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The conventional histopathology of the sinus is a criterium for the therapeutic indication, since it is possible to distinguish between granulomatous chronic sinusitis, chronic sinusitis with oedema and nasal polyposis. Each one of these clinical pictures has his own etiology and requires a specific therapeutic approach.
BACKGROUND: The mechanism of neutrophil recruitment in patients with chronic sinusitis is unclear. OBJECTIVE: This study aims to elucidate the role of IL-8 in inducing neutrophil accumulation in the nasal discharge of patients with chronic sinusitis. METHODS: Nasal discharge and mucosal specimens were obtained from two groups of patients, those with chronic sinusitis and those with allergic rhinitis. The samples were subjected to immunohistochemical examination and in situ hybridization. The IL-8 level in the nasal discharge was measured by enzyme immunoassay. RESULTS: Immunoreactivity to IL-8 was observed in polymorphonuclear cells of nasal smear, in nasal gland duct cells, and in epithelial cells of the chronic sinusitis group; whereas those of the allergic rhinitis group mostly showed little or no reaction. Similar patterns of localization were shown by in situ hybridization for IL-8 messenger RNA. The IL-8 level in nasal discharge was significantly higher in the chronic sinusitis group than in the allergic rhinitis group. CONCLUSION: These results suggest that chemotactic factors in sinus effusion, including IL-8 derived from nasal gland duct cells and epithelial cells, attract neutrophils out of mucosa, and the neutrophils that have emigrated into the sinus effusion secrete IL-8. This induces further neutrophil accumulation in the sinus effusion of patients with chronic sinusitis.
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Sinusitis can be defined as inflammation of the paranasal sinus mucosa. However, the definition of chronic sinusitis is not yet fully established. As chronic sinusitis occurs both on an infectious and non-infectious basis there are many symptoms, local as well as general, from the upper respiratory tract. It is generally agreed that the time aspect of the disease is important. Long-term symptoms, i.e. more than 3 months, and objective findings of mucosal inflammation are criteria for chronic sinusitis. In clinical practice it is also important to realize that mucosal changes usually persist for at least 8 weeks after the treatment of an acute infection. Interest has lately been focused on local sinusal inflammation, especially on the inflammatory cells whose immunoactive products seem to keep inflammation ongoing even after the infection is cured. It is not clear to which extent the mucosal damage, with granulation tissue, polyp formation and fibrosis, is reversible. In chronic sinusitis, the ostial function is disturbed, especially in patients with nasal polyposis. This function must be re-established, but it is still uncertain whether obstruction in the osteomeatal complex is primary or secondary to other factors. Further research into local immunological factors and analysis of the development of special local tissue pathology in sinusitis is necessary in order to be able to establish exactly why acute sinusitis does not resolve but turns into a chronic inflammatory disease.
Chronic sinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. The common use of multiple broad-spectrum oral antibiotics and endoscopic sinus surgery to treat this condition may alter the pathogenes that promote persistence of chronic sinusitis. Forty-eight culture-positive patients with chronic sinusitis who had been medically treated for at least 3 months and had undergone sinus surgery were bacteriologically evaluated. Swab specimens of the middle meatus and sphenoethmoid recess were aseptically obtained endoscopically and cultured for aerobes. Coagulase-negative staphylococci were the most common isolates (45.8%), followed by Streptococcus pneumoniae (16.7%), Enterobacteriaceae (16.7%), Staphylococcus aureus (10.4%), and Pseudomonas aeruginosa (10.4%). Coagulase-negative staphylococci were the most frequently isolated organisms in our study, as in many other studies. Despite the significant predominance of these organisms, they have always been assumed to be contaminants, and their presence in culture has been discounted. Coagulase-negative S aureus may be a pathogen in the chronic sinusitis process, and sensitivities of this isolate should be obtained for evaluation and possible treatment of the disease.
