Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis / 영남의대학술지

BACKGROUND: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. MATERIALS AND METHODS: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. RESULTS: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. CONCLUSIONS: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

Treatment Outcomes and Acoustic Rhinometric Results in Endoscopic Sinus Surgery of Adult Chronic Paranasal Sinusitis / 영남의대학술지

BACKGROUND: Chronic paranasal sinusitis is one of the most common disease in the otorhinolaryngologic field. Endoscopic sinus surgery is treatment of choice in chronic paranasal sinusitis. The aim of this study was to evaluate objective and subjective treatment outcomes of endoscopic sinus surgery in adult chronic paranasal sinusitis with or without polyp. MATERIALS AND METHODS: We reviewed 84 adult patients underwent endoscopic sinus surgery by one surgeon from June 1999 to June 2000, prospectively. We analyzed preoperative and postoperative subjective symptom scores and acoustic rhinometric results. RESULTS: Fifty cases were male and thirty four cases female. The average age was of 33 year-old (range: 17 to 66 years). There was significantly improvement of symptom scores in postoperative 3 months and 6 months compared with preoperative symptom scores. There was significantly increased postoperative total volume of nasal cavity. When we compared high score group with low score group, there was statistically significant improvement of symptom scores between preoperative stage and postoperative 3 months in radiologic grading group. CONCLUSIONS: Endoscopic sinus surgery is considered to be effective for the treatment of chronic paranasal sinusitis. It seems to be helpful to employ subjective symptom score system and objective total volume change of nasal cavity through acoustic rhinometric test to analyze effectiveness of endoscopic sinus surgery. In this study, the most important preoperative factor of sinus surgery outcomes is radiologic grading system.

Osteitis in Patients with Chronic Paranasal Sinusitis Evaluated by 99mTc-MDP bone SPECT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this study is to investigate the incidence and clinical implication of osteitis in patients with chronic paranasal sinusitis. MATERIALS AND METHODS: Forty three patients diagnosed as chronic paranasal sinusitis were examined with 99mTc-MDP bone SPECT preoperatively and underwent endoscopic operation, and 6 volunteers were recruited and examined as a control group. Each SPECT image was semiquantitatively assigned one of three grades of 0, 1, 2 according to intensities of isotope uptake. Quantitative analysis of the uptake of the isotope was performed by computer. The incidence of osteitis was analyzed. The correlation between semiquantitative grades and quantitative uptake indices was evaluated, and degree of isotope uptake and the severity of mucosal pathology on CT was correlated. The degree of isotope uptake between the patients who had recurrence and had not was compared. RESULTS: Quantitative evaluation of uptake indices were significantly higher in the patient group than in the control group. Marked uptakes of isotope on the sinus areas, suggesting the presence of osteitis, were shown in the patient group by 53.5%. The semiquantitative grades and quantitative indices showed positive correlation, and SPECT and CT scan findings also showed significant correlation. The uptake indices of patients who had recurrence were significantly higher than those of patients who showed no recurrence in both ethmoid sinus areas. CONCLUSIONS: The results of this study showed that significant proportion of patients with chronic paranasal sinusitis have osteitis, and patients with more severe osteitis represent poorer postoperative courses.

Microbiologic Study of Chronic Sinusitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The microbiology of chronic sinusitis in children can be anticipated according to the patient's age, clinical presentation, and immunologic state. In acute stage, viral upper respiratory infections frequently precede bacterial superinfection by Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. In contrast to acute sinusitis, alpha-hemolytic Streptococcus, coagulase negative Staphylococcus and Staphylococcus aureus are common in chronic sinusitis, which may be caused by exacerbations of infection with the bacterial species that cause acute disease. The use of empiric antibiotics directed at the most offending organism is usually appropriate and effective in clinical situation. But the emergency and increasing occurrence of antibiotic resistance has increased the failure rate. MATERIAL AND METHODS: In this prospective study, 50 patients with the diagnosis of chronic sinusitis were evaluated microbiologically by Sinoject (Atos, Sweden) guided aspiration. RESULTS: We cultured alpha-hemoltic Streptococcus in 14 patients, coagulase negative Staphylococcus in 4 patients, Staphylococcus aureus in three patients, gram-positive bacilli in two patients, Streptococcus pneumoniae in one patient. The results of PCR for Hemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis were 32%, 20%, 10%, respectively, and it showed higher detection rates than conventional culture test. CONCLUSION: We advise that all bacterial isolates of cultures of chronic sinusitis in children should undergo appropriate typing and antibiotic sensitivity tests so that the appropriate antibiotic treatment may be employed.

