Serogroup B Meningococcal Sepsis and Meningitis Associated With Meningococcal Acute Otitis Media, and Paranasal Sinusitis in an Infant: A Case Report.

Meningococcal disease (MD) is a potentially lethal condition. Typically, following infection, MD manifests with high fever, with signs and symptoms of severe septicemia with or without purpura, and in more than half of cases with meningitis. Acute otitis media (AOM) caused by Neisseria meningitidis has scarcely been reported, mostly without severe MD, and there are no reports of meningococcal paranasal sinusitis (PS). We present the case of a previously healthy 11-month-old infant who started with fever and cough and further developed intense irritability and right spontaneous purulent otorrhea, with subsequent increased fever and seizures. Blood, cerebrospinal, and middle ear fluid cultures were positive for N. meningitidis serogroup B, and a CT scan showed both maxillary and ethmoidal sinusitis. Intravenous ceftriaxone was administered for eight days, and three months following discharge, no sequelae were identified. This is the first report of a patient with MD associated with sepsis, meningitis, AOM, and PS.

Pediatric COVID-19 Involving Complicated Sinusitis With Intracranial Extension and Lemierre Syndrome: A Case Report.

Pediatric coronavirus disease 2019 (COVID-19) has been associated with various complications including chronic respiratory disease and multisystem inflammatory syndrome. There are a few reported cases of complicated sinusitis following pediatric COVID-19 infection. We present a patient with recent COVID-19 who developed complicated sinusitis with intracranial extension and Lemierre syndrome. A 16-year-old female with a history of COVID-19 diagnosis 17 days prior presented with worsening head and neck symptoms. Physical examination demonstrated left proptosis, cranial nerve (CN) VI palsy, and limited neck range of motion. Imaging demonstrated bilateral sinus disease, a 3.3 × 2 × 3-centimeter sellar/clival abscess, bilateral cavernous sinus thrombosis, and thrombosis of bilateral internal jugular veins. Urgent endoscopic sinus surgery was performed, and long-term intravenous antibiotics and anticoagulation were initiated with improvement in symptoms over three weeks. Providers caring for patients with COVID-19 should keep complicated sinusitis and Lemierre syndrome in their differential. Further study of COVID-19 pathophysiology in the sinonasal mucosa is needed.

Clinical Characteristics of Rhinosinusitis in Children in a Tertiary Care Center.

BACKGROUND: Rhinosinusitis (RS) is a term used in clinical practice to describe inflammation of the paranasal and nasal sinuses. This condition can be categorized based on the duration of symptoms into acute, subacute, and chronic RS. It is important to note that RS presents differently in pediatric patients compared to adults. In children, typical symptoms include cough, bad breath (halitosis), irritability, fatigue, and swelling around the eyes. This study aims to shed light on the prevalence and clinical characteristics of RS in the pediatric age group. METHODS: This retrospective cohort study was conducted at King Abdullah Specialized Children's Hospital (KASCH) in Riyadh, Saudi Arabia, which is a tertiary care center under the authority of the Ministry of National Guard Health Affairs (MNGHA) in Saudi Arabia, using the medical records of all patients diagnosed with RS between 2019 and 2022. RESULTS: In this study, 345 pediatric patients with RS were examined. A significant portion (n = 106, 30.7%) were older than 12 years, and males made up the majority (n = 210, 60.9%). Chronic RS without nasal polyps prevailed (n = 299, 86.7%), mainly affecting the maxillary sinus (n = 200, 58%). Notably, 29% (n = 100) were diagnosed after age 12. Key symptoms included nasal congestion (n = 233, 67.5%), nasal discharge (n = 202, 58.6%), and facial discomfort (n = 191, 55.4%). Most (n = 314, 91%) received medical treatment, resulting in improvement for 78.8% (n = 272). Of those not improving (n = 73, 21.2%), 47.9% (n = 35) received medical management, and the rest underwent surgery, primarily functional endoscopic sinus surgery (n = 38, 52.1%). CONCLUSION:  RS is a common condition affecting children, with symptoms like nasal obstruction, discharge, and facial discomfort. Chronic RS, particularly in the maxillary sinus, is the most prevalent type. Medical treatment was the first choice and generally effective, but when needed, surgical intervention, mainly functional endoscopic sinus surgery, was pursued.

