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PubMed2000

Physiologic variations in dural venous sinus flow on phase-contrast MR imaging.

OBJECTIVE: Our study quantifies normal physiologic variations of dural sinus flow using phase-contrast MR imaging. SUBJECTS AND METHODS: Fifteen volunteers were imaged using nontriggered and triggered phase-contrast MR venography of the superior sagittal and transverse sinuses. Triggered scans were obtained during regular breathing; nontriggered scans were obtained during regular breathing, breath-holding, deep inspiratory breath-holding, and deep expiratory breath-holding. Analysis of variance, Bonferroni method, and Dunn post hoc analysis were used to determine any significant differences in the mean flow and velocity between the different breathing maneuvers. A paired t test was used to compare flow between sinuses during regular breathing. RESULTS: Deep inspiratory breath-holding and deep expiratory breath-holding resulted in a significant decrease in blood flow and velocity in all dural sinuses compared with regular breathing. During deep inspiratory breath-holding, blood flow decreased 30.8% in the superior sagittal sinus, 19.7% in the left transverse sinus, and 19.1% in the right transverse sinus. Similarly, during deep expiratory breath-holding, blood flow decreased 30.2% in the superior sagittal sinus, 20.8% in the left transverse sinus, and 20.3% in the right transverse sinus. The sum of the flow in the transverse sinuses was significantly greater than in the sagittal sinus. Normal pulsatility of dural sinus blood velocity was also characterized for all measured sinuses. CONCLUSION: Characterization of variations in dural sinus velocity and flow as a function of the cardiac cycle and breathing maneuvers, using phase-contrast MR imaging, may help separate physiologic from pathologic changes of flow resulting from conditions that influence the cerebrovascular circulation.

Adult↗
PubMed1985

Anatomic variations of venous sinuses in the region of the torcular Herophili.

In this study of 110 cranial cavities from adult cadavers, the superior sagittal sinus was found to divide into two channels. In most cases, the division was associated with a dural partition. Essentially, the variations as observed in this study could be grouped into three types: Type 1 includes those specimens in which the sagittal sinus drains into one lateral sinus and the straight sinus into the other, with no connection between the two. Type 2 includes those specimens in which the superior sagittal sinuses and the straight sinus fork, and the forks from both sinuses join to form the lateral sinuses. Type 3 includes those specimens in which a confluence of sinuses exists, varying from a common pool to merely a potential confluence, depending upon the presence of pads, incomplete partitions, and complete partitions of dura mater. Rare findings previously not reported consist of double straight sinuses draining into one transverse sinus; the superior sagittal sinus dividing into three channels with two transverse sinuses on one side; a transverse sinus originating from a tentorial vein; and drainage of a tentorial vein into the confluence of sinuses.

Cranial Sinuses↗
PubMed2001

Fungal infections of the paranasal sinuses.

Fungal infections can be mainly grouped into four types. The invasive forms are acute sinusitis (fulminant), chronic sinusitis (indolent), whereas the non-invasive forms are mycetoma and allergic fungal sinusitis. From December 1993 to December 1997, 27 cases of fungal sinusitis, 22 of which were noninvasive forms, and 5 of which were invasive forms, were treated and are presented in this study. When we classified the patients with fungal sinusitis, 11 were diagnosed as mycetoma, 9 as allergic fungal sinusitis, 3 as acute fulminant sinusitis and 2 as chronic indolent sinusitis, while 2 patients were not included in our four groups of sinusitis. In all mycetoma cases the active agent was Aspergillus. Patients with non invasive forms of sinusitis were all treated with endoscopic sinus surgery. 2 of the patients with invasive forms of sinusitis underwent maxillectomy and they were given Amphotericin-B. With a mean follow up of 20 months, only 3 recurrences were seen. The infection recurred in 2 patients with allergic fungal sinusitis and 1 patient with chronic invasive sinusitis. However, 2 patients with acute fulminant invasive sinusitis died before they were operated on, and 1 patient died postoperatively.

Acute Disease↗
PubMed2001

[Metastases to the paranasal sinuses: case report and review of the literature].

