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PubMed1991

Repetitive sinoatrial exit block as the major mechanism of drug-provoked long sinus or atrial pause.

Prolonged sinus or atrial pause occurred in six patients with paroxysmal supraventricular tachycardia after drug administration. All six patients had normal sinus node function during control electrophysiologic study; the sinus cycle length ranged from 510 to 900 ms (mean 743 +/- 141) and the longest sinus node recovery time ranged from 800 to 1,230 ms (mean 1,018 +/- 168). A long sinus or atrial pause occurring at the termination of tachycardia or cessation of atrial pacing, ranging from 3,100 to 8,200 ms (mean 6,270 +/- 1,674), was provoked by the administration of various drugs. These included an intravenous bolus injection of adenosine triphosphate (5 mg; one patient), intravenous bolus injection of verapamil (5 mg; one patient), a combination of a single oral dose of diltiazem (120 mg) and propranolol (20 to 40 mg; three patients), oral diltiazem (240 mg/day; one patient) and a combination of oral diltiazem (240 mg/day) and propranolol (160 mg/day; one patient). In five patients, low frequency deflections suggestive of sinus node activity with a cycle length between 620 and 3,500 ms were recorded during pauses. These findings suggest that repetitive sinoatrial exit block was responsible for the pause. Sinus slowing with a long arrest suggesting suppression of sinus automaticity was also noted in three of these five patients; the longest sinus arrest in these three patients was 4,160, 4,800 and greater than 4,910 ms, respectively. The remaining patient with a pause of 6,840 ms had no recordable sinus activity, either reflecting suppression of sinus automaticity or technical failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1994

Temporary unilateral amaurosis with pneumosinus dilatans of the sphenoid sinus.

Pneumosinus dilatans (PSD), first described by Meyes in 1898, is an abnormal dilatation of one or more of the paranasal sinuses without bony erosion. The term sinus pneumocele indicates the presence of bony erosion. Review of the literature from 1968 to 1992 revealed 24 cases of idiopathic PSD and 17 cases of pneumocele of various paranasal sinuses. PSD occurred most commonly in the frontal sinus. Males were more often affected than females. The average age for males ranged from 16.5 for the maxillary sinus to 35.5 years for the sphenoid sinus. Pneumoceles occurred most commonly in the maxillary sinus. The average age for males ranged from 29 years for the frontal sinus and 47 years for the ethmoid sinus. Two patients (1 pneumocele and 1 PSD) had a temporary loss of vision. We report the case of a 37-year-old mountain climber who experienced temporary loss of vision in his left eye above 3000 m. Vision returned below 2000 m. High resolution computed tomography scan revealed pneumosinus dilatans of the sphenoid sinus with dehiscence of the optic canal on the left side. Endonasal microendoscopic resection of the anterior wall of the left sphenoid sinus was performed. The patient has remained symptom-free after 2 years of follow-up. Pneumosinus dilatans should always be considered in the differential diagnosis of sudden visual loss associated with atmospheric pressure changes.

Case Reports↗
PubMed1998

The excised preauricular sinus in 14 years of experience: is there a problem?

