of patients treated for chronic sinusitis at a tertiary-care academic medical center (n = 57, mean age 46.8 years). Disease-specific symptom severity was measured with a validated health status instrument, and CT stage was quantified with the Harvard CT staging system. RESULTS: In a multivariate analysis, symptom severity based on CT findings emerged as a strong predictor of both improvement in symptom score outcome (beta = 0.47, P = 0.01) and absolute symptom level after treatment (beta = -0.58, P = 0.001). CONCLUSIONS: Severity as assessed by a pretreatment CT scan is a strong predictor of outcome. Patients with higher symptom severity based on CT scans showed significantly larger improvement and lower absolute levels of symptom severity after treatment. This study links CT scan findings and subjective patient-based outcomes (symptom scores) using a validated outcomes instrument.

Chronic Disease↗
PubMed1999

Endoscopic sinus surgery improves pulmonary function in patients with asthma associated with chronic sinusitis.

We evaluated the clinical efficacy of endonasal endoscopic sinus surgery (ESS) in patients with asthma associated with chronic sinusitis. Twenty-one patients (13 men and 8 women) from 27 to 72 years old were enrolled in this study. All patients had had sinus-related symptoms for more than 3 months and had computed tomographic evidence of paranasal sinus opacification. Fifteen patients underwent bilateral endonasal ESS under local anesthesia, and 6 other patients without surgery were controls. The sinus-related symptoms of the preoperative and postoperative periods were assessed via a questionnaire. The period 6 months prior to surgery was compared with that 6 months postoperatively with regard to peak expiratory flow and total dosage of systemic glucocorticoids. Sinus-related symptoms in the ESS group were significantly improved 6 months postoperatively. The average peak expiratory flow 6 months following surgery was improved in the ESS patients, ranging from 40 to 190 L/min. Seven patients showed a reduction in the need for corticosteroids, whereas 2 patients were unchanged and 2 patients required larger dosages. The remaining 4 patients needed no corticosteroids before or after ESS. No significant changes in sinus-related symptoms or peak expiratory flow were obtained for the control group. Improvement of paranasal sinus disease by successful ESS can alleviate pulmonary dysfunction in asthma associated with chronic sinusitis. We believe that adequate and positive treatment for chronic sinusitis would reduce not only the nasal and sinus-related symptoms evoked by chronic sinusitis, but also some of the signs induced by asthma.

Adult↗
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↗