The case of an 87-year old man with widespread prostatic cancer is reported. During the autopsy macroscopically visible metastases were found within the frontal sinuses. These tumor masses destroyed the posterior osseous wall of the frontal sinus and formed polypoid bulging masses. In contrast to the macroscopically unaffected mucous membrane of the sphenoid sinus the maceration specimen of the skull base demonstrated a spongious-mossy, osteoplastic metastasis, lining the sphenoid sinus like a tapestry. This affection started from an exhaustive osteoplastic metastasis within the clivus. No metastases could be found in both antrums or the ethmoids. Retrospectively no symptoms from the paranasal sinuses could be eruated, only occasional pain of the frontal bone. The review of the world literature with 123 reports revealed 169 cases. Renal cell carcinomas most frequently metastasize into the paranasal sinuses (67 cases), followed by bronchogenic carcinomas (15 cases). Thyroid cancers and cancers of the mammary gland are responsible for 13 respectively 14 cases. The prostate also adds 12 cases. The paranasal sinuses are affected in diminishing frequency: maxillary sinus (55 cases), sphenoid sinus (37 cases), ethmoidal cells (23 cases) and frontal sinus (15 cases). In 38 cases exhaustive metastases affecting two or more paranasal sinuses are reported. The statement of literature, that metastases affecting the paranasal sinuses are much more frequent than reported, cannot be supported by our study, because the intensive autoptic investigation of 50 skulls of patients suffering from widespread cancers revealed no further cases of metastatic processes of the paranasal sinuses.

Aged↗
PubMed1996

Does sinus vaginal epithelium persist in the adult mouse vagina?

It generally is held that the murine vagina develops from the urogenital sinus and the lower portion of the Müllerian ducts and that both endodermally derived sinus epithelium and mesodermally derived Müllerian epithelium contribute to the adult vagina. We tested Müllerian and urogenital sinus-derived vaginal epithelia for their ability to differentiate in response to various hormonal conditions and compared these responses to those of the in situ vagina. Tissue recombinants were prepared with 0-day Müllerian-derived vaginal epithelium and vaginal mesenchyme. Similarly, tissue recombinants containing urogenital sinus-derived vaginal epithelium were prepared with either 0-day sinus vaginal epithelium or 16-day fetal urogenital sinus epithelium and vaginal mesenchyme. Müllerian- or sinus-derived vaginal mesenchyme was used to construct the tissue recombinants; however, the source of the mesenchyme had no influence on the results. Tissue recombinants were grafted to the renal capsule of female mice, allowed to develop for 1 month, and exposed to various hormonal treatments. In diethylstilbestrol-treated hosts, all tissue recombinants regardless of the source of the epithelium were lined by a cornified epithelium. In contrast, only in tissue recombinants containing mesodermally derived Müllerian vaginal epithelium did the epithelium mucify in response to progesterone plus estrogen or become atrophic in ovariectomized hosts. These are the same epithelial modifications seen in the hosts' vagina. Tissue recombinants containing endodermally derived urogenital sinus epithelium or sinus vaginal epithelium and grafts of intact urogenital sinus maintained a stratified squamous noncornified epithelium in both ovariectomized and progesterone plus estrogen-treated hosts. Furthermore, in tissue recombinants containing Müllerian vaginal epithelium and vaginal mesenchyme, estrogen induced a slightly higher epithelial labeling index than in tissue recombinants containing urogenital sinus epithelium or sinus vaginal epithelium. The epithelial labeling index was the same regardless of the source of the vaginal mesenchyme. These results indicate that Müllerian-derived and sinus-derived vaginal epithelia are not equivalent and suggest that Müllerian vaginal epithelium displaces sinus vaginal epithelium during postnatal development. The replacement may result in part from a slight but consistently higher proliferation rate in Müllerian versus sinus vaginal epithelium.

Animals↗
PubMed1994

Major coronary sinus abnormalities: identification of occurrence and significance in radiofrequency ablation of supraventricular tachycardia.

