Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “sinusitis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,585 records · Page 88Linked to original sources
PubMed2004

Association of frontal sinus development with somatic and skeletal maturation in Aboriginal Australians: a longitudinal study.

There have been very few studies of frontal sinus development and its association with other growth parameters in humans. The aim of this study was to investigate the relationship of frontal sinus development with somatic and skeletal maturation in a sample of Aboriginal Australians. The sample comprised 31 individuals, of whom 17 were males and 14 females. For the selected subjects the following records were available: lateral head radiographs, hand-wrist radiographs and stature recordings, generally covering the age range from 7 to 18 years. Descriptive statistics for frontal sinus size, skeletal ossification and body height were calculated at yearly intervals and comparisons made between the sexes. Growth velocities in frontal sinus height, frontal sinus depth and stature were also calculated for both sexes. The frontal sinus was found to display a well-defined adolescent growth spurt, with its peak velocity occurring after the peak velocity in body height. Females were found to attain peak velocity in sinus height earlier, on average, than males but they attained peak velocity in sinus depth at a similar age to males. The sequence of hand-wrist ossification events followed a similar pattern in both sexes, with events in females occurring approximately one year earlier than those in males. These results indicate that an adolescent spurt is present in frontal sinus growth and that the spurt tends to occur after statural velocity has peaked. Hand-wrist ossification events also tend to have a close relationship to peak statural and frontal sinus velocity and these relationships may be useful in clinical situations for predictive purposes.

Adolescent↗
PubMed2003

[Complicated sinusitis and nasal endoscopic surgery].

BACKGROUND: Complicated sinusitis can result in a significant morbidity if not appropriately managed. Traditionally, surgical cases were treated by external approaches. Now a days, the introduction of endoscopic sinus surgery allows such complications to be endoscopically approached. AIM: This study was designed to evaluate our results in complicated sinusitis treated by endoscopic sinus surgery. METHODS: The study reviewed 18 patients with evidence of sinusitis complications treated with endoscopic sinus surgery between 1993 and March 2000. There were 12 orbital and 6 intracraneal complications. Six patients did need an additional surgical approach. RESULTS: Seventeen patients (94%) had a relief of their symptoms. One patient with a superior orbital fisura syndrome died a month later due to vascular and respiratory complications. Another patient with fronto-lateral sinusitis required frontal osteoplasty for persistent disease. Two patients had long-term neurological sequelae (seizure). None had ocular sequelae. There were no complications due to the surgery. CONCLUSION: The endoscopic sinus surgery is a safe procedure with a high success rate in the treatment of complicated sinusitis. At present, open approaches to the sinuses are rarely indicated.

Adolescent↗
PubMed1997

Prognosis for allergic fungal sinusitis.

Allergic fungal sinusitis is a recently described clinical entity that has gained increased attention as a cause of chronic sinusitis. The diagnosis can be established by demonstrating (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic CT scan; (4) eosinophilic mucus without fungal invasion into sinus tissue; and (5) positive fungal stain of sinus contents removed intraoperatively or during office endoscopy. The exact pathogenesis of allergic fungal sinusitis remains controversial, and no treatment modality has proved to be consistently effective. Several reports during the last decade have suggested that allergic fungal sinusitis recurs more frequently than chronic bacterial sinusitis, but no studies have specifically addressed the prognosis of allergic fungal sinusitis. During the past two and a half years, we have treated 26 patients with allergic fungal sinusitis. The treatment always included functional endoscopic sinus surgery, topical nasal steroids, postoperative nasal saline irrigations, and endoscopic cleaning in the office. Adjuvant medical therapy included systemic steroids, oral antifungals, a combination of systemic steroids and oral antifungals, or in some cases, no additional treatment. Outcome was graded subjectively as improved, unchanged, or worse. Mean follow-up was 14.5 months. Twenty-two of 26 patients were improved. In reviewing postoperative outcomes, we observed endoscopic recurrent disease that generally preceded patient symptoms. Consequently, we developed an endoscopic staging system to record postoperative clinical status. Use of this staging system allowed evaluation of various treatments and enabled classification of patient outcome. Nineteen of 24 patients examined with extensive follow-up had objective signs of recurrent disease. It appears that this is a chronic disease characterized by physical signs that appear before the return of subjective clinical symptoms.

