Diagnosis Of Rhinosinusitis Research Articles

The potential role of Helicobacter pylori in chronic rhinosinusitis with or without nasal polyposis

BackgroundCertain gastrointestinal and extra-intestinal diseases are caused by the gram-negative bacterium Helicobacter pylori (H. pylori). We aimed to determine the potential H. pylori role in chronic rhinosinusitis (CRS) with or without nasal polyposis. This cross-sectional study was conducted on 80 subjects of any age and sex diagnosed with CRS (CRSWNP and CRSSNP) who had failed medical treatment and scheduled for surgery. Patients were further categorised into two equal groups: study group (n = 40) were diagnosed with CRS with or without nasal polyposis (CRSWNP and CRSSNP) who had failed medical treatment and scheduled for surgery, and control group (40 patients) were admitted for septoplasty. All patients had clinical assessment, physical assessment, diagnosis of rhinosinusitis (according to EPOS), based on symptoms, rhinoscopic/endoscopic findings, CT scan findings, questionnaire for gastroesophageal reflux disease (GERD), and questionnaire for laryngopharyngeal reflux (LPR). Samples were collected in the operating room during surgery from both groups and PCR tissue was done.ResultsThe study group patients demonstrated significantly higher history of GERD, LPR, and H. pylori. H. pylori patients had significantly lower ages than those without (P = 0.03). Patients with H. pylori revealed significantly higher GERD history (P < 0.001) and LPR (P = 0.002) than those without H. pylori. History of GERD (P = 0.003), LPR (P = 0.043), and H. pylori presence (P = 0.028) were significant predictors, controlling for the abovementioned variables.ConclusionsWe concluded that a significant correlation was observed between the H. pylori presence in the sinonasal mucosa and nasal polyps and the development of chronic rhinosinusitis with or without nasal polyps.

An unusual presentation of subacute Haemophilus parainfluenzae endocarditis in a low-risk woman treated by minimally invasive mitral valve repair: a case report

BackgroundHACEK endocarditis is usually insidious and can often be difficult to diagnose due to the slow-growing nature of the organisms. This report presents our experience in treating a patient with Haemophilus parainfluenzae endocarditis.Case presentationWe describe the case of a previously fit and well 23 year-old woman who presented to her local emergency department with a four-week history of persistent febrile illness. She had associated nausea, vomiting, and lethargy. This was preceded by an episode of mucopurulent rhinorrhoea. She was treated empirically with oral amoxicillin for a putative diagnosis of rhinosinusitis. Initially, her symptoms abated, however, she was readmitted with high fevers and a new pansystolic murmur. Transthoracic echocardiography revealed a large, mobile, echogenic mass, tethered to the posterior mitral valve leaflet (PMVL) and mild mitral regurgitation (MR). On examination, she had multiple non-tender, erythematous macules on the plantar surface of her feet, consistent with Janeway lesions. Two separate blood cultures grew H. parainfluenzae. Infectious diseases recommended a four-week course of intravenous ceftriaxone. Transesophageal echocardiography demonstrated a perforation within the P3 segment of the PMVL. Subsequently, the patient underwent mitral valve repair surgery with an uneventful recovery.ConclusionsOur case highlights the importance of promptly diagnosing HACEK endocarditis. A prolonged course of antibiotic therapy can be lifesaving, and surgery is often necessary to address complications such as perforation within the mitral valve leaflets. In our patient, we were able to perform a sliding P2 leaflet plasty for good quality repair of the mitral valve, through a minimally invasive right anterior thoracotomy.

The Role of Interleukins in the Diagnosis of Rhinosinusitis

The Role of Interleukins in the Diagnosis of Rhinosinusitis

Clinical and Radiological Evaluation of Chronic Rhinosinusitis

Introduction The diagnosis of rhinosinusitis is based on clinical grounds having characteristic symptoms, combined with objective evidence of mucosal inflammation. We studied the corelation between the symptoms of the patients, clinical and endoscopic findings with CT scan findings in chronic rhinosinusitis (CRS). Materials and Methods Patients above the age of 15yrs fulfilling the criteria of Chronic sinusitis laid by European position paper on rhinosinusitis and nasal polyps (EPOS) 2012 were prospectively studied. Demographic and clinical profile were noted. Diagnostic Nasal Endoscopy was done and findings were recorded. Patients were undergone CT evaluation after giving appropriate medical management. Clinical, endoscopic and radiological findings were compared with similar studies. Data was analysed using IBM SPSS software version 20. Results This study included 118 patients of Chronic Rhinosinusitis. Patients commonly male between the age group of 21-30 years presented with nasal obstruction, headache and nasal discharge in order of presentation. Diagnostic Nasal endoscopy revealed Septal deviation in 64.4% and medialize uncinate process in 15.2% of cases. Nasal discharge (48.3%) was commonest finding. CT scan suggested deviated nasal septum (70.4%), concha bullosa (30.5%), blocked osteo-meatal complex (68.6%) in patients of CRS. Presence of Agger Nasi cell (49.2%), Haller cell (12.7%) and Onodi cell (15.7%) seen in these patients. Conclusion CT scan and diagnostic endoscopy along with detailed clinical examination are essential component for assessment of a patient with chronic rhinosinusitis. CT scan is considered as gold standard but endoscopy is also a valuable tool for diagnostic evaluation of patients with CRS.

