Sinugene endokranielle Komplikation ohne initiale klassische neurologische Symptomatik

Zusammenfassung Bei einem 14-jährigen Jungen entwickelte sich aus einer Pansinusitis ein ausgedehnter leptomeningealer Infekt. Die zu erwartenden neurologischen Symptome, wie starke Kopfschmerzen, massives Erbrechen, Somnolenz und Meningismus traten nicht oder erst sehr spät auf. Schließlich kam es zu einer Halbseitensymptomatik, und es traten epileptische Anfälle auf. Der trotz der geringen Symptome ausgedehnte Befund wurde kombiniert neurochirurgisch und von endonasal operativ saniert, und es wurde eine antibiotische Therapie durchgeführt. Es kam zu einer raschen Restitutio ad integrum.     

Atypical sinusitis in adults must lead to looking for cystic fibrosis and primary ciliary dyskinesia

HYPOTHESES/OBJECTIVES:: In adults, purulent pansinusitis or nasal polyposis starting early in life or that is permanently infected or associated either with chronic bronchial infection, infertility, or situs inversus are uncommon. In these atypical cases of chronic sinusitis (ACS), a primary dysfunction of the mucociliary clearance can be suspected. Adult patients with ACS were therefore investigated to detect primary ciliary dyskinesia (PCD) or cystic fibrosis (CF). STUDY DESIGN: Open, prospective study. PATIENTS AND METHODS: Forty-two patients with ACS were investigated with ciliary beat frequency and ultrastructure analysis in nasal cells and cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis in blood leukocytes. RESULTS: The diagnosis of PCD was confirmed in seven (17%) patients. At least one CFTR gene mutation was detected in 16 (38%) patients. The diagnosis of CF was suggested in three (7%) compound heterozygous patients. Another 13 (31%) patients were heterozygous for a CFTR gene mutation or a complex allele. Comparison of clinical features of ACS showed that only a family history of chronic sinusitis (P <.01) or chronic bronchitis (P <.02) and the presence of diffuse bronchiectasis (P <.0001) or serous otitis media (P <.0001) were significantly more frequent in PCD patients than in patients carrying CFTR gene mutations or those without PCD or CFTR gene mutations. CONCLUSIONS: ACS should be considered a remarkable entity in which congenital abnormalities of epithelial cells are frequently detected (55% of patients). The higher frequency of mutations in ACS patients compared with the general population suggests that heterozygoty for CFTR gene mutation could be a sinusitis-causing status.     

Diagnosis and pathology of unilateral maxillary sinus opacification with or without evidence of contralateral disease

OBJECTIVE: Determine the diagnostic criteria and etiology of complete unilateral maxillary sinus opacification. METHODS: A prospective analysis was performed on patients presenting to a tertiary care rhinology practice with complaints of chronic rhinosinusitis or acute exacerbation. Sixty-four consecutive patients were identified with unilateral maxillary sinus opacification on computed tomography (CT) scan after at least a 3-week medical therapy for rhinosinusitis. The study population comprised 30 men and 34 women with a mean age of 47.0 years. All patients completed a symptom score questionnaire, received nasal endoscopy, and CT imaging. Patient symptoms and endoscopic and radiographic findings were analyzed to determine patterns related to final diagnosis. RESULTS: All 64 patients underwent functional endoscopic sinus surgery. Each surgical specimen was sent for pathologic confirmation of the diagnosis. Sixteen mucoceles, 12 cases of nasal polyposis, 27 cases of acute or chronic sinusitis, 7 cases of inverting papilloma, and 2 cases of mycetoma were identified. Endoscopic and radiographic appearances were correlated with each disease process. CONCLUSION: Unilateral maxillary sinus opacification is a relatively common finding. Early identification of inverting papillomas and mucoceles may avoid delay in surgical intervention, whereas acute/chronic rhinosinusitis and nasal polyposis can initially be managed medically. Careful history, endoscopic examination, and radiographic studies can often determine the responsible disease process.     

Upper respiratory tract infections

Acute respiratory infections accounts for 20–40% of outpatient and 12–35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis areS. pneumoniae, H. influenzae, M. catarrhalis,S. aureus andS. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10–14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.     

功能性内窥镜鼻窦手术对不同型期鼻窦炎鼻粘液纤毛清除率的影响

目的：探讨功能性鼻窦内窥镜手术（ＦＥＳＳ）对不同型期鼻窦炎患者鼻粘液纤毛清除率的影响。方法：将１０５例（１９３侧）鼻窦炎、鼻息肉患者进行分型分期和ＦＥＳＳ后疗效评定;用糖精法测定术前和术后３、６个月的鼻 粘液纤毛输送率（ＭＴＲ）。结果：①从Ⅰ￣Ⅲ型疗效呈递减趋势,Ⅱ型Ⅱ、Ⅲ期和Ⅲ型的疗效较差。②术前Ⅰ型Ⅰ、Ⅱ期ＭＴＲ和Ⅱ型Ⅰ期间无显著性差异,而与Ⅱ型Ⅱ、Ⅲ期和Ⅲ型间有显著性差异。③术后３个月的ＭＴ     

