Bacterial Sinusitis Research Articles

2944. Comparative Effectiveness and Safety of 5-7 days versus 10 days of Antibiotics for Acute Bacterial Sinusitis in Children

Abstract Background Acute bacterial sinusitis accounts for 5 million pediatric antibiotic prescriptions in the United States each year, with 65% amoxicillin or amoxicillin-clavulanate. More than 90% of pediatric patients are prescribed 10+ days of antibiotics. No study has compared shorter to longer treatment. This study compares 5-7 days versus 10 days of treatment in children and adolescents. Methods This cohort study included patients < 18 years with an outpatient encounter for acute sinusitis and a same-day dispensation of either a 5–7 day supply or a 10 day supply of amoxicillin or amoxicillin-clavulanate between January 1, 2017 and December 31, 2020 in the MarketScan Commercial Claims and Encounters database. Treatment failure, defined as a new antibiotic dispensation, an ED or inpatient encounter for acute sinusitis, or an inpatient complication of acute sinusitis, was assessed in the first 5, 10, and 30 days after cohort entry. Adverse and control outcomes were captured. We used Cox proportional hazards regression with propensity score (PS) overlap weights for confounding control. Results The initial cohort included 254,629 patients, among which 19,627 patients were prescribed a 5-7-day treatment (exposure) and 235,002 patients were prescribed a 10-day treatment (referent). After PS overlap weighting, groups were balanced on all measured covariates (Table 1). The rate of 30-day treatment failure was 167.77 per 1,000 person-years (95% CI, 155.94, 180.49) among patients dispensed 5-7 days of treatment and 150.19 per 1,000 person-years (95% CI, 145.54, 154.99) among patients dispensed 10 days of treatment (hazard ratio 1.12 [95% CI, 1.03,1.21]) (Table 2). Adverse events were rare, and there was no difference between groups in a negative control outcome (Table 3).Table 1:Patient and treatment characteristicsTable 2:Treatment FailureTable 3:Adverse and control outcomes Conclusion The absolute risk of treatment failure was very low. Children and adolescents dispensed 5-7 days of antibiotic treatment had a slightly higher rate of treatment failure compared to 10 days of antibiotic treatment. Adverse effects were rare, with a potentially lower rate of yeast infections following shorter treatment. The marginal benefit and increased risk of side effects with longer treatment indicates that shorter treatment of acute bacterial sinusitis, 5-7 days, may be a reasonable initial approach in some populations. Disclosures Timothy J. Savage, MD, MPH, MSc, UCB: Contract to Brigham and Women's Hospital Krista F. Huybrechts, PhD, MS, Takeda: Grant/Research Support|UCB: Grant/Research Support

Overcoming Delayed Diagnosis of Chronic Invasive Fungal Sinusitis in the Immunocompetent Patient: A Case Report

Study Design Case report. Objective To highlight the diagnostic and treatment dilemma associated with chronic invasive fungal sinusitis (CIFS) in the immunocompetent individual. Methods The patient was initially treated for chronic bacterial sinusitis with antibiotic therapy and multiple surgical debridement with no evidence of fungal organisms. Following the completion of the left partial maxillectomy, mucormycosis was finally identified on histopathology, and the appropriate antimicrobial therapy was initiated. During this time, the patient received an interim maxillary obturator for speech and oral function. Following the resolution of CIFS, a computed tomography (CT) of the face was obtained for computer-aided surgical planning for a vascularized fibula flap reconstruction with endosseous dental implants using patient-specific surgical cutting guides and a reconstruction plate. Results Optimal esthetic and functional outcomes were achieved following the placement of the definitive dental prosthesis. The patient remained free of disease and without pain 2 years postoperatively. Conclusions Chronic invasive fungal sinusitis in the immunocompetent patient remains rare; however, delayed diagnosis can lead to inadequate treatment and extensive soft and hard tissue necrosis. Obtaining sufficient tissue sampling is essential for a definitive diagnosis of CIFS. This report demonstrates the challenge in diagnosing CIFS and the importance of the multidisciplinary approach to treat CIFS associated with extensive involvement of the maxilla.

