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1.
Sci Rep ; 14(1): 8649, 2024 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-38622183

RESUMEN

Potentially fatal fungal sphenoid sinusitis (FSS) causes visual damage. However, few studies have reported on its visual impairment and prognosis. Five hundred and eleven FSS patients with ocular complications treated at Beijing Tongren Hospital were recruited and clinical features and visual outcomes were determined. Thirty-two of the 511 patients (6%) had visual impairment, with 13 and 19 patients having invasive and noninvasive FSS, respectively. Eighteen patients (56.25%) had diabetes and 2 patient (6.25%) had long-term systemic use of antibiotics (n = 1) and corticosteroids (n = 1). All patients had visual impairment, which was more severe in invasive FSS than in noninvasive FSS. Bony wall defects and sclerosis were observed in 19 patients (59.38%), and 11 patients (34.38%) had microcalcification in their sphenoid sinusitis on computed tomography (CT). After a 5-year follow-up, three patients (9.38%) died. Patients with noninvasive FSS had a higher improvement rate in visual acuity than their counterparts. In the multivariate analysis, sphenoid sinus wall sclerosis on CT was associated with better visual prognosis. FSS can cause vision loss with persistent headaches, particularly in those with diabetes. CT showed the sphenoid sinus wall sclerosis, indicating a better visual prognosis in FSS with visual impairment.


Asunto(s)
Diabetes Mellitus , Micosis , Sinusitis , Sinusitis del Esfenoides , Baja Visión , Humanos , Sinusitis del Esfenoides/complicaciones , Sinusitis del Esfenoides/diagnóstico por imagen , Esclerosis , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/microbiología , Micosis/complicaciones , Trastornos de la Visión/complicaciones , Baja Visión/complicaciones , Estudios Retrospectivos
2.
PLoS One ; 19(4): e0299489, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38687757

RESUMEN

OBJECTIVES: Computed tomography (CT) and cone beam computed tomography (CBCT) represent the main imaging modalities used in rhinosinusitis patients and are also important in odontogenic sinusitis (OS) diagnostics. Reports, however, often lack information on dentition. Here, we aimed to determine how maxillary dentition is initially interpreted in rhinosinusitis patients' CT/CBCT reports and which dental findings in particular are potentially missed, thus needing more attention. STUDY DESIGN: CT/CBCT scans and radiological reports from 300 rhinosinusitis patients were analysed focusing specifically on dental findings. An experienced oral and maxillofacial radiologist re-evaluated the scans and the assessment was compared to the original reports using the McNemar test. RESULTS: From the 300 original reports, 233 (77.7%) mentioned the maxillary teeth. The most frequent statement (126/300, 42.0%) was 'no apical periodontitis'. Apical periodontitis and severe alveolar bone loss were significantly overlooked (p < 0.001). Amongst the 225 patients for whom the CT/CBCT report initially lacked information on dental pathology, 22 patients were diagnosed with apical periodontitis and 16 with severe alveolar bone loss upon re-evaluation. CONCLUSIONS: Dental pathology remains underreported in rhinosinusitis patients' CT/CBCT reports. Because these reports affect OS diagnostics, a routine and structured review of the maxillary teeth by a radiologist is necessary. Such examinations should encompass the maxillary teeth.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Sinusitis , Humanos , Femenino , Masculino , Tomografía Computarizada de Haz Cónico/métodos , Adulto , Sinusitis/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Anciano , Adulto Joven , Adolescente , Rinitis/diagnóstico por imagen , Pérdida de Hueso Alveolar/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Senos Paranasales/patología , Anciano de 80 o más Años , Periodontitis Periapical/diagnóstico por imagen , Periodontitis Periapical/patología
3.
Int J Pediatr Otorhinolaryngol ; 180: 111958, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38657427

