[Mycoses of the paranasal sinus system]. / Mykosen des Nasennebenhöhlensystems.

BACKGROUND: During the last few years, in increasing number of fungal infections in the paranasal sinus system has been observed. Aspergillus species as well as mucor and candida albicans are especially responsible for these mycoses. PATIENTS: Twenty-seven cases of a fungal infection of the paranasal sinuses were observed between 1986 and 1997. The majority of the patients showed a chronic noninvasive form with affection of the maxillary sinus. Other forms (fulminant invasive form, chronic invasive form, allergic fungal sinusitis) are described. Typical features for fungal infection do exist in MRI and CT. CONCLUSIONS: A flexible therapeutic strategy is required in which appropriate pharmacologic and surgical options are tailored to the respective clinical picture.

Brodimoprim in maxillary sinusitis.

Recent studies on bacteriological findings in chronic maxillary sinusitis show a great variety of aerobic as well as anaerobic germs. For these reasons adequate chemotherapy has to support the necessary surgical procedure. In this study, the author reports about 60 adult patients suffering from chronic maxillary sinusitis. All of them had to undergo surgical treatment by the Caldwell-Luc procedure. Postoperatively, 30 of them were treated with brodimoprim, the others with doxycycline for 7 days. Bacteriological investigations have been performed during and at several days after surgery. At the same time, a number of laboratory data and the complications observed were registered. In this way, a comparative study of the two antibiotic drugs concerning the therapy of chronic maxillary sinusitis was established.

[Allergic Aspergillus sinusitis]. / Die allergische Aspergillus-Sinusitis.

The leading symptom of the allergic aspergillus sinusitis is the accumulation of mucoid material, Charcot-Leyden crystals and scattered aspergillus hyphae can usually be found. The mucosa itself shows a typically allergic reaction with distinct eosinophilia and additional inflammatory infiltrates. The histological and serological appearance of the allergic aspergillus sinusitis resembles that of allergic bronchopulmonary aspergillosis. The relation between these syndrome, as well as the treatment of allergic aspergillus sinusitis, are discussed.

[Aspergillosis of the nasal sinuses]. / Die Aspergillose der Nasennebenhöhlen.

Aspergillosis of the paranasal sinuses is located mainly in the maxillary sinus, in a few cases in the sphenoid sinus. In typical cases the infection is unilateral. As a rule, the infection leads to a concrement formation in the diseased sinus. This concrement is sometimes characterised by dense masses of calcium phosphate, which seem like metallic structures on x-ray film. With regard to the course of aspergillosis in the paranasal sinuses, we must distinguish between an invasive-destructive form and a non-invasive form. The non-invasive form can be healed by removing the mycotic masses by surgical procedures. In the course of the invasive-destructive form, surgical procedures must be supported by systemic antimycotic treatment. Nevertheless, prognosis in these cases is poor. Finally, it is pointed out that aspergillus infections of the paranasal sinuses can occur even without clearly established immunological deficiencies.

Tympanoplasty and tuberculosis of the middle ear.

This report concerns 6 cases of middle ear tuberculosis. Typical clinical signs for this infection nowadays consist in a pale-coloured mucosa, spontaneous facial paresis, pneumatization of the mastoid and in a changing performation of the tympanic membrane. These signs can occur single or in combination. Under a specific chemotherapeutic treatment even in tuberculous infection of the middle ear tympanoplasty can be performed without danger for the newly transplanted tympanic membrane. One should consider tuberculous infection especially in cases when for apparently inexplicable reasons necrosis of the transplant occurs postoperatively.