Chronic Sinus Disease Research Articles

Balloon sinuplasty: two-year follow up using Sino-Nasal Outcome Test-22 outcomes.

Balloon sinuplasty is a relatively new surgical technology proposed as a less invasive way of treating chronic rhinosinusitis and frontal sinus disease. It is crucial to monitor safety and efficacy to allow informed clinical decisions and appropriate counselling of patients. There are few papers with long-term follow up. Patients were selected for surgery based on symptoms of frontal pain and pressure or headache, pre-operative Sino-Nasal Outcome Test-22 scores, and computed tomography findings. All were resistant to appropriate medical therapy. Balloon sinuplasty was performed followed by a Sino-Nasal Outcome Test-22 questionnaire at two months and then two years. All patients underwent successful operations with no failure of technology or technique. There were no significant complications. The average Sino-Nasal Outcome Test-22 score reduced from 46 pre-operatively (standard error: +/- 5.7, n = 9) to 23 at 2 months (standard error: +/- 7.6, n = 7). At 2 years, the average Sino-Nasal Outcome Test score was 23 (standard error: +/- 4.3, n = 6). There was an even larger lasting benefit when pain or pressure symptoms were analysed in isolation. This study adds to the evidence of technique safety and feasibility. The procedure resulted in a significant long-term improvement in symptoms.

Mini Caldwell-Luc - How We Do It

Functional endoscopic sinus surgery has become the standard of care for chronic sinus disease. However, even with angled endoscopes it is difficult to visualize the entire maxillary sinus and a failure to do so often leads to incomplete disease clearance. This article describes our variation-the Mini Caldwell Luc (MCL) procedure, which we have found effective in disease clearance with minimal morbidity. The advantage of this procedure lies in the fact that the majority or entire procedure may be performed with a 0-degree endoscope and straight instruments.

Clinical and Radiologic Characterization of Frontal Sinusitis in the Pediatric Population.

Frontal sinusitis in the pediatric population is a disease that has not been thoroughly studied or characterized. The goals of this study are to characterize the clinical presentation, radiologic variables, treatment modalities, complications, and prognosis associated with acute and chronic frontal sinus disease in the pediatric population. IRB-approved retrospective cohort study of pediatric patients who were diagnosed with acute (AFS) or chronic frontal sinusitis (CFS) and underwent frontal sinus surgery at a tertiary level Children's Hospital from 2006 to 2016. Patients with AFS were compared to patients with CFS. Statistical analysis completed using chi-square test or Fisher's exact test, statistical significance set at P < .05. A total of 19 patients with AFS and 15 patients with CFS were analyzed. There was a male predominance in AFS and female predominance in CFS (P < .05).AFS patients were less likely to have allergies, prior sinus disease, or significant comorbidities (P < .05).Additionally, AFS patients presented with constitutional, neurologic, and ocular symptoms. The CFS group had predominantly sinonasal symptoms. CT-scan analysis showed that AFS patients had higher prevalence of complex frontal anatomy (Type-II cells, concha bullosa) compared with CFS patients (P < .05). Culture results were positive in 78% of the AFS group, with S. Anginosus (53%), Anaerobes (20%), and normal flora (17%). In the CFS group cultures were positive in 60% of the patients, 56% grew normal flora, 13% H. Influenzae, 6.5% Pseudomonas, and 24.5% other species. CFS patients were more likely to have persistent sinus disease and require repeat sinus procedures (P < .05). There are 2 distinct presentations of frontal sinus disease in the pediatric population. Patients with AFS vary significantly from those with CFS. Males, ages 13 to 18 years old, who cultured positive for S. Anginosus (former S.Milleri) dominated the AFS subgroup. Whereas as female patients with a history of allergic rhinitis and muco-cilliary disease were more prominent in the CRS subgroup. Correct identification and understanding of these 2 different entities are crucial for the appropriate short and long-term patient management.