Adolescent↗
PubMed2004

Headaches due to nasal and paranasal sinus disease.

Sinus infections are much less common today than they were in the preantibiotic era, but they still are overdiagnosed. Acute sinusitis, a relatively uncommon cause of headache, is the result of infection of one or more of the cranial sinuses. Acute sinusitis usually is characterized by purulent discharge in the nasal passages and a pain profile determined by the site of infection. Sinusitis is overdiagnosed as a cause of headache because of the belief that pain over the sinuses must be related to the sinuses. In fact, frontal head pain more often is caused by migraine and tension-type headache. It should not follow that if a patient fails to respond to treatment for migraine and tension-type headache one should reconsider the diagnosis of sinus disease. Whether or not nasal obstruction can lead to chronic headache is controversial. Paradoxically, sinus disease also tends to be underdiagnosed, as sphenoid sinus infection frequently is missed.

Diagnosis, Differential↗
PubMed2003

3He MR imaging of porcine paranasal sinuses.

RATIONALE AND OBJECTIVES: The aim of this study was to test the effectiveness of laser-hyperpolarized helium 3 (3He) as a contrast agent for magnetic resonance (MR) imaging of porcine paranasal sinuses. MATERIALS AND METHODS: Imaging experiments were conducted on the heads of four 50-kg Yorkshire pigs after open sinus surgery was performed. Paranasal sinus MR images were obtained with laser-polarized 3He gas produced through the spin-exchange method. The gas was delivered into the sinuses through two 14-gauge plastic catheters inserted in the nostrils. The 3He MR images were then compared with spatially correlated proton MR images. RESULTS: The porcine paranasal sinuses were adequately depicted by MR imaging with hyperpolarized 3He. The signal intensity of the paranasal sinuses on the 3He MR images was related to the size of the opening joining the sinuses to the nasal cavity and was clearly time dependent. CONCLUSION: Hyperpolarized 3He MR imaging may be particularly useful for identifying the anatomic configuration of the paranasal sinuses, as well as for assessing sinus aeration. Further study of the time-dependence of 3He signal intensity may help increase understanding of gas exchange in the sinuses.

Animals↗
PubMed1997

Open trial of intravenous immune serum globulin for chronic sinusitis in children.

BACKGROUND: Chronic sinusitis in children is a complex clinical problem. Some patients do not improve with medical therapy and some fail surgery as well. OBJECTIVE: A therapeutic trial of intravenous immune serum globulin (IVIG) was given to children whose sinus disease was recalcitrant to the usual therapeutic modalities. The objective of IVIG administration was to modulate the inflammatory process contributing to the chronicity of the sinusitis. METHODS: Six patients were given a 12-month trial of monthly (400 mg/kg) IVIG infusions. Entry criteria included persistence of sinusitis after 3 months of full course antibiotics, or two episodes of sinusitis within a 3-month period while on prophylactic antibiotics. All patients had abnormal sinus CT (computerized tomography) scans at entry. Three of the six patients remained symptomatic despite prior sinus surgery. Patients with primary immune deficiencies were excluded. Each patient served as his own control based on their previous 12-month history and clinical course. Four of the 6 patients were atopic as demonstrated by prick skin testing; however, all patients had nasal eosinophilia. RESULTS: Full course antibiotic use decreased in five of the six patients (183 to 84 days); correspondingly, the episodes of sinusitis decreased (average 9 to 4 per year). In addition, sinus CT scans showed significant improvement. CONCLUSION: This preliminary open-trial of IVIG suggests its usefulness as adjunct therapy to medical management in selected patients with chronic sinus disease. The mechanism(s) by which IVIG may be helpful is probably not based on the concept of replacement therapy, but more likely as an immune or inflammatory modulating agent.

Anti-Bacterial Agents↗
PubMed1997

Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part I. Evaluation of anorganic bovine-derived bone matrix.