Pediatric Recurrent Unilateral Trochleitis in Association With Paranasal Sinusitis: A Case Report.

Trochleitis is an easily treatable condition; however, it is often misdiagnosed by many clinicians because of its rare incidence. We report the case of a 14-year-old Saudi male patient, known to have type 1 diabetes mellitus (DM) and pansinusitis, who presented to the emergency department with a one-day history of severe right periorbital pain exacerbated by upgaze and supraduction. There was intense point tenderness on palpation over the trochlear region of the orbit with no underlying swelling or redness. Both eyes had a corrected visual acuity of 0.8. Mildly limited elevation (-1) of the right eye was noted. All other extraocular movements were normal in both eyes. Contrast-enhanced CT of the head and orbits showed mild trochlear swelling, inflammation, and pansinusitis. He was treated with a single intratrochlear injection of steroids, which immediately and significantly improved the symptoms. To the best of our knowledge, this is the second case of trochleitis associated with paranasal sinusitis in children. This suggests that a possible, but rare, association between these two conditions may exist in the pediatric population.

An Analysis of Biologic Therapies in Patients With Asthma and Chronic Rhinosinusitis.

Background Asthma, Allergic rhinitis (AR), Chronic Obstructive Pulmonary Disease (COPD), Eczema, and Chronic Rhinosinusitis with Sinonasal Polyposis (CRSwNP) are illnesses often characterized by type 2 (T2) inflammation, wherein T helper (Th) cells release pro-inflammatory cytokines such as IL (interleukin)-4, IL-5, IL-9, and IL-13. This response may also promote the production of IgE and an increase in/activation of serum eosinophils. In the aforementioned type 2 inflammatory diseases, this immune response can cause excess mucous production, inflammation of the airways, other atopic responses when patients are exposed to certain environmental allergic triggers. Relatively new biologic monoclonal antibody therapies such as dupilumab (blocks IL-4 and IL-13), benralizumab (blocks IL-5), mepolizumab (blocks IL-5), and omalizumab (blocks IgE Fc/fragment of crystallization region) offer novel therapeutic targets that more specifically and directly block type 2 inflammatory responses. Methods To examine the effect of monoclonal antibody biologic therapies on patient indicators of type 2 inflammation, a retrospective analysis of 193 patients on biologic therapy was conducted, and these patients were compared to 48 control patients with type 2 inflammatory diseases who did not initiate biologic therapy. Total Lund-MacKay radiographic score, FEV1 (forced expiratory volume in the first second), FEF25-75 (forced expiratory flow from 25-75% of the forced vital capacity curve), annualized pulmonary exacerbations, oral corticosteroid dose, and serum eosinophils were recorded at baseline (zero months), and at three, six, nine, and twelve months after initiation of biologic therapy. Least squares mean data and the percent change from the baseline of least squares mean for the biologic and control groups were compared. Results Omalizumab was the most common biologic therapy prescribed. Control patients were younger than patients who initiated biologic therapy. Patients on biologic therapy had statistically significant reductions in Lund-MacKay score, improvements in FEV1 and FEF25-75, reductions in serum IgE levels, and reductions in serum Eosinophils. Patients on biologic therapy also had statistically significant reductions in annualized pulmonary exacerbations and oral corticosteroid dose compared to controls. Conclusions Patients with a variety of type 2 inflammatory conditions appear to have significant improvements in lung function, radiographic sinusitis, and serum markers of type 2 inflammation after initiation of biologic therapy versus controls. These therapeutic medications appear to significantly improve type 2 inflammatory disease course in patients who can tolerate these medications.

Acute Vision Loss as the Initial Manifestation of Granulomatosis with Polyangiitis Involving the Orbital Apex.