Topical Management of Chronic Rhinosinusitis

Abstract Chronic rhinosinusitis (CRS) is an inflammatory condition involving nasal passages and therefore the paranasal sinuses for 12 weeks or longer [1]. It are often subdivided into three types: CRS with nasal polyposis (CRS with NP), CRS without nasal polyposis (CRS without NP), and Allergic fungal rhinosinusitis (AFRS). To diagnose CRS we require a minimum of two of 4 of its cardinal signs/symptoms. Additionally, direct visualization or imaging for objective documentation of mucosal inflammation is required. CRS therapy is aimed to scale back its symptoms and improve quality of life because it can't be cured in most patients. Thus, the goals of its therapy include the following: • Control mucosal edema and inflammation of nasal and paranasal sinuses • Maintain adequate sinus ventilation and drainage • Treat any infecting or colonizing micro-organisms, if present • Reduce the amount of acute exacerbations Mucosal remodeling is that the presumably underlying mechanism causing irreversible chronic sinus disease, almost like that happens in severe asthma [2]. In patients with both disorders, medical treatment of CRS can help in asthma control. Multiple topical and systemic therapies are utilized in the management of CRS, including saline washes and sprays, intranasal and systemic glucocorticoids, anti-leukotriene agents, and antibiotics.

Outcome of Excision with Primary Midline Closure for Sacrococcygeal Pilonidal Sinus Disease

Sacrococcygeal Pilonidal sinus disease is common chronic inflammatory disease affecting chiefly young adult male . It cause much discomfort and morbidity and affect negatively the quality of life of patients. There are various techniques of surgical treatment for the chronic sinuses but still there is no gold standard one. The aim of this study to report our experience with excision and midline closure technique of chronic Sacrococcygeal Pilonidal sinus disease and to identify the outcome of the procedure for postoperative wound complications and recurrence rate. This is a retrospective study with telephone contact and review of 36 patients operated for Sacrococcygeal pilonidal sinus disease from January 2011 through January 2016 under care of one consultant surgeon (the Author) in Public and Private Hospitals in Rania, Sulaimani, Iraq. Inclusion criteria was all patients with chronic midline located sinuses without evidence of acute inflammation. Exclusion criteria was all infected ,off midline located sinuses and recurrent sinuses. Elliptical Excision of the sinuses with primary midline closure over a vacuum drainage performed. End point of this study was rate of wound complications and recurrence of sinus. Thirty six patients with median age 22 years (range 14-40) with 24/12 male /female ratio. Median follow up was 24 months (12 - 66 months), the recurrence occurred in 3/36 ( 8.3%) patients at a median of 12 months (range 5 - 48), failure of treatment in 5/36 (13.9%) patients, and postoperative wound complications was seen in 5/36 ( 13.9%) patients. In the conclusion, excision and primary midline closure is simple, effective and preferable procedure for management of uncomplicated Sacrococcygeal pilonidal sinus disease associated with early wound healing and low rate of postoperative wound complications and recurrence rate.

Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial.

ObjectiveEndoscopic sinus surgery represents the gold standard for surgical treatment of chronic sinus diseases. Thereby, navigation systems can be of distinct use. In our study, we tested the recently developed KARL STORZ NAV1 SinusTracker navigation software that incorporates elements of augmented reality (AR) to provide a better preoperative planning and guidance during the surgical procedure.MethodsOne hundred patients with chronic sinus disease were operated on using either a conventional navigation software (n = 52, non‐AR, control group) or a navigation software incorporating AR elements (n = 48, AR, intervention group). Incidence of postoperative complications, duration of surgery, surgeon‐reported benefit from the navigation system and patient‐reported postoperative rehabilitation were assessed.ResultsThe surgeons reported a higher benefit during surgery, used the navigation system for more surgical steps and spent longer time with preoperative image analysis when using the AR system as compared with the non‐AR system. No significant differences were seen in terms of postoperative complications, target registration error, operation time and postoperative rehabilitation.ConclusionThe AR enhanced navigation software shows a high acceptance by sinus surgeons in different stages of surgical training and offers potential benefits during surgery without affecting the duration of the operation or the incidence of postoperative complications.Level of evidence1b.

