Optimal duration of macrolide treatment for chronic sinusitis after endoscopic sinus surgery.

OBJECTIVE: The objective is to determine the appropriate duration of postoperative macrolide therapy for chronic rhinosinusitis to obtain a favourable outcome with endoscopic sinus surgery (ESS). METHODS: The effectiveness of postoperative macrolide treatment was examined in patients with chronic rhinosinusitis who underwent ESS, by comparing 3-month (44 patients) and 6-month administration (66 patients) of clarithromycin (CAM) (200mg/day). Evaluation was made based on subjective symptoms and endoscopic findings at 3, 6 and 12 months after surgery. RESULTS: Seventeen (3-month CAM group) and 22 (6-month CAM group) subjects were able to be followed up to 12 months after surgery. No difference in effectiveness was observed between the groups until 6 months after surgery, but the 6-month treatment group showed significantly higher disappearance rates and significantly lower visual analogue scale (VAS) scores in the subjective symptoms of rhinorrhea and postnasal drip at 12 months after surgery. The positive finding rate of postnasal drip by endoscopic examination was also significantly lower in the 6-month treatment group at 12 months after surgery. These changes over time indicated gradual deterioration after discontinuation of CAM treatment in the 3-month treatment group, whereas a small improvement was observed after discontinuation in the 6-month treatment group. CONCLUSION: The results indicate that chronic sinusitis patients with rhinorrhea or postnasal drip should be treated with macrolides for 6 months after surgery in order to improve the long-term outcome of endoscopic sinus surgery.

Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice.

CONCLUSION: Our herpes simplex virus (HSV) labyrinthitis mouse model suggests that HSV infection induces vestibular neuritis and sudden deafness. OBJECTIVE: Viral labyrinthitis has been postulated to play a role in vestibular neuritis and sudden deafness. We established a mouse model to investigate the pathogenesis of HSV-induced labyrinthitis. The relationship between HSV infection and apoptosis in the labyrinth was assessed. METHODS: HSV types 1 and 2 were inoculated into the middle ear of mice, and the function of the cochlear and vestibular nerves was assessed. Histopathological changes were examined with hematoxylin and eosin staining. Anti-HSV immunohistochemistry staining and TUNEL staining were done to investigate the relationship between HSV-infected cells and apoptotic cells. RESULTS: Hearing loss and vestibular dysfunction were observed in all mice after inoculation of HSV type 1 or 2. In the cochlear duct, columnar epithelial cells in the stria vascularis were infected with HSV, but only a portion of the infected cells underwent apoptosis. In contrast, many uninfected cells in the spiral organ of Corti were apoptotic. Vestibular dysfunction was observed when vestibular ganglion cells were largely infected, but not apoptotic. These findings recapitulate sudden deafness and vestibular neuritis described in patients.

Postoperative olfaction in chronic sinusitis: smokers versus nonsmokers.

In order to study the efficacy of surgical intervention, as well as the influence of cigarette smoking on olfaction in clinical states, we examined olfactory ability by means of the University of Pennsylvania Smell Identification Test (UPSIT). We enrolled 37 patients 21 to 60 years of age who underwent surgery for chronic sinusitis. Normosmia was defined as an UPSIT score of 30 or more. Among these patients, 31 had a disturbance in their smelling ability in the preoperative stage, and the improvement rate, defined as a rise in score of 4 or more points after surgery, was 64.5%; 11 were well healed. However, all 7 patients who were more than 40 years old at the time of surgery, and currently smoking cigarettes, had a significant deficit in olfaction in the preoperative stage and even in the postoperative stage. This study demonstrated that cigarette smoking has adverse effects on olfactory ability, especially for older patients.