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PubMed2004

Frontal sinus anatomical variations with potential consequences for the orbit. Study on cadavers.

Anatomical variations of the frontal sinuses that may play a role in the correlation between frontal sinusitis and orbital complications are described. There were used 18 cadavers during routine educational cadaver dissections, one month after theirs withdrawal from the formol basin. The dissections of the cranial cavity and the orbits were performed so as to reveal the frontal sinuses. An unusual bilateral posterior extension of the frontal sinus mucosa was found in two of the cadavers. The projection of the mucosa was covering half of the orbital roof in a 60 year old male and one third of the orbital roof in a 59 year old male. Among the other cadavers that presented normal variations of the frontal sinuses, there was also a case of a 57 year old female with a complete aplasia of the frontal sinuses. Such anatomical variations with unusual extension of the frontal sinuses above orbital roof may support the correlation between frontal sinusitis and the possible complications from the orbit and these cases may be considered as 'high risk' cases for orbital complications during a frontal sinusitis.

Female↗
PubMedDate not supplied

Computed tomography vs. magnetic resonance imaging of acute bacterial sinusitis: a rabbit model.

PURPOSE: Computed topography (CT) and magnetic resonance imaging (MRI) are important, both clinically and in a research setting, in assessing bacterial sinusitis (BS). The use of CT scanning to evaluate sinus opacification in a reversible model of rabbit acute sinusitis has been reported. MRI offers the potential for better visualization of soft tissue and fluid changes within the paranasal sinuses. MRI has potential as a research tool in animal models of sinusitis. This article compares the use of CT and MRI in measuring maxillary sinus opacification in rabbits during experimental, reversible BS. MATERIALS AND METHODS: In 2 independent trials, New Zealand White rabbits were imaged for baseline anatomy, and BS was generated by sinus inoculation with Staphylococcus aureus. Serial imaging was performed as a measure of the progression and resolution of BS during the trials. Two experienced, independent reviewers then scored each CT and MRI for percent opacification of the maxillary sinus. These scores were analyzed to assess the degree of agreement between the reviewers. RESULTS: The correlation coefficients for CT and MRI were 0.6816 and 0.3584, respectively. The Z-statistic comparing these correlation coefficients was significant (P < .0001), indicating that CT is a more precise measure of reversible BS in this rabbit model. Differences in mean scan time and cost per scan were also significantly different (P < .0001), with CT being both quicker and less expensive. CONCLUSIONS: Greater interobserver consistency of scan interpretation, with less time and cost, make CT the preferred tool for measuring BS in this rabbit model. Attributes of MRI such as better resolution of fluid-tissue interfaces and custom surface coil design for visualization of specific anatomic structures are discussed as they may increase the effectiveness of MRI as an imaging modality in future sinusitis research.

Acute Disease↗
PubMed2000

[The correlation between the CD4 count in HIV-positive patients and the radiological findings in diseases of the paranasal sinuses].

BACKGROUND AND OBJECTIVE: Sinusitis is a frequent and typical disease in HIV-positive patients. It was the aim of this study to examine retrospectively computed tomograms (CT) and magnetic resonance images (MRI) of such patients for sinusitis. PATIENTS AND METHODS: CT and MRI of the nasal sinuses were retrospectively analysed in 71 HIV-positive patients. RESULTS: Sinusitis was diagnosed in 49 of the 71 patients by conventional radiology (38), CT (13) and/or MRI. In patients with sinusitis, contrary to those without it, there was a significant correlation between progression of the HIV infection, as measured by reduction in CD4 count, and an increased number of symptoms (r = -0.297; p < 0.05). The latter also correlated significantly with the frequency of concomitant sinusitis (r = 0.336, p < 0.05). The radiological findings correlated more closely with the CD4 count when tomography was used. The correlation coefficient for the number of patients with concomitant sinus disease rose from r = -0.305 to r = -0.459 and for the degree of severity from r = -0.324 to r = -0.484 (p < 0.05). Severity of sinus disease was clearly more marked among HIV-positive than HIV-negative patients. CONCLUSION: The severity of sinusitis in HIV-positive patients correlated directly with the level of the CD4 count. In these patients tomographic methods are preferable to conventional radiology.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Cytokine pattern in various forms of sinusitis].

