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Journal of Clinical Epidemiology Sep 2000The objective of this study was to assess the discriminative properties of the methods for diagnosing acute maxillary sinusitis (AMS) in unselected patients. The study... (Comparative Study)
Comparative Study Meta-Analysis
The objective of this study was to assess the discriminative properties of the methods for diagnosing acute maxillary sinusitis (AMS) in unselected patients. The study design was a systematic review of evaluation studies identified by using Medline, by searching reference lists, by hand searches, and by contacting investigators. Evaluation studies were conducted anywhere in the world. Subjects were adults with suspected AMS. Main outcome measures were: sensitivity, specificity, positive and negative likelihood ratios of the primary studies, weighted means of these parameters in each comparison (clinical examination, radiography, and ultrasound compared to a reference standard in diagnosing AMS), and summary ROC curves and their Q* points where sensitivity equals specificity. For the years from 1962 to present, 49 study reports were found; 11 articles on studies that included a total of 1144 patients were eligible. Compared to sinus puncture, radiography was the most accurate method for diagnosing AMS: the Q* point on the summary ROC curve was 0.82 (95% confidence interval, CI, 0.78-0.85). Ultrasound was slightly less accurate than radiography compared to sinus puncture (Q* 0.80, 95% CI 0.76-0.83). Only two articles reported clinical examination compared to sinus puncture and the Q* for them was 0.75 (95% 0.58-0.86). Clinical examination is a rather unreliable method for diagnosing AMS, even in the hands of experienced specialists. Using radiography or ultrasound improves the accuracy of diagnosis. The diagnosis of AMS is rarely studied in primary care settings. Future comparative trials should preferably combine diagnosis and treatment, evaluating the two aspects of clinical management as unit.
Topics: Acute Disease; Adult; Humans; Maxillary Sinusitis; Punctures; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography
PubMed: 11004420
DOI: 10.1016/s0895-4356(99)00213-9 -
American Journal of Otolaryngology 2015Culture-directed antibiotic therapy represents an important component in the management paradigm of chronic rhinosinusitis (CRS). The objective of this study was to... (Review)
Review
BACKGROUND
Culture-directed antibiotic therapy represents an important component in the management paradigm of chronic rhinosinusitis (CRS). The objective of this study was to systematically review the literature to assess culture yield of the most common aerobic and anaerobic pathogens.
METHODS
A total of 43 studies between 1975 and 2010 were included.
RESULTS
The composite data comprised 3528 patients with 6005 total culture specimens. The cultures were obtained in operating room in 33 (76.7%) and clinic in 10 (23.3%) of the studies, respectively. The most common site of culture was the maxillary sinus in 18 (41.9%) of the studies. The most common assay techniques reported were swab in 19 (44.2%) and aspirate in 12 (27.9%) studies. The most common gram positive aerobes reported were coagulase negative Staphylococcus and Staphylococcus aureus in 630 (34.7%) and 481 (26.5%) of the cultures, respectively. The most common gram negative aerobes included Haemophilus influenzae and Pseudomonas aeruginosa in 245 (27.0%) and 198 (21.6%) cultures, respectively. The most common anaerobes reported were Peptostreptococcus species in 156 (19.6%) and Bacteroides species in 153 (19.2%) cultures.
CONCLUSION
This study provides a composite snapshot of the literature accrued on the microbiology of CRS. It should serve to apprise clinicians on the most common aerobic and anaerobic organisms in CRS patients when employing culture-directed antimicrobial therapy.