RESUMEN

INTRODUCTION: As the role of sinonasal anatomical variants as predisposing factors in determining the lateralization of acute rhinosinusitis-related orbital complications (ARS-OC) in pediatrics remains a topic of debate, this study further explores the potential association between anatomical variations and ARS-OC. METHODS: A retrospective study was conducted on children who had been admitted with ARS-OC using medical records and sinus CT scans to compare anatomical differences between the affected and contralateral sides. This study aimed to identify bony anatomical disparities that may impact OC laterality secondary to ARS. The anatomical features examined included septal deviation, concha bullosa, lamina papyracea dehiscence (LPD), and uncinate process abnormalities. RESULTS: The CT scans of 57 pediatric patients (114 sides) were reviewed. Our results indicated that bony anatomical variations were associated with ARS-OC laterality (63 % vs. 37 %, P = 0.006), yielding an odds ratio of 2.91. Additionally, our study revealed a significant association between ipsilateral LPD with the increased risk of ARS-OC (39 % vs. 1.8 %, P < 0.05), with an odds ratio of 34.3 compared to the opposite side. CONCLUSIONS: LPD might play a role in the pathophysiology of pediatric ARS-OC, as it is associated with a significantly higher risk of affecting the ipsilateral side. Further research is necessary to determine whether LPD is a causative factor or a result of ARS.


Asunto(s)
Senos Paranasales , Rinitis , Sinusitis , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Retrospectivos , Niño , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Rinitis/complicaciones , Rinitis/diagnóstico por imagen , Enfermedad Aguda , Preescolar , Senos Paranasales/diagnóstico por imagen , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/etiología , Adolescente , Variación Anatómica , Rinosinusitis
4.
Sensors (Basel) ; 24(6)2024 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-38544195

RESUMEN

Accurate paranasal sinus segmentation is essential for reducing surgical complications through surgical guidance systems. This study introduces a multiclass Convolutional Neural Network (CNN) segmentation model by comparing four 3D U-Net variations-normal, residual, dense, and residual-dense. Data normalization and training were conducted on a 40-patient test set (20 normal, 20 abnormal) using 5-fold cross-validation. The normal 3D U-Net demonstrated superior performance with an F1 score of 84.29% on the normal test set and 79.32% on the abnormal set, exhibiting higher true positive rates for the sphenoid and maxillary sinus in both sets. Despite effective segmentation in clear sinuses, limitations were observed in mucosal inflammation. Nevertheless, the algorithm's enhanced segmentation of abnormal sinuses suggests potential clinical applications, with ongoing refinements expected for broader utility.


Asunto(s)
Aprendizaje Profundo , Sinusitis , Humanos , Sinusitis/diagnóstico por imagen , Redes Neurales de la Computación , Seno Maxilar , Tomografía Computarizada por Rayos X/métodos , Procesamiento de Imagen Asistido por Computador/métodos
5.
Saudi Med J ; 45(3): 235-240, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38438210

RESUMEN

OBJECTIVES: To assess the impact of changes in sinus aeration on dose variation in nasopharyngeal cases using a single beam with various field sizes and real patient computed tomography (CT) images. METHODS: The calculations were carried out on a computer equipped with an Intel Xeon (R) Gold 5118 processor operating at 2.30 GHz in 2022 at Taibah University, Al Madinah Al Munawwarah for a retrospective nasopharyngeal case. At the patient level, the impact on dose distribution was examined for different field sizes by comparing the percentage depth dose. The dose discrepancy was evaluated by comparing the dose delivered without considering the anatomical changes observed in the initial fraction to the dose adjusted to account for these changes using a 2D gamma analysis. With a criterion of 1% dose difference and 1 mm distance to agreement, the gamma level for analysis was set at 95%. RESULTS: The study findings indicated that the observed effect diminished by approximately 50% for both 5 cm x 5 cm and 10 cm x 10 cm field sizes compared to the 3 cm x 3 cm size, where there was an overlap between the planning target volume and sinusitis. CONCLUSION: The study concluded that the impact of dose discrepancy was more pronounced in smaller field sizes.


Asunto(s)
Sinusitis , Humanos , Estudios Retrospectivos , Sinusitis/diagnóstico por imagen , Sinusitis/radioterapia , Tomografía Computarizada por Rayos X , Universidades
6.
Eur Arch Otorhinolaryngol ; 281(5): 2421-2428, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38225396

RESUMEN

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.