Granulomatosis with polyangiitis (GPA) is a systemic autoimmune disease consisting of necrotizing granulomatosis of the respiratory tract, necrotizing vasculitis, and necrotizing glomerulonephritis. It is under the category of ANCA-associated vasculitis, which involves small vessels. The nose, sinus, and ear were the most affected sites besides lung and kidney in localized form. They might precede other disease manifestations before progressing to the systemic form. Our patient presented with an intractable headache, followed by acute vision loss. His symptoms deteriorated regardless of antibiotic treatment for paranasal sinusitis. The sequential CT/MRI images showed the inflammatory raid of the orbital apex and cavernous sinus within days. The sinus biopsy and elevated PR3-anti-neutrophil cytoplasmic antibody led us to the diagnosis of GPA. Fortunately, the patient's vision improved gradually after steroid and immunosuppressant treatment.

Pyogenic meningitis and trigeminal neuritis secondary to periodontogenic paranasal sinusitis in a red deer (Cervus elaphus).

An adult female red deer died of a severe seizure and dysbasia. Postmortem computed tomography (CT) and magnetic resonance imaging (MRI) were performed. On CT, deciduous right maxillary second and third premolar teeth were observed, and the right infraorbital canal was disrupted. MRI showed that the right trigeminal nerve was enlarged and the right subarachnoid cavity was occupied by fluid and gas. On gross examination, the right paranasal sinus, swollen muscles of the orbit and tonsils, right trigeminal nerve, and right cerebrum surface contained a yellowish-white, cheese-like pus. Based on these findings, the deer was believed to have developed pyogenic meningitis caused by a neuropathic infection secondary to periodontogenic paranasal sinusitis.

Post-traumatic Orbital Abscess in an Adult With No Evidence of Orbital Fracture, Paranasal Sinusitis, or Foreign Body Migration.

A 35-year-old man was hit against his left eye by his child's foot. Two days following trauma, the patient noticed diplopia in the upward and right gazes. On the first examination seven days after trauma, computed tomographic (CT) images revealed a small mass in the inferolateral orbit near the inferior orbital fissure. There was no radiological evidence of orbital fracture, paranasal sinusitis, or foreign body. Immediately after the first examination, the patient had a history of fever, retrobulbar pain, and nausea. These symptoms gradually worsened, and the patient visited the emergency department of our hospital at 13 days following trauma. CT images showed enlargement in the size of the mass. The diagnosis of the orbital abscess was made, and emergent drainage of the abscess was performed, followed by administration of intravenous antibiotics. On the fifth postoperative day, cultures of the abscess specimen showed growth of Fusobacterium nucleatum (4+), Parvimonas micra (4+), and Prevotella intermedia (4+). The patient's condition improved significantly and at the 1.5-month follow-up, the patient did not have any symptoms related to the orbital abscess.

Paranasal sinusitis at the initiation of chemotherapy is a risk factor for invasive fungal disease in children and adolescents with cancer.

BACKGROUND: The impact of paranasal sinusitis on the clinical outcome of patients with cancer remains unknown. The aim of this study was to determine whether paranasal sinusitis at the initiation of chemotherapy (SAI) affects the development of infectious complications in children and adolescents with cancer. METHODS: A retrospective cohort analysis of patients aged 0-20 years with cancer who received chemotherapy was performed. SAI was defined as the presence of a fluid level or mucosal swelling or total opacity on sinus computed tomography examination before the initiation of chemotherapy. The primary outcome measures were the incidence of bacteremia, septic shock, and invasive fungal disease (IFD, including proven, probable, and possible cases). RESULTS: SAI was observed in 57 (44%) of 130 enrolled patients. There were no significant differences in age, sex, and disease distribution between the patients with SAI (SAI group) and those without (non-SAI group). There was no significant difference in the 1-year cumulative incidence of bacteremia or septic shock after treatment initiation between the two groups (bacteremia, SAI group 33% vs. non-SAI group 35%, P = 0.53; septic shock, SAI group 4% vs. non-SAI group 4%, P = 0.87). The 1-year cumulative incidence of IFD was higher in the SAI group than in the non-SAI group (22% vs. 6%, P = 0.012). Cumulative incidence analysis after inverse probability of treatment weighting adjustment showed that the SAI group was more likely to develop IFD (HR: 3.5, 95% CI: 1.1-11.2, P = 0.033). CONCLUSIONS: Our findings suggest that patients with SAI may be at higher risk for IFD during chemotherapy.

