Paranasal sinusitis associated with nasotracheal and orotracheal long-term intubation.

The impact of nasotracheal and orotracheal long-term intubation on the development of sinusitis paranasalis was investigated in a prospective study. Daily A-scan ultrasound examinations of the maxillary sinuses were performed on 44 intensive care unit patients (20 nasally, 24 orally intubated) who required prolonged intubation (greater than 24 hours). At the end of the investigation period 19 (95%) of 20 nasotracheally and 15 (63%) of 24 orotracheally intubated patients showed pathologic antral sinus findings. In nasally intubated patients the incidence of bilateral sinusitis was significantly higher and its onset sooner. Pathologic organisms were found in the sinus aspirates in seven of 13 nasotracheally intubated patients, but only in two of nine patients with an oral tube. Thus, the nasotracheal tube can be seen as an adding factor in the development of sinusitis paranasalis.     

Clinical characteristics of nosocomial sinusitis

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 +/- 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.     

Bacteriology of sinusitis in human immunodeficiency virus-positive patients: Implications for management

The bacteriology of sinusitis in human immunodeficiency virus (HIV)-infected patients has been only sporadically reported. In this study, we report the results of cultures taken from 12 HIV patients with refractory chronic sinusitis who underwent surgery. Nine of the 12 patients had positive cultures with 16 isolates and 5 patients having multiple isolates. Five of the 12 patients grew out atypical or opportunistic infections not responsive to standard medical therapy, including 3 patients with cytomegalovirus, 1 with Aspergillus fumigatus, and 1 with Mycobacterium kansasii. These results suggest the need for aggressive medical care for HIV-infected patients with sinusitis and early intervention for tissue cultures in patients who do not respond to standard antibiotic regimens.     

Preoperative diagnosis of allergic fungal sinusitis

OBJECTIVES/HYPOTHESIS: Although the diagnosis of allergic fungal sinusitis is mainly based on characteristic histopathological findings, certain preoperative diagnostic criteria have been proposed. However, their usefulness in differentiating allergic fungal sinusitis from other sinus diseases is unknown. The objective of the study was to identify accurate preoperative diagnostic parameters for allergic fungal sinusitis. STUDY DESIGN: Prospective, comparative study. METHODS: Twenty consecutive cases of allergic fungal sinusitis were evaluated prospectively and compared with 16 cases of ethmoidal polyposis and 5 cases of invasive sinus aspergillosis, with regard to various clinical, radiological, and immunological parameters. All patients were categorized based on histopathological findings. RESULTS: Nasal polyps were seen in all 20 cases of allergic fungal sinusitis, all 16 cases of ethmoidal polyposis, and 2 of 5 cases of invasive sinus aspergillosis. Computed tomography (CT) scan hyper-attenuation was seen in all 20 cases of allergic fungal sinusitis but also in 2 (13%) cases of ethmoidal polyposis and 2 (40%) cases of invasive sinus aspergillosis. Serum levels of specific anti-Aspergillus immunoglobulin E were elevated in 14 (70%) cases of allergic fungal sinusitis, 2 (13%) cases of ethmoidal polyposis, and 3 (60%) cases of invasive sinus aspergillosis. The combination of all three (ie, nasal polyps, CT scan hyper-attenuation, and elevated titers of anti-Aspergillus immunoglobulin) was not found in any case of ethmoidal polyposis or invasive sinus aspergillosis. This triad demonstrated a sensitivity of 70% and a specificity of 100% for the preoperative diagnosis of allergic fungal sinusitis. CONCLUSIONS: Nasal polyps, CT scan, and specific immunoglobulin E titers, when considered in combination, have a high preoperative diagnostic value in allergic fungal sinusitis. However, they should not be considered in isolation because considerable overlap occurs with invasive sinus aspergillosis and ethmoidal polyposis.     

