Clinical presentation of acute rhinosinusitis in children reflects paranasal sinus development

BACKGROUND: Acute rhinosinusitis (ARS) usually presents with respiratory symptoms that persist for more than 10 days without improving. The aim of the study was to establish whether age may have any influence on the clinical presentation during childhood. METHODS: This prospective study evaluated 287 consecutive children (152 males and 135 females, aged between 2 and 15 years), in whom mild-moderate ARS was clinically suspected. Nasal endoscopy was performed in all of them to confirm the diagnosis. RESULTS: Endoscopy confirmed clinical diagnosis of ARS in 256 patients (89.2%). The age has shown to have significant influence on the clinical presentation pattern. CONCLUSIONS: This study provides evidence that age significantly influences the clinical presentation in children with mild-moderate ARS.     

鼻鼻窦解剖变异与慢性鼻窦炎的关系

目的量化研究鼻鼻窦解剖变异与慢性鼻窦炎的发病的关系。方法用自行开发的计算机图像分析系统定量分析９１例慢性鼻窦炎患者的冠状位鼻窦ＣＴ，观测指标包括：骨性解剖结构变异（包括中鼻甲气化、反常曲线中鼻甲、Ｈａｌｅｒ气房、鼻中隔偏曲、上颌窦发育不良、鼻丘气房、钩突气化）、筛漏斗、钩突角度、筛泡等，测量相应结构的冠状位截面积、角度、长度。应用统计软件ＳＰＳＳ进行统计。结果全中甲或中甲下部气化的发生率随前筛、上颌窦内软组织影增厚而升高；有额窦炎组病人的鼻丘气房最大纵向垂径明显大于无额窦炎组（分别为１１．７±５．５ｍｍ和８．５±３．７ｍｍ，Ｐ＜０．０１）；Ｈａｌｅｒ气房在上颌窦炎组和非上颌窦炎组的发生率无显著差异，但前组发生炎症的Ｈａｌｅｒ气房明显多于后组（分别为７７．８％和３３．３％，Ｐ＜０．０５），且前组Ｈａｌｅｒ气房的冠状位截面积明显大于后组（分别为９１．６±１７．８ｍｍ２和４１．６±１２．６ｍｍ２，Ｐ＜０．０５）；钩突角度随上颌窦内软组织增厚而减小；筛泡冠状位截面积随前筛窦内软组织增厚而增大（Ｐ＜０．０１）。结论某些鼻、鼻窦解剖变异与慢性鼻窦炎的发病相关。     

The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children

CONCLUSIONS: Anatomical variations in the nose and paranasal sinuses are common in children. Due to the absence of a definitive relationship between anatomical variations and sinus disease, local, systemic or environmental factors appear to be more significant in pediatric sinusitis than the anatomic variations. OBJECTIVE: Chronic sinusitis is increasing in the pediatric population. Following the initial reports of functional endoscopic sinus surgery (FESS) for children, the majority of patients undergoing this procedure have experienced improved quality of life. Thus, we need to know the precise anatomy and anatomical variations of the nose, as well as the relationship between such anatomy and chronic sinusitis. PATIENTS AND METHODS: To determine the extent and distribution of disease, as well as associated anatomic abnormalities, computed tomography (CT) scans were performed on 113 children with persistent symptoms of sinusitis after failure of medical therapies. RESULTS: The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. There was no relationship between age and severity of sinusitis. Agger nasi cell was the most common anatomical variation, followed by septal deviation, Haller cell, concha bullosa, paradoxical middle turbinate, and Onodi cell. The prevalence of septal deviation increased with age. There was no significant relationship between the sinusitis and anatomic variations.     