鼻源性视功能损害的诊断和鼻内窥镜手术治疗

目的　探讨鼻窦炎性疾病合并视功能损害的诊断和鼻内窥镜手术治疗的疗效。方法　分析 32例 (32眼 )鼻源性视功能损害的临床表现和鼻内窥镜手术治疗效果。结果　 11眼治愈 ,2 0眼获不同程度改善 ,1眼无效 ,随访 6个月～ 3年无复发。结论　鼻窦炎性疾病可以引起视功能损害 ,及早诊断以及鼻内窥镜手术配合药物治疗可望获得良好效果。     

内镜鼻窦手术后Rhino凝胶填塞效果的观察

目的 前瞻性比较新型鼻腔填塞材料Rhino凝胶与传统填塞物用于内镜鼻窦手术后填塞的效果.方法 对双侧病变基本对称,手术范围基本相同的24例慢性鼻窦炎患者行内镜鼻窦手术,术后右侧鼻腔以Rhino凝胶填塞(观察组),左侧鼻腔以藻酸钙+油纱条填塞(对照组).术后1日抽取对照侧填充物,观察侧凝胶保留至术后1周第1次内镜复查时清理,鼻腔冲洗、鼻喷糖皮质激素等其他局部处理双侧鼻腔相同.采用视觉模拟量表(visual analog scale,VAS)记录两侧鼻腔术后当天(填塞期)、术后第1天(抽取左侧填充物时)、术后第2天(抽取左侧填充物后)患者鼻痛、鼻堵程度,分泌物、渗血、流泪量,以及术后内镜复查术腔恢复情况(干痂、分泌物、反应膜、黏膜水肿、囊泡、窦口阻塞),并对两组上述11项观察项目评分和上皮化时间进行比较.结果 苏醒时因血压过高,凝胶侧鼻腔出血改用纱条填塞1例;外地患者失访2例.余21例完成2～20个月的随访.术后当天、术后第1天鼻痛,术后当天流泪评分,Rhino组<对照组(Z值分别为-3.575、-3.546、-2.736,P值均<0.05);术后第1天渗血评分,Rhino组<对照组(Z=-3.075,P<0.05);术后1周术腔干痂评分,Rhino组<对照组(Z=-2.103,P<0.05);其余各项评分差异无统计学意义;凝胶侧术腔平均上皮化时间为(10.7±2.6)周,对照侧为(10.6±2.9)周,两组差异无统计学意义(t=-0.146,P=0.886).结论 Rhino凝胶可减轻患者鼻腔填塞期的不适,并可避免专门撤除填充物造成的痛苦和出血,较传统方法有明显的优越性.在促进术腔恢复方面与传统方式相当.     

慢性鼻-鼻窦炎细菌生物膜形态观察

目的 观察慢性鼻-鼻窦炎患者,鼻内镜所取钩突、筛泡或上颌窦黏膜样本是否存在细菌牛物膜及其形态特征.方法 本实验共取鼻内镜术中黏膜样本12份,实验组为慢性鼻.鼻窦炎鼻内镜手术患者6例,对照组为阻塞性睡眠呼吸暂停综合征鼻内镜手术患者6例.样本用标准的扫描电镜方法 处理.实验组详细记录患者的年龄、性别、症状、鼻窦CT、鼻内镜检查和变应原皮肤点刺试验结果 .结果 扫描电镜下见慢性鼻一鼻窦炎患者鼻腔鼻窦黏膜纤毛缺失、倒伏、排列紊乱,实验组中5例可见不同形成阶段、各种形态的细菌生物膜,1例可见丝状真菌样结构.实验组细菌生物膜出现率为83.3%.对照组6例均未观察到细菌生物膜.结论 慢性鼻-鼻窦炎鼻腔鼻窦黏膜纤毛有不同程度的损伤,黏膜表面存在处于生命周期不同阶段的细菌牛物膜.     

鼻内镜术后中西药结合冲洗对鼻腔黏膜早期变化的技术研究报告

目的鼻内镜术后应用自制中药液加西药液冲洗鼻腔，观察鼻腔黏膜变化，为鼻腔术后黏膜的早期修复，寻求中西医结合治疗的有效方法。方法鼻内镜手术患者120例，随机分为两组，中西药结合组60例患者用生理盐水250ml加庆大霉素8万u以及自制中药液250ml，于术后第2天取出鼻腔油纱条开始每日冲洗鼻腔2次，对照组60例患者同法用生理盐水、甲硝唑各250ml冲洗，予以记录。结果两组术后第3天各项指标评分经t检验，差异无统计学意义（P〉0．05），于术后第5、7、9、11大各项指标评分中西药结合组均明显高于对照组（P〈0．05）。结论术后用中西药液结合冲洗鼻腔可以提高鼻内镜手术的疗效。