Frequency of the odontogenic maxillary sinusitis extended to the anterior ethmoid sinus and response to surgical treatment.

OBJECTIVES: Odontogenic sinusitis usually affects the maxillary sinus but may extend to the anterior ethmoid sinuses. The purpose of this study is to determine the percentage of odontogenic maxillary sinusitis extended to the anterior ethmoid sinuses and determine also the surgical resolution differences between odontogenic maxillary sinusitis and odontogenic maxillary associated to anterior ethmoidal sinusitis. STUDY DESIGN: This is a retrospective cohort study performed on 55 patients diagnosed of odontogenic sinusitis and treated surgically by functional endoscopic sinus surgery. RESULTS: This study showed that 52.7% of odontogenic maxillary sinusitis spreads to anterior ethmoid, causing added anterior ethmoid sinusitis. We found that 92.3% of the odontogenic maxillary sinusitis (who underwent middle meatal antrostomy) and 96.5% of the odontogenic maxillary sinusitis extended to the anterior ethmoid (treated with middle meatal antrostomy and anterior ethmoidectomy) were cured. CONCLUSION: Ethmoid involvement is frequent in maxillary odontogenic sinusitis. The ethmoid involvement does not worsen the results of "functional endoscopic sinus surgery" applied to the odontogenic sinusitis.

Rhino-orbital fungal infection: two cases report.

Rhino-orbital fungal infections are serious and life threatening complications of immunocompromised host. The authors reported two cases of rapid progressive proptosis and eyelid necrosis of immunocompromised patients who suffered from highly malignant T-celled lymphoblastic leukemia/lymphoma and congenital heart disease with multiple anomalies. Although early diagnosis was made and prompt treatments including medical and surgical interventions were performed, both patients died.

Influence of allergy in patients with nasal polyposis after endoscopic sinus surgery.

CONCLUSION: Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS). OBJECTIVES: To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP. PATIENTS AND METHODS: This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied. RESULTS: Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.

Pediatric sinusitis:symptom profiles with associated atopic conditions.

INTRODUCTION: Sinusitis is a very common disease in childhood. Clinical manifestations in childhood sinusitis are different than in adult. Information in childhood sinusitis in Thailand is limited. We performed a prospective descriptive study to determine clinical characteristics of childhood sinusitis in Thailand MATERIAL AND METHOD: One hundred pediatric patients with clinical diagnosis of sinusitis attending pediatric allergy clinic, pediatric outpatient clinic, and pediatric ENT clinic were recruited. Clinical diagnosis was defined by presence of symptoms indicating upper respiratory infections with exudates at middle meatus by anterior rhinoscopy. Thorough history taking and physical examinations were conducted with findings recording into sinusitis questionnaire. Sinus radiographs were taken in 77 patients and were read blindly a single radiologist who was unaware of clinical conditions of patients. Allergy skin prick tests were performed with a panel of common aeroallergens in Thailand. RESULTS: Age range of the 100 patients were between 1.7 to 12.4 years with a mean (+/- SD) of 6 +/- 2.72 years. History of atopic disease among patients and their families was positive in 49% and 47% respectively. Four most common clinical manifestations were rhinorrhea (95%), nocturnal and productive cough (91%), nasal congestion (74%) and posterior nasal dripping (66%). The three most common signs were obstruction of middle meatus (100%), swelling of turbinates (92%) and granular pharynx (48%). All paranasal sinuses X-rays were abnormal with maxillary sinus being the most commonly involved sinus (99%) followed by ethmoid sinus (91%). The majority of patients had involvement of more than one sinus. Skin prick tests were positive in 53.6%. The two most common sensitizing allergens were dust mites (57.7) and cockroaches (18.6%). CONCLUSION: The presence of symptoms of rhinorrhea, cough, nasal congestion and posterior nasal drip should alert physicians for diagnosis of sinusitis in pediatric patients. Maxillary and ethmoid sinus were the most common sinuses involved. Atopic predisposition is present in up to 53.6% in this population.

Sinonasal aspergillosis in immunocompetent Indian children: an eight-year experience.

A retrospective study of 40 otherwise healthy children suffering from paranasal aspergillosis is presented. Fifteen percentage of this group was under 10 years of age. The clinical characteristics were marked facial deformity, orbital involvement (52.5%) and skull base erosion (12.5%). Ethmoid sinus was the commonest sinus to be affected. Aspergillus serology was positive in 35% and fungal culture grew the organism in 40%. Histopathology revealed allergic or non-invasive fungal infections without any tissue invasions. Surgery was performed in all except one case. Recurrence was 15% treated by revision surgery and antifungal therapy.

Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren.

AIM: Sinus image abnormalities are common among children examined for indications other than sinus disease. The purpose of this study was to determine the frequency of sinus abnormalities among otherwise healthy children attending school. METHODS: Magnetic resonance imaging (MRI) was performed on 24 children aged 8-9 y, 18 of whom were re-examined after 6-7 mo. RESULTS: Sinus abnormalities were common. An abnormality was seen in 12 of the children [50%, 95% confidence interval (95% CI) 29-71%], and 9 (38%, 95% CI 19-59%) had abnormalities in the maxillary sinuses. As many as 8 (42%, 95% CI 20-67%) of the asymptomatic children (lacking clinical symptoms or findings) had abnormalities in the maxillary or ethmoidal sinuses. The follow-up examination showed that about half of the abnormal sinus MRI findings had resolved or improved without any intervention. CONCLUSION: Abnormal sinus MRI findings are common both among otherwise healthy children attending school and in totally asymptomatic children. As incidental findings, these should be interpreted as normal and do not indicate any need for treatment in children imaged for purposes other than sinus disease.

Allergic fungal sinusitis in the southeastern USA: involvement of a new agent Epicoccum nigrum Ehrenb. ex Schlecht. 1824.

Alternaria alternata, Aspergillus spp., Bipolaris spicifera, Curvularia lunata, Epicoccum nigrum and Fusarium solani were isolated repeatedly from groups of patients among 96 diagnosed with allergic fungal sinusitis (AFS). Epicoccum nigrum was obtained consistently from four patients, one of whom yielded mycelial masses consistent in morphology with E. nigrum. Fifteen of the predominant fungi recovered from air samples from selected patients' residences included the same species isolated from the mucin of its inhabitants. Air samples from other buildings, whose occupants (non-AFS individuals) complained of poor indoor air quality or of symptoms of the sick building syndrome (SBS), yielded some of the same species involved in AFS. An association of SBS with AFS was not established. Eight of the species implicated in AFS were found to colonize the surfaces of indoor construction and finishing materials at sites other than the residence of the patient. To our knowledge, this is the first report that E. nigrum can colonize nasal sinuses and cause AFS.

A 13-year report on childhood sinusitis: clinical presentations, predisposing factors and possible means of prevention.

Two hundred and nineteen children with sinusitis treated as in-patients at Huddinge University Hospital during the period 1980-1992 have been reviewed. Epidemiological data, the clinical picture, treatment and complications are described. The prevalence of significant predisposing conditions (such as upper airway allergy, asthma, and immunoglobulin deficiency) has been estimated. Serious sinusitis complications are few, surgery is only rarely required, and previously-recognized important predisposing paediatric conditions are not significantly more common than in the general juvenile population. Improved medication and prevention may have reduced the incidence of serious sinus infections in risk groups today. Children with cystic fibrosis have been reviewed with regard to the necessity of both sinus and nasal polyp surgery. Aggressive medical therapy appears to have reduced their need for sinus surgery as well as polypectomy.

Prevalence of paranasal sinus abnormalities on MRI in a non-ENT population.

A prospective MRI sinus study primarily applied to a group of patients with suspected neurological intercranial pathology is carried out. Even in this non-ENT population, the prevalence of inflammatory sinusitis abnormalities on MRI is high.

Australian experience with functional endoscopic sinus surgery and its complications.

There have been reports of severe complications from functional endoscopic sinus surgery; however, it is unclear as to how the rate compares with that of the more traditional forms of intranasal surgery. To ascertain this, I circulated a questionnaire to 100 otolaryngologists in Australia known to have an interest in endoscopic nasal surgery and analyzed the results. The results of this survey show that complications are very infrequent and that the rates for functional endoscopic sinus surgery compare favorably with those of the traditional techniques.

Ciliary beating frequency in chronic sinusitis.

Ciliary beating frequency, one component of mucociliary function, was measured outside of the sinus in vitro with a photoelectric method in 150 patients with chronic sinusitis and in 26 control subjects. In the mucosal samples of 35 patients (23%), no ciliary activity was seen. Ciliary beating frequency in maxillary sinus mucosa of the rest of the 115 patients (77%) was, as an average, 16.6 +/- 3.0 Hz (range, 10.9 to 23.3 Hz) and it was 15.9 +/- 2.6 Hz (range, 13.2 to 22.8 Hz) for the control patients. No differences in ciliary beating frequency were found according to quality of sinus secretion, prevalent respiratory allergy, or mucosal thickness. However, in sinuses with purulent secretion, ciliary beating frequency was slightly better (P < .05) than in "empty" sinuses. The study suggests that in many cases of chronic sinusitis, the sinus mucosa still has a capacity to recure.

