Concomitant acute sinusitis and acute lung rejection

Two lung transplant recipients had concomitant acute sinusitis and acute lung rejection. Antibiotics and decongestants alleviated the sinusitis, but the symptoms of cough and dyspnea as well as spirometric defects necessitated treatment of acute lung rejection. In patients with clinical evidence of acute sinusitis after lung transplantation, concomitant acute lung rejection should be suspected if dyspnea or pulmonary dysfunction is also present. This appears to be the first report of concomitant acute sinusitis and acute lung rejection.     

Patients' and physicians' views on the management of acute maxillary sinusitis

OBJECTIVES: To study the views of patients and physicians on the management of suspected acute maxillary sinusitis and on suggested changes in practice. DESIGN: Cross-sectional survey and focus group interviews of both patients and physicians. SETTING: Primary care in Finland. RESULTS: A total of 175 patients and 245 physicians replied to the survey (response rates 88% and 70%, respectively). Eight focus groups were conducted, four with patients (n = 22) and four with physicians (n = 20). Patients had less trust than physicians in the natural healing process of acute maxillary sinusitis: only 33% as opposed to 95% of physicians agreed that acute maxillary sinusitis might heal without medication. The patients emphasised the importance of careful diagnosis. Physicians experienced the diagnostic uncertainty and the demands from authorities to use fewer antibiotics as problematic. CONCLUSIONS: Most patients with suspected acute maxillary sinusitis primarily want the physician to aim at making a specific diagnosis. Physicians feel they are forced to prescribe too many antibiotics for sinusitis because of patient's expectations and lack of good diagnostic means for acute maxillary sinusitis. Better diagnostic tools, both national and local guidelines, and patient information might help to change practice towards the use of fewer antibiotics.     

Childhood sinusitis.

Childhood sinusitis is difficult to diagnose. It is classified on the basis of duration of inflammation--acute or chronic--and cause of inflammation--infectious or noninfectious. Infectious sinusitis is often a result of obstruction of the osteomeatal complex. Inflammation in noninfectious sinusitis is similar to the inflammatory changes detected in respiratory mucosa of patients with asthma. Acute sinusitis is primarily an infectious process similar to a prolonged infection of the upper respiratory tract. Plain radiography has limited value for the diagnosis of acute sinusitis in children. The most effective treatment of acute sinusitis is administration of a beta-lactamase-resistant antibiotic. Chronic sinusitis may be infectious, noninfectious, or both. Coronal computed tomography of the sinuses and nasal endoscopy are the preferred methods for determining the presence of chronic sinusitis. When physicians prescribe therapy for chronic sinusitis, they need to consider whether the underlying cause is infectious, noninfectious, or both. Treatment of chronic infectious sinusitis is most effective when a beta-lactamase-resistant antibiotic is administered. Chronic noninfectious sinusitis may respond to topically intranasally applied corticosteroids. If medical treatment fails to resolve the disease within 3 months, surgical intervention may be necessary. Finally, although an association between asthma and sinusitis exists, a cause-and-effect relationship has not been established.     

学龄前儿童鼻咽部菌群与上呼吸道感染和急性鼻窦炎的关系研究

目的　研究学龄前儿童鼻咽部菌群分布和影响因素并探究其与上呼吸道感染和急性鼻窦炎的关系。方法　选取 94 例学龄前儿童为研究对象,分别收集人口学信息、病史和暴露史,采集基线、四季、发生上呼吸道感染和急性鼻窦 炎时期的鼻咽部菌群样本,通过对样本细菌进行培养研究学龄前儿童鼻咽部菌群与上呼吸道感染和急性鼻窦炎的关系。 结果　学龄前儿童鼻咽部菌群分布主要以链球菌属、奈瑟菌属、嗜血杆菌属和莫拉氏菌属为主,其影响因素主要有季节 （r 2=0.137,P <0.01）、急性鼻窦炎感染史（r 2=0.070,P <0.01）、冠状病毒感染史（r2 =0.048,P <0.05）和家中有吸烟 者（r 2=0.048,P <0.05）。鼻咽部菌群数与上呼吸道感染次数呈负相关关系（F =6.579,P =0.002）,另外相较于未感染 儿童,首次感染时间间隔小于60 天的菌群数降低（P ＜ 0.001）。发生急性鼻窦炎会使鼻咽部菌群数显著减少（P ＜ 0.05）。 结论　健康学龄前儿童鼻咽部菌群与急性鼻窦炎和上呼吸道感染有关。     

