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Pharmaceutical Research Feb 2022Optimising intranasal distribution and retention of topical therapy is essential for effectively managing patients with chronic rhinosinusitis, including those that have... (Comparative Study)
Comparative Study
BACKGROUND
Optimising intranasal distribution and retention of topical therapy is essential for effectively managing patients with chronic rhinosinusitis, including those that have had functional endoscopic sinus surgery (FESS). This study presents a new technique for quantifying in vitro experiments of fluticasone propionate deposition within the sinuses of a 3D-printed model from a post-FESS patient.
METHODS
Circular filter papers were placed on the sinus surfaces of the model. Deposition of fluticasone on the filter paper was quantified using high-performance liquid chromatography (HPLC) assay-based techniques. The deposition patterns of two nasal drug delivery devices, an aqueous nasal spray (Flixonase) and metered dose inhaler (Flixotide), were compared. The effects of airflow (0 L/min vs. 12 L/min) and administration angle (30° vs. and 45°) were evaluated.
RESULTS
Inhaled airflow made little difference to sinus deposition for either device. A 45° administration angle improved frontal sinus deposition with the nasal spray and both ethmoidal and sphenoidal deposition with the inhaler. The inhaler provided significantly better deposition within the ethmoid sinuses (8.5x) and within the maxillary sinuses (3.9x) compared with the nasal spray under the same conditions.
CONCLUSION
In the post-FESS model analysed, the inhaler produced better sinus deposition overall compared with the nasal spray. The techniques described can be used and adapted for in vitro performance testing of different drug formulations and intranasal devices under different experimental conditions. They can also help validate computational fluid dynamics modelling and in vivo studies.
Topics: Administration, Inhalation; Drug Compounding; Female; Fluticasone; Glucocorticoids; Humans; Metered Dose Inhalers; Middle Aged; Models, Anatomic; Nasal Sprays; Paranasal Sinuses; Printing, Three-Dimensional; Tissue Distribution; Transanal Endoscopic Surgery
PubMed: 35137359
DOI: 10.1007/s11095-021-03129-2 -
Head and Neck Pathology Mar 2023Basaloid neoplasms of the sinonasal tract represent a significant group of tumors with histological overlap but often with different etiologies (i.e., viral, genetics),... (Review)
Review
BACKGROUND
Basaloid neoplasms of the sinonasal tract represent a significant group of tumors with histological overlap but often with different etiologies (i.e., viral, genetics), clinical management, and prognostic significance.
METHODS
Review.
RESULTS
"Basaloid" generally refers to cells with coarse chromatin in round nuclei and sparse cytoplasm, resembling cells of epithelial basal layers or imparting an "immature" appearance. Tumors with this characteristic in the sinonasal tract are represented by a spectrum of benign to high-grade malignant neoplasms, such as adenoid cystic carcinoma, NUT carcinoma, sinonasal undifferentiated carcinoma, SWI/SNF complex-deficient carcinomas, and adamantinoma-like Ewing sarcoma.
CONCLUSION
In some instances, histology alone may be sufficient for diagnosis. However, limited biopsy material or fine-needle aspiration specimens may be particularly challenging. Therefore, often other diagnostic procedures, including a combination of histology, immunohistochemistry (IHC), DNA and RNA testing, and molecular genetics are necessary to establish an accurate diagnosis.
Topics: Humans; Carcinoma; Paranasal Sinuses; Maxillary Sinus Neoplasms; Sarcoma, Ewing; Prognosis
PubMed: 36928732
DOI: 10.1007/s12105-022-01508-8 -
Folia Morphologica 2022The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia...
BACKGROUND
The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population.
MATERIALS AND METHODS
The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes.
RESULTS
The average size of both sphenoid sinus ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinus ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm).
CONCLUSIONS
Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.
Topics: Adult; Female; Humans; Male; Paranasal Sinuses; Poland; Retrospective Studies; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 34219216
DOI: 10.5603/FM.a2021.0063 -
Acta Veterinaria Scandinavica Jun 2020Horses may acquire a range of paranasal sinus diseases. Clinical studies show slight differences regarding anatomical regions and age. Histopathological examination of...