Topics: Anti-Infective Agents; Chronic Disease; Endoscopy; Humans; Pseudomonas Infections; Pseudomonas aeruginosa; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus
PubMed: 25964173
DOI: 10.1016/j.amjoto.2015.04.010 -
Clinical Implant Dentistry and Related... Jun 2024Cone-beam computed tomography (CBCT) imaging of the maxillary sinus is indispensable for implantologists, offering three-dimensional anatomical visualization,... (Review)
Review
Cone-beam computed tomography (CBCT) imaging of the maxillary sinus is indispensable for implantologists, offering three-dimensional anatomical visualization, morphological variation detection, and abnormality identification, all critical for diagnostics and treatment planning in digital implant workflows. The following systematic review presented the current evidence pertaining to the use of artificial intelligence (AI) for CBCT-derived maxillary sinus imaging tasks. An electronic search was conducted on PubMed, Web of Science, and Cochrane up until January 2024. Based on the eligibility criteria, 14 articles were included that reported on the use of AI for the automation of CBCT-derived maxillary sinus assessment tasks. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to evaluate the risk of bias and applicability concerns. The AI models used were designed to automate tasks such as segmentation, classification, and prediction. Most studies related to automated maxillary sinus segmentation demonstrated high performance. In terms of classification tasks, the highest accuracy was observed for diagnosing sinusitis (99.7%), whereas the lowest accuracy was detected for classifying abnormalities such as fungal balls and chronic rhinosinusitis (83.0%). Regarding implant treatment planning, the classification of automated surgical plans for maxillary sinus floor augmentation based on residual bone height showed high accuracy (97%). Additionally, AI demonstrated high performance in predicting gender and sinus volume. In conclusion, although AI shows promising potential in automating maxillary sinus imaging tasks which could be useful for diagnostic and planning tasks in implantology, there is a need for more diverse datasets to improve the generalizability and clinical relevance of AI models. Future studies are suggested to focus on expanding the datasets, making the AI model's source available, and adhering to standardized AI reporting guidelines.
PubMed: 38863306
DOI: 10.1111/cid.13352 -
American Journal of Rhinology & Allergy May 2021RARS is a challenging clinical phenomenon that affects many patients, and diagnostic criteria for this condition are not fully characterized in the literature.
BACKGROUND
RARS is a challenging clinical phenomenon that affects many patients, and diagnostic criteria for this condition are not fully characterized in the literature.
OBJECTIVE
To examine diagnostic criteria for recurrent acute rhinosinusitis (RARS).
STUDY DESIGN
Systematic review.
METHODS
Cochrane, PubMed (MEDLINE), clinicaltrials.gov, EMBASE, Google Scholar, and Web of Science databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA statement guidelines. Full text articles pertinent to the diagnostic criteria of RARS were included in this review. Inclusion criteria included articles specifically addressing RARS; studies with 3 or more patients; and articles in English.
RESULTS
A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 22 of these ultimately met inclusion criteria. The level of evidence was generally low. Studies and guidelines have used many different definitions for RARS diagnosis over the years based on symptomatology, physical examination, nasal endoscopy, imaging, and laboratory domains. Clinically important RARS has been defined most commonly as 4 or more discrete episodes of ARS per year, but this frequency is typically based on expert opinion. Additionally, radiologic anatomic associations such as concha bullosa, accessory maxillary os, and narrowed infundibular distance may be associated with RARS. Endoscopic visualization and imaging are sometimes used to confirm the presence of sinus disease during exacerbations of RARS, but there is variability in this practice.
CONCLUSION
The diagnostic definition for RARS has developed over time and is currently based on low level 4 and 5 evidence. Because of the migratory definition of RARS, comparing inter-study results of RARS management remains difficult, and future studies should aim to follow current expert guidelines on diagnostic criteria of RARS.
Topics: Acute Disease; Humans; Recurrence; Retrospective Studies; Rhinitis; Sinusitis
PubMed: 32954839
DOI: 10.1177/1945892420956871 -
Journal of Otolaryngology - Head & Neck... Jul 2019Ectopic sinonasal teeth are uncommon. The classic approach to removal of such foreign bodies was the Caldwell-Luc. In recent years however, endoscopic approaches have...
