Tumor de Pott y absceso cerebral secundario a sinusitis aguda de foco dentario en paciente pediátrico / Pott's tumor and cerebral abscess secondary to acute sinusitis of dental focus in a pediatric patient

El tumor de Pott es una entidad rara, definida como un absceso subperióstico asociado a osteomielitis del hueso frontal. Suele presentarse como complicación de sinusitis aguda o crónica del seno frontal, y se describe con mayor incidencia en población pediátrica, siendo una complicación grave por su alta morbimortalidad. Se presenta a un paciente pediátrico con tumor de Pott y absceso cerebral posterior a una sinusitis aguda de foco odontogénico, en la que los pilares de tratamiento son drenaje quirúrgico precoz y antibioticoterapia prolongada. Se describe la clínica, manejo médico-quirúrgico y seguimiento posterior, ya que, en ausencia de antecedentes, se debe buscar dirigida- mente enfermedad periodontal y realizar un estudio de inmunodeficiencia primaria.

Pott's tumor is a rare entity, defined as a subperiosteal abscess associated with osteomyelitis of the frontal bone. It usually presents as a complication of acute or chronic sinusitis of the frontal sinus and it is described with a higher incidence in the pediatric population, being a serious complication due to its high morbidity and mortality. We present a pediatric patient with Pott's tumor and brain abscess after acute sinusitis of odontogenic focus, in which the pillars of treatment are an early surgical drainage and prolonged antibiotic therapy. The clinic, medical-surgical management and subsequent follow-up are described, since in the absence of antecedents, periodontal disease should be sought directly and a study of primary immunodeficiency performed.

A Study on Orbital Cellulitis Due to Acute Sinusitis: A Multidisciplinary Approach

Introduction: Orbital infection has spread beyond the orbital septum leads to orbital cellulitis. The distinctive features of orbitalcellulitis are proptosis and limitation of ocular movements. Additional useful signs are chemosis of bulbar conjunctiva, reducedvisual acuity, afferent pupillary defect, and toxic systemic symptoms. Prompt diagnosis and treatment of orbital cellulitis is vitalas it is associated with serious complications such as cavernous venous thrombosis, visual loss, meningitis, brain abscess,and sepsis.Aims and Objectives: The purpose of this study is to evaluate clinical presentation, treatment outcomes, and post-surgicalcomplications of diagnosed case of orbital cellulitis.Materials and Methods: This is a cross-sectional study of patients with orbital cellulitis as a complication of acute sinusitis. Allthe patients were subjected to thorough clinical examination, ophthalmic and radiological evaluation. Computed tomographyof paranasal sinuses done. All the patients in this study received appropriate medical and surgical management and follow-upevaluation done at the 1st month and 3 months.Results: Orbital cellulitis due to fungal sinusitis is prevalent among uncontrolled type 2 diabetes mellitus patients in our study.Surgical management such as endoscopic sinus surgery with intravenous antibiotic therapy found to be more effective thanconservative management alone.Conclusion: Strict diabetic control, appropriate surgical and medical management, and a vigilant follow up resulted to a better outcome.

Multi-center clinical trial of Biyuan Pills in treating acute sinusitis syndrome with wind-evil invading lung / 中草药

Objective To observe the efficacy and safety of Biyuan Pills in treating acute sinusitis with syndrome of wind pathogen invading lung. Methods A method with randomized, positive-drug, parallel-controlled, doubled-blind, double-dummy, and multi-center trial was designed in the clinical study. The 330 cases were served as treatment group, taking Biyuan Pills for 10 d, 110 cases as control group, receiving Xiangju Capsule for 10 d. The curative effectiveness clinical diseases were the main observing parameter. Results Markedly effective rate and total effective rate of test group was 59.87% (58.93%) and 92.04% (90.60%), and that of control group was 51.40% (50.93%) and 84.11% (83.33%). Two groups total effective comparative differences were statistically significant (P < 0.05), the experimental group was better than the control group. The healing rate of TCM syndromes was 64.65% (63.64%) in the experimental group and 51.40% (50.93%) in the control group. The difference between the two groups was statistically significant (P < 0.05), and the experimental group was superior to the control group. After treatment, the symptoms of TCM in the two groups were significantly improved, and the improvement of nasal congestion and headache in the experimental group was better than that in the control group (P < 0.05). In the experiment, there were nine adverse events in the experimental group and one adverse event in the control group. No abnormal changes in clinical laboratory indicators related to the study drugs were found in either group. Conclusion Biyuan Pills is safe and effective in treating acute sinusitis with syndrome of wind pathogen and invading lung.