BACKGROUND
Horses may acquire a range of paranasal sinus diseases. Clinical studies show slight differences regarding anatomical regions and age. Histopathological examination of tissue samples could play an important role in the diagnostic process. Therefore, detailed knowledge of the histological appearance of the paranasal sinus mucosa (PSM) and the nasomaxillary aperture mucosa (NAM) is essential. The objective of this study was to determine topographic and age-related differences within the healthy equine PSM. In addition, we aimed to gain detailed knowledge of the histological appearance of the NAM in comparison to the PSM.
RESULTS
The PSM had an average height of 75.72 ± 44.48 μm with a two-row pseudostratified columnar epithelium of 13.52 ± 4.78 μm. The parameters mucosal height, epithelial height and number of goblet cells revealed significant dependency of the sample site and age group. The maxillary and dorsal conchal sinus showed the highest values for these parameters. In terms of age, younger horses showed a significantly higher total mucosal height in contrast to a significantly lower epithelial height than older horses. Positive correlation was seen between the epithelial height and number of goblet cells. The NAM had an average height of 820.27 ± 653.21 μm. Its pseudostratified epithelium was usually arranged in three rows and had an average height of 44.9 ± 12.78 μm. The number of goblet cells in the NAM was five times higher than in the PSM. Serous glands were found in only 4% of the PSM samples and 100% of the NAM samples.
CONCLUSIONS
There are significant histological differences between different paranasal sinus sites and between different groups of age. This may be related to an altered susceptibility for certain pathologies. The striking difference in the histological appearance of the NAM compared to the PSM could be due to an enhanced role in mucociliary clearance. Further studies are necessary to improve the understanding of mucosal function in specific paranasal sinus compartments and mucosal changes generated by different diseases.
Topics: Age Factors; Animals; Cadaver; Cross-Sectional Studies; Horses; Maxilla; Nasal Mucosa; Paranasal Sinuses; Skull
PubMed: 32576268
DOI: 10.1186/s13028-020-00534-2 -
Ear, Nose, & Throat Journal Nov 2023The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian...
OBJECTIVES
The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian hospitals between 2012 and 2019.
METHODS
A retrospective chart review of cases of frontal and ethmoid osteomas from the of Milan and the of Rome was performed. All patients underwent preoperative computed tomography and, when orbital or intracranial extension was suspected, magnetic resonance imaging. Surgical treatment was performed according to Chiu classification.
RESULTS
A total of 38 cases of frontal and ethmoid sinus osteomas were included in the study; 22 patients were men and 16 were women. The mean age at diagnosis was 49 years. Seven (18.4%) patients were treated using an open approach; 3 (7.9%) patients underwent open and endoscopic approach; the remaining 28 (73.7%) patients were treated with endoscopic approach. Seven (18.4%) patients had a cerebrospinal fluid leak intraoperatively and were treated with the placement of tissue graft through the defect. The mean follow-up time was 18 months; no recurrence was observed at 12-month follow-up.
CONCLUSION
Osteomas of the frontal and ethmoid sinuses can be treated using different techniques, mostly endoscopically. The choice of surgical approach (endoscopic vs open) depends on the location and size of the osteoma, anatomical size, characteristic of the sinus, surgeon's experience, and available existing technical facilities. Cerebrospinal fluid leak is a possible complication of surgery.
Topics: Male; Humans; Female; Middle Aged; Ethmoid Sinus; Retrospective Studies; Paranasal Sinus Neoplasms; Treatment Outcome; Endoscopy; Osteoma; Hospitals; Cerebrospinal Fluid Leak; Frontal Sinus
PubMed: 34176317
DOI: 10.1177/01455613211016895 -
Dento Maxillo Facial Radiology Jul 2017The aim of this study was to compare the observer performance of a cohort of radiographers in reporting CT sinus and facial bone investigations against a reference...