Coronary sinus catheterization is important in electrophysiologic study of patients with supraventricular tachycardia. It can provide an anatomic guide for localization of slow atrioventricular nodal pathway and accessory pathways in the posteroseptal area and left-sided atrioventricular ring. However, the morphologic features of the coronary sinus and its significance in patients with supraventricular tachycardia have not been determined. Four hundred eight patients with accessory pathway-mediated tachyarrhythmia and atrioventricular nodal reentrant tachycardia underwent coronary arteriography for a coronary sinus venogram before electrophysiologic study and radiofrequency ablation. The venous phase of left coronary arteriography that delineated the morphologic features of the coronary sinus was carefully evaluated and recorded in multiple projections. Major coronary sinus abnormalities were defined, and they were found in 12 patients (2.9%). Six patients had angulation of the coronary sinus, 4 patients had hypoplasia of the coronary sinus, 1 patient had narrowing of the proximal coronary sinus, and 1 patient had a fistula from persistent left superior vena cava to the coronary sinus. Of 175 patients with atrioventricular nodal reentrant tachycardia, only 1 patient had major coronary sinus abnormalities (proximal angulation), whereas of 233 patients with accessory pathway-mediated tachycardia, 11 patients had major coronary sinus abnormalities (0.6% vs 4.7%, p < 0.05). The accessory pathways in patients with major coronary sinus abnormalities were located exclusively in the left free wall and posteroseptal area. Proper coronary sinus catheterization could be accomplished in 396 patients with a normal coronary sinus, whereas it could be accomplished in only 1 of the 12 patients with major coronary sinus abnormalities (396/396 vs 1/12, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Interatrial communication through the mouth of the coronary sinus.

OBJECTIVES: We describe the structure of, and suggest an etiology for, the interatrial communication which can occur through the mouth of the coronary sinus. Based on the study of human embryos, we propose that the defect is best explained by dissolution of the wall of the coronary sinus adjacent to the left atrium, permitting shunting between the atriums through the right atrial orifice of the sinus. BACKGROUND: An interatrial communication across the mouth of the coronary sinus defect was first described in 1965 by Raghib and colleagues, its existence being predicated on the basis of incomplete formation of the left "atriovenous fold". Their hypothesis implies that the coronary sinus never develops, and thus the atrial septum itself is incomplete. METHODS: We have studied the development of the coronary sinus in a series of human embryos. Based on this work, we present the anatomical findings in 6 specimens with varying degrees of dissolution of the walls of the coronary sinus, and ten specimens with isomerism of the right atrial appendages, in which the sinus has never been formed. RESULTS: The coronary sinus defect is not a hole within the atrial septum, but a communication between the atriums through the mouth of the sinus. There was a range of defects in our series of specimens with usual atrial arrangement, extending from complete absence of the walls which normally separate the coronary sinus from the left atrium, to small fenestrations between this vessel and the left atrial cavity. In the hearts with isomerism of the right atrial appendages, however, we never observed an orifice of the coronary sinus. Thus, a coronary sinus defect cannot exist in this setting. CONCLUSIONS: Our findings indicate that the defect requires initial formation of the walls of the coronary sinus, but with subsequent dissolution of the wall adjacent to the left atrium. This produces a communication between the atriums through the mouth of the sinus.

Autopsy↗
PubMedDate not supplied

Maxillary sinusitis as a surrogate model for CF gene therapy clinical trials in patients with antrostomies.