DETERMINATION OF PREVALENCE AND CAUSES OF SINUSITIS IN PEOPLE EXAMINED AT THE EAR NOSE THROAT HOSPITAL OF THE CENTRAL REGION, 2022

The study was conducted to determine the prevalence of sinusitis and the rate of bacterial, fungal and allergic sinusitis among the people examined at the Ear Nose Throat Hospital of the Central Region in 2022.The study was designed using descriptive research method.The prevalence of sinusitis in people who came for examination was 25.27% (379/1500), including 47.50% (180/379) with bacterial sinusitis, 18.20% (69/379) with fungal sinusitis, and 34.30% (130/379) with allergic sinusitis. The rate of sinusitis in males and females was 42.28% (183/379) and 57.72% respectively. Those people aged from 18 to 60 were the most infected, accounting for 83.90%, followed by those doing freelance jobs (70.98%). Some risk factors included chronic nasopharyngitis (OR = 7.99: 3.36 – 9.32), history of otitis media (OR = = 3.51: 1.76 – 5.35). No association between allergy and sinusitis was found (OR = 0.23: 0.16 -1.53). The rate of sinusitis in women was higher than that in men, in which bacterial sinusitis accounted for the largest proportion and commonly seen in the age group of 18 to 60. Related factors included chronic nasopharyngitis and history of otitis media.

The Effects of Oral Challenges on Antibiotic Prescribing Practices for Acute Bacterial Sinusitis

The Effects of Oral Challenges on Antibiotic Prescribing Practices for Acute Bacterial Sinusitis

Statement of Retraction: Application values of two Co(II) coordination polymers on bacterial acute sinusitis by reducing the Streptococcus pneumoniae viability

Statement of Retraction: Application values of two Co(II) coordination polymers on bacterial acute sinusitis by reducing the Streptococcus pneumoniae viability

Relationship Between Maxillary Fungal Sinusitis and Odontogenic Infection, Dental Implant

Background and Objectives One of the common causes of chronic bacterial sinusitis is odontogenic infection, which has recently attracted attention and many studies are being conducted. However, studies on the relationship between chronic fungal sinusitis and odontogenic infection, which are commonly encountered in clinical practice, are still lacking. In this study, we investigated the association between chronic fungal sinusitis, odontogenic infection and dental implant.Subjects and Method We retrospectively reviewed medical records and paranasal sinus (PNS) CT scans of 198 patients who were treated in our institution for maxillary fungal sinusitis between March 2010 and October 2020.Results We defined two groups of maxillary sinuses (MS) according to the presence of fungal ball (fungal group; n=204 vs. normal group; n=192). Fungal sinusitis was diagnosed in all 204 cases of the fungal group. In the normal group, the mean MS volume was 17.0±6.2 mL, and in the fungal group, the mean MS volume was 13.8±5.2 mL. The volumes of MS were statistically small in the fungal group (<i>p</i><0.001). In 141 (69.1%) of 204 sinuses in the fungal group, findings suggestive of odontogenic infection were confirmed on the PNS CT scans and were statistically significant (<i>p</i><0.001, odds ratio=2.537). Of 204 sinuses in the fungal group, 26 (12.7%) had dental implants and were not statistically significant (<i>p</i>=0.107, odds ratio=1.724).Conclusion This study suggests odontogenic infection to be a risk factor for developing fungal sinusitis in the ipsilateral maxillary sinus.

Isolated fungal sinusitis of the sphenoid sinus - A case report

Introduction: Isolated sphenoidal fungal sinusitis is a rare disease, representing 3% of all sinusitis cases. The disease usually occurs together with other paranasal sinus infections. Viral, bacterial, parasitic, and fungal infections can cause sinusitis. Fungal infection of the sphenoidal sinuses is rarely diagnosed, as it has no characteristic symptoms and is not much different from bacterial or other sinusitis infections. The diagnosis of fungal sphenoid sinusitis is based on history taking, physical examination, and supporting examination. The therapy aims to reduce sinus cavity inflammation, improve drainage, and overcome the pressure on the sinuses that cause painful symptoms. Endoscopic Sinus Surgery (ESS) is a surgical technique on the paranasal sinuses using an endoscope that aims to improve ventilation and mucociliary clearance of the sinuses.

Prospects for the application of bacteriophages in the treatment of sinusitis caused by antibiotic-resistant bacterial strains