兔鼻窦炎模型骨质重塑的CT观察

目的观察不同造模时间兔鼻窦炎模型鼻寞骨质重塑的CT表现及时间相关趋势。方法采用窦口阻塞加细菌接种方法建立兔鼻窦炎模型，按造模时间不同分为2、4、6、8、12周组，每组8只。分别进行鼻窦CT扫描。主要观察指标包括骨质破坏和骨质增生：次要指标包括软组织变化等共6项。结果早期模型主要表现为骨质破坏，6周及以后的模型除骨质破坏，还出现骨质增生。其中，2周和4周组均有6只动物出现骨质破坏；后3组出现骨质破坏和骨质增生动物的数量分别是7、7、6只和3、5、7只。其余指标无明显差异。结论免鼻窦炎模型鼻窦骨质重塑特征在CT主要表现为骨质破坏和骨质增生；早期以骨质破坏为主，6周及以后表现为骨质破坏和骨质增生共存，且随时间延长，骨质增生更为明显。     

Potential role of abnormal ion transport in the pathogenesis of chronic sinusitis

OBJECTIVES: To create well-differentiated cultures of normal and chronic sinusitis paranasal sinus epithelial cells and to compare their electrophysiologic properties. DESIGN: In vitro investigation using primary sinus epithelial cells, initially cultured on plastic tissue culture dishes. Cells were characterized by means of immunocytochemical analysis and then passaged to air-liquid interface culture conditions. The morphologic features of air-liquid interface cultures were assessed using light and electron microscopy. Epithelial Na(+) channel, Na(+)-K(+)-2Cl(-) cotransporter, cystic fibrosis transmembrane conductance regulator, and Ca(2+)-activated Cl(-) channel function were investigated in Ussing chambers. SUBJECTS: Specimens were obtained from 15 patients undergoing transsphenoidal pituitary procedures, tumor removal, or trauma repair and from 9 patients with chronic sinusitis. RESULTS: After culture at an air-liquid interface for 21 days, the epithelium was pseudostratified and contained basal, mucous secretory, and ciliated cells. There were no detectable morphologic differences between normal and chronic sinusitis cells. In cultures of normal cells, median basal short circuit current was 4.7 microA/cm(2), and Na(+) transport, defined as the amiloride hydrochloride-sensitive component, was approximately 20% of the total. Basal and amiloride-sensitive short circuit currents were greater in cultures of chronic sinusitis cells. Basal short circuit currents in both types of cultures were insensitive to the Cl(-) transport inhibitor bumetanide, but all responded to forskolin or uridine triphosphate. After amiloride pretreatment, forskolin and uridine triphosphate responses were greater in chronic sinusitis cells. CONCLUSIONS: We established methods for well-differentiated sinus epithelial cultures. The cells exhibited Na(+) absorption and Cl(-) secretion, and elevated rates of ion transport may be pathophysiologically relevant in chronic sinusitis.     

Incidence of maxillary sinusitis in intensive care patients with nasal intubation--ultrasonic diagnosis as a screening test

Acute maxillary sinusitis due to nasotracheal intubation during intensive care is seldom considered as a cause of fever of unknown origin. Forty six patients admitted to a post-operative intensive care unit had their maxillary sinuses examined using a mobile "A-scan" ultrasonic scanner. Follow-up examinations were performed regularly. As early as the 5th day of treatment 36 out of 46 patients who had undergone nasotracheal intubation showed pathological ultrasonic results. Bilateral involvement was most frequent. In unilateral findings at the first examination, the intubated side was three times as often affected as the other side. Early extubation, early partial mobilisation and/or early administration of antibiotics did not prevent the occurrence of pathological ultrasonic findings. Acute maxillary sinusitis must thus be considered a frequent complication of nasotracheal intubation.     

中鼻甲垂直部长度和慢性鼻窦炎的相关性研究

目的探讨中鼻甲垂直部上下径的长度（中鼻甲长度）与慢性鼻窦炎的相关性,为术中处理中鼻甲提供参考依据。方法结合CT和鼻内镜检查结果,对106例慢性鼻窦炎患者和50例健康志愿者的中鼻甲垂直部长度进行对比分析。对慢性鼻窦炎的CT结果进行Lund-mackey评分,对两组中鼻甲长度进行独立样本均数t检验;对慢性鼻窦炎程度与中鼻甲长度的相关性进行Pearson相关分析。结果慢性鼻窦炎组中鼻甲长度为（23．9198±3．4611）mm,对照组中鼻甲长度为（21．3600±2．9900）mm,两组比较差异具有统计学意义（t=6．348,P〈0．01）;慢性鼻窦炎患者Lund—mackey评分结果为（5．9198±2．5603）分,鼻甲长度与Lund—mackey CT评分呈正相关（r=0．253,P=0．000）。结论中鼻甲垂直部的长度与慢性鼻窦炎发生有相关性,中鼻甲过长可能也是导致慢性鼻窦炎发生发展的原因之一,术中可根据中鼻甲的长度适当处理。     

