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PubMed1997

Histamine 2 receptor blocker-ranitidine and sinus node dysfunction.

BACKGROUND: Histamine 2 (H2) receptors were observed to be present in the sinus node. H2 receptor blockers could attenuate the histamine-induced increase in sinus rate and could thereby worsen sinus node dysfunction. However, the data pertaining to electrophysiological effects of H2 receptor blocker ranitidine on sinus node function are not available as yet, although bradycardia has been occasionally reported along with ranitidine. The present study evaluates the electrophysiological effects of ranitidine on sinus node function, and also determines the safety of administering ranitidine to patients suffering from sinus node dysfunction. METHODS: Thirty-nine patients with clinical diagnosis of sinus node dysfunction were selected for this study. Electrophysiological effects of intravenous injection of 150 mg ranitidine on sinus node function was evaluated. Tests were performed for 21 patients in the basal state (Group 1) and for 18 patients (Group 2) after autonomic blockade (propranolol 0.2 mg/kg, and atropine 0.04 mg/kg). The sinus cycle length (SCL), sinus node recovery time (SNRT), corrected sinus node recovery time (CSNRT), sinoatrial conduction time (SACT), atrio-His (AH) and His-ventricle (HV) intervals and blood pressure (BP) before and after ranitidine were analyzed. RESULTS: In Group 1, changes in SCL, SNRT, CSNRT, SACT, AH, HV and BP were not found to be significant. However, in Group 2, wherein the patients received ranitidine after autonomic blockade, it was observed that ranitidine significantly prolonged SCL (905.0 +/- 31.0 to 1000.0 +/- 40.0 msec, p = 0.001), decreased systolic BP (134.7 +/- 4.7 to 124.8 +/- 4.8 mmHg, p < 0.001), and diastolic BP (71.9 +/- 2.0 to 67.9 +/- 1.9 mmHg, p = 0.001), while the changes in SNRT, CSNRT, SACT, AH and HV were not significant. CONCLUSIONS: A clinical dose of 150 mg ranitidine must be administered by a slow intravenous infusion for at least 5 minutes in case of patients suffering from sinus node dysfunction. Continuous monitoring of BP and heart rate are necessary, especially in cases of autonomic denervation.

Adult↗
PubMed1989

Sphenoid sinus mucocele.

Sphenoid sinus mucocele is a rare entity that can occur alone or as a result of ethmoid sinusitis and polyposis. A myriad of presentations is possible due to the presence of important contiguous neurologic and vascular structures. Past surgical approaches to the sphenoid sinus have problems associated with them. The endoscopic sinus technique offers outstanding visualization and a safe, straight-forward approach to the sphenoid sinus. Four patients with documented mucocele of the sphenoid sinus were treated successfully with endoscopic sinus surgery. The technique involves partial removal of the inferior middle turbinate and direct entrance into the sphenoid sinus through the anterior sinus wall. Other sinus abnormalities can be treated simultaneously as required. Sphenoid sinus mucocele is discussed from the standpoint of cause, clinical presentation, and treatment options.

Adolescent↗
PubMed2004

[Infection transfer between the maxillary sinus and endocranium].

BACKGROUND: Rhinogenous brain abscesses usually originate from a frontal sinusitis, rarely from the ethmoidal system or the maxillary sinus. However, there are different pathways that can lead to the transfer of a maxillary infection to the endocranial compartment. PATIENT: A patient with frontal brain abscesses originating from a maxillary sinus infection is presented and diagnostic steps, therapy as well as pathophysiology are discussed. PATHOPHYSIOLOGY: The venous plexus of the maxillary sinus drains through the posterior wall of the antrum of Highmore into the deep facial vein that leads into the pterygoid plexus and then through the rete foraminis ovalis into the cavernous sinus. In addition, numerous small veins perforate the osseous roof of the maxillary sinus and enter the orbit joining the superior or inferior ophthalmic vein. They are also connected to the cavernous sinus or the pterygoid plexus. A number of veins perforate the anterior wall of the maxillary sinus communicating with the angular vein that drains into the superior ophthalmic vein and into the cavernous sinus. From the cavernous sinus, the blood arrives at the deep middle cerebral vein that usually communicates through the white substance towards the brain's superficial venous system. CONCLUSION: The presence of these maxillo-cerebral venous anastomoses explains the spread of infection from the maxillary sinus to the white substance of the brain without any direct association with the base of the skull.

