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International Forum of Allergy &... Nov 2017Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting...
BACKGROUND
Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting their utility as imaging biomarkers. We hypothesized that software-aided, quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease.
METHODS
Adults with rhinologic complaints undergoing computed tomography imaging were recruited at an urban, academic, tertiary care center (n = 45 with Lund-Mackay [LM] scores ≥4). Three-dimensional (3D) volumetric image analysis was performed using a semiautomated method to obtain a "Chicago-modified Lund-Mackay" (Chicago MLM) score, which provides a continuous scale to quantify extent of opacification. Linear regression was used to test the association of the Chicago MLM score with concurrent symptoms (Total Nasal Symptom Score [TNSS]) and disease-specific quality of life, based on the Sinonasal Outcome Test-22 (SNOT-22).
RESULTS
Chicago MLM scores were significantly associated with both symptoms (p = 0.037) and disease-specific quality of life (p = 0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associations. These findings were even more robust when analysis was limited to patients with more severe disease (LM >6).
CONCLUSION
The quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use.
Topics: Adult; Chronic Disease; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Paranasal Sinuses; Quality of Life; Rhinitis; Severity of Illness Index; Sinusitis
PubMed: 28941169
DOI: 10.1002/alr.22014 -
Journal of Neurological Surgery. Part... Aug 2019Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no...
Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Prospectively randomized study. Tertiary academic center. Sixty patients underwent endoscopic endonasal pituitary surgery. Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Pre- and postoperative mean VAS scores were 71.67 ± 11.47 and 67.67 ± 9.71 mm in the intact septum group and 77.67 ± 14.06 and 62.67 ± 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.
PubMed: 31316889
DOI: 10.1055/s-0038-1673695 -
Korean Journal of Pediatrics Feb 2015Isolated sphenoid sinusitis is a rare disease in children, and its symptoms are often nonspecific and confusing. Rarely, severe headache can be the first or only symptom...
Isolated sphenoid sinusitis is a rare disease in children, and its symptoms are often nonspecific and confusing. Rarely, severe headache can be the first or only symptom of isolated sphenoid sinusitis. New daily persistent headache (NDPH) is a form of chronic daily headache that may have features of both migraines and tension-type headaches. NDPH is difficult to diagnose and requires a multifaceted approach. Here, we report on a 10-year-old boy and an 11-year-old girl who both presented with typical NDPH symptoms. These patients had no nasal symptoms or signs of infection. Neither nonsteroidal anti-inflammatory drugs nor topiramate had any effect on the headaches. Their neurological and ophthalmological examinations were normal. The results of routine blood work, including thyroid function tests, inflammatory markers, complete blood count, tests for viral infection, and a metabolic panel, were normal. A brain magnetic resonance imaging scan showed isolated sphenoid sinusitis. Both patients' symptoms resolved completely after approximately 1 month of oral antibiotics for sinusitis.
PubMed: 25774200
DOI: 10.3345/kjp.2015.58.2.73 -
The American Journal of Case Reports May 2023BACKGROUND Optic neuritis is a rare but possible complication of sphenoid sinusitis. CASE REPORT We present a case of a young woman with recurrent optic neuritis... (Review)
Review
BACKGROUND Optic neuritis is a rare but possible complication of sphenoid sinusitis. CASE REPORT We present a case of a young woman with recurrent optic neuritis associated with chronic sphenoid sinusitis. A 29-year-old woman with visual impairment of the left eye to Snellen distance best-corrected visual acuity (DBCVA) of 0.5 and migraine headaches accompanied by vomiting and dizziness reported to the ophthalmic emergency room. The preliminary diagnosis was demyelinating optic neuritis. On head computed tomography, a polypoid lesion of the sphenoid sinus was found and qualified for elective endoscopic treatment. During a 4-year follow-up, evaluation of DBCVA, fundus appearance, visual field, ganglion cells layer (GCL), peripapillary retinal nerve fiber layer (RNFL) thickness, and ganglion cells and visual pathway function (pattern electroretinogram - PERG, pattern visual evoked potentials - PVEPs) were performed. Four years after the occurrence of the initial symptoms, surgical drainage of the sphenoid sinus was performed, which revealed a chronic inflammatory infiltrate and a sinus wall defect on the left side around the entrance to the visual canal. After surgery, headaches and other neurological symptoms resolved, but DBCVA deteriorated in the left eye to finger counting/hand motion, partial atrophy of the optic nerve developed, the visual field defect progressed to 20 central degrees, GCL and RNFL atrophy appeared, and deterioration of ganglion cells and visual pathway function were observed. CONCLUSIONS In patients with optic neuritis and atypical headaches, sphenoid sinusitis should be considered in the differential diagnosis. Delayed laryngological intervention can cause irreversible damage to the optic nerve.