A Follow-up Study of Endoscopic Sinus Surgery in Chronic Sinusitis-Assessment of Preoperative OMU-CT Gradings and Postoperative Follow-up Period- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery has become an effective tool for the treatment of chronic sinusitis. The success of this procedure can be best determined by a long-term evaluation of the surgery results from patients who are grouped according to the prepoerative severity of the disease. In this study we attempted to evaluate the results of endoscopic sinus surgery according to the severity of the disease and the length of the follow-up period. MATERIALS AND METHODS: Questionnaires were sent out to 313 patients with chronic sinusitis who underwent endoscopic sinus surgery at our department from April 1992 to October 1995. Replies from 118 patients (37.69%) were analyzed. All patients had taken preoperative ostiomeatal unit computed tomography (OMU-CT) and their results were graded according to the Levine and May's grading system. The follow-up periods ranged from 7 to 51 months, with the mean of 27 months. RESULTS: All nasal symptoms including nasal obstruction, rhinorrhea, postnasal drip, anosmia and headache significantly improved. The nasal obstruction symptom improved by 76.8%, rhinorrhea 62.1%, postnasal drip 64.4%, anosmia 50.0% and headache 80.0%. However, no statistical significance could be drawn between the improvement rate and the different lengths of the follow-up periods. CONCLUSION: The results suggest that endoscopic sinus surgery might improve nasal symptoms in patients with chronic sinusitis regardless of the severity of disease and the length of follow-up period.

The Relationship between Clinical Patterns of Sinusitis and Anatomical Variation / 대한이비인후과학회지

BACKGROUND: With the advent of functional endoscopic sinus surgery, the importance of the ostiomeatal unit(OMU) has been known. Anatomic abnormalities, irreversible inflammatory changes, or obstruction of ostiomeatal unit lead to sinus ostial obstruction and subsequent chronic or recurrent sinusitis. For these reasons, septal deviation, concha bullosa and paradoxical middile turbinate may compress the uncinate process and occlude the infundibulum and then they may induce anterior paranasal sinusitis. OBJECTIVES: This study was conducted to evaluate the relationship between the existence of anatomical variations of sinonasal regions and Babbel's five patterns of chronic sinusitis based on coronal plane CT and to be helpful in treatment of chronic sinusitis. MATERIALS AND METHOD: From february 1994 to February 1996, Coronal plane CT scans of 150 patients with bilateral sinonasal disease were retrospectively reviewed. We examined anatomical variations-paradoxical middle turbinate, concha bullosa, and septal deviation-using PNS CT and analyzed the finding of PNS CT based on Babbel's five patterns of chronic sinusitis. One patient with bilateral sinonasal disease was considered as two different cases. RESULTS: In consequence of this study, the existence of anatomical variations don't show any influence on the paranasal sinusitis patterns. CONCLUSION: This study suggests that the existence of anatomical variations may not be significantly associated with respective incidence of the paranasal sinusitis patterns and may similarly influence in each patterns of chronic sinusitis.

Changes of the Olfaction after Nasal Surgery in Chronic Sinusitis / 대한이비인후과학회지

It is well known that olfactory dysfunction relates to many etiologies such as obstructive nasal and sinus diseases, upper respiratory tract infections, head trauma, aging, congenital anomalies, endocrine diseases, drugs and so forth. Chronic paranasal sinusitis is the most common etiology of olfactory dysfunction. So, We studied the effect of the surgery on olfaction in patients with chronic paranasal sinusitis. A preoperative and postoperative evaluation of the olfactory function was carried out in 80 patients using the T and T olfactometer. All patients were divided into two groups-chronic paranasal sinusitis and chronic paranasal sinusitis with polyposis. According to the preoperative recognition threshold, olfactory function of all patients were divided into five groups. The group 1 was normal, group 2 was mild decreased, group 3 was moderate decreased, group 4 was severe decreased and group 5 was anosmia. Almost patients were improved on olfaction in the postoperative state. The olfactory fissure was usually closed in patients with nasal polyp. In the patients with closed olfactory fissure, recognition threshold was 4.9+/-1.5 and in opened olfactory fissure, 1.9+/-1.8. Therefore the olfactory fissure was the one of the most important factors on olfaction.