Adult↗
PubMed1988

Carotid sinus hypersensitivity in patients with unexplained syncope: clinical, electrophysiologic, and long-term follow-up observations.

To assess the incidence and clinical characteristics of carotid sinus hypersensitivity and the relationship to electrophysiologic findings, 76 patients with unexplained syncope underwent carotid sinus massage during electrophysiologic studies for syncope evaluation. Twenty-one patients (28%) were found to have carotid sinus hypersensitivity. Of these 21 patients, 11 (52%) had coronary artery disease, two (10%) had hypertensive heart disease, and eight (38%) had no organic heart disease. During electrophysiologic studies, abnormal sinus node function was found in three patients (14%), abnormal atrioventricular (AV) node function was noted in four (19%), and combined abnormal sinus node and AV node functions were seen in three (14%). Eleven patients (53%) had a normal electrophysiologic study. During carotid sinus massage, sinus arrest alone was observed in 12 patients (57%), and combined sinus arrest and AV nodal block was seen in nine (43%). Thirteen patients were treated with a permanent pacemaker, in whom either carotid sinus massage reproduced the symptom or concomitant sinus node or AV node abnormality, or organic heart disease was present. With a mean follow-up of 42 +/- 19 months, none of these 13 patients had recurrent syncope. However, one of eight patients (13%) who did not receive a pacemaker had recurrence of syncope. Subsequently, this patient has done well after implantation of a pacemaker. These observations suggest that there is a significant incidence of carotid sinus hypersensitivity in patients with unexplained syncope. Permanent pacing appears to be beneficial in selected patients based on clinical and electrophysiologic findings.

Arrhythmia, Sinus↗
PubMed2004

The role of agger nasi air cells in patients requiring revision endoscopic frontal sinus surgery.

OBJECTIVES: To determine the association of agger nasi air cell disease with frontal rhinosinusitis, assessed by computed tomography (CT), in patients who require revision functional endoscopic sinus surgery (FESS). METHODS: We prospectively collected data on patients undergoing revision FESS at a tertiary care medical center over an 18-month period. Sinus CT scans were graded as per Lund-Mackay. Frontal sinus findings on CT scan were correlated with the presence or absence of disease in agger nasi air cells. RESULTS: Eighty patients underwent revision FESS in an 18-month period. A total of 160 sides were evaluated by sinus CT scan with agger nasi being present in all but 11 sides (93%). One patient did not have a pneumatized frontal sinus on 1 side and so 148 sides were available for study. Frontal sinus disease was present in 119 and absent in 29 sides. The average CT grade of patients with frontal rhinosinusitis was 8.4 while it was only 3.0 in patients without frontal rhinosinusitis (P = 0.000). Agger nasi air cell disease was present in only 3 of 29 (10%) sides in patients without frontal rhinosinusitis and was present in all 119 (100%) sides of patients with frontal rhinosinusitis (P = 0.0000). CONCLUSION: Agger nasi air cells are a common anatomic feature, present in 93% of our patients. Agger nasi air cell disease correlates strongly with frontal sinus disease as assessed by sinus CT scan in patients undergoing revision FESS. In addition, frontal sinus disease correlates with the severity of overall sinus disease as determined by sinus CT scan.

Adolescent↗
PubMed2005

Routine histopathology in uncomplicated sinus surgery: is it necessary?