OBJECTIVES
The aim of this study was to compare the observer performance of a cohort of radiographers in reporting CT sinus and facial bone investigations against a reference standard and alternative comparator of summary data from peer-reviewed literature.
METHODS
The participants (n = 6) completed a 9-month part-time distance learning training programme prior to reporting an examination bank (n = 25 cases) from a retrospectively collected and anonymized digital imaging and communications in medicine archive of CT examinations with referral histories and clinical reports. A literature search was performed to identify an additional alternative comparison reference standard from studies reporting observer performance data in CT sinus and facial bone investigations of both trauma and sinus pathology (target conditions). The data analyses used to measure observer performance and determine differences between the cohort and the reference standards used statistical assessment models including accuracy, sensitivity, specificity, kappa (κ) and summary receiver-operating characteristic curves with estimated area under the curve (AUC).
RESULTS
The cohort of radiographer sensitivity was 97.5%, specificity 93.6% and accuracy 95%, with p < 0.000, and a κ = 0.9121 score of agreement. The mean radiographer AUC was 0.9822. The summary reported data of the alternative literature reference standard comparator were AUC 0.9533 for sinus and 0.9374 for trauma.
CONCLUSIONS
The results suggest that this cohort of radiographers at the end of a period training in CT sinus and facial bones are able to clinically report comparably high standards.
Topics: Clinical Competence; Education, Dental, Continuing; Educational Measurement; Facial Bones; Humans; Paranasal Sinus Diseases; Paranasal Sinuses; Radiology; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 28267931
DOI: 10.1259/dmfr.20160440 -
American Journal of Rhinology & Allergy 2013IgE hypersensitivity is important to the pathogenesis of allergic diseases and the development and persistence of airway inflammation. Allergic immunomodulation... (Review)
Review
IgE hypersensitivity is important to the pathogenesis of allergic diseases and the development and persistence of airway inflammation. Allergic immunomodulation encompasses various therapies that attempt to suppress or modify the immune mechanisms responsible for IgE-mediated disease. These include allergy immunotherapy (AIT) in the forms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), as well as the emergence of biological agents, such as anti-IgE, for allergic respiratory disease. Clinical evidence strongly supports the efficacy and safety of AIT for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma, but for chronic rhinosinusitis evidence is lacking. In allergic rhinitis, the decision to initiate AIT depends on the degree to which symptoms can be reduced by avoidance and medication, the amount and type of medication required to control symptoms, the adverse effects of medication, the severity and duration of symptoms, and their effect on quality of life. AIT has the potential to produce sustained long-lasting immune modulation and possibly avoid or reduce lifelong requirements for medical therapy. Although SLIT is currently being evaluated, SCIT remains the preferred form of AIT in the United States because of robust efficacy data, availability of allergen extracts, and current Food and Drug Administration approval. However, SLIT holds the potential for greater patient safety and convenience. Other immunomodulators such as anti-IgE also hold promise, but require further investigation.
Topics: Administration, Sublingual; Animals; Antibodies, Monoclonal; Desensitization, Immunologic; Humans; Immunoglobulin E; Immunomodulation; Injections, Subcutaneous; Paranasal Sinuses; Respiratory Hypersensitivity; United States; United States Food and Drug Administration
PubMed: 23711045
DOI: 10.2500/ajra.2013.27.3930 -
Ear, Nose, & Throat Journal Aug 2022This study aimed to investigate and analyze the anatomic characteristics of the retromaxillary cell (RMC) by using computed tomography (CT) images of paranasal sinuses...
OBJECTIVE
This study aimed to investigate and analyze the anatomic characteristics of the retromaxillary cell (RMC) by using computed tomography (CT) images of paranasal sinuses and to improve its identification with ethmomaxillary sinus (EMS).
METHODS
The paranasal sinus CT scans of 441 outpatients or inpatients in our hospital from January 2018 to October 2018 were analyzed. The incidence of RMC, EMS, Haller cell, imaging anatomical characteristics, and morphological manifestations were observed via sinus CTs. The relationship of RMC and ipsilateral maxillary sinusitis was analyzed.