Acute frontal sinusitis: etiological factors and treatment outcome.

A retrospective analysis of patients with acute frontal sinusitis treated at Kuopio University Hospital between 1981 and 1990 was performed to define etiological factors, clinical course and response to treatment. The study comprised 91 patients, 67 men and 24 women, aged from 9 to 65 years with a mean age for men of 32 years and for women of 29 years. Thirty-nine patients (43%) had previously been suffering from seasonal or chronic rhinitis, which in 22 was allergic, in 15 vasomotoric and in 2 due to intolerance to acetylsalicylic acid. In one case there was a recent and in another an old nasal trauma. Forty-seven patients (52%) were hospitalized, the others treated as outpatients. All received medical treatment. In 49 patients (54%) there was contemporary maxillary sinusitis which was treated with irrigations. Nasal polyps were detected and removed in 18 patients (20%). Anterior ethmoidectomy was made in 11 patients (12%) and trephination of the diseased frontal sinus to avoid complications in 8 patients (9%). No complications occurred. In 5 patients (5%) acute frontal sinusitis recurred once and a chronic course was seen in another 5 patients of whom 3 had chronic allergic and one vasomotor rhinitis.

Relationship of chronic ethmoidal sinusitis, maxillary sinusitis, and ostial permeability controlled by sinusomanometry: statistical study.

Three hundred sixty-seven successive patients suffering from chronic maxillary sinusitis (CMS) were thoroughly examined by means of maxillary sinusoscopy, a CT scan of the facial sinuses, and sinusomanometry (SMM). Ninety-eight cases of unilateral CMS, 269 cases of bilateral CMS, and 444 chronic ethmoidal sinusitis (CES) cases were evaluated. According to SMM, the maxillary ostia were divided into two groups: 1. maxillary ostium patency (MOP) group and 2. the maxillary ostium nonpatency (MONP) group. The unilateral and bilateral pathologies were separately analyzed so as to minimize the effects of general or systemic causes on the results. MONP is, in both bilateral and unilateral groups, significantly linked with the presence of ethmoidal sinusitis (P < 10(-6); P = .026), while the correlation between MOP and the ethmoid status does not appear to be significant in either group. Thus, there seems to be a close relationship between CES and maxillary ostial dyspermeability in cases of CMS.

[Incidence of non-tumor anomalies of the facial sinuses on x-ray computed tomography of the brain of asymptomatic patients. Clinical and radiologic correlations between involvements of ethmoid cells and other sinus cavities]. / Fréquence des anomalies non tumorales des sinus de la face au cours d'examens TDM de l'encéphale chez des sujets asymptomatiques. Corrélations cliniques et radiologiques entre l'atteinte des cellules ethmoïdales et celles des autres cavités sinusales.

Two hundred ninety five consecutive brain CT examinations of asymptomatic adults were studied prospectively for detection of nontumoral paranasal sinus abnormalities. CT alterations were found in 104 cases (35.3%), localized to the ethmoid cells in 83 cases, the maxillary sinuses in 56 cases, the sphenoid sinuses in 19 cases, and the frontal sinuses in 18 cases. The relationships between ethmoid cells disease and alterations of the large paranasal cavities are analysed, and the association with previous sinusitis or rhinitis is evaluated. Frontal sinus disease is associated in more than two-thirds of the cases with pathologic meatic and/or unciform ethmoid cells, but such an association could not be demonstrated for the other cavities.

[Management of chronic sinusitis in children].

The managements and the results of therapy for children with chronic sinusitis were reported. During the period of 1980 to 1988, 190 patients, aged 3 to 15, were examined at our outpatient clinic. The pathologic conditions of the maxillary sinus were examined by the contrast x-ray study (X-MFT). The mild, moderate and severe lesions in the maxillary sinus evaluated by X-MFT were 22%, 44; and 34%, respectively. Sixty-two per cent of ethmoid sinus was opacified in occipito-frontal view. The degree of patency of the maxillary ostium was evaluated by an application of the constant pressure to the maxillary sinus. Almost all maxillary ostia of these patients were patent. Nasal mucociliary clearance was reduced in 37% of the patients examined after the saccharin method. Antral lavages were performed once in a week for the therapy of 72% of children with chronic sinusitis. The efficacy of this modality was evaluated by the above mentioned items. The maxillary and ethmoid lesions, and nasal mucociliary transit time were significantly improved by the modality after 25 months in average. These results indicate that the antral lavage is an useful therapy for chronic sinusitis in children.