Treatment of chronic rhinosinusitis using erythromycin phonophoresis

Bacterial biofilms have been implicated in many chronic infective diseases, including chronic rhinosinusitis (CRS). Therapeutic ultrasound enhances the breakdown of bacterial biofilms and is clinically effective in CRS treatment, while phonophoresis has also been utilized for antibiotic delivery through the skin. The objective of this case report is to describe the results of a novel treatment, erythromycin phonophoresis, in a woman with CRS. A 31-year-old woman with a 7-month history of CRS refractory to conventional medical management was treated with erythromycin phonophoresis to both maxillary sinuses. Individual sinus symptom severity was assessed and sinus CT scans were obtained both pretreatment and posttreatment. After treatment, the total sinusitis symptom score improved from 12 to 0 and the CT scan showed almost complete disease resolution. At 5-month follow-up, the patient reported sustained improvement. Erythromycin phonophoresis has potential as an effective treatment for CRS.     

A preliminary study into the effect of low-intensity pulsed ultrasound on chronic maxillary and frontal sinusitis

Sinusitis is a very common acute or chronic illness that affects a significant percentage of individuals. Recently, therapeutic ultrasound was reported as a treatment for chronic sinusitis. The purpose of this study was twofold: 1) to evaluate the effectiveness of low-intensity pulsed ultrasound (US) in chronic sinusitis using a pretest-posttest research design and 2) to determine the level of association between the independent variables of initial presence of symptoms, age, gender, and duration of disease and the dependent variable of improvement of symptoms. Patients with chronic sinusitis were treated with low-intensity pulsed US, 3 days per week for 15 sessions. Fifty-seven patients (18 females and 39 males; mean age, 35 years) were included in the study. The results of the McNemar test showed a significant change in proportions of post nasal drip and nasal obstruction, two common leading symptoms of patients with chronic sinusitis (p < 0.001). Most of the major and minor symptoms showed significant changes after US therapy (p < 0.05). The total improvement of symptoms was 81.3%. The greatest improvement in symptoms was observed in nasal discharge (100%), followed by facial pain (95.4%) and postnasal drip (82.7%), three major factors in sinusitis. There was a significant, low association between the initial presence of symptoms and the improvement of symptoms after US therapy (chi(2) = 30.352; df = 12; p = 0.002; phi value = 0.356). A significant, low association was also noted between the age and the improvement of symptoms after intervention (chi(2) = 17.548; df = 6; p = 0.007; phi value = 0.270). It may be concluded that low-intensity pulsed US has a significant effect on chronic sinusitis and improves patient symptoms in our study group.     

Comparison of B-mode ultrasound and computed tomography in the diagnosis of maxillary sinusitis in mechanically ventilated patients.

OBJECTIVE: To compare B-mode ultrasound with sinus computed tomograph (CT) scan in the diagnosis of sinusitis in intubated patients undergoing mechanical ventilation. DESIGN: Prospective, clinical investigation. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Fifty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of paranasal sinusitis with purulent nasal discharge. INTERVENTIONS: One hundred paranasal sinuses were examined. A paranasal CT scan and a B-mode ultrasound were performed the same day. Radiologic maxillary sinusitis (RMS) was defined as complete opacification of the sinus or as the presence of an air-fluid level. Absence of RMS was defined as normal sinus or as the presence of mucosal thickening. Important RMS was defined by total opacity or air-fluid level larger than half of the sinus area. Moderate RMS was defined by air-fluid level inferior than half of the sinus area. For ultrasonographic procedure, the image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: 1) a moderate lesion was defined as the visualization only of the hyperechogenic posterior wall of the sinus; 2) an important lesion was defined as the hyperechogenic visualization of posterior wall and the extension by the internal wall of the sinus outlining the hypoechogenic sinus cavity. MEASUREMENTS AND MAIN RESULTS: Sensibility, specificity, positive predictive value, and negative predictive value of B-mode ultrasound compared with CT were, respectively: 100% (95% confidence intervals [95% CI] = 94.9-100.0), 96.7% (95% CI = 82.8-99.9), 98.6% (95% CI = 92.4-99.9), and 100% (95% CI = 88.1-100). The concordance between a moderate B-mode ultrasound lesion and a moderate RMS on CT, and between an important B-mode ultrasound lesion and an important RMS on CT, assessed using kappa statistics was 93%. The concordance between B-mode ultrasound's results and CT's results assessed using weighted kappa statistics was 97%. CONCLUSION: B-mode ultrasound may be proposed first-line in a ventilated patient with suspicion of maxillary sinusitis.     

