Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of uniq...Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multidisciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.展开更多
Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed ...Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.展开更多
Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observatio...Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.展开更多
Objective:To explore effective nursing programs for surgical patients with chronic sinusitis(CS).Methods:62 CS surgery patients were randomly divided into a research group and a control group with 31 cases in each gro...Objective:To explore effective nursing programs for surgical patients with chronic sinusitis(CS).Methods:62 CS surgery patients were randomly divided into a research group and a control group with 31 cases in each group.The patients in the research group received cognitive nursing care,while the patients in the control group received routine nursing care.The nursing effects of the two groups were compared.Results:The postoperative quality-of-life scores,health behavior scores,complication rates,and nursing satisfaction scores of the patients in the research group were all better than those of the control group(P<0.05).Conclusion:The cognitive nursing model significantly improves the condition of CS surgery patients,thus it should be popularized.展开更多
Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies....Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.展开更多
[Objectives]To make an evaluation of the efficacy and safety of Biyuan Tongqiao Granule in the treatment of chronic sinusitis in children,and provide evidence-based medical reference for clinical use.[Methods]Database...[Objectives]To make an evaluation of the efficacy and safety of Biyuan Tongqiao Granule in the treatment of chronic sinusitis in children,and provide evidence-based medical reference for clinical use.[Methods]Databases such as Chinese Biomedical Literature Service System(SinoMed),China Knowledge Infrastructure(CNKI),Wanfang Digital Journal Full-text Database(WF),VIP Database(VIP),EmBase,PubMed,Science Direct,and Cochrane Library were used to collect the clinical randomized controlled trials of Biyuan Tongqiao Granule in children with chronic sinusitis published since the creation of databases.The quality of the included literature was evaluated and the data were extracted.The data was analyzed using Review Manager 5.3 software for meta-analysis,and descriptive analysis was performed for studies that could not be combined.The GRADE method was applied to evaluate the quality of evidence.[Results]A total of 12 studies were included,including 1645 cases of patients.The analysis results show that compared with the control group,Biyuan Tongqiao Granule has an excellent curative effect on children with chronic sinusitis and has a lower incidence of adverse reactions.The GRADE evidence level indicated that the sinus CT scan lesion score was intermediate evidence,and the visual analog score,endoscopic mucosal morphology score,and total effective rate were low-level evidence.[Conclusions]Biyuan Tongqiao Granule has a significant effect in treating chronic sinusitis in children and does not increase the incidence of adverse reactions,but its efficacy and safety need support of more high-quality studies.展开更多
BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal r...BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.展开更多
<strong>Introduction:</strong> Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refr...<strong>Introduction:</strong> Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refractoriness. Functional endoscopic sinus surgery (FESS) is the most common surgical technique preferred in CRS not responding to medical management, showing high success rates. However, some failure has been noted, requiring revision FESS. CT (Computed Tomography) is a diagnostic tool for CRS, and aids in improving surgical outcomes. Combined with the Lund-Mackay scoring system, CT can help stage the CRS, predicting the need for revision surgery. <strong>Methods:</strong> In our paper, we aimed to study the relationship between severity of CRS using radiological staging and revision of functional endoscopic sinus surgery, assessing outcome after at least 1 year of follow-up. There was a single centre retrospective study involving 150 patients selected by random sampling, to study the correlation between the severity of chronic rhinosinusitis and revision of functional endoscopic sinus surgery (FESS). The study was conducted in the ENT department of King Hamad University Hospital, Bahrain for a time period of 6 months. Records were scanned and scored using Lund-Mackay system. Lund Mackay score of 10 and above was considered severe. The relation between increased severity with Lund Mackay score on the CT scan and the need for revision sinus surgeries was then determined. <strong>Results and Conclusion:</strong> This study concludes that LMS score in CT scans can be used to predict the outcomes of primary FESS procedure and the need for revision surgery in the management of CRS.展开更多
Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and ...Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and methods: This descriptive and longitudinal study was conducted on 12 months from March 2012 to February 2013 in 9 cases of sinusitis complications in the department of Otorhinolaryngology at the University Hospital Gabriel Toure in Bamako. Results: The average age of patients was 22.7 years;a median of 19 years within 6 men and 3 women with almost 12.9 days of care seeking duration. The factors of risky were the use of nonsteroid anti-inflammatory drugs NSAID (4 cases), maxillofacial trauma (1 case) and HIV (1 case). Facial pain was the major symptom, such as frontal oedema, rhinorrhea with pus shedding and nasal obstruction. Computer tomography was used for complications specification. Frontal sinusitis was the most encountered with subperiosteal abscess (44.4%). Streptococcus pneumoniae was identified in 3 cases. Medical treatment associated to surgery was conducted on 7 patients. Two cases of death have been registered. Conclusion: The complicated sinusitis is an emergency and dangerous disease requiring specific care by a multidisciplinary staff. Much of complications are commonly encountered despite the antibiotic era.展开更多
BACKGROUND Sinusitis-derived subperiosteal orbital collection is uncommon and is usually diagnosed as subperiosteal orbital abscess or,rarely,as hematoma.We report a unique and even rarer case of subperiosteal orbital...BACKGROUND Sinusitis-derived subperiosteal orbital collection is uncommon and is usually diagnosed as subperiosteal orbital abscess or,rarely,as hematoma.We report a unique and even rarer case of subperiosteal orbital collection,which is actually a complication of hematoma and abscess.CASE SUMMARY A 26-year-old female presented with left eyeball pain and ipsilateral chemosis.She had no history of head trauma or upper respiratory infection.Her blood cell count showed an increase in leukocytes.Fiberoptic rhinolaryngoscopy revealed only mucosal edema of the left olfactory crest without apparent discharge.The computed tomography scan results showed an opaque left posterior ethmoid cell with a thickened bony shell and fusiform changes in the periosteal elevation of the medial wall of the left orbit.Emergent surgery revealed an ethmoid mucocele complicated with subperiosteal orbital hematoma and abscess.The pathology of the lamina papyracea between the mucocele and subperiosteal collection was necrotic,and the overlying mucosa was de-epithelialized.CONCLUSION Subperiosteal orbital hematoma with abscess in a patient with sinusitis adds to the current knowledge of orbital complications of sinusitis.展开更多
Dear Editor,We have presented the unusual case of periorbital necrotizing fasciitis(NF) coexisting with sinusitis and intracranial epidural abscess in a healthy young patient that was successfully managed with medical...Dear Editor,We have presented the unusual case of periorbital necrotizing fasciitis(NF) coexisting with sinusitis and intracranial epidural abscess in a healthy young patient that was successfully managed with medical and surgical treatments. The authors obtained informed consent in person and adhered to the tenets of the Declaration of Helsinki.展开更多
Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate t...Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.展开更多
Objective: The aim of this study was to evaluate intra- and inter-observer reproducibility of sinus x-rays in comparison to sinus computed tomography (CT) in chronic rhinosinusitis (CRS) patients. Methods: This was a ...Objective: The aim of this study was to evaluate intra- and inter-observer reproducibility of sinus x-rays in comparison to sinus computed tomography (CT) in chronic rhinosinusitis (CRS) patients. Methods: This was a prospective controlled study for which 14 adult CRS patients were recruited. Patients underwent a sinus multi-detector CT scan as well as additional sinus x-rays at the same time. Symptom interview and skin prick tests were performed. Lund-Mackay (LM) scores and 43 other findings in paranasal sinuses were analyzed by three blinded observers from CT-scans and x-rays. We compared agreement between sinus CT and x-rays (intra-observer reproducibility) and between three observers (inter-observer reproducibility) by Cohen’s kappa. Results: In at least 90% of the cases, the status of 47/49 structures was detectable in CT scans, whereas the status of only 8/49 structures was detectable in x-rays. The majority of the 25 visualized structures had poor intra-observer and inter-observer reproducibility. Conclusion: Only a few structures can be visualized in paranasal sinus x-rays and compared to paranasal sinus CT-scans, their reproducibility is poor. Our results strongly support the current consensus of radiation dose reduction by limiting the number of x-rays.展开更多