Asunto(s)
Rinitis , Sinusitis , Sinusitis del Esfenoides , Masculino , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Sinusitis del Esfenoides/diagnóstico por imagen , Sinusitis del Esfenoides/terapia , Rinitis/diagnóstico , Enfermedad Crónica , Sinusitis/diagnóstico por imagen , Sinusitis/tratamiento farmacológico , Cefalea , Enfermedad Aguda
7.
Int J Pediatr Otorhinolaryngol ; 177: 111865, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38262225

RESUMEN

OBJECTIVE: Orbital complications account for approximately 74-85 % of all complications of acute sinusitis, affect the pediatric population more frequently, and can have devastating consequences. In the years following the COVID-19 pandemic (2022, 2023), a high number of children presented to our clinic with orbital complications. 1)Has there been an increase in orbital complications in the post-covid era? 2)To what extent has the use of MRI reduced radiation in pediatric patients? DESIGN: In our retrospective data analysis, all pediatric patients (age 0-16 years) treated at a university ENT clinic during the period 01/2014-06/2023 who presented with an orbital complication of rhinosinusitis were included. The analysis was descriptive. RESULTS: Forty-four children with orbital complications of rhinosinusitis were treated during the study period, 14 females and 30 males. Most patients (n = 23, 52 %) presented during the years of the waning Covid-19 pandemic (01/2022 to 06/2023). MRI was the initial imaging modality (n = 22,50 %); CT was performed in 17 of 44 cases (39 %) when surgery was indicated. The most common germ detected was of the Streptococcus species, and the predominant antibiotic administered was amipicillin/sulbactam. CONCLUSION: The standard operating procedure (SOP) established at our hospital in 2014 was followed in 42/44 cases. Except for 2 cases, CT was performed exclusively when surgery was indicated. Imaging-related radiation could be avoided in 27 patients (61 %). There was a 30 % increase in orbital complications related to sinus infections postpandemically.


Asunto(s)
COVID-19 , Enfermedades Orbitales , Rinosinusitis , Sinusitis , Masculino , Femenino , Niño , Humanos , Recién Nacido , Lactante , Preescolar , Adolescente , Enfermedades Orbitales/epidemiología , Enfermedades Orbitales/etiología , Enfermedades Orbitales/terapia , Estudios Retrospectivos , Pandemias , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/epidemiología , Enfermedad Aguda , COVID-19/complicaciones , COVID-19/epidemiología
8.
Vet Surg ; 53(1): 54-66, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37602997

RESUMEN

OBJECTIVE: The recent availability of standing computed tomography (CT) for equine paranasal sinus disease has enhanced diagnosis and enabled more targeted surgery compared to radiography and sinoscopy. To date, there have been no studies which have critically evaluated the benefit of preoperative CT versus radiography and sinoscopy on complications and outcome in horses undergoing sinus trephination. STUDY DESIGN: Retrospective study. ANIMALS: A total of 229 equids. METHODS: The medical records of equids (229) presented for sinusitis treated via trephination that had CT, radiography and/or sinoscopy at time of surgery between 2009 and 2022 were reviewed. Outcome and complications were evaluated for six different pre- and intraoperative imaging modalities. RESULTS: The six groups did not differ in demographics or disease category, though equids with less weight (p = .0179) and shorter disease duration (p = .0075) were more likely to have radiography and sinoscopy based surgical planning. Short-term postoperative complications occurred in 30.1% and were higher in groups using preoperative CT imaging (p = .01), with hemorrhage being the most common surgical complication. Following initial trephination surgery, 57.0% (127/223) of cases resolved and there was no difference between the imaging groups. Final resolution after follow-up medical or surgical treatment increased to 94.6% (211/223) and was not different between the imaging groups or between primary or secondary sinusitis. Additional nasal fenestrations to improve sinonasal drainage, maxillary septal bulla fenestrations and trephinations to treat nasal conchal bullae were made in the CT groups. CLINICAL SIGNIFICANCE: CT provided additional diagnostic information and enabled different surgical approaches but did not improve resolution in this study population.


Asunto(s)
Enfermedades de los Caballos , Sinusitis , Humanos , Caballos , Animales , Estudios Retrospectivos , Trepanación/veterinaria , Sinusitis/diagnóstico por imagen , Sinusitis/cirugía , Sinusitis/veterinaria , Tomografía Computarizada por Rayos X/veterinaria , Radiografía , Enfermedades de los Caballos/diagnóstico por imagen , Enfermedades de los Caballos/cirugía
9.
Int Forum Allergy Rhinol ; 14(3): 738-740, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37482946

RESUMEN

KEY POINTS: The pandemic caused an increase in computed tomography imaging in patients with sinusitis, which persisted post-COVID. Nasal endoscopies significantly decreased during COVID but returned to pre-COVID levels in 2022. The management of cerebrospinal fluid leaks, tumors, and orbital pathology was not impacted by the pandemic.