BACKGROUND: Inflammatory sinus diseases include acute sinusitis, chronic purulent sinusitis, and chronic polypoid rhinosinusitis. We investigated the cytokine profile of different types of rhinosinusitis in order to evaluate whether a distinct form of rhinosinusitis is associated with the expression of a specific cytokine profile. METHODS AND PATIENTS: Fresh sinus mucosa obtained during routine surgery from patients with acute sinusitis (n = 10), chronic sinusitis (n = 7), antrochoanal polyp (n = 10), nasal polyps (n = 8), and controls of turbinate mucosa (n = 7) were homogenized. The cytokine protein content (IL-1 beta,IL-3,IL-5,IL-6,IL-8,GM-CSF) of tissue homogenates was measured using ELISA technique. RESULTS: In the group of proinflammatory cytokines, the protein levels measured for interleukin IL-8, a proinflammatory cytokine, IL-1 beta, and IL-6 were elevated in acute sinusitis. In the group of eosinophil-activating cytokines interleukin-3, -5 and granulocyte an makrophage-colony stimulating factor, we measured a significantly elevated protein level of IL-5 in nasal polyp tissue in contrast to significantly elevated IL-3 protein level in chronic sinusitis. CONCLUSIONS: These findings suggest that IL-8 plays a pivotal role in neutrophil-dominated and IL-5 in eosinophil-dominated sinusitis. IL-3 seems to sustain chronic inflammation.

Biopsy↗
PubMed1997

[Endonasal, microscopically controlled frontal sinus surgery].

BACKGROUND: The anatomic variation of the frontal sinus and frontal recess can create both a diagnostic and therapeutic challenge. Most cases of frontal sinus disease can now be treated by endoscopic approaches. For refractory cases or those with severe pathology, the microscopically controlled drainage (MCD) operation has at times been successful and spared the patient the morbidity of an external approach. The aim of this study was to evaluate microscopically controlled frontal sinus surgery in these difficult cases. MATERIAL AND METHODS: Prospective analysis was performed on the efficacy of MCD in patients for whom endoscopic sinus surgery had failed or in primary cases with severe pathology or unfavorable anatomy. The technique employs a self-retaining endonasal retractor and a diamond bur under microscopic visualization to remove solid bone (frontal spine) obstructing the sinus drainage and allow a wide opening of the frontal recess while causing minimal mucosal damage. Unilateral drainage (extended frontal sinus drainage operation), and in some cases bilateral drainage (median drainage procedure) is employed. RESULTS: With an average of 23 months of follow-up, over 90% of patients were either free of symptoms or substantially improved after the MCD procedure. Three patients required revision surgery (extend the opening into a median drainage procedure) for adequate relief of symptoms. CONCLUSIONS: The MCD procedure is highly successful in the treatment of frontal recess disease, particularly in those cases of severe pathology or difficult anatomy. It may be used in those cases refractory to standard endoscopic sinus surgery where an external approach and frontal sinus obliteration are contemplated. As with endoscopic sinus surgery, precise knowledge of the frontal recess and neighboring landmarks is critical, and adequate drainage with minimal mucosal disruption should be the goal.

Drainage↗
PubMed2000

Prognosis and prediction of response to surgery in allergic patients with chronic sinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) occurs frequently in patients with atopy, but little is known of the prognosis after surgery and of factors that may predict a poor outcome. OBJECTIVE: Our purpose was to assess the long-term prognosis in atopic patients with CRS who undergo surgery and whether certain immune markers could predict a worse prognosis in this setting. METHODS: Fifteen patients with diffuse involvement of the sinuses on computed tomographic (CT) scan but without nasal polyposis underwent ethmoidectomy with middle meatotomy for CRS when it was clinically indicated. All patients had a biopsy of the inferior turbinate and of the most inflamed areas of the maxillary and ethmoid sinuses at the time of surgery. Follow-up was performed by video endoscopy and by assessment of 2 chronic sinusitis questionnaires at 0, 6, and 24 months postoperatively. The number of lymphocyte subsets (CD3, CD4, CD8), mast cells and eosinophils, and cells expressing IL-4 and IL-5 messenger RNA (mRNA) in all 3 biopsy sites at the time of surgery were compared with the clinical response after surgery. RESULTS: Seven patients had persistent improvement after surgery, with a decrease in pain, rhinorrhea, or nasal obstruction and a decrease in the need for medication. Eight patients were unchanged or worsened after surgery with disabling rhinorrhea and repeated sinusitis. We found no difference in the number of inflammatory cells, lymphocyte subsets, or IL-4 mRNA-positive cells in the sinus mucosa between responders and nonresponders. However, an increased number of cells expressing IL-5 mRNA was found in the ethmoid sinus at the time of surgery in patients who did not respond to the surgical intervention (P =.007). CONCLUSION: More than 50% of patients with perennial rhinitis and CRS do not improve after surgery, a response that may be predicted by more cells expressing IL-5 mRNA in the ethmoid sinuses. The increased number of cells expressing IL-5 mRNA may have the potential to be used as a marker for prediction of the response to surgery. The worsening of symptoms in some patients with CRS after sinus surgery could be a result of the disturbance of the anatomy of the sinuses and exposure to the environmental allergens.