BACKGROUND: Assessing the biological activity and clinical efficacy of gene therapy is critically important in cystic fibrosis (CF). It is widely accepted that clinical testing using surrogate markers including pulmonary function will be useful in assessing clinical efficacy. One problem with pulmonary surrogate markers of CF disease is the large number of patients and length of time required to demonstrate clinical efficacy. An alternative to pulmonary testing of new CF treatments is use of the maxillary sinuses as a surrogate model of CF lung disease. Using CF sinusitis as a surrogate model for testing clinical efficacy of new treatments is attractive because CF upper respiratory disease is similar to the lower respiratory disease with respect to electrophysiology and microbiology. METHODS: Sinusitis recurrence in untreated sinuses was analyzed during a prospective, randomized, unblinded, dose-escalation, within-subjects, phase I clinical trial of the adeno-associated virus mediated cystic fibrosis transmembrane conductance regulator (AAV-CFTR) gene transfer. RESULTS: Clinical symptoms combined with sinus endoscopy proved useful in the diagnosis of unilateral and bilateral sinusitis recurrence. Sinusitis recurred at a rate of 45% during one month of follow-up. IL-8 concentration rose in sinus fluids from affected sinuses. Bacterial cultures and increased sinus leukocytes corroborated recurrent sinusitis. Sinus CT scans were also useful in diagnosing recurrent sinusitis in this surrogate model of CF infectious exacerbations. CONCLUSIONS: CF sinusitis as a surrogate for lung disease is particularly well-suited for phase II clinical trials of gene transfer agents, with the potential for measuring clinical efficacy in relatively small numbers of patients over relatively short periods of time.

Adult↗
PubMed1989

Experimentally induced sinusitis: the importance of vasomotor regulation.

An acute pneumococcal maxillary sinusitis was induced in New Zealand white rabbits by unilateral obstruction of the sinus ostium and then injecting 10(8) Streptococcus pneumoniae into the sinus. After subjecting this bacterial strain to one animal passage, the bacteria were reisolated in nine of ten infected maxillary sinuses. All rabbits developed a unilateral purulent sinusitis, while a non-purulent sinusitis could be induced by occlusion only of the maxillary ostium. By using a non-diffusable tracer, microspheres labelled with Sn113, blood flow measurements were performed on these sinuses. These studies showed that the blood flow of the infected sinuses was significantly higher than on the control side. However, in chronic sinusitis (with a blocked ostium), the blood flow did not differ significantly from that on the control side. Biochemical studies in the animals with purulent sinusitis demonstrated that lactate concentration in the mucosa was significantly higher as compared to the control side. The glucose concentration was significantly lower in the mucosa of the infected side, as was the ATP content of the sinus mucosa in purulent sinusitis. These results indicate an increased glycolysis as well as a relative energy depletion in the sinus mucosa in purulent sinusitis, which could result in an impaired epithelial function.

Animals↗
PubMed1991

Sinus parasystole.

Sinus parasystole is the expression of a protected nondominant sinus pacemaker, which is totally independent of the dominant rhythm. Two forms of sinus parasystole are described: (1) an active form, where both the dominant and the parasystolic pacemakers are located within the sinus node and (2) a passive form, where the basic rhythm is ectopic and the sinus pacemaker is protected as a result of complete retrograde SA block. Three cases of sinus parasystole are analyzed. In the active form of the arrhythmia the parasystolic sinus P waves are identical to those of the basic sinus rhythm. The diagnosis is suggested by variably coupled premature sinus P waves occurring with mathematically related intervals. This relationship between the parasystolic intervals can not be precise whenever complicating factors such as modulation occur. The recognition of active sinus parasystole is difficult, since the parasystolic P waves do not differ from basic P waves, so that the pattern resembles that of sinus arrhythmia or sinus extrasystoles. The passive form of sinus parasystole is more easily recognized due to the clear-cut difference between the dominant ectopic atrial waves and the "parasystolic" sinus P waves, which manifest with variable coupling intervals and reflect mathematically related intervals in between.

Adult↗
PubMed1994

Assessment of inflammation in noninfectious chronic maxillary sinusitis.