The congenital preauricular sinus is usually asymptomatic. However, if recurrent infection occurs, complete surgical excision of the sinus is required. If the sinus tracts are not entirely removed, recurrence is likely to follow. A retrospective study of the surgical results at The Hospital for Sick Children in Toronto, Ontario, was completed. One-hundred sixty-five primary preauricular excision procedures, performed in 146 patients between the years 1982 and 1996, were reviewed. All clinical, operative, and postoperative data were gathered. Patient outcome and epidemiologic issues were addressed. The overall recurrence rate of this series was 9.09 percent (15 of 165 sinuses). For the group of patients with active infection present at surgery, the recurrence rate was 15.79 percent, and when no infection was present, recurrence rate was 8.22 percent (p value = 0.32, odds ratio = 2.09). Moreover, in patients who underwent surgical drainage of an abscess before the procedure, 16.7 percent of the sinuses recurred, whereas in the patients who did not have an abscess, only 8.16 percent recurred (p value = 0.25, odds ratio = 2.25). In the group of patients in whom auricular cartilage was not excised from the base of the tract, 18.52 percent of the sinuses recurred; when cartilage was excised, the recurrence rate was 4.5 percent (p value = 0.006). A very high recurrence rate of 21.95 percent was found in the group of patients in whom no modality was used to demonstrate the sinus tract at surgery. A high recurrence rate of 10.87 percent was found in the group for whom probing with a cannula was used to identify the tract (p value = 0.17); a low recurrence rate of 2 percent was found in a group with dye injection only (p value = 0.015). In those patients in whom sinus probing and dye injection were used simultaneously, there were no recurrences (0 percent, p value < 0.05). In conclusion, a patient with an actively infected preauricular sinus or one with a previous abscess may have a tendency to experience a higher recurrence rate after excisional surgery. Excising a cartilage piece at the base of the tract and demonstrating the sinus with dye injection or with dye injection and probing at the time of surgery will reduce recurrence rates. In conclusion, we advise the excision of cartilage in the base of the tract as well as the use of methylene blue injection and probing of the sinus at surgery.

Adolescent↗
PubMed1996

Comparison of bipolar atrial electrogram amplitude in sinus rhythm, atrial fibrillation, and atrial flutter.

Automatic mode switching pacemakers revert to non-atrial tracking modes in response to sensed atrial tachyarrhythmias. It is unclear how atrial electrogram amplitudes in sinus rhythm compare to those during atrial tachyarrhythmias. In this study, peak-to-peak bipolar atrial electrogram amplitudes were measured during sinus rhythm and either atrial fibrillation or atrial flutter in 69 patients. The mean atrial electrogram amplitudes were 1.59 +/- 1.36 mV during sinus rhythm and 0.77 +/- 0.58 mV during atrial fibrillation (P < 0.0001) for 25 patients with atrial fibrillation and 1.81 +/- 2.07 mV during sinus and 1.5 +/- 1.81 mV (P < 0.0001) for 44 patients with atrial flutter. The mean electrogram amplitudes during both atrial fibrillation and flutter correlated significantly with amplitudes during sinus rhythm (R = 0.79, R = 0.94, respectively, both P < 0.0001). The coefficient of variance of individual electrogram amplitudes was greater in atrial fibrillation than sinus (P < 0.0001). By comparing 20th percentile electrogram amplitudes in atrial fibrillation and flutter to mean sinus amplitudes, intermittent very low electrogram amplitudes (< 0.3 mV) were more likely during atrial fibrillation and flutter if the mean sinus electrogram amplitudes were < 1.5 mV and < 0.5 mV, respectively (P < 0.01). Eightieth percentile electrogram amplitude values in atrial fibrillation and flutter were equally likely to exceed mean sinus amplitude values in respective patients. In conclusion, mean atrial electrogram amplitudes during atrial fibrillation and flutter are less than but correlated to sinus rhythm electrogram amplitudes. Very low amplitude individual electrograms during these atrial arrhythmias are associated with low mean sinus rhythm electrogram amplitudes. These findings may have implications for the programming of permanent dual chamber pacemakers in patients with paroxysmal atrial fibrillation and flutter.

Adolescent↗
PubMed1982

The cellular electrophysiologic mechanism of the dual actions of disopyramide on rabbit sinus node function.