OBJECTIVE: To evaluate the incidence of occult pathology in routine, uncomplicated endoscopic sinus surgery, and to suggest guidelines for when to send specimens for histopathologic exam. STUDY DESIGN AND SETTING: Retrospective analysis of case records of 790 patients who underwent 868 endoscopic sinus surgeries at a tertiary care center from 1986 to 2003. Indications were chronic sinusitis, recurrent acute sinusitis, nasal polyposis, or combinations of these diagnoses. All cases were considered routine and did not involve preoperative suspicion of neoplasm or other complicating factors. Charts were reviewed for surgical indication, patient age, laterality of disease, history of prior sinus surgery, intraoperative suspicion of tumor, and final histopathology. RESULTS: In 868 cases of endoscopic sinus surgery, occult neoplasm was diagnosed in 2 patients (0.23%). In one patient, the initial surgery cured the lesion. Final histopathology of the remaining 866 (99.8%) specimens was consistent with inflammation and/or nasal polyposis. In 121 cases of unilateral sinusitis, none was positive for neoplasm. In 277 cases involving bilateral nasal polyposis and 13 involving unilateral polyposis, no neoplasms were found. Intraoperative suspicion of neoplasm occurred in 12 cases, with all specimens read as consistent with sinusitis and/or polyposis. CONCLUSIONS: Histopathologic review of every specimen obtained in routine sinus surgery for sinusitis and/or nasal polyposis is not indicated. Submission of specimen is indicated in routine cases when: 1) there is intraoperative suspicion of tumor, 2) unilateral nasal polyposis is present, 3) unilateral sinus opacification is present, and 4) additional diagnostic information is needed (eg, presence of eosinophils, fungal forms, etc.). SIGNIFICANCE: Establishes a safe and reasonable standard of care, with potential cost savings and medico-legal ramifications.

Adolescent↗
PubMed2005

Prevalence of pus in radiologically diseased sinuses in patients undergoing surgery for chronic rhinosinusitis.

OBJECTIVE: To establish the prevalence of pus in radiologically diseased sinuses in patients undergoing sinus surgery and to correlate this with the bacterial load in the sinuses. STUDY DESIGN AND SETTING: A prospective study performed on adult patients with the diagnosis of chronic sinusitis undergoing endoscopic sinus surgery at an Adelaide group of academic hospitals. In 45 consecutive and unselected patients, a radiologically diseased sinus was surgically opened, and a specially designed suction aspirator was placed into the sinus under endoscopic control. These aspirates were Gram stained and cultured to quantify the polymorphonuclear neutrophil count, bacterial flora, and bacterial colony count. The CT scans of all patients were graded by using the Lund-Mackay scoring system. RESULTS: A variety of bacteria, most commonly staphylococci, were cultured from a radiologically diseased sinus in 88% of patients. There was no correlation between the bacterial colony count and presence of pus, and only 11% of patients had microscopic evidence of inflammation in sinus aspirates. There was no correlation between the Lund-Mackay CT score and the presence of pus in the sinus. CONCLUSIONS: The majority of patients undergoing surgery for chronic sinusitis did not have a purulent exudate, and there was no correlation with the bacterial load. The usefulness of antibiotics in the treatment of chronic rhinosinusitis, in the absence of macroscopic pus, is questionable.

Adult↗
PubMed2001

Paranasal sinus computed tomographic findings of children with chronic cough.

OBJECTIVE: Chronic cough is a frequent problem in the practice of clinical pediatrics, and sinusitis is a common etiologic factor. In this study, our aim was to determine the prevalence of sinus abnormalities in pediatric patients presenting with chronic cough. METHODS: Forty-two patients, ranging from 3 to 16 years of age from both sexes completed the study. Paranasal sinuses were examined by coronal paranasal sinus limited computed tomographic scan. The CT scan findings were categorized as no disease, minimal, moderate and severe sinusitis. RESULTS: The most frequent symptoms after cough were rhinorrhea, sniffling, and halitosis. We found sinus abnormalities in 66.6% and no abnormality in 33.3% of the children. Age and sex were not important factors in sinus disease. There was no correlation between sinus findings and any of symptoms. The most common anatomical abnormalities were concha bullosa, paradoxical middle turbinate, Haller's cells, and deviated nasal septum. These abnormalities were not correlated with sinus disease. CONCLUSION: Paranasal sinus abnormalities are common among pediatric patients with chronic cough and imaging studies of the sinuses should be considered in these children.