BACKGROUND AND AIM: Pathologic examination of the sinus mucosa and titration of inflammatory mediators in the sinus fluid were carried out to characterize inflammation in chronic sinusitis and determine whether patients with chronic allergic rhinitis (CAR) and sinusitis differ from patients with chronic nonallergic rhinitis (CNAR) and sinusitis. METHODS: Nine control subjects (patients requiring ear, nose, and throat surgery not related to sinusitis), 12 patients with CAR and sinusitis, and 13 patients with CNAR and sinusitis were investigated. Eosinophil cationic protein, tryptase, myeloperoxidase, histamine, and prostaglandin D2 were measured in the sinus lavage fluids, and cells were enumerated. The cellular infiltrate was studied by immunohistochemistry with monoclonal antibodies against eosinophil cationic protein (eosinophils), tryptase (mast cells), neutrophil elastase (neutrophils), CD3 (lymphocytes), CD68 (macrophages), and proliferating cell nuclear antigens. RESULTS: Neutrophils were not increased in sinusitis. In comparison with control subjects, patients with CAR and CNAR with sinusitis showed significant increases in eosinophils and macrophages in biopsy specimens and in eosinophil cationic protein in sinus lavage fluids. In comparison with patients with CNAR, patients with CAR had an increased number of intraepithelial mast cells and lymphocytes. CONCLUSIONS: These findings suggest that patients with CNAR and sinusitis can be distinguished from patients with CAR and sinusitis, which resembles nonallergic rhinitis with eosinophilia syndrome.

Adolescent↗
PubMed1998

Sinusitis in the common cold.

BACKGROUND: Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections. OBJECTIVE: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults. METHODS: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed. RESULTS: On day 7, 39% of patients with the common cold in the placebo group (n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects. CONCLUSION: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur.

Adult↗
PubMedDate not supplied

Penetration of loracarbef into the maxillary sinus: a pharmacokinetic assessment.

Loracarbef, a beta-lactam antibiotic of the carbacephem class, is active in vitro against pathogens associated with acute maxillary sinusitis. To study the extent and duration of maxillary sinus fluid penetration after administration of loracarbef, 20 patients (10 men, 10 women; average age, 41 +/- 13 years) with acute sinusitis were treated with loracarbef 400 mg every 12 hours for 10 days. A lavage catheter was inserted into the maxillary sinus, and 150-microL sinus fluid samples were obtained at 0 (baseline), 0.5, 1, 1.5, 2, and 2.5 hours after the first dose and at 24 and 48 hours (12 hours after the second and fourth doses, respectively). Venous blood samples were obtained at the same times. Maxillary fluid and serum samples were frozen immediately at -20 degrees C to -70 degrees C until later bioassay using a direct agar diffusion method. Excluding missing data or inappropriately timed samples, the mean (+/- SD) sinus fluid concentrations were 0.16 +/- 0.12 microgram/mL at baseline, 0.23 +/- 0.17 microgram/mL at 0.5 hour, 1.11 +/- 1.44 micrograms/mL at 1 hour, 1.63 +/- 2.07 micrograms/mL at 1.5 hours, 1.75 +/- 2.01 micrograms/mL at 2 hours, and 1.60 +/- 1.96 micrograms/mL at 2.5 hours after dose. The mean sinus fluid concentration before the third dose (approximately 12 hours after the second dose) was 1.01 +/- 0.89 microgram/mL and before the fifth dose (approximately 12 hours after the fourth dose) was 0.88 +/- 0.90 microgram/mL. Taking the highest sinus fluid concentration measured in each patient, the mean peak sinus fluid concentration was 2.12 +/- 1.98 micrograms/mL (range, 0 to 6.7 micrograms/mL). The pretherapy peripheral leukocyte count appeared to have a statistically significant association (P < 0.01) with loracarbef sinus fluid penetration as estimated by the sinus fluid area under the concentration-time curve at 0 to 2.5 hours. Loracarbef 400 mg twice daily achieved sinus fluid concentrations that appeared to exceed the minimum concentration required to inhibit 90% of relevant acute sinusitis pathogens throughout the 12-hour interdose interval in most patients with acute maxillary sinusitis.

Adult↗
PubMed1996

[Development of the spheno-ethmoid paranasal sinus system using axial computerized tomography imaging].