To determine the contribution of disopyramide's suggested opposing direct depressant and indirect acceleratory actions on sinus node function, we studied the effects of disopyramide, 1 x 10(-7) to 1 x 10(-4) M, on isolated rabbit sinus node preparations using standard microelectrode techniques. Transmembrane potentials were recorded simultaneously from the sinus node and adjoining crista terminalis area. Disopyramide, as much as 1 x 10(-5) M, had no effects on the sinus cycle length. At a concentration of 1 x 10(-4) M, sinus cycle length was significantly prolonged due to prolongation of the sinus nodal action potential duration. During cholinergic blockade with atropine, 1 x 10(-6) M, disopyramide, 1 x 10(-7) to 1 x 10(-4) M, significantly prolonged sinus cycle length as a result of a prolongation of the sinus nodal action potential duration and a decrease of the slope of phase 4 depolarization. During cholinergic stimulation with carbamyl choline, 1 x 10(-9) M, disopyramide, 1 x 10(-7) to 1 x 10(-6) M, tended to reverse carbamyl choline-induced prolongation of the sinus cycle length (NS). This acceleratory action of disopyramide was caused by a significant increase of the slope of phase 4 depolarization. Disopyramide, 1 x 10(-7) to 1 x 10(-4) M, had no significant effects on corrected sinus node recovery time or on sinoatrial conduction time under any conditions studied. We conclude that disopyramide has a direct depressant action on normal sinus node cells at the upper therapeutic and toxic levels, which is enhanced during cholinergic blockade, and that disopyramide's acceleratory action appears only at much lower concentrations and only during cholinergic stimulation.

Action Potentials↗
PubMed1992

Sinus node automaticity during atrial fibrillation in isolated rabbit hearts.

BACKGROUND: It is still unclear what role the sinus node may play in the genesis or perpetuation of atrial fibrillation. Therefore, we studied the electrical activity in different regions of the sinus node during atrial fibrillation. METHODS AND RESULTS: In Langendorff-perfused rabbit hearts, paroxysms of atrial fibrillation were induced by burst pacing. Standard microelectrode techniques were used to record transmembrane potentials from different regions of the sinus node. We found that during atrial fibrillation, a high degree (5:1) of sinoatrial entrance block was present that protected the pacemaker fibers in the center of the sinus node against the high rate of fibrillatory impulses. As a result, the true pacemaker fibers in the center of the node were activated with only a slightly higher average rate than during sinus rhythm. Spontaneous diastolic depolarization was still present but was modulated by electrotonic depolarizations due to intranodal conduction block of atrial fibrillatory impulses. Incidentally, phase 4 depolarization resulted in the generation of spontaneous action potentials in the sinus node. However, the high activation rate in the sinoatrial border during atrial fibrillation prevented these spontaneous impulses to exit from the sinus node. Because of the minimal degree of sinus node overdrive suppression (9%) and the presence of concealed automaticity during atrial fibrillation, spontaneous termination of atrial fibrillation was promptly followed by resumption of normal sinus rhythm. CONCLUSIONS: During atrial fibrillation, sinus automaticity still is present in the center of the sinus node and hardly overdrive suppressed due to a high degree of sinoatrial entrance block.

Animals↗
PubMed1979

An analysis of the effects of acetylcholine on conduction and refractoriness in the rabbit sinus node.

The effects of acetylcholine (ACh) on sinus node automaticity, atrio-sinus conduction, and refractoriness were studied in 41 isolated rabbit right atrial preparations. Average control rate was 126 beats/min, and ACh 5 x 10(-8) M, 5 x 10(-7) M, and 5 x 10(-6) M significantly decreased heart rate by 7, 15, and 43%, respectively (P less than 0.01, 0.001, and 0.001). Atrio-sinus conduction time at a pacing cycle length of 400 msec did not significantly change during exposure to ACh 5 x 10(-8) and 5 x 10(-7) M. However, the mean effective refractory period (ERP) of the sinus node, at a pacing cycle length of 400 msec, increased from 183 +/- 16 msec to 210 +/- 24 msec during exposure to ACh 5 x 10(-7) M (P less than 0.025). The change in ERP followed the change in action potential duration. In contrast to the lack of effect of ACh 5 x 10(-7) M on atrio-sinus conduction time, ACh 5 x 10(-6) M caused 2:1 atrio-sinus block in 8 of 10 experiments. The site of block was identified using multiple microelectrode impalements, and occurred between the perinodal fibers bordering on the edge of the sinus node and the pacemaker area in the sinus node proper. When the pacing cycle length was increased and 1:1 atrio-sinus conduciton was present, conduction time did not significantly differ from control. At this longer pacing cycle length the mean ERP of the sinus node was 380 msec greater than control and lasted well after repolarization was completed. Thus, atrio-sinus block during exposure to ACh 5 x 10(-6) M resulted from a marked prolongation of refractoriness.

