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European Archives of... May 2024Isolated sphenoidal sinusitis (ISS) is a rare disease with non-specific symptoms and a potential for complications. Diagnosis is made clinically, endoscopically, and...
INTRODUCTION
Isolated sphenoidal sinusitis (ISS) is a rare disease with non-specific symptoms and a potential for complications. Diagnosis is made clinically, endoscopically, and with imaging like CT scans or MRIs. This study aimed to evaluate if ISS meets the EPOS 2020 criteria for diagnosing acute rhinosinusitis and if new diagnostic criteria are needed.
MATERIALS AND METHODS
The study analyzed 193 charts and examination records from 2000 to 2022 in patients diagnosed with isolated sphenoidal sinusitis at the Ziv Medical Center in Safed, Israel. Of the 193, 57 patients were excluded, and the remaining 136 patients were included in the final analysis. Patients were evaluated using Ear, Nose and Throat (ENT), neurological and sinonasal video endoscopy, radiological findings, demographic data, symptoms and signs, and laboratory results. All these findings were reviewed according to the EPOS 2020 acute sinusitis diagnosis criteria and were analyzed to determine if ISS symptoms and signs fulfilled them.
RESULTS
The patients included 40 men and 96 women, ranging in age from 17 to 86 years (mean ± SD, 37 ± 15.2 years). A positive endoscopy and radiography were encountered in 29.4%, and headache was present in 98%; the most common type was retro-orbital headache (31%). The results showed that there is no relationship between the symptoms of isolated sphenoidal sinusitis and the criteria for diagnosing acute sinusitis according to EPOS 2020.
CONCLUSION
ISS is an uncommon entity encountered in clinical practice with non-specific symptoms and a potential for complications. Therefore, the condition must be kept in mind by clinicians, and prompt diagnosis and treatment must be initiated. This kind of sinusitis does not fulfill the standard guidelines for acute sinusitis diagnosis criteria.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Sphenoid Sinusitis; Rhinitis; Chronic Disease; Sinusitis; Headache; Acute Disease
PubMed: 38225396
DOI: 10.1007/s00405-023-08405-y -
Frontiers in Cellular and Infection... 2017Rabbits are useful for preclinical studies of sinusitis because of similar physiologic features to humans. The objective of this study is to develop a rabbit model of...
Rabbits are useful for preclinical studies of sinusitis because of similar physiologic features to humans. The objective of this study is to develop a rabbit model of sinusitis that permits assessment of microanatomy and sampling for evaluating shifts in the sinus microbiota during the development of sinusitis and to test how the mucociliary clearance (MCC) defect might lead to dysbiosis and chronic rhinosinusitis (CRS). Generation of CRS was accomplished with an insertion of a sterile sponge into the left middle meatus of New Zealand white rabbits ( = 9) for 2 weeks. After sponge removal, 4 rabbits were observed for another 10 weeks and evaluated for CRS using endoscopy, microCT, visualization of the functional micro-anatomy by micro-optical coherence tomography (μOCT), and histopathological analysis of the sinus mucosa. Samples were taken from the left middle meatus and submitted for microbiome analysis. CT demonstrated opacification of all left sinuses at 2 weeks in all rabbits ( = 9), which persisted in animals followed for another 12 weeks ( = 4). Histology at week 2 showed mostly neutrophils. On week 14, significant infiltration of plasma cells and lymphocytes was noted with increased submucosal glands compared to controls ( = 0.02). Functional microanatomy at 2 weeks showed diminished periciliary layer (PCL) depth ( < 0.0001) and mucus transport ( = 0.0044) compared to controls despite a thick mucus layer. By 12 weeks, the thickened mucus layer was resolved but PCL depletion persisted in addition to decreased ciliary beat frequency (CBF; < 0.0001). The mucin fermenting microbes () dominated on week 2 and there was a significant shift to potential pathogens (e.g., ) by week 14 compared to both controls and the acute phase ( < 0.05). We anticipate this reproducible model will provide a means for identifying underlying mechanisms of airway-surface liquid (ASL) depletion and fundamental changes in sinus microbial communities that contribute to the development of CRS. The rabbit model of sinusitis exhibited diminished PCL depth with delayed mucus transport and significant alterations and shift in the sinus microbiome during the development of chronic inflammation.