BACKGROUND: Exact knowledge of age- and sex-related development of the paranasal sinuses is essential to assess their role in infantile diseases in the midface region. Moreover it helps to minimize the risk in case of therapeutic intervention. METHODS/PATIENTS: On the basis of more than 5600 axial computed tomographic images (CT images) we evaluated the sex-related size (width and length) and evidence of the different sinuses from birth to age 25 focussing on the central part of the paranasal sinuses, the ethmoidal cells, and the sphenoidal sinuses. RESULTS/CONCLUSIONS: The sphenoethmoidal complex is of special interest in early ages since it is already completely developed in newborns (ethmoidal cells: 94% for both sexes) or at least shows a rapid development during the first decade. After age 8, both sinuses are almost regularly represented on CT with identical percentages as an indication of common origin. This is confirmed by only slight differences in size between the two sexes (ethmoidal cells: 5,7 - 10,1%: sphenoid sinuses: 5,4-9,7%) after termination of expansion and by similar periods of expansion (ethmoid cells: until age 10, female, to 14, male and female in length; sphenoidal sinuses: until age 14, female, to 15, male and female) which partly differ from the other sinuses. However, the difference between male and female sinuses is statistically significant primarily at later ages (age 25: length of sphenoidal sinuses: p < 0.0001/width of ethmoidal cells: p = 0.0117/length of ethmoidal cells: p = 0.0072). The definitive size of the ethmoidal cells (male: width 16.4 mm x length 40.7 mm: female: 14.9 mm x 38.5 mm) agrees with the results obtained from anatomic and radiologic studies. In contrast, we found substantial variability in both directions (up to 214%) for the sphenoidal sinuses. Since on almost 60-70% of the CT images the intersphenoidal septum was not represented, we can provide more detailed data about the whole sphenoidal complex (male: width 31.0 mm x length 24.5 mm; female: 29.4 mm x 26.9 mm). In conclusion, our findings agree with the data from other studies using different methods. Moreover we can determine size of the different sinuses at any time between birth and age 25 for both sexes. The ethmoidal cells and the sphenoidal sinuses are highly significant in early infantile paranasal sinus diseases.

Adolescent↗
PubMed1990

Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia.

Maxillary sinus hypoplasia is an anomaly of the paranasal sinuses occasionally encountered by otolaryngologists. Although this entity has been previously reported, an association between maxillary sinus hypoplasia and anomalies of other paranasal sinus structures, such as the uncinate process, has not yet been described. Additionally, the literature lacks a system by which the various types of maxillary sinus hypoplasia can be classified using computerized tomographic (CT) imaging. Two hundred and two consecutive coronal sinus computerized tomographic scans from patients undergoing evaluation at our institution were analyzed to determine the prevalence of MSH and associated paranasal sinus anomalies. The overall prevalence of maxillary sinus hypoplasia was 10.4%. Three distinct patterns of hypoplasia were evident. Type I, characterized by a normal uncinate process, a well-defined infundibular passage, and mild sinus hypoplasia, occurred in 14 patients (6.9%). Type II, characterized by absence or hypoplasia of the uncinate process, an ill-defined infundibular passage, and soft-tissue density opacification of a significantly hypoplastic sinus occurred in 6 patients (3.0%). Type III, characterized by absence of the uncinate process and a profoundly hypoplastic, cleft-like sinus, occurred in 1 patient (0.5%). Recognition of associated anomalies of the uncinate process in patients with maxillary sinus hypoplasia undergoing sinus surgery is of utmost clinical significance because the uncinate process serves as a key landmark during functional endoscopic sinus surgery. Failure to recognize hypoplasia or absence of the uncinate process could lead to inadvertent intraoperative damage to the adjacent medial orbital wall.

Abnormalities, Multiple↗
PubMedDate not supplied

Antimicrobial effect on rabbit sinusitis after temporary ostial occlusion.

