Progression of sinus disease in the intubated patient

BACKGROUND: Sinus disease in the intubated patient remains a frequent reason behind otolaryngological consultation to the Intensive Care Unit. Previous prospective studies often have been limited to only one computed tomography (CT) scan of the sinuses. The purpose of this study was to verify the development of sinus disease in the orotracheally intubated patient and determine a radiographic pattern of its progression if present. METHODS: The charts of all patients admitted to the hospital with a diagnosis of aneurysm or subarachnoid hemorrhage over a 2-year period were evaluated. Patients who were orotracheally intubated with at least one postintubation CT scan of the head were included. CT scans obtained after the initiation of antibiotics or tracheostomy were excluded. The Lund-Mackay staging system was used to evaluate the scans. RESULTS: A total of 50 patients with 172 scans were evaluated. Analysis revealed a significant trend toward increasing severity of radiological sinus disease over the first 7 days of intubation (p < 0.001). The presence of a nasogastric tube (NGT) resulted in an increased Lund-Mackay score, but the trend remained significant for patients without an NGT as well. CONCLUSION: This study shows that the presence and progression of sinus findings is fairly common in the intubated patient and that although the placement of an NGT increased the rate of development of sinus findings, the lack of one did not preclude sinus disease. Clinical exam remains a more important indicator of disease when evaluating the Intensive Care Unit patient for rhinosinusitis.     

Sinusitis in children

Sixty-eight children with the primary diagnosis of sinusitis have been admitted to the B.C. Children's Hospital since its opening in 1982 until July of 1986. Sinusitis in children under six years differs in presentation and course from sinusitis in older children. Children under six years seem to respond well to antibiotics while some children over six need surgery. Underlying diseases were present in half the cases and should be searched for in children who present with recurrent sinusitis.     

Sinusitis

Sinusitis (which should more accurately be called rhinosinusitis because of regular involvement of the nasal cavities) is one of the most widespread illnesses in Europe and the USA, with considerable socioeconomic burden and an increasing prevalence. From a clinical point of view, a distinction is made between acute, acute recurrent and chronic sinusitis. For the patients affected, sinusitis is associated with irritating to agonizing symptoms, which can have a seriously adverse effect on the quality of life. If complications arise, major risks may be involved affecting the orbits and neurocranium. Rational, evidence-based diagnosis and therapy is therefore absolutely essential. Guidelines may be helpful, particularly since data available on medication-based treatment, especially of the chronic form, are extremely sparse.     

Conversion to Chronic Invasive Fungal Sinusitis From Allergic Fungal Sinusitis in Immunocompetence

A review of the treatment of allergic and invasive fungal sinusitis, as well as a presentation of the first recorded case of a conversion from allergic fungal sinusitis (AFS) to chronic granulomatous invasive sinusitis and the fourth case of invasive fungal sinusitis associated with Curvularia. This immunocompetent patient suffering from chronic AFS converted after repeated high‐dose steroid tapers and noncompliance. AFS may present atypically and should be suspected even in immunocompetent patients with sinus disease who report new onset pain and neurologic symptoms. Clinicians should consider the potential complications associated with repeated systemic steroid administration. Laryngoscope, 129:2447–2450, 2019     

Sinusitis and the acute orbit in children

Acute orbital infection is an uncommon condition which is often secondary to acute sinusitis. Although it can present in any age group it is most prevalent in children and may cause impaired vision, blindness, intracranial complications and death. This paper documents the experience at the Royal Liverpool Childrens Hospital, Alder Hey, from 1973 to 1989. Clinical details were recorded retrospectively from the hospital case notes. Sixty-eight children had orbital sepsis of whom 30 had associated acute sinusitis. Of these 30 children, orbital sepsis was always unilateral with a preference for the left side; ten had diplopia of whom four had a sub-periosteal abscess which was subsequently drained. There were no serious complications although two children had diplopia for two to three months.     

Microbial flora of the subglottis in intubated pediatric patients

Infection of the intubated subglottis is felt to be one of the many factors involved in the pathogenesis of acquired cicatricial subglottic stenosis. The precise role of infection is unclear and the microbial flora has not been established. An analysis of subglottic culture material, from 22 intubated pediatric patients undergoing tracheotomy, has been performed to establish the nature of the subglottic microbial flora. Fifty-nine isolates were found, including 19 types of organisms. The number of isolates per patient ranged from one to eight, with an average of 2.7 isolates per patient. The most common isolates in the 22 patients were α-hemolytic Streptococcus viridans (17 isolates-77%), Neisseria sp. (6 isolates-27%), Pseudomonas sp. (5 isolates-22%), and coagulase negative Staphylococcus sp. (5 isolates-22%). This data indicates that colonization of the subglottis in intubated pediatric patients is polymicrobial in nature. α-Hemolytic Streptococcus viridans and Neisseria sp. were most common, with a shift in cultured flora towards Pseudomonas sp. in patients intubated for more than 10 days. In view of this, antimicrobial therapy may be of benefit in preventing acquired cicatricial subglottic stenosis.     

Reflux und Sinusitis

Ohne Zusammenfassung

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Reflux and sinusitisCan associations be assumed?

     

Einseitige Sinusitis maxillaris

Haemangioma originating in the paranasal sinuses are a rare entity. In the case of unilateral sinusitis the differential diagnosis should include tumors. The following case of a 30-year-old female patient with a therapy-resistant sinusitis showed bone destruction and a maxillary shadow on computed tomography. The histological exam resulted in a cavernous haemangioma.     

Sinusitis bei Kindern

Sinusitiden bei Kindern treten relativ h?ufig auf, verlaufen meist aber unkompliziert. Probleme entstehen bei rezidivierenden und chronischen Sinusitiden und bei Komplikationen akuter Sinusitiden. Die Diagnosestellung ist bei Kindern durch mangelnde Kooperation und altersspezifische anatomische Gegebenheiten sowohl mit klinischen Mitteln wie auch unter Einsatz bildgebender Diagnostik erschwert. Die Behandlung kindlicher Sinusitiden beinhaltet in erster Linie konservative Therapiemethoden. In besonderen F?llen kommen chirurgische Therapiemethoden in Frage. Dabei ist zu berücksichtigen, da? bei Kindern die Entwicklung der Nasennebenh?hlen und des Mittelgesichtes sowie auch die Entwicklung des Immunsystems noch nicht abgeschlossen sind. Für akute Komplikationen von Sinusitiden wie z.B. subperiostale Abszesse der Orbita, k?nnen heute ebenso wie bei konservativ nicht abheilenden chronischen oder chronisch rezidivierenden Sinusitiden mikroskopische und endoskopische endonasale Operationsmethoden eingesetzt werden. Insgesamt ist die Diagnostik und Therapie kindlicher Erkrankungen der Nasennebenh?hlen weit weniger wissenschaftlich abgesichert als bei Erwachsenen.     

慢性蝶窦炎

蝶窦炎因其特殊的解剖部位及无独特临床症状，往往被临床医师忽视，以往报道少。本组分析了５８例蝶窦炎，其特异的临床症状不明显，由于ＣＴ、ＭＲＩ和鼻内窥镜的广泛应用，使本病诊断已不困难。鼻内窥镜下的手术处理，患者痛苦少，操作简单。本组大部分病例（５３例）为继发于鼻腔及筛窦病变的蝶筛窦炎，孤立性蝶窦炎５例，在临床上比较少见。