OBJECTIVE: This study was conducted to investigate the expression of alpha IL5 and alpha GM-CSF receptors (alpha IL5r and alpha GM-CSFr) mRNA in the paranasal sinus mucosa of atopic and nonatopic subjects with chronic sinusitis compared to controls. DESIGN: This was a prospective study of patients presenting with the diagnosis of chronic sinusitis of at least 6 months' duration. METHOD: Fourteen patients with stable chronic sinusitis (7 atopic, 7 nonatopic) and 7 controls were included, from whom sinus mucosal biopsies were obtained and examined for membrane-bound alpha IL5r and alpha GM-CSFr mRNA using in situ hybridization. RESULTS: There was a significant difference in the number of cells expressing alpha IL5r mRNA per high-power field in both atopic and nonatopic subjects compared to controls, and in the number of cells expressing alpha GM-CSFr mRNA in both atopic and nonatopic subjects compared with controls. The number of alpha IL5r mRNA-positive cells was significantly greater in the atopic versus nonatopic groups, whereas alpha GM-CSFr mRNA-positive cells were greater in number in the nonatopic versus atopic groups. CONCLUSION: Both alpha IL5r and alpha GM-CSFr are upregulated in chronic sinusitis, suggesting that increases in both Th-2 cytokines and their receptors may be important in the pathology of the disease. Furthermore, the predominant associations of alpha IL5r with atopic chronic sinusitis and alpha GM-CSFr with nonatopic chronic sinusitis suggest that the chronic inflammation in this condition may arise from differential activation of distinct cytokine pathways depending on whether or not there is associated atopy.
The etiological role of concha bullosa in chronic sinusitis is controversial. Previous investigators have not studied the relationship between the location of concha bullosa and different chronic sinusitis patterns. We performed coronal paranasal sinuses CT in 100 Chinese patients with signs and symptoms of chronic sinusitis and recorded the presence and location of the concha bullosa and the pattern of sinonasal disease. The incidence of concha bullosa was 47%. The presence of concha bullosa showed no statistically significant association with different patterns of chronic sinusitis.
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Chronic sinusitis is a prevalent problem. The symptoms of CS cause patients to seek medical attention, and therefore the presence of symptoms drives the use of health care resources. There is widespread clinical belief that computed tomography (CT) scan findings may be a reasonable proxy for disease severity in chronic sinusitis, and many authors have proposed that CT scan findings make up the key component in severity staging systems for chronic sinusitis. However, the relationship between symptom severity and CT scan findings in chronic sinusitis has not been well explained to date. To explore this relationship further, we examined data from consecutive patients with both a CT scan and a sinusitis symptom score, from ongoing prospective outcomes studies at two large academic centers in different cities (n = 254). CT scans were graded using two validated staging systems; symptom severity was assessed using two validated health status instruments and summary items. In addition, we explored multiple statistical modifications and permutations of CT staging to identify potential relationships between the two variables. In summary, no association between CT scan findings and symptom severity could be identified using both CT staging systems and patient-based symptom instruments. For instance, CT scans were examined: after eliminating normal scans, using different scoring algorithms, by worst side, by nonlinear association, when grouped into strata, and by eliminating patients with very severe disease; no statistical association was found between CT findings and patient-based symptoms using any of those techniques. Since symptom severity is a pivotal outcome measure in chronic sinusitis, these findings have significant implications for outcomes research and the development of severity staging systems.
The distribution of fibronectin (FN) in operative specimens of maxillary sinus mucosa from 35 patients with chronic sinusitis was examined immunohistochemically. Mouse monoclonal antibody to human FN was used for the peroxidase-antiperoxidase staining technique. FN was found in most of the serous cells and in some (about 10%) of the mucous cells in the nasal glands, and also in the nasal fluid in the lumina. It was not found elsewhere, be it in the epithelial cells, the basement membrane, or the interstitial tissue, except in two patients. These results suggest that FN is produced in the nasal glands and secreted into the nasal fluid in the maxillary sinus in chronic sinusitis.
A multicentric study was conducted to evaluate the clinical efficacy and tolerance of ofloxacin in the treatment of chronic sinusitis and chronic otitis (CSOM) in outpatients. Two hundred milligrams of ofloxacin was administered twice a day orally for 12 days in 198 patients with chronic sinusitis and 215 patients with CSOM. Cultures for bacteriology were carried out before treatment. The spectrum of pathogens sensitive to ofloxacin included Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis and Haemophilus influenzae. Higher concentrations of ofloxacin were obtained at sites of infection than in serum. Favorable results were achieved clinically in 93.7% of chronic sinusitis cases and 93.9% of CSOM cases. Adverse effects occurred in only 4.1% of cases. These results support the use of ofloxacin as the drug of first choice in the treatment of chronic sinusitis and CSOM in adult outpatients.