Fungal diseases of the paranasal sinuses

Fungal diseases of the paranasal sinuses can be categorized into the invasive and noninvasive varieties. The invasive form has been classified as acute fulminant fungal sinusitis, granulomatous invasive fungal sinusitis, and chronic invasive fungal sinusitis. The noninvasive form can be classified as the fungus ball and the allergic fungal sinusitis. The following review discusses the various types of fungal sinusitis with a special emphasis on the CT and MR imaging features.     

Patients’ and physicians’ views on the management of acute maxillary sinusitis

Objectives To study the views of patients and physicians on the management of suspected acute maxillary sinusitis and on suggested changes in practice.

Design Cross-sectional survey and focus group interviews of both patients and physicians.

Setting Primary care in Finland.

Results A total of 175 patients and 245 physicians replied to the survey (response rates 88% and 70%, respectively). Eight focus groups were conducted, four with patients (n=22) and four with physicians (n=20). Patients had less trust than physicians in the natural healing process of acute maxillary sinusitis: only 33% as opposed to 95% of physicians agreed that acute maxillary sinusitis might heal without medication. The patients emphasised the importance of careful diagnosis. Physicians experienced the diagnostic uncertainty and the demands from authorities to use fewer antibiotics as problematic.

Conclusions Most patients with suspected acute maxillary sinusitis primarily want the physician to aim at making a specific diagnosis. Physicians feel they are forced to prescribe too many antibiotics for sinusitis because of patient's expectations and lack of good diagnostic means for acute maxillary sinusitis. Better diagnostic tools, both national and local guidelines, and patient information might help to change practice towards the use of fewer antibiotics.     

The diagnosis and management of acute and chronic sinusitis

Both acute and chronic sinusitis are common diseases associated with significant morbidity and consumption of health care dollars. Acute sinusitis is caused by an infectious process and can often be difficult to distinguish from a viral upper respiratory infection, as signs, symptoms, and even the results of most diagnostic tests overlap. In contrast, chronic sinusitis is an inflammatory disease and, contrary to common practice, long term antibiotics are likely not useful. This article reviews the diagnosis and management of both acute and chronic sinusitis and includes discussion of the prevalence of disease, our current understanding of disease pathogenesis, diagnosis, and contemporary treatment.     

Comparative study of cefuroxime axetil and amoxycillin in the treatment of acute sinusitis in general practice

Cefuroxime axetil was compared with amoxycillin in the treatment of acute and acute on chronic sinusitis in a multicentre general practice study. A total of 160 patients were randomized to receive 250 mg cefuroxime axetil orally twice daily, or 250 mg amoxycillin orally three times daily for 10 days. Of the 45 assessable patients with acute sinusitis 43 (96%) were cured or improved using cefuroxime axetil compared with 49 (94%) of the assessable patients in the amoxycillin-treated group. In patients with acute on chronic sinusitis, cefuroxime axetil resulted in an 80% (16/20) cure or improvement, with a 68% (13/19) response in the case of amoxycillin. Adverse events were mainly gastro-intestinal and none was considered serious in either treatment group, although three patients receiving cefuroxime axetil were withdrawn from treatment. It is concluded that cefuroxime axetil is at least as clinically efficacious as amoxycillin in the treatment of acute sinusitis in adults.     

