Bilateral Sinusitis Research Articles

日帰り内視鏡下鼻内手術

Day-surgery is expected to advance with the development of medical technology and social and economic demand. In this study, the charts of 55 cases (53 patients aged 11-81y. o.) who underwent endoscopic sinus surgery (ESS) as day-surgery were analyzed retrospectively and questionnaires on the operation were performed. ESS was performed in 39 cases of chronic sinusitis, 9 cases of paranasal cyst, 3 cases of inverted papilloma and 2 other cases. The operative procedures were performed on the unilateral cavity in 47 cases, and on the bilateral cavity in 8 cases. In most patients only the unilateral maxillary and ethmoid sinuses were operated on. While bleeding volume was under 10ml in 49 cases, it was over 50ml in 3 cases. Although the average operation time was about 55 minutes, it took over 90 minutes in 5 cases. Because of post operative bleeding, prolonged management or reconsultation was needed on the operation day in 4 cases. Admission was necessary in 2 cases; one due to tinnitus and vertigo, and the other due to cerebrospinal fluid leak. According to the questionnaires, most of patients wanted a day-sugery because of their schedule, and they were mainly anxious about bleeding after returning home. From the findings of this study we suggest that the indications of day-surgery in ESS are 1. The patient is over 10 y.o. and has no severe past-history. 2. The patient lives near the hospital. 3. The diagnosis is unilateral sinusitis, or bilateral sinusitis that is mild on at least one side, or paranasal cyst for which an endonasal approach is required, or benign tumor without risk of excessive bleeding. The control of bleeding and the prevention of infection are the most important issues for the advance of ESS as day-surgery.

Pseudomonas aeruginosaStomatitis as a Sequel to Trichomoniasis in Captive Saker Falcons (Falco cherrug)

Twelve adult female saker falcons developed reduced appetite, progressive weight loss, and unilateral or bilateral sinusitis. Nodular white or yellow caseous lesions were visible on the oropharynx and tongue of all birds. One falcon had 2 caseous masses on either side of the tracheobronchial syrinx, resulting in severe tracheal stenosis. All 12 birds had a history of mild to moderate trichomonal infections 3–4 weeks before examination. In all birds, bacterial culture of samples from these masses yielded pure growths of Pseudomonas aeruginosa. The birds were treated with a combination of piperacillin (100 mg/kg) and tobramycin (10 mg/kg) administered intramuscularly q12h for 7 days. Oropharyngeal lesions were debrided, and the oral cavity of each bird was sprayed with a 1% povidone iodine mouthwash preparation. In birds with unilateral or bilateral sinusitis, a solution of 0.2 ml of a 5% chlorhexidine gluconate preparation diluted to 20 ml with sterile saline was used to flush the affected sinus q12h for 3–5 days. Tracheal masses in the 1 falcon were removed by curettage during tracheoscopy. Oropharyngeal lesions in all birds were completely resolved within 8–18 days of treatment. Trichomoniasis coupled with stress during the training and hunting seasons may have predisposed these falcons to infection with P aeruginosa.

Magnetic resonance imaging of orbital abscesses

The magnetic resonance imaging features of two orbital abscesses are reported, with correlation to clinical, computed tomographic and ultrasound findings.In the first case, a 16-year-old boy, after bilateral ethmoidal sinusitis, meningitis and right orbital cellulitis, developed an intraconal abscess. CT revealed a hypodense core, surrounded by a brighter pseudocapsule. On T1-weighted MRI, the center of the abscess appeared hypointense and the capsule isointense to muscle. On T2, the core was hyperintense, and the pseudocapsule was not evident. Ultrasonography showed a well-defined rounded lesion, with low-to-medium internal reflectivity. Follow-up was carried out by CT and ultrasound until complete healing.In the second case, after chemotherapy for a sytemic T-cell lymphoma, a 41-year-old man developed frontal and ethmoidal sinusitis and a left superior orbital mass originating from the frontal sinus. On T1-weighted MRI, the mass appeared hypointense, with a darker core, which appeared hyperintense on T2...

アレルギー性慢性中耳炎例

A 44-year-old man with a history of nasal allergy and drug eruption was complaining of persistent bilateral hearing loss, otorrhea and dizziness. He had previously undergone middle ear surgery twice on his right ear and 5 times on his left ear over the past 2 years. The characteristic findings were abundant eosinophils in the thick, glue-like otorrhea, high serum IgE levels to house dust, and bilateral paranasal sinusitis of an allergic origin. He had previously undergone surgery twice for bilateral sinusitis and three times for recurrent chronic otitis media. Histologic examinations of the middle ear granulation tissues revealed an enormous infiltration of eosinophils, suggesting that there was allergic inflammation. Desensitization to house dust allergens together with the general and topical administration of steroids were effective in controlling the disease. However, the patient still suffered from intermittent otorrhea from both ears. The allergic otitis media was believed to be caused by a type 1 allergy to house dust in this case.