Acetylcholine↗
PubMed1998

Differential expression of gap junction proteins in the canine sinus node.

Electrical coupling of pacemaker cells at gap junctions appears to play an important role in sinus node function. Although the major cardiac gap junction protein, connexin43 (Cx43), is expressed abundantly in atrial and ventricular muscle, its expression in the sinus node has been a subject of controversy. The objectives of the present study were to determine whether Cx43 is expressed by sinus node myocytes, to characterize the spectrum of connexin expression phenotypes in sinus node pacemaker cells, and to define the spatial distribution of different connexin phenotypes in the intact sinus node. To fulfill these objectives, we performed high-resolution immunohistochemical analysis of disaggregated adult canine sinus node preparations. Using enhanced tissue preservation and antigen retrieval techniques, we also performed immunohistochemical studies on sections of intact canine sinus node tissue. Analysis of disaggregated sinus node preparations revealed three populations of pacemaker cells distinguished on the basis of connexin immunohistochemical phenotype: approximately 55% of cells expressed only connexin40 (Cx40); 30% to 35% of cells expressed Cx43, connexin45 (Cx45), and Cx40; and the remaining cells had no detectable connexin expression. In immunostained sections of intact sinus node, Cx43- and Cx45-positive cells were limited in their distribution and were observed in discrete bundles that appeared to abut atrial myocytes. In contrast, Cx40 immunoreactive signal was widely distributed in the sinus node region. These results indicate that subsets of pacemaker cells express distinct connexin phenotypes. Differential expression of connexins could create regions within the sinus node with different conduction properties, thereby contributing to the nonuniform conduction properties seen in this tissue.

Animals↗
PubMed2006

[Sacrococcygeal dermal sinus presented bacterial meningitis: a case report].

A rare case of sacrococcygeal dermal sinus suffering from relapsing meningitis is presented. In addition, deference of clinical figure and pathology between sacrococcygeal region and other regions are discussed. A 10 -month-old boy was suffering from relapsing meningitis. Spinal MRI was performed to find occult spinal dysraphism because he had a pit on his hip. The MRI revealed sacrococcygeal dermal sinus. He received surgical resection of dermal sinus based on this findings. Interestingly, different from other dermal sinuses, the dermal sinus runs to caudal direction, and was fused filum terminale with dermoid cyst. This interesting pathological feature of sacrococcygeal dermal sinus seems to come from developmental difference between sacrococcygeal dermal sinus and the other dermal sinuses. Only sacrococcygeal dermal sinus is related with caudal cell mass on its pathogenesis. Because filum terminale is also developed from caudal cell mass, sacrococcygeal dermal sinus seems to be related with filum terminale. Most important differential diagnosis is coccygeal pit that is found in 1 -4% of newborn baby. The clinical feature and pathology got from our case must be very helpful to distinguish sacrococcygeal dermal sinus from coccygeal pit.

Diagnosis, Differential↗
PubMed1977

[Sinus dysfunction and nodo-hisian conductive disorders. Indication for definitive cardiac stimulation].