Managing sinusitis in children

Because of the prevalence of upper respiratory tract infections (URIs), sinusitis is a condition commonly encountered in the pediatric population. Some 5% to 10% of children with URIs also have sinusitis. A thorough clinical evaluation enables the health care provider to accurately diagnose sinusitis in children without overuse of computed tomography scans or antibiotics. This article discusses the diagnosis and treatment of acute sinusitis in children.     

鼻内镜手术治疗真菌性鼻-鼻窦炎的围术期护理

目的探讨鼻内镜手术治疗真菌性鼻-鼻窦炎围术期的护理方法。方法选择行鼻内镜手术治疗的96例真菌性鼻-鼻窦炎患者,不同类型的鼻窦炎患者采取个性化的护理措施,总结护理方法。结果96例真菌性鼻-鼻窦炎患者中,真菌球型鼻-鼻窦炎76例,变态反应真菌性鼻-鼻窦炎12例,急性暴发性真菌性鼻-鼻窦炎2例,慢性侵袭性真菌性鼻-鼻窦炎6例,所有患者随访1～8年,无一例出现护理并发症。结论对于不同类型的真菌性鼻-鼻窦炎,需根据患者的具体情况做好围术期护理,以减少术后并发症及复发的可能。     

Bacteriological findings in nasopharynx specimens from patients with a clinical diagnosis of acute sinusitis

OBJECTIVE: To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. DESIGN: Prospective study. SETTING: Patients from general practice in Vestfold county, Norway. PATIENTS: 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. MAIN OUTCOME MEASURES: Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. RESULTS: In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty-five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. CONCLUSION: Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group.     

Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports

Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.     

Brodimoprim versus amoxicillin in the treatment of acute sinusitis.

A new dihydrofolate inhibitor, brodimoprim, was compared with amoxicillin in the treatment of acute sinusitis in a general practice controlled study. Eighty adult outpatients with acute sinusitis were randomly assigned to receive 200 mg of brodimoprim once daily or 750 mg of amoxicillin thrice daily for seven to 10 days. The mean duration of treatment was 9.2 days in the brodimoprim group and 9.1 days in the amoxicillin group. In most patients the symptoms of sinusitis had disappeared by day 5 of treatment. The reduction in symptom scores was more marked in the brodimoprim-treated patients than in the amoxicillin-treated patients. Bacteriologic examinations after treatment were performed in 20 patients of each treatment group. At completion of treatment, the causative pathogen had been eradicated in 14 of 20 patients treated with brodimoprim and in 12 of 20 patients treated with amoxicillin. Treatment side effects were reported by two brodimoprim-treated patients (skin reactions) and by six amoxicillin-treated patients (gastrointestinal distrubances or skin reactions). The results indicate that brodimoprim is safe and effective in the treatment of acute sinusitis in adults.     

Comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of acute bacterial sinusitis.

This double-masked, multicenter, randomized clinical trial compared the efficacy and tolerability of cefuroxime axetil and amoxicillin/clavulanate in the treatment of acute bacterial maxillary sinusitis. A total of 263 patients with acute bacterial maxillary sinusitis were randomly assigned to receive 10 days of treatment with either cefuroxime axetil 250 mg twice daily (n = 132) or amoxicillin/clavulanate 500/125 mg 3 times daily (n = 131). Patients' responses to treatment were assessed once during treatment (6 to 8 days after the start of treatment), at the end of treatment (1 to 3 days posttreatment), and at follow-up (26 to 30 days after cessation of treatment). Clinical success, defined as cure or improvement, was equivalent in the cefuroxime axetil and amoxicillin/ clavulanate groups at the end-of-treatment and follow-up assessments. Patients in both groups showed improvements in symptoms of acute sinusitis at the during-treatment visit. Treatment with amoxicillin/clavulanate was associated with a significantly higher incidence of drug-related adverse events than treatment with cefuroxime axetil (29% vs 17%), primarily reflecting a higher incidence of gastrointestinal adverse events (23% vs 11%), particularly diarrhea. Two patients in the cefuroxime axetil group and 8 patients in the amoxicillin/clavulanate group withdrew from the study due to adverse events (P = 0.06). These results indicate that cefuroxime axetil 250 mg twice daily is as effective as amoxicillin/clavulanate 500 mg 3 times daily in the treatment of acute sinusitis and produces fewer gastrointestinal adverse events. cefuroxime axetil, amoxicillin/clavulanate, acute sinusitis.     