The aim of this study was to evaluate clinically, histologically and histometrically the use of anorganic bovine bone matrix (i.e. Bio-oss) as a grafting material for maxillary sinus augmentation procedures. In 4 adult male rhesus monkeys (i.e. Macaca mulatta) the 1st, 2nd and 3rd maxillary molars on one side of the jaws were extracted. The remaining bone between the alveolar crest and the bottom of the sinus was then reduced to 3-4 mm. After 3 months, maxillary sinus augmentation procedures were performed on one side of the jaws in each monkey and the sinuses were grafted with the bovine bone matrix. At that time, 2 IMZ pure titanium plasma coated implants were immediately placed into the augmented sinuses (i.e. simultaneous implants-loaded group). After 4 months, 2 additional similar implants were placed into these previously augmented sinuses (i.e. delayed implants-loaded group). Four months later, the abutment connection was performed and all 4 implants were loaded with a gold-alloy bridge for 6 months (i.e. until sacrifice of the animals). The contralateral side of each monkey received the same treatment with the exception that the extractions were performed 7 months after those in the opposite side and that the implants in this side were not loaded. Thus, 2 additional study groups (i.e. simultaneous implants-unloaded group and delayed implants-unloaded group) were obtained. Clinically, all loaded implants were stable at the day of sacrifice. Histologically, the grafted sinuses exhibited significant bone formation with integration of the bovine bone matrix particles to the new bone. Direct mineralized bone-to-implant contact was greater for the delayed implant placement groups than for the implants installed simultaneously with the sinus augmentation. Furthermore, the percentage of direct mineralized bone-to-implant contact was greater in the residual bone than in the augmented area. It was concluded that the anorganic bovine bone matrix facilitated bone formation and implant osseointegration in the augmented sinuses and that the delayed implant placement in combination with the sinus augmentation procedure seemed to be preferable.

Alveolar Process↗
PubMed2001

Factors influencing 133-xenon washout in a nose-sinus model.

The 133-xenon washout technique is a non-invasive method for the evaluation of ventilation of the paranasal sinuses. The half-time of 133-xenon washout (T(1/2)) is considered to reflect sinus ostial function and sinus ventilation. However, it is not known how morphological and physiological factors affect the washout from the paranasal sinuses. The aim of the present study was to evaluate how sinus volume, ostial diameter and nasal ventilation influence 133-xenon washout in a nose-sinus model. This is important for the interpretation of measurements of 133-xenon washout from paranasal sinuses in healthy subjects and in subjects with sinus disease. The 133-xenon washout was measured with a scintillation camera. The statistical analysis of the results showed that the logarithm (to the base 10) of the half-time of 133-xenon washout is linearly related to the ostial diameter, the sinus volume and the nasal ventilation in the model. In a multiple linear regression model, the most important factor contributing to 133-xenon washout was found to be the ostial diameter, which explained 76% of the variation in log T(1/2). In the same statistical model the sinus volume explained 7.5% and the ventilation 5.3% of the variation in log T(1/2). Calculations of the functional ostial diameter in healthy subjects were made, based on the results of the model study. The mean functional ostial diameter was found to be 3.5 mm (range 0.5-7.5 mm). The results obtained with the present model experiments may be of importance for the correct interpretation of the results of measurements of 133-xenon washout in healthy subjects and patients.

Humans↗
PubMed2001

Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction.

Surgery of meningiomas involving dural sinuses leaves the surgeon confronted with a dilemma: leave the fragment invading the sinus and have a higher risk of recurrence, or attempt a total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. The authors report a series of 80 meningiomas (72 of the sagittal sinus, 5 of the transverse sinus and 3 of the torcular) in whom gross total removal was achieved in all but 7 cases (i.e., 91%), and venous reconstruction attempted in a majority. In total, 70 patients (87.5%) had a good outcome and resumed their previous activities. There was a permanent neurological deficit in seven (8.7%) due to infarction secondary to injury of central veins (all but one in the sagittal sinus mid-third). Three patients (3.6%) died from brain swelling; all with meningioma totally occluding the sinus and in whom resection was achieved without sinus reconstruction. There were two recurrences (2.5%) in this series which has a mean follow-up of 8.5 years. The conclusion is to favour, whenever possible, total removal with sinus reconstruction, using a patch for meningiomas with partial sinus invasion and a venous bypass for those with total sinus occlusion.

Adolescent↗
PubMed2005

[Paranasal sinus mucoceles: surgical management and long term results].

