The impact of sinusitis on dose distribution in a radiotherapy plan by in silico study.

OBJECTIVES: To assess the impact of changes in sinus aeration on dose variation in nasopharyngeal cases using a single beam with various field sizes and real patient computed tomography (CT) images. METHODS: The calculations were carried out on a computer equipped with an Intel Xeon (R) Gold 5118 processor operating at 2.30 GHz in 2022 at Taibah University, Al Madinah Al Munawwarah for a retrospective nasopharyngeal case. At the patient level, the impact on dose distribution was examined for different field sizes by comparing the percentage depth dose. The dose discrepancy was evaluated by comparing the dose delivered without considering the anatomical changes observed in the initial fraction to the dose adjusted to account for these changes using a 2D gamma analysis. With a criterion of 1% dose difference and 1 mm distance to agreement, the gamma level for analysis was set at 95%. RESULTS: The study findings indicated that the observed effect diminished by approximately 50% for both 5 cm x 5 cm and 10 cm x 10 cm field sizes compared to the 3 cm x 3 cm size, where there was an overlap between the planning target volume and sinusitis. CONCLUSION: The study concluded that the impact of dose discrepancy was more pronounced in smaller field sizes.

Three Synchronous Primary Extranodal Mantle Cell Lymphomas Involving Torus Tubarius, Posterior Nasopharynx, and Base of the Tongue 65 Years After Treatment of Chronic Sinusitis with Nasopharyngeal Radium Irradiation.

BACKGROUND Radiation, specifically ionizing radiation, causes broad-spectrum gene damage, including double-strand DNA breaks, single DNA strand breaks, cross links, and individual base lesions, thus causing chromosomal translocations, deletions, point mutations, and, consequently, various types of cancer. Radiation also causes genomic instability in cells, which enhances the rate of mutations in the descendants of the irradiated cell after many generations of normal replications. CASE REPORT We report the first case of mantle cell lymphoma of the torus tubarius, and the first CD10-positive mantle cell lymphoma of the Waldeyer's ring. Mantle cell lymphoma appeared 65 years after treatment of chronic sinusitis with nasopharyngeal radium irradiation. CONCLUSIONS On the basis of the medical literature about atomic bomb survivors, nuclear plant workers, and radiologists exposed to radiation, and our case, we conclude that radiation can, in a very small percentage of exposed individuals, cause non-Hodgkin lymphoma: in 0.24% of atomic bomb survivors and in at least 0.13% of the patients treated with nasopharyngeal radium irradiation. Non-Hodgkin lymphoma can occur many decades after radiation exposure, and individuals treated with nasopharyngeal radium irradiation, usually in their childhood, need continuing follow-up.

Clival keloid after nasopharyngeal radium irradiation masquerading as skull base malignancy.

OBJECTIVES/HYPOTHESIS: Nonchordomatous lesions of the clivus are rare entities. Nasopharyngeal radium irradiation (NRI) treatment consists of application of radium to the posterior nasopharynx near the orifice of the Eustachian tubes, an area adjacent to the clivus. Here we present a unique case of a patient with a history of NRI 70 years prior to presentation with a space-occupying clival lesion suspicion for a skull-based malignancy. This lesion was resected using an endoscopic endonasal approach. Histopathological analysis revealed a clival keloid, an entity not previously reported in the literature.

A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients' quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest-posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0-3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (ηp(2) ηp(2) = 0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.

Phototherapy for chronic rhinosinusitis.

OBJECTIVES: Near-infrared laser illumination (NILI), with or without photo-activated (PA) agents, has bactericidal and wound healing promoting effects. NILI may have a potential role managing chronic rhinosinusitis (CRS). METHODS: A prospective randomized study with 23 symptomatic post-surgical CRS patients with positive cultures was conducted. Two groups (GR1 and GR2) were treated with NILI. Objective nasal endoscopic scoring (NES) was elaborated. GR1 was treated with a 940 nm laser, while GR2 was treated with a topical PA agent, indocyanine-green, followed with 810 nm laser. SNOT20 scores, NES, and cultures were obtained prior to illumination. Saccharin test was performed 1 week following treatment. RESULTS: Some cultures remained positive through treatment, with Staph. aureus predominating. Both therapy arms demonstrated clinical efficacy. The SNOT20 score change was 0.9, 0.8 for GR1 and GR2, respectively (P < 0.05). Improvement (P < 0.05) was observed based on NES. No significant difference was observed between two treatment groups. All passed the saccharin test. Therapeutic effect was sustained for a minimum of 2 months. Side effects were minimal. CONCLUSIONS: NILI was objectively and subjectively beneficial in managing CRS, safe, reproducible, sustained and appeared not to interfere with ciliary motility. CRS exacerbation was avoided without using antibiotics or steroids.