Topics: Animals; Biodiversity; Biopsy; Chronic Disease; Disease Models, Animal; Female; Humans; Microbiota; Rabbits; Rhinitis; Sinusitis; X-Ray Microtomography
PubMed: 29376039
DOI: 10.3389/fcimb.2017.00540 -
The Journal of Allergy and Clinical... Sep 1992It was previously believed that sinusitis lasting longer than 3 months might lead to irreversible disease. Experience with functional endoscopic sinus surgery indicates... (Review)
Review
It was previously believed that sinusitis lasting longer than 3 months might lead to irreversible disease. Experience with functional endoscopic sinus surgery indicates that this is rarely the case. Functional endoscopic sinus surgery describes an approach whereby target areas of obstruction are cleared of disease, which allows for ventilation of secondarily involved sinuses and return of mucociliary function. Although endoscopic sinus surgery is one of the techniques most frequently used to manage chronic sinus disease, it is not a suitable surgical approach for every otolaryngologist or all patient settings. Success with this endoscopic approach for chronic sinus disease is based primarily on rigorous perioperative medical care and postoperative surgical debridement. The greatest advancement that the nasal endoscope has brought to patient care is the ability to diagnose disease and follow objectively the effects of different treatment modalities. This advantage is recognized by allergists and used at several centers.
Topics: Acute Disease; Anesthesia; Chronic Disease; Endoscopy; Humans; Maxillary Sinus; Maxillary Sinusitis; Postoperative Care; Recurrence; Risk Factors; Tomography, X-Ray Computed
PubMed: 1527341
DOI: 10.1016/0091-6749(92)90175-2 -
Clinical and Experimental Allergy :... May 2012The classification of asthma to identify forms which have different contributing causes is useful for all cases in which the disease requires regular treatment, but it... (Review)
Review
The classification of asthma to identify forms which have different contributing causes is useful for all cases in which the disease requires regular treatment, but it is essential for the management of severe asthma. Many forms of the disease can occur, and complex mixtures are not uncommon; here we artificially separated the cases into four groups: (i) inhalant allergy, (ii) fungal sensitization with or without colonization (including ABPA); (iii) severe sinusitis with or without aspirin-exacerbated respiratory disease (AERD), and (iv) non-inflammatory cases, including those associated with severe obesity and vocal cord dysfunction (VCD). The reason for focusing on these groups is because they illustrate how much the specific management depends upon correct classification. Inhalant allergy can present as chronically severe asthma. However, severe attacks of asthma requiring hospital admission can occur in cases which are generally only mild or moderate. The best recognized and probably the most common cause of these acute episodes is acute infection with a rhinovirus. Recent evidence suggests that high titre IgE, particularly to dust mite, correlates to exacerbations of asthma related to rhinovirus infection. Although it is well recognized that the fungus Aspergillus can colonize the lungs and cause severe disease, it is less well recognized that those cases may not have full criteria for diagnosis of ABPA or may involve other fungi. Identifying fungal cases is important, because treatment with imidazole antifungals can provide significant benefit. Taken together, specific treatment using allergen avoidance, immunotherapy, anti-IgE, or antifungal treatment is an important part of the successful management of severe asthma, and each of these requires correctly identifying specific sensitization.
Topics: Allergens; Animals; Antigens, Fungal; Antigens, Viral; Asthma; Disease Models, Animal; Disease Progression; Humans; Inhalation; Obesity; Respiratory System; Rhinovirus; Severity of Illness Index; Sinusitis; Vocal Cords
PubMed: 22515388
DOI: 10.1111/j.1365-2222.2011.03944.x -
Ear, Nose, & Throat Journal Dec 2022This case study demonstrates a 58-year-old female who contracted COVID-19 post-vaccination presenting with severe left-sided facial pain, headaches, and dyspnea. A...