BACKGROUND: The aim of this study was to determine the best surgical approach in the treatment of paranasal sinus mucoceles according to their localization. MATERIAL AND METHODS: A retrospective analysis was carried out in 255 patients with 290 sinus mucoceles who were treated surgically at the ENT-Department of the Hospital Fulda gAG between 1983 and 2001. This series include 125 frontal sinus, 23 frontoethmoid, 41 ethmoid, 72 maxillary sinus and 26 sphenoid mucoceles. The patients' history, presenting symptoms, radiological findings, and surgical management were reviewed. Of them, 185 patients were followed by endoscopic and CT or MRI control during a period of up to 19 years, median follow-up was 12 years. RESULTS: In 168 out of 255 patients (66 %) the mucoceles were arisen due to previous sinus surgery, in 37 cases (14 %) after traumatic lesions, in 5 patients (2 %) due to chronic sinusitis and in 2 cases (<1 %) according to tumors. In 43 cases (17 %) no causes were found. In 78.8 % the previous operation was performed via an external approach, either according to Jansen/Ritter or Caldwell-Luc, contrary to 1.5 % after endonasal surgery. The median period until mucocele appearance was 15 years for maxillary sinus, 13 years for frontoethmoid, 10 years for ethmoid, and 8 years for frontal and sphenoid sinus celes, respectively. 201 mucoceles (69.3 %) have been operated endonasal micro-endoscopically, 18.6 % via the osteoplastic approach, 10 % endoscopically combined with an osteoplastic procedure and only 2 % according to Jansen/Ritter. Thereafter, recurrence of mucoceles was found in 4 patients only ( = 2.2 %; related to the endonasal approach = 1.6 %). CONCLUSION: Frontoethmoidal, ethmoidal, sphenoidal and maxillary sinus mucoceles are excellent indication for exclusively endonasal micro-endoscopic surgery. The osteoplastic approach combined with endonasal surgery is suitable in far lateral located frontal or maxillary sinus mucoceles.

Adolescent↗
PubMed2003

Cysteinyl leukotriene expression in chronic hyperplastic sinusitis-nasal polyposis: importance to eosinophilia and asthma.

BACKGROUND: Chronic hyperplastic eosinophilic sinusitis (CHS) results from the unregulated proliferation of eosinophils, T(H)2-like lymphocytes, goblet cells, mast cells, and fibroblasts and is present in most patients with asthma. The frequent coexpression of these disorders and their shared pathophysiology suggests that these are similar disorders affecting the upper and lower airways. OBJECTIVE: We evaluated the expression of cysteinyl leukotrienes (CysLTs) in sinus tissue from subjects with CHS compared with that seen in healthy sinus tissue. METHODS: Nasal polyp and sinus tissue was evaluated from 58 individuals undergoing elective functional endoscopic sinus surgery. The diagnosis of CHS was demonstrated through the presence of eosinophilia and activated (EG2(+)) eosinophils, as determined by means of tissue immunohistochemistry. Data were compared with those from both nasal polyp tissue without eosinophilic inflammation and healthy control sinus tissue obtained from the sinus ostiomeatal complex at the time of surgery for unrelated disorders. CysLTs were quantified by means of ELISA in lipid-extracted tissue. Activation of the metabolic pathway leading to CysLT synthesis was demonstrated by ribonuclease protection. Subjects were genotyped for leukotriene C(4) (LTC(4)) synthase C-to-A promoter polymorphism. RESULTS: CysLT concentrations were significantly higher in tissue obtained from subjects with CHS (776.7 +/- 201.9 pg/g tissue) compared with that seen in healthy sinus tissue (355.7 +/- 101.6 pg/g tissue, P <.03). CysLT concentrations within noneosinophilic nasal polyps (328.0 +/- 116.4 pg/g tissue) were similar to those in control tissue. The presence of CysLTs in CHS was associated with increased expression of LTC(4) synthase mRNA. The C-to-A promoter polymorphism was associated with trends toward the increased presence of CHS and CysLTs. CONCLUSIONS: CHS is characterized by the increased presence of CysLTs when compared with concentrations seen in tissue from patients with chronic inflammatory sinusitis or healthy sinus tissue. These studies support the use of LT modifiers as anti-inflammatory agents that might have clinical benefit in patients with these disorders.

Adult↗
PubMed2003

Chronic sinusitis: defective T-cells responding to superantigens, treated by reduction of fungi in the nose and air.

