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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526520

RESUMO

A 10-year-old child had painful periorbital swelling in the left eye. It was diagnosed as preseptal cellulitis and treated with oral antibiotics. Three days later, the ocular condition worsened so the child was referred for further management. On examination, the child had a temperature of 102 °F. Ocular examination revealed proptosis, restricted ocular movements and a relative afferent pupillary defect in the left eye. Ocular examination of the right eye was normal. There was a history of recurrent episodes of cold in the past. CT scan orbit and sinuses revealed signs of orbital cellulitis with sinusitis on the left side. The child was treated with parenteral antibiotics and endoscopic sinus surgery. A child presenting with unilateral periorbital swelling needs to be thoroughly evaluated. It is important to differentiate orbital cellulitis from preseptal cellulitis. Orbital cellulitis is an emergency and delay in diagnosis can lead to vision and life-threatening intracranial complications.


Assuntos
Antibacterianos/uso terapêutico , Endoscopia , Celulite Orbitária/diagnóstico , Sinusite/diagnóstico , Celulite (Flegmão)/diagnóstico , Criança , Diagnóstico Tardio , Edema/diagnóstico por imagem , Edema/fisiopatologia , Exoftalmia/diagnóstico por imagem , Exoftalmia/fisiopatologia , Humanos , Masculino , Oftalmoplegia/fisiopatologia , Celulite Orbitária/diagnóstico por imagem , Celulite Orbitária/fisiopatologia , Celulite Orbitária/terapia , Distúrbios Pupilares/fisiopatologia , Sinusite/diagnóstico por imagem , Sinusite/terapia , Tomografia Computadorizada por Raios X
2.
Am J Otolaryngol ; 41(6): 102746, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33198053

RESUMO

With the ongoing development of the COVID-19 pandemic, research continues to emerge regarding the pathophysiology, characteristics, and treatment considerations for patients with COVID-19. No reports have highlighted the specific challenges posed in the management of pediatric patients with COVID-19 who present with complicated rhinosinusitis. In this report, we discuss our preoperative, intraoperative, and postoperative multidisciplinary treatment strategy for these cases and provide two examples of complicated rhinosinusitis cases in COVID-19 patients, treated with two different approaches. Pearls, insights, and a brief review of the literature are discussed.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Rinite/virologia , Sinusite/virologia , Adolescente , Betacoronavirus , Criança , Técnicas de Laboratório Clínico , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/terapia , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Rinite/diagnóstico por imagem , Rinite/terapia , Sinusite/diagnóstico por imagem , Sinusite/terapia
3.
Head Face Med ; 16(1): 24, 2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33050926

RESUMO

BACKGROUND: Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS. METHODS: It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019. RESULTS: The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001). CONCLUSION: Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.


Assuntos
Seio Maxilar , Sinusite , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/terapia , Pessoa de Meia-Idade , Mucocele/diagnóstico por imagem , Mucocele/terapia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/terapia , Estudos Retrospectivos , Sinusite/diagnóstico por imagem , Sinusite/terapia , Tomografia Computadorizada por Raios X
4.
R I Med J (2013) ; 103(6): 23-24, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32752560

RESUMO

A previously healthy 25-year-old Asian male was admitted with acute respiratory failure due to COVID-19 pneumonia to our intensive care unit. He received empiric therapy and higher level of respiratory support via a high flow nasal cannula. Notably, human metapneumovirus was detected from the nasopharyngeal swab by RT-PCR. Six days post-ICU admission, sinusitis was clinically and sonographically detected. SARS-CoV-2 was detected in the fluid aspirated from the antrum. The patient has made an uneventful recovery. Further studies are required to investigate co-infections with SARS-CoV-2 and other viruses.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Metapneumovirus/isolamento & purificação , Nasofaringe/virologia , Infecções por Paramyxoviridae/diagnóstico , Pneumonia Viral/diagnóstico , Sinusite/diagnóstico por imagem , Adulto , Coinfecção , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Humanos , Unidades de Terapia Intensiva , Masculino , Pandemias , Infecções por Paramyxoviridae/complicações , Infecções por Paramyxoviridae/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia
5.
PLoS One ; 15(6): e0235432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32598351