The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children

Conclusions. Anatomical variations in the nose and paranasal sinuses are common in children. Due to the absence of a definitive relationship between anatomical variations and sinus disease, local, systemic or environmental factors appear to be more significant in pediatric sinusitis than the anatomic variations. Objective. Chronic sinusitis is increasing in the pediatric population. Following the initial reports of functional endoscopic sinus surgery (FESS) for children, the majority of patients undergoing this procedure have experienced improved quality of life. Thus, we need to know the precise anatomy and anatomical variations of the nose, as well as the relationship between such anatomy and chronic sinusitis. Patients and methods. To determine the extent and distribution of disease, as well as associated anatomic abnormalities, computed tomography (CT) scans were performed on 113 children with persistent symptoms of sinusitis after failure of medical therapies. Results. The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. There was no relationship between age and severity of sinusitis. Agger nasi cell was the most common anatomical variation, followed by septal deviation, Haller cell, concha bullosa, paradoxical middle turbinate, and Onodi cell. The prevalence of septal deviation increased with age. There was no significant relationship between the sinusitis and anatomic variations.     

Nasal cavity and paranasal sinus bony variations: a computed tomographic study

Variations of the nasal cavity are very important for the otolaryngologist in functional endoscopic sinus surgery. To provide data on bony variations of this region, we performed high resolution computed tomography images of paranasal sinuses on 82 adult patients without sinus pathology and on 90 adult patients with sinus disease. We observed paradoxical curvature of the middle concha in 11 (12.22%) sinus patients and 6 (7.31%) in non-sinus patients. Concha bullosa was observed in 26 sinus patients (28.88%) and 22 (26.83%) in non-sinus patients, deviated nasal septum in 20 (22.22%) sinus and 10 (12%) non-sinus, Haller's cell in 5 (5.55%) sinus and in 3 (3.65%) non-sinus, agger nasi cell in 7 (7.77%) sinus and 4 (4.88%) non-sinus patients. Pneumatisation of cristae galli was observed in 8 (8.88%) sinus and 2 (2.44%) non-sinus, of the anterior clinoid process in 5 (5.55%) sinus and 1 (1.22%) non-sinus patients, pneumatisation of the nasal septum in 7 (7.77%) and of the pterygoid recess in 12 (13.33%) sinus patients. We did not find any correlation between age intervals and paranasal sinus variations, and also no statistically significant difference was observed between males and females. These data provide very important information to guide the otolaryngologist and/or radiologist in the evaluation of patients with coronal CT which guides functional endoscopic sinus surgery.     

鼻鼻窦解剖变异与慢性鼻窦炎的关系

量化研究鼻鼻窦解剖变异与慢性鼻炎的发病的关系。用自行开发计算机图像分析系统定量分析９１例慢性鼻窦炎患者的冠状位鼻窦ＣＴ，观测指标包括：骨性解剖结构变异，筛漏钹突角度，筛泡等，测量相应结构的冠状位截面积，角度，长度。     

鼻窦炎患者鼻窦骨结构变异和鼻窦粘膜异常的CT扫描分析

对109例临床疑为鼻窦炎患者的CT冠状扫描结果进行了分析,鼻窦粘膜异常改变者93例(85.3％),16例粘膜呈正常影像(14.7％),93例鼻窦粘膜异常改变者中,发现鼻窦骨结构变异60例(64.5％)。通过对鼻窦骨结构变异和鼻窦炎情况的观察分析,认为鼻窦骨结构变异可能是鼻窦炎致病因素之一。鼻窦粘膜异常以前组筛窦和上颌窦发生率最高,同时伴有窦口鼻道复合体粘膜异常,支持了鼻窦口引流障碍可以继发鼻窦炎的观点。作者认为采用鼻窦CT冠状扫描对判断鼻窦炎的病因和临床诊断具有重要意义。     

Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery

Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the “background” prevalence of these findings are needed to determine their clinical relevance. A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbi-nate, Haller's cells, and pneumatization of the unci-nate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons. Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus-like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region. Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus CT scans.     