In this study, the author used endoscopic sinus photography to study the effects of reduction of fungi in the nose, and in environmental air, on the sinus mucosa of 639 patients diagnosed with chronic rhinosinusitis. Sinus mucosal photographs were taken before and after reduction of fungal load in the nose and air, to determine if there was an optimum environmental air fungal load associated with sinus mucosal recovery to normal appearance. Systemic symptoms associated with fungal exposure, which resolved when fungus was removed from the patient and the environmental air and reappeared with recurrent environmental fungal exposure, are also discussed and are termed systemic fungal symptoms. Interventions consisted of nasal fungal load reduction with normal saline nasal irrigations and antimicrobial nasal sprays, and environmental air fungal load reduction with high-efficiency particulate air (HEPA) filtration in combination with ionizers or evaporation of a solution of botanical extract. Main outcome measures were obtained with environmental air 1-hr gravity-plate fungal colony counts, laser air particle counts, and endoscopic sinus photography. Blood levels of immunoglobulins IgG and IgE for 7 common molds were also determined. After intervention, 94% of patients who used antimicrobial nasal sprays and who reduced their environmental fungal air count to 0-4 colonies per 1-hr agar gravity-plate exposure (n = 365) exhibited normal sinus mucosa by endoscopic exam. Environmental air fungal counts that exceeded 4 colonies resulted in sinus mucosal abnormalities ranging from edema, to pus and/or nasal polyps at higher counts. Neutralization of allergy, and/or surgery, were used as appropriate following implementation of environmental measures. On the basis of these observations, as well as detailed clinical experience and a review of the current literature, the author hypothesizes that the pathogenesis of chronic rhinosinusitis, allergic fungal sinusitis, and systemic fungal symptoms is a genetic defect at the variable beta chain helper T-cell receptor (TCR Vbeta) site which requires the presence of an antigen (fungus). Chronic sinusitis patients who have recurring exposure to environmental air that contains fungal concentrations in excess of 4 colonies per 1-hr agar plate exposure appear to have an increased risk of persistent chronic sinusitis and/or systemic symptoms, regardless of the medical treatment provided.

Adolescent↗
PubMed2001

Preliminary study of the deposition of aerosol in the maxillary sinuses using a plastinated model.

In spite of the widespread use of aerosols in respiratory diseases, very few studies have been performed in the field of ear, nose, and throat (ENT) disorders. The conditions for penetration of aerosols inside the sinus cavities are thus still not understood fully. The aim of this study was to investigate the penetration of aerosols inside maxillary sinuses in vitro, using plastinated models. Three plastinated specimens of the nose and sinuses were made from three different corpses. These specimens were validated by CT scans and were used to study deposition of aerosol in the maxillary sinuses. We performed scintigraphic images of the models in above, face, and profile views using a technetium (99mTc)-labelled solution to show aerosol deposition. We also counted the radioactivity deposited on gauze compresses placed inside the maxillary sinuses. In addition, we constructed a measuring unit with miniature humidity sensors placed inside the sinuses. We recorded the changes in relative humidity observed during nebulization. Results from these studies showed that scintigraphic images of the specimen, whatever the incidence of the views, were not accurate enough to differentiate the aerosol deposition in the maxillary sinuses from that in the nasal cavity. Using indirect counting on gauze compresses made possible the quantification of local aerosol deposition, and we found that aerosols entered into the sinuses. This confirmed that aerosols could reach the middle meatus, which is the main area for sinusitis disorders. The increased activity compared to background varied from 17 to 127%. The humidity sensors recorded changes in relative humidity during the nebulization. These humidity changes fitted a nonlinear model represented by the equation: y = b0 (1 - e(-b1t)), where b0 is the plateau and b1 is the speed to reach the plateau. These techniques may be useful in the future for in vitro characterization of aerosol penetration into the maxillary sinuses.

Aerosols↗
PubMed2003

The usefulness of carotid sinus massage in different patient groups.