Purulent diseases in otorhinolaryngology are of great interest due to their widespread prevalence and the objective difficulties of treatment. One of the most frequently encountered nosological forms is purulent sinusitis. A key element in the complex treatment of bacterial sinusitis is systemic antibiotic therapy aimed at the eradication of pathobionts from the focus of infection. However, the increasing worldwide drug resistance of etiologically significant microorganisms complicates antibacterial chemotherapy of purulent sinusitis and raises questions about its future feasibility. The threat of a change from a resistance era to a post-antibiotic era is very significant, given the acute shortage of new antibiotics and the relatively rapid adaptation of bacterial microorganisms to them. The global community is therefore faced with the challenge of finding other drugs with antimicrobial activity. In recent decades, genetically modified virulent bacteriophages and phagolytes isolated on their basis are becoming increasingly attractive in the fight against purulent infections of various localizations caused by drug-resistant bacteria. This literature review focuses on the potential of phage therapy for acute bacterial sinusitis in an era of globally increasing bacterial strain resistance. The article details the causative agents of community-acquired and hospital-acquired acute sinusitis, the main mechanisms of bacterial antibiotic resistance, the effect of virulent phages on bacteria, and studies on the efficacy of phage therapy in the treatment of acute sinusitis. The facts outlined herein clearly indicate the efficacy of phage therapy, as well as therapeutic perspectives on using bacteriophages in the complex treatment of purulent sinusitis caused by antibiotic-resistant microbiota.

Aspergillosis Causing Orbital Subperiosteal Abscess in an Immunocompetent Child: A Rare Presentation.

Orbital abscesses are primarily seen in children as complication of ethmoid bacterial sinusitis. We report a case of invasive aspergillosis causing orbital abscess in an immunocompetent child which resolved with surgery followed by antifungal therapy. This case highlights need for histopathological, and microbiological examination, including fungal culture in such cases.

Invasive Sinusitis Presenting with Orbital Complications in COVID Patients: Is Mucor the Only Cause?

The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatmentwas documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.

Acute Bacterial Sinusitis

Acute Bacterial Sinusitis

Statement of Retraction: Two new Zn(II) and Ni(II) coordination polymers: treatment effect on acute bacterial sinusitis by inhibiting the methicillin resistant Staphylococcus aureus growth

Statement of Retraction: Two new Zn(II) and Ni(II) coordination polymers: treatment effect on acute bacterial sinusitis by inhibiting the methicillin resistant Staphylococcus aureus growth

Bleach-Induced Chemical Sinusitis and Orbital Cellulitis Following Root Canal Treatment

The authors describe an unusual case of chemical sinusitis and orbital cellulitis secondary to a sodium hypochlorite accident in a patient who had just undergone root canal treatment. The patient presented with acute, progressive symptoms of unilateral maxillary sinusitis, facial cellulitis and orbital cellulitis which began hours after root canal treatment on the ipsilateral side. He was admitted to hospital under the care of the Otorhinolaryngology team and reviewed regularly by the Ophthalmologists. He underwent Endoscopic Sinus Surgery during his hospital stay. The intraoperative findings revealed necrotic sinus mucosa and slough within the involved maxillary sinus, which were suggestive of chemical burn injury induced by the highly alkaline sodium hypochlorite solution used during root canal treatment. He was treated postoperatively with regular nasal toilet, culture-directed antibiotics and topical ocular pressure-lowering eyedrops. He displayed a slow recovery with eventually no orbital sequelae, but experienced persistent cheek numbness three months post-injury. Severe chemical sinusitis with orbital cellulitis secondary to sodium hypochlorite accident is a rare complication of root canal treatment, with potentially severe consequences. It can present with symptoms similar to complicated acute bacterial sinusitis. Otorhinolaryngologists and dental surgeons should maintain a high index of suspicion when managing a patient post-root canal treatment with symptoms of unilateral sinusitis, facial cellulitis, orbital cellulitis and even airway compromise. This would allow prompt intervention before sight or life-threatening complications set in.

The effectiveness of a polyvalent antigenic complex including bacterial lysates in the treatment and prevention of rhinosinusitis against the background of acute respiratory viral infections and COVID-19 (clinical description)

One of the urgent tasks of the Ministry of Health of the Russian Federation, noted in the State report on the state of sanitary and epidemiological welfare of the population, is the improvement and implementation of diagnostic and treatment and prevention technologies. First of all, this concerns the continued growth of respiratory viral infections, seasonal influenza epidemics, where SARS-CoV-2 coronavirus infection occupies a special place, which often cause various otorhinolaryngological complications – acute and exacerbations of chronic tonsillopharyngitis, rhinosinusitis, tubotitis, purulent otitis media. In the treatment of bacterial sinusitis, in accordance with clinical recommendations, intranasal corticosteroids, elimination therapy, herbal remedies, and antibacterial drugs are used. Due to the period of the SARS-CoV-2 pandemic, a significant proportion of patients took large doses of antibacterial drugs, which caused an increase in the resistance of microorganisms to them. In this regard, it is possible to use immunostimulating drugs that stimulate cellular and humoral immunity, promote the development of a specific immune response and activate nonspecific defense factors such as lysozyme, mucin, lactoferrin and normalize mucociliary clearance. As a rule, the identification of a viral agent is carried out in case of a severe clinical course of the disease or complications from the ORL and other organs, and the use of immunostimulating agents in complex therapy is necessary at the earliest possible time of the disease. In this context, the use of immunostimulants containing polyvalent antigenic complexes, including bacterial lysates, the most common pathogens of respiratory infections, is justified. It is preferable in these cases to use lysates of bacteria obtained by mechanical destruction of bacterial cells, since they have a more pronounced non-specific immunostimulatory and specific vaccinating effect.