RESUMO

Chronic rhinosinusitis (CRS) is a prevalent condition. Clinical diagnosis requires subjective evidence (i.e. symptoms) and objective evidence of inflammation (e.g. sinus computed tomography [CT]). Few studies have assessed differences in common CT scoring approaches for CRS, the Lund-Mackay (LM) system and its modified version (mLM); none in a general population sample. The aims of this study were to answer the following: (1) Is mLM superior to LM? (2) Should nasal cavity opacification be included in scoring? (3) How should location-specific scores be utilized? (4) If location-specific scores are summed, what should be the cutoff? (5) Are associations of opacification with symptoms observed when using different measurement approaches? We scored sinus CTs using LM and mLM from 526 subjects selected from a larger CRS study. Exploratory factor analysis (EFA) assessed similarity of mLM and LM. Latent class analysis (LCA) identified subgroups of sinus opacification patterns. Factors associated with group membership and relations with nasal and sinus symptoms (NSS) guided clinical relevance. EFA suggested no differences between LM and mLM, or after addition of nasal cavity opacification. LCA identified three opacification groups: no/mild, localized, and diffuse. Males were 2.7x more likely to have diffuse opacification than females, as were those with asthma or hay fever. A LM cutoff of 3 had similar performance to the currently used 4. Diffuse opacification was associated with nasal blockage and smell loss. Differing patterns of opacification may be clinically relevant, improving measurement of objective evidence in studies of CRS and sinus diseases.


Assuntos
Inflamação/diagnóstico , Rinite/diagnóstico , Índice de Gravidade de Doença , Sinusite/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Inflamação/diagnóstico por imagem , Inflamação/etiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Rinite/diagnóstico por imagem , Rinite/etiologia , Sinusite/diagnóstico por imagem , Sinusite/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
Medicine (Baltimore) ; 99(25): e20572, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569182

RESUMO

RATIONALE: Infection is a major trigger or pathogenic origin in a substantial proportion of glomerulonephritis (GN) patients, typically manifesting infection-related GN (IRGN). Various microorganisms, infection sites, and clinical and histopathological features are involved in IRGN. Once an infectious origin is identified and successfully eradicated, nephrotic syndrome or kidney dysfunction is spontaneously resolved. However, if patients are asymptomatic and the origin is undetermined, the diagnosis and treatment of GN is challenging. This case presentation reported on an IRGN case manifesting steroid-resistant nephrotic syndrome associated with asymptomatic sinusitis as a pathogenic origin. PATIENT CONCERNS: A 68-year-old male presented with severe kidney dysfunction and edema in both extremities. DIAGNOSIS: The patient was clinically diagnosed with hypocomplementemic nephrotic syndrome and kidney dysfunction and histopathologically with diffuse proliferative GN and a focal pattern of membranoproliferative GN. The findings suggested that idiopathic membranoproliferative glomerulonephritis type I was more likely than IRGN, given a critical lack of apparent infection. INTERVENTIONS: Combined intravenous methylprednisolone, oral prednisolone, and cyclosporin did not improve the patient's condition. Thus, IRGN associated with inapparent infectious origin was suspected. Repeated thorough and careful examinations including CT scan showed sinusitis in his left maxillary sinus. Moreover, reanalysis of kidney specimen revealed positive nephritis-associated plasmin receptor in glomeruli, a typical finding for IRGN, supporting a pathogenic significance of his sinusitis. Medical treatment was initiated with 200 mg oral clarithromycin daily. OUTCOMES: Oral clarithromycin gradually improved proteinuria and hypocomplementemia and resulted in nephrotic syndrome remission in parallel with opacification resolution of sinuses shown on CT. LESSONS: This case presentation showed that asymptomatic sinusitis is potentially a pathogenic IRGN origin. A gold standard therapy for idiopathic GN, corticosteroid could be damaging in uncontrolled or underdiagnosed infection. In asymptomatic patients, a thorough screening of infectious diseases, including sinusitis, together with a renal histological evaluation of glomerular nephritis-associated plasmin receptor deposition is also essential in treating a wide spectrum of GN.