A consecutive series of 80 patients has been the object of intracavitary electrophysiological studies, including a study of sinus function and of node/His conduction, before implantation of a definitive cardiac pacemaker. Investigation of the sinus yielded normal or insignificant results in 32 cases. It revealed certain criteria of "major" sinus dysfunction (TRSC 1000 ms; more than compensatory return cycles where there was SAP) in 39 cases, made up of 18/20 in group I (documented evidence of sinus malfunction), 10/14 in group II (sinus bradycardia less than or equal to 55/mn), 9/44 in group III (A-V conduction defects), and 2/2 in group IV (paroxysmal supraventricular tachycardia); criteria of "minor" sinus dysfunction (TRSC between 550 and 1000 ms, TECASA greater than 210 ms) were found in only 9 cases (group I--1; group II--2, group III--6). The association of sinus malfunction with node/His conduction defects was found in 29 cases, the site of the AV block being nodal in 7 cases, intra-His in 2 cases, infra-His in 10 cases, and a combination of nodal and infra-nodal in 10 cases. In 59 cases, the severity of the AV block (40 cases), of the sinus malfunction (17 cases) or of the sinus bradycardia (2 cases) was already obvious, and investigation of the sinus was not critical in determining the indications for a cardiac pacemaker. In 21 cases, however, this investigation was a determining factor, and most especially in 12 cases from group II. Sinus investigation seems to represent, in addition, a valuable indicator for the decision to install a pacemaker in a certain number of litigious cases.

Arrhythmias, Cardiac↗
PubMed1998

Clinical outcome of endoscopic surgery for frontal sinusitis.

OBJECTIVE: To determine the efficacy of endoscopic surgery for chronic frontal sinusitis. DESIGN: A prospective analysis of established measures of clinical outcome (Chronic Sinusitis Survey and Short Form 36) that was administered to patients before frontal sinus surgery and at intervals of 3 months, 6 months, and 1 year after surgery. INTERVENTIONS: For limited disease, the frontal recess was opened and the frontal ostium probed or enlarged. For more severe cases, a drill was used to resect the frontal sinus floor and interfrontal septum. SETTING: Private and institutional-based practices at an academic medical center. SUBJECTS: Eighty-seven patients who underwent endoscopic surgery for frontal sinusitis, including 24 patients with severe disease who underwent a frontal sinus drillout procedure. MAIN OUTCOME MEASURES: Scores on the Chronic Sinusitis Survey, Short Form 36, and surgical revision rate. RESULTS: Significant improvement in facial pain, nasal drainage, and congestion was observed 1 year after surgery (P<.01). Medication use was also significantly reduced during this period (P<.01). Quality-of-life measures showed greatest improvement in the domain of social functioning (P<.05). Three (12.5%) of 24 patients who underwent a frontal sinus drillout procedure did not respond to surgery secondary to restenosis of the frontal ostium. CONCLUSIONS: Although the long-term results of endoscopic surgery for frontal sinusitis are unknown, this approach appears to be effective for most patients and may provide a reasonable alternative to frontal sinus obliteration surgery in selected cases.

Adolescent↗
PubMed1988

Sinusitis in the nasotracheally intubated patient.

Maxillary sinusitis as a complication of nasotracheal intubation has long been recognized as difficult to diagnose and equally difficult to treat. To better define this problem from a diagnostic and therapeutic standpoint, we studied patients admitted to the surgical intensive care unit at the University of Texas Health Science Center at Houston-Hermann Hospital over a six-month period. During this time, we identified 19 cases of maxillary sinusitis. Diagnostic criteria included fever, leukocytosis, purulent rhinorrhea, and maxillary sinus opacification or air fluid level noted on sinus roentgenograms. Patients who met these criteria underwent maxillary sinus aspiration. Sixteen patients were receiving antibiotic therapy when sinusitis was diagnosed. All patients had their endotracheal tubes replaced orally, had diseased maxillary antra lavaged, and underwent appropriate antibiotic therapy guided by culture and sensitivity studies. Four of 19 patients required more than one sinus lavage, but all patients had their sinus disease resolve. These data suggest an aggressive approach to diagnosing sinusitis in the nasotracheally intubated patient is needed. A maxillary sinus aspiration and lavage should be an integral part of the diagnosis and treatment of these patients.