真菌性鼻窦炎CT的非特征性表现

目的：回顾分析真菌性鼻窦炎患者术前CT,提出非特征性的临床表现,以提高术前诊断的准确性。方法：术后病理诊断为真菌性鼻窦炎患者CT176例,术前均行鼻窦CT检查及鼻内镜检查。所有患者均经鼻内镜下鼻窦开放术,术中清理窦内病变并经病理检查证实为真菌感染。其中单纯蝶窦35例,单纯上颌窦84例,筛窦上颌窦49例,全组鼻窦3例,筛窦蝶窦5例。观察以上各组术前CT除病变钙化特征以外的非特征性表现。结果：本组患者共176例179侧,其中单侧173例,双侧3例（全组鼻窦感染）。CT的非特征性改变包括：窦内病变密度均匀增高,窦内病变密度不均匀增高,受累鼻窦内侧壁可有骨质吸收。病理证实179侧中,单纯蝶窦组CT病变钙化27侧,CT病变非特征性改变8侧,其中窦内均匀密度增高5侧,不均匀密度增高3侧;单纯上颌窦组病变钙化72侧,病变非特征性改变12侧,其中窦内均匀密度增高8侧,不均匀密度增高4侧,伴有骨质吸收5侧;筛窦上颌窦组病变钙化36侧,病变非特征性改变13侧,其中窦内均匀密度增高9侧,不均匀密度增高4侧,伴有骨质吸收6侧;全组鼻窦组病变钙化6侧;筛窦蝶窦组病变钙化5例。窦内病变钙化达81.56％。结论：窦内病变的钙化被视为真菌性鼻窦炎CT的特征性表现,但在临床工作中可观察到部分真菌性鼻窦炎术前CT的非特征性改变。当缺乏CT的特征性表现时,仅通过CT尚不能作出真菌性鼻窦炎的术前诊断,需其他检查手段来做鉴别诊断,甚至需经手术探查后的病理诊断来确诊。     

Microbiology of chronic frontal sinusitis

OBJECTIVES: To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis. STUDY DESIGN: Retrospective, nonrandomized study. METHODS: Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis. RESULTS: Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase-negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase-negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery. CONCLUSIONS: This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase-negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.     

Severity staging in chronic sinusitis: are CT scan findings related to patient symptoms?

Chronic sinusitis is a prevalent problem. The symptoms of CS cause patients to seek medical attention, and therefore the presence of symptoms drives the use of health care resources. There is widespread clinical belief that computed tomography (CT) scan findings may be a reasonable proxy for disease severity in chronic sinusitis, and many authors have proposed that CT scan findings make up the key component in severity staging systems for chronic sinusitis. However, the relationship between symptom severity and CT scan findings in chronic sinusitis has not been well explained to date. To explore this relationship further, we examined data from consecutive patients with both a CT scan and a sinusitis symptom score, from ongoing prospective outcomes studies at two large academic centers in different cities (n = 254). CT scans were graded using two validated staging systems; symptom severity was assessed using two validated health status instruments and summary items. In addition, we explored multiple statistical modifications and permutations of CT staging to identify potential relationships between the two variables. In summary, no association between CT scan findings and symptom severity could be identified using both CT staging systems and patient-based symptom instruments. For instance, CT scans were examined: after eliminating normal scans, using different scoring algorithms, by worst side, by nonlinear association, when grouped into strata, and by eliminating patients with very severe disease; no statistical association was found between CT findings and patient-based symptoms using any of those techniques. Since symptom severity is a pivotal outcome measure in chronic sinusitis, these findings have significant implications for outcomes research and the development of severity staging systems.     