Chuanxiong-Chatiao powder and Cangerzi powder combined with routine treatment for acute rhinosinusitis / 国际中医中药杂志

Objective@#To evaluate the efficacy of Chuanxiong-Chatiao powder and Cangerzi powder combined with routine treatmentfor the patients with acute rhinosinusitis.@*Methods@#A total of 104 patients with acute rhinosinusitis were enrolled and divided into the treatment group (52 patients) and the control group (52 patients) by random number table method. Patients in the control group were treated with routine treatment of western medicine, while those in the treatment group with Chuanxiong-Chatiao powder and Cangerzi powder plus routine treatment of western medicine. All the treatments lasted 30 days, with follow-up of 6 months. The total symptom scores (TSS), nasal obstruction, nasal discharge, dizziness, and nasal secretion improvement time, and the clinical curative effect of the two groups were observed and recorded.@*Results@#The total effective rate in the treatment group was significantly higher than that in the control group [86.5% (45/52) vs. 69.2% (36/52); χ2=4.522, P=0.034]. After treatment, the TSS of the treatment group were significantly lower than the control group (3.9 ± 0.5 vs. 5.9 ± 0.6; t=18.466, P<0.01). The nasal obstruction, nasal discharge, dizziness, and nasal secretion improvement time in the treatment group was superior to those in the control group (t were 5.367, 8.034, -7.525 ,-6.757, P<0.01). In the follow-up of 6 months, the recurrence rate in the treatment group was significantly higher than that in the control group [33.3% (9/27) vs. 11.4% (4/35); χ2=4.413, P=0.036].@*Conclusions@#Chuanxiong-Chatiao powder and Cangerzi powder combined with routine treatment can improve the clinical symptoms in patients western medicine with acute rhinosinusitis.

A Randomized, Open Label, Prospective, Comparative Study Evaluating the Efficacy and Safety of Fixed Dose Combination of Cefpodoxime 200 Mg + Clavulanic Acid 125 Mg Vs Cefpodoxime 200 Mg in Acute Bacterial Sinusitis.

Background: Fixed dose combination of cefpodoximeclavulanic acid and cefpodoxime both are commonly used in the treatment acute bacterial sinusitis. However, comparative clinical studies between the fixed dose combination of cefpodoxime-clavulanic acid versus cefpodoxime alone are not available. Objective: A postmarketing study was conducted to evaluate the efficacy and safety of fixed dose combination of cefpodoxime proxetil plus potassium clavulonate versus cefpodoxime proxetil in treatment of acute bacterial sinusitis. Material and methods: A total of 202 patients were enrolled in an open label, randomized, parallel group, two arms multicentric study. Patients were treated either with fixed dose combination of cefpodoxime 200 mg plus clavulanic acid 125 mg or cefpodoxime 200 mg; both given as one tablet twice daily for ten days. The efficacy was evaluated at baseline, day three, day five and day ten while the safety was assessed at screening and day 10. Statistical analysis: Intention to treat population was used to analyse the safety results while efficacy was evaluated in per protocol population. Chi square test was used to evaluate the efficacy parameters on six point Likert scale, global evaluation of efficacy and safety by investigators and patients. Results: Cure rate was higher in study group (58.43%) compared to control group (46.81%), however, the difference was not significant. No significant difference was seen in

Changes in prescription of antibiotics based on Gram stains in an otorhinolaryngology outpatient clinic : A pilot study / 日本プライマリ・ケア連合学会誌