OBJECTIVE: To observe the incidence rate of chronic sinusitis in the patients with perennial allergic rhinitis, and explore the possible etiology of sinusitis. METHOD: Fifty-seven patients were examined with endoscope and CT scan. RESULT: Of the 57 patients, 18 (32%) patients had chronic sinusitis, among which 17 patients had different kinds and different extents of anatomy abnormalities of nose cavity including deviation of nasal septum, concha bullosa, hypertrophy of uncinate process, paradoxical curvature of middle turbinate, etc. Thirty-nine patients didn't complicated with chronic sinusitis, among which only 7 patients had anatomy abnormalities of nose cavity. CONCLUSION: Anatomy abnormalities of nose cavity may be the basic etiology of sinusitis in patients with perennial allergic rhinitis; The edema of nasal mucous and the change of nasal discharge caused by perennial allergic rhinitis may be the triggering factor of chronic sinusitis. Both of these two factors are involved in the pathogenesis of sinusitis.
OBJECTIVES: It is likely that genetic factors play a role in the etiology of chronic sinusitis, and airway inflammation is an important pathological feature in chronic sinusitis. We hypothesized that individuals with greater inflammatory responses may be more likely to acquire the disease. Polymorphisms of the tumor necrosis factor (TNF) genes have been described, and certain inflammatory diseases are reportedly associated with certain alleles of TNF genes. The purpose of this study is to examine whether there is an association between some alleles of TNF genes and chronic sinusitis. STUDY DESIGN: Thirty-eight Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells on plain radiographic films. METHODS: Both tumor necrosis factor-alpha (TNF-alpha) and tumor necrosis factor-beta (TNF-beta) gene polymorphisms were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms in these patients and 35 healthy control subjects. RESULTS: A significantly higher frequency (P < .05) of TNFB*2 allele of TNF-beta gene polymorphism was observed in patients with chronic sinusitis (74%) compared with control subjects (56%). There was no association between alleles of TNF-alpha and chronic sinusitis. CONCLUSION: We concluded that TNF-beta gene polymorphism may form a component of the genetic predisposition to chronic sinusitis in Japanese patients.
OBJECTIVE: To investigate the differentially expressed proteins among chronic sinusitis, nasal polyps and normal nasal mucosa by means of proteomic technology, and select the candidate biomarkers of chronic sinusitis and nasal polyps. METHODS: Proteins extracted from chronic sinusitis, nasal polyps and normal nasal mucosa were separated and the differentially expressed proteins were identified by series of proteomic tools, including immobilized pH4-7 gradient two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis, modified coomassie brilliant blue staining, images scanning by the Image Scanner apparatus, PDQuest analysis software, peptide mass fingerprinting based on matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS) by in-gel digestion extract, and Mascot searching in NCBInr and SWISS-PROT databases. RESULTS: The 2-DE patterns with high resolution and reproducibility were obtained. The protein spots separated and visualized in chronic sinusitis, nasal polyps and normal nasal mucosa gel were 1020 +/- 40, 1112 +/- 10 and 1008 +/- 25, respectively. And the match rates were (93 +/- 2)%, (95 +/- 1)% [see text] (90 +/- 3)% respectively. Thirteen differentially expressed spots were found from chronic sinusitis, nasal polyps and normal nasal mucosa gel. We selected and recommend Keratin 8 and APOA1 proteins as candidate biomarkers of nasal polyps, and PLUNC protein, PACAP protein, NKEF-B and SOD as candidate biomarkers of chronic sinusitis. CONCLUSIONS: The differentially expressed proteins among chronic sinusitis, nasal polyps and normal nasal mucosa can be efficiently and relatively reliably identified via the techniques of proteomics. These techniques will play a very important role in the researches for new objective indicators possibly employed in the future classifying, staging and prognosis.
OBJECTIVE: The cause of pediatric chronic sinusitis is multifactorial, but nasal edema appears to be the initial pathologic step. The objective of this study is to evaluate gastronasal reflux as a possible cause of pediatric sinusitis. METHODS: Thirty children with chronic sinusitis were believed to be appropriate candidates for functional endoscopic sinus surgery. Children were evaluated retrospectively for their response to reflux therapy with regard to their sinus symptoms and avoidance of sinus surgery. RESULTS: Two of the 30 children were eventually excluded because they were taken to surgery for the specific purpose of contact point release. Chart review at 24-month follow-up indicated that 25 of the 28 children (89%) avoided sinus surgery. CONCLUSION: After reflux treatment, the number of children requiring sinus surgery was dramatically reduced. The results of this preliminary pediatric study indicate that gastronasal reflux should be evaluated and treated before sinus surgical intervention.