长期低剂量克拉霉素治疗慢性鼻窦炎

目的：观察长期低剂量克拉霉素治疗慢性鼻窦炎的疗效。方法：2002年4月至2003年1月我们用低剂量克拉霉素治疗63例慢性鼻窦炎，检测治疗前后糖精传输时间，观察治疗3、6个月后患者症状、鼻内镜检查、鼻窦CT检查及鼻窦黏膜病理的改善情况。结果：治疗3、6个月后鼻腔通气改善分别为66.7%、73.0%、；鼻涕量减少65.1%、74.6%；头痛减轻73.5%、85.3%；嗅觉改善30.0%、35.0%；鼻内镜检查好转55.8%、69.2%；CT扫描结果较用药前改善61.4%、68.4%；病理检查示鼻窦黏膜炎症减轻38.5%、61.5%。治疗前平均ST为(35.5±6.3)min，用药3个月后为(27.8±6.6)min，6个月后为(19.7±7.1)min。结论：长期低剂量克拉霉素治疗慢性鼻窦炎效果较好。     

鼻内镜与CT扫描对慢性鼻窦炎诊断的协同作用

目的探讨鼻内镜与CT扫描对慢性鼻窦炎诊断的协同作用.方法回顾分析164例慢性鼻窦炎患者的临床资料,总结鼻内镜与CT扫描对本病诊断的协同作用.结果164例慢性鼻窦炎中,31例CT扫描窦口鼻道复合体基本正常,但鼻内镜检查却发现窦口鼻道复合体存在黏膜病变.CT漏诊率为18.9%.其中19例行功能性鼻内镜手术,治愈率为89.4%;其余12例行保守治疗,治愈率为33.3%,差异有显著性意义(P＜0.05).结论在慢性鼻窦炎诊断中鼻内镜与CT扫描有着重要的协同作用.鼻内镜对窦口鼻道复合体黏膜病变的诊断具有更优越的价值.     

鼻及鼻窦疾病的CT诊断价值

目的 认识鼻及鼻窦疾病的ＣＴ诊断价值。方法 本文对９６例慢性鼻炎、鼻窦炎,鼻及鼻窦肿瘤进行ＣＴ检查,并结合病理检查结果对其进行分析。结果 发现ＣＴ能清晰地显示鼻窦解剖结构,包括窦口－鼻道复合体及前后筛房,筛房与眼眶之间关系及后筛与蝶窦颅底间的关系。对鼻窦内组织情况也能清晰显示,用ＣＴ对慢性增生性鼻窦炎进行分期,有利于手术前制定手术方案和评估预后。对慢性鼻窦炎、上颌窦囊肿、筛窦炎的诊断准确率分别为９     

蝶窦炎并眼-神经科综合征5例的临床分析

目的 :探讨蝶窦炎所致眼 神经科综合征的临床特征和治疗方法。方法 :回顾性分析 5例蝶窦炎并眼 神经科综合征病例的临床资料 ,CT扫描是主要诊断依据 ;手术治疗 3例 ,保守治疗 2例。结果 :蝶窦开放术或保守治疗均缓解了头痛症状 ,但视力障碍和其它眼 神经科体征无改善。结论 :CT扫描有利于早期诊断和排除球后占位性病变 ;对于有并发症的蝶窦炎宜尽早手术 ,同时宜行视神经管减压术     

Laser and topical mitomycin C for management of nasal synechia after FESS: a preliminary report

The objective of the study is to assess the role of diode laser coupled with topical mitomycin C (MMC) in the management of synechia after endoscopic sinus surgery. Twenty-five patients with recurrent sinusitis due to synechia between the middle turbinate and lateral nasal wall after endoscopic sinus surgery were included in this study. Diode laser was used to divide the synechia and MMC was applied topically in the area of the middle meatus for 5 min. Patients were followed for 6 months to assess symptoms improvement, recurrence of synechia and CT scan changes. Most of our patients reported improvement of their symptoms, recurrent synechia occurred in 15% of the patients with significant improvement of the CT scan findings. In conclusion, the diode laser with topical MMC is an outpatient procedure which is simple, safe and effective in managing postoperative nasal synechia.     