A randomized, double-blind clinical trial comparing the effects of continuous and pulsed ultrasound in patients with chronic rhinosinusitis

The objective of the present study was to compare the effects of continuous ultrasound (CUS) with pulsed ultrasound (PUS) in patients with chronic rhinosinusitis (CRS). In this prospective, randomized, double-blind, parallel group study, 40 patients (10 losses) with CRS participated. Patients received either continuous or pulsed (1:9) 1 MHz ultrasound (US) using a US head of 1?cm2 at 1 W/cm2 and 0.5 W/cm2 for the maxillary and frontal sinuses, respectively. Treatment was performed in 10 sessions, 3 days per week, with US given every other day. The primary outcome measure was percent improvement in the Sinusitis Symptom Score. Measurements were taken before and after 10 treatment sessions. The patients were followed up monthly for 2 months. After treatment, both groups improved significantly on the Sinusitis Symptoms Score. Patients who received PUS had significantly decreased total symptom scores compared with patients receiving CUS (mean change 9.8 vs. 5.6, p?=?0.049). The percent improvement in the Sinusitis Symptom Score between the PUS group (65.2 SD 23.1) and the CUS group (43.9 SD 40.7) was not statistically significant (p?=?0.09). The effect size for each treatment was large; PUS: d?=?3.92 and CUS: d?=?1.93. Symptom improvement in both groups was similar at the 2-month follow-up. These results support the use of therapeutic US for CRS. This pilot study gives only marginal evidence to favor PUS over CUS.     

真菌性鼻窦炎19例诊治体会

目的:通过回顾分析19例真菌性鼻窦炎的临床资料,以提高该病的诊断和治疗水平。方法;对收治的19例真菌性鼻窦炎患者作鼻窦CT检查和鼻内镜检查,并行相应手术治疗。结果:所有病例均为单侧鼻窦发病,其中病变单纯累及上颌窦者12例、单纯累及筛窦者2例、单纯累及蝶窦者1例,有3例同时累及上颌窦和筛窦,有1例同时累及上颌窦、筛窦和蝶窦。有15例(78.9%)窦腔软组织团块影中可见斑点状钙化灶,5例窦腔有不同程度的骨质吸收和破坏。术后随访2年,有3例复发。结论:真菌性鼻窦炎好发于上颌窦,多为单侧鼻窦发病,CT具有较高的诊断价值,手术具有较好的治疗效果。     

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 (η_p² η_p² = 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.     

A randomized,double-blind clinical trial comparing the effects of continuous and pulsed ultrasound in patients with chronic rhinosinusitis

The objective of the present study was to compare the effects of continuous ultrasound (CUS) with pulsed ultrasound (PUS) in patients with chronic rhinosinusitis (CRS). In this prospective, randomized, double-blind, parallel group study, 40 patients (10 losses) with CRS participated. Patients received either continuous or pulsed (1:9) 1 MHz ultrasound (US) using a US head of 1?cm² at 1 W/cm² and 0.5 W/cm² for the maxillary and frontal sinuses, respectively. Treatment was performed in 10 sessions, 3 days per week, with US given every other day. The primary outcome measure was percent improvement in the Sinusitis Symptom Score. Measurements were taken before and after 10 treatment sessions. The patients were followed up monthly for 2 months. After treatment, both groups improved significantly on the Sinusitis Symptoms Score. Patients who received PUS had significantly decreased total symptom scores compared with patients receiving CUS (mean change 9.8 vs. 5.6, p?=?0.049). The percent improvement in the Sinusitis Symptom Score between the PUS group (65.2 SD 23.1) and the CUS group (43.9 SD 40.7) was not statistically significant (p?=?0.09). The effect size for each treatment was large; PUS: d?=?3.92 and CUS: d?=?1.93. Symptom improvement in both groups was similar at the 2-month follow-up. These results support the use of therapeutic US for CRS. This pilot study gives only marginal evidence to favor PUS over CUS.     

霉菌性副鼻窦炎的CT表现

目的探讨霉茵性副鼻窦炎的CT特征和鉴别诊断。方法回顾分析18例经手术病理证实的霉菌性副鼻窦炎的CT表现。结果单侧副鼻窦发病14例，双侧副鼻窦发病4例，病变主要在上颌窦14例，累及同侧筛窦9例、蝶窦3例、额窦3例，病变侵犯后鼻孔4例。霉茵性副鼻窦炎的CT表现主要为：病变窦腔软组织阴影充填呈铸形改变，病灶内出现点状、条状钙化灶，窦腔骨壁增厚使窭腔缩小。结论霉菌性副鼻窦炎的CT表现具有窦腔缩小，窦腔密度不均增高及点状，条状钙化等特征，CT可作出正确诊断。     