<b>Purpose</b> : This preliminary study was aimed to investigate potentially beneficial changes in prescription of antibiotics by use of Gram staining in an otorhinolaryngology outpatient clinic.<br><b>Methods</b> : This study was done in a single clinic. Changes in the type and amount of antibiotics prescribed, in addition to the clinical outcomes prior to and following introduction of Gram staining, were analyzed retrospectively.<br><b>Results</b> : Following introduction of Gram staining in 2005, the costs for antibiotics per person per year decreased to about one-fifth. The number of prescriptions per 100 patients decreased from 20.9 in 2006 to 3.6 in 2012 for macrolides, from 7.9 in 2005 to 2.4 in 2012 for third-generation cephalosporins, and increased from 1.6 in 2004 to 3.9 in 2012 for penicillins. In addition, for every 50 pediatric cases of acute sinusitis, the number of patients to whom no antibiotics were prescribed increased 9-fold and the number of patients to whom 2 or more types of antibiotics were prescribed decreased from 26 to 9 cases, while the mean period in days until resolution was shortened by 6 days.<br><b>Conclusion</b> : The results of this pilot study suggest that the use of Gram staining for diagnosis and prescription of antibiotics in an otorhinolaryngology outpatient clinic may lead to significantly improved antibiotic prescription practices. Further study through proper controlled studies are felt to be neceesary.

Relativity between Deviation of Nasal Septum and Acute Sinusitis / 浙江中医药大学学报

[Objective] To discuss the relativity between the deviation of nasal spetum and acute sinusitis ’offering relative theoretic base for clinical perven-tion, causa morbi, diagnosis and treatment.[Method] Select 1 case of deviation of nasal spetum from Hangzhou City First People Hospital, make pair com-parison 2 sides of the sinus, record the attack of 2 flanks of sinus with deviation of septum(frontal sinus, maxil ary sinus, frontal and back ethmoidal cellules, sphenoid sinus) for the sinusitis, and make quantitative analysis to the severity, evalulate susceptivity and severity. [Result] There ’s no difference of statistical meaning on the occurrence rate and sinusitis scores for the 2 flanks of the patient.[Conclusion]For such patient of acute sinusitis, the susceptivity and severi-ty are the same for 2 flanks of nasal cavity; the pure correction of the deviation can ’t effectively prevent or treat acute sinusitis; for such patient, we shal correspondingly evaluate and treat the compensatory change caused by deviated spetum.

Acute Severe Eye Pain and Epistaxis in a 16-year-old Male Teenager ‐ What Clinical Clues May Aid a GP In Diagnosing Acute Sinusitis?

A 16-year-old teenager presented with acute severe eye pain and mild epistaxis. The family physician diagnosed an ophthalmologic emergency requiring evaluation. Acute sinusitis was not entertained. Subsequently, ENT evaluation and CT scan confirmed maxillary and anterior ethmoidal sinusitis. This lead to a search for criteria to improve diagnosis of acute sinusitis in the GP setting. Two or more of these symptoms ‐ mucopurulent rhinorrhoea, nasal obstruction/congestion, facial pain/pressure and decreased sense of smell increase its likelihood. Other important issues discussed include differential diagnosis of eye pain associated with epistaxis, potential orbital complications of sinusitis and causes of the quiet, non-red eye.

Simultaneous Subperiosteal and Subdural Abscesses Occurred as Complications of Acute Sinusitis

Acute sinusitis is a common medical problem which can result in serious complications if it is not managed appropriately. The most common complication of acute sinusitis is orbital complication, followed by intracranial complications. Concomitant involvement of the orbit and the brain as complications of acute sinusitis is very rare. We were presented with a case of a 27-year-old woman who suffered from subperiosteal abscess in the orbit and subdural abscess in the frontal area. Endoscopic sinus surgery, drainage of the subperiosteal abscess through eyebrow incision and drainage of the subdural abscess through craniotomy were performed. The postoperative course was uneventful, and the patient was free of ocular and neurologic symptoms at the eight month follow-up.

A Ten Year Retrospective Review of Orbital Complications Secondary to Acute Sinusitis in Children

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.

A Case of Simultaneous Orbital Cellulitis and Intracranial Complication

PURPOSE: To report a case of simultaneous orbital cellulitis and intracranial complications of acute sinusitis in a young patient. CASE SUMMARY: The 11-year-old male presented with a one-day history of left periorbital erythematous swelling, fever and headache. He was diagnosed with acute sinusitis at the department of otorhinolaryngology, and endoscopic sinus drainage of pus was performed. However, the patient's symptoms did not improve. The next day, a subdural abscess was found on brain computed tomography. He was treated by external drainage of the periosteal abscess via a subbrow incision and systemic antibiotics, as well as anticonvulsant medication. CONCLUSIONS: Twenty days after external drainage and beginning systemic antibiotics and anticonvulsant treatment, he was discharged with improved orbital cellulitis symptoms and a resolved subdural abscess.