OBJECTIVES: To create well-differentiated cultures of normal and chronic sinusitis paranasal sinus epithelial cells and to compare their electrophysiologic properties. DESIGN: In vitro investigation using primary sinus epithelial cells, initially cultured on plastic tissue culture dishes. Cells were characterized by means of immunocytochemical analysis and then passaged to air-liquid interface culture conditions. The morphologic features of air-liquid interface cultures were assessed using light and electron microscopy. Epithelial Na(+) channel, Na(+)-K(+)-2Cl(-) cotransporter, cystic fibrosis transmembrane conductance regulator, and Ca(2+)-activated Cl(-) channel function were investigated in Ussing chambers. SUBJECTS: Specimens were obtained from 15 patients undergoing transsphenoidal pituitary procedures, tumor removal, or trauma repair and from 9 patients with chronic sinusitis. RESULTS: After culture at an air-liquid interface for 21 days, the epithelium was pseudostratified and contained basal, mucous secretory, and ciliated cells. There were no detectable morphologic differences between normal and chronic sinusitis cells. In cultures of normal cells, median basal short circuit current was 4.7 microA/cm(2), and Na(+) transport, defined as the amiloride hydrochloride-sensitive component, was approximately 20% of the total. Basal and amiloride-sensitive short circuit currents were greater in cultures of chronic sinusitis cells. Basal short circuit currents in both types of cultures were insensitive to the Cl(-) transport inhibitor bumetanide, but all responded to forskolin or uridine triphosphate. After amiloride pretreatment, forskolin and uridine triphosphate responses were greater in chronic sinusitis cells. CONCLUSIONS: We established methods for well-differentiated sinus epithelial cultures. The cells exhibited Na(+) absorption and Cl(-) secretion, and elevated rates of ion transport may be pathophysiologically relevant in chronic sinusitis.
BACKGROUND: The treatment of acute, recurrent, and chronic sinusitis remains controversial because of the presence of a wide variety of aerobic and anaerobic bacteria in the sinuses. DESIGN: This double-blind, randomized trial compared cefaclor with amoxicillin in the treatment of acute, recurrent, and chronic maxillary sinusitis using clinical evaluation, roentgenography, and microbiologic evaluation of antral aspirates. SETTING: Outpatient office of five otorhinolaryngologists in Salt Lake City, Utah. PATIENTS: One hundred eight adult patients with acute, recurrent, or chronic maxillary sinusitis. INTERVENTION: Oral treatment with cefaclor (500 mg) twice daily or amoxicillin (500 mg) three times daily for 10 days. MAIN OUTCOME MEASURE: Clinical response to treatment with cefaclor vs amoxicillin. RESULTS: Fifty-six patients with acute sinusitis, 25 with recurrent sinusitis, and 15 with chronic sinusitis were evaluable. Although multiple organisms were common in each group, patients with acute sinusitis were more likely to have Haemophilus influenzae or Streptococcus pneumoniae, and patients with recurrent or chronic sinusitis were more likely to have anaerobes in sinus aspirate. Whether treated with cefaclor or amoxicillin, clinical improvement occurred in 86% of patients with acute sinusitis and 56% of patients with recurrent sinusitis. Patients with chronic sinusitis were too few to allow statistical analysis of the differences in outcome between them and patients with recurrent or acute sinusitis. Resistance of the cultured organisms to the study drug used was unrelated to treatment outcome. CONCLUSIONS: The rate of clinical improvement was high in patients with acute sinusitis but was less favorable in those with recurrent and chronic disease regardless of the study drug used. The susceptibility of organisms isolated to the study drugs was unrelated to outcome.
Although medical and surgical strategies for chronic sinusitis have been greatly refined during the last 2 decades, many patients continue to suffer. Bacterial biofilms are three-dimensional aggregates of bacteria that recently have been shown to play a major role in many chronic infections. There is growing evidence that bacterial biofilms may play a role in some forms of recalcitrant chronic sinusitis that persists despite surgically opened sinus cavities and what seems to be appropriate, culture-directed antibiotic therapy. New directions in therapy aimed at biofilms may provide some success in treatment for patients with chronic sinusitis.