Adolescent↗
PubMed1994

The use of cancellous bone for frontal sinus obliteration and reconstruction of frontal bony defects.

OBJECTIVE: The objective of this report is to review our experience and indications for the use of cancellous bone in frontal sinus obliteration and reconstruction of frontal defects. We also describe a method of minimizing iliac crest donor-site morbidity. DESIGN: Case series. SETTING: Patients treated on the Facial Plastics and Trauma Service at the University of Cincinnati (Ohio) Medical Center. PATIENTS: Ten patients were selected for frontal sinus obliteration and reconstruction of frontal defects with cancellous bone based on the following criteria: (1) complex frontal bony defects involving the frontal sinus; (2) acute trauma with loss or comminution of more than 40% of either anterior or posterior sinus wall; and (3) failure of previous frontal sinus obliteration for either chronic sinusitis or trauma. INTERVENTION: The use of cancellous bone grafts for frontal sinus obliteration and reconstruction of frontal defects. MAIN OUTCOME MEASURE: Success of cancellous bone grafts in frontal sinus obliteration and reconstruction of frontal defects. RESULTS: Follow-up averaged 26 months. Follow-up computed tomographic scans showed good maintenance of graft volume and complete frontal sinus obliteration in all patients. Seven of 10 patients reported minimal donor-site discomfort and three patients had moderate pain. CONCLUSION: Cancellous bone grafts are effective, with acceptable donor-site morbidity, for frontal sinus obliteration and frontal reconstruction in patients in whom adipose grafts would have a significant chance of complications or long-term failure.

Adipose Tissue↗
PubMed2001

Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.

Although many investigations on the bacteriology of chronic sinusitis have been reported, there is still much discussion about the physiological flora of the nose and paranasal sinuses, the role of the various aerobic and anaerobic "pathogenic" bacteria, and the influence of the anatomical location from which samples for bacteriology are taken. We conducted a qualitative and semi-quantitative bacteriological examination of patients with chronic sinusitis undergoing a transnasal sinus operation (patient group), and of patients without chronic sinusitis undergoing a septoplasty (control group). In both groups brush smears of the inferior nasal turbinate and biopsies of the middle nasal turbinate were taken, with additional biopsies of the maxillary sinus and ethmoidal bulla in the chronic sinusitis group. In both groups coagulase-negative staphylococci were identified in almost all samples. Staphylococcus aureus was found in 22% (middle turbinate) to 33% (inferior turbinate) of the samples from the control group and in 33% (maxillary sinus, middle turbinate) to 50% (inferior turbinate) of the samples from the patient group. Other (pathogenic) aerobic bacteria were found much more rarely and only slight distinctions between control and patient group were observed. The concentrations of the different bacterial species (colony-forming units) were comparable in both groups. Strictly anaerobic bacteria and fungi were not identified. Only small discrepancies between the various methods and/or locations of sampling were found. Based on our bacteriological findings a differentiation between patients with and without chronic sinusitis was not possible. These results shed doubt on the clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.

Adolescent↗
PubMed2004

Evaluation of maxillary sinus after treatment of midfacial fractures.