Objective: It is to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran. Methods: This cross-sectional study was conducted during 18 months (from 21 March 2009 till 22 Se...Objective: It is to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran. Methods: This cross-sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Hospitals. Thirty-six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis. Results: Thirty-five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of parasinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients were considered as proven, from these, 17 samples had positive growth. The culture aetiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were matched with histopathology findings. Significant associations were considered for radiologic finding and histopathology and culture (p 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: DM is the most common predisposing factor for IFS followed by ALL and AML. The most common aetiology of IFS was found to be Aspergillus fumigant followed by Mucormycosis and Candida. None of antifungal agents could successfully cover all the species.展开更多
Subperiosteal implants are generally used in the severely resorbed areas, and although dwindling in use, they have shown to be successful treatment options for the edentulous dental patients. We report a case of maxil...Subperiosteal implants are generally used in the severely resorbed areas, and although dwindling in use, they have shown to be successful treatment options for the edentulous dental patients. We report a case of maxillary subperiosteal implantitis that caused sinusitis. A 59-year-old man was referred to our clinic in March 2003 with a chief complaint of pain and swelling in the bilateral upper molar region. He received a surgical operation for maxillary subperiosteal implant at another dental clinic in April 2001. CT scans demonstrated that the radiopacity of the right maxillary sinus extended to the ethmoid and frontal sinuses. Extensive surgical debridement was performed. The radiopacity of the right maxillary sinus in CT almost disappeared in a month. Two months later, the occlusal function was recovered using a new maxillary complete denture. The patient has had no symptoms and no occlusal disturbance by the denture for more than nine years.展开更多
Fungal rhinosinusitis (FRS) is categorized as being either invasive or non-invasive based on the histopathological evidence of tissue invasion by fungi. Endoscopic sinus surgery (ESS) has become the gold standard trea...Fungal rhinosinusitis (FRS) is categorized as being either invasive or non-invasive based on the histopathological evidence of tissue invasion by fungi. Endoscopic sinus surgery (ESS) has become the gold standard treatment for non-invasive FRS including sinus fungal ball. It is considered to be an effective and safe procedure. It is important to keep a sufficient field of view in order to remove the fungal debris completely. ESS should also prevent damage to the nasal cavity structures including the inferior turbinate. This report mainly describes the endoscopic surgical procedures for fungal ball of the maxillary sinus (sinus mycelia) based on our methods and review of the literature, including written articles in Japanese. ESS procedures include the middle meatus approach for the maxillary sinus, the combined approach (both middle and inferior meatal antrostomy) for the maxillary sinus, and endoscopic modified medial maxillectomy (EMMM).展开更多
Background: Invasive fungal sinusitis is one of the less common forms of fungal infection more commonly described in North Africa and Asia. It affects healthy and immunologically competent individuals typically compli...Background: Invasive fungal sinusitis is one of the less common forms of fungal infection more commonly described in North Africa and Asia. It affects healthy and immunologically competent individuals typically complicating chronic rhinosinusitis. Surgical debridement and adjuvant antifungal treatment are the mainstay of management of this condition. Objective: To describe the clinical presentation, pathological features and management of patients with invasive fungal sinusitis managed at a tertiary health facility, southwestern Nigeria. Method: Medical records of all patients with invasive fungal sinusitis managed between January 2009 and December 2018 were retrospectively reviewed. Results: Six patients with invasive fungal sinusitis were managed during the study