Worsening Rhinosinusitis as a Prognostic Factor for Patients with Nasopharyngeal Carcinoma: A Retrospective Study.

Rhinosinusitis is common in patients with nasopharyngeal carcinoma (NPC). Our study aimed to explore the role of rhinosinusitis severity in NPC prognosis. Medical records and radiologic examinations of 90 patients with NPC at a single medical center from 2009−2016 were retrospectively analyzed. The Lund−Mackay (L−M) score was obtained for each patient before and after 6 months of treatment. Rhinosinusitis diagnosis was based on L−M scores of ≥4. L−M score differences were calculated as pre-treatment rhinosinusitis (PRRS) minus post-treatment rhinosinusitis (PSRS). L−M score difference was sub-grouped into “L−M scores > 0”, “L−M scores = 0”, and “L−M scores < 0”. Clinical staging of our patients based on the American Joint Committee on Cancer 7th edition were: stage I in nine, stage II in seventeen, stage III in twenty-two, and stage IV in forty-two patients; twenty-seven (30%) patients had died. PRRS incidence was 34.4%, and PSRS was 36.7%. Median of L−M scores difference was 0 (−2.2). L−M score difference was an independent prognostic factor for the overall survival of patients with NPC (p < 0.05). Therefore, worsening rhinosinusitis was a prognostic factor for patients with NPC. Clinicians should consider NPC as a warning sign of poor prognosis during routine follow-ups.

Study of Acute and Chronic Sinusitis – Symptoms, Diagnosis and Treatment: A Review article

Background: Sinusitis is an inflammatory condition that affects the mucous membrane lining the airways. Chronic rhinosinusitis and acute rhinosinusitis are the two types. Rhinosinusitis is characterized by facial pain, congestion, and headache. Due to the widespread prevalence of sinusitis, there must be an evaluation of the case because the diagnoses are more serious in the advanced stages of the disease and impact the outcome of care. Objectives: The objective of this study was to conduct a literature evaluation of chronic and acute rhinosinusitis, risk factors, symptoms and signs of sinusitis, diagnostic, sinusitis treatment, and antibiotic treatment, as well as new databases. Conclusion: Rhinosinusitis diagnosis is based on physician experience, with the history and examination serving as the foundation. It is just as vital to identify the underlying pathogen as it is to understand the patient's comorbidities to develop a proper treatment approach and minimize unwanted consequences.

Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management.

Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach. This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed. Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases. Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can't be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi.

Rhinosinusitis and its impact on quality of life in children.

Rhinitis and rhinosinusitis are common conditions which have a significant burden on healthcare services and can lead to reduced productivity in patients across the entire age spectrum. Three disease-specific quality of life tools were analysed in hospital and community settings to explore prevalence, disease characteristics and financial costs to sufferers, and to compare these aspects between cohorts (young children, young adult and adults). These tools were Modified Sino-Nasal Outcome Test-20 (MSNOT-20) questionnaire for adults, MSNOT-20 Young Persons Questionnaire (MSYPQ) for 11-16-year-olds and Sami's Rhinosinusitis Diagnosis and Impact questionnaire for 5-10-year-olds. One of the top three symptoms in children aged 5-10 years was cough, which is a much less common symptom in adults. These validated, disease-specific, quality of life questionnaires provide a fuller illustration of the patient experience, allowing comprehensive comparative analysis across the ages.

Chronic Rhinosinusitis and the Risk of Erectile Dysfunction.

Chronic rhinosinusitis is a common disease associated with reductions in quality of life across a range of measures, including sexual health. We conducted a case-control study assessing chronic rhinosinusitis prevalence among men with and without clinically significant erectile dysfunction. We found that chronic rhinosinusitis was significantly associated with erectile dysfunction (odds ratio = 2.0, 95% CI = 1.8-2.4, P < .001) and that this association remained significant even when the interval between chronic rhinosinusitis diagnosis and erectile dysfunction treatment was restricted. This study adds to a growing body of literature demonstrating an association between chronic rhinosinusitis and sexual dysfunction.