Rhinosinusitis and the role of imaging.

Acute, uncomplicated rhinosinusitis is a clinical diagnosis. Imaging should only be used in the case of complicated sinus infections, recurrent or chronic sinus disease, or in surgical planning. The authors discuss key features of complicated and uncomplicated rhinosinusitis, management, and recommendations on the use of imaging in diagnosis.

Rhinology: Sinus surgery in the older patient

In 2050, the elderly population will reach a projected 83.7 million and will represent 20% of the population in the United States. Chronic rhinosinusitis remains the sixth most common chronic disease in the geriatric population. It is often disregarded as a secondary problem in patients perceived as frail, with multiple other medical comorbidities and polypharmacy. The pathophysiologic changes that happen in the elderly make for a unique disease that requires special attention. Symptoms can be nonspecific but elderly with chronic sinus disease have a decreased quality of life metrics that can be significantly improved with medical or surgical interventions. Procedures in the form of in-office under local anesthesia or in the operating room under general anesthesia can be offered and safely performed but not without a slightly elevated risk of complications. Thus, particular considerations concerning anticoagulation, anesthesia techniques and proper choice of surgical options are necessary.

All Patients With Common Variable Immunodeficiency Disorders (CVID) Should Be Routinely Offered Diagnostic Genetic Testing.

Common Variable Immunodeficiency Disorders (CVID) are a rare group of primary immunodeficiency disorders (PIDs) where late onset antibody failure leads to immune system failure (1). Onset of symptoms can occur from early childhood to the eighth decade or later (2). Current estimates suggest a prevalence between 1: 25 000 to 1: 100 000 in Caucasians (3, 4). For reasons that are unclear, CVID appears to be less frequent in Asian and African populations, although there may be ascertainment bias. The majority of patients with CVID present with recurrent and severe infections. Untreated, patients are predisposed to chronic suppuration of the respiratory tract, often resulting in chronic sinus disease and bronchiectasis. Approximately 25% of CVID patients suffer autoimmune or inflammatory sequelae, consequent to immune dysregulation (5). There is also an increased risk of malignancy (6). There is no single clinical feature or laboratory test, which is pathognomonic for CVID. The identification of CVID therefore relies on diagnostic criteria. There are currently three new sets of diagnostic criteria for CVID (7–9). The Ameratunga et al. (7) criteria require symptomatic primary hypogammaglobulinemia with relevant laboratory tests to establish the diagnosis. The threshold for IgG was set at 5 g/l for adults. The revised European Society for immunodeficiencies (8) are similar to the Ameratunga et al. criteria. The most recent International Consensus Document (9) CVID criteria claim to be able to make a definite diagnosis on the basis of a single abnormal vaccine challenge result in a patient with primary hypogammaglobulinemia (9). The latter two criteria have set the threshold for IgG at 2 sd below the mean. Although immunoglobulin levels do not follow a Gaussian distribution (10), this is generally accepted as an IgG below 7 g/l. These criteria also exclude late onset combined immunodeficiency (LOCID) from the diagnosis. The immunoglobulin levels are also required to be repeated in these latter criteria. There is ongoing debate about the utility these diagnostic criteria, the variability of IgG levels over time, the unreliability of vaccine challenge responses and flow cytometry in the diagnosis of CVID. As discussed below, this variability in protein-based assays is a strong argument for genetic testing of all patients with a CVID phenotype.