Adolescent↗
PubMed1983

Frontal sinusitis and its intracranial complications.

Although there has been a significant decrease in the incidence of frontal sinus disease since the advent of antibiotics, frontal sinus infection still occurs and may follow a clinical course not unlike that seen during the preantibiotic era. Secondarily to cranial and intracranial invasion the following complications may occur: osteomyelitis, cavernous sinus thrombosis, meningitis, extradural, subdural and cerebral abscess. The proximity of the frontal sinus to both the dura and the marrow of the frontal bone, as well as a rich communicating venous system, lends support to the facility of intracranial extension. Classically, frontal sinusitis presents with headache or pain usually following an upper respiratory infection. Purulent nasal discharge may be noted on physical examination. Roentgenographic studies will show opacification or an air-fluid level within the sinus. We present 4 cases of intracranial complications of frontal sinusitis seen in male adolescents. It is our contention that this disease bears a notable preponderance in males; a postulation that appears to be substantiated in the literature. Frequently even the classic signs and symptoms of frontal sinusitis may be undetected, which indicates that certainly the more subtle presentation of this disease may escape diagnosis during the course of examination. The use of CT scanning has proved an invaluable tool in the diagnosis of both frontal sinusitis and intracranial involvement. The importance of its incorporation into the diagnostic workup of the patient with frontal sinus disease cannot be overemphasized. We advocate aggressive medical and surgical management for all adolescents presenting with frontal sinusitis in an attempt to avoid possible intracranial complications.

Adolescent↗
PubMed1999

The role of computed tomography scans in evaluating sinus disease in pediatric patients.

OBJECTIVES: To determine the incidence and severity of sinus abnormalities in children undergoing computed tomography (CT) of the sinuses for suspected chronic sinusitis. To compare these findings with abnormalities noted on random CT scans. METHODS: Sixty CT scans, performed for evaluation of sinus disease in symptomatic children aged 2-12, were compared with 50 CT scans of children aged 2-12 of the orbits or sinuses obtained for indications other than sinusitis. A staging system was applied to assess the severity of abnormalities. RESULTS: Mucoperiosteal thickening was present in 60% of symptomatic and 46%, of random CT scans (logistic regression, P = 0.144). Children aged 2-4 and 9-12 had an increased prevalence of abnormalities in both groups, although these findings were not statistically significant (logistic regression, P = 0.817). Early stage sinus disease was present in the majority of random (96%) and symptomatic (85%) children. CONCLUSIONS: There is a high incidence of mucoperiosteal thickening in the paranasal sinuses of children. CT scans of the sinuses should be obtained from children who are being considered for sinus surgery after failing the appropriate medical therapy. Decisions regarding the need for sinus surgery should not be solely based on imaging abnormalities.

Child↗
PubMed1995

Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration.

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Adult↗
PubMed2001

Frontal sinus obliteration with the pericranial flap.

BACKGROUND: Frontal sinus obliteration is often accomplished by autologous grafts such as fat, muscle, or bone. These avascular grafts carry an increased risk of resorption and infection as well as donor site morbidity. Vascular regional flaps may be used to obliterate small sinuses with less morbidity. OBJECTIVES: To review our experience with the use of the pericranial flap for obliteration of the frontal sinus. METHODS: The records of 10 patients who underwent obliteration of the frontal sinus with the pericranial flap were reviewed. Demographics, indications for frontal sinus obliteration, immediate and late complications, and long-term outcome were recorded. These results were compared with those in the current literature. RESULTS: Ten sinuses were obliterated with the pericranial flap. Indications included frontal sinus mucocele, mucopyocele, frontal sinus osteomyelitis, and frontal sinus fracture. The median follow-up was 3 years. There was 1 short-term complication of persistent headache for 1 month, and there was asymptomatic recurrence of a neofrontal sinus in 1 case. CONCLUSIONS: The pericranial flap is a vascularized local flap that is easily harvested. The use of the pericranial flap avoids donor site morbidity associated with free fat or cancellous bone grafts. The pericranial flap arms the head and neck surgeon with an effective alternative to other methods of frontal sinus obliteration.