Assuntos
Glomerulonefrite Membranoproliferativa/diagnóstico , Sinusite/complicações , Idoso , Doenças Assintomáticas , Diagnóstico Diferencial , Glomerulonefrite Membranoproliferativa/etiologia , Glomerulonefrite Membranoproliferativa/patologia , Humanos , Masculino , Síndrome Nefrótica/congênito , Síndrome Nefrótica/diagnóstico , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 147-156, jun. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115829

RESUMO

INTRODUCCIÓN: La rinosinusitis crónica odontogénica (RSCO) es un proceso inflamatorio/infeccioso de la mucosa nasal y senos paranasales (SPN) de origen dental. Corresponde a una patología subdiagnosticada en la actualidad. El gold standard diagnóstico es la tomografia computarizada. Los tratamientos difieren, desde tratamiento médico aislado hasta médico-quirúrgico de SPN o combinados. OBJETIVO: Caracterizar los resultados clinicos e imagenológicos de pacientes con RSCO en función del tratamiento recibido, para establecer recomendaciones terapéuticas. Describir la frecuencia de subdiagnóstico de esta patología. MATERIAL Y MÉTODO: Estudio descriptivo, retrospectivo. Se incluyeron pacientes con diagnóstico clínico e imagenológico de RSCO entre los años 2013-2017 en un centro de atención médico privado, a los que se realizó una tomografía computarizada cone beam de control. Fueron excluidos aquellos con rinosinusitis crónica, cirugía endoscópica funcional (CEF) previa, cáncer, embarazadas, rechazo a tomografía computarizada cone beam, ausencia de imágenes preoperatorias y menores de 18 años. RESULTADOS: De un total de 27 pacientes, en los operados de CEF (n =24; 89%) la resolución total de los síntomas se logró en 20/24 (83%), resolución parcial 3/24 (12,5%) y persistencia de los síntomas 1/24 (4%). Discusión: De los pacientes con RSCO 22/27 (81%) no tenían reportado el foco dental en el informe radiológico a pesar de ser visible. Aquellos pacientes con sintomatologia postratamiento, hubo factores identificados como la bilateralidad, mala dentadura general, falta de combinación de tratamiento dental y CEF. CONCLUSIONES: La CEF combinada con tratamiento dental concomitante, tiene un alto grado de éxito radiológico y clínico en esta patología. No fue posible demostrar si siempre es requerida la exodoncia con cierre de fístula oro-antral o si se pueden seleccionar pacientes para un tratamiento más conservador.


INTRODUCTION: Chronic odontogenic rhinosinusitis (CORS) is an inflammatory/infectious process of the nasal mucosa and sinuses of dental origin. Actually, it corresponds to an underdiagnosed pathology. The gold standard diagnosis is computed tomography. The treatments differ, from isolated medical treatment to medical-surgical sinuses or combined. AIM: To characterize the clinical and imaging results of patients with CORS according to the treatment received, to establish therapeutic recommendations. In addition to describing the frequency of subdiagnosis of this pathology. MATERIAL AND METHOD: Descriptive, retrospective study. Patients with clinical and imaging diagnosis of CORS between 2013-2017 were included in a private medical care center, to whom a cone beam computed tomography control was performed. Those with chronic rhinosinusitis, previous functional endoscopic sinus surgery (FESS), cancer, pregnant women, rejection of cone beam computed tomography, absence of preoperative images and those under 18 years were excluded. RESULTS: Of all patients operated on FESS (n =24; 89%) the total resolution of the symptoms was 20/24 (83%), partial resolution 3/24 (12.5%) and persistence of the symptoms a 1/24 (4%). Discussion: 22/27 (81%) of patients with CORS had not reported the dental focus in the radiological report despite being visible. Those patients with post-treatment symptoms had identified factors such as bilaterality, general bad teeth, lack of combination of dental treatment and FESS. CONCLUSION: The FESS combined with concomitant dental treatment, has a high degree of radiological and clinical success in this pathology. It was not possible to demonstrate whether exodontia with closure of oroantral fistula is always required or if patients can be selected for a more conservative treatment.