鼻用激素联合克拉霉素治疗慢性鼻-鼻窦炎疗效观察

目的探讨鼻用激素和克拉霉素联合用药对慢性鼻-鼻窦炎(CRS)的治疗效果。方法将130例CRS患者随机分成3组,即布地奈德鼻喷雾剂组(42例)、克拉霉素组(45例)和布地奈德鼻喷雾剂联合克拉霉素组(43例),疗程均为12周,治疗前后采用主观症状自评治疗效果及Lund-Mackey鼻窦CT评分。结果布地奈德鼻喷雾剂联合克拉霉素组自评得分[(2.39±0.58)分]显著低于布地奈德鼻喷雾剂组[(3.98±1.57)分]和克拉霉素组[(4.12±1.35)分],差异有统计学意义(P<0.05),Lund-Mackey鼻窦CT评分布地奈德鼻喷雾剂联合克拉霉素组[(2.61±0.91)分]显著低于布地奈德鼻喷雾剂组[(4.33±1.05)分]和克拉霉素组[(4.37±0.92)分],差异有统计学意义(P<0.05)。结论布地奈德鼻喷雾剂和克拉霉素联合用药治疗CRS临床疗效较好。     

慢性鼻窦炎的成因探讨

目的：探讨慢性鼻窦炎的成因。方法：分析80例慢性鼻窦炎患者的病史、体征、CT表现及手术中所见。结果：慢性鼻窦炎患者中伴有过敏性鼻炎者占40％，窦口鼻道复合体（ostimeatal complex，OMC）阻塞者占55％，鼻中隔偏曲者占67％，上呼吸道感染者占20％，复发性鼻息肉者占13％。结论：慢性鼻窦炎的发病是由变态反应、OMC阻塞、鼻中隔偏曲、感染等诸因素共同作用的结果。     

功能性鼻内镜鼻窦术后纳吸棉填塞止血对患者舒适度和术腔恢复效果的影响

目的:探讨功能性鼻内镜鼻窦术(functional endoscopic sinus surgery,FESS)后纳吸棉填塞止血对患者舒适度和术腔恢复效果的影响。方法:前瞻性选取2017年7月至2020年5月期间在皖北煤电集团总医院耳鼻咽喉科接受FESS的90例慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者,采用随机数表法分为纳吸棉组(n=45)和明胶海绵组(n=45);纳吸棉组FESS术后采用纳吸棉填塞术腔止血,明胶海绵组采用明胶海绵填塞术腔止血,术后随访3个月。观察两组止血和鼻腔症状缓解情况,采用视觉模拟疼痛量表(Visual Analogue Scale,VAS)评分评估患者舒适度,利用鼻内镜检查Lund-Kennedy评分和测量鼻腔气道阻力观察术腔恢复效果。结果:两组均充分止血,术腔术后未出现活动性出血,纳吸棉组术后4周鼻阻塞、鼻痛症状程度明显轻于明胶海绵组(P<0.05);纳吸棉组术后2、4周VAS评分显著低于明胶海绵组,术后4周、3个月鼻内镜Lund-Kennedy评分均低于明胶海绵组,差异均有统计学意义(P<0.05);纳吸棉组术后第1次鼻腔气道阻力显著低于明胶海绵组(P<0.05)。结论:纳吸棉是CRS患者FESS术后理想的鼻腔填塞止血材料,在缓解术腔相关症状、减轻疼痛、促进术腔恢复和改善鼻腔通气方面效果显著。     

鼻内镜下真菌性上颌窦炎的术式选择及疗效评估

目的鼻内镜下采用3种不同入路手术治疗真菌性上颌窦炎并对其临床疗效进行观察,为临床个体化治疗真菌性上颌窦炎提供参考。方法以该院2016年1月-2017年12月收治的84例非侵袭性真菌性上颌窦炎的手术患者作为研究对象,术前常规行鼻内镜检查和鼻窦CT检查,根据病变的部位范围选择手术方式,将患者分为3组:A组30例,行鼻腔外侧壁保留黏膜瓣的下鼻道入路;B组20例,行上颌窦自然口入路手术;C组34例,行联合入路手术。结果 84例患者均治愈,血涕、面部胀痛、头痛或鼻腔异味症状逐步消失,鼻内镜复查见术腔愈合好,上皮化良好,各鼻道无异常分泌物,术腔病变无残留,无鼻腔粘连、前鼻孔狭窄、鼻泪管损伤或其他并发症。术后6个月复查鼻窦CT无病变残留,下鼻道黏膜瓣愈合良好。结论术前根据病变部位及范围选择手术方式个体化治疗真菌性上颌窦炎,能充分暴露上颌窦窦腔,有效清除病变,避免损伤鼻腔鼻窦的正常结构,达到既微创又能彻底清除病灶的目的。     