This case study demonstrates a 58-year-old female who contracted COVID-19 post-vaccination presenting with severe left-sided facial pain, headaches, and dyspnea. A computed tomography was ordered and showed acute sinusitis, and upon bedside endoscopy, the patient was shown to have necrosis of the left-sided middle turbinate with no discoloration, palate necrosis, or facial changes. All samples of the necrotic tissue were reported to be invasive fungal sinusitis. The entire turbinate was resected in the operating room and ethmoid, frontal, and maxillary sinuses were healthy. Chest x-rays post-operatively showed pulmonary effusions and edema although the patient was not stable enough for a lung examination to rule out a pulmonary fungal infection. A bedside endoscopy showed no further necrosis post-operatively although a repeat endoscopy showed duskiness at the lateral attachment of the basal lamella right at the most posterior resection of the middle turbinate. The patient was placed on multiple antifungal agents. The patient remained in hypoxemic respiratory failure and septic shock while on pressors and 2 weeks following this, expired. Post-COVID-19 patients have been shown in the literature to have an increased risk of developing invasive fungal sinusitis (IFS) and all IFS cases during active COVID-19 infection have had a 100% mortality rate.
Topics: Humans; Female; Middle Aged; COVID-19; Sinusitis; Invasive Fungal Infections; Turbinates; Necrosis
PubMed: 35770808
DOI: 10.1177/01455613221112337 -
Medical Mycology Journal 2017Fungal sinusitis is divided into two categories depending on mucosal invasion by fungus, i.e., invasive and noninvasive. Invasive fungal sinusitis is further divided... (Review)
Review
Fungal sinusitis is divided into two categories depending on mucosal invasion by fungus, i.e., invasive and noninvasive. Invasive fungal sinusitis is further divided into acute and chronic disease based on time course. Noninvasive fungal sinusitis includes chronic noninvasive sinusitis (fungal ball type) and allergic fungal sinusitis. Chronic noninvasive sinusitis is the most predominant fungal sinusitis in Japan, followed by allergic fungal sinusitis. Invasive fungal sinusitis is rare. Hyphal tissue invasion is seen in invasive fungal sinusitis. Acute invasive fungal sinusitis demonstrates hyphal vascular invasion while chronic invasive fungal sinusitis usually does not. Fungal tissue invasion is never found in noninvasive sinusitis. A fungal ball may exist adjacent to sinus mucosa, but its hyphae never invade the mucosa. Fungal balls sometimes contain conidial heads and calcium oxalate, which aid in identifying the fungus in the tissue. Allergic fungal sinusitis is characterized by allergic mucin that is admixed with numerous eosinophils and sparsely scattered fungal elements. Histopathology is important in classifying fungal sinusitis, especially in confirming tissue invasion by the fungus.
Topics: Calcium Oxalate; Chronic Disease; Disease Progression; Fungi; Humans; Invasive Fungal Infections; Mucins; Nasal Mucosa; Sinusitis; Spores, Fungal
PubMed: 29187720
DOI: 10.3314/mmj.17.018 -
JAMA Network Open May 2023Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC.
IMPORTANCE
Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC.
OBJECTIVE
To evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respiratory conditions in a UC network.
DESIGN, SETTING, AND PARTICIPANTS
This quality improvement study conducted in a UC network with 38 UC clinics and 1 telemedicine clinic included 493 724 total UC encounters. The study compared the antibiotic prescribing rates of all UC clinicians who encountered respiratory conditions for a 12-month baseline period (July 1, 2018, through June 30, 2019) with an intervention period (July 1, 2019, through June 30, 2020). A sustainability period (July 1, 2020, through June 30, 2021) was added post hoc.
INTERVENTIONS
Stewardship interventions included (1) education for clinicians and patients, (2) electronic health record (EHR) tools, (3) a transparent clinician benchmarking dashboard, and (4) media. Occurring independently but concurrent with the interventions, a stewardship measure was introduced by UC leadership into the quality measures, including a financial incentive.
MAIN OUTCOMES AND MEASURES
The primary outcome was the percentage of UC encounters with an antibiotic prescription for a respiratory condition. Secondary outcomes included antibiotic prescribing when antibiotics were not indicated (tier 3 encounters) and first-line antibiotics for acute otitis media, sinusitis, and pharyngitis. Interrupted time series with binomial generalized estimating equations were used to compare periods.