Assuntos
Humanos , Masculino , Feminino , Sinusite/cirurgia , Rinite/cirurgia , Sinusite/diagnóstico por imagem , Rinite/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Endoscopia , Tomografia Computadorizada de Feixe Cônico , Infecção Focal Dentária/complicações
9.
Sci Rep ; 10(1): 3688, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111952

RESUMO

Acute invasive fungal rhinosinusitis (AIFRS) can spread beyond the sinonasal cavity. It is necessary to analyze the association between the specific site involved in the extrasinonasal area and the survival rate to predict patient prognosis. We investigated 50 patients who had extrasinonasal lesions on preoperative gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) scan and underwent wide surgical resection of AIFRS. The specific sites with loss of contrast enhancement (LoCE) on Gd-enhanced MRI were analyzed for AIFRS-specific survival rate. The most common underlying disease was diabetes mellitus followed by hematological malignancy. The most common symptoms were headache and facial pain. Seven patients (14.0%) expired because of AIFRS progression. Poor prognosis was independently associated with LoCE at the skull base on preoperative MRI (HR = 35.846, P = 0.004). In patients with AIFRS extending to the extrasinonasal area, LoCE at the skull base was an independent poor prognostic factor.


Assuntos
Dor Facial , Cefaleia , Infecções Fúngicas Invasivas , Imagem por Ressonância Magnética , Rinite , Sinusite , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Dor Facial/diagnóstico por imagem , Dor Facial/mortalidade , Dor Facial/cirurgia , Feminino , Seguimentos , Cefaleia/diagnóstico por imagem , Cefaleia/mortalidade , Cefaleia/cirurgia , Humanos , Infecções Fúngicas Invasivas/diagnóstico por imagem , Infecções Fúngicas Invasivas/mortalidade , Infecções Fúngicas Invasivas/cirurgia , Masculino , Pessoa de Meia-Idade , Rinite/diagnóstico por imagem , Rinite/mortalidade , Rinite/cirurgia , Sinusite/diagnóstico por imagem , Sinusite/mortalidade , Sinusite/cirurgia , Taxa de Sobrevida
10.
Am J Otolaryngol ; 41(3): 102444, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32127210

RESUMO

PURPOSE: The non-invasive diagnosis of acute rhinosinusitis (ARS) remains an unresolved problem of modern otolaryngology. Analog diaphanoscopy of reduced transillumination (shading) could be enhanced by a digital image processing of the maxillary sinuses. By this means, the limited ergonomics of this safe and low-cost method can be overcome, and merits renewed the investigation. Here, we compared the diagnostic sensitivity and specificity of digital diaphanoscopy and computed tomography (CT) in detecting shading in the maxillary sinus. MATERIALS AND METHODS: We examined 103 adults using both digital diaphanoscopy of the maxillary sinus and native-phase cranial CT. We developed a scoring system for investigation of shading in the maxillary sinus using diaphanoscopy and compared the sensitivity and specificity with that of CT. Also, we documented a follow-up of acute rhinosinusitis. RESULTS: In diagnosing shading in the maxillary sinus, digital diaphanoscopy had a sensitivity of 86% and a specificity of 88%. Digital diaphanoscopy can be used not only in the screening of ARS but also for documentation of its course. CONCLUSION: This study supports the role of modern digital diaphanoscopy in the diagnosis of shading in the maxillary sinus, especially in patients with ARS when CT imaging is not recommended. The ergonomics of analog diaphanoscopy could be significantly improved for physicians and patients by the implementation of modern hardware and software components. Further development of the technique and the use of several discrete wavelengths will improve this method's sensitivity and specificity.


Assuntos
Técnicas de Diagnóstico Otológico , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Transiluminação/métodos , Doença Aguda , Humanos , Seio Maxilar/diagnóstico por imagem , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
11.
J Korean Med Sci ; 35(3): e22, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31950777

RESUMO

BACKGROUND: Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. METHODS: This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. RESULTS: Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso- to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. CONCLUSION: Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.


Assuntos
Imagem por Ressonância Magnética , Micoses/diagnóstico , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Aspergillus/isolamento & purificação , Calcificação Fisiológica , Candida/isolamento & purificação , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Estudos Retrospectivos , Sinusite/microbiologia
12.
J Pak Med Assoc ; 70(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31954022