Does This Patient Have Sinusitis?

To the Editor. —The article on sinusitis by Williams and Simel1is a valuable contribution, but the authors overstate their case in two areas. First, they cite two studies of maxillary sinusitis2,3to support their claim that randomized trials have shown that sinusitis antibiotics for rapid resolution. The word requires is too strong here, since a majority of untreated subjects in both studies were improved or cured at 10 days. Moreover, one was a pediatric study that may not be applicable to adults.2The other was an adult study with methodologic weaknesses.3A primary end point was subjective improvement, but patients and investigators were not blinded to treatment; and the nasal decongestant only group had more bilateral sinusitis and completely opacified sinuses than the lincomycin group, suggesting that more complicated cases might have been assigned to the no-antibiotic group. Interestingly, an authority cited by Williams

Paranasal sinusitis associated with nasotracheal and orotracheal long-term intubation.

The impact of nasotracheal and orotracheal long-term intubation on the development of sinusitis paranasalis was investigated in a prospective study. Daily A-scan ultrasound examinations of the maxillary sinuses were performed on 44 intensive care unit patients (20 nasally, 24 orally intubated) who required prolonged intubation (greater than 24 hours). At the end of the investigation period 19 (95%) of 20 nasotracheally and 15 (63%) of 24 orotracheally intubated patients showed pathologic antral sinus findings. In nasally intubated patients the incidence of bilateral sinusitis was significantly higher and its onset sooner. Pathologic organisms were found in the sinus aspirates in seven of 13 nasotracheally intubated patients, but only in two of nine patients with an oral tube. Thus, the nasotracheal tube can be seen as an adding factor in the development of sinusitis paranasalis.

ＩＣＵ患者にみられた急性副鼻腔炎

We describe four patients with acute sinusitis which developed in the intensive care unit following the long term use of intubation tubes or nasogastric tubes. They had fever and leukocytosis which started 8 to 25 days after insertion.CT scans revealed sinusitis in all four cases. In two patients, the lesions were seen recognized only in a maxillary sinus, while the remaining two showed evidence of pansinusitis, one had bilateral sinusitis. Cultures of maxillary discharge grew out staphylococcus aureus, peptostreptococcus, candida albicans and citrobacter freundii. All four cases were treated with antral puncture and sinus irrigation, and definite improvement of acute sinusitis was documented. Intubation tubes and feeding tubes in the nasal cavities may be considered one of the etiologic factors leading to acute sinusitis. In this regard, in the clinical courses of such ICU patients with persistent fever of unknown origin and/or leukocytosis, acute sinusitis should be kept in mind as possible of infection.

片側上顎洞炎の検出菌の特徴と薬剤選択

Unilateral sinusitis includes maxillary sinusitis of dental origin, fungal maxillary sinusitis, and acute sinusitis. Microorganisms of 50 cases of unilateral maxillary sinusitis were studied. Eighty-six strains and 24 kinds of bacteria were detected. They included mainly Streptococcus pneumoniae(15.1%), Haemophilus influenzae(12.8%), Peptostreptococcus(10.5%), and Bacteroides (14%). Of the total 86 strains isolated, 41(47.7%)were aerobic and 45(52.3%) were anaerobic.Anaerobic microorganisms play a more important role in unilateral maxillary sinusitis than in bilateral sinusitis. This should be considered when selecting antibiotics for the treatment of unilateral maxillary sinusitis

Clinical significance of unilateral sinusitis.

In general, the etiologic factors of chronic paranasal sinusitis are systemic conditions such as nutrition, predisposition, allergy, and local factors such as nasal anatomic conditions. Among these factors, the development of unilateral sinusitis is a model case verifying the influence of local factors. In my study of 640 cases over a certain period of time, a comparison was made between 161 cases of unilateral sinusitis and 479 cases of bilateral sinusitis in order to verify the effects of local factors in the development of this disease. Patients with a history of previous sinus surgery or tumors were eliminated from the cases. 1. The male-female incidence rate, and the age distribution of the patients at the initial visit showed no prominent differences between unilateral and bilateral cases. 2. It was found that a larger number of cases of unilateral sinusitis had a duration of less than one year as compared to bilateral sinusitis which were longer than and year. Therefore it can be said that the duration of unilateral sinusitis is usually shorter than that of bilateral sinusitis. 3. In unilateral cases the patients with moderate to severe nasal septal deviation, one number of patients with septal deviation towards the diseased side was twice as high as that on the non-affected side. 4. The incidence rate of polyps occurring in the middle meatus was shown to be about twice as high in bilateral cases as in unilateral cases.(ABSTRACT TRUNCATED AT 250 WORDS)