Adolescent↗
PubMed2000

Complications of acute sinusitis in children.

Acute sinusitis is often a mild, self-limiting disease. However, in some cases, especially among children, sinusitis may become a severe, even life-threatening, disease. To examine the nature of complications of acute sinusitis, we studied the cases of children treated at the Helsinki University ENT Hospital, because of a complication caused by acute sinusitis from January 1997 to September 1998. There were 12 children (4 girls, 8 boys), whose ages ranged from 16 months to 16 years. One child had an epidural abscess, one got meningitis and cavernous sinus thrombosis, five had orbital cellulitis, one of whom lost her vision permanently in one eye, and five had preseptal cellulitis. All the children were treated with intravenous antibiotics and all, except the youngest, were treated with a direct sinus puncture. An operation (intranasal antrostomy, orbital drainage, functional endoscopic sinus surgery or adenoidectomy) was performed on six patients. In the majority of children, acute sinusitis is a mild self-limiting disease. However, severe complications still exist. When a complication of sinusitis is suspected, it is of utmost importance that the child be sent immediately to a hospital for proper diagnosis and treatment.

Acute Disease↗
PubMed2005

Histopathologic characteristics of chronic sinusitis with bronchial asthma.

CONCLUSION: These findings suggest that patients with both sinusitis and asthma present the histopathologic characteristic of a marked chronic inflammatory reaction, and that eosinophil infiltration may play a significant role in this marked inflammation of the sinus mucosa. OBJECTIVE: Chronic sinusitis and bronchial asthma are known to be closely related. However, the appearance of the mucosa in chronic sinusitis patients with asthma is somewhat different from that in patients without asthma. MATERIAL AND METHODS. We compared the sinus mucosal histopathologies of asthmatic patients with those of non-asthmatic patients. Fifty-three sinusitis patients with a diagnosis of asthma and 54 sinusitis patients without asthma, who served as controls, were enrolled in the study. All of these patients underwent endoscopic sinus surgery. The following seven light microscopic findings were compared in the asthmatic and non-asthmatic groups: the thickness of the basement membrane, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophil infiltration, lymphocyte infiltration and polymorphonuclear leukocyte infiltration. In addition, we explored a possible link between asthma and sinusitis by comparing the following factors in asthmatic and non-asthmatic patients: the presence of allergy, the degree of preoperative polyposis and the extent of preoperative disease as scored by means of ostiomeatal unit CT findings. RESULTS: No statistically significant differences were found between the two groups in terms of the presence of allergy, the degree of preoperative polyposis or the extent of preoperative disease. Basement membrane thickening, goblet cell hyperplasia and eosinophil infiltration were more prominent in the asthmatic compared to the non-asthmatic group (p <0.05).

Adolescent↗
PubMed1997

Treatment of frontal sinus osteoma using a craniofacial approach.

Osteoma is one of most common benign tumors of the nose and paranasal sinuses, with the frontal sinus being its most frequent location. It may be locally destructive and aggressive with possible intracranial complications. Osteoma of the frontal sinus comprises 57% of all osteomas in the paranasal sinuses. In 1939, Childrey reviewed 3,510 consecutive sinus radiographs taken for any reason and found an incidence of 0.43% of paranasal sinus osteomas. There are many operative approaches for frontal sinus osteomas, such as external frontoethmoidal approach and osteoplastic frontal sinusectomy, both with high recurrence rates. Those traditional operative methods cannot radically eradiate the osteoma grown in the posterior table of the frontal sinus. From July 1991 to June 1992, three patients with symptomatic frontal sinus osteomas were operated by a craniofacial approach. One patient is presented here in detail. A coronal incision is used and is found to be beneficial both in surgical exposure and in reconstruction with a calvarial bone graft. The patient has been followed for 3.5 years without osteoma recurrence.

