Bacteria and viruses in maxillary sinuses of patients with primary hypogammaglobulinemia.

OBJECTIVE: To study bacteria and viruses in maxillary sinuses of patients with primary hypogammaglobulinemia receiving immunoglobulin therapy. DESIGN: Prospective cross-sectional study during 6 months. SETTING: Tertiary care university hospital. PATIENTS: Seventeen patients with primary hypogammaglobulinemia (10 males and 7 females; mean age, 39 years [age range, 11-71 years]). Sixteen patients had common variable immunodeficiency, and 1 patient had X-linked agammaglobulinemia. MAIN OUTCOME MEASURES: Magnetic resonance imaging and x-ray imaging of paranasal sinuses when patients did not have signs of acute infection and reevaluation 6 months later. Maxillary sinus aspiration and lavage were performed at a follow-up visit. Sinus fluid analysis for bacteria and viruses was performed by culture and by polymerase chain reaction. A questionnaire on symptoms related to sinusitis was administered during the follow-up period. RESULTS: Among 17 patients, 9 (53%) had radiologically defined sinusitis without subjective symptoms at study enrollment. At reevaluation 6 months later, radiological findings remained unchanged in two thirds of the patients. Among 15 patients, bacteria were found in sinus lavage samples from 13 patients, and viruses were found in samples from 7 patients. Eight patients had 2 pathogens or more on bacterial culture. Rhinovirus was identified from sinus lavage samples in 5 patients (33%), enterovirus in 3 patients (20%), and respiratory syncytial virus in 1 patient (7%). Pathogenic bacteria were found in maxillary sinuses of all patients who tested positive for rhinovirus and enterovirus. No fungi were found. During the follow-up period, 6 patients reported mucopurulent drainage. CONCLUSIONS: Bacteria and viruses were commonly found in maxillary sinuses of patients with primary hypogammaglobulinemia. Yearly evaluation by an ear, nose, and throat surgeon is recommended.

Bioactive glass S53P4 in frontal sinus obliteration: a long-term clinical experience.

BACKGROUND: Synthetic, osteoconductive, and antimicrobial bioactive glass (BAG) has been used in many surgical applications. METHODS: BAG was used as obliteration material in a series of osteoplastic frontal sinus operations on 42 patients suffering from chronic frontal sinusitis, which could not be cured with other means of treatment. RESULTS: Accurate obliteration of sinuses was achieved in 39 patients. Uneventful recovery and clinical outcome were seen in 92% of the patients. Histopathologic samples harvested at 1, 5, and 10 years after obliteration revealed a healing process progressing from the fibrous tissue phase to bone formation with scattered fibrous tissue and bony obliteration maintaining BAG granule remnants. Fourier-transform infrared (FTIR) studies showed bone produced by BAG to be similar to natural frontal bone. Micorobiologic cultures obtained with histologic samples revealed no growth of bacteria. CONCLUSIONS: BAG appears to be a reliable frontal sinus obliteration material, providing favorable conditions for total bony sinus obliteration.

Acute sinusitis: Finnish clinical practice guidelines.

These clinical practice guidelines aim at providing assistance mainly to primary health care physicians for the diagnosis and management of acute sinusitis. Despite the huge impact of upper respiratory infections, criteria for diagnoses are often vague, and physicians are often uncertain of their diagnoses. This is not surprising, as the sole definition of acute sinusitis is somewhat confusing, not to mention the existing discrepancies between treatments, even among specialists. The Finnish Society of Otorhinolaryngology has set up a committee to evaluate existing data on acute sinusitis and to formulate these guidelines. The committee comprised Finnish experts in adult and paediatric otorhinolaryngology, clinical microbiology, radiology, paediatrics, and epidemiology. Recommendations given are based on the principles of evidence-based medicine, with the level of evidence presented.

Recurrent tinnitus and associated ear symptoms in adults.

This study aimed to reveal in general population the prevalence, associations, and statistical model of recurrent tinnitus by means of a mailed questionnaire. The study sample consisted of 1720 randomly selected adults who were classified into three subgroups: recurrent (once a month or more often), occasional (less often than once a month), and no tinnitus. According to age and gender standardized prevalence, recurrent tinnitus was reported in 15% of the sample. It was statistically highly significantly associated with earache, fullness of ears shoulder pain, the 25-years age group, and visits to a physician. The strongest predictor of recurrent tinnitus was fullness of ears followed by earache, shoulder ache, and temporomandibular disorder pain. We conclude that recurrent tinnitus seems to be quite common in adults and associated with earache and fullness of ears In patients with tinnitus without clinical findings, the examination of the stomatognathic system and cervical spine is recommended.

Characteristics of subjects with secondary otalgia.