[Efficacy of noninvasive hemolaserotherapy in patients with bronchial asthma and concomitant rhinosinusitis]. / Effektivnost' neinvazivnoi gemolazeroterapii u bol'nykh bronkhial'noi astmoi s soputstvuiushchim rinosinusitom.

AIM: To study efficacy of low-intensive infrared laser radiation impact on the tympanic membrane in patients with bronchial asthma (BA) and concomitant rhinosinusitis (RS). MATERIAL AND METHODS: 78 patients with moderate BA of a mixed type and concomitant chronic RS were divided into 3 groups: group 1 patients received medication plus infrared laser radiation of the tympanic membrane and paranasal sinuses; group 2 patients were exposed to supravenous laser radiation (0.63 mcm); group 3 received pharmacotherapy alone. The effect of the treatment was assessed by spirometry, peakflowmetry and paranasal sinuses findings. RESULTS: The highest response was achieved in group 1 which manifested with positive changes in clinical, device and spirometric data on BA and x-ray data on RS courses. The least effective treatment was observed in group 3. CONCLUSION: Use of infrared laser radiation of the tympanic membrane and paranasal sinuses projection in the treatment of BA patients with RS is effective, nontoxic and easy to use both in hospitals and outpatient departments.

Radio-tympano-sinu-orthesis with 186Re-colloid: a new treatment modality for chronic otitis media and paranasal mucositis.

UNLABELLED: This preliminary treatment trial was performed to evaluate the safety and clinical efficacy of intracavitary therapy with (186)Re-colloid in patients with recurrent otitis media and paranasal sinusitis, resistant to pharmacotherapy and surgical treatment. METHODS: Thirty-nine applications of 5-35 MBq (186)Re-colloid into the tympanon and the paranasal sinuses were performed in 6 patients. Biodistribution and biokinetics were studied by gamma-camera imaging. Clinical success was documented 6-20 mo after therapy by each patient's self-evaluation and by rhinootologic follow-up, using a 4-step score. RESULTS: No harmful side effects were seen. There was good-to-excellent clinical improvement with a score of +1.44 +/- 0.5 by each patient's self-evaluation and by physicians scoring of +0.81 +/- 0.9 with only negligible extracranial tracer deposition. CONCLUSION: This novel treatment option using intracavitary application of (186)Re-colloid in chronic otitis media and sinusitis is safe and effective. The term "radio-tympano-sinu-orthesis" might be proposed analogously to the well-known radiosynoviorthesis.

Radiation exposure: a new risk factor for idiopathic perifoveal telangiectasis.

OBJECTIVE: To examine the association between previous radiation exposure and idiopathic perifoveal telangiectasis (IPT). DESIGN: A multicentered, individually matched, case-control study design was used. PARTICIPANTS/CONTROLS: Sixty-five case subjects were matched with 175 control subjects. Individuals with unequivocal evidence of angiographically confirmed IPT were included as cases. Control subjects were matched for center, age, and gender. MAIN OUTCOME MEASURE: The main exposures of interest were a history of therapeutic head or neck irradiation and environmental radiation exposure. METHODS: A standardized questionnaire was administered to case and control subjects. Data were collected for the main exposures of interest as well as pertinent covariates. Conditional logistic regression was used to evaluate therapeutic and environmental radiation as risks for IPT. RESULTS: On univariate analysis, head or neck irradiation was associated with IPT (odds ratios [OR] = 4.15, 95% confidence interval [CI] = 1.30-13.24). While controlling for diabetes and family history of diabetes, IPT was found to be associated with both head or neck irradiation (OR = 4.06, 95% CI = 1.20-13.76) and with environmental irradiation (OR = 6.73, 95% CI = 1.06-42.74). CONCLUSIONS: This study presents a previously unreported association between prior radiation exposure and IPT.

Estimates of numbers of civilians treated with nasopharyngeal radium irradiation in the United States.