Bone Neoplasms↗
PubMedDate not supplied

Prevalence of incidental paranasal sinuses opacification in pediatric patients: a CT study.

A prospective evaluation of the paranasal sinuses was performed on a consecutive series of 137 pediatric patients referred for cranial CT. Approximately one-half of the patients less than 13 years of age had some degree of maxillary or ethmoid sinus opacification. The prevalence and severity of opacification was approximately the same for the maxillary and ethmoid sinuses. Sphenoid sinus abnormality was less common (16% of patients) and was usually minimal or mild. No incidental frontal sinus abnormalities were observed. This study confirms previous reports, based on plain film radiography, of the prevalence of incidental maxillary sinus opacification in children. However, contrary to some prior studies, we did not find a relatively higher rate of opacification in children less than 1 year of age. This may be due to overdiagnosis of maxillary sinus opacification on plain films, in small children. The diagnosis of sinusitis in childhood must take into account not only the radiographic findings but clinical signs and symptoms. Correlation is needed to avoid overdiagnosis in patients referred for sinus radiography for nonspecific indications or who have incidental opacification noted on radiographic or CT studies of the skull and brain.

Adolescent↗
PubMed1998

Sinus lateralis in endoscopic ethmoidectomy.

OBJECTIVE: To characterize the anatomy of the sinus lateralis and enable a more accurate and safe approach to endoscopic ethmoidectomy. STUDY DESIGN: An anatomic study of 33 cadaver heads providing a prospective evaluation of 50 ethmoid sinuses. The sinus lateralis, in particular, was thoroughly examined and typical variations were classified into four categories. A technique using the sinus lateralis as a critical landmark is described which allows calculated removal of anterior ethmoid cells in a posterior-to-anterior direction, avoiding inadvertent entry into the posterior ethmoid. Prospective evaluation of this technique in 12 pediatric patients found it to be safe and particularly useful for neophyte endoscopic surgeons. METHODS: Endoscopic examination of 50 cadaver sinuses using 0-, 30-, and 70-degree, 4-mm telescopes to dissect the anterior ethmoid. The characteristics of each sinus lateralis were documented. To confirm the endoscopic findings, we grossly examined each specimen. RESULTS: Four different categories of sinus lateralis formation were identified: type I (n = 22), posterosuperior extension to skull base; type II (n = 15), posterior extension to sphenoid face; type III (n = 8), abrupt termination posterior to ethmoid bulla; and type IV (n = 5), extension into posterior ethmoid through dehiscent basal lamella. CONCLUSIONS: The sinus lateralis is a consistent feature of the anterior ethmoid. Type I and II patterns are most conducive to the aforementioned technique. Type III is the most difficult to identify endoscopically, whereas type IV is most apt to encourage an unplanned posterior ethmoidectomy. Regardless of the chosen ethmoidectomy technique, careful assessment of the sinus lateralis should enable more accurate and safe removal of ethmoid disease with reduced complications.

Cadaver↗
PubMed1998

Endovascular treatment of traumatic dural sinus thrombosis: case report.

OBJECTIVE: Dural sinus thrombosis has rarely been associated with closed head injury. We present a unique case involving the use of endovascular thrombolysis in the treatment of traumatic dural sinus thrombosis, which has not been reported. CLINICAL PRESENTATION: A 20-year-old male patient suffered a severe closed head injury while skiing. He developed refractory elevated intracranial pressure requiring barbiturate coma. Angiography demonstrated thrombosis of the dominant right transverse and sigmoid sinuses, with partial thrombosis of the superior sagittal sinus. Urokinase was administered via a microcatheter within the thrombus as a bolus of 250,000 units and then as a continuous infusion of 60,000 to 100,000 units per hour for 48 hours. The patient was maintained in a barbiturate coma and heparinized. Serial angiography was performed to assess the sinus patency and efficacy of thrombolysis. RESULTS: After 48 hours of thrombolysis, angiography demonstrated normal patency of the superior sagittal, right transverse, and right sigmoid sinuses. The intracranial pressure decreased after thrombolysis and was manageable with conventional techniques. Within 48 hours of the completed thrombolysis, the barbiturates were withdrawn and the patient's neurological status rapidly improved until the time of discharge 2 weeks later. DISCUSSION AND CONCLUSION: This case documents a rare instance of traumatic dural sinus thrombosis resulting from a closed head injury. In addition, endovascular thrombolysis resulted in subsequent opening of the dural sinuses and effective intracranial pressure management, despite the presence of a hemorrhagic contusion. Heparin was effective in maintaining sinus patency and was used safely in conjunction with urokinase in this setting of head injury.