RESULTS
The baseline period included 207 047 UC encounters for respiratory conditions (56.8% female; mean [SD] age, 30.0 [21.4] years; 92.0% White race); the intervention period included 183 893 UC encounters (56.4% female; mean [SD] age, 30.7 [20.8] years; 91.2% White race). Antibiotic prescribing for respiratory conditions decreased from 47.8% (baseline) to 33.3% (intervention). During the initial intervention month, a 22% reduction in antibiotic prescribing occurred (odds ratio [OR], 0.78; 95% CI, 0.71-0.86). Antibiotic prescriptions decreased by 5% monthly during the intervention (OR, 0.95; 95% CI, 0.94-0.96). Antibiotic prescribing for tier 3 encounters decreased by 47% (OR, 0.53; 95% CI, 0.44-63), and first-line antibiotic prescriptions increased by 18% (OR, 1.18; 95% CI, 1.09-1.29) during the initial intervention month. Antibiotic prescriptions for tier 3 encounters decreased by an additional 4% each month (OR, 0.96; 95% CI, 0.94-0.98), whereas first-line antibiotic prescriptions did not change (OR, 1.00; 95% CI, 0.99-1.01). Antibiotic prescribing for respiratory conditions remained stable in the sustainability period.
CONCLUSIONS AND RELEVANCE
The findings of this quality improvement study indicated that a UC antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for UC antibiotic stewardship.
Topics: Humans; Female; Adult; Male; Respiratory Tract Infections; Antimicrobial Stewardship; Sinusitis; Anti-Bacterial Agents; Ambulatory Care
PubMed: 37166794
DOI: 10.1001/jamanetworkopen.2023.13011 -
Journal of Ayub Medical College,... 2016Orbital involvement in sinonasal diseases can present as proptosis, ophthalmoplegia or even as blindness due to optic nerve damage. There are a number of sinonasal...
BACKGROUND
Orbital involvement in sinonasal diseases can present as proptosis, ophthalmoplegia or even as blindness due to optic nerve damage. There are a number of sinonasal diseases which can involve eyes. The purpose of this study was to enlist diagnoses of all the patients with sinonasal disease, in which orbit was also involved unilaterally or bilaterally and to analyse the management strategy and final outcome in all the cases.
METHODS
Hundred consecutive patients having orbital symptoms along with sinonasal complaints that presented in ENT department of Shaikh Zayed federal postgraduate medical institute were included in our prospective study. CT scan and/or MRI were done in all the cases and ophthalmological consultation was done. Patients with sinonasal complaints without clinical involvement of orbit and those with primary orbital pathology were excluded from our study. Final diagnosis was made after histopathological confirmation.
RESULTS
A total of 37% of the patients were diagnosed to be having "Allergic fungal rhinosinusitis" 17% had "mucormycosis", 16% had "chronic invasive fungal sinusitis". Other pathologies identified were Nasopharyngeal CA (4%), Squamous cell Ca (4%), cavernous sinus thrombosis (3%), Adenocarcinoma (3%), Angiofibroma (2%) fibrous dysplasia (2%) and Acute complicated Rhinosinusitis (2%) Following rare pathologies were identified in only one patient each. These included Lymphoma, Osteoma, and Rhabdomyosarcoma, Transitional cell carcinoma arising from inverted papilloma, Hemangiopericytoma, Spindle cell sarcoma, Pituitary adenoma, Giant cell sarcoma, malignant undifferentiated tumour, plexiform neurofibroma and sinonasal tuberculosis. Most common orbital symptom was proptosis. Eighty-one patients had proptosis followed by 23 patients with diplopia, 22 patients with ophthalmoplegia, 16 patients with visual loss and 15 patients with ptosis.
CONCLUSIONS
Orbital involvement in most of the sinonasal diseases indicate extensive and aggressive nature of the pathology and many of these, even if they are not malignancies are difficult to treat. This is especially true for acute fulminant and chronic invasive fungal rhinosinusitis.
