MEDLINE Abstracts: Sinusitis
What's new concerning sinusitis? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Allergy & Clinical Immunology.
Varonen H, Kunnamo I, Savolainen S, et al
Scand J Prim Health Care. 2003;21:121-126
Objectives: To compare antibiotics and placebo in patients with clinically diagnosed acute maxillary sinusitis (AMS). To study whether sinus ultrasound examination would help to detect those patients who benefit from antibiotic therapy.
Designs: A double-blind, randomised, placebo-controlled multicentre trial.
Setting: Nine primary care sites in Finland.
Subjects: 150 adult patients (mean age 39.7 years) with a clinical diagnosis of sinusitis.
Intervention: Antibiotics (amoxicillin 750 mg x 2, doxycycline 100 mg x 2 or penicillin V 1500 mg x 2) or placebo twice daily for 7 days; all patients were examined with sinus ultrasound after randomisation.
Main Outcome Measure: Clinical success (patients' report of recovery) in telephone interview at 2 weeks.
Results: A total of 146 patients completed the 2-week follow-up. Patients receiving antibiotics achieved a slightly higher rate of clinical success than patients receiving placebo (80% vs 66%; P = 0.068).
Conclusions: Antibiotics hasten symptom relief in AMS. Yet many patients recover in 2 weeks without antimicrobial treatment. Only half of patients with a clinical diagnosis of AMS have sinusitis in ultrasound examination.
Reider JM, Nashelsky J
J Fam Pract. 2003;52:565-567; discussion 567
Accurate diagnosis of acute sinusitis in both children and adults depends on the history and clinical examination of the patient. While the clinical signs and symptoms of acute sinusitis are often difficult to distinguish from viral upper respiratory infection, such an assessment remains the best approach to diagnosing acute sinusitis (strength of recommendation [SOR]: A). There is no role for imaging in the diagnosis of acute sinusitis. For patients who have persistent symptoms, or those for whom surgery is being considered, some guidelines suggest that coronal computed tomography (CT) scan of the paranasal sinuses be considered (SOR: C, expert opinion).
Paju S, Bernstein JM, Haase EM, Scannapieco FA
J Med Microbiol. 2003;52:591-597
Chronic maxillary sinusitis is a chronic inflammatory condition in which the role of microbial infection remains undefined. Bacteria have been isolated from chronically inflamed sinuses; however, their role in the chronicity of inflammation is unknown. The objective of this study was to determine whether bacteria are present in clinical samples from chronic maxillary sinusitis and to assess the diversity of the flora present. Washes and/or tissue samples from endoscopic sinus surgery on 11 patients with chronic maxillary sinusitis were subjected to PCR amplification of bacterial 16S rDNA using 3 universal primer pairs, followed by cloning and sequencing. The samples were also assessed for the presence of bacteria and fungi by conventional culture methods. Viable bacteria and/or bacterial 16S rDNA were detected from maxillary sinus samples of 5 of the 11 patients examined (45%). Three sinus samples were positive by both PCR and culture methods, one was positive only by PCR, and one only by culture. Thirteen bacterial species were identified: Abiotrophia defectiva, Enterococcus avium, Eubacterium sp., Granulicatella elegans, Neisseria sp., Prevotella sp., Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, Stenotrophomonas maltophilia, Streptococcus gordonii, Streptococcus mitis/Streptococcus oralis and Streptococcus sp. Fungi were not detected. In one patient, Streptococcus mitis/Streptococcus oralis, and in another patient Pseudomonas aeruginosa, were detected from both the sinus and the oral cavity using species-specific PCR primers. These results suggest that both aerobic and anaerobic bacteria can be detected in nearly half of chronic maxillary sinusitis cases.
Kalavagunta S, Reddy KT
Rhinology. 2003;41:113-117
Aim: To determine the incidence of variations of maxillary sinus pneumatization especially when it is extensive and the associated anomalies.
Study Design: Two hundred consecutive direct coronal paranasal sinus computed tomography (CT) scans were reviewed retrospectively. Extensive maxillary sinus pneumatization (EMSP) was defined as one in which the largest horizontal and/or vertical dimension of the maxillary sinus equalled or exceeded 90% of the corresponding diameter of the orbit. Further, subtype I, II, and III were defined depending on whether the pneumatization was extensive in one dimension (horizontal or vertical), 2 dimensions (horizontal and vertical) and by the presence of sphenomaxillary plate, intermaxillary plate, or extension into frontal recess.