Accidental Falls↗
PubMed2006

Clinical outcomes after endoscopic sinus surgery.

PURPOSE OF REVIEW: Chronic rhinosinusitis continues to present diagnostic and therapeutic challenges for clinicians. Recently, attention has been focused on reliable and valid measures of outcomes for many sinonasal diseases. As a significant fraction of patients with chronic rhinosinusitis will come to endoscopic sinus surgery, there has been a dedicated focus on determining objective clinical outcomes after medical and surgical treatment for CRS. This has been aided by validated instruments for measuring both symptom outcomes and quality of life after endoscopic sinus surgery. RECENT FINDINGS: Recent studies have demonstrated that endoscopic sinus surgery provides statistically and clinically significant improvements in most sinonasal symptoms. These benefits are maintained more than 1 year after surgery. In addition, the significant adverse effects of chronic rhinosinusitis on quality of life can be reversed with appropriate endoscopic sinus surgery. Certain sub-populations do not fare as well with endoscopic sinus surgery, however; adjunctive medical management is required to maintain symptomatic and quality-of-life improvements for patients with nasal polyposis. Unfortunately, paranasal sinus computed tomography scan findings do not predict symptomatic or quality-of-life improvements after endoscopic sinus surgery. SUMMARY: With reliable objective evidence of the health benefits of endoscopic sinus surgery, patients should be considered for such surgery after failure of medical management. Further work is required to characterize outcomes for sub-populations, and to stage and select patients who will derive appropriate benefit from endoscopic sinus surgery.

Chronic Disease↗
PubMed2003

Molecular analysis of bacterial flora associated with chronically inflamed maxillary sinuses.

Chronic maxillary sinusitis is a chronic inflammatory condition in which the role of microbial infection remains undefined. Bacteria have been isolated from chronically inflamed sinuses; however, their role in the chronicity of inflammation is unknown. The objective of this study was to determine whether bacteria are present in clinical samples from chronic maxillary sinusitis and to assess the diversity of the flora present. Washes and/or tissue samples from endoscopic sinus surgery on 11 patients with chronic maxillary sinusitis were subjected to PCR amplification of bacterial 16S rDNA using three universal primer pairs, followed by cloning and sequencing. The samples were also assessed for the presence of bacteria and fungi by conventional culture methods. Viable bacteria and/or bacterial 16S rDNA were detected from maxillary sinus samples of five of the 11 patients examined (45 %). Three sinus samples were positive by both PCR and culture methods, one was positive only by PCR, and one only by culture. Thirteen bacterial species were identified: Abiotrophia defectiva, Enterococcus avium, Eubacterium sp., Granulicatella elegans, Neisseria sp., Prevotella sp., Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, Stenotrophomonas maltophilia, Streptococcus gordonii, Streptococcus mitis/Streptococcus oralis and Streptococcus sp. Fungi were not detected. In one patient Streptococcus mitis/Streptococcus oralis, and in another patient Pseudomonas aeruginosa, were detected from both the sinus and the oral cavity using species-specific PCR primers. These results suggest that both aerobic and anaerobic bacteria can be detected in nearly half of chronic maxillary sinusitis cases.

Bacteria↗
PubMed2006

Use of scintigraphy for diagnosis of equine paranasal sinus disorders.

OBJECTIVES: To describe and analyze subjective and objective scintigraphic findings in horses with paranasal sinus disorders. ANIMALS: Horses with suspected disorders of the paranasal sinuses or cheek teeth (n = 48) and control horses (n = 30). METHODS: 99Technetium-methylenediphosphate (99Tc-MDP; 7500 MBq) was administered for scintigraphic examination of the skull. Abnormal patterns of increased radionuclide uptake (IRU) were identified and subjectively described. Scintigrams and radiographs were blindly assessed by 2 clinicians and the accuracy of the imaging modalities was compared. Objective analysis was performed by comparing regions of interest (ROI) drawn over areas of abnormal IRU to the equivalent area on the unaffected side using the Mann-Whitney test. An ROI ratio (affected:non-affected sides) was also calculated for each lesion. RESULTS: Twenty-eight horses were diagnosed with primary (15) or secondary (13) sinusitis. Nine primary sinusitis cases had focal area(s) of moderate or marked IRU in addition to a more diffuse uptake in the affected sinus(es). kappa was marginally higher for scintigraphic assessment of paranasal sinus disorders than for radiographic assessment. There were significant differences in mean counts/pixel in ROI drawn on the affected side compared with the non-affected side. There was considerable overlap between the magnitudes of ROI ratios found with many different disorders. CONCLUSIONS: Scintigraphy can be useful for differentiation of sinusitis of dental origin from other causes of sinusitis. Quantitative analysis of scintigrams is not reliable for identification of particular disorders. CLINICAL RELEVANCE: Focal areas of moderate or marked IRU may be observed with primary sinusitis. Careful 3-dimensional localization of the lesion, along with consideration of other clinical and diagnostic findings should be performed to prevent false-positive diagnoses of periapical infection in such instances.