Deep Learning for Diagnosis of Paranasal Sinusitis Using Multi-View Radiographs.

Accurate image interpretation of Waters' and Caldwell view radiographs used for sinusitis screening is challenging. Therefore, we developed a deep learning algorithm for diagnosing frontal, ethmoid, and maxillary sinusitis on both Waters' and Caldwell views. The datasets were selected for the training and validation set (n = 1403, sinusitis% = 34.3%) and the test set (n = 132, sinusitis% = 29.5%) by temporal separation. The algorithm can simultaneously detect and classify each paranasal sinus using both Waters' and Caldwell views without manual cropping. Single- and multi-view models were compared. Our proposed algorithm satisfactorily diagnosed frontal, ethmoid, and maxillary sinusitis on both Waters' and Caldwell views (area under the curve (AUC), 0.71 (95% confidence interval, 0.62-0.80), 0.78 (0.72-0.85), and 0.88 (0.84-0.92), respectively). The one-sided DeLong's test was used to compare the AUCs, and the Obuchowski-Rockette model was used to pool the AUCs of the radiologists. The algorithm yielded a higher AUC than radiologists for ethmoid and maxillary sinusitis (p = 0.012 and 0.013, respectively). The multi-view model also exhibited a higher AUC than the single Waters' view model for maxillary sinusitis (p = 0.038). Therefore, our algorithm showed diagnostic performances comparable to radiologists and enhanced the value of radiography as a first-line imaging modality in assessing multiple sinusitis.

Hypophysitis Due to Paranasal Sinusitis: Neurosurgical Perspective from Developing World.

BACKGROUND: Sinusitis is a common clinical condition, but sphenoid sinusitis is a less common form and even rarer is hypophysitis as a complication of the latter. Clinically, hypophysitis may mimic a pituitary neoplasm in presenting with mass effect and pituitary hormone dysfunction. CASE DESCRIPTION: We present 5 cases of sinusitis-related hypophysitis treated at the Royal Care International Hospital in Khartoum, Sudan. Clinical symptoms at presentation included headache, fever, ptosis, ophthalmoplegia, and history of sinusitis with running nose (nasal discharge). None of the patients were immunocompromised or showed signs of meningitis. Laboratory tests indicated neutrophilia and elevated inflammatory indices, namely C-reactive protein and erythrocyte sedimentation rate. There was also a disturbance of the hypothalamic-pituitary hormone axis, particularly impaired cortisol level. Magnetic resonance imaging scans on all patients revealed swollen masses in the pituitary fossa and enhancement of the sellar region and paranasal sinuses, especially the sphenoid sinus. All cases were empirically treated with hydrocortisone and amoxicillin-clavulanate, resulting in reversal of symptoms. CONCLUSIONS: Sinusitis is common in tropical regions where the climate is usually warm and often hot and dry. Here, the condition is considered a common incidental finding in magnetic resonance imaging examinations done for various indications. Hence it is not considered to be a serious health problem. Though our cohort of cases is small, we emphasize the importance of keeping a high index of suspicion for the diagnosis of hypophysitis in relevant case settings. This would help make an early diagnosis and ensure appropriate medical, perhaps nonsurgical, management.

[The differential approach to the surgical treatment of pathologies of the frontal sinus]. / Differentsirovannyi podkhod k khirurgicheskomu lecheniiu patologii lobnoi pazukhi.

The surgical intervention for the management of frontal sinusitis is required in a large fraction of patients presenting with this condition. The treatment of choice for the pathology in question is endoscopic endonasal frontotomy. Whenever the endoscopic technique is impossible to employ, the surgeon has to resort to an extranasal operation on the frontal sinus. The indications for the application of such strategy include the pathological conditions complicated by the intracranial and orbital processes, the presence of large benign tumours, recurrent post-surgical purulent sinusitis and traumatic frontal sinusitis. For the preservation of the functionally competent frontal sinus during extranasal frontotomy, a frontonasal fistula with all bony walls and maximally spared mucous membrane can be created. In order to remove an osteotoma from the frontal sinus, we applied the osteoplastic approach with the formation of the osteo-periosteal flap from the frontal wall of the sinus. In those cases when it was impossible to restore the frontal sinus and there was a closed bone cavity undergoing purulent inflammation we practiced obliteration of the cavity with the use of a porous carbon implant.

