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Asian Journal of Surgery Jan 2023Acute invasive fungal rhinosinusitis (AIFR) is a rare disease, but the prognosis is by no means ideal. Pathologically, fungal infection is not only located in the sinus... (Review)
Review
Acute invasive fungal rhinosinusitis (AIFR) is a rare disease, but the prognosis is by no means ideal. Pathologically, fungal infection is not only located in the sinus cavity, but also invades the sinus mucosa and bone wall, the surrounding structures and tissues such as the orbit and anterior skull base are often compromised and are accompanied with intracranial and extracranial complications. Despite decades of efforts, acute invasive fungal rhinosinusitis remains a devastating disease, the mortality of the disease continues to hover around 50%. The main impediments to improving the prognosis of acute invasive fungal rhinosinusitis are the difficulties of early diagnosis and the rapid reversal of immune insufficiency. Moreover, aggressive surgery combined with systemic antifungal therapy are significant positive prognostic factors as well. Progress and standardization of AIFR treatment protocols have been limited by the scarcity of the disease and the absence of published randomized studies. Therewith, how to improve the therapeutic outcome and reduce the mortality rate has always been a challenging clinical discussion. We have summarized the relevant case series and literature from the recent years, management with optimal diagnostic and curative strategies are reviewed.
Topics: Humans; Rhinitis; Sinusitis; Paranasal Sinuses; Mycoses; Acute Disease
PubMed: 35589479
DOI: 10.1016/j.asjsur.2022.05.006 -
International Journal of Pediatric... May 2022Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications,...
OBJECTIVE
Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention.
METHODS
A retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted.
RESULTS
65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%.
CONCLUSION
Intracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.
Topics: Brain Abscess; Child; Empyema, Subdural; Epidural Abscess; Humans; Otitis Media; Retrospective Studies; Sinusitis; Suppuration
PubMed: 35272257
DOI: 10.1016/j.ijporl.2022.111093 -
Advances in Pediatrics Aug 2022Rhinosinusitis in children, as in adults, can be classified by duration (acute, recurrent, and chronic) and by cause (viral, bacterial, and inflammatory) and needs to be... (Review)
Review
Rhinosinusitis in children, as in adults, can be classified by duration (acute, recurrent, and chronic) and by cause (viral, bacterial, and inflammatory) and needs to be treated accordingly after careful investigation which include through clinical history, laboratory tests, and, if necessary, nasal endoscopy and imaging studies.
Topics: Adult; Child; Chronic Disease; Humans; Rhinitis; Sinusitis
PubMed: 35985718
DOI: 10.1016/j.yapd.2022.03.012 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jul 2022To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children. The data of 51 cases with acute sinusitis comorbid...
To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children. The data of 51 cases with acute sinusitis comorbid with orbital cellulitis in Tianjin Children's Hospital from April 2016 to March 2021 were retrospectively analyzed. According to the extent of infection, the patients were divided into two groups:pre-septal orbital cellulitis(7 cases) and post-septal orbital cellulitis(44 cases). The general clinical characteristics, clinical manifestations, laboratory examination and treatment were compared between the two groups. Among them, 23 cases(6 in pre-septal orbital cellulitis group and 17 in post-septal orbital cellulitis group) were cured by medicine treatment; 28 cases were cured by surgical treatment after failure of medicine treatment. There was no significant difference in age, gender and medical history between the two groups. Redness, swelling, heat and pain in eyelid was the most common clinical manifestations of orbital cellulitis in children, followed by fever, headache, runny nose, eye fixation, and vision loss. WBC count and neutrophils percentage were significantly higher in post-septal orbital cellulitis group. All children were followed up for 3 months to 3 years, 1 case was lost to follow-up, 50 cases had no recurrence and recovered well. Orbital cellulitis is a common and rapid developing complication of sinusitis in children. Early diagnosis and effective anti-infection treatment are very important for prognosis. Orbital CT plays an important role in the determination and evaluation of this complication. When conservative treatment is ineffective, surgical drainage in time can reduce the occurrence of serious ocular sequelae.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Humans; Orbital Cellulitis; Retrospective Studies; Sinusitis
PubMed: 35822379
DOI: 10.13201/j.issn.2096-7993.2022.07.008 -
JAMA Jan 2024
Comparative Study
Topics: Child; Humans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Sinusitis; Acute Disease; Drug Combinations; Anti-Bacterial Agents
PubMed: 38227039
DOI: 10.1001/jama.2023.23642 -
Annals of Allergy, Asthma & Immunology... Nov 2022To summarize the pitfalls associated with defining exactly what constitutes an "impaired" antibody response to polysaccharide antigens and the importance of documenting... (Review)
Review
OBJECTIVE
To summarize the pitfalls associated with defining exactly what constitutes an "impaired" antibody response to polysaccharide antigens and the importance of documenting actual pyogenic infections before making a diagnosis of an immune deficiency. Specific antibody deficiency is an immune deficiency defined by the presence of normal quantitative levels of immunoglobulins, but impaired antibody responses to polysaccharide antigens, in patients presenting with frequent otosinopulmonary infections with pyogenic bacteria.