A key precipitating factor in the pathogenesis of acute bacterial sinusitis (ABS) is ostiomeatal obstruction. It has been postulated that ABS cannot resolve until the sinus ostium is patent. The primary purpose of this study is to quantify sinusitis resolution after temporary ostial occlusion in a rabbit model. A secondary aim is to quantify bacterial clearance with and without antimicrobial therapy in Staphylococcus aureus infected sinuses. A blinded, placebo controlled study in 10 New Zealand white rabbits was performed using Merocel as a temporary maxillary sinus ostial obstruction. Computerized tomography (CT) of the maxillary sinuses was obtained before and after bilateral ostial occlusion; sinuses were cultured and then the left sinus was injected with approximately 10(8) cfu/mL S. aureus. CT imaging and sinus cultures were obtained and then the ostial plugs were removed. Serial CT and cultures were done until sinusitis resolved and cultures were negative for S. aureus. Mean CT sinusitis scores increased with ostial obstruction and decreased with ostial plug removal (P < 0.0001 and P < 0.001). Injection of S. aureus did not significantly change mean CT sinusitis scores despite being cultured from 45% of sinuses. Antimicrobial therapy was not significant in reducing mean CT scan sinusitis scores or positive cultures. Resolution of mucosal swelling is more dependent on relief of ostial obstruction rather than antimicrobial therapy in this rabbit model.

Animals↗
PubMedDate not supplied

Short and long-term treatment results in chronic maxillary sinusitis.

The diagnostic criteria and the length of the observation period are essential factors influencing the results of treatment of maxillary sinusitis. In 198 patients (244 sinuses) with chronic maxillary sinusitis of either rhinogenous or dental etiology all patients were judged as cured or improved at the short-term control 1-3 months after completion of therapy. The long-term observation (mean 3.5 years) revealed different figures of healing. Satisfactory results after conservative therapy were seen in only 34% while the Caldwell-Luc operation gave good results in 80%. In sinusitis of dental origin, dental treatment combined with local sinus surgery was successful in 90%. In 78 sinuses investigated by sinoscopy, discrepancy between the symptoms and the endoscopic findings was seen in 14 cases (18%). Information obtained by questionnaire is therefore unreliable. In 30 sinuses operated upon with the Caldwell-Luc procedure, discrepancy between radiographic and endoscopic findings was seen in 3 cases (10%). Contributory factors, e.g. nasal polyps, dental infections and nasal allergy were found in 48 out of 84 sinuses not completely healed at the long-term control. Patients treated for chronic maxillary sinusitis must be followed up over a long period. A clinical control after 1-2 years, including sinoscopy or sinus radiographs, is recommended even in patients free from symptoms of sinusitis. Sinoscopy seems to be more reliable than sinus radiography and should be performed if the sinus radiographs show any pathology. The patients are also recommended to visit their dentists regularly, due to the close relationship between dental infections and chronic maxillary sinus diseases.

Anti-Bacterial Agents↗
PubMed1995

[Combined macro-micro-endoscopic technique (COMMET) in endonasal sinus surgery: II. Objective assessment and results].

To optimize success in sinus surgery, we use a combined macro-micro-endoscopic technique (COMMET). This technique effectively combines use of the headlamp, microscope, and endoscope according to the demands of each anatomical region. Between April 1991 and March 1994, we successfully performed this technique on 461 patients (798 sides). According to CT scans, about 40% of the patients had pansinusitis, and about 30% of the patients had anterior and posterior ethmoiditis combined with inflammation of other sinuses. Hence, severe cases requiring total ethmoidectomy accounted for about 70% of all sides. All patients were operated on under general anesthesia. The objective of this operation was restoration of drainage and ventilation, and then to allow recovery of the reversible mucosal lesions. The goal of surgery was to normalize all paranasal sinuses. In many patients, there is little correlation between postoperative objective findings in the paranasal sinuses and subjective improvement. Therefore, postoperative subjective improvement cannot be used as the criterion for evaluating the improvement of sinus disease. Hence, we established an objective grading system based on CT and endoscopic findings and evaluated improvements in each sinus after drainage and ventilation had been restored. The rates of normalization over 1 year following surgery (mean follow-up time was 19-20 months) were 64% in the frontal sinus, 72% in the anterior ethmoid sinus, 68% in the maxillary sinus, 90% in the posterior ethmoid sinus and 80% in the sphenoid sinus. The results differed from sinus to sinus, suggesting that there are different factors impairing recovery in each sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