慢性鼻-鼻窦炎患者血清特异性IgE检测的临床意义分析

目的观察和分析慢性鼻-鼻窦炎（CRS）患者血清特异性IgE（sIgE）检测的临床意义。方法选取120例CRS患者作为研究对象,对所有纳入患者的血清sIgE和总IgE（tIgE）进行半定量检测,根据sIgE检测结果将纳入患者分为sIgE阳性组和sIgE阴性组,根据tIgE检测结果将纳入患者分为tIgE阳性组和tIgE阴性组。对各组患者的伴发鼻息肉情况、合并哮喘情况、鼻内镜Lund评分、鼻窦Lund-Mackay CT评分进行观察和比较。结果纳入患者中的tIgE阳性例数为62例,阳性率为51.67%,sIgE阳性例数为18例,阳性率为15%;tIgE阳性组患者与tIgE阴性组患者的各项临床表现的差异均无显著性（P〉0.05）,sIgE阳性组患者的合并哮喘比例和内镜评分均显著高于sIgE阴性组（P〈0.05）,两组患者的伴息肉情况和CT评分的差异无显著性（P〉0.05）。结论 CRS患者的变应反应程度较高,致敏变应原以室内吸入性变应原为主,多为混合性致敏,血清sIgE检测有助于明确诱发CRS的变应原种类,并可用于辅助预测患者的鼻粘膜病变程度和预后情况。     

慢性上颌窦炎影响因素的CT分析

目的探讨窦口鼻道复合体病变及解剖变异与慢性上颌窦炎的关系.方法对CT诊断的52例单侧慢性上颌窦炎进行两侧对比分析.结果患侧与健侧筛泡截面分别为(77.75±33.51) mm2和(34±20.27) mm2(P<0.01).两侧分别有19个及10个大筛泡.患侧伴有32组筛窦炎,对侧21组.鼻息肉11例,单发于上颌窦炎侧9例,对侧仅1例,双侧1例.结论大筛泡、前中组筛窦炎症、鼻息肉与慢性上颌窦炎有关.     

慢性鼻-鼻窦炎患者的主观症状调查及护理对策

目的调查慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者的主观症状,为制定针对性的护理干预措施提供依据。方法采用问卷调查法对2007年8月至2008年12月在金华市中心医院住院治疗的90例CRS患者的主观症状及严重程度进行调查。结果 CRS患者的主观症状主要有鼻塞、流涕、头痛及嗅觉减退等,但症状的性质及程度各有不同;而CRS患者在抗生素使用过程中存在盲目性和不规范性。结论为提高CRS患者的生存质量,须重视对CRS患者主观症状及性质的评估,并根据患者的实际情况给予针对性的健康宣教和有效的护理干预措施。     

Transnasal puncture based on echographic sinusitis evidence in mechanically ventilated patients with suspicion of nosocomial maxillary sinusitis

Objective The aim of this prospective study was to evaluate the value of sinus echography results to directly indicate a transnasal puncture in intubated patients with suspicion of nosocomial maxillary sinusitis.Design prospective clinical investigation.Setting medical intensive care unit.Patients sixty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of maxillary sinusitis with purulent nasal discharge.Interventions 120 sinuses were examined by sinus ultrasound. The image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: (1) a partial sinusogram was defined as the visualization of the hyperechogenic posterior wall of the sinus; and (2) a complete sinusogram was defined as the hyperechogenic visualization of posterior wall and the extension by the internal and external walls of the sinus. When sinus ultrasound was positive, a transnasal puncture was performed the same day. The transnasal puncture was positive if a fluid was obtained from sinus aspiration. The transnasal puncture was negative if there was no aspirated material. Measurements and results sinus ultrasound was positive in 84 cases (54 complete sinusograms and 30 partial sinusograms). Seventy-eight of 84 transnasal punctures were positive. Sensitivity of a sinusogram for obtaining positive transnasal puncture was 100%, and specificity was 86% (100% in case of complete sinusogram) in a clinically selected population. The only six negative transnasal punctures were performed in patients with partial sinusogram. Conclusions Ultrasound sinusitis evidence seems to be of value to indicate and perform a transnasal puncture directly, avoiding CT exam.     