Superior turbinate pneumatization in patients with chronic rhinosinusitis: prevalence on paranasal sinus CT

With the availability of high-resolution computed tomography (CT), a great deal of attention has been paid to the anatomy of the paranasal sinuses. But while investigators have focused on the osteomeatal complex and its relation to chronic rhinosinusitis, there has been little discussion of the superior turbinate. Although a few anatomic studies have tried to quantify pneumatization of the superior turbinate, the prevalence of this finding on radiography is not well addressed in the literature. We prospectively studied 100 consecutively presenting patients who underwent coronal CT of the paranasal sinuses (200 sides) for the evaluation of symptoms of chronic rhinosinusitis at an academic tertiary referral center to determine the prevalence of pneumatization of the superior turbinate. We found evidence of pneumatization in 44 of the 200 sides, for a prevalence of 22%. In all, pneumatized superior turbinates were found in 27 patients (27%)-bilaterally in 17 (17%) and unilaterally in 10 (10%).     

Evaluation of ultrastructural changes in paranasal sinus mucosa after functional endoscopic sinus surgery in patients with chronic rhinosinusitis

The purpose of this study was to compare the preoperative and postoperative ultrastructural changes of paranasal sinus mucosa in patients treated with functional endoscopic sinus surgery for chronic rhinosinusitis. Twelve patients undergoing functional endoscopic sinus surgery for the treatment of chronic rhinosinusitis were involved. The ethmoid sinus mucosa was sampled during the operation and approximately 6 months after the operation. The ciliated epithelium of sinus mucosa was evaluated with transmission electron microscopy. The samples were taken at the Otolaryngology Department of Istanbul University School of Medicine. Electron microscopic study was performed at the Histology and Embryology Department of the same University. Preoperatively, ciliated epithelial cells of the sinus mucosa of the patients showed degenerated ultrastructure with decreased number of cilia, cytoplasmic protrusions, cisternal dilatations of endoplasmic reticulum, and mitochondrial swellings. Remnants of degenerated cells and cellular separations at cell junctions were evident in the diseased epithelium. Goblet cells were frequent along the epithelial lining. Postoperatively, normal architecture and ultrastructure of the ciliated epithelium was restored. These observations showed that unlike other surgical operations, paranasal sinus mucosa can regenerate and the ciliated epithelium can return to normal after functional endoscopic sinus surgergy.     

Nasal and paranasal sinus anatomical variations in patients with rhinogenic contact point headache

Objective

To define anatomical variations that may lead to rhinogenic contact point headache.

Methods

Paranasal sinuses CT scan and medical records of sixty-five patients who underwent a successful endoscopic surgery for rhinogenic contact point headache reviewed.

Results

Eleven distinct anatomical variations were found in patients with rhinogenic contact point headache. All of them were surgically curable.

Conclusion

There are multiple anatomical situations that may lead to rhinogenic contact point headache and each one has its own characteristics. Treatment plan should be personalized for every patient considering the diagnosed anatomical variation.     

Changes of maxillary sinus volume and bony thickness of the paranasal sinuses in longstanding pediatric chronic rhinosinusitis

OBJECTIVES: To evaluate the chronic bony changes in the paranasal sinuses of longstanding chronic rhinosinusitis (CRS) in pediatric patients and to compare them with normal controls. STUDY DESIGN: A single-institution retrospective analysis. METHOD: Thirty 15- and 16-year-old children with longstanding CRS, for more than 2 years, despite maximal medical treatment and had a Lund CT score over 20 were enrolled as the CRS group. They were compared with 45 age and gender matched randomly selected normal controls without CRS. No enrolled patient had a history of nasal or adenoid surgery. The volume of the maxillary sinus was measured using a three-dimensional CT reconstruction program (V-works 4.0). The bony thickness of the maxillary (MS) and ethmoid sinuses (ES) and the middle turbinate (MT) was measured and compared. In addition, we evaluated the effect of disease duration on the sinus volume and bony thickness. RESULTS: The mean volume of the MS was 22.5+/-4.4 cm(3) in the normal group and 20.0+/-4.1 cm(3) in the CRS group; this difference was statistically significant (p=0.02). However, there was no correlation found between the disease duration and maxillary sinus volume (r=-0.07, p=0.69). The mean thicknesses of the bony walls were 1.0+/-0.4 mm (MS), 0.8+/-0.4 mm (ES) and 1.8+/-0.5 mm (MT) in the normal group and 1.2+/-0.3 mm (MS), 1.2+/-0.4 mm (ES) and 2.4+/-0.5 mm (MT) in the CRS group; these differences were significant (p<0.01). In addition, the bony thickness of the ES was significantly correlated with the duration of symptoms (r=0.44, p=0.03). CONCLUSION: The volume of the maxillary sinuses decreased and the bony thickness of the paranasal sinuses increased with longstanding pediatric CRS.     

