ABSTRACT
PURPOSE: Review the microbiology of chronic rhinosinusitis and test the hypothesis that bacterial infections are not the predominant etiology for chronic rhinosinusitis. MATERIALS AND METHODS: Tissue cultures were prospectively collected from the ethmoid mucosa of 179 patients (94 had chronic rhinosinusitis and 85 had chronic rhinosinusitis with polyposis) at the time of endoscopic sinus surgery. All patients were off antibiotics for at least 1 week at the time of surgery. Both aerobic and anaerobic cultures were obtained for each specimen. RESULTS: A total of 263 isolates were identified (average: 1.5 isolates per specimen). Coagulase-negative Staphylococcus, a likely contaminant, was the most common isolate and was identified in 51% of patients. Forty percent of patients (72/179) grew pathogenic aerobic bacteria, the most common was Staphylococcus aureus (18%). Six percent of patients (10/179) grew pathogenic anaerobic bacteria. The microbiology of patients with and without nasal polyposis was not significantly different. CONCLUSION: These findings suggest that factors other than bacterial infection may play an integral role in the pathogenesis of chronic rhinosinusitis.
Subject(s)
Bacterial Infections/complications , Ethmoid Sinusitis/microbiology , Adult , Bacteria, Anaerobic/isolation & purification , Chronic Disease , Ethmoid Sinusitis/etiology , Female , Humans , Male , Nasal Mucosa/microbiology , Nasal Polyps/microbiology , Prospective Studies , Staphylococcal Infections/complications , Staphylococcus aureus/isolation & purificationABSTRACT
OBJECTIVE: Our goal was to describe ethmoid mucocele as a late complication of endoscopic ethmoidectomy. STUDY DESIGN: This was a retrospective review of 14 patients who were diagnosed with ethmoid mucoceles after endoscopic ethmoidectomy. Reviewed data included patient demographics, indication for the original surgery, presenting symptoms, computed tomography results, surgical treatment, operative findings, and recurrence of disease. RESULTS: The mucoceles were diagnosed 1 to 13 years after endoscopic ethmoidectomy. The most common presenting symptom was facial pressure or pain. Twelve patients had middle meatal adhesions. A round mass was seen by endoscopy in the ethmoid cavity in 5 patients. Nine mucoceles were located in the anterior ethmoid and 3 were located in the posterior ethmoid, and 2 involved both. The mucoceles were marsupialized via revision endoscopic ethmoidectomy in 12 patients, whereas 2 had both external and endoscopic approaches taken. CONCLUSION: Ethmoid mucocele can form as a late complication of endoscopic ethmoidectomy. It is commonly associated with middle meatal adhesions.
Subject(s)
Endoscopy/adverse effects , Ethmoid Sinus/surgery , Mucocele/etiology , Paranasal Sinus Diseases/etiology , Adult , Aged , Female , Humans , Male , Middle Aged , Mucocele/diagnosis , Paranasal Sinus Diseases/diagnosis , Retrospective Studies , Time FactorsABSTRACT
The purpose of this article is to describe a chronic variant of invasive fungal sinusitis (IFS) and discuss its management. This is a retrospective review of two cases of IFS that were characterized by atypical clinical courses. Patient 1 was a 75-year-old man with noninsulin-dependent diabetes mellitus who came to us with a 5-month history of headache. Computed tomography detected an opacified left sphenoid sinus. After the man failed to respond to medical therapy, he underwent a left endoscopic sphenoidotomy. Pathologic examination revealed that septate, branching fungal hyphae had invaded the soft tissues. The patient was started on oral itraconazole, but later switched to intravenous amphotericin B in response to intracranial extension. The man's disease stabilized, but he died a little more than 1 year later of unrelated causes. Patient 2 was an otherwise healthy 41-year-old woman who came to us with nasal congestion and unilateral nasal polyps. She underwent endoscopic sinus surgery. Pathologic examination identified granulomatous sinusitis and septate, branching fungal hyphae that had invaded the soft tissue of the middle turbinate. The patient was not treated with systemic antifungal medications because of the localized nature of the fungal invasion and the lack of bone invasion or erosion. She has now been symptom-free for 5 years. These two cases demonstrate that IFS can appear in a chronic variant form that is characterized by an indolent course and histologic evidence of tissue invasion by fungal hyphae. The type of treatment is dependent on the extent of the disease on initial examination and the rapidity of its progression.