Asunto(s)
COVID-19 , Sinusitis , Humanos , COVID-19/epidemiología , Pandemias , Endoscopía , Tomografía Computarizada por Rayos X , Sinusitis/diagnóstico por imagen , Sinusitis/epidemiología , Sinusitis/terapia
10.
J Craniofac Surg ; 35(1): e102-e103, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37983056

RESUMEN

It is rare that cavernous sinus complications are caused by maxillary sinus lesions because the locations of these lesions are some distant from each other. The authors describe an unusual presentation that the primary lesion was located in the maxillary sinus and triggered cavernous sinus syndrome and optic nerve symptoms. The most likely possibility was that the infection traveled retrograde along the vascular plexus. Removal of maxillary sinus lesions and establishment ventilation may achieve source control.


Asunto(s)
Síndromes del Seno Cavernoso , Seno Cavernoso , Sinusitis Maxilar , Micosis , Sinusitis , Humanos , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/cirugía , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/terapia , Micosis/complicaciones , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía
11.
Eur Arch Otorhinolaryngol ; 281(2): 795-803, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37882847

RESUMEN

BACKGROUND: Cystic fibrosis (CF) is a severe systemic disease that affects many aspects of patients' lives. It is known that the progression of the disease adversely affects lower and upper airways including the paranasal sinuses. However, its impact on sinus development in the pediatric population is not fully examined. The purpose of this study was to evaluate the development of the paranasal sinuses in a pediatric population with CF and compare it to a control group consisting of healthy children. METHODS: The results of computed tomography (CT) scans of children with the disease and the control group were evaluated. The study included 114 CT images of children in the study group and 126 images of healthy children aged 0-18 years. The volumes of maxillary, frontal, and sphenoid sinuses were analyzed. The obtained results were compared with those of the control group and analyzed statistically. RESULTS: The volume and the development of the paranasal sinuses in both groups increased with age, but statistically significant differences were found between the study and the control group. CONCLUSIONS: The obtained results provide valuable knowledge regarding the impact of the CF on sinuses development. Also, they may be important in understanding the progression of the disease and its influence on the quality and length of life of patients. The results may contribute to enhanced diagnostics and have implications for improving therapy for patients with chronic sinusitis associated with CF.


Asunto(s)
Fibrosis Quística , Senos Paranasales , Sinusitis , Humanos , Niño , Fibrosis Quística/complicaciones , Fibrosis Quística/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Sinusitis/complicaciones , Seno Esfenoidal , Tomografía Computarizada por Rayos X
12.
Laryngoscope ; 134(6): 2626-2633, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38126613

RESUMEN

OBJECTIVE: To provide real-life evidence on long-term radiological changes in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab, and to assess possible differences between radiological and clinical results in terms of endoscopic findings and Patient-Reported-Outcomes (PROs). METHODS: Consecutive patients treated with dupilumab for recalcitrant CRSwNP were required to undergo CT scan at baseline (T0) and after 12 (T1) since first administration. A group of patients also performed CT scan at 52 weeks (T2) to assess long-term outcomes. At each timepoint, patients underwent nasal endoscopy, assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analogue-Scales (VAS) for sinonasal symptoms. RESULTS: In fifty-three included patients, from T0 to T1 we detected a significant reduction in mean Lund-Mackay score (LM), PROs (SNOT-22, VAS) and endoscopic (NPS, LKS) scores (p < 0.05). In the subset of patients that reached T2 (n = 30), compared to T1, we observed a further significant decrease in mean LM, SNOT-22, VAS, and NPS scores, but not in LKS (p = 0.420). At T1, the highest improvement was observed in PROs (SNOT-22: 56.26%), and polyp size (NPS: 49.83%). Conversely, between T1 and T2, sinus opacification was shown to be the most improved outcome (LM: 36.86%). CONCLUSIONS: Our experience showed that poorly controlled CRSwNP patients treated with dupilumab experienced significant improvement in radiologic, endoscopic and clinical disease severity. While in the initial 3 months, PROs garnered attention for showing earlier effectiveness, radiological outcomes revealed sustained and gradual efficacy in a longer term. LEVEL OF EVIDENCE: Level 4. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 4 evidence Laryngoscope, 134:2626-2633, 2024.