Nasal and paranasal sinus schwannomas

Although nearly half of all schwannomas involve the head and neck region, nasal and paranasal sinus presentations are quite rare in the literature. Two of the latter cases are presented in this report. In the first, the tumor originated from the nasal septum and was completely excised under local anesthesia. In the second, the schwannoma arose from the left frontal and anterior ethmoidal sinuses. This lesion was totally removed through a combined endoscopic intranasal and external frontoethmoidectomy approach. The patients have shown no tumor recurrence in 6 years and 18 months of follow-up, respectively. The extreme rarity of nasal and paranasal sinus schwannoma is the basis for discussion of these cases.     

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Haller's cells) in 6%, spheno-ethmoid cells (Onodi's cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.     

慢性鼻鼻窦炎、鼻息肉与鼻部解剖变异的鼻窦冠状位CT研究

目的：探讨慢性鼻鼻窦炎及鼻息肉与鼻部解剖变异的关系。方法：分析411例鼻窦冠状位CT资料,分为正常组（A）、慢性鼻鼻窦炎组(B)、鼻息肉组(C)3组。统计中鼻甲、钩突变异及Haller′s气房、鼻中隔偏曲等在3组的发生率,并应用统计软件SPSS 12.0分析其与慢性鼻鼻窦炎及鼻息肉的关系。结果：中鼻甲气化、反向弯曲及直形中鼻甲在A组的发生率分别为23.39%、8.06%、3.23%; 在B组为38.52%、18.58%、12.84%;C组为37.45%、21.70%、17.02%。A组中鼻甲各解剖变异与B、C两组差异有统计学意义（P＜0.01）。钩突气化、上端分叉及反向弯曲在A组中的发生率为4.03%、4.83%、0.00%;B组中为7.10%、2.73%、2.18%;C组为8.51%、3.83%、7.23%。钩突反向弯曲在A组与C组间、B组与C组间分布差异有统计学意义（P＜0.01）。结论：中鼻甲各解剖变异与慢性鼻鼻窦炎、鼻息肉的发生有关;钩突反向弯曲较易引发鼻息肉;钩突气化、钩突上端分叉、鼻中隔偏曲及Haller′s气房与慢性鼻鼻窦炎、鼻息肉的发生无相关性。     

Analysis of paranasal sinus development and anatomical variations: a CT genetic study in twins

Objective: To determine if anatomical variations in the paranasal sinuses of twins are the result of genetic or environmental influences. Study design: A prospective, observational study. Setting: An academic hospital in Brussels, Belgium. Participants: Twenty‐five volunteer twins (17 identical twins and eight non‐identical twins). Of the identical twins, six were both female and 11 both male. The mean age was 40.6 years (18–49). Of the non‐identical twins, one pair was female and seven were male. The mean age was 39.6 years (25–48). Main outcome measures: The CT‐scan similarity in anatomical structures (frontal cells, agger nasi cells, concha bullosa, infraorbital cells and changes in the shape of the lamina orbitalis), and the intranasal and paranasal sinus morphology was compared between the twins. Results: Among the studied variables, there was no statistically significant difference between the two twin groups (Fisher's exact test, P > 0.05). Regarding combine‐studied parameters, there were no identical CT scans in the twins. However, a tendency of non‐genetic influence existed in the development of frontal cell type III and IV, and infraorbital cells, as well as a liability of genetic influence in the presence of concha bullosa. Conclusion: In this study, the differences in anatomical structure of the paranasal sinuses between identical and non‐identical twin pairs were not statistically significant. This indicates that environmental factors are more significant than genetic ones in the development of anatomical variations in paranasal sinus anatomy.