DATA SOURCES
PubMed review using the following keywords: specific antibody deficiency, pneumococcal vaccination, Salmonella vaccination, infectious sinusitis.
STUDY SELECTION
This review focused on key studies that have been utilized to define what constitutes a "normal" humoral immune response to pneumococcal and Salmonella vaccination in healthy subjects and on published studies defining current expert opinion.
RESULTS
Published studies demonstrate wide variability in response to pneumococcal vaccination in healthy individuals, making it daunting to define what constitutes an abnormal response. These challenges are exacerbated by striking laboratory variability in reporting results.
CONCLUSION
Clinical examinations in individuals with self-reported recurrent acute sinusitis or lower respiratory infections need to document an infectious etiology with pyogenic bacteria and must rule out an underlying primary airway inflammatory disorder before consideration is made regarding the presence of an immune deficiency. In addition, decision making regarding diagnosis and treatment of patients who are examined for humoral immunodeficiency should not hinge solely on the strict application of defined cutoffs for "normal" response to a single polysaccharide vaccine, but rather a global assessment of humoral immune function in the context of the clinical presentation.
Topics: Humans; Antibodies, Bacterial; Pneumococcal Vaccines; Streptococcus pneumoniae; Primary Immunodeficiency Diseases; Immunologic Deficiency Syndromes; Vaccination; Sinusitis
PubMed: 35671934
DOI: 10.1016/j.anai.2022.05.028 -
Seminars in Arthritis and Rheumatism Feb 2022To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA).
OBJECTIVE
To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA).
METHODS
This case-control study using the Mass General Brigham Biobank matched incident RA cases, confirmed by ACR/EULAR criteria, with at least seven years preceding electronic health record (EHR) data to three controls on age, sex, and EHR history from RA diagnosis (index date). We ascertained timing (>0-5 years/>5-10 years/>10 years) of the first documented respiratory tract disease prior to index date using diagnosis codes. We estimated odds ratios (OR) with 95% confidence intervals (CI) for RA for each respiratory exposure using logistic regression models, adjusting for potential confounders. We also conducted a stratified analysis by serostatus and smoking.
RESULTS
We identified 625 incident RA cases (median 56 years, 75% female, 57% seropositive) and 1,875 controls. Acute sinusitis was associated with RA only in the >5 to 10 years before RA (OR 3.90, 95% CI:1.90,8.01). In contrast, pneumonia was associated with RA only in the >0 to 5 years before RA (OR 1.73, 95% CI:1.00,3.00), and chronic respiratory tract diseases only >10 years before RA (OR 1.43, 95% CI:1.00,2.05). All respiratory tract diseases tended to show a stronger association with seronegative RA than seropositive RA, although the interaction was statistically significant only for chronic sinusitis (p=0.04). Respiratory diseases showed a nonsignificantly stronger association among smokers than nonsmokers.
CONCLUSION
Sinusitis and other respiratory diseases are associated with increased risk of RA, especially 5 years before RA onset. RA may begin many years before clinical onset.
Topics: Arthritis, Rheumatoid; Case-Control Studies; Female; Humans; Incidence; Male; Risk Factors; Sinusitis; Smoking
PubMed: 35042150
DOI: 10.1016/j.semarthrit.2021.11.008 -
Current Allergy and Asthma Reports Feb 2023To analyze and compare the effects of herbal medicines (HMs) for treating different forms of rhinosinusitis. (Meta-Analysis)
Meta-Analysis Review
PURPOSE OF REVIEW
To analyze and compare the effects of herbal medicines (HMs) for treating different forms of rhinosinusitis.
RECENT FINDINGS
Forty-seven randomized controlled trials evaluating 18 HMs in six different rhinosinusitis populations were included in the network meta-analysis. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. For the common cold, Pelargonium sidoides offered the most beneficial effect on symptom improvement (moderate certainty of evidence). For acute post-viral rhinosinusitis, Cineole and Pelargonium sidoides were the most effective treatments for controlling symptoms (moderate certainty), while Spicae aetheroleum was most effective for health-related quality of life (HRQoL) improvement (moderate certainty). For chronic rhinosinusitis without nasal polyps (CRSsNP), Origanum vulgare was the most beneficial treatment for improving symptoms and HRQoL (low certainty). Evidence of HMs for acute bacterial rhinosinusitis, chronic rhinosinusitis with nasal polyps, and unclassified chronic rhinosinusitis was restricted to a limited number of studies. Adverse events should be of concern in some HMs, such as Spicae aetheroleum or Mytorl. Several HMs improved patient-important outcomes, above minimal clinically important differences, in treating common cold, acute post-viral rhinosinusitis, and CRSsNP. Further studies with adequate sample sizes and long-term follow-ups are warranted to support the current evidence.
TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION
PROSPERO ID: CRD42022328265 May 10, 2022.
Topics: Humans; Nasal Polyps; Common Cold; Network Meta-Analysis; Quality of Life; Sinusitis; Acute Disease; Chronic Disease; Plant Extracts
PubMed: 36609950
DOI: 10.1007/s11882-022-01060-z -
American Journal of Rhinology & Allergy Nov 2022Nasal mucus is proving to be a useful means by which to study the pathogenesis of chronic rhinosinusitis (CRS). Given the increase in publications examining nasal mucus... (Review)
Review
BACKGROUND
Nasal mucus is proving to be a useful means by which to study the pathogenesis of chronic rhinosinusitis (CRS). Given the increase in publications examining nasal mucus and the lack of a review on this topic, we will focus on this noninvasive approach to studying CRS. Particular attention will be drawn towards inflammatory cytokines and biomarkers and their influence on disease severity.
METHODS
A literature review of papers published in English pertaining to nasal mucus was performed using the PubMed database. The search utilized combinations of the following keywords: sinusitis, polyps, sample collection, nasal mucus, or nasal secretion. Studies solely on acute or bacterial sinusitis, allergic rhinitis, or cystic fibrosis were not included.
RESULTS
A wide variety of materials and methods have been used to collect nasal mucus. Numerous assay types have been performed with the most common being ELISA, cytometric bead array, and proteomics. Most studies have focused on examining the levels of Th1/Th2 cytokines along with chemokines associated with type 2 immunity. Other factors identified include growth factors, senescence-associated proteins, complement, and antimicrobial defenses have also been identified. Nasal mucus cytokines have proven useful in cluster analysis and predicting postoperative improvement in Sino-nasal Outcome Test (SNOT-22) scores. One limitation of the use of nasal mucus is that some studies have suggested that nasal mucus does not always reflect the tissue microenvironment.
CONCLUSIONS
Nasal mucus represents a critical tool by which to examine the sinonasal microenvironment in a noninvasive manner. Unlike studies of tissue, it can be utilized in both surgically and medically managed patients and avoids the trauma of biopsies. However, studies are still needed to determine the most effective method for nasal mucus collection. Studies should also take care to confirm that nasal mucus markers do, in fact, reflect the levels of the product studied in the tissue.
Topics: Biomarkers; Chronic Disease; Cytokines; Humans; Mucus; Nasal Polyps; Rhinitis; Sinusitis
PubMed: 35848564
DOI: 10.1177/19458924221111830 -
Otolaryngology--head and Neck Surgery :... Apr 2022Odontogenic sinusitis (ODS) can cause infectious orbital, intracranial, and osseous complications. Diagnosis and management of complicated ODS have not been discussed in...
OBJECTIVE
Odontogenic sinusitis (ODS) can cause infectious orbital, intracranial, and osseous complications. Diagnosis and management of complicated ODS have not been discussed in recent sinusitis guidelines. The purpose of this systematic review was to describe epidemiological and clinical features, as well as management strategies of complicated ODS.
DATA SOURCES
PubMed, EMBASE, and Cochrane Library.
REVIEW METHODS
A systematic review was performed to describe various features of complicated ODS. All complicated ODS studies were included in qualitative analysis, but studies were only included in quantitative analysis if they reported specific patient-level data.
RESULTS
Of 1126 studies identified, 75 studies with 110 complicated ODS cases were included in qualitative analysis, and 47 studies with 62 orbital and intracranial complications were included in quantitative analyses. About 70% of complicated ODS cases were orbital complications. Only 23% of complicated ODS studies were published in otolaryngology journals. Regarding ODS-related orbital and intracranial complications, about 80% occurred in adults, and 75% were male. Complicated ODS occurred most commonly from apical periodontitis of maxillary molars. There were no relationships between sinusitis extent and orbital or intracranial complications. High rates of anaerobic and α-hemolytic streptococcal bacteria were identified in complicated ODS. Management generally included systemic antibiotics covering aerobic and anaerobic bacteria, and surgical interventions were generally performed to address both the complications (orbital and/or intracranial) and possible infectious sources (dentition and sinuses).
CONCLUSION
ODS should be considered in all patients with infectious extrasinus complications. Multidisciplinary management between otolaryngologists, dental specialists, ophthalmologists, and neurosurgeons should be considered to optimize outcomes.
Topics: Adult; Anti-Bacterial Agents; Humans; Male; Orbital Diseases; Otolaryngologists; Otolaryngology; Paranasal Sinuses; Sinusitis
PubMed: 34253072
DOI: 10.1177/01945998211026268