Animals↗
PubMed2003

Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren.

AIM: Sinus image abnormalities are common among children examined for indications other than sinus disease. The purpose of this study was to determine the frequency of sinus abnormalities among otherwise healthy children attending school. METHODS: Magnetic resonance imaging (MRI) was performed on 24 children aged 8-9 y, 18 of whom were re-examined after 6-7 mo. RESULTS: Sinus abnormalities were common. An abnormality was seen in 12 of the children [50%, 95% confidence interval (95% CI) 29-71%], and 9 (38%, 95% CI 19-59%) had abnormalities in the maxillary sinuses. As many as 8 (42%, 95% CI 20-67%) of the asymptomatic children (lacking clinical symptoms or findings) had abnormalities in the maxillary or ethmoidal sinuses. The follow-up examination showed that about half of the abnormal sinus MRI findings had resolved or improved without any intervention. CONCLUSION: Abnormal sinus MRI findings are common both among otherwise healthy children attending school and in totally asymptomatic children. As incidental findings, these should be interpreted as normal and do not indicate any need for treatment in children imaged for purposes other than sinus disease.

Adolescent↗
PubMed1987

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse. II. Radiological findings.

The radiographic findings in 167 horses subjected to radiography of the facial area, nasal cavity and paranasal sinuses are recorded. Cases were grouped according to clinical diagnosis and the common and disparate radiographic features between and within groups are discussed. Dental disease occurred most frequently and accounted for about 30 per cent of cases, most of which had periapical infection. This disorder presented as two distinct clinical entities in almost equal numbers affected teeth with roots rostral to the maxillary sinus usually produced facial swelling, whereas those with roots within the sinus were generally associated with nasal discharge as a result of secondary sinusitis. In the former group periapical changes could readily be identified on radiographs, but in the latter group affected teeth could be recognised with confidence in only about half the cases. Primary sinusitis was the commonest specific condition recorded and accounted for 32 cases, three of which were mycotic. Using lateral erect projections, comparison of the radiographic features of primary sinusitis and sinusitis secondary to dental disease showed some useful differentiating signs. In four ponies, rhinitis associated with sinusitis led to disruption of the intra-nasal structures but mycotic rhinitis, nasal ulceration and an intra-nasal foreign body produced no radiographic abnormalities. Sixteen cases of suture periostitis were recorded, with varying degrees of new bone formation, and of 13 animals presented for evaluation of trauma, pre-diagnosed fractures were demonstrated in 10 and complications due to sinusitis in three.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

The bacteriology of acute maxillary sinusitis.

Sinus secretions obtained by antral aspiration from 347 patients with acute maxillary sinusitis were examined bacteriologically. Special attention was paid to the method by which anaerobic bacteria could be recovered. On the total, 485 sinus secretion samples were examined, of these 336 were aspirates, 149 yields of injection-aspirations. Aerobic bacteria were cultured from 263 aspirates and from 100 injection-aspiration samples. Only anaerobes were recovered from 6 sinuses. Bacterial culture was negative in 115 sinuses (24%). The most common pathogens isolated were Haemophilus influenzae (50.5%), Streptococcus pneumoniae (18.5%), Streptococcus pyogenes (5%) and Branhamella catarrhalis (1.5%). A true anaerobic infection was considered to be present in only 7 sinuses (1.5%) indicating that anaerobes are not a significant cause of acute maxillary sinusitis. According to this study the most common pathogen in acute maxillary sinusitis in young adults is H. influenzae. From this follows that in such patients aminopenicillins may be a more appropriate choice than conventional penicillin in the antimicrobial treatment of acute maxillary sinusitis.

Adult↗