Clinical Correlation of Chronic Rhinosinusitis with Nasal Polyps

Background: Chronic rhino sinusitis with and without nasal polyps represent different group of one chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. Coexistence of chronic rhinosinusitis with nasal polyps' has similar characteristics of inflammation that supports assumption that chronic rhinosinusitis and nasal polyps may at least be in part, the same disease process.&#x0D; Objectives: This study is aimed to correlate the chronic rhinosinusitis associated with nasal polyps.&#x0D; Methods: This was a prospective descriptive study was conducted on the patients attending the department of ENT in NGMC teaching hospital from March 2016 to September 2017.&#x0D; Result: There were 70 cases including 47male and 23 female, with an age range of 17 years to 65 years.&#x0D; Conclusion: This study supports that a patient with chronic rhinosinusitis associated with nasal polyps is a subtype of chronic sinus disease.

Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation

PurposeThis study aimed to standardize the technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT) associated with laser epilation. MethodsAll pediatric patients presenting with acute or chronic pilonidal sinus disease (PSD) who underwent PEPSiT in our institution over a 36-month period (July 2015–July 2018), were included in the study. Pre- and postoperative management, recurrence rate, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated. ResultsA total of 59 patients (23 girls and 36 boys) underwent PEPSiT during the study period. Ten/59 patients (16.9%) had recurrent PSD after open repair, and 4/59 (6.7%) presented a concomitant pilonidal cyst. All children underwent laser epilation pre- and postoperatively over the last 15 months. The average length of surgery was 27.5 min (range 20–45). The average pain score during the first 48 postoperative hours was 2.7 (range 2–5), and the average analgesic requirement was 20 h (range 16–24). The average hospitalization was 22.4 h (range 18–36). At 1 month postoperatively, external openings were healed in all patients. During follow-up, 1 recurrence (1.6%) was recorded and successfully re-treated with PEPSiT. ConclusionsWe believe that PEPSiT represents the technique of choice for treatment of PSD in the pediatric population. It is crucial to standardize the technique consisting of pre- and postoperative laser epilation, PEPSiT, and accurate postoperative wound management with eosin and sulfadiazine spray. Level of evidenceTreatment study — Level IV

Long-Term Effectiveness of Balloon Catheter Sinuplasty in Pediatric Chronic Maxillary Sinusitis.

The objective of our study was to assess the long-term effectiveness of balloon catheter sinuplasty in the treatment of pediatric chronic maxillary sinusitis following failed first-line medical and surgical management with adenoidectomy. Pediatric patients younger than 12 years were reviewed for having failed previous adenoidectomy and undergone a balloon catheter sinuplasty between August 2006 and March 2011 for chronic rhinosinusitis. Demographic data and clinical characteristics were recorded in patients who met inclusion criteria. Outcomes were assessed by need for functional endoscopic sinus surgery and persistence of chronic infection within at least 5 years of follow-up. Failure was defined by any child who was rediagnosed with chronic sinus disease after balloon catheter sinuplasty or who required endoscopic sinus surgery within 5 years. Sixty-two children were reviewed, with 38 patients meeting inclusion criteria (prior adenoidectomy, a preoperative Lund-Mackay score of ≥5, and balloon catheter sinuplasty). The mean age (standard deviation) was 6.76 (2.27) years with an age range of 2 to 11 years. Eight children (21.1%, P < .01) continued to have chronic sinus complaints following balloon procedure, with 5 (13.1%) individuals requiring eventual endoscopic surgery within 5 years. Age, asthma, allergy, and gender did not have any statistically significant impact on outcome. Balloon catheter sinuplasty is an effective long-term alternative for the treatment of chronic rhinosinusitis in pediatric patients, hoping to avoid further infections and eventual endoscopic surgery.

Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease.

