Unilateral sinonasal disease in 376 adult patients: a retrospective study / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the clinical and pathological features of patients with unilateral sinonasal disease (USD).@*METHODS@#A retrospective analysis was completed on 376 adult patients with USD from January 2015 to December 2016. Their presenting symptoms, nasal endoscope, CT scanning, and pathology were analyzed respectively.@*RESULTS@#Among the 267 (71.01%) patients with inflammatory disease, there were 4 pathological types. And there were 8 pathological types in 60 (15.96%) patients with benign tumor. Of the 49 patients with malignant tumor, there were 15 pathological types which included squamous carcinoma, malignant melanoma, and lymphoma, as well as myoepithelial carcinoma and Mesodermal mesoderm. The onset age of inflammation group was younger than that of benign (<0.05) or malignant tumor groups (<0.05). The misdiagnosis rate was 8.33% in benign tumor (5/60), and 10.20% in malignant tumor (5/49). Nasal polyps was the most common misdiagnosis in the groups of benign and malignant tumor.@*CONCLUSIONS@#The pathology of adult patients with USD is complicated, and no specific clinical feature was found for distinguishing between benign and malignant lesions. The tumor took a quite proportion in adult patients with USD. Therefore, careful consideration should be taken before diagnosing patients with USD in order to reduce misdiagnosis rate.

Association of the laterality of chronic suppurative otitis media and sinonasal disease based on temporal bone CT scans and Lund Mackay scoring system

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the association between the laterality of chronic suppurative otitis media (CSOM) and the laterality of sinonasal disease, based on temporal bone CT scan results and Lund-Mackay Scoring system, among patients admitted for ear surgery in a tertiary government hospital in Metro Manila.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective review of records<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Ninety-eight (98) patients diagnosed with chronic suppurative otitis media admitted for otologic surgery in the Department of Otorhinolaryngology- Head and Neck Surgery from January 2011 to June 2014 were considered for inclusion. Hospital charts and temporal bone CT scan results were retrieved and analyzed for ear and sinonasal radiographic abnormalities and laterality. Excluded were those without CT scan plates, who underwent temporal bone surgery for reasons other than chronic suppurative otitis media, and those with incomplete records. the Lund-Mackay Scoring System was used to grade sinonasal findings which were compared to CSOM complications. Data was analyzed using t-test, ANOVA for homogenous numerical data, Kruskal-Wallis for heterogenous numerical data, and chi-square test for nominal type of data.<br /><strong>RESULTS:</strong> Of the 64 patients included in the study, 12 or 18.75% had radiographic sinonasal abnormalities. There was no significant association between the laterality of ear disease and the laterality of sinonasal pathology as there was no significant difference in the proportion of subjects with sinonasal disease according to laterality of CSOM (p=.32). When site of nose pathology was compared to Lund-Mackay graded scores, it was found that bilateral nose pathology generally had a higher Lund-Mackay score of 8.60 ± 5.60. However, there was no significant difference in the Lund-Mackay score according to the nose pathology site (p=.20). An association was seen between total LMS and patients with ear pathologies, but no significant difference was noted (p=.44). Although patients with ear complications had higher LM scores, this was not statistically significant.<br /><strong>CONCLUSION:</strong> Laterality of ear disease was not associated with the laterality of sinonasal disease, although CSOM complications were associated with high Lund-Mackay scores. Future, better-designed studies may shed more light on these associations.<br /><br /> </p>

Aspergilosis nasosinusal con extensión intracraneal en una paciente inmunocompetente: una entidad infrecuente con características radiológicas típicas / Sinonasal aspergillosis with intracranial extension in an immunocompetent patient: a rare disease with typical imaging features

El aspergilo es un hongo ubicuo. Las localizaciones de infección primaria más comunes son el tracto respiratorio y los senos paranasales. La afectación intracraneal es rara y conlleva una alta mortalidad. Ocurre mayoritariamente por extensión hematógena desde el pulmón, pero en pacientes inmunocompetentes, la extensión directa desde los senos paranasales es más común. Describimos el caso de una mujer de 25 años originaria de India que se presentó en el servicio de urgencia de nuestro centro hospitalario con cefalea frontal crónica y progresiva. Los hallazgos en los estudios de imágenes sugirieron el diagnóstico de sinusitis fúngica con extensión intracraneal, siendo el patógeno más frecuente el aspergilo. El diagnóstico fue confirmado anátomo-patológicamente. Revisamos los hallazgos radiológicos típicos que deben ayudar al diagnóstico precoz de esta entidad, rara, pero potencialmente mortal.

Aspergillus is a ubiquitous fungus. The most common primary sites of infection are the respiratory tract and sinuses. Intracranial infection is rare and implies a high mortality. It occurs mainly by hematogenous extension from the lung, but in immunocompetent patients, direct extension from the sinuses is more common. We describe the case of a 25 year old woman from India who consulted in the emergency room of our hospital with chronic and progressive frontal headache. The findings in imaging studies suggested the diagnosis of fungal sinusitis with intracranial extension, being the most common pathogen of Aspergillus. The diagnosis was anatomically-pathologically confirmed. We review the typical radiological findings which should help in the early diagnosis of this rare but potentially fatal disease.