Adipose Tissue↗
PubMed2002

A phase II, double-blind, randomized, placebo-controlled clinical trial of tgAAVCF using maxillary sinus delivery in patients with cystic fibrosis with antrostomies.

tgAAVCF, an adeno-associated cystic fibrosis transmembrane conductance regulator (CFTR) viral vector/gene construct, was administered to 23 patients in a Phase II, double-blind, randomized, placebo-controlled clinical trial. For each patient, a dose of 100,000 replication units of tgAAVCF was administered to one maxillary sinus, while the contralateral maxillary sinus received a placebo treatment, thereby establishing an inpatient control. Neither the primary efficacy endpoint, defined as the rate of relapse of clinically defined, endoscopically diagnosed recurrent sinusitis, nor several secondary endpoints (sinus transepithelial potential difference [TEPD], histopathology, sinus fluid interleukin [IL]-8 measurements) achieved statistical significance when comparing treated to control sinuses within patients. One secondary endpoint, measurements of the anti-inflammatory cytokine IL-10 in sinus fluid, was significantly (p < 0.03) increased in the tgAAVCF-treated sinus relative to the placebo-treated sinus at day 90 after vector instillation. The tgAAVCF administration was well tolerated, without adverse respiratory events, and there was no evidence of enhanced inflammation in sinus histopathology or alterations in serum-neutralizing antibody titer to adeno-associated virus (AAV) capsid protein after vector administration. In summary, this Phase II trial confirms the safety of tgAAVCF but provides little support of its efficacy in the within-patient controlled sinus study. Various potentially confounding factors are discussed.

Administration, Intranasal↗
PubMedDate not supplied

Endoscopic examination of normal paranasal sinuses in horses.

The frontal, caudal maxillary, and rostral maxillary sinuses of 10 equine cadavers were examined endoscopically, and the findings were confirmed by sinusotomy. Similar endoscopic examinations were performed in five conscious, adult horses by using sedation and local anesthesia. Useful portals of entry for the arthroscope in adult horses were: for the frontal sinus, 60% of the distance in a lateral direction from midline to the medial canthus and 0.5 cm caudal to the medial canthus; for the caudal maxillary sinus, 2 cm rostral and 2 cm ventral to the medial canthus; and for the rostral maxillary sinus, 50% of the distance from the rostral end of the facial crest to the level of the medial canthus and 1 cm ventral to a line joining the infraorbital foramen and the medial canthus. The frontal sinus portal was most useful for examination of the frontal and caudal maxillary sinuses. The caudal maxillary sinus portal was most useful for examining the sphenopalatine sinus. Structures in the frontal and caudal maxillary sinuses could be approached surgically by viewing them through the frontal sinus portal and guiding an instrument to them through the caudal maxillary sinus portal. Tooth root identification was reliable for the second and third upper molars in animals older than 5 years, but was more difficult for the rostral teeth and in younger animals. Endoscopy was not difficult to perform and was well tolerated in standing, sedated horses. The only complication of this procedure was mild, local subcutaneous emphysema that resolved spontaneously within 14 days.

Anesthesia, Local↗
PubMed1996

CT findings in general practice patients with suspected acute sinusitis.

PURPOSE: To study CT findings in general practice patients with a clinical diagnosis of acute sinusitis, and to examine the interobserver variation between 2 radiologists with regard to their CT evaluation. MATERIAL AND METHODS: Two hundred and one patients were examined with coronal CT images of the paranasal sinuses within 2 days of the clinical diagnosis. Patients with chronic sinusitis were excluded. Fluid level or total opacification of any sinus were used as evidence of sinusitis. RESULTS: One hundred and twenty-seven (63%) patients had fluid level or total opacification in a sinus region, most in more than one region. One hundred and fifteen had CT signs of sinusitis in the ethmoid region, 84 in the maxillary, 18 in the frontal, and 10 in the sphenoid. Forty-nine patients had a negative Ct. In the evaluation of interobserver agreement, the overall assessment of the CT yielded a kappa value of 0.70. CONCLUSION: The study demonstrated great variation in the CT findings in general practice patients with suspected acute sinusitis. More than one sinus region was affected in most patients in whom sinusitis was confirmed by CT imaging; the most common combination was ethmoid and maxillary sinuses. The interobserver agreement was substantial.