Bacterial colonization or infection in chronic sinusitis

The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.     

Macrolide immunomodulatory effects and symptom resolution in acute exacerbation of chronic bronchitis and acute maxillary sinusitis: a focus on clarithromycin

Bacterial respiratory tract infections are common in the primary care setting and patients often seek the assistance of a healthcare professional in order to achieve resolution of their symptoms. Antibiotic agents that offer rapid symptom relief, in addition to excellent bacteriological and clinical cure, are highly desired. Macrolides have proven to be highly effective in treating acute bacterial exacerbations of chronic bronchitis and acute maxillary sinusitis. In addition, immunomodulatory effects that may contribute to symptom resolution have been reported. This article reviews current literature on symptom resolution in acute bacterial exacerbations of chronic bronchitis and acute maxillary sinusitis, with a focus on clarithromycin, and explores the potential mechanisms that may contribute to this action.     

Upper respiratory tract infections

Upper respiratory tract infections are among the most common acute infections in humans. This review discusses the clinically important aspects of the epidemiology, etiology, clinical presentation, diagnosis, management, complications, and prevention of the common cold, pharyngitis, otitis media, and sinusitis. Most episodes of the common cold and pharyngitis are of viral origin, and curative therapy is not available. Streptococcal pharyngitis, acute otitis media, and sinusitis are secondary to bacterial infections, and antibiotic therapy is important.     

儿童急性孤立性蝶窦炎临床分析

目的 探讨儿童急性孤立性蝶窦炎的临床表现、危险因素、诊断、并发症及治疗.方法 回顾性分析儿童急性孤立性蝶窦炎的病例,所有的病例均行鼻内镜检查和/或CT平扫检查确诊,并与英文文献中的儿童急性孤立性蝶窦炎的病例相比较.重点阐述儿童急性孤立性蝶窦炎的临床表现、相关危险因素、诊断方法、并发症与治疗手段.结果 根据临床表现患者可分为两组:严重性急性蝶窦炎组和非严重性急性蝶窦炎组.严重性急性蝶窦炎组以发热、头痛及高发生率的神经系统症状为特征,游泳及潜水为其可能的危险因素.非严重性急性蝶窦炎组以头痛为主要临床表现,过敏性鼻炎为其危险因素.结论 儿童急性孤立性蝶窦炎的诊断较为困难,相关的文献报道也较少.儿科及耳鼻喉科医生应高度重视其潜在的、严重的并发症.     

Bacteriological findings in nasopharynx specimens from patients with a clinical diagnosis of acute sinusitis

Objective - To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. Design - Prospective study. Setting - Patients from general practice in Vestfold county, Norway. Patients - 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. Main outcome measures - Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. Results - In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. Conclusion - Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group.     

Predictors of duration of acute sinusitis episodes treated with antibiotics

Objective - To evaluate which factors present at the onset of acute sinusitis predict the duration of illness among adult patients treated with antibiotics. Design - Cohort study with a 30-day follow-up. Setting - Norwegian general practice. Subjects - Eighty-six adult patients with a clinical diagnosis of acute sinusitis confirmed by Computed Tomography. Methods - Signs, symptoms and other variables present at the onset of treatment were dichotomized and analysed bivariately with duration of the sinusitis episode, using the log-rank test. Age, gender, and factors with p-values under 0.15 were modelled in a Cox regression analysis to assess independent predictors for illness duration. Main outcome measure - Duration of illness. Results - Illness duration was significantly and positively associated with increasing age and with a higher clinical severity score at the onset of treatment. No other factors were independent predictors of illness duration. Conclusion - The age of the patient and the clinical severity of the sinusitis at the onset of treatment were independent predictors of illness duration in adult patients treated with antibiotics.