Acute bacterial sinusitis: current concepts in antibiotic therapy

Acute rhinosinusitis is a widespread pathology faced by both outpatient doctors and otorhinolaryngologists in hospitals. At the same time, only understanding of the principles for diagnosing various forms of sinusitis, in particular, the criteria for bacterial sinusitis, provides the adequate treatment decisions. Antibacterial therapy plays a key role in the treatment of patients with acute bacterial sinusitis. Additionally, there is an increasing frequency of the antibiotic resistance of the main bacterial pathogens in the respiratory group of diseases. Both in Russian and foreign clinical guidelines, the so-called lines of antibacterial therapy are clearly identified. Strict adherence to the national recommendations and a thorough analysis of clinical and anamnestic data allows a rational approach to the choice of an antibacterial drug. There is an increase in the rate of uncontrolled and inadequate antibacterial therapy, particularly using of penicillins and short course of macrolides, over the last decade. Such trend is dangerous due to the increased risks for the development of the antibiotic resistance to those groups of antibiotics. Use of dispersible forms is one of the key point of the strategies to overcome the antibiotic resistance. The most important features of dispersible forms of antibiotics are prevented destruction in the stomach and maximal absorption in the upper parts of small intestine. It allows to increase the bioavailability of the drug and to minimize the impact on the intestinal microbiome, which reduces the incidence of common adverse reactions from the gastrointestinal tract. According to literature, oral administration of dispersible forms of drugs allows to reach the plasma concentrations similar to those in parenteral administration.

Accuracy of identifying pediatric acute bacterial sinusitis diagnoses in outpatient claims data.

Acute bacterial sinusitis is among the most frequent outpatient infections in children and adolescents and is well suited to study in large healthcare utilization databases, but the validity of International Classification of Diseases, 10th Revision (ICD-10) codes together with antibiotic prescriptions to identify cases of acute bacterial sinusitis has not been established. We aimed to evaluate the validity of ICD-10 codes combined with antibiotic prescriptions to identify new diagnoses of acute bacterial sinusitis among pediatric patients evaluated in the outpatient setting. Children and adolescents aged 17 years and younger with an outpatient diagnosis of acute sinusitis along with an antibiotic prescription from an ambulatory facility affiliated with the Mass General Brigham health system were identified via a clinical data warehouse. Patients were stratified by age (0-5 years, 6-11 years, and 12-17 years), and 50 cases per age group were randomly sampled. Medical records were independently reviewed by two pediatric infectious diseases physicians to assess for the documentation of a clinician-defined diagnosis of acute bacterial sinusitis. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated. A total of 150 patients were included in the final cohort. Frontal, maxillary, and "unspecified" sinuses accounted for 88% of the diagnoses. The positive predictive value of the algorithm to identify clinician-defined diagnoses of acute bacterial sinusitis was 92% (95% CI 87%, 95%). The PPVs were consistent across age strata. ICD-10 codes for acute sinusitis, when paired with a same-day antibiotic prescription, have a high positive predictive value among a cohort of pediatric patients, suggesting that they can be used to study new acute bacterial sinusitis diagnoses with claims.

COVID-19 infection and extensive subdural empyema: cause or consequence?