Results: EMSP was found in 8%, of these 7% were bilateral and 1% was unilateral. (Subtype I, II, and III constituting 1%, 3%, and 4% respectively).
Conclusion: EMSP has been defined as a group and a classification proposed. EMSP will result in an atypical clinical picture, has a role in the pathogenesis of frontal sinusitis in some cases, and may predispose injury to the orbit during endoscopic sinus surgery (ESS).
Catalano PJ, Roffman EJ
Otolaryngol Head Neck Surg. 2003;128:875-881
Objectives: In this study, we compared postoperative synechia rates and morbidity for different middle meatal (MM) stents after minimally invasive sinus techniques (MIST).
Study Design: In a prospective study, we included 100 patients with bilateral chronic sinusitis undergoing MIST at a tertiary care facility with a single surgeon.
Methods: For all patients, MeroGel stents were placed in the right MM, Gelfilm stents were placed in the left MM. Follow-up consisted of 3 postoperative visits between weeks 1 and 12 with endoscopic evaluation for synechia, granulation tissue, stent retention, nasal obstruction, headache, and infection.
Results: Synechia developed in 4 patients on the left and in none on the right (P = .04). There were no significant side-specific differences regarding postoperative nasal congestion, headache, or sinusitis. Mean stent retention time was 7.9 days for MeroGel and 5.6 days for Gelfilm (P = .0004).
Conclusion: Compared with Gelfilm, Merogel MM stents produced less synechia; Merogel retains its position in the MM longer than Gelfilm; and the incidence of postoperative MM synechia can be reduced when absorbable MM stents are used in conjunction with MIST.
Passali D, Bernstein JM, Passali FM, Damiani V, Passali GC, Bellussi L
Arch Otolaryngol Head Neck Surg. 2003;129:656-659
Objective: To demonstrate the long-term efficacy of intranasal furosemide, an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell, vs no therapeutic intervention vs intranasal mometasone furoate, a corticosteroid, in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis.
Design: Randomized prospective controlled study. Patients were examined every 6 months during follow-up (range, 1 to 9 years).
Patients: One hundred seventy patients with bilateral obstructive or minimally obstructive chronic hyperplastic sinusitis with nasal polyposis.
Intervention: All patients were surgically treated in the ENT Department, University of Siena Medical School. One month after surgery, group 1 patients (n = 97) started treatment with intranasal furosemide; group 2 (n = 40) received no therapeutic treatment; and group 3 (n = 33) were treated with mometasone.
Main Outcome Measures: Clinical and instrumental evaluation of postoperative outcomes.
Results: Seventeen (17.5%) of 97 patients in group 1, 12 (30.0%) of 40 patients in group 2, and 8 (24.2%) of 33 patients in group 3 experienced nasal polyposis relapses. We noted a prevalence of early-stage relapse in patients treated with furosemide or mometasone; whereas patients who did not receive any treatment experienced more severe grades of chronic hyperplastic sinusitis with nasal polyposis (P < .005).
Conclusion: Use of intranasal furosemide represents a valid therapeutic treatment in the prevention of chronic hyperplastic sinusitis with nasal polyposis.
Matsune S, Kono M, Sun D, Ushikai M, Kurono Y
Acta Otolaryngol. 2003;123:519-523
Objectives: In order to elucidate the pathogenesis of the radiologic opacity of the sinuses frequently observed in patients with allergic rhinitis, the mechanisms underlying their sinus mucosal swelling were studied clinically.
Material and Methods: We confirmed the presence of hypoxia in inflamed sinuses and obstruction of the sinus ostium in operated patients with chronic sinusitis by digitally monitoring the oxygen tension. The possibility of radiologic sinus shadow was also investigated after transient obstruction of the natural ostium.
Results: The oxygen tension was significantly lower in inflamed than non-inflamed sinuses (P < .01), irrespective of the presence or absence of allergic rhinitis. In 54.5% of patients without sinusitis, transient obstruction of the middle meatus by gauze packing resulted in the appearance of a pathologic sinus shadow on radiograms obtained after septoplasty and turbinotomy. In both allergic and non-allergic rhinitis, thick opacity was the most frequently encountered pattern (P < .01).
Conclusion: Our study revealed that in the absence of a primary allergic reaction in the sinus mucosa, blocking of the middle meatus and ostium by allergic swelling of the nasal mucosa may induce hypoxia and secondary mucosal swelling in the sinuses.
