The clinical features and prognostic analysis of visual function damage caused by fungal sphenoid sinusitis / 中华眼底病杂志

Objective:To observe the clinical characteristics of patients with visual impairment caused by fungal sphenoid sinusitis and analyze the influencing factors related to visual prognosis.Methods:A retrospective clinical study. From January 2006 to December 2020, 44 patients (55 eyes) with visual impairment caused by fungal sphenoid sinusitis confirmed by imaging and pathological examination in the Department of Ophthalmology of Beijing Tongren Hospital were included in the study. Patients was first diagnosed in the Department of Ophthalmology due to monocular or binocular vision loss, or binocular diplopia, limited eye movement and ptosis. All patients underwent visual acuity examination and fundus color photography. CT examination of paranasal sinus or orbit was performed in 37 cases; magnetic resonance imaging (MRI) of paranasal sinus, brain or orbit was performed in 34 cases. All patients underwent endoscopic sinus opening combined with intrasinus lesion clearance; 14 cases were treated with antifungal drugs after operation. The average follow-up time was 59.61±37.70 months. Comparison of clinical characteristics between invasive and non-invasive fungal sphenoid sinusitis were by χ 2 test or Fisher exact test. The influencing factors with P<0.2 in univariate analysis were selected for multivariate regression analysis. Results:Among the 44 patients, there were 19 males and 25 females; the ratio of male to female was 1:1.3; the average age of visual symptoms was 61.48 ± 12.17 years; 23 cases (52.3%, 23/44) suffered from immune dysfunction, including 21 cases of diabetes mellitus. The visual acuity decreased in 33 cases (44 eyes) (75.0%, 33/44). There were 15 cases of binocular diplopia with eye movement disorder (34.0%, 15/44), including 6 cases with visual impairment. The visual acuity of the affected eye was no light perception-0.8. There were 35 cases with headache (79.5%, 35/44). Nasal symptoms were found in 14 cases (31.8%, 14/44). There were 40 and 4 cases of Aspergillus and Mucor infection in sphenoid sinus, respectively. Among the 37 cases who underwent CT examination of paranasal sinus or orbit, there were soft tissue filling in the sinus cavity, including 19 cases of high-density calcification in the sinus cavity (51.4%, 19/37); bone defect of sinus wall were in 24 cases (64.9%, 24/37). There were 26 cases (70.3%, 26/37) of sinus wall osteosclerosis. MRI of paranasal sinus, brain or orbit was performed in 34 cases. T1WI of sphenoid sinus lesions showed low signal, high signal and equal signal in 14, 10 and 9 cases, respectively; T2WI showed high signal, low signal and equal signal in 13, 16 and 2 cases respectively. After enhancement, the lesions were strengthened in 11 cases, no obvious enhancement in 23 cases, and the surrounding mucosa was thickened and strengthened. The lesions involved the orbital apex and cavernous sinus in 18 and 16 cases, respectively; orbital apex and cavernous sinus were involved in 12 cases. Six months after operation, visual acuity was significantly improved in 27 eyes (65.9%, 27/41); visual acuity did not improve in 14 eyes (34.1%, 14/41). Multivariate regression analysis showed that the change of sinus wall osteosclerosis was associated with higher visual acuity improvement rate (odds ratio= 0.089, 95% confidence interval 0.015-0.529, P=0.008). Conclusions:Fungal sphenoid sinusitis related visual impairment is relatively common in elderly female patients with low immune function; monocular vision loss with persistent headache is the most common clinical symptom; imaging findings of sphenoid sinus lesions are an important basis for diagnosis. Sphenoid sinus opening combined with sinus lesion clearance is an effective treatment. After operation, the visual acuity of most patients can be improved. The prognosis of visual acuity was relatively good in patients with hyperplasia and sclerosis of sphenoid sinus wall bone.