period. All patients were immunocompetent and the mean age at presentation was 30.7 years ± 7.2 years. The average duration of symptoms prior to presentation was 18.5 months (Interquartile range, 67.5 months), and all six patients had orbital involvement and intracranial extension of the mass at presentation. They all had surgical debridement, and the specimens were sent for histological examination. Mycological studies carried out on two specimens isolated Aspergillus fumigatusas the fungal agent and all patients were started on post-operative oral antifungal chemotherapy. Five patients completed their chemotherapy and fared well with no recurrence while one patient had irregular and incomplete antifungal treatment, and developed recurrent infection before abandoning further treatment. Conclusion: Chronic invasive fungal sinusitis is an uncommon infection and fairly difficult to manage. However, timely diagnosis and combined surgical and medical treatment can give good outcomes in the patients.展开更多
Background: Esthesioneuroblastoma, a rare tumour of the nasal vault, can present with symptoms that can be mistaken for common conditions such as chronic rhinosinusitis or recurrent epistaxis. Case presentation: A 52-...Background: Esthesioneuroblastoma, a rare tumour of the nasal vault, can present with symptoms that can be mistaken for common conditions such as chronic rhinosinusitis or recurrent epistaxis. Case presentation: A 52-year-old, previously healthy, Caucasian female presented to the emergency room with two months of nasal congestion and a spontaneous, protracted nosebleed that required a nasal clamp to settle. In the following months she had another episode of epistaxis in addition to fatigue, headaches, anosmia, difficulty breathing, worsening vision, weight loss and behavioral changes. Subsequent investigations led to the diagnosis of esthesioneuroblastoma. Conclusion: When patients present with recurrent epistaxis or chronic rhinosinusitis that does not respond to a reasonable course of medical therapy and/or have atypical associated symptoms, further investigations should be considered. The presences of red flags, such as weight loss, severe headaches, vision changes or bizarre behavior are also clues that alternate diagnoses and further additional workup should be considered.展开更多
Introduction: Chronic sinusitis affects all age groups and is a cause for significant morbidity. Recent realization that noninfectious inflammatory causes can predispose to infectious sinusitis has evoked renewed inte...Introduction: Chronic sinusitis affects all age groups and is a cause for significant morbidity. Recent realization that noninfectious inflammatory causes can predispose to infectious sinusitis has evoked renewed interest in developing and documenting efficacious ancillary therapies that could supplement antibiotic use. Hypertonic saline solution has been shown to increase mucociliary clearance and ciliary beat frequency. Objectives: A double blinded randomized comparative study was undertaken to evaluate the effect of hypertonic saline (3.5%) nasal drops and normal saline (0.9%) nasal drops, to assess the tolerance of hypertonic saline nasal drops and to know if hypertonic nasal drops improve the “quality of life” in patients with chronic sinusitis. Methods: Fifty patients diagnosed as chronic sinusitis in the age group of 18-45 years were randomized into two groups;Group A was treated with normal saline and Group B with 3.5% hypertonic saline for a period of 4 weeks. Pre and Post treatment x-rays of the paranasal sinuses (Water’s view) were graded and radiological scores were given accordingly. The symptoms were evaluated before and after treatment using visual analogue score. Patients were queried about tolerance to the nasal solution and scores were given. Conclusion: Hypertonic saline nasal solution is more efficacious than normal saline solution in the treatment of patients with chronic sinusitis. Hypertonic saline nasal solution was well tolerated and it improved quality of life in these patients.展开更多
The ocular-orbital complications of sinusitis constitute a diagnostic and therapeutic urgency that requires a correct multidisciplinary assumption. Objectives: The description of clinical and therapeutic data of the o...The ocular-orbital complications of sinusitis constitute a diagnostic and therapeutic urgency that requires a correct multidisciplinary assumption. Objectives: The description of clinical and therapeutic data of the orbital complications of acute sinusitis. Methods: Our work is based on a retrospective study of 86 cases of ocular-orbital complications of sinusitis hospitalized at the ENTdepartment of Hassan II Hospital in Fes (Morocco), between the years of 2006 and 2014. Results: It is about 56 men and 30 women. The average age was 24 years, with