What's new concerning sinusitis? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Allergy & Clinical Immunology.
Varonen H, Kunnamo I, Savolainen S, et al
Scand J Prim Health Care. 2003;21:121-126
Objectives: To compare antibiotics and placebo in patients with clinically diagnosed acute maxillary sinusitis (AMS). To study whether sinus ultrasound examination would help to detect those patients who benefit from antibiotic therapy.
Designs: A double-blind, randomised, placebo-controlled multicentre trial.
Setting: Nine primary care sites in Finland.
Subjects: 150 adult patients (mean age 39.7 years) with a clinical diagnosis of sinusitis.
Intervention: Antibiotics (amoxicillin 750 mg x 2, doxycycline 100 mg x 2 or penicillin V 1500 mg x 2) or placebo twice daily for 7 days; all patients were examined with sinus ultrasound after randomisation.
Main Outcome Measure: Clinical success (patients' report of recovery) in telephone interview at 2 weeks.
Results: A total of 146 patients completed the 2-week follow-up. Patients receiving antibiotics achieved a slightly higher rate of clinical success than patients receiving placebo (80% vs 66%; P = 0.068).
Conclusions: Antibiotics hasten symptom relief in AMS. Yet many patients recover in 2 weeks without antimicrobial treatment. Only half of patients with a clinical diagnosis of AMS have sinusitis in ultrasound examination.
Reider JM, Nashelsky J
J Fam Pract. 2003;52:565-567; discussion 567
Accurate diagnosis of acute sinusitis in both children and adults depends on the history and clinical examination of the patient. While the clinical signs and symptoms of acute sinusitis are often difficult to distinguish from viral upper respiratory infection, such an assessment remains the best approach to diagnosing acute sinusitis (strength of recommendation [SOR]: A). There is no role for imaging in the diagnosis of acute sinusitis. For patients who have persistent symptoms, or those for whom surgery is being considered, some guidelines suggest that coronal computed tomography (CT) scan of the paranasal sinuses be considered (SOR: C, expert opinion).
Paju S, Bernstein JM, Haase EM, Scannapieco FA
J Med Microbiol. 2003;52:591-597
Chronic maxillary sinusitis is a chronic inflammatory condition in which the role of microbial infection remains undefined. Bacteria have been isolated from chronically inflamed sinuses; however, their role in the chronicity of inflammation is unknown. The objective of this study was to determine whether bacteria are present in clinical samples from chronic maxillary sinusitis and to assess the diversity of the flora present. Washes and/or tissue samples from endoscopic sinus surgery on 11 patients with chronic maxillary sinusitis were subjected to PCR amplification of bacterial 16S rDNA using 3 universal primer pairs, followed by cloning and sequencing. The samples were also assessed for the presence of bacteria and fungi by conventional culture methods. Viable bacteria and/or bacterial 16S rDNA were detected from maxillary sinus samples of 5 of the 11 patients examined (45%). Three sinus samples were positive by both PCR and culture methods, one was positive only by PCR, and one only by culture. Thirteen bacterial species were identified: Abiotrophia defectiva, Enterococcus avium, Eubacterium sp., Granulicatella elegans, Neisseria sp., Prevotella sp., Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, Stenotrophomonas maltophilia, Streptococcus gordonii, Streptococcus mitis/Streptococcus oralis and Streptococcus sp. Fungi were not detected. In one patient, Streptococcus mitis/Streptococcus oralis, and in another patient Pseudomonas aeruginosa, were detected from both the sinus and the oral cavity using species-specific PCR primers. These results suggest that both aerobic and anaerobic bacteria can be detected in nearly half of chronic maxillary sinusitis cases.
Kalavagunta S, Reddy KT
Rhinology. 2003;41:113-117
Aim: To determine the incidence of variations of maxillary sinus pneumatization especially when it is extensive and the associated anomalies.
Study Design: Two hundred consecutive direct coronal paranasal sinus computed tomography (CT) scans were reviewed retrospectively. Extensive maxillary sinus pneumatization (EMSP) was defined as one in which the largest horizontal and/or vertical dimension of the maxillary sinus equalled or exceeded 90% of the corresponding diameter of the orbit. Further, subtype I, II, and III were defined depending on whether the pneumatization was extensive in one dimension (horizontal or vertical), 2 dimensions (horizontal and vertical) and by the presence of sphenomaxillary plate, intermaxillary plate, or extension into frontal recess.