INTRODUCTION
Ectopic sinonasal teeth are uncommon. The classic approach to removal of such foreign bodies was the Caldwell-Luc. In recent years however, endoscopic approaches have become increasingly utilized. Despite this, there is a dearth of literature and consensus regarding the endoscopic removal of ectopic sinonasal teeth. As such, we conducted a systematic review on all cases of endoscopic removal of ectopic sinonasal teeth in the literature. With an understanding of the literature, clinical and technical decision making for patients with this pathology may be elucidated.
METHODS
Systematic review of the Ovid Medline, EMBASE Classic and Pubmed databases were conducted using PRISMA guidelines.
RESULTS
Our search identified 100 articles. Final inclusion consisted of 23 studies with a total of 27 patient cases. The majority of the patients included were male (70.4%) with a mean age of 27.06 years. Patients presented with a multitude of symptoms, with nasal obstruction (48.14%), rhinorrhea (22.2%), facial pain (22.2%) and epistaxis (22.2%) being most common. Surgeons mostly reported using a 0° endoscope (22.2%) and performing a maxillary antrostomy/uncinectomy (37%) and simple extraction under general anesthetic (41%).
CONCLUSIONS
This systematic review analyzed important epidemiological, clinical and technical information regarding patients with endoscopic removal of sinonasal ectopic teeth. Further research is needed to promote implementation of such data into clinical practice.
Topics: Adult; Endoscopy; Female; Humans; Male; Maxillary Sinus; Nasal Cavity; Nasal Obstruction; Otorhinolaryngologic Surgical Procedures; Paranasal Sinus Diseases; Sinusitis; Tooth Eruption, Ectopic
PubMed: 31277707
DOI: 10.1186/s40463-019-0353-8 -
Otolaryngology--head and Neck Surgery :... Jul 2022To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology.
DATA SOURCES
Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles.
REVIEW METHODS
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis.
RESULTS
A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%).
CONCLUSION
The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.
Topics: Chronic Disease; Cysts; Humans; Maxilla; Paranasal Sinuses; Sinusitis
PubMed: 34340618
DOI: 10.1177/01945998211035097 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2016The use of zygomatic implants in the prosthetic rehabilitation of the patient with severe maxillary bone atrophy is another therapeutic alternative, not exempt from...
BACKGROUND
The use of zygomatic implants in the prosthetic rehabilitation of the patient with severe maxillary bone atrophy is another therapeutic alternative, not exempt from complications. The main objective of this review is to analyze and describe the most frequent surgical complications associated with the use of zygomatic implants.
MATERIAL AND METHODS
An electronic database search on PubMed, along with a manual search, without taking into account date nor language, was undertaken by two observers, selecting studies that comprised a study period from 6 to 12 months, any type of clinical trial, and series that included a follow-up and/or review period during the aforementioned margin, that mentioned at least two types of complications.
RESULTS
Out of the initial search that yielded 455 studies, 67 were considered potentially relevant for the present study, out of which 14 were finally selected. Out of the most frequent surgical complications, sinusitis (3,9%) and failure in osseointegration (2,44%) are highlighted.
CONCLUSIONS
The analysis of the results shows that the most frequent complications are sinusitis and failure in osseointegration of the zygomatic implant. However, a standardised data collection system for the data on complications is needed.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Follow-Up Studies; Humans; Maxilla; Zygoma
PubMed: 27694789
DOI: 10.4317/medoral.21357 -
The British Journal of General Practice... Aug 2022Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment.
AIM
To develop prediction models for computed tomography (CT)-confirmed ARS and culture-confirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS.
DESIGN AND SETTING
This was a systematic review and individual participant data meta-analysis.
METHOD
CT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling.
RESULTS
Among 426 patients from three studies, 140 patients (32.9%) had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimism-corrected c-statistic of 0.73 (95% confidence interval [CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95% CI = 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2%) had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95% CI = 0.63 to 0.77) and a calibration slope of 1.00 (95% CI = 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition.
CONCLUSION
Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; C-Reactive Protein; Humans; Primary Health Care; Rhinitis; Sinusitis; Tomography, X-Ray Computed
PubMed: 35817585
DOI: 10.3399/BJGP.2021.0585 -
American Journal of Rhinology & Allergy Nov 2018Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may...