AIM: to determine the positive yield of carotid sinus massage in different patient groups: unexplained syncope, falls, dizziness and controls. DESIGN: observational study. SETTING: teaching hospital. METHODS: we studied consecutive patients over the age of 60 years referred to the 'falls clinic' with a history of unexplained syncope, unexplained falls and unexplained dizziness. We also studied asymptomatic control subjects recruited from a general practice register aged 60 years and over. All patients and control subjects underwent a full clinical assessment (comprehensive history and detailed clinical examination including supine and erect blood pressure measurements) and 12-lead electrocardiography. We performed carotid sinus massage in the supine position for 5 seconds separately on both sides followed by repeating the procedure in the upright positions using a motorised tilt table. Heart rate and blood pressure were recorded using a cardiac monitor and digital plethysmography respectively. The test was considered positive if carotid sinus massage produced asystole with more than a 3 second pause (cardioinhibitory type of carotid sinus syndrome), or a fall in systolic blood pressure of more than 50 mmHg in the absence of significant cardioinhibition (vasodepressor type of carotid sinus syndrome) or where there was evidence of both vasodepressor and cardio-inhibition as above (mixed type). RESULTS: we studied 44 asymptomatic control subjects and 221 symptomatic patients (130 with unexplained syncope, 41 with unexplained falls and 50 with unexplained dizziness). In the overall symptomatic patient group, the positive yield (any type of carotid sinus syndrome) was 17.6% (95% CI = 12.7-22.5). The positive yield in men (26.3% (95% CI = 16.4-36.2)) was twice that in women (13.1% (95% CI = 7.6-18.6)) (P = 0.014). Overall any type of carotid sinus syndrome was present in 22.3% (n = 29) of the syncope group, 17.1% (n = 7) in the unexplained fallers group and 6% (n = 3) in the dizziness group. We also found that no women with unexplained dizziness had a positive carotid sinus massage test. None of the controls demonstrated a positive response. None of the subjects suffered any complications during or after the test. CONCLUSION: the positive yield of carotid sinus massage in symptomatic patients was 17.6% with the yield in men being twice that in women. None of the asymptomatic control subjects demonstrated a positive response. The yields in unexplained syncope and unexplained falls patients were around 4-fold and 3-fold higher respectively than in unexplained dizziness patients. The positive yield in women with unexplained dizziness (without a definite history of syncope and falls) is zero. Hence, carotid sinus massage in older adults should particularly be targeted at patients with unexplained syncope and unexplained falls.

Accidental Falls↗
PubMed1984

Autonomic blockade and sick sinus syndrome. New concept in the interpretation of electrophysiological and Holter data.

Autonomic blockade is commonly employed as a test of sinus node dysfunction. We compared primary and secondary atrial postpacing pauses and postextrasystolic sino-atrial responses before and after autonomic blockade in 56 patients with the clinical diagnosis of sick sinus syndrome. Pharmacological autonomic blockade was achieved by atropine 0.04 mg kg-1 and propranolol 0.2 mg kg-1, i.v. In a group of patients with a normal intrinsic heart rate the number of positive electrophysiologic variables associated with sinus node dysfunction declined after autonomic blockade. In 91% of these patients, sinus node function was characterized by a normal intrinsic recovery time, gradual exponential return to the constant sinus cycle length, and biphasic postextrasystolic return responses. Three patients in this group had intrinsic SA-block revealed by atrial pacing and verified by Holter monitoring. Besides normal intrinsic pacemaker properties in 53% of patients, rhythm monitoring revealed severe sinus node dysfunction as manifested by bradycardia and the tachycardia-bradycardia syndrome. SA-block and sinus arrest up to 29120 ms. In the abnormal intrinsic heart rate group, disturbed intrinsic rhythmicity was characterized in all by a prolonged corrected intrinsic recovery time (2320 +/- 2740 ms [+/- SD]), arrhythmia and/or bradycardia in the secondary postpacing cycles, chaotic postextrasystolic patterns, or prolonged sinoatrial conduction times. Significantly slow minimal heart rates during sleep significantly prolonged average sinus cycle lengths and positive ECGs for sinoatrial disorders in the waking period were present on the 24-h rhythm recording. It is concluded that intrinsic heart rate obtained by autonomic blockade is the best and most simple method for the diagnosis of intrinsic sinus node dysfunction. Combined autonomic blockade and electrophysiological tests can be of great value in unmasking the severity and degree of intrinsic dysfunction and analyzing the abnormality of secondary pacemaker function. These investigations, however, are rather insensitive and therefore ineffective in detecting autonomic sinus node dysfunction. To assess the role and significance of the autonomous neurovegetative tone in the genesis of sinoatrial disorders, rhythm monitoring is required.