Results: EMSP was found in 8%, of these 7% were bilateral and 1% was unilateral. (Subtype I, II, and III constituting 1%, 3%, and 4% respectively).
Conclusion: EMSP has been defined as a group and a classification proposed. EMSP will result in an atypical clinical picture, has a role in the pathogenesis of frontal sinusitis in some cases, and may predispose injury to the orbit during endoscopic sinus surgery (ESS).
Catalano PJ, Roffman EJ
Otolaryngol Head Neck Surg. 2003;128:875-881
Objectives: In this study, we compared postoperative synechia rates and morbidity for different middle meatal (MM) stents after minimally invasive sinus techniques (MIST).
Study Design: In a prospective study, we included 100 patients with bilateral chronic sinusitis undergoing MIST at a tertiary care facility with a single surgeon.
Methods: For all patients, MeroGel stents were placed in the right MM, Gelfilm stents were placed in the left MM. Follow-up consisted of 3 postoperative visits between weeks 1 and 12 with endoscopic evaluation for synechia, granulation tissue, stent retention, nasal obstruction, headache, and infection.
Results: Synechia developed in 4 patients on the left and in none on the right (P = .04). There were no significant side-specific differences regarding postoperative nasal congestion, headache, or sinusitis. Mean stent retention time was 7.9 days for MeroGel and 5.6 days for Gelfilm (P = .0004).
Conclusion: Compared with Gelfilm, Merogel MM stents produced less synechia; Merogel retains its position in the MM longer than Gelfilm; and the incidence of postoperative MM synechia can be reduced when absorbable MM stents are used in conjunction with MIST.
Passali D, Bernstein JM, Passali FM, Damiani V, Passali GC, Bellussi L
Arch Otolaryngol Head Neck Surg. 2003;129:656-659
Objective: To demonstrate the long-term efficacy of intranasal furosemide, an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell, vs no therapeutic intervention vs intranasal mometasone furoate, a corticosteroid, in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis.
Design: Randomized prospective controlled study. Patients were examined every 6 months during follow-up (range, 1 to 9 years).
Patients: One hundred seventy patients with bilateral obstructive or minimally obstructive chronic hyperplastic sinusitis with nasal polyposis.
Intervention: All patients were surgically treated in the ENT Department, University of Siena Medical School. One month after surgery, group 1 patients (n = 97) started treatment with intranasal furosemide; group 2 (n = 40) received no therapeutic treatment; and group 3 (n = 33) were treated with mometasone.
Main Outcome Measures: Clinical and instrumental evaluation of postoperative outcomes.
Results: Seventeen (17.5%) of 97 patients in group 1, 12 (30.0%) of 40 patients in group 2, and 8 (24.2%) of 33 patients in group 3 experienced nasal polyposis relapses. We noted a prevalence of early-stage relapse in patients treated with furosemide or mometasone; whereas patients who did not receive any treatment experienced more severe grades of chronic hyperplastic sinusitis with nasal polyposis (P < .005).
Conclusion: Use of intranasal furosemide represents a valid therapeutic treatment in the prevention of chronic hyperplastic sinusitis with nasal polyposis.
Matsune S, Kono M, Sun D, Ushikai M, Kurono Y
Acta Otolaryngol. 2003;123:519-523
Objectives: In order to elucidate the pathogenesis of the radiologic opacity of the sinuses frequently observed in patients with allergic rhinitis, the mechanisms underlying their sinus mucosal swelling were studied clinically.
Material and Methods: We confirmed the presence of hypoxia in inflamed sinuses and obstruction of the sinus ostium in operated patients with chronic sinusitis by digitally monitoring the oxygen tension. The possibility of radiologic sinus shadow was also investigated after transient obstruction of the natural ostium.
Results: The oxygen tension was significantly lower in inflamed than non-inflamed sinuses (P < .01), irrespective of the presence or absence of allergic rhinitis. In 54.5% of patients without sinusitis, transient obstruction of the middle meatus by gauze packing resulted in the appearance of a pathologic sinus shadow on radiograms obtained after septoplasty and turbinotomy. In both allergic and non-allergic rhinitis, thick opacity was the most frequently encountered pattern (P < .01).
Conclusion: Our study revealed that in the absence of a primary allergic reaction in the sinus mucosa, blocking of the middle meatus and ostium by allergic swelling of the nasal mucosa may induce hypoxia and secondary mucosal swelling in the sinuses.