Trombosis del seno cavernoso derecho secundaria a rinosinusitis esfenoidal: reporte de caso / Right cavernous sinus thrombosis secondary to sphenoidal rhinosinusitis: case report

RESUMEN La rinosinusitis bacteriana aguda es la infección de la mucosa nasal y de senos paranasales, que se manifiesta con congestión nasal, rinorrea purulenta y fiebre, de curso generalmente autolimitado. La trombosis del seno cavernoso (TSC) es una complicación poco frecuente, que se asocia a compromiso del seno esfenoidal y etmoidal, manifestándose clínicamente con cefalea, fiebre, alteración de pares craneanos y síntomas oculares. Ante su sospecha el estudio imagenológico es fundamental. En estos exámenes se debe buscar un defecto de llene en el seno cavernoso comprometido. El tratamiento debe iniciarse de forma precoz y contempla: antibioticoterapia, drenaje quirúrgico del seno afectado y anticoagulación. Se presenta a un paciente pediátrico masculino con TSC derecha posterior a una rinosinusitis esfenoidal no tratada, que respondió favorablemente al tratamiento. Se describe la clínica y manejo de esta patología, que presenta alta morbimortalidad, y que puede disminuirse considerablemente con un tratamiento precoz y agresivo.

ABSTRACT Acute bacterial rhinosinusitis is the infection of the nasal and paranasal mucous membrane, with symptoms such as nasal congestion, purulent rhinorrhea and fever, usually self-limiting. Cavernous sinus thrombosis (CST) is a rare complication, which is associated with sphenoid and ethmoid sinus involvement, clinically manifest with headache, fever, cranial nerve involvement and ocular symptoms. When suspected, imaging studies will confirm the clinical impression. They will show abnormal flow parameters in the compromised cavernous sinus. The treatment has to start as soon as possible and consists in broad spectrum intravenous antibiotics, surgical drainage of the site of the infection and anticoagulation. We present a patient with a right CST secondary to a non-treated sphenoidal sinusitis, that responded favorably to treatment. The clinical and management of this pathology is described, which presents a high morbidity and mortality that can be reduced considerably with an early and aggressive treatment.

A Case of Septal Abscess and Sphenoid Sinusitis after Dental Implant / 대한이비인후과학회지

A nasal septal abscess results from the collection of purulent fluid between the cartilage of bony septum and overlying mucoperichondrium or mucoperiosteum. Unless early diagnosis and surgical treatment are performed, serious complications such as cavernous sinus thrombophlebitis, sepsis, and saddle nose may occur. We report a case of septal abscess and sphenoid sinusitis that occurred after dental implant. A 74-year-old female with diabetes and liver cirrhosis was referred to the hospital for management of rapidly aggravated perinasal pain, nasal obstruction, and headache. The patient had undergone dental implant in the right upper incisor area 6 days ago. A CT revealed septal abscess and bilateral sphenoid sinusitis. The patient was operated upon to drain septal abscess, and both sphenoid sinuses were opened widely.

Sphenoid Sinusitis with Haemophilus influenzae Septicemia / 대한내과학회지

Haemophilus influenzae grows both aerobically and anaerobically and is an exclusively human pathogen. We present a case of septicemia originating from unilateral sphenoid sinusitis caused by non-typeable H. influenzae. No reports of sinusitis presenting as septicemia in a healthy young immunocompetent adult in South Korea have previously been published.

Differential Diagnosis and Treatment of Isolated Pathologies of the Sphenoid Sinus: Retrospective Study of 46 Cases

Introduction Isolated disease of the sphenoid is rare and has often been overlooked due to its remote location and difficult access. Objective A retrospective study of the main causes of isolated sphenoid sinus diseases with discussion of the most appropriate methods of diagnosis and treatment. Methods A total of 46 cases of isolated sphenoid disease treated between January 2008 and December 2013 were evaluated by objective ear, nose, and throat examination and video endoscopy, computed tomography of the paranasal sinuses, and, in some cases, magnetic resonance imaging. In each case, we decided between drug and/or endoscopic treatment. Results We identified 12 cases of isolated sphenoiditis (26.1% ), 3 cases of fungal sphenoiditis (6.5% ), 3 cases of sphenochoanal polyps (6.5% ), 22 cases of mucocele (47.8% ), 2 cases of cerebrospinal fluid leak (4.3% ), and 1 case each of meningoencephalocele (2.1% ), inverted papilloma (2.1% ), fibrous dysplasia (2.1% ), and squamous cell carcinoma (2.1% ). Conclusion A prevalence of inflammatory and infectious diseases was found, and endoscopic surgery for the sphenoid sinus approach is effective in treating various diseases of the isolated sphenoid, whether complicated or not. .