RESUMO

OBJECTIVE: To determine the prevalence of fungal infections causing nasal polyposis (AFRS-Allergic fungal rhino sinusitis) in the local population. METHODS: It is a cross sectional study, carried out from October 2010 to January 2015 on 221 patients in the ENT Department of Abbasi Shaheed Hospital and Karachi Medical & Dental College in collaboration with the microbiology department. This study included patients who had a clinical diagnosis of nasal polyposis with or without fungal infection on the basis of nasoendoscopic examinations. All patients underwent Functional Endoscopic Sinus Surgery (FESS) and the diagnosis of (AFRS-Allergic fungal rhino sinusitis) was considered after histopathological confirmation of eosinophilic mucous containing hyphae. Numerator included the total number of patients who presented to the ENT out-patient clinic of Abbasi Shaheed Hospital suffering from nasal polyposis secondary to fungal infection during the follow-up period of the study. On the other hand, denominator included all the patients who attended the ENT out-patient clinics during the same follow-up period. This determined the period prevalence of fungal infections in nasal polyposis at a tertiary care centre in Karachi. RESULTS: Data was collected, a descriptive analysis was performed and a Computed Tomography (CT) grading was done. On the basis of histopathology, 90 (40.7%) patients were found to have fungal infection. CONCLUSIONS: The prevalence of fungal infections was 40.7% (90 patients) in nasal polyposis.


Assuntos
Micoses , Pólipos Nasais , Sinusite , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/complicações , Micoses/diagnóstico por imagem , Micoses/epidemiologia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/epidemiologia , Pólipos Nasais/microbiologia , Paquistão/epidemiologia , Prevalência , Sinusite/diagnóstico por imagem , Sinusite/epidemiologia , Sinusite/microbiologia , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
J Craniofac Surg ; 31(1): 37-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31403512

RESUMO

The goal of this study was to investigate the association between various sinonasal anatomical variations and the morphological features of lateral nasal bone, using paranasal computerized tomography (PNCT) sections. Two hundred and fifty patients who underwent a PNCT scan because of a prediagnosis of nasal septum deviation or sinusitis were included in the study. For each patient, presence of the following anatomical variations was determined on CT sections: length and thickness of nasal bone, thickness of intermediate nasal bone, pneumatized middle turbinate, paradox middle turbinate, Agger nasi cell, Haller cell, Onodi cell, supraorbital cell, pneumatized uncinate process, and nasal septal deviation. The effect of each anatomical variation on the length and thickness of the lateral nasal bone was investigated. The patients with bilateral pneumatized middle turbinate and the patients with bilateral Agger nasi cell had a thinner lateral nasal bone both on the right and the left sides compared to those without. The patients with bilateral Onodi cell and Agger nasi cell had a longer lateral nasal bone both on the right and the left sides compared to those without. The nasal bone thickness was significantly thicker on the deviation side than the contralateral nasal bone. The nasal bone length was significantly longer on the side of the septum deviation. In this study, we found that sex, presence of Agger nasi and Onodi cells, pneumatization of middle turbinate, and direction of nasal septal deviation influenced the morphology of the nasal bone. For successful nasal surgery, careful examination of preoperative anatomical variations is very important.


Assuntos
Osso Nasal/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Orbit ; 39(1): 45-47, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31169421

RESUMO

Allergic fungal sinusitis (AFS) arises from a host hypersensitivity reaction to fungi residing within the sino-nasal tract. Computed tomography imaging may show heterogenous sinus opacification with bony erosion and expansion into the orbits. With advanced orbital involvement there is a risk of optic neuropathy and irreversible vision loss. We present a patient with AFS who presented with bilateral proptosis and early optic neuropathy. Radiologically, there was evidence of bony erosion and orbital wall compression. Following oral corticosteroids and full-house endoscopic sinus surgery, these changes reversed considerably. This case shows that bony and anatomical orbital changes from AFS are reversible with adequate surgical treatment.


Assuntos
Endoscopia/métodos , Micoses/terapia , Doenças Orbitárias/patologia , Doenças Orbitárias/terapia , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Adulto , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/terapia , Micoses/diagnóstico por imagem , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Pólipos Nasais/diagnóstico , Pólipos Nasais/etiologia , Doenças Orbitárias/diagnóstico por imagem , Prednisona/uso terapêutico , Prognóstico , Medição de Risco , Sinusite/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Rhinology ; 58(1): 36-44, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671433