To present an evaluation of a surfactant-containing polymeric membrane foam wound dressing for use on patients with chronic pilonidal sinus disease. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After completing this continuing education activity, you should be able to:1. Recall risk factors for and pathophysiology of pilonidal sinus wounds.2. Summarize the evidence-based elements of wound assessment and treatment.3. Identify the study methodology and results. To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.This case series was conducted in an outpatient dermatology and wound clinic. Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.Dressing changes were performed daily because of frequent contamination from bowel evacuation, sweating, or frictional forces in the perianal and intergluteal skin. Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.Subjects were predominantly males (81% [n = 13]) with a mean age of 23 years. At study initiation, the mean wound duration was 3.2 months, and mean surface area was 3.3 cm (0.18-19.6 cm). The majority of wounds showed signs of superficial infection (63% [n = 10]) and deep infection (88% [n = 14]). At week 12, 10 wounds (63%) had closed, 1 (6%) had decreased in surface area, 2 (13%) had increased in size, and 3 (19%) of the patients were lost to follow-up. Mean pain score was 3.4 at first visit; most patients reported reduction in pain scores by weeks 4 and 12. Participants reported improved mobility and ability to self-apply dressing. No adverse reactions were observed.Use of a surfactant-containing polymeric membrane foam wound dressing with glycerin may have facilitated wound closure in 10 of 13 patients who completed the 12-week study.

Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease.

Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease.

A clinico-radiological study of anatomical variations of nose and para-nasal sinuses in chronic rhinosinusitis patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There are a lot of&lt;strong&gt; &lt;/strong&gt;anatomical variations in para-nasal sinuses that are responsible for various sinus pathologies. CT scan of paranasal sinuses prior to functional endoscopic sinus surgery has become extremely important to know the anatomy and its variations to avoid complications during surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was performed in 100 patients at King George’s Medical University, Lucknow UP, India to compare the anatomical variations between nasal endoscopy and CT scan findings. The outcome measures were deviated nasal septum, paradoxical middle turbinate, concha bullosa, medialized/lateralised uncinate process, pneumatized uncinate process, large ethmoid bulla, accessory ostium, Agger nasii cells, Haller’s cells and Onodi cells. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this&lt;strong&gt; &lt;/strong&gt;study&lt;strong&gt; &lt;/strong&gt;the age of the patients were 30.00±9.56 yrs. with male to female ratio 1.9:1. Deviated nasal septum was the most common anatomical abnormality (70%) followed by large bulla ethmoidalis 17%. Occurrence of different types of special cells were studied which are better visualized on coronal CT scan images. Among these cells Agger nasi was the most common variety (15%) followed by Haller’s cells (11%) and Onodi cell (3%). Concha bullosa was present in 8%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The importance of CT and nasal endoscopy can be seen in patients with persistent symptoms to identify the anatomical variations that may responsible for the development of chronic sinus disease. In cases of sinusitis patients all the para-nasal sinus should be properly investigated to avoid complications. &lt;/p&gt;

Sinus and Upper Airway Surgery in Children.

Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments. Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable. More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.

Systematic Reviews and Meta-analysis in Rhinosinusitis: a Critical Review of the Reviews.

There has been an explosion in the number of published systematic reviews on chronic rhinosinusitis in the last decade. While the aim of these reviews in facilitating evidence-based practice is laudable, poor quality reviews may contain significant bias that can mislead a non-discerning reader. Attention therefore must be given to review methodology before implanting findings. Organisations such as the Cochrane Collaboration promote high-quality reviews, but are limited in chronic sinus disease by heterogeneous outcomes and a paucity of randomised trials.

Comparison between the Sinus and Gut Microbiome in Patients with Chronic Sinus Disease