Adolescent, female, 12 years old, with a history of headache and vomiting, without fever, with progressive worsening and coma. Laboratory tests showed positive SARS-CoV-2 PCR RNA. She has not had the vaccine for COVID-19. A non-contrast-enhanced cranial tomography(Figure 1a) showed a right fronto-temporo-parietal cortical hypodense area with significant midline shift. A decompressive craniectomy was performed with drainage of extensive subdural empyema(Figure 1c). Subdural empyema is most often a consequence of paranasal sinus infections. With the COVID-19 virus also located in the paranasal sinuses, it is not possible to determine whether it is a consequence or cause of subdural empyema (1). Although the pathophysiology is unclear, it is possible that upper respiratory infection by COVID-19 creates a favorable environment for bacterial sinusitis coinfection(Figure 1b), intracranial extension, and formation of subdural empyema (2). Another possible explanation is that the SARS-CoV-2 virus infection affects the immune system and makes the individual more susceptible to infection (3). Therefore, more studies are needed to clarify the relationship between SARS-CoV-2 infection and other infections. Figure Caption Figure 1 (a) Computed tomography of the skull, with the axial section showing a right fronto-temporo-parietal hypodense area(black arrows) with significant midline shift(black arrowheads). (b) Computed tomography of the skull, with the coronal section showing signs of sinusitis with opacification of the right ethmoid sinus(black arrow). (c) Intraoperative view after opening the dura mater showing exposure of the right fronto-temporo-parietal cortex covered by viscous purulent secretion(black arrow). (d) Computed tomography of the skull, with the coronal section showing after treatment without ethmoid opacification(black arrow) and small postoperative CSF collection(black arrowhead).

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

A rational approach to drug therapy of acute bacterial sinusitis in patients who have had a coronavirus infection

Introduction. In the complex therapy of acute bacterial sinusitis, drugs that have antibacterial, anti-inflammatory, mucolytic effects are widely used. The article discusses the effectiveness of the use of a phytopreparation containing standardized myrtol, limonene, cineol and alpha – pinene in the treatment of acute sinusitis in patients who have undergone SARS-CoV-2.Aim. To increase the effectiveness of conservative therapy of acute bacterial sinusitis in people who have undergone a new coronavirus infection (SARS-CoV-2) using a complex phytopreparation.Materials and methods. A simple randomized controlled clinical research study involved 83 patients suffering from acute bacterial sinusitis after a coronavirus infection. Potential, safety and recovery time were evaluated in two groups: a group of patients (n = 41) taking standardized Myrtol limonel, cineol and alpha – pinene (a phytotherapeutic drug), compared with a group (n = 42) taking an antibacterial drug. The severity of clinical manifestations was assessed according to the VAS scale, cognitive functions and memory were carried out using standard psychological tests and an assessment of the quality of life according to SNOT-22.Results and discussion. The use of Respero Myrtol forte, containing standardized Myrtol limonel, cineol and alpha-pinene, in the complex therapy of bacterial sinusitis in people who have undergone a new coronavirus infection (SARS-CoV-2) has significantly improved clinical symptoms, cognitive functions and the quality of life. Good drug tolerance, high potential and safety, recovery and improvement of the quality of life at an early date were noted.Conclusions. In the treatment of patients with bacterial sinusitis in people who have undergone a new coronavirus infection (SARS-CoV-2), Respiro Myrtol forte has shown high antibacterial, anti-inflammatory and mucolytic effects, good bioavailability, tolerance and safety.

A case report on recurrent alternating Tolosa-Hunt syndrome due to bacterial sphenoid sinusitis: rediscussing the diagnostic terminology and classification

BackgroundTolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia caused by idiopathic granulomatous inflammation involving the cavernous sinus region. Patients respond well to steroid therapy. THS is included in the differential diagnosis of cavernous sinus syndrome, so it is important to fully exclude other lesions in this area before treatment, otherwise steroid treatment may lead to fatal outcomes. Here we describe a patient who initially presented with symptoms that simulated THS symptoms and developed recurrent alternating painful ophthalmoplegia during follow-up, and the patient was finally diagnosed with cavernous sinusitis caused by bacterial sphenoid sinusitis.Case presentationA 34-year-old woman presented with left painful ophthalmoplegia. Magnetic resonance imaging (MRI) revealed abnormal signals in the left cavernous sinus area, and these abnormal signals were suspected to be THS. After steroid treatment, the patient obtained pain relief and had complete recovery of her ophthalmoplegia. However, right painful ophthalmoplegia appeared during the follow-up period. MRI showed obvious inflammatory signals in the right cavernous sinus and right sphenoid sinus. Then nasal sinus puncture and aspiration culture were performed, and the results showed a coagulase-negative staphylococcus infection. After antibiotic treatment with vancomycin, the painful ophthalmoplegia completely resolved, and the neurological examination and MRI returned to normal.ConclusionSome other causes of painful ophthalmoplegia also fulfill the diagnostic criteria for THS in the International Classification of Headache Disorders third edition (ICHD-3) and respond well to steroid therapy. Early diagnosis of THS may be harmful to patients, and clinicians should exercise great caution when dealing with similar cases without a biopsy. Using “cavernous sinus syndrome” instead of “Tolosa-Hunt syndrome” as a diagnostic category may provide a better clinical thinking for etiological diagnosis.