Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis.

BACKGROUND: Bacterial odontogenic sinusitis (ODS) is distinct from other forms of rhinosinusitis. Diagnosing ODS can be challenging because of nonspecific clinical presentations and underrepresentation in the literature. The purpose of this study was to compare maxillary sinus bacterial cultures between patients with ODS and chronic rhinosinusitis (CRS), to determine whether certain bacteria are associated with ODS. METHODS: This was a retrospective case-control study of 276 consecutive patients from August 2015 to August 2019 who underwent endoscopic sinus surgery (ESS) for bacterial ODS, CRS without nasal polyps (CRSsNP), or CRS with nasal polyps (CRSwNP). When present, pus was sterilely cultured from maxillary sinuses after maxillary antrostomy, and aerobic and anaerobic cultures were immediately sent for processing. Demographics and culture results were compared between ODS and CRS patients, and then separately between ODS and CRSsNP, and ODS and CRSwNP. ODS culture results were also compared between different dental pathologies (endodontic vs oroantral fistula). RESULTS: The following bacteria were significantly more likely in ODS compared to CRS: mixed anaerobes, Fusobacterium spp., Eikenella corrodens, Streptococcus intermedius, Streptococcus anginosus, and Streptococcus constellatus. Staphylococcus aureus and Pseudomonas aeruginosa were inversely related to ODS. There were no significant differences in cultures between the different dental pathologies. CONCLUSION: Certain bacteria were more likely to be associated with ODS compared to CRS when purulence was cultured from the maxillary sinus. Physicians should evaluate for an odontogenic source of sinusitis when these ODS-associated bacteria are identified in maxillary sinus cultures.

Optimal timing of endoscopic sinus surgery for odontogenic sinusitis.

OBJECTIVES: Odontogenic sinusitis (ODS) is more common than historically reported, and management recommendations are limited in the literature. Although ODS case series have shown successful outcomes with dental treatment and endoscopic sinus surgery (ESS), no studies have considered the optimal timing of these treatments. The purpose of this study was to analyze times to ODS resolution after primary dental treatment and ESS based on symptom, 22-item sinonasal outcome test (SNOT-22), and endoscopic outcomes. STUDY DESIGN: Prospective cohort study. METHODS: Thirty-seven symptomatic ODS patients who failed medical management were offered primary dental treatment or ESS. Eleven patients selected primary dental treatment, and 26 patients selected ESS. The following variables were collected prospectively at every office visit before and after dental treatment or ESS: SNOT-22, presence or absence of cardinal sinusitis symptoms, and presence or absence of middle meatal endoscopy findings (edema, polyps, purulence). Times to resolution of these clinical variables were analyzed with t test, chi-square test, Fisher exact test, McNemar test, and Kaplan-Meier survival analysis. RESULTS: Patients in the dental treatment and ESS groups showed no significant differences in preoperative sinusitis disease burdens based on symptoms, SNOT-22, endoscopy, and computed tomography. The ESS group experienced faster and more significant improvement in nearly all symptom, SNOT-22, and endoscopic outcomes. CONCLUSIONS: For symptomatic ODS, primary ESS resulted in faster resolution of SNOT-22, sinusitis symptoms, and endoscopic findings in ODS patients compared with primary dental treatment. ESS can be considered first-line therapy for symptomatic ODS, followed by dental treatment when necessary. LEVEL OF EVIDENCE: 2b Laryngoscope, 129:1976-1983, 2019.

Head and Bottle Angles Achieved by Patients During High-Volume Sinonasal Irrigations.

BACKGROUND: Certain head positions can optimize topical irrigation distribution to specific sinuses. No studies have assessed whether patients attain these positions when irrigating. OBJECTIVE: The purpose of this study was to assess head and bottle angles achieved when patients irrigate based on instructions from an irrigation device or from a Rhinologist. METHODS: Study approval was obtained from Henry Ford Health System's Institutional Review Board (10604). Forty-two patients with various rhinologic conditions were equally divided into groups based on irrigation instruction type: pictoral instructions from an irrigation device or written/verbal instructions from a Rhinologist. Both groups' instructions directed nose-to-floor head positioning. Simulating home irrigations, patients irrigated 120 mL of saline into each naris using 240 mL squeeze bottles. Frontal and lateral views were captured using video cameras. On frontal view, angles were measured between (1) nasal dorsum (ND) and bottle tip (BT; n = 84) and (2) ND and vertical (V; n = 84). On lateral view, angles were measured between (1) line from nasion-to-pogonion (NTP) and horizontal (H) (n = 73) and (2) NTP and BT (n = 73). RESULTS: On lateral view, average angle between NTP and H was 20.0° (standard deviation [SD] = 13.1, 95% confidence interval [CI] = 17.0-23.0) and between NTP and BT was 59.4° (SD = 15.8, 95% CI = 55.8-63.1). On frontal view, average angle between ND and V was 9.5° (SD = 19.5, 95% CI = 5.3-13.6) and between ND and BT was 24.5° (SD = 12.0, 95% CI = 21.9-27.0). There were no significant angle differences between sides or instruction types. CONCLUSION: When instructed to irrigate in the nose-to-floor head position, patients achieved a head position uprotated 20° on lateral view and vertex rotated 10° away from the side of irrigation on frontal view.