New daily persistent headache with isolated sphenoiditis in children / 소아과

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.

Acute Rhinosinusitis in Prominently Pneumatized Sphenoid Sinus Presenting with Unilateral Abducens Nerve Palsy / 대한이비인후과학회지

Acute rhinosinusitis is a rare cause of abducens nerve palsy. Most reported cases with VIth cranial nerve palsy associated sphenoid sinusitis are fungal sphenoid sinusitis, mucocele, or severe bacterial sinusitis. In this report, we present a patient with acute mild sphenoid sinusitis presented as abducens nerve palsy associated with prominent sphenoid pneumatization to the Dorello's canal.

A Case of Pituitary Metastasis of Lung Cancer Presenting as Cavernous Sinus Syndrome / 대한이비인후과학회지

The cavernous sinus contains significant structures such as the internal carotid artery and cranial nerves III to VI. Cavernous sinus lesions may cause ophthalmoplegia, proptosis, and diplopia. We report a 56-year-old woman who presented with throbbing headache and associated right-sided ocular pain. While awaiting imaging studies, she suddenly developed opthalmoplegia and ptosis of the right eye. She had ipsilateral palsy of the third and fourth cranial nerves, while the sixth nerve remained intact. Magnetic resonance imaging revealed a pituitary gland mass extending into the right cavernous sinus with associated sphenoid sinusitis. The patient underwent endoscopic sinus surgery and subsequent pituitary tumor removal by transsphenoidal approach. During preoperative evaluation, a mass was found protruding in her left bronchus. The pituitary tumor pathologic examination revealed metastatic adenocarcinoma of the lung. In this patient, the initial symptoms of lung cancer were headache and cavernous sinus syndrome, which had metastasized to the pituitary gland.

Ruptured Infectious Internal Carotid Artery Aneurysm Presenting with Epistaxis: A Case Report

Cavernous carotid aneurysms represent fewer than 2% of all intracranial aneurysms and are a rare cause of epistaxis, but rupture of an aneurysm into the sphenoid sinus may result in a massive hemorrhage. Infectious intracranial aneurysms are rare, but can develop as a result of direct extension from bacterial endocarditis or local infection of the head, neck, face, and paranasal sinus. The incidence of infectious intracavernous aneurysm is much lower. Because the sphenoid sinus is located adjacent to the cavernous sinus, sphenoid sinusitis may cause an infectious carotid aneurysm. We have experienced a case of ruptured infectious carotid aneurysm following sphenoid sinusitis presenting with epistaxis. We describe several aspects of the diagnosis and management of this rare case with a review of the literature.

Isolated Sphenoid Sinusitis with Orbital and Intracranial Complication

Sphenoid sinus is adjacent to important intracranial structures, such as major intracranial vessels and some cranial nerves. However isolated sphenoid sinusitis is often misdiagnosed because presenting symptoms are initially subtle. Therefore, if the diagnosis of the isolated sphenoid sinusitis is delayed and complications occur, it will lead to disastrous results. We experienced a rare case in which a 51-year-old male patient developed both brain abscess and abuducens nerve palsy and report this case with a review of the case and related articles.