Incidental paranasal sinusitis on routine brain magnetic resonance scans: association with atherosclerosis.

BACKGROUND: Incidental paranasal sinusitis (IPS) is common on imaging for non-sinusitis disorders, usually without symptoms or obstructive features, and possibly arising from periodontitis (PD). PD associations with atherosclerosis have been widely reported. We test if IPS may also be associated with atherosclerosis. METHODS: IPS was scored retrospectively in a random sample of 180 magnetic resonance (MR) brain scans and compared with chart review for atherosclerosis (all subtypes), rhinosinusitis, and related factors (smoking, asthma, and relevant surgery). IPS was scored out of 30, from all sinuses, with maxillary sinuses weighted double volumetrically. Significant IPS (Sig IPS) was designated as 6 or more out of 30. Bivariate logistic regression was used to test for associations of Sig IPS to the clinical data, with multivariate analysis then testing for potential confounders. RESULTS: A total of 173 subjects were analyzed (7 exclusions). MR indications included suspected acute/prior stroke (22.0%). Sig IPS found in 20 (11.6%). Positive histories for atherosclerosis were cerebral, 57 (32.9%); coronary, 48 (27.7%); and peripheral arterial disease, 14 (8.1%). IPS ≥6 was strongly associated with cerebrovascular disease (odds ratio [OR] 6.0, p < 0.001), and less robustly to smoking (OR 2.9, p = 0.07) and rhinosinusitis (OR 2.4, p = 0.09). No associations with coronary or peripheral artery diseases were found. After controlling for smoking and rhinosinusitis, yielding significant subclinical sinusitis, the link of Sig IPS to cerebrovascular disease persisted (modified OR 5.2, p = 0.002). CONCLUSION: Significant incidental sinusitis, which is mostly subclinical sinusitis, is associated with cerebrovascular disease but not other atheroscleroses. This suggests possible common causation of both by PD.

Prognostic factors of paranasal sinusitis with intracranial invasion: A 14-year review of cases at Hualien Buddhist Tzu Chi Hospital.

Intracranial invasion of paranasal sinusitis is an emergency condition that requires surgical and medical intervention in order to avoid further deterioration. We surveyed patients at the Buddhist Tzu Chi Hospital (Hualien, Taiwan) who had paranasal sinusitis with intracranial invasion. A total of 505 patients with paranasal sinusitis were surveyed at Hualien Buddhist Tzu Chi Hospital over a 14-year period (2000-2013). Data on clinical presentations, microbiology, host factors, postinterventional morbidity, and postinterventional mortality are presented. Of the 505 patients, nine had intracranial invasions (incidence rate, 1.8%). The mortality rate was high among these patients (44.4%, 4/9). Among the various risk factors identified, diabetes had the greatest influence (66.7%, 6/9), which in combination with an immunocompromised condition and cirrhosis is indicative of a poor prognosis.

Effect of Endoscopic Sinus Surgery on Paranasal Sinus Fungus Balls / 昆明医科大学学报

Objective To study and observe the effect of transnasal endoscopic surgery in the treatment of patients with fungal paranasal sinusitis.Methods A total of 82 cases of patients with fungal paranasal sinusitis were collected and divided into the control group (40 cases) and the observation group (40 cases) according to the principles of random,single blind and parallel control design,the patients in the control group received conventional surgical treatment,and the patients in the observation group received transnasal endoscopic surgical treatment,the two groups were observed and compared in terms of treatment efficiency,sinus cavity scores in the lesion range,average operation time,postoperative complication rate and patients' satisfaction degree.Results The effective rate in treatment group was 94.6％,significantly higher than that of control group (80.0％);the lesions sinus cavity score was 0 points in observation group,significantly lower than the control group (13.1 ± 1.9),the average operation time was (45.4 ± 10.9) min in the observation group,significantly shorter in the control group (76.3 ± 10.5) min;the postoperative complication rate was 3.2％ in the observation group,which was significantly lower than that of 25.6％ in the control group (P＜0.05).Conclusion The transnasal endoscopic surgery in the treatment of patients with fungal paranasal sinusitis can effectively improve the treatment efficiency,remove the mold lesions in the sinuses of patients,shorten the operation time and reduce the postoperative complication rate,and is conducive to promoting the rehabilitation of patients and improving the quality of life of patients,thus it is worth popularization and application.

