Radiologic imaging in the management of sinusitis.
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Sinusitis is one of the most common diseases treated by primary care physicians. Uncomplicated sinusitis does not require radiologic imagery. However, when symptoms are recurrent or refractory despite adequate treatment, further diagnostic evaluations may be indicated. Plain radiography has a limited role in the management of sinusitis. Although air-fluid levels and complete opacification of a sinus are more specific for sinusitis, they are only seen in 60 percent of cases. Noncontrast coronal computed tomographic (CT) images can define the nasal anatomy much more precisely. Mucosal thickening, polyps, and other sinus abnormalities can be seen in 40 percent of symptomatic adults; however, clinical correlation is needed to avoid overdiagnosis of sinusitis because of nonspecific CT findings. Use of CT is typically reserved for difficult cases or to define anatomy prior to sinus surgery. Magnetic resonance imaging (MRI) cannot define bony anatomy as well as CT. MRI is only used to differentiate soft-tissue structures, such as in cases of suspected fungal infection or neoplasm. Referral will occasionally be needed in unusual or complicated cases. Immunocompromised persons and smokers are at increased risk for serious sinusitis complications. (+info)
Nasal septal perforation caused by invasive fungal sinusitis.
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Nasal septal perforation presents a distinct challenge to otorhinolaryngologists, and is a problem for patients. Although it has a variety of causes, previous septal surgery is the most common reason. We present a 57-year-old woman who had recurrent chronic sinusitis. A left nasal mass was noted and excised via endoscopic sinus surgery. Invasive aspergillosis sinusitis was proven both grossly and histopathologically, and a nasal septal perforation was also noted during the operation. Although there has been only a single other case presented by Siberry in 1997, we postulate that perforation of the nasal septum as with the case described herein is a rare complication of invasive fungal sinusitis. (+info)
Sinus computed tomography scan and markers of inflammation in vocal cord dysfunction and asthma.
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BACKGROUND: The inappropriate closure of the vocal cords is characteristic of vocal cord dysfunction (VCD). These patients present with wheezing and frequently receive a misdiagnosis of asthma. OBJECTIVE: To demonstrate the ability of computed tomography (CT) scored for the presence and extent of sinus disease and markers of inflammation to distinguish patients with VCD from patients with asthma. METHODS: Comparisons of 13 patients with VCD were made to 77 patients presenting to the emergency room with acute asthma, 31 non-acute asthmatic patients, and 65 nonasthmatic controls. Evaluation consisted of exhaled nitric oxide gas (eNO), circulating eosinophils, and total serum immunoglobulin (Ig)E, as well as the sinus CT scan. RESULTS: Extensive sinus CT changes were present in 23 of 74 acute asthmatic patients, 5 of 29 non-acute asthmatic patients, and 2 of 59 nonasthmatic controls. In addition, absolute eosinophil counts, eNO, and total IgE were significantly elevated among the asthmatic patients. Sinus symptoms reported by questionnaire did not predict sinus CT findings. Among the patients with VCD, none had extensive sinus disease. They also had normal eNO, low IgE, and normal eosinophil count. Five of the patients presenting to the emergency room who were identified as acute asthmatic were identified with VCD by laryngoscopy and were all characterized by the absence of significant inflammation on their sinus CT scan, low IgE, and normal eosinophil count. CONCLUSIONS: Among patients presenting with intermittent or reversible airway obstruction, patients with VCD can be distinguished from asthma by minimum or absence of inflammation in their sinuses as shown by CT scan. Clinical symptom scores are not predictive of presence or extent of sinus disease in most cases. (+info)
Radio-tympano-sinu-orthesis with 186Re-colloid: a new treatment modality for chronic otitis media and paranasal mucositis.
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This preliminary treatment trial was performed to evaluate the safety and clinical efficacy of intracavitary therapy with (186)Re-colloid in patients with recurrent otitis media and paranasal sinusitis, resistant to pharmacotherapy and surgical treatment. METHODS: Thirty-nine applications of 5-35 MBq (186)Re-colloid into the tympanon and the paranasal sinuses were performed in 6 patients. Biodistribution and biokinetics were studied by gamma-camera imaging. Clinical success was documented 6-20 mo after therapy by each patient's self-evaluation and by rhinootologic follow-up, using a 4-step score. RESULTS: No harmful side effects were seen. There was good-to-excellent clinical improvement with a score of +1.44 +/- 0.5 by each patient's self-evaluation and by physicians scoring of +0.81 +/- 0.9 with only negligible extracranial tracer deposition. CONCLUSION: This novel treatment option using intracavitary application of (186)Re-colloid in chronic otitis media and sinusitis is safe and effective. The term "radio-tympano-sinu-orthesis" might be proposed analogously to the well-known radiosynoviorthesis. (+info)
Low dose sultamicillin in acute sinusitis.