A Case of Tolosa-Hunt Syndrome

Tolosa-Hunt syndrome (cavernoussinusitis) is a term used to describe diseases involving the content of the superior orbital fissure and/or anterior cavernous sinus, presenting as painful ophthalmoplegia, along with granulomatous inflammation. The third, fourth, fifth and sixth cranial nerves pass through the carvenous sinus. Thus, when infection spreads into the cavernous sinus, these cranial nerves may be paralyzed and corneal reflexes may disappear. Pain and hypoesthesia of the area, which is innervated by the maxillary branch of the fifth nerve, can be accompanied with this syndrome. Tolosa-Hunt syndrome can be improved dramatically with high-dose steroid therapy. A 15-year-old boy who had retro-orbital pain, diplopia and exophthalmos was diagnosed with sphenoid sinusitis by PNS CT. He underwent brain MRI and neurologic examination because the symptoms persisted after the endoscopic sinus surgery. He was finally diagnosed with Tolosa-Hunt syndrome and his symptoms were improved with steroid therapy.

Cerebrospinal Fluid Rhinorrhea Secondary to Acute Sphenoid Sinusitis

Acute sphenoid sinusitis is a relatively uncommon disease in the post-antibiotic era. Furthermore direct bony destruction and intracranial complications secondary to sphenoid sinusitis are extremely rare. However, it can have a high morbidity and mortality rate. If the diagnosis is delayed, serious problems can occur, so early diagnosis and treatment are required. We represent and discuss a case of cerebrospinal fluid (CSF) rhinorrhea with wide bony destruction directly, secondary to acute sphenoid sinusitis.

A Case of Olfactory Neuroblastoma in Sphenoid Sinus / 대한이비인후과학회지

Olfactory neuroblastoma is a relatively uncommon malignant tumor originating from neuroectoderm and it usually arises from the superior portion of the nasal cavity, such as superior turbinate, superior part of septum, or cribriform plate. Cases of olfactory neuroblastoma from sphenoid sinus, in which olfactory epithelium rarely exists, have been rarely reported. Although nasal obstruction and epistaxis are the most common presenting symptoms of olfatory neroblastoma, our patient presented with headache and dizziness. The most common cause of isolated sphenoid lesion is inflammation, but the possibility of tumorous conditions should not be excluded without thorough evaluation. The authors experienced a rare case of olfactory neuroblastoma from sphenoid sinus that had been confused as isolated sphenoid sinusitis. So we report our unusual case with a brief review of literature.

A Case of Optic Neuritis in Acute Sphenoid Sinusitis

PURPOSE: We encountered a rare case of optic neuritis that developed in a sphenoid sinusitis. This case has not been reported at any of the Korean Ophthalmological Society meetings. CASE SUMMARY: A 12-year-old boy with swollen optic disc was diagnosed with optic neuritis secondary to sphenoid sinusitis, through orbit MRI (magnetic resonance imaging) and paranasal sinus CT (computed tomography). We observed the recovery of visual acuity and the improvement of papilledema after treatment. In the initial examination, the BCVA (best-corrected visual acuity) of the right eye was only hand movement. Papilledema was detected by ophthalmoscopy. Orbit MRI and paranasal sinus CT were then performed, which revealed that sphenoid sinusitis had invaded the right optic nerve. Treatment included the use of antibiotics, systemic steroid therapy, and endoscopic sinus surgery. One month after treatment, the BCVA of the right eye was 1.0 and the papilla of right eye had a normal ophthalmoscopic finding. CONCLUSIONS: Sphenoid sinusitis can be a cause of optic neuritis. The treatment of optic neuritis caused by paranasal sinusitis must include antibiotics use or endoscopic sinus surgery to remove the sinus inflammation as well as high dose steroid therapy.

Sphenoidal Sinusitis with Epidural Empyema Presenting as Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a common condition that produces pain in the orofacial area. However, the exact cause of TN is still unknown. Various etiologies such as tumor, multiple sclerosis and other compressive lesions have been implicated as possible causes. A 35-year-old woman was admitted due to right facial pain which was diagnosed as TN. A brain MRI revealed sphenoidal sinusitis with epidural empyema. We report a case of complicated sinusitis with epidural empyema presenting as TN.