Empyema of the nasal conchal bulla as a cause of chronic unilateral nasal discharge in the horse: 10 cases (2013-2014).

REASONS FOR PERFORMING STUDY: Empyema of the nasal conchal bullae has recently been identified in horses suffering from chronic unilateral nasal discharge. The diagnosis and management of such cases has not been reported previously. OBJECTIVES: To describe the diagnosis and treatment of cases suffering from empyema of the nasal conchal bullae and report the frequency of diagnosis from a population of horses referred for head computed tomography (CT). STUDY DESIGN: Retrospective case review. METHODS: Records from cases diagnosed with nasal conchal bulla disease using CT were reviewed. RESULTS: Abnormalities of the nasal conchal bullae were identified by CT in 10 cases (8 ventral conchal bulla, 2 dorsal conchal bulla), from 102 equine head CT examinations. Eight cases were subsequently treated at the study clinic, 7 of which had concurrent paranasal sinus disease. In 3 cases, fenestration of the ventral conchal bulla per nasum facilitated drainage and clearance of empyema. CONCLUSIONS: Disease of the conchal bullae should be considered as a potential cause of chronic unilateral nasal discharge in horses. Clearance of empyema within these bullae is unlikely to occur through lavage of the paranasal sinuses alone. Where necessary, fenestration of the bulla allows physical removal of infected material.

Staphylococcal immune complexes and myelinolytic toxin in early acute multiple sclerosis lesions-An immunohistological study supported by multifactorial cluster analysis and antigen-imprint isoelectric focusing.

Highly significant clinical, epidemiological and pathogenetic similarities between multiple sclerosis (MS) and nasopharyngeal sinusitis has led to the hypothesis that MS is caused by the inadvertent incorporation of the lymphatic drainage of the nasopharynx into the extracellular fluid circulation of the CNS. It has been postulated that, in response to antigenic and toxic products generated by the mucosal nasopharygeal flora, the leptomeninges and CNS parenchyma acquire the characteristics of a persistently stimulated lymphoid organ. Using an extensive panel of bacterial antibodies, tissues from exceptionally early cases, identified and classified using multifactorial cluster analysis, were screened for bacterial antigens using immunohistological methods. Anti-staphylococcal antibodies detected antigen co-locating with IgG/C3d immune complexes in pre-demyelinating and in primary lesions. The distribution of the antigen in relation to the morphogenesis of early acute MS lesions is detailed. Evidence for the intrathecal processing of staphylococcal antigen was obtained using isoelectric focusing and antigen imprinting to identify antigen-specific oligoclonal bands. Employing a combination of isoelectric focusing, western blotting and mass spectrometric analysis, evidence for the intrathecal processing of staphylococcal ß-haemolysin (sphingomyelinase) was obtained using CSF from MS cases. While a myelinolytic transportable toxin may be an important component in the pathogenesis of demyelination, in oligodendrocyte apoptosis, and in deviant immune responses within the CNS, the detection of other as yet unidentified staphylococcal-positive and negative oligoclonal bands points to the involvement of a cocktail of transportable antigens leaking in a similar manner into the CNS from the paranasal sinus mucosal tissues where these molecules are conserved by the resident flora to manipulate and subvert the normal processes of local and systemic immunity. Evidence for the access of other bacterial transportables to the CNS in MS should now be sought. The presence of 'high-output' toxigenic bacterial strains within the nasopharyngeal flora of MS patients should also be explored. The use of tracer molecules to detect and quantify nose-to-brain transport in MS patients is clearly apposite.