Adolescent↗
PubMed2006

Paranasal fungal sinusitis: contributions of histopathology to diagnosis: a report of 60 cases and literature review.

Sixty cases of fungal sinusitis are presented from 2 institutions, accumulated from 1971 to 2005. Fifty cases were from a large suburban general hospital and 10 from a major university referral center. Two of the 50 and 3 of the 10, respectively, were immunocompromised patients and had acute fulminant disease. This suggests that encountering the various forms of this disease may, in part, be dependent on the referral nature of the institution. The remainder were immune competent and had chronic symptoms of nasal discharge, stuffiness, and facial pain. Imaging studies frequently showed sinus expansion, opacification, and bone erosion, although no clinical or radiographic features were predictive of extrasinus extension. Chronic fungal sinusitis is principally represented by fungus ball/mycetoma and allergic fungal sinusitis. The recent literature suggests a predominance of or a predominant interest in allergic fungal sinusitis. Hyphal colonies and the presence of allergic mucin with scattered organisms are histologic observations and are the respective keys to these diagnoses. However, the etiologic role of the fungus in chronic cases is not settled. Patients with chronic sinusitis who yield positive sinus cultures only, but have no organisms visualized histologically, are not universally regarded as having fungal sinusitis. The interest in fungal sinusitis has generated a prominent role for the pathologist. An awareness of the various forms of the disease and thorough histopathologic study, including submission of all tissues removed at surgery and recognition of allergic mucin, are essential. Acute fulminant/invasive fungal sinusitis may require frozen section for adequate management.

Adolescent↗
PubMed2000

Bone involvement in sinusitis: an apparent pathway for the spread of disease.

OBJECTIVES/HYPOTHESIS: To study the effects of bone involvement in experimentally induced sinusitis and the effect of involved bone on the overlying mucosa. STUDY DESIGN: Animal study. METHODS: Sinusitis was induced unilaterally with Pseudomonas aeruginosa in the maxillary sinus of 19 New Zealand white rabbits. At 6 weeks, the pathogenic organism was confirmed by culture, and a segment of the bone from the medial wall of the sinus implanted in a submucosal pocket in the opposite sinus. The rabbits were killed at predetermined time intervals up to 13 weeks from sinusitis induction, and en bloc sinus sections were decalcified and stained. RESULTS: The implanted bone reabsorbed partially or totally in all specimens. However, the study revealed clear histological evidence of bone involvement adjacent to the infected sinuses and the bony changes extended to the noninfected side in all specimens. The histological findings were identical to those seen in chronic osteomyelitis. CONCLUSIONS: This study demonstrates the ability for pseudomonal sinusitis, at least in the presence of surgical intervention, to involve bone at a distance from the site of primary infection in the absence of intervening mucosal disease. If confirmed with additional organisms and models, these findings have significant implications for the therapeutic management of chronic sinus disease.

Animals↗
PubMed1990

Surgical approaches to the cavernous sinus: a microsurgical study.

The surgical approaches to the cavernous sinus were examined in 50 adult cadaveric cavernous sinuses using magnification of X3 to X40. The following approaches were examined: 1) the superior intradural approach directed through a frontotemporal craniotomy and the roof of the cavernous sinus; 2) the superior intradural approach combined with an extradural approach for removing the anterior clinoid process and unroofing the optic canal and orbit; 3) the superomedial approach directed through a supraorbital craniotomy and subfrontal exposure to the wall of the sinus adjacent to the pituitary gland; 4) the lateral intradural approach directed below the temporal lobe to the lateral wall of the sinus; 5) the lateral extradural approach for exposure of the internal carotid artery in the floor of the middle cranial fossa proximal to the sinus; 6) the combined lateral and inferolateral approach, in which the infratemporal fossa was opened and the full course of the petrous carotid artery and the lateral wall of the sinus were exposed and; 7) the inferomedial approach, in which the medial wall of the sinus was exposed by the transnasal-transsphenoidal route. It was clear that a single approach was not capable of providing access to all parts of the sinus. The intracavernous structures best exposed by each route are reviewed. The osseous relationships in the region were examined in dry skulls. Anatomic variants important in exposing the cavernous sinus are reviewed.

Adult↗