Asunto(s)
Anticuerpos Monoclonales Humanizados , Pólipos Nasales , Rinitis , Sinusitis , Tomografía Computarizada por Rayos X , Humanos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Masculino , Femenino , Persona de Mediana Edad , Pólipos Nasales/tratamiento farmacológico , Pólipos Nasales/complicaciones , Resultado del Tratamiento , Sinusitis/tratamiento farmacológico , Sinusitis/diagnóstico por imagen , Rinitis/tratamiento farmacológico , Enfermedad Crónica , Adulto , Medición de Resultados Informados por el Paciente , Endoscopía/métodos , Anciano , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Transpl Infect Dis ; 26(1): e14226, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38151992

RESUMEN

BACKGROUND: Patients with end-stage liver disease can be treated with a liver transplantation (LT). Before listing, candidates are subjected to a screening procedure according to the EASL Clinical Practice Guidelines for LT. In our hospital, this includes an ear, nose, and throat (ENT) examination, directed towards the identification of (asymptomatic) infections and head and neck malignancies. METHODS: We retrospectively reviewed all ENT screening examinations in LT candidates from 2007 to 2022. The screening consisted of a visit to the ENT outpatient clinic combined with sinus radiography. RESULTS: ENT screening was performed in 1099 patients. Sixty-one cases were identified, either diagnosed with an infection (n = 58, almost exclusively sinusitis) or a neoplasm (n = 3, of which two malignancies). With binary logistic regression, we could not identify significant risk factors for diagnosing sinusitis. 711 patients underwent LT. After LT, two patients developed a novel malignancy of the head and neck area, while 14 patients were diagnosed with sinusitis, two of the latter already showed opacification on sinus radiography during screening. Despite immunosuppressive drugs, no complicated sinusitis was observed. CONCLUSION: Sinusitis or a neoplasm was diagnosed in almost 6% in a large cohort of LT candidates. Although almost a third of sinusitis patients were not treated accordingly, we did not observe any complicated sinusitis after LT. A more conservative approach to sinusitis may therefore be justified in LT candidates, especially in asymptomatic cases. At our institution, we aim to refer only those patients with specific ENT complaints .


Asunto(s)
Trasplante de Hígado , Neoplasias , Sinusitis , Humanos , Estudios Retrospectivos , Faringe , Trasplante de Hígado/efectos adversos , Sinusitis/diagnóstico por imagen
14.
Georgian Med News ; (343): 18-22, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38096509

RESUMEN

The most effective process of quitting smoking can be achieved through precise and complete identification of the adverse effects on the human body. The aim was to examine the influence of smoking on the density of the walls of the paranasal sinuses. 80 individuals of the young age and both genders were included into the research. Depending on the presence of pathological changes in the sinuses and smoking habits, all participants were divided into four groups. It was found that in the group of smokers without any paranasal sinus pathology, the density is 2.66% lower than the intact group. This figure is significantly higher in patients suffering from rhinosinusitis but not smoking, where it is 45.18%. The maximum difference from the control group is observed in individuals suffering from chronic rhinosinusitis and being smokers, with a difference of 81.03%. Pedagogical aspects of the impact of smoking on the human body based on radiographic density indicators of maxillary sinus bone walls were detected. It has been observed that smoking can exacerbate the negative impact of inflammatory processes in the paranasal sinuses.


Asunto(s)
Seno Maxilar , Sinusitis , Humanos , Femenino , Masculino , Seno Maxilar/diagnóstico por imagen , Cuerpo Humano , Sinusitis/diagnóstico por imagen , Maxilar/patología , Fumar/efectos adversos
15.
Emerg Radiol ; 30(6): 807-810, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37845401

RESUMEN

Acute invasive fungal sinusitis (AIFS) is a fungal infection of the nasal cavity and paranasal sinuses with associated invasion of adjacent vessels and soft/hard tissues. It usually occurs in immunocompromised patients and may follow a rapid course of less than four weeks with high mortality rate. We report a 39-year-old male with relapse of acute myelogenous leukemia (AML) who was under evaluation for neutropenic fever. On his sinus CT, there was loss of calcification of his nasal septum when compared to a prior head CT, a sign indicative of an aggressive infectious process. He was diagnosed with AIFS and underwent emergent surgical debridement and systemic antifungal therapy, leading to a positive outcome. The sign described on CT ("Vanishing Nasal Septum" sign) may provide an additional, reliable tool to prospectively identify locally aggressive cases of invasive fungal infections of the nasal cavity at an earlier stage and improve patient outcomes.