RESULTS
The incidence of RMC is 83.90% (740/882). The incidence of males and females was 83.81% (414/494) and 84.02% (326/388), respectively. The incidence of bilateral (72.79%, 321/441) was much higher than that of unilateral (22.22%, 98/441). The lateral extension of the RMC ranged from 1.18 to 13.31 mm, with an average of 6.10 ± 2.03 mm. The incidence of ipsilateral maxillary sinus opacification on the RMC sides and non-RMC sides has no significance difference (χ = .054, = .459). The incidence of Haller cell and EMS decreased significantly in the presence of RMC ( < .01).
CONCLUSION
The RMC is an anatomical variation originating from posterior ethmoid cells, which is commonly encountered in the clinic. The pneumatization of RMC is highly variable, and a bilateral is common. During endoscopic sinus surgery, it is necessary to carefully identify such an air cell to ensure the complete opening of the paranasal sinus during surgery.
Topics: Ethmoid Bone; Female; Head; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Paranasal Sinuses; Tomography, X-Ray Computed
PubMed: 32627620
DOI: 10.1177/0145561320936963 -
American Journal of Rhinology & Allergy 2012Human exposure to fungal elements is inevitable, with normal respiration routinely depositing fungal hyphae within the nose and paranasal sinuses. Fungal species can... (Review)
Review
BACKGROUND
Human exposure to fungal elements is inevitable, with normal respiration routinely depositing fungal hyphae within the nose and paranasal sinuses. Fungal species can cause sinonasal disease, with clinical outcomes ranging from mild symptoms to intracranial invasion and death. There has been much debate regarding the precise role fungal species play in sinonasal disease and optimal treatment strategies.
METHODS
A literature review of fungal diseases of the nose and sinuses was conducted.
RESULTS
Presentation, diagnosis, and current management strategies of each recognized form of fungal rhinosinusitis was reviewed.
CONCLUSION
Each form of fungal rhinosinusitis has a characteristic presentation and clinical course, with the immune status of the host playing a critical pathophysiological role. Accurate diagnosis and targeted treatment strategies are necessary to achieve optimal outcomes.
Topics: Acetates; Animals; Anti-Inflammatory Agents; Cyclopropanes; Diagnosis, Differential; Fungi; Humans; Immunity, Mucosal; Mycoses; Paranasal Sinuses; Quinolines; Rhinitis; Sinusitis; Steroids; Sulfides; Treatment Outcome
PubMed: 23168148
DOI: 10.2500/ajra.2012.26.3807 -
European Annals of Otorhinolaryngology,... Jan 2022The concept of ethmoidal sinuses composed of ethmoidal air cells does not appear to fit with the embryological origin of the ethmoid. Post-natal formation of the...
The concept of ethmoidal sinuses composed of ethmoidal air cells does not appear to fit with the embryological origin of the ethmoid. Post-natal formation of the paranasal sinuses, as visualized by MRI, appears to be fundamentally different from the embryological development of the ethmoid sinus. These two organs also appear to have very distinct functions: paranasal sinuses play a role in respiration and sanitization of the respiratory tract, while the ethmoid sinus plays a role in olfaction. However, human acquisition of bipedalism resulted in ethmoidal compartmentalization into olfactory clefts lined by olfactory mucosa and the ethmoidal labyrinth formed by a meshwork of ethmoturbinals that have lost their olfactory mucosa. Ethmoturbinals are septa that increase the surface area of olfactory mucosa in mammalian olfactory chambers. Embryological development of the human ethmoid sinus can be seen as the result of curved stacking of ethmoturbinal septa forming passages. Surgically, these passages can be accessed via the middle, superior and supreme meati. An ethmoidectomy technique following the ethmoturbinal passages can therefore be described. This structure of the ethmoidal labyrinth is both useful and necessary for the teaching of ethmoidal surgery.
Topics: Animals; Ethmoid Bone; Ethmoid Sinus; Humans; Paranasal Sinuses; Smell
PubMed: 33931331
DOI: 10.1016/j.anorl.2021.04.005