the extremes of 3 years and 65 years. The average time of consultation was 13 dates. The achievement was frontal-ethmoido in 26 cases, and it is about a pan sinusitis in 24 cases. About 13% and 7% of cases were classified respectively in the stage III and the stage IV of chandler. The surgery was done for 24 cases. Bacteriological sample was performed among 24 patients and allowed to isolate a streptococcus (3.5%), and a staphylococcus (5.8%), and a poly microbial flora for 15.1% of patients. A death in sepsis panel was noted for a patient who presented a thrombosis of cavernous sinus. And we have noted a persistent left exophthalmia without the diminution of visual acuity for another patient. Conclusion: The orbital complications of sinusitis require a multi-disciplinary medical approach associated to ear specialist, ophthalmologist, and neuro-radiology. A precocious diagnosis, an appropriate anti-biotic therapy, and sometimes an associated surgical treatment, can significantly diminish the mortality and the morbidity related to this pathology.展开更多
基金project was supported by grants from National Natural Science Foundations of China (Nos. 82025010, 81630023, 81900917)Changjiang Scholars and Innovative Research Team (No. IRT13082)+4 种基金CAMS Innovation Fund for Medical Sciences (No. 2019-I2M-5-022)Beijing Municipal Science and Technology Commision (Nos. Z181100001618002, Z211100002921057)Capital’s Funds for Health Improvement and Research (No.CFH2022-1-1091)Beijing Municipal Administration of Hospitals’ Mission Project (No. SML20150203)Beijing Municipal Administration of Hospitals’ Dengfeng Project (No. DFL20190202)。
文摘Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multidisciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.
基金supported by grants from the National Natural Science Foundation of China(No.81873694)the Key Research and Development Program of Hubei Province(No.2021BCA119 and No.2022BCA005)Knowledge Innovation Program of Wuhan-Basic Research(No.2022020801010446).
文摘Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.
文摘Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.
文摘Objective:To explore effective nursing programs for surgical patients with chronic sinusitis(CS).Methods:62 CS surgery patients were randomly divided into a research group and a control group with 31 cases in each group.The patients in the research group received cognitive nursing care,while the patients in the control group received routine nursing care.The nursing effects of the two groups were compared.Results:The postoperative quality-of-life scores,health behavior scores,complication rates,and nursing satisfaction scores of the patients in the research group were all better than those of the control group(P<0.05).Conclusion:The cognitive nursing model significantly improves the condition of CS surgery patients,thus it should be popularized.
基金Supported by JSPS KAKENHI(Grants-in-Aid for Scientific Research),No.25462642
文摘Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.
基金Supported by National Key Subject of Drug Innovation(No.2018ZX09201010-005)National Key Research and Development Program of China(No.2019YFC1711200-05).
文摘[Objectives]To make an evaluation of the efficacy and safety of Biyuan Tongqiao Granule in the treatment of chronic sinusitis in children,and provide evidence-based medical reference for clinical use.[Methods]Databases such as Chinese Biomedical Literature Service System(SinoMed),China Knowledge Infrastructure(CNKI),Wanfang Digital Journal Full-text Database(WF),VIP Database(VIP),EmBase,PubMed,Science Direct,and Cochrane Library were used to collect the clinical randomized controlled trials of Biyuan Tongqiao Granule in children with chronic sinusitis published since the creation of databases.The quality of the included literature was evaluated and the data were extracted.The data was analyzed using Review Manager 5.3 software for meta-analysis,and descriptive analysis was performed for studies that could not be combined.The GRADE method was applied to evaluate the quality of evidence.[Results]A total of 12 studies were included,including 1645 cases of patients.The analysis results show that compared with the control group,Biyuan Tongqiao Granule has an excellent curative effect on children with chronic sinusitis and has a lower incidence of adverse reactions.The GRADE evidence level indicated that the sinus CT scan lesion score was intermediate evidence,and the visual analog score,endoscopic mucosal morphology score,and total effective rate were low-level evidence.[Conclusions]Biyuan Tongqiao Granule has a significant effect in treating chronic sinusitis in children and does not increase the incidence of adverse reactions,but its efficacy and safety need support of more high-quality studies.
文摘BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.