An open-label study of the efficacy and safety of a herbal secretolytic preparation as a sole therapy in patients with sinusitis.

This is an open-label, non-comparative controlled study of the efficacy and safety of a herbal secretolytic preparation (Sinupretฎ) as a single therapy in patients with sinusitis. The study was conducted at the Department of Otolaryngology, Siriraj Hospital, Bangkok, during the period January - December 2000. Thirty-nine patients with symptoms and signs of sinusitis, which were confirmed by abnormal endoscopic findings and abnormal radiological findings, were included. All patients received Sinupretฎ, two sugar-coated tablets orally three times a day for 21 days. Symptoms and signs were evaluated on three occasions; the first (day 0, V1) before the treatment started, the second (V2) on day 14, and the third (V3) on day 21. There were no other additional adjunctive treatments. Primary outcome measures were the change in the percentage of patients who had three main symptoms (i.e. nasal obstruction, nasal discharge and sinus headache), abnormal endoscopic findings (i.e. mucosal swelling and nasal secretion), and abnormal radiological findings (i.e. air-fluid level, opacification, and mucoperiosteal thickening). Global assessment was rated by the patients using a visual analogue scale (VAS). The clinical response was classified as cure, improvement, failure, and relapse. Treatment success was defined as cure or improvement. Adverse events were also recorded. There were 14 males and 25 females, with a mean age of 39.7 + 14.1 years (16-75). Twenty three patients had chronic sinusitis (CS) and 16 patients had acute sinusitis (AS). The duration of symptoms in the CS group was 16.4 + 25.6 months (1-96), and in the AS group was 21.3 + 9.4 days (7-30). At V1, 34 patients (87.2%) had nasal discharge, 26 patients (66.7%) had obstruction, and 25 patients (64.1%) had sinus headache. At This is an open-label, non-comparative controlled study of the efficacy and safety of a herbal secretolytic preparation (Sinupretasาa single therapy in patients with sinusitis. The study was conducted at the Department of Otolaryngology, Siriraj Hospital, Bangkok, during the period January - December 2000. Thirty-nine patients with symptoms and signs of sinusitis, which were confirmed by abnormal endoscopic findings and abnormal radiological findings, were included. All patients received Sinupretฎ, two sugar-coated tablets orally three times a day for 21 days. Symptoms and signs were evaluated on three occasions; the first (day 0, V1) before the treatment started, the second (V2) on day 14, and the third (V3) on day 21. There were no other additional adjunctive treatments. Primary outcome measures were the change in the percentage of patients who had three main symptoms (i.e. nasal obstruction, nasal discharge and sinus headache), abnormal endoscopic findings (i.e. mucosal swelling and nasal secretion), and abnormal radiological findings (i.e. air-fluid level, opacification, and mucoperiosteal thickening). Global assessment was rated by the patients using a visual analogue scale (VAS). The clinical response was classified as cure, improvement, failure, and relapse. Treatment success was defined as cure or improvement. Adverse events were also recorded.V3, the percentage of patients who had symptoms decreased signiticantly to 64.1%, 41.0% and 38.5% for these three symptoms respectively. The same was true for the percentage of patients who had abnormal endoscopic findings. The percentage of patients showing radiological evidence of improvement was 61.5% (33.3% normal, 28.2% improvement), with no change in 38.5% of patients. Treatment success was recorded in 31 out of 39 patients (79.4% : cure 23.0%, improvement 56.4%). In four patients (10.3%) treatment failed and in four other patients (10.3%) there was a relapse in symptoms and signs. Adverse events were reported in 4 patients (10.3%), which were mild and resolved spontaneously. This study shows the efficacy and safety of a 3-week course of a herbal secretolytic preparation (Sinupretฎ) in the treatment of sinusitis, either acute or chronic. The incidence of adverse events was low and they were tolerated by the patients. The use of this herbal secretolytic preparation as a sole treatment is effective in most cases of uncomplicated sinusitis. This can decrease the risk of adverse drug reactions from antibiotic therapy and is a cheaper treatment.

A Case of Sinusitis-Induced Intracranial Complication / 대한이비인후과학회지

Sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. Intracranial complications are pathologically caused by direct extension of the disease through the bony defect or hematogenous spread. Radiologic evaluation must include computerized tomography for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of intravenous antibiotics. Recently we have experienced one subdural abscess secondary to acute sinusitis.