[Clinico-anamnestic diagnostics of chronic maxillary sinusitis associated with chlamydial infection]. / Kliniko-anamnesticheskaya diagnostika khronicheskogo verkhnechelyustnogo sinusita, assotsiirovannogo s khlamidiinym infitsirovaniem.

The present study included 201 adult patients presenting with exacerbation of chronic maxillary sinusitis. The presence of Chlamydia trachomatis and Chl. pneumoniae was verified by the direct immunofluorescencetechnique and polymerase chain reaction. The study material consisted of swipes und swabs from the mucous membrane of the middle nasal passage. The information from the patients was collected with the use of a questionnaire specially elaborated for the purpose of this study. The correlation relationships were established by means of gamma-statistics. The method is based on the calculation of the integral index characterizing the risk of development of chlamydial infection using the scoring scale for the evaluation of the clinical and anamnestic characteristics of the patients. The assessment of the risk of chlamydial colonization by the anamnestic method makes it possible to enhance the effectiveness of clinical diagnostics of chlamydial infection and thereby provides a basis for the prescription of the adequate anti-chlamydial treatment facilitating reduction of the frequency of complications and preventing dissemination of the causative factor of the disease. Moreover, this approach creates the conditions for the targeted selection of the patients to be referred to the laboratory verification of Chlamydia. Highoperating performance and effectiveness characteristics of the clinic-anamnestic diagnostics make it a method of choice for the wide application in the clinical practice.

Late diagnosis of an occult tumour - what lessons can we learn?

OBJECTIVE: Malignant tumours of the nasal cavity and paranasal sinuses are rare and late presentation of a maxillary sinus tumour is common due to the vague nature of the symptoms which can delay diagnosis. METHODS: We report a female with a maxillary sinus tumour who was initially diagnosed with chronic idiopathic facial pain (CIFP) and sinusitis, which subsequently led to a delay in diagnosis and treatment of her tumour. RESULTS: There was no clinical extra- or intra-oral pathology, however, she had varying clinical presentations of facial pain, anosmia, loss of gustatory function, and infra-orbital nerve paraesthesia. CT and MRI scans confirmed obliteration of the left maxillary sinus by a solid mass involving ethmoid and sphenoid sinuses and some cranial nerves. Biopsy confirmed a poorly differentiated carcinoma of the ethmoid and sphenoid sinuses and invasion of the cavernous sinus. CONCLUSION: A morbid, but hidden tumour was left undiagnosed due to the unusual presentation of the patient's symptoms. It is essential that all patients are managed holistically and thorough historical, clinical and radiographic examination and appropriate investigations are carried out to prevent unnecessary and potentially time-wasting treatment.

Antral lavage using the Luma transilluminaton wire and vortex irrigator--a safe and effective advance in treating pediatric sinusitis.

INTRODUCTION: While the treatment of pediatric sinusitis can be controversial, there is evidence that performing antral lavage in combination with adenoidectomy can improve treatment outcomes. We present an "over the wire" technique using new technology that can improve accuracy and reliability when performing antral lavage. METHODS: The LUMA fiberoptic light wire (Acclarent Inc.) and Vortex sinus irrigation catheter (Acclarent Inc.) were used to perform antral lavage as an adjunct in the treatment of pediatric sinusitis. DISCUSSION: We found this method to have multiple advantages over other techniques of lavage. These advantages include: 1) confirmation of position in the maxillary sinus by transillumination, 2) improvement of the safety and accuracy of the lavage, 3) ability to balloon dilate the natural ostium and ethmoid infundibulum or to obtain cultures at the time of lavage if clinically warranted or indicated by CT evidence, 4) avoidance of radiation from the use of fluoroscopy associated with other balloon sinuplasty equipment and techniques, and 5) no alteration of normal anatomy. CONCLUSION: We found this technique to give the surgeon a reliable, safe, versatile, and efficacious alternative before consideration of more invasive procedures in the pediatric population with chronic sinusitis.

Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background.

The following principles of appropriate antibiotic use for adults with acute rhinosinusitis apply to the diagnosis and treatment of acute maxillary and ethmoid rhinosinusitis in adults who are not immunocompromised. Most cases of acute rhinosinusitis diagnosed in ambulatory care are caused by uncomplicated viral upper respiratory tract infections. Bacterial and viral rhinosinusitis are difficult to differentiate on clinical grounds. The clinical diagnosis of acute bacterial rhinosinusitis should be reserved for patients with rhinosinusitis symptoms lasting 7 days or more who have maxillary pain or tenderness in the face or teeth (especially when unilateral) and purulent nasal secretions. Patients with rhinosinusitis symptoms that last less than 7 days are unlikely to have bacterial infection, although rarely some patients with acute bacterial rhinosinusitis present with dramatic symptoms of severe unilateral maxillary pain, swelling, and fever. Sinus radiography is not recommended for diagnosis in routine cases. Acute rhinosinusitis resolves without antibiotic treatment in most cases. Symptomatic treatment and reassurance is the preferred initial management strategy for patients with mild symptoms. Antibiotic therapy should be reserved for patients with moderately severe symptoms who meet the criteria for the clinical diagnosis of acute bacterial rhinosinusitis and for those with severe rhinosinusitis symptoms-especially those with unilateral facial pain-regardless of duration of illness. For initial treatment, the most narrow-spectrum agent active against the likely pathogens, Streptococcus pneumoniae and Haemophilus influenzae, should be used.