Paranasal Sinusitis Occurred by Anthracosis / 대한이비인후과학회지

Anthracosis is a black pigmentation of bronchial mucosa or lung parenchyma induced by inhaled soot. It is most commonly found in those persons who have worked as coal miners. Anthracosis is known to be induced when coal dust remains on the surface of the mucous membranes after it is inhaled through the bronchi, which can cause changes or atrophy of the upper airway and abnormality of the self-purification function and it can disrupt the defensive reaction of the respiratory organs. To our knowledge, there has been no report of recurrent paranasal sinusitis caused by anthracosis. Herein, with a review of the literature, we report a rare case of paranasal sinusitis caused by anthracosis in a 51-year-old man.

Clinical Features of Bilateral Paranasal Sinus Fungus Ball

BACKGROUND AND OBJECTIVES: Paranasal sinus fungus balls occur usually in a single sinus, most frequently the maxillary sinus. The goal of this study was to delineate the clinical features of a bilateral paranasal sinus fungus ball. MATERIALS AND METHODS: We retrospectively reviewed seven patients who presented with a bilateral sinus fungus ball and who received endoscopic sinus surgery between July 2004 and January 2009. We analyzed age, gender, chief complaint, associated symptoms, nasal endoscopic findings, ostiomeatal unit (OMU) computed tomography (CT) results, and surgical findings. RESULT: The male to female ratio was 1:6, and the age range was from 40 to 76 years. The chief complaints were nasal obstruction in three patients, foul odour in two, postnasal dripping in one, and cheek pain in one patient. Calcification of the paranasal sinus upon CT was observed in three cases (43%). A fungus ball was found in the maxillary sinus or middle meatus in all cases. CONCLUSION: Bilateral paranasal sinus fungus balls usually involve the bilateral maxillary sinus or middle meatus and often invade the anterior ethmoid sinus or frontal sinus.

Related factors of sinusitis after radiotherapy for nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective To explore the incidence and factors of paranasal sinusitis among nasopharyngeal carcinoma (NPC) patients after radiotherapy. Methods Retrospectively evaluated the clinical data of 144 NPC patients without paranasal sinusitis before radiotherapy, including 82 cases in T1/T2 stage and 62 cases in T3/T4 stage treated in the First Affiliated Hospital of Bengbu Medical College from 2000 to 2005. MRI images before and after radiotherapy were compared. The incidence and factors of paranasal sinusitis were analyzed. There were 58 cases of nasal invasion. Nasopharyngeal carcinoma was given at face-neck joint portal with 6 MV X-ray fractionated irradiation 68-78 Gy during 6-8 weeks. The number of patients who received radiotherapy with less than or equal to 70 Gy, more than 70 Gy radiation doses were 89 and 55, respectively. Cervical part were treated with high-energy electron beam, patients with positive neck lymph nodes and with negative neck lymph nodes received 64-74 Gy doses during 6-8 weeks and 50-54 Gy during 4-5 weeks, respectively. Results Among the 144 NPC patients 86.8%(125/144) developed paranasal sinusitis after radiotherapy, the incidence rates of paranasal sinusitis (IRPS) was higher among stage T3 + T4 patients than that among stage T1 + T2 patients (94% vs 82% ,x2=4.32, P ＜0.05). Among patients who were given radiotherapy with more than 70 Gy,less than or equal to 70 Gy radiation doses on the nasopharynx, the IRPS were 95% and 82.0% (x2 = 4.65, P ＜ 0.05 ). The IRPS in patients with nasal cavity infringement was higher than that in others (95% vs. 81% , x2 = 5.46,P ＜0.05). The IRPS at 3, 6, 12 months, and more than 1 year after radiotherapy were 13.6% ,31.2% ,48.8% and 6.4%, respectively (x2 = 70.48, P ＜ 0.001 ). Conclusions The incidence of paranasal sinusitis in NPC patients after radiotherapy was very high, and reached a peak in one year. It was influeneed by invasion of nasal cavity or not, the dose of radiotherapy and T stage.