BACKGROUND
Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may lead to intracranial complications or orbital and optic nerve compression.
OBJECTIVE
To assess the presentation and management of benign paranasal sinus osteoneogenic tumors.
METHODS
Systematic review of the symptoms and surgical treatment of these lesions, and a case series of 2 adolescents with osteomas impinging on the orbit treated with a multiportal approach.
RESULTS
Forty-eight cases of osteomas, osteoblastoma, or osteoid osteomas were reviewed from 43 articles. The average age was 14 years, 67% of tumors were osteomas, and 48% were greater than 3 cm in longest dimension. Compared to osteoblastomas, osteomas had a greater male to female ratio (4.3:1; P = .02), presented at older age ( P = .03) with a smaller tumor burden ( P = .003), and had prior trauma or surgery ( P < .001). The ethmoid, frontal, maxillary, and sphenoid sinuses were affected in decreasing order of frequency. A purely endoscopic sinus surgery approach was taken in 31% of cases, open approach in 62% of cases, and combined approach in 7% of cases. Osteoblastoma patients had a 32% rate of recurrence, compared to only 3% among osteoma patients. On univariate logistics regression of patient demographics, tumor characteristics, and surgical approaches predictive of surgical outcomes, only tumor type was predictive of postoperative recurrence (odds ratio: 0.07; 95% confidence interval, 0.007-0.77; P = .029).
CONCLUSION
There was no association between surgical approach and postoperative complications or rate of recurrence. However, a transnasal and transorbital multiportal approach avoids facial incisions.
Topics: Adolescent; Bone Neoplasms; Carcinogenesis; Child; Endoscopy; Headache; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Orbit; Osteogenesis; Osteoma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed
PubMed: 30132339
DOI: 10.1177/1945892418793475 -
Clinical Oral Implants Research Sep 2009To date, there are still no clear cut guidelines for the use of autogenous bone or bone substitutes. (Comparative Study)
Comparative Study Review
BACKGROUND
To date, there are still no clear cut guidelines for the use of autogenous bone or bone substitutes.
AIM
The aim of the present review was to analyze the current literature in order to determine whether there are advantages of using autogenous bone (AB) over bone substitutes (BS) in sinus floor augmentation. The focused question was: is AB superior to BS for sinus floor augmentation in partially dentate or edentulous patients in terms of implant survival, patient morbidity, sinusitis, graft loss, costs, and risk of disease transmission?
MATERIALS AND METHODS
The analysis was limited to titanium implants with modified surfaces placed in sites with 6 mm of residual bone height and a lateral wall approach to the sinus. A literature search was performed for human studies focusing on sinus floor augmentation.
RESULTS
Twenty-one articles were included in the review. The highest level of evidence consisted of prospective cohort studies. A descriptive analysis of the constructed evidence tables indicated that the type of graft did not seem to be associated with the success of the procedure, its complications, or implant survival. Length of healing period, simultaneous implant placement or a staged approach or the height of the residual alveolar crest, sinusitis or graft loss did not modify the lack of effect of graft material on the outcomes. Three studies documented that there was donor site morbidity present after the harvest of AB. When iliac crest bone was harvested this sometimes required hospitalization and surgery under general anesthesia. Moreover, bone harvest extended the operating time. The assessment of disease transmission by BS was not a topic of any of the included articles.
DISCUSSION AND CONCLUSION
The retrieved evidence provides a low level of support for selection of AB or a bone substitute. Clear reasons could not be identified that should prompt the clinician to prefer AB or BS.
Topics: Bone Substitutes; Bone Transplantation; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Disease Transmission, Infectious; Graft Rejection; Humans; Maxillary Sinus; Maxillary Sinusitis; Oral Surgical Procedures, Preprosthetic; Treatment Outcome
PubMed: 19663959
DOI: 10.1111/j.1600-0501.2009.01776.x