A diagnostic dilemma for chronic rhinosinusitis: definition accuracy and validity

BACKGROUND: The current definition of chronic rhinosinusitis is a symptom-based definition with minimal reliance on objective information. Based on this definition, patients are diagnosed and treatedl with medical therapy. A computed tomography (CT) scan is obtained only if the patient is not improved after medical therapy. No study is available evaluating in an evidence-based manner the accuracy of the current definition and its impact on diagnosis and treatment. METHODS: This study represents 78 patients evaluated in a prospective fashion who met the subjective criteria for the definition of chronic rhinosinusitis. All patients underwent a complete history with a questionnaire evaluating symptom severity, a physical exam including anterior rhinoscopy and endoscopy, and a CT scan obtained on the day of their initial visit. Objective CT scan findings were compared with the subjective findings and related to the ultimate diagnosis of chronic sinusitis. RESULTS: Only 37/78 (47%) had a positive (+) CT scan, indicating demonstrable sinusitis. There also was no real diffrence in symptom severity between patients with positive (+) and negative (-) CT scanning. CONCLUSION: The current symptom-based definition of chronic sinusitis poorly predicts whether a patient truly has chronic sinusitis and needs reevaluation.     

The role of Chlamydia pneumoniae infection in children with chronic sinusitis

BACKGROUND: Chlamydia pneumoniae infection is a frequent cause of lower respiratory disease in both adults and children. However, its role in upper respiratory disease, including sinusitis, is less clear. OBJECTIVE: To determine the role of infection with C. pneumoniae in chronic sinusitis in children. DESIGN: Prospective collection of specimens. SETTING: Tertiary care academic medical center. PARTICIPANTS: Children with clinical and radiologic evidence of chronic sinusitis unresponsive to medical management undergoing adenoidectomy, maxillary sinus lavage, or endoscopic sinus surgery for treatment.Intervention Nasopharyngeal and middle meatal swabs and portions of surgical specimens were obtained and cultured for C. pneumoniae. RESULTS: Specimens were obtained from 20 children (14 boys and 6 girls) aged 3 through 16 years. Thirteen bilateral endoscopic ethmoidectomies with maxillary antrostomies, 10 adenoidectomies, and 3 bilateral maxillary sinus lavages were performed. Chlamydia pneumoniae was isolated from the nasopharyngeal swab and adenoid tissue of 1 child (aged 6 years); however, his middle meatal swabs and maxillary sinus aspirates were negative. After 10 days of treatment with clarithromycin, repeat nasopharyngeal cultures were negative for C. pneumoniae. CONCLUSIONS: With the use of sensitive culture methods, C. pneumoniae was not isolated from sinus specimens of children enrolled in this study. This preliminary study suggests that C. pneumoniae does not play a significant role in chronic sinusitis in children.     

慢性上颌窦炎窦粘膜的免疫组化研究

目的：探讨慢性鼻窦炎局部粘膜中免疫活性细胞和分泌免疫成分在防御炎症过程中的作用。方法：采用免疫组化染色法对两型鼻突炎粘膜的９种免疫活性细胞和４种分泌免疫成分进行检测。结果：鼻窦炎Ⅰ型中Ｔ淋巴细胞、Ｔ４细胞亚群、Ｂ细胞、巨噬细胞明显高于正常对照组（Ｐ〈０．０１）;鼻窦炎Ⅱ型中Ｔ淋巴细胞、Ｔ８细胞亚群、Ｂ细胞、肥大细胞、嗜酸性细胞明显高于正常对照组（Ｐ〈０．０１）;两型中的Ｔ４／Ｔ８细胞比值有明显差异     

Sinogenic subdural empyema and Streptococcus anginosus.

Subdural empyema (SDE) is most commonly caused by sinusitis and, without early diagnosis and neurosurgical intervention, is associated with high mortality. In a patient with sinusitis who presents with mental status changes, the diagnosis of SDE should be suspected on clinical grounds, even in the absence of significant computed tomographic findings. Computed tomography with contrast is a useful aid in the diagnosis of SDE, but findings may be subtle, and contrasted magnetic resonance imaging is superior. The association of Streptococcus anginosus sinusitis and related intracranial sequelae is important owing to the potentially catastrophic complications and should be recognized by otolaryngologists. In view of the rapidly progressing nature of sinogenic SDE, physicians should strongly consider early institution of aggressive therapy consisting of craniotomy with concurrent sinus drainage in patients in whom sinogenic SDE is suspected on clinical grounds, particularly in the presence of S. anginosus-positive sinus cultures.