Nasopharyngeal radium irradiation was used 35 to 50 years ago for treatment of hearing loss, chronic ear infections, asthma, and other conditions. I reviewed the medical literature for published articles on the nonmilitary use of nasopharyngeal radium irradiation. Four years have minimum documented numbers of radium applicators in use (1946, 600; 1948, 1000; 1958, 2000; 1961, 2000). Two levels of physician use were assumed, a high estimate of 25 patients per week and a low estimate of 5 patients per week. It was assumed that physicians used the applicators 50 weeks per year. Typical treatments involved two applicators at a time (one for each nostril) for three sessions. Using a formula reflecting the number of applicators in use, the number of patients a physician would treat in a week, the number of weeks in a year an applicator would be used, and the number of applicators and sessions per patient, I then estimated the number of children who might have been treated. This estimate is that approximately 500,000 to 2.5 million persons might have been treated with nasopharyngeal radium. Because the lack of documentation for numerous parts of the equation required that I make a large number of assumptions, this estimate should be considered a rough approximation of the number of civilians treated.

[Use of laser therapy in inflammatory diseases of the paranasal sinuses]. / Primenenie lazernoi terapii pri vospalitel'nykh zabolevaniiakh okolonosovykh pazukh.

105 patients with acute and chronic inflammation of the paranasal sinuses were exposed to the radiation of the semiconductor laser Uzor using gallium arsenide. The treatment combined antiinflammatory drugs with vasoconstrictive nasal drops, maxillary puncture and laser radiation. Intolerance to laser effects was registered in 3 patients. The course of treatment included 5-6 sessions in acute sinusitis and 10 sessions in chronic sinusitis. Laser therapy was found effective as it reduced the time of treatment by 1-2 days.

[Low-intensity laser irradiation in otorhinolaryngology]. / Nizkoénergeticheskoe lazernoe izluchenie v otorinolaringologii.

Low-intensity laser irradiation is a modality widely practiced in otorhinolaryngology. Basing on extensive personal experience and literature data the authors provide ENT specialists with relevant techniques and parameters of the radiation for different otorhinolaryngological diseases.

Pulsed magnetotherapy in Czechoslovakia--a review.

Pulsed magnetotherapy has been used in Czechoslovakia for more than one decade. It has been proved that this type of physical therapy is very efficient mainly in rheumatic diseases, in paediatrics (sinusitis, enuresis), and in balneological care of patients suffering from ischaemic disorders of lower extremities. Promising results have also been obtained in neurological diseases (multiple sclerosis, spastic conditions) and in ophthalmology, in degenerative diseases of the retina.

[Laser treatment of sinusitis in general practice assessed by a double-blind controlled study]. / Laserbehandling af bihulebetaendelse i almen laegepraksis vurderet ved en dobbeltblind kontrolleret undersøgelse.

The effect of Low Level Laser therapy (Galium-Aluminium-Arsenide laser, 30 mW/830 nm, Unilaser 2000 3B) on sinuitis was evaluated in a double-blind randomised clinical study comprising 60 patients from general practice. All patients received three treatments (90 seconds radiation on each sinus) with one to three days interval. No statistically significant differences in pain relief, well-being or duration of illness were observed between patients treated with laser and a placebo.

[Differential diagnosis of destructive processes of the skull base. Aggressive polypoid eosinophilic pansinusitis with expression of carcinoembryonic antigen (CEA)]. / Ein Beitrag zur Differentialdiagnose von destruierenden Prozessen der Schädelbasis. Die aggressive polypöse eosinophile Pansinusitis mit Expression von karzinoembryonalem Antigen (CEA).

We report a woman with extensive polypoid sinusitis and bony destruction of the middle and posterior skull base. Histological examination of the specimen from the paranasal sinuses and adjacent skull base revealed polypoid eosinophilic sinusitis: malignancy could be excluded histologically and clinically. Plasma-CEA-levels were elevated to 85 micrograms/l with no typical source of CEA expression, and they fell after therapy. Immunocytochemistry revealed a remarkable expression of CEA in the surface epithelia of the specimen obtained from the paranasal sinuses. CEA-immunoscintigraphy showed an enhancement in the regions of the paranasal sinuses without expression elsewhere in the body. The authors discuss the possibility of using CEA as a marker for aggressive forms of chronic sinusitis and suggest radiotherapy is a successful treatment option in addition to surgery. The observation period of almost two years confirms the value of the chosen therapy.