Topics: Adolescent; Adult; Aged; Child; Eye Diseases; Female; Humans; Male; Middle Aged; Paranasal Sinus Neoplasms; Prospective Studies; Rhinitis; Sinusitis; Young Adult
PubMed: 28586604
DOI: No ID Found -
Le Infezioni in Medicina Dec 2015Acute rhinosinusitis (ARS) is a very common/disease faced more often by general practitioners than ear, nose and throat specialists, pneumologists or allergologists. In... (Review)
Review
Acute rhinosinusitis (ARS) is a very common/disease faced more often by general practitioners than ear, nose and throat specialists, pneumologists or allergologists. In an outpatients setting, upper respiratory tract infection is the third most common cause of a primary care consultation, one third of which is attributable to ARS, diagnosed upon clinical presentation. In some cases however, signs and symptoms do not allow clear differentiation from viral, post-viral or bacterial infection. This compels GPs and family doctors to make a careful choice and first use the best antimicrobial treatment to avoid recurrences or complications and the rise of antibiotic resistance. Amoxicillin, thanks to its narrow spectrum against likely respiratory pathogens, is recommended as first-line therapy to treat acute bacterial rhinosinusitis by several international guidelines, being safe at the same time. Other antibiotics (beta-lactams, macrolides and newer drugs, such as fluoroquinolones) have been evaluated in double-blind studies versus placebo or comparative studies in terms of efficacy, safety and costs. Prulifloxacin, the active metabolite of ulifloxacin, is an oral fluoroquinolone with a broad in vitro activity spectrum against Gram positive and negative bacteria and among fluoroquinolones has the lowest power of inducing resistance. In vitro and in vivo studies have shown its clinical efficacy and pathogen eradication. Ulifloxacin T(1/2) and plasma and tissue concentrations including the nose-paranasal sinuses mucosa allow once daily administration at the dosage of 600 mg. Prulifloxacin shows a high safety profile: it is the fluoroquinolone with the lowest risk of cardiac arrhythmias for prolongation of the QT interval; the CNS penetration is negligible; in women prulifloxacin does not affect the lactobacillary component of the vaginal microbiota, lowering the risk of genito-urinary tract infections. The pharmacokinetic characteristics and safety profile of prulifloxacin make it the antibiotic option with the best potential to achieve clinical cures and bacteriological eradication, well tolerated and safe without specific restriction or posologic changes in the elderly and in patients with co-morbidities in multiple treatment, hence resolving ARS reliably and being simple and easy to administer.
Topics: Administration, Oral; Ambulatory Care Facilities; Anti-Bacterial Agents; Dioxolanes; Evidence-Based Medicine; Fluoroquinolones; Humans; Piperazines; Randomized Controlled Trials as Topic; Rhinitis; Sinusitis; Treatment Outcome
PubMed: 26700078
DOI: No ID Found -
The Journal of Allergy and Clinical... May 2018Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and sinuses that affects up to 12% of the population in Europe and the United States. This... (Review)
Review
Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and sinuses that affects up to 12% of the population in Europe and the United States. This complex disease is likely driven by multiple environmental, genetic, and inflammatory mechanisms, and recent studies suggest that B cells might play a critical role in disease pathogenesis. B cells and their antibodies have undisputed roles in health and disease within the airway mucosae. Deficient or inadequate B-cell responses can lead to susceptibility to infectious disease in the nose, whereas excess antibody production, including autoantibodies, can promote damaging inflammation. Thus, patients with B-cell defects often have either chronic or recurrent acute infections, and this can be associated with nonpolypoid CRS. In contrast, many patients with CRS with nasal polyps, which is less likely to be driven by pathogens, have excess production of local immunoglobulins, including autoreactive antibodies. These B-cell responses activate complement in many patients and likely contribute to immunopathogenic responses. A better understanding of the B cell-associated mechanisms that drive disease in patients with CRS should be a high priority in the quest to understand the pathogenesis of this disease.
Topics: Antibodies; B-Lymphocytes; Chronic Disease; Humans; Rhinitis; Sinusitis
PubMed: 29731101
DOI: 10.1016/j.jaci.2018.03.002