Objectives: Associations between the gut microbiome and various non-GI related diseases have been detailed in recent studies. This investigation aims to directly compare the gut and sinus microbes in patients with chronic sinus disease and in control patients to determine if any link exists between the sinus and gut microbiota. Methods: This was a prospective study conducted from February 2016 to August 2017. It was conducted at a tertiary care academic rhinology practice on 16 patients undergoing rhinologic surgery. The primary outcome measure was to determine if any overlap exists between the gut and sinus microbiome in a given subject. A secondary outcome was to assess the effect of prior antibiotic therapy on the diversity of the gut microbiome. Results: There were 7 patients with chronic rhinosinusitis (CRS) with polyps, 6 patients with CRS without polyps and 3 control patients. Only one patient demonstrated an overlap of sinus and gut microbiotia. In patients receiving a reduced number of antibiotic courses over the past 24 months (0 or 1 course), there was a mean of 7.7 (SD 2.2) gut bacteria isolated from stool samples. In patients receiving more antibiotic courses (2+ courses), there was a mean of 5.1 (SD 2.3) gut bacteria isolated. This difference reached statistical significance (p=0.043). Conclusion: Minimal overlap between the sinus and gut microbiome was demonstrated, but further studies are needed to elucidate this potential association. This study supports the theory that antibiotics tend to reduce microbial diversity in the gastrointestinal tract.

Man with a swollen mass on sacrococcygeal region.

A 43-year-old male patient presented to the emergency department with 8 days of a painful swollen mass on sacrococcygeal region. He had no personal or family medical conditions and was receiving cephalexin 500 mg four times a day two days ago. Examination revealed an erythematous, fluctuant, swollen mass on sacrococcygeal region and an orifice at the buttock cleft (A). He was afebrile and nontoxic. Laboratory study results were unremarkable. Incision, drainage, currettage were made, leaving the surgical wound open for secondary healing. The diagnosis of pilonidal cyst with abscess was performed. Pilonidal sinus probably derives from the perineal pilosebaceous unit and precursor pits associated with trapped hairs. The penetrating hairs may cause a foreign-body giant cell reaction, sometimes with secondary bacterial infection, with can cause a sudden onset of pilonidal abscess. It occurs more commonly in individuals with stiff dark or auburn hair. There are four clinical presentation of the disease: symptomatic, acute pilonidal abscess, chronic fistulizing form or complex pilonidal sinus disease. Chronic fistulizant form is the most common clinical presentation. The sacrococcygeal location is the most common site but it can occur on the pubis, anterior perineum and very rarely, the penis. Asymptomatic pits do not require treatment. For acute abscesses, the options available are: aspiration followed by treatment with antibiotics and later curative intent surgery; drainage without curettage; drainage and curettage.

Local Phenol Application Versus Excision with Modified Primary Closure Technique in Pilonidal Sinus Disease: A Comparative Study

Background: Different procedures are practiced nowadays for management of pilonidal sinus disease (PSD), ranging from the minimally invasive techniques to the complex flap techniques. Each procedure has its own advantages and drawbacks in terms of patient’s satisfaction, follow up and recurrence rate. Local phenol application into the sinus track was practiced with encouraging results. The limited excision and modification of the primary closed technique has shown both low wound dehiscence and recurrence rates. The objective of this study is to evaluate and compare the local application of phenol 80% in the pilonidal sinus tracks after minimal debridement with the limited excision and modified primary closure technique. Methods: 52 patients suffering from chronic pilonidal sinus disease were divided equally into 2 groups. Patients in group I were managed with local phenol application under local anesthesia. In group II, the patients were operated upon by limited excision of the skin bearing the sinus pits and the underlying granulation tissue with modified primary closure technique using the gluteus maximus fasciae to close the cavity left followed by closure of the subcutaneous tissue and skin with leaving a suction drain inside. Results: The median duration of phenol applications procedure was 20 ± 11 minutes versus 41 ± 13 minutes in the modified primary closure technique. There was a significant difference between both groups as regards the duration of pain killers’ use. By 5 weeks, signs of complete healing were shown in 22 patients (84.5%) of the phenol group, versus 25 patients (96.2%) in the surgery group with no statistic difference between both. The recurrence of PSD in the phenol group was detected in 2 cases (7.7%) while it was one case (3.8%) in the surgery group (p=0.163). Conclusion: both procedures are simple, less surgically demanding, having simple postoperative care, low complication and recurrence rates, early recovery and good patient satisfaction.