文摘<strong>Introduction:</strong> Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refractoriness. Functional endoscopic sinus surgery (FESS) is the most common surgical technique preferred in CRS not responding to medical management, showing high success rates. However, some failure has been noted, requiring revision FESS. CT (Computed Tomography) is a diagnostic tool for CRS, and aids in improving surgical outcomes. Combined with the Lund-Mackay scoring system, CT can help stage the CRS, predicting the need for revision surgery. <strong>Methods:</strong> In our paper, we aimed to study the relationship between severity of CRS using radiological staging and revision of functional endoscopic sinus surgery, assessing outcome after at least 1 year of follow-up. There was a single centre retrospective study involving 150 patients selected by random sampling, to study the correlation between the severity of chronic rhinosinusitis and revision of functional endoscopic sinus surgery (FESS). The study was conducted in the ENT department of King Hamad University Hospital, Bahrain for a time period of 6 months. Records were scanned and scored using Lund-Mackay system. Lund Mackay score of 10 and above was considered severe. The relation between increased severity with Lund Mackay score on the CT scan and the need for revision sinus surgeries was then determined. <strong>Results and Conclusion:</strong> This study concludes that LMS score in CT scans can be used to predict the outcomes of primary FESS procedure and the need for revision surgery in the management of CRS.
文摘Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and methods: This descriptive and longitudinal study was conducted on 12 months from March 2012 to February 2013 in 9 cases of sinusitis complications in the department of Otorhinolaryngology at the University Hospital Gabriel Toure in Bamako. Results: The average age of patients was 22.7 years;a median of 19 years within 6 men and 3 women with almost 12.9 days of care seeking duration. The factors of risky were the use of nonsteroid anti-inflammatory drugs NSAID (4 cases), maxillofacial trauma (1 case) and HIV (1 case). Facial pain was the major symptom, such as frontal oedema, rhinorrhea with pus shedding and nasal obstruction. Computer tomography was used for complications specification. Frontal sinusitis was the most encountered with subperiosteal abscess (44.4%). Streptococcus pneumoniae was identified in 3 cases. Medical treatment associated to surgery was conducted on 7 patients. Two cases of death have been registered. Conclusion: The complicated sinusitis is an emergency and dangerous disease requiring specific care by a multidisciplinary staff. Much of complications are commonly encountered despite the antibiotic era.
文摘BACKGROUND Sinusitis-derived subperiosteal orbital collection is uncommon and is usually diagnosed as subperiosteal orbital abscess or,rarely,as hematoma.We report a unique and even rarer case of subperiosteal orbital collection,which is actually a complication of hematoma and abscess.CASE SUMMARY A 26-year-old female presented with left eyeball pain and ipsilateral chemosis.She had no history of head trauma or upper respiratory infection.Her blood cell count showed an increase in leukocytes.Fiberoptic rhinolaryngoscopy revealed only mucosal edema of the left olfactory crest without apparent discharge.The computed tomography scan results showed an opaque left posterior ethmoid cell with a thickened bony shell and fusiform changes in the periosteal elevation of the medial wall of the left orbit.Emergent surgery revealed an ethmoid mucocele complicated with subperiosteal orbital hematoma and abscess.The pathology of the lamina papyracea between the mucocele and subperiosteal collection was necrotic,and the overlying mucosa was de-epithelialized.CONCLUSION Subperiosteal orbital hematoma with abscess in a patient with sinusitis adds to the current knowledge of orbital complications of sinusitis.
文摘Dear Editor,We have presented the unusual case of periorbital necrotizing fasciitis(NF) coexisting with sinusitis and intracranial epidural abscess in a healthy young patient that was successfully managed with medical and surgical treatments. The authors obtained informed consent in person and adhered to the tenets of the Declaration of Helsinki.
文摘Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.