Anti-inflammatory activity of clarithromycin in adults with chronically inflamed sinus mucosa

In a phase IV, open-label study, 25 patients with clinically stable chronic sinusitis and persistent maxillary sinus inflammation were treated for 14 days with clarithromycin 500 mg twice daily. Biopsy specimens of the maxillary sinus mucosa were obtained pretreatment and evaluated for macrophages (CD68), eosinophils (MBP), elastase, interleukin-6 (IL-6), IL-8, tumor necrosis factoralpha (TNF-α), and activity of eosinophils (EG2), as well as edema score. Clinical signs and symptoms were assessed pretreatment, at the end of treatment, and 1 and 2 weeks later. Statistically significant reductions (P≤.05) from pretreatment were observed for all markers of sinus mucosal inflammation, including CD68, EG2, elastase, IL-6, IL-8, TNF-α, and edema score, with a trend to decreased total eosinophil count. Improvement was observed for all clinical signs and symptoms of chronic sinusitis—sinus pain, sinus headache, nasal congestion, nasal discharge, and mucopurulent discharge—up to 14 days after the end of treatment. Cultures to evaluate persistent infection withChlamydia pneumoniae showed negative results. Significant reductions in various markers of sinus mucosal inflammation support the role of clarithromycin in modulating immunologic responses. Improvement of clinical signs and symptoms in patients with chronic inflammatory sinusitis not meeting criteria for known or presumed bacterial infection was also noted up to 2 weeks after completion of a 14-day course of clarithromycin.     

Four-cut sinus computed tomographic scanning in screening for sinus disease

OBJECTIVE: We sought to calculate the sensitivity, specificity, negative predictive value, and positive predictive value of a limited sinus computed tomographic (CT) scan for sinus disease. METHODS: We conducted a retrospective case series. Inclusion criteria included a sinus CT scan obtained between April 1999 and November 2000. From the complete sinus CT scan, the limited series were obtained by blocking from view all the other cuts and leaving the radiologist only four slices to read (midfrontal, anterior maxillary sinuses, posterior maxillary sinuses, and midsphenoidal). The complete CT scan was the "gold standard." RESULTS: Fifty-one patients were eligible. We observed 81.3% sensitivity, 89.5% specificity, a 73.9% negative predictive value, and a 92.9% positive predictive value for the limited CT scan for the detection of sinus disease. This sensitivity and specificity were higher than reported in the literature for plain films. CONCLUSION: The limited sinus CT scan is superior to plain radiographs but is not as good as the full CT scan in the evaluation of sinusitis.     

鼻内镜下上颌窦窦口开放联合下鼻道开窗入路手术治疗真菌性鼻窦炎的有效性和安全性

目的探讨鼻内镜下上颌窦窦口开放联合下鼻道开窗入路手术治疗真菌性鼻窦炎的有效性和安全性。方法选取2013年9月至2018年8月于我院行手术治疗的真菌性鼻窦炎患者146例,依患者意愿分为对照组(n=69)和研究组(n=77),分别行鼻内镜下上颌窦窦口开放术和鼻内镜下上颌窦窦口开放联合下鼻道开窗入路术治疗,随访3个月。比较两组手术前及随访结束后的鼻内镜评分、生存质量、术后并发症发生情况。结果随访结束后,两组患者的鼻内镜评分和生存质量评分均明显低于手术前,且研究组低于对照组(P<0.05)。两组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论鼻内镜下上颌窦窦口开放联合下鼻道开窗入路术治疗真菌性鼻窦炎可改善患者的临床症状,提高其生存质量,且并发症少。     

Sinus Headaches Reconsidered: Referred Cephalgia of Rhinologic Origin Masquerading as Refractory Primary Headaches

Headache associated with acute sinusitis is a well-recognized entity; the diagnosis is easily made due to the associated nasal and sinus symptoms. However, the phenomenon of referred headache from chronic sinusitis or intranasal abnormalities or both without upper respiratory symptoms is not well understood. Only recently have the nasal and sinus cavities been adequately visualized by both the human eye and radiographic techniques; a fact that may account for the historic neglect in considering this region a factor in headache etiology. Modern techniques employed in the workup of sinusitis, namely the use of rigid nasal endoscopes and coronal-plane CT scanning, have greatly enhanced the clinician's ability to evaluate and diagnose pathology in this area. This report describes a series of patients presenting with various primary headache syndromes without significant nasal or sinus symptoms who failed to respond to conventional antiheadache therapy. On nasal endoscopic and coronal CT examinations, various intranasal and sinus abnormalities were found (either anatomic variations or subclinical inflammation). Medical and/or surgical therapy addressing the sinonasal pathology resulted in improvement in every case, ranging from decreased severity of attacks to total resolution of headaches. A model explaining the possible mechanism of referred vascular-type headache from sinus and nasal origin is proposed.