Asunto(s)
Infecciones Fúngicas Invasoras , Micosis , Sinusitis , Masculino , Humanos , Adulto , Micosis/diagnóstico por imagen , Micosis/cirugía , Sinusitis/diagnóstico por imagen , Sinusitis/microbiología , Infecciones Fúngicas Invasoras/diagnóstico por imagen , Tabique Nasal/diagnóstico por imagen
16.
Radiat Oncol ; 18(1): 153, 2023 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-37723540

RESUMEN

OBJECTIVE: To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients. PATIENTS AND METHODS: A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS. RESULTS: (1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040). CONCLUSION: (1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.


Asunto(s)
Neoplasias Nasofaríngeas , Sinusitis , Humanos , Carcinoma Nasofaríngeo/radioterapia , Estudios Retrospectivos , Sinusitis/diagnóstico por imagen , Sinusitis/etiología , Imagen por Resonancia Magnética , Neoplasias Nasofaríngeas/radioterapia
17.
Braz J Otorhinolaryngol ; 89(5): 101316, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37678009

RESUMEN

OBJECTIVE: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. METHODS: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. RESULTS: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. CONCLUSIONS: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS.


Asunto(s)
Celulitis Orbitaria , Enfermedades Orbitales , Rinitis , Sinusitis , Humanos , Estudios Retrospectivos , Absceso/diagnóstico por imagen , Absceso/etiología , Rinitis/complicaciones , Rinitis/diagnóstico por imagen , Rinitis/cirugía , Celulitis Orbitaria/diagnóstico por imagen , Celulitis Orbitaria/etiología , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/cirugía , Enfermedad Aguda , Enfermedades Orbitales/etiología , Enfermedades Orbitales/complicaciones
18.
J Infect Dev Ctries ; 17(6): 854-859, 2023 06 30.
Artículo en Inglés | MEDLINE | ID: mdl-37406069

RESUMEN

INTRODUCTION: Chronic rhinosinusitis (CRS) is inflammation of the nasal cavity and paranasal sinus mucosa. The aim of this study was to examine which of the available radiological and clinical parameters is the best indicator of the CRS severity. METHODOLOGY: In order to classify CRS, we used both a subjective assessment tool such as SNOT-22 questionnaire, as well as an objective tool such as clinical examination. We introduced three forms of CRS (mild, moderate and severe). Within these groups, we evaluated the computerized tomography (CT) parameters used as an indicator of bone remodeling, the Lund-Mackay score (LMS), CT properties of the soft tissue content in the maxillary sinuses, presence of nasal polypus (NP), presence of fungal infection and parameters indicating allergic status. RESULTS: Frequencies of NP, positive eosinophil count, presence of fungi, areas of high attenuation, and duration of CRS and LMS significantly increased with the increased severity of CRS. Anterior wall thickness and density increased in the severe forms of CRS in the group assessed by SNOT-22. Positive correlation was detected between LMS and maximal density of sinus content and between duration of CRS and anterior wall thickness. CONCLUSIONS: Morphological changes of sinus wall detected in CT could be a useful indicator of CRS severity. Changes in bone morphology are more likely to occur in patients with longer-lasting CRS. The presence of fungi, allergic inflammation of any origin and nasal polypus potentiates more severe forms of CRS both clinically and subjectively.


Asunto(s)
Senos Paranasales , Rinitis , Sinusitis , Humanos , Sinusitis/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Radiografía , Tomografía Computarizada por Rayos X , Inflamación , Enfermedad Crónica , Rinitis/diagnóstico por imagen
19.
Braz J Otorhinolaryngol ; 89(4): 101287, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37442058