文摘Objective: The aim of this study was to evaluate intra- and inter-observer reproducibility of sinus x-rays in comparison to sinus computed tomography (CT) in chronic rhinosinusitis (CRS) patients. Methods: This was a prospective controlled study for which 14 adult CRS patients were recruited. Patients underwent a sinus multi-detector CT scan as well as additional sinus x-rays at the same time. Symptom interview and skin prick tests were performed. Lund-Mackay (LM) scores and 43 other findings in paranasal sinuses were analyzed by three blinded observers from CT-scans and x-rays. We compared agreement between sinus CT and x-rays (intra-observer reproducibility) and between three observers (inter-observer reproducibility) by Cohen’s kappa. Results: In at least 90% of the cases, the status of 47/49 structures was detectable in CT scans, whereas the status of only 8/49 structures was detectable in x-rays. The majority of the 25 visualized structures had poor intra-observer and inter-observer reproducibility. Conclusion: Only a few structures can be visualized in paranasal sinus x-rays and compared to paranasal sinus CT-scans, their reproducibility is poor. Our results strongly support the current consensus of radiation dose reduction by limiting the number of x-rays.
文摘Objective: It is to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran. Methods: This cross-sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Hospitals. Thirty-six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis. Results: Thirty-five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of parasinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients were considered as proven, from these, 17 samples had positive growth. The culture aetiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were matched with histopathology findings. Significant associations were considered for radiologic finding and histopathology and culture (p 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: DM is the most common predisposing factor for IFS followed by ALL and AML. The most common aetiology of IFS was found to be Aspergillus fumigant followed by Mucormycosis and Candida. None of antifungal agents could successfully cover all the species.
文摘Subperiosteal implants are generally used in the severely resorbed areas, and although dwindling in use, they have shown to be successful treatment options for the edentulous dental patients. We report a case of maxillary subperiosteal implantitis that caused sinusitis. A 59-year-old man was referred to our clinic in March 2003 with a chief complaint of pain and swelling in the bilateral upper molar region. He received a surgical operation for maxillary subperiosteal implant at another dental clinic in April 2001. CT scans demonstrated that the radiopacity of the right maxillary sinus extended to the ethmoid and frontal sinuses. Extensive surgical debridement was performed. The radiopacity of the right maxillary sinus in CT almost disappeared in a month. Two months later, the occlusal function was recovered using a new maxillary complete denture. The patient has had no symptoms and no occlusal disturbance by the denture for more than nine years.
文摘Fungal rhinosinusitis (FRS) is categorized as being either invasive or non-invasive based on the histopathological evidence of tissue invasion by fungi. Endoscopic sinus surgery (ESS) has become the gold standard treatment for non-invasive FRS including sinus fungal ball. It is considered to be an effective and safe procedure. It is important to keep a sufficient field of view in order to remove the fungal debris completely. ESS should also prevent damage to the nasal cavity structures including the inferior turbinate. This report mainly describes the endoscopic surgical procedures for fungal ball of the maxillary sinus (sinus mycelia) based on our methods and review of the literature, including written articles in Japanese. ESS procedures include the middle meatus approach for the maxillary sinus, the combined approach (both middle and inferior meatal antrostomy) for the maxillary sinus, and endoscopic modified medial maxillectomy (EMMM).
文摘Background: Invasive fungal sinusitis is one of the less common forms of fungal infection more commonly described in North Africa and Asia. It affects healthy and immunologically competent individuals typically complicating chronic rhinosinusitis. Surgical debridement and adjuvant antifungal treatment are the mainstay of management of this condition. Objective: To describe the clinical presentation, pathological features and management of patients with invasive fungal sinusitis managed at a tertiary health facility, southwestern Nigeria. Method: Medical records of all patients with invasive fungal sinusitis managed between January 2009 and December 2018 were retrospectively reviewed. Results: Six patients with invasive fungal sinusitis were managed during the study period. All patients were immunocompetent and the mean age at presentation was 30.7 years ± 7.2 years. The average duration of symptoms prior to presentation was 18.5 months (Interquartile range, 67.5 months), and all six patients had orbital involvement and intracranial extension of the mass at presentation. They all had surgical debridement, and the specimens were sent for histological examination. Mycological studies carried out on two specimens isolated Aspergillus fumigatusas the fungal agent and all patients were started on post-operative oral antifungal chemotherapy. Five patients completed their chemotherapy and fared well with no recurrence while one patient had irregular and incomplete antifungal treatment, and developed recurrent infection before abandoning further treatment. Conclusion: Chronic invasive fungal sinusitis is an uncommon infection and fairly difficult to manage. However, timely diagnosis and combined surgical and medical treatment can give good outcomes in the patients.