Topics: Female; Humans; Adult; Sphenoid Sinusitis; Evoked Potentials, Visual; Optic Neuritis; Vision Disorders; Chronic Disease; Headache; Tomography, Optical Coherence; Atrophy
PubMed: 37179452
DOI: 10.12659/AJCR.939267 -
Allergy Apr 2020Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings.
BACKGROUND
Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings.
OBJECTIVE
To describe radiologic sinus opacification and the prevalence of CRS, defined by the co-occurrence of symptoms and sinus opacification, in a general population-based sample.
METHODS
We collected questionnaires and sinus CT scans from 646 participants selected from a source population of 200 769 primary care patients. Symptom status (CRS ) was based on guideline criteria, and objective radiologic inflammation (CRS ) was based on the Lund-Mackay (L-M) score using multiple L-M thresholds for positivity. Participants with symptoms and radiologic inflammation were classified as CRS . We performed negative binomial regression to assess factors associated with L-M score and logistic regression to evaluate factors associated with CRS . Using weighted analysis, we calculated estimates for the source population.
RESULTS
The proportion of women with L-M scores ≥ 3, 4, or 6 (CRS ) was 11.1%, 9.9%, and 5.7%, respectively, and 16.1%, 14.6%, and 8.7% among men. The respective proportion with CRS was 1.7%, 1.6%, and 0.45% among women and 8.8%, 7.5%, and 3.6% among men. Men had higher odds of CRS compared to women. A greater proportion of men (vs women) had any opacification in the frontal, anterior ethmoid, and sphenoid sinuses.
CONCLUSION
In a general population-based sample in Pennsylvania, sinus opacification was more common among men than in women and opacification occurred in different locations by sex. Male sex, migraine headache, and prior sinus surgery were associated with higher odds of CRS .
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Humans; Inflammation; Male; Middle Aged; Paranasal Sinuses; Pennsylvania; Rhinitis; Sinusitis; Young Adult
PubMed: 31713250
DOI: 10.1111/all.14106 -
Journal of Ophthalmology 2021Acute invasive fungal rhinosinusitis (AIFRS) is a hazardous infectious disease with rapid progression and high mortality and morbidities. Further orbital involvement is...
BACKGROUNDS
Acute invasive fungal rhinosinusitis (AIFRS) is a hazardous infectious disease with rapid progression and high mortality and morbidities. Further orbital involvement is commonly seen. This study aims to analyze risk factors, clinical characteristics, and outcomes between patients with or without orbital involvement.
METHODS
A retrospective review was performed in a single tertiary medical center over a span of 13 years (2005-2018). A total of 21 patients with diagnosis of AIFRS were enrolled. We reviewed the patients' basic characteristics, comorbidities, clinical presentations, image study findings, culture pathogens, and treatment outcomes and analyzed the differences between orbital-involved and orbital sparing disease.
RESULTS
The most common comorbidities in AIFRS were diabetes mellitus (DM) and hematological malignancy. Nine the 21 AIFRS patients had orbital-involved disease. Patients with orbital involvement had a higher prevalence of DM ( < 0.05). Image studies revealed significant infection of the ethmoid sinus, sphenoid sinus, and frontal sinus in the group with orbital complication ( < 0.05). , and were cultured in both groups. Five patients in the orbital involvement group expired, with all of them having an initial presentation of conscious disturbance ( < 0.01). Rhino-orbital-cerebral fungal infection was noticed in 3 of the 5 expired patients.
CONCLUSION
In AIFRS patients, DM other than hematological malignancy was the main risk factor for orbital-involved disease. Patients with ethmoid, sphenoid, or frontal sinusitis had a higher possibility of orbital complication. Poor consciousness at initial presentation revealed highest possibility of rhino-orbital-cerebral fungal infection and led to death.
PubMed: 34194822
DOI: 10.1155/2021/9987871 -
Internal Medicine (Tokyo, Japan) May 2024A 64-year-old woman was transported to the emergency room with a headache and fever. She presented with a right ocular protrusion, hyperemia, and tenderness in the neck....
A 64-year-old woman was transported to the emergency room with a headache and fever. She presented with a right ocular protrusion, hyperemia, and tenderness in the neck. Contrast-enhanced MRI of the head showed a high DWI signal in the bilateral sphenoid sinuses and contrast defects along the bilateral internal jugular and superior ophthalmic veins. Blood and CSF cultures revealed Streptococcus milleri group. Surgery was performed for Lemierre's syndrome secondary to sphenoid sinusitis. The patient was treated with antibiotics and anticoagulant therapy, but a duodenal ulcer and brain abscess thereafter developed. However, multidisciplinary endoscopic and surgical treatment saved her life.