AIMS: To investigate whether secondary otalgia is associated with cervical spine disorder (CSD), temporomandibular disorders (TMD), or both, and to describe the pain characteristics and the comorbidity of secondary otalgia in subjects with and without CSD and TMD. METHODS: A mailed questionnaire was sent to a random sample of 2,500 people aged 25 to 65 years. Altogether 1,720 recipients responded. Inclusion criteria were pain inside or around the ear without infection, tumor, or trauma, of 6 or more months duration, and a pain frequency of at least once a month. Altogether 152 respondents fulfilled the criteria, and of these 100 participated in the clinical examinations and interviews. RESULTS: Based on standardized examinations and interviews, 91 subjects had secondary otalgia and 9 had primary otalgia. Most (85%) of the 91 subjects with secondary otalgia also had signs and symptoms of TMD and/or CSD and were therefore classified into 3 groups: CSD (35%), TMD (20%), or "Combination," ie, signs and symptoms of both TMD and CSD (30%). Subjects without CSD or TMD (15%) reported the same level of intensity and impact of otalgia on daily living and psychological distress as the others but less frequent head and neck pain and fewer sleep-related problems. CONCLUSIONS: Most of the subjects reporting secondary otalgia also suffered from CSD or TMD or both. Thus, in patients with secondary otalgia, an examination of the cervical spine and the stomatognathic system should be routinely performed.

Frontal sinus and skull bone defect obliteration with three synthetic bioactive materials. A comparative study.

Three synthetic bioactive materials were studied in an experimental model to compare their usability in a frontal sinus and a skull bone defect obliteration. Bioactive glass number 9 (BAG(1)), bioactive glass number 13 (BAG(2)), and hydroxyapatite (HA) granules were investigated. BAG(1) and HA granules have been previously tested clinically. The clinical usefulness of BAG(2) granules has not been tested. Upper bony walls of 45 Elco rabbits' frontal sinuses were drilled open from four separate holes with the use of a standard method. The skull bone defects and the sinuses in frontal bone were filled with BAG(1) or BAG(2) on one side, and with HA on the other side. Two parallel posterior defects were covered with a pedicled periosteum flap, and two anterior defects with a free flap. The resorption of materials, new bone, and fibrous-tissue formation were observed with a histomorphometric method at 1, 3, and 6 months postoperatively. Scanning-electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR) were done at 6 months. In histomorphometry, the new bone formation increased with all the investigated materials throughout the study (p < 0.001), but the results showed higher new bone formation in the defects filled with BAG(1) than in corresponding BAG(2)- or HA- filled defects. New bone formation and resorption of materials were faster in defects covered by pedicled than by free periosteum flaps (p < 0.001). Intimate contact between the used materials and new bone was confirmed by SEM. FTIR analysis of bone produced by BAG(1) and BAG(2) was of the same type as natural frontal bone. BAG(2) can be manufactured in various shapes, and thus, could possibly be used in clinical conditions requiring a special anatomical implant shape. However, more research is needed regarding this property of BAG(2).

Vocal loading among day care center teachers.

Day care center teachers suffer from voice disorders more often than nurses do. Several risk factors may increase voice disorder prevalence of day care center teachers. The risk factors can be bound to their job content and manner of working i.e. having to raise their voice to attract the attention of the children and to offer them the possibility to perceive spoken information, or to the environment i.e. poor acoustics and excess background noise. The purpose of this study was to measure some of the risk factors for voice disorders of day care center teachers and of a control group (nurses); these were speaking times and speech levels. The background noise levels during activities and RASTI-values (Rapid Speech Transmission Index), i.e. measures of the acoustics of rooms, were also measured at the day care centers. It was found that day care center teachers use their voices more and with higher levels than nurses do. It was also found that the background noise levels are high, which is partly due to the poor acoustics (lack of sufficient attenuation) of the rooms. Control of excess background noise is of utmost importance both for speakers' speech production as well as children's speech recognition.

Healing results of prolonged acute frontal sinusitis treated with endoscopic sinus surgery.

In a marked part of patients suffering from acute frontal sinusitis, the symptoms do not resolve after initial therapy (antibiotics and/or trephination). The prolongation of the healing or recurrences may be caused by persistent inflammation or by structural abnormalities at the nasofrontal connection. During the last decade endoscopic surgery (FES) has become a very useful method to restore the frontonasal drainage although long term results of this kind of population are rare. We evaluated the results of endoscopic surgery in two patient groups (total number of 50) both operated after prolongation (persistent symptoms after 4 weeks) of the initial acute phase of the frontal sinusitis. The first group (A, 15 patients, first trephined) was followed-up 4 years, the number of recurrences after the first FES was 60% and in the other group (B, no initial trephination) with over 6 months follow-up, 91% of patients had recurrences. In group A pre- and postoperative CT-scanning was used to determine the possible anatomical variations that could be causing the failures. All but 3 patients showed some kind of abnormal anatomical variation. In group B only preoperative CT was done. In most cases the reasons for recurrences of frontal sinusitis were polyps and/or chronic inflammation at the ethmoidal region.