RESUMEN

OBJECTIVES: For the treatment of chronic rhinosinusitis functional endoscopic sinus surgery is a well-established therapy with high initial success rates. However, a significant proportion of patients have persistent disease requiring revision surgery. To date, studies including data of large patient collectives are missing. In this study, we aimed to identify anatomic factors increasing the need for revision surgery in a large patient collective with chronic rhinosinusitis without nasal polyps. METHODS: Data were collected retrospectively on patients with recurrent or persistent chronic rhinosinusitis without nasal polyps requiring revision surgery. The patients' symptomatology, endoscopic and radiographic findings were analyzed. Preoperatively, patients were evaluated with endoscopic examination of the nose and paranasal sinuses. In all individuals computed tomography of the sinuses was performed. Images were evaluated according to the Lund-Mackay system. Information was also collected intraoperatively. RESULTS: 253 patients were included. The most common anatomic factor was incomplete anterior ethmoidectomy (51%), followed by residual uncinated process (37%), middle turbinate lateralization (25%), incomplete posterior ethmoidectomy (20%), frontal recess scarring (19%), and middle meatal stenosis (9%). Other factors such as persistent sphenoid pathology was less frequent. CONCLUSION: Iatrogenic causes with inadequate resection of obstructing structures seem to be a principal risk factor for recurrent chronic rhinosinusitis and the need for revision sinus surgery. Meticulous attention in the area of the ostiomeatal complex during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary endoscopic sinus surgery. LEVEL OF EVIDENCE: 2b.


Asunto(s)
Seno Frontal , Pólipos Nasales , Senos Paranasales , Rinitis , Sinusitis , Humanos , Pólipos Nasales/complicaciones , Pólipos Nasales/diagnóstico por imagen , Pólipos Nasales/cirugía , Reoperación , Estudios Retrospectivos , Cicatriz/patología , Cicatriz/cirugía , Rinitis/diagnóstico por imagen , Rinitis/cirugía , Sinusitis/diagnóstico por imagen , Sinusitis/cirugía , Senos Paranasales/cirugía , Endoscopía , Enfermedad Crónica
20.
Comput Methods Programs Biomed ; 240: 107708, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37473588

RESUMEN

BACKGROUND AND OBJECTIVE: The cone-beam computed tomography (CBCT) provides three-dimensional volumetric imaging of a target with low radiation dose and cost compared with conventional computed tomography, and it is widely used in the detection of paranasal sinus disease. However, it lacks the sensitivity to detect soft tissue lesions owing to reconstruction constraints. Consequently, only physicians with expertise in CBCT reading can distinguish between inherent artifacts or noise and diseases, restricting the use of this imaging modality. The development of artificial intelligence (AI)-based computer-aided diagnosis methods for CBCT to overcome the shortage of experienced physicians has attracted substantial attention. However, advanced AI-based diagnosis addressing intrinsic noise in CBCT has not been devised, discouraging the practical use of AI solutions for CBCT. We introduce the development of AI-based computer-aided diagnosis for CBCT considering the intrinsic imaging noise and evaluate its efficacy and implications. METHODS: We propose an AI-based computer-aided diagnosis method using CBCT with a denoising module. This module is implemented before diagnosis to reconstruct the internal ground-truth full-dose scan corresponding to an input CBCT image and thereby improve the diagnostic performance. The proposed method is model agnostic and compatible with various existing and future AI-based denoising or diagnosis models. RESULTS: The external validation results for the unified diagnosis of sinus fungal ball, chronic rhinosinusitis, and normal cases show that the proposed method improves the micro-, macro-average area under the curve, and accuracy by 7.4, 5.6, and 9.6% (from 86.2, 87.0, and 73.4 to 93.6, 92.6, and 83.0%), respectively, compared with a baseline while improving human diagnosis accuracy by 11% (from 71.7 to 83.0%), demonstrating technical differentiation and clinical effectiveness. In addition, the physician's ability to evaluate the AI-derived diagnosis results may be enhanced compared with existing solutions. CONCLUSION: This pioneering study on AI-based diagnosis using CBCT indicates that denoising can improve diagnostic performance and reader interpretability in images from the sinonasal area, thereby providing a new approach and direction to radiographic image reconstruction regarding the development of AI-based diagnostic solutions. Furthermore, we believe that the performance enhancement will expedite the adoption of automated diagnostic solutions using CBCT, especially in locations with a shortage of skilled clinicians and limited access to high-dose scanning.


Asunto(s)
Sinusitis , Tomografía Computarizada de Haz Cónico Espiral , Humanos , Inteligencia Artificial , Seno Maxilar/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Fantasmas de Imagen
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