Topics: Humans; Female; Lemierre Syndrome; Middle Aged; Streptococcus milleri Group; Streptococcal Infections
PubMed: 37743513
DOI: 10.2169/internalmedicine.2311-23 -
NMC Case Report Journal Apr 2016Pneumocephalus is a rare but important complication of acute isolated sphenoid sinusitis (ISS). If not adequately treated, it may cause serious neurological and...
Pneumocephalus is a rare but important complication of acute isolated sphenoid sinusitis (ISS). If not adequately treated, it may cause serious neurological and life-threatening complications. We report the presence of free air in the cavernous sinus arising from intracranial extension of acute ISS. A 41-year-old healthy man presented to our department with a 7-day history of headache. Neurological examination revealed no meningitis, and cerebrospinal fluid culture was negative. A head computed tomography (CT) and magnetic resonance imaging on admission revealed sinusitis in the sphenoid sinus and presence of air in the cavernous sinus. We started an antibiotic treatment and the patient's fever immediately decreased and the inflammatory response improved. In addition, the bilateral retro-orbital headache diminished. A repeated head CT scan revealed that fluid retention in the sphenoid sinus and air in the cavernous sinus had disappeared. To our knowledge, this is the fifth case of pneumocephalus accompanied by acute ISS reported in the literature and the first case report of intracranial air located only in the cavernous sinus. Meningitis accompanied by pneumocephalus can be a warning sign for poor outcome in patients with ISS.
PubMed: 28663997
DOI: 10.2176/nmccrj.cr.2015-0260 -
European Journal of Case Reports in... 2018Orbital apex syndrome (OAS) is an uncommon disorder characterized by visual loss, ophthalmoplegia, ptosis and hypoaesthesia of the forehead. OAS may result from a...
UNLABELLED
Orbital apex syndrome (OAS) is an uncommon disorder characterized by visual loss, ophthalmoplegia, ptosis and hypoaesthesia of the forehead. OAS may result from a variety of inflammatory, infectious, neoplastic and vascular conditions that cause damage to the superior orbital fissure (with resultant oculomotor (III), trochlear (IV), abducens (VI) and ophthalmic branch of the trigeminal nerve (V1) palsies) and to the optic canal leading to optic nerve (II) dysfunction. This case report describes the clinical development of OAS in a patient with bacterial sphenoid sinusitis.
LEARNING POINTS
Orbital apex syndrome (OAS) is an uncommon manifestation of a wide range of disease entities, with management ranging from antibiotic therapy to immunosuppression and surgery.OAS can be life-threatening if there is disease invasion through ophthalmic vessels or bone fissures, leading to intra-cranial involvement.Without adequate knowledge and clinical suspicion, OAS can be easily missed or misdiagnosed, resulting in delayed treatment and devastating loss of function or even death.
PubMed: 30756053
DOI: 10.12890/2018_000905 -
Indian Journal of Otolaryngology and... Oct 2022Describe experience of managing paranasal sinus mucoceles, with either endoscopic endonasal approach (EESS) or combined external with EESS approach. Retrospective study...
Describe experience of managing paranasal sinus mucoceles, with either endoscopic endonasal approach (EESS) or combined external with EESS approach. Retrospective study done at SDMCMS&H, between 2007 and 2019, on patients undergoing surgical excision of mucocele. Results described as mean, median, mode, percentages. Twenty-one patients were included, with male to female ratio (0.75:1), mean age (42.95 years). Commonest presentation were facial pain (42.85%),visual symptoms (28.57%), headache (23.80%). Signs included, proptosis (52.38%), facial deformity (23.80%). Imaging: showed frontal mucoceles (42.85%), fronto-ethmoid (38.09%), ethmoid (14.28%), sphenoid (4.76%). Orbital extension in 42.85%, sinusitis (33.33%), skull base erosion (23.80%). EESS or combined external and EESS approach (61.90%, 38.09% respectively) were performed. Complete excision of mucocele wall done. Recurrence in two cases(average-2.5 years),revision surgery performed without further recurrences. Either EESS or combined external and EESS approach used based on site and extension of mucoceles. Complete peeling of mucocele wall without obliteration of the sinus cavity was the mode of surgical management in all cases.
PubMed: 36452573
DOI: 10.1007/s12070-020-02206-z