Isolated sphenoid sinus inflammatory disease / 中国耳鼻咽喉头颈外科

OBJECTIVE To add to the current bodyof knowledge on isolated sphenoid sinus inflammatorydisease in order to promote early diagnosis and prompttreatment to prevent critical complications. METHODS A retrospective analysis was performed on 23 clinical cases of isolated sphenoid sinus inflammatory disease. The clinical features,radiological features,treatment and follow-up results were reviewed in the light of relevant literature. RESULTS The most common symptoms of the disease were headache and visual disturbance. All patients were treated by endoscopic sinus surgery and followed-up for 6-14 months. No recurrence was observed. CONCLUSION Diagnosis of isolated sphenoid sinus inflammatory disease at its early stages is difficult to ascertain because of the non-specificity of its symptoms. The widespread use of nasal endoscopy and CT examination makes early pre-operative diagnoses possible. Managing sphenoid sinus inflammatory disease with functional endoscopic sinus surgery is the preferred method of treatment.

The clinical analysis of fungus ball sphenoid sinusitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To improve the knowledge on the early diagnosis and treatment of the isolated fungus ball sphenoid sinusitis.METHODS A retrospe ctive study was made on10cases of isolated fungus ball sphenoid sinusitis to discuss the clinical manifestation,radiographic features and treatment with endoscopic sinus surgery.RESULTS The common symptoms in10cases were headache and/or bloody nasal discharge.Radiographic features of the disease were a soft tissue image occupying the sphenoid sinus with bones wall thickening.A soft tissue image with calcification in the sphenoid sinus was the feature of CT image.All the patients were treated by nasal endoscopic sinus surgery and cured after followed up for3to18.CONCLUSION Isolated fungus ball sphenoid sinusitis was difficult to diagnose in early stage because of its non-specif ic symptoms.The nasal endoscopy and CT scan make the early diagnosis possible.The diagnosis can be def initely confi rmed by pathological studies.Treatment with endoscopic sinus surgery is an effective method for fungus ball sphenoid sinusitis.

A Case of Epidural Abscess in Middle Cranial Fossa Secondary to Acute Sphenoid Sinusitis

Acute or chronic sinusitis is common disease of ENT. Most cases usually respond to appropriate treatment; however, some cases occasionally progress to the development of serious complication and poor prognosis. The orbital complications are most common complication fallowed by intracranial complications. The incidence of sinogenic intracranial complications is about 3.7-11.0% and these complications are progressively decreasing however the complications occur due to incorrect use of antibiotics, antibiotics resistant pathogens, decreasing host immunity, improper diagnosis and delayed surgical treatment. Therefore the case of epidural abscess in anterior portion of middle cranial fossa secondary to acute sphenoid sinusitis, which was treated with transnasal endoscopic sphenoidotomy and intravenous antibiotics, is being reported.

A Case of Abducens Nerve Palsy Caused by Isolated Sphenoid Fungal Sinusitis

Isolated sphenoid sinusitis is a rare disorder. There are some difficulties in its diagnosis; therefore the first presentation of this disorder might be with complications. These complications are essentially due to the anatomical location of the sinus and its proximity to the intra-cranial and orbital contents, to which infection may easily spread. A case of isolated sphenoid fungal sinusitis with unilateral abducent nerve palsy is being reported which was successfully treated by parenteral antibiotic therapy and endonasal endoscopic sphenoidotomy.

A Case of Multiple Vasculitis and Stroke due to Sphenoid Sinusitis / 대한이비인후과학회지

Sinogenic intracranial complications are rare but serious conditions. Sometimes, the diagnosis is delayed because the initial symptoms of sphenoid sinuses intracranial complications are not remarkable especially when they are of sphenoid sinus origin. Deep location of the sphenoid sinuses places them adjacent to the dura mater, major intracranial vessels, and some cranial nerves. Therefore, delayed diagnosis of the sphenoid sinusitis and its complications can make disastrous results. We experienced a 55 year old female patient who developed fulminant meningitis, vasculitis, and a stroke due to vasculitis as a complication of sphenoid sinusitis. We review the case and related articles.