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OBJECTIVES: To study the effectiveness of low dose sultamicillin in the treatment of acute sinusitis. METHODS: A total of 108 patients, between 16-56 years of age (mean 32.8), suffering from acute sinusitis took part in the trial. Patients received orally 2 x 375 mg sultamicillin, and compared with patients receiving 3 x 500 mg amoxicillin. The first control was made between the 5th and 7th days. A patient was considered clinically cured when all pretreatment signs and symptoms of infection were eliminated. Clinical improvement was defined as the partial disappearance of pretreatment signs and symptoms. In either result, study drugs were reconstituted for additional 5 days. Failure was defined as no change or worsening of signs and symptoms; and study drug was changed. The second control was made between 10-12th days, and the third was four weeks later. RESULTS: The clinical success (improvement + cure) rate was (17+11)/42 (66.6%) and (28+21)/66 (74.2%) for amoxicillin and sultamicillin respectively, at first control. All improved patients were cured at the second control. No significant side-effects were noted in either amoxicillin or sultamicillin treated patients. All side effects were gastrointestinal, 11.9% and 3.0% in the same order. CONCLUSIONS: Low dose sultamicillin was comparable to amoxicillin; sultamicillin has fewer side effects than amoxicillin (p>0.05). (+info)
Yellow-nail syndrome: report of three cases.
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The yellow nail syndrome, a combination of yellow discolouration of and dystrophic changes in the nails, pleural effusions and lymphedema, is thought to be relatively rare; to date 44 cases have been reported. Of a further three patients with this syndrome, one had all three features, one had the yellow nails alone and the other had pleural effusions and lymphedema without classic nail changes. Each had recurrent lower respiratory tract infections; and of all 47, chronic pulmonary infections occurred in approximately one quarter and were frequently associated with chronic sinus infections. The underlying abnormality is presumed to be a congenital defect of the lymphatics, but so far this has not been demonstrated to be the cause of the nail changes, the pathogenesis of which remains obscure. (+info)
Measures of health-related quality of life for adults with acute sinusitis. A systematic review.
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CONTEXT: Symptoms suggestive of acute sinusitis are a common reason for patients to visit primary care providers. Since objective measures of outcome have not been shown to be related to patient reported outcomes, measures of treatment success have focused on symptom relief and improved health-related quality of life (HRQL). Assessing the appropriate role of treatment - for example, antibiotics for patients with acute sinusitis - requires valid, reliable, and responsive measures of outcome. We identified symptom scores and HRQL instruments for adults with sinusitis and assessed their performance characteristics. DATA SOURCES: Articles identified through computer searches of the medline, premedline, and embase databases, the Cochrane Library, and internet documents; inquiries to experts in sinusitis and outcomes assessment; and review of reference lists. STUDY SELECTION: Studies that used HRQL instruments or evaluated the performance characteristics of symptom scores in adults with sinusitis, published in English after 1966. DATA EXTRACTION: Two reviewers independently extracted data on study design, setting, and patient characteristics; instrument length and format; and instrument validity, reliability, responsiveness to change, and interpretability. Study quality was assessed using a 10-point score. DATA SYNTHESIS: Of 1,340 articles in the original search, 29 articles using 16 HRQL instruments and 5 symptoms scores met inclusion and exclusion criteria. The overall quality of these studies was low; only 4 studies scored higher than 4 of 10 points. Four studies included patients with acute sinusitis, but only 2 included exclusively acute sinusitis patients. Three instruments have been shown to meet basic requirements for validity, reliability, and responsiveness: the Chronic Sinusitis Survey, the Rhinosinusitis Outcome Measure-31, and the Sinonasal Outcome Test-16. No instrument has been validated in a primary care setting or for patients with acute sinusitis. CONCLUSIONS: Few validated measures of sinusitis-specific HRQL are available. The 3 instruments shown to be valid, reliable, and responsive have been assessed in patients with chronic sinusitis. No measure has been validated in primary care settings or for patients with acute sinusitis. A lack of valid, responsive outcome measures may limit current treatment recommendations for patients with acute sinusitis. (+info)
The pre-travel medical evaluation: the traveler with chronic illness and the geriatric traveler.
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The pre-travel medical evaluation of elderly patients and patients with chronic illness requires special assessment and advice. Screening and special precautions are reviewed for traveling patients with respiratory disease, cardiac disease, sinusitis, diabetes mellitus, HIV infection, and other chronic medical conditions. Current guidelines for empiric therapy and prophylaxis of travelers' diarrhea are reviewed, with emphasis on concerns in geriatric or chronically ill travelers. Special considerations such as potential drug-drug interactions and insurance coverage are also discussed. (+info)