文摘Background: Esthesioneuroblastoma, a rare tumour of the nasal vault, can present with symptoms that can be mistaken for common conditions such as chronic rhinosinusitis or recurrent epistaxis. Case presentation: A 52-year-old, previously healthy, Caucasian female presented to the emergency room with two months of nasal congestion and a spontaneous, protracted nosebleed that required a nasal clamp to settle. In the following months she had another episode of epistaxis in addition to fatigue, headaches, anosmia, difficulty breathing, worsening vision, weight loss and behavioral changes. Subsequent investigations led to the diagnosis of esthesioneuroblastoma. Conclusion: When patients present with recurrent epistaxis or chronic rhinosinusitis that does not respond to a reasonable course of medical therapy and/or have atypical associated symptoms, further investigations should be considered. The presences of red flags, such as weight loss, severe headaches, vision changes or bizarre behavior are also clues that alternate diagnoses and further additional workup should be considered.
文摘Introduction: Chronic sinusitis affects all age groups and is a cause for significant morbidity. Recent realization that noninfectious inflammatory causes can predispose to infectious sinusitis has evoked renewed interest in developing and documenting efficacious ancillary therapies that could supplement antibiotic use. Hypertonic saline solution has been shown to increase mucociliary clearance and ciliary beat frequency. Objectives: A double blinded randomized comparative study was undertaken to evaluate the effect of hypertonic saline (3.5%) nasal drops and normal saline (0.9%) nasal drops, to assess the tolerance of hypertonic saline nasal drops and to know if hypertonic nasal drops improve the “quality of life” in patients with chronic sinusitis. Methods: Fifty patients diagnosed as chronic sinusitis in the age group of 18-45 years were randomized into two groups;Group A was treated with normal saline and Group B with 3.5% hypertonic saline for a period of 4 weeks. Pre and Post treatment x-rays of the paranasal sinuses (Water’s view) were graded and radiological scores were given accordingly. The symptoms were evaluated before and after treatment using visual analogue score. Patients were queried about tolerance to the nasal solution and scores were given. Conclusion: Hypertonic saline nasal solution is more efficacious than normal saline solution in the treatment of patients with chronic sinusitis. Hypertonic saline nasal solution was well tolerated and it improved quality of life in these patients.
文摘The ocular-orbital complications of sinusitis constitute a diagnostic and therapeutic urgency that requires a correct multidisciplinary assumption. Objectives: The description of clinical and therapeutic data of the orbital complications of acute sinusitis. Methods: Our work is based on a retrospective study of 86 cases of ocular-orbital complications of sinusitis hospitalized at the ENTdepartment of Hassan II Hospital in Fes (Morocco), between the years of 2006 and 2014. Results: It is about 56 men and 30 women. The average age was 24 years, with the extremes of 3 years and 65 years. The average time of consultation was 13 dates. The achievement was frontal-ethmoido in 26 cases, and it is about a pan sinusitis in 24 cases. About 13% and 7% of cases were classified respectively in the stage III and the stage IV of chandler. The surgery was done for 24 cases. Bacteriological sample was performed among 24 patients and allowed to isolate a streptococcus (3.5%), and a staphylococcus (5.8%), and a poly microbial flora for 15.1% of patients. A death in sepsis panel was noted for a patient who presented a thrombosis of cavernous sinus. And we have noted a persistent left exophthalmia without the diminution of visual acuity for another patient. Conclusion: The orbital complications of sinusitis require a multi-disciplinary medical approach associated to ear specialist, ophthalmologist, and neuro-radiology. A precocious diagnosis, an appropriate anti-biotic therapy, and sometimes an associated surgical treatment, can significantly diminish the mortality and the morbidity related to this pathology.
