Value of antral puncture in the intensive care patient with fever of unknown origin.

OBJECTIVE: To evaluate the use of maxillary sinus puncture as a routine diagnostic procedure to exclude or confirm purulent sinusitis in intensive care unit (ICU) patients presenting with fever or a septic state of unknown origin. STUDY DESIGN: Retrospective. METHODS: All patients admitted to the ICU at the University Hospital Ghent who required ENT examination to exclude acute sinusitis as possible cause of their otherwise inexplicable fever or septic state underwent maxillary sinus puncture via the inferior meatus. The results of clinical examination and the relation between the presence of foreign bodies (e.g., nasogastric tubes) and culture results from the middle meatus and sinuses were analyzed. RESULTS: One hundred five punctures were performed in 53 patients. Macroscopic purulent effusions were obtained from 25 and nonpurulent effusions from 19 sinuses. The presence of a nasogastric tube did not influence puncture results but significantly increased colonization of the middle meatus. Staphylococcus aureus and Gram-negative agents were frequently cultured from sinus aspirates. Although purulent secretions often reveal no growth, most patients present with a multibacterial (40%) or monobacterial (28%) infection. Simple anterior rhinoscopy reduces the need for antral puncture. Only 8% of punctures in patients with a normal clinical examination were positive. CONCLUSIONS: Antral puncture proves to be a simple, fast, safe, inexpensive, and effective procedure for immediate diagnosis of acute nosocomial sinusitis in ICU patients and is therefore recommended as first procedure in these patients, even when only minor clinical abnormalities are present.

Value of computed tomography of the temporal bone in acute otomastoiditis.

In this study we report our experience with 24 patients with acute mastoiditis treated at the University Hospital in Ghent, Belgium. The most common presenting signs and symptoms of acute mastoiditis were an abnormal tympanic membrane (21/24), otorrhea (17/24) and earache (13/24). Postauricular edema and erythema with protrusion of the ear, often used as a diagnostic criterion, was present in only 3 patients. Demineralisation of the trabeculae was the most frequent radiological finding (13/24). Based on CT findings a distinction was made between two groups: acute incipient mastoiditis (13/24) and acute coalescent mastoiditis (5/24). Thirteen patients recovered with conservative therapy consisting of IV antibiotics and early myringotomy with or without placement of a ventilation tube. Mastoidectomy was required in 11 patients. Nine patients presented with a complication of infection extending beyond the mastoid compartment. The results are discussed and the value of CT scanning as a diagnostic tool and decisive element in the choice of therapy is analysed.