Acute Disease↗
PubMed2006

Fatty tissue within the maxillary sinus: a rare finding.

BACKGROUND: We report a rare case of fatty tissue within the maxillary sinus in a 21-year-old woman, with a history of several previous punctures of the maxillary sinus. CASE PRESENTATION: Clinical data of the patient was analysed retrospectively. The patient presented with symptoms of left-sided chronic maxillary sinusitis and had undergone several punctures of the left maxillary sinus 18 months earlier. Subsequent to one of the procedures an acute pain in the left orbit lasting a couple of days was noted. Left endoscopic transnasal antrotomy was performed. The maxillary sinus was filled with polypous, chronically inflamed mucous membrane. Upon its removal, the maxillary roof was identified as drawn downwards and covered with normal mucous membrane. Upon dissection of the membrane, adipose tissue filling the zygomatic recess of the sinus was identified and subsequently removed. The maxillary roof was unchanged. Histopathologic examination confirmed the material to be adipose tissue. No short or long term sequelae occurred. CONCLUSION: Adipose tissue can be found in the maxillary sinus most commonly when penetrating from surrounding locations. It is our hypothesis that in the reported patient it penetrated from the orbit to the maxillary sinus following puncture. It seems that a hole in the maxillary sinus roof, about 1 mm in diameter, caused by the needle, may have been a portal of entry for the adipose tissue into the maxillary sinus. The discussed case suggests particular care be taken in performing puncture of the maxillary sinus.

Adipose Tissue↗
PubMed2003

Sinusitis.

Sinusitis is one of the most common health care complaints in the United States. Approximately one in eight people in the US will have sinusitis at one time in their lives. Until recently, sinusitis has been an undertreated disease. The drastic negative effect of sinusitis on patients' quality of life has been generally underappreciated and unrecognized. Recent studies show that patients score the effects of chronic sinus disease in areas such as bodily pain and social functioning as more debilitating than diseases such as angina, congestive heart failure, emphysema, chronic bronchitis, and lower back pain, to name a few. In the past, many patients were told they would just have to "live with" their sinus problem. However, there have been enormous advances in the past 15 years in the ability to diagnose and treat these problems. This is largely because of technological advances in nasal endoscopy and X-ray imaging. Also, the development of newer, more powerful medications and significant advances in surgical treatment have played a major role in improved patient care. In this article, we provide an overview of sinusitis. We describe the modern definition of sinusitis and the normal physiology of the sinuses. We discuss the causes of sinusitis with attention to the role of allergies, acid reflux, and other related disorders. Finally, we review the current approach to the diagnosis of sinusitis.

Humans↗
PubMed1989

Comparison of plain radiographs and coronal CT scans in infants and children with recurrent sinusitis.

We performed a prospective study of 70 infants and children with recurrent sinusitis. We compared plain radiographs with coronal CT scans of the sinuses to determine if plain radiographs can be used to accurately diagnose and localize residual sinus disease amenable to endoscopic surgery. This residual disease is thought to be important in the pathogenesis of recurrences of sinusitis. The patients were taking antibiotics and were clinically well at the time of the two examinations (performed on the same day). Findings on slightly over 80% of the CT scans were abnormal. In about 75% of the patients, the findings on plain radiographs did not correlate with those on CT scans. About 45% of the patients had normal findings on plain radiographs of at least one sinus with an abnormality of that sinus shown on CT scans. Almost 35% of the patients had what was interpreted as an abnormality of at least one sinus on plain radiographs, but that sinus was normal on CT scans. Sinusitis in infants and children is often underdiagnosed or overdiagnosed on the basis of findings on plain radiographs of the sinuses. Plain radiographs cannot be used to determine the need for, or to guide, endoscopic surgery on the sinuses.

Adolescent↗