RESUMO

BACKGROUND: The extent of endoscopic sinus surgery (ESS) required for optimal outcomes in chronic rhinosinusitis (CRS) is undefined. We evaluated whether concordance between the extent of surgery and degree of radiographic disease influences postoperative outcomes. METHODS: 247 CRS patients who underwent ESS were retrospectively assigned a concordance score reflecting the similarity between the extent of surgery and degree of radiographic disease. 0 points were assigned when sinusotomy was performed on a diseased sinus, or no sinusotomy was performed on a nondiseased sinus; plus 1 for sinusotomy on a nondiseased sinus; and -1 for a diseased sinus left unopened. The total possible score ranged from minus 10 to plus 10. Patients were divided into 5 subgroups according to variance from complete concordance. SNOT-22 scores and revision rates were compared at 6 and 24 months. RESULTS: All five subgroups had similar preoperative SNOT-22 scores and improved at 6 months postoperatively. At 6 months postoperatively, the most conservatively operated and most extensively operated subgroups each achieved equivalent improvements in SNOT-22 as the completely concordant subgroup. At 24 months, the most extensively operated subgroup had a 12.5-point smaller improvement in SNOT-22 scores compared to the completely concordant subgroup. Multivariate analysis showed no association between concordance score and revision rate. CONCLUSIONS: Symptom improvement and revision rates after ESS do not appear to correlate with the degree of concordance between extent of surgery and radiographic disease. More extensive surgery than indicated by CT confers neither greater symptomatic improvement nor long-term detriment.


Assuntos
Endoscopia , Procedimentos Cirúrgicos Nasais , Seios Paranasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Doença Crônica , Humanos , Radiografia , Estudos Retrospectivos , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Resultado do Tratamento
17.
Am J Otolaryngol ; 41(1): 102301, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31732306

RESUMO

PURPOSE: Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography. Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS. MATERIALS AND METHODS: A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed. RESULTS: Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not. CONCLUSIONS: Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.


Assuntos
Basófilos , Eosinófilos , Micoses/sangue , Micoses/microbiologia , Rinite Alérgica/sangue , Rinite Alérgica/microbiologia , Sinusite/sangue , Sinusite/microbiologia , Adulto , Doença Crônica , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/análise , Micoses/diagnóstico por imagem , Micoses/cirurgia , Pólipos Nasais/sangue , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/microbiologia , Pólipos Nasais/cirurgia , Prognóstico , Recidiva , Estudos Retrospectivos , Rinite Alérgica/diagnóstico por imagem , Rinite Alérgica/cirurgia , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios X
18.
Orbit ; 39(1): 64-67, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30822175

RESUMO

Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences. Mucormycosis and Aspergillus species are the most common causes of such infections. Alternaria fungal sinusitis is a known entity, but its ability to cause an orbital apex syndrome has not yet been reported. Here, we present a case of orbital apex syndrome in an immunocompromised patient with invasive fungal sinusitis caused by Alternaria species. The patient underwent sinus washout and placement of an intraorbital catheter for local instillation of amphotericin B for 10 days, in addition to systemic antifungal treatment, with clinical resolution of infection. The use of an intraorbital catheter for local treatment of fungal infection may offer an exenteration-sparing treatment option in these patients.


Assuntos
Alternaria/isolamento & purificação , Alternariose/diagnóstico , Anfotericina B/administração & dosagem , Infecções Oculares Fúngicas/complicações , Doenças Orbitárias/microbiologia , Sinusite/microbiologia , Idoso , Alternaria/patogenicidade , Alternariose/complicações , Alternariose/tratamento farmacológico , Terapia Combinada , Desbridamento/métodos , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Seguimentos , Fungemia/diagnóstico por imagem , Fungemia/microbiologia , Fungemia/terapia , Humanos , Hospedeiro Imunocomprometido/imunologia , Injeções Intralesionais , Masculino , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/terapia , Medição de Risco , Sinusite/complicações , Sinusite/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 813-818, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795541