PURPOSE: Maxillary sinuses are the most frequently injured anatomic region of the facial skeleton in midfacial fractures. The purpose of this study was to evaluate the patients with maxillary sinus wall fractures using clinical examinations, maxillofacial computed tomography (CT), and cranial bone single-photon emission tomography (SPECT) and to interpret the results of these examinations to evaluate the indications of surgical intervention or drainage for maxillary sinus after maxillary sinus wall fractures. MATERIALS AND METHODS: The results of examinations of 15 patients with maxillary sinus fractures who were treated for midfacial fractures were evaluated. Follow-up examinations were performed in the range of 3 to 47 months after surgery (average, 19.8 months). The patients ranged in age from 10 to 45 years, with an average age of 31.6 years. There were 11 male and 4 female patients. Seven patients had Le Fort II fractures, 6 patients had tripod zygomatic fractures, 1 patient had infraorbital fracture, and 1 patient had zygomatic arch fracture. Operative procedure was performed in all cases. To evaluate maxillary sinus after surgery, maxillofacial computed tomography (CT), cranial bone SPECT, and maxillary sinusitis evaluation form were used in all patients. RESULTS: Maxillofacial CT scans were related to sinusitis in 9 patients who had positive complaints for sinusitis. The cranial bone SPECT showed positive uptake at the fractured sites in 8 patients, minimal uptake in 2 patients, and normal uptake in 5 patients. CONCLUSIONS: Clinical examination, maxillofacial CT, and cranial bone SPECT are the most reliable methods available today for the diagnosis and follow-up of complications of maxillary sinus fractures.

Adult↗
PubMed1995

Diagnostic criteria for allergic fungal sinusitis.

Diagnostic criteria for allergic fungal sinusitis have not been established, and clinical information consists primarily of isolated case reports. We proposed five diagnostic criteria for allergic fungal sinusitis including: (1) the demonstration of the characteristic eosinophil-rich allergic mucin visually or histopathologically, (2) a positive fungal stain or culture from the sinus at surgery, and (3) the absence of immunodeficiency or diabetes. With these criteria, seven patients in our metropolitan area with allergic fungal sinusitis were identified in a short period. Initial symptoms in our seven patients reflected those in 99 case reports in that two children were first seen with proptosis, one child and three adults with nasal congestion, and one adult with symptoms of chronic sinusitis. All had pansinusitis as shown on x-ray films. Six patients were atopic, five had nasal polyposis, and five had Curvularia species cultured from the sinuses. Infections with Bipolaris species, asthma, and chronic sinusitis were less common in our patients than in those previously reported. Recurrent symptoms and additional surgery sometimes resulted when the diagnosis was delayed by failure to obtain silver stains for fungus on surgical material sent for histopathologic review. Sinus tomography showed that the fungal material in the sinuses was of high density, which distinguished it from polyps or bacterial exudate. Bony compression, erosion, and rupture of the sinus walls were common. Results of IgE levels, precipitin determinations, and eosinophil counts were variable in both our patients and those in the literature. On the basis of our review, we believe that the simple diagnostic criteria proposed are appropriate for both research and clinical purposes.

Adolescent↗
PubMed1988

[Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis].

Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

Adult↗
PubMed1997

Maxillary sinus septa: incidence, morphology and clinical implications.

This study was carried out to examine the incidence, morphology and clinical implication of antral septa. Out of 265 maxillary sinuses, 65 sinuses in atrophic maxillae were examined clinically during sinus floor elevation and 200 sinuses examined radiographically (CT), the latter being further subdivided into non-atrophic/dentate and atrophic/edentulous maxillary segments. Eighteen (27.7%) out of 65 clinically-examined maxillae and 32 (16%) out of the 200 non-preselected CT-examined maxillary sinuses showed antral septa. CT-topogram subclassification revealed 21 septa (13.2%) in 159 non-atrophic and 11 septa (26.8%) in 41 atrophic maxillary segments (P < 0.01). Morphologically, CT examination yielded one complete septum (0.5%), 21 incomplete septa on the sinus floor and 10 incomplete septa on the anterior antral wall (5%). CT revealed a significantly greater dimension of antral septa in non-atrophic maxillary segments than in atrophic ones (P < 0.01). In atrophic maxillary sinuses, the incidence (27.7% vs 26.8%), morphology (all septa located on sinus floor) and height (8.1 +/- 2.5 mm vs 6.8 +/- 1.6 mm) did not differ between the clinical and the CT examinations. Detailed knowledge about location, morphology and height of antral septa is clinically relevant to reduce the rate of complications when maxillary sinus surgery, i.e. sinus floor elevation, is carried out.

Adult↗