RESUMO

Objective: To investigate the prevalence and radiographic characteristics of ethmomaxillary sinus (EMS) in chronic rhinosinusitis (CRS) patients by CT scan, as well as their endoscopic surgical significance in antrostomy. Methods: A retrospective analysis of 111 CRS patients who were prepared for surgery in Department of Otorhinolaryngology Head and Neck Surgery of Peking University People's Hospital from February to December of 2017 was performed. In all CRS patients, 79 patients were bilateral CRS and 32 were unilateral. The patients were divided into two groups according to whether they had history of surgery. Only the sides with CRS were analyzed. There were 98 patients (167 sides) in the non-surgical history group and 13 patients (23 sides) in the surgical history group. The prevalence of EMS in CRS sides in the two groups was counted by analyzing the CT images. The CT image features and anatomical variations associated with EMS in CRS sides in the non-surgical history group were also analyzed. SPSS 22.0 software was used for statistic analysis. Results: The prevalence of EMS in CRS sides was 21.7% (5/23) in the surgical history group and 12.0% (20/167) in the non-surgical history group. No statistically significant difference in the prevalence of EMS was found between the two groups (χ(2)=0.940, P>0.05). The medial-lateral diameters of the EMS ranged from 8.50 to 14.10 mm with an average of (10.38±1.69) mm (Mean±SD). The shape of the bony septum between the EMS and maxillary sinus was divided into three types: convex toward to the EMS (2 sides), convex toward to maxillary sinus (5 sides) and flat (13 sides). The Lund-Mackay (LM) scores of the maxillary sinuses in patients with and without EMS showed no statistically significant difference (1.60±0.50 vs 1.40±0.62, Z=1.285, P>0.05). The EMS obstructed the drainage of maxillary sinus posteriorly, medially and superiorly. All the EMS in diseased sides were dissected endoscopicly to improve drainage. In the non-surgical history group, the EMS coexisting anatomic variations were the Onodi cell (7/20), Haller cell (3/20), concha bullosa (6/20) and maxillary sinus hypoplasia (3/20). Conclusions: There is relatively high prevalence of the EMS in CRS patients. This is adjacent to the orbit, overpneumatizes laterally and obstructs the drainage of the maxillary sinus. Complete dissection of the EMS is helpful to improve the drainage of maxillary sinus.


Assuntos
Seio Etmoidal/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Doença Crônica , Endoscopia , Humanos , Procedimentos Cirúrgicos Nasais , Estudos Retrospectivos , Rinite/diagnóstico por imagem , Rinite/cirurgia , Tomografia Computadorizada por Raios X
20.
Zhonghua Yi Xue Za Zhi ; 99(43): 3417-3419, 2019 Nov 19.
Artigo em Chinês | MEDLINE | ID: mdl-31752470

RESUMO

Objective: To evaluate the value of CT in the differential diagnosis of Pseudomonas aeruginosa sinusitis and fungal ball in paranasal sinus caused by Aspergilus flavus. Methods: In this retrospective study, CT results of 74 cases of Pseudomonas aeruginosa sinusitis including 31 male cases and 43 female cases with age onset from 15 to 74 years old (mean±SD was 50±13) and 72 cases of fungal ball in paranasal sinus caused by Aspergilus flavus including 28 male cases and 44 female cases with age onset from 25 to 78 years old (mean±SD was 53±15) at Beijing Tongren Hospital confirmed by histopathology were enrolled from January 2013 to May 2017. The CT characteristics of the two groups of cases were compared using χ(2) test, and P<0.05 was considered statistically significant. Results: Soft tissue opacification of the involved paranasal sinus was found on CT in each case of the two groups. There were significant differences in the rate of single sinus involvement (44.6% and 90.3% respectively), the incidence of lesion associated with maxillary sinus (91.9% and 70.8% respectively), ethmoid sinus (41.9% and 2.8% respectively), frontal sinus (29.7% and 0 respectively), calcification (50.0% and 72.2% respectively), and the enlargement of maxillary sinus opening (13.2% and 35.3% respectively), in addition to the central calcification (83.8% and 59.6% respectively) between the two groups (all P<0.05). However, the incidence of sphenoid sinus involvement (32.4% and 34.7% respectively), bone sclerosis (56.8% and 62.5% respectively) or destruction(18.9% and 16.7% respectively) were not found different between the two groups (P>0.05). Conclusion: Though the CT findings are similar between the two diseases such as soft tissue opacification of the involved paranasal sinus with calcification and bone sclerosis or destruction, there are still a few characteristics on CT in differentiating the one from the other. The involvement of multi-sinuses, maxillary sinus, ethmoid sinus and frontal sinus, the central calcification are more common in the Pseudomonas aeruginosa sinusitis. However, the CT features including single sinus involvement, calcification and enlargement of maxillary sinus opening, can be seen more often in the fungal ball in paranasal sinus caused by Aspergilus flavus.


Assuntos
Seios Paranasais , Sinusite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa , Estudos Retrospectivos , Sinusite/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
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