Evaluation of neutrophil functional activity for rhinosinusitis diagnosis.

Bacterial rhinosinusitis (BRS) is a complicated form of rhinosinusitis, characterized by its acute course and tendency to chronicity. A significant role in pathogenetic mechanisms of HRS is played by functional state of neutrophils responsible for inflammation development at HRS. Investigation of neutrophils metabolic activity on external stimuli by chemiluminescence method in patients with acute and chronic forms of the disease will enable to develop method of differential diagnostics of BRS forms. The examination of 65 patients with BRS which were divided into patients with acute form (n=35) and chronic form of the disease (n=30) was carried out. The control group consisted of 30 healthy subjects. Functional activity of neutrophils was studied in whole blood by chemiluminescence with double stimulation (phorbol-12-myristate-13-acetate (PMA) and N-formylmethionyl-leucyl-phenylalanine (fMLP). In patients with the acute form of BRS we found an increase in parameters of specific maximum intensity of neutrophils luminescence, light sum of spontaneous and stimulated luminol-dependent chemiluminescence and a decrease in time to maximum output. Patients with the chronic form of BRS revealed a decrease in the luminescence of spontaneous, stimulated neutrophil production and maximum luminescence intensity. On the basis of significant differences in chemiluminescence indices of neutrophils, a method of differential diagnosis of the BRS forms was developed. The results obtained testify to increased production of reactive oxygen species (ROS) by neutrophils in the process of killing in patients with acute form of LRS and depletion of cell function and reserve in patients with the chronic form. Developed on the basis of the studied indicators method of diagnosing the forms of BRS by chemiluminescence will allow to differentiate acute and chronic forms of the disease, which will increase the effectiveness of treatment of patients.

Role of the microbiology laboratory tests in diagnosis inflammation of the upper respiratory tract

Infections of the upper respiratory tract are one of the main reasons why patients visit their primary care physician. Most of these are viral infections, requiring only symptomatic treatment. In the case of infections of bacterial etiology, apart from thorough medical history and physical examination, microbiological tests play an important role. They allow for the precise identification of the microorganism and determine sensitivity to antibiotics. Avoiding unjustified or wrong antibiotic therapy supports the fight against multi-drug resistant organisms, which are an increasing challenge for modern medicine. One of the most common causes of pharyngitis is Streptococcus pyogenes infection. Despite the possibility of performing rapid antigen detection test, pharyngeal culture remains the gold standard in the diagnosis of bacterial infections in this area. Otitis media is considered by the authors as well as sinusitis. The primary ethiology of the otitis media are viruses following the dysfunction of the Eustachian tube, which causes secondary bacterial infection. The anatomical structure of the middle ear prevents direct collection of material for microbiological examination, except in the case of spontaneous perforation of the tympanic membrane or paracentesis. Sinusitis is mostly viral infection and is diagnosed based on clinical symptoms. In the routine diagnosis of rhinosinusitis, microbiological testing is not recommended, however the authors discuss the principles and indications for extending the diagnostics. The following article argues the most common pathogens responsible for infections in the mouth, throat, middle ear, and paranasal sinuses. The authors pay special attention to the quality of the collected material, protection of the sample and the method of transport to the laboratory. Compliance with the following standards in everyday clinical practice may reduce the percentage of non-diagnostic results and will help in making an accurate diagnosis.

A Swedish population-based study of complications due to acute rhinosinusitis in children 5–18 years old

BackgroundThere are few population-based studies of complications due to acute rhinosinusitis in children. The aim was to clarify the admission and complication rate and analyze bacterial cultures in children five to 18 years old in Stockholm, Sweden. MethodsThis was a population-based observational cohort study with retrospectively collected data from individual medical records, from 1 July 2003 to 30 June 2016 in Stockholm, Sweden. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed. ResultsIncidence of admission due to acute rhinosinusitis was 7.8 per 100 000 children per year (boys 9.2, girls 6.2) and 61% of the admitted children were boys. A severe – postseptal orbital, intracranial or osseous – complication, was present in 34% of admissions (postseptal orbital 28%, intracranial 6%, osseous 4%), resulting in an incidence of 2.6 severe complications per 100 000 children per year (boys 3.6, girls 1.6). Orbital preseptal cellulitis was present in 88% of admissions. Incidence of surgery was 1.3 per 100 000 per year (boys 1.8, girls 0.8) and the percentage of admitted children that had surgery increased with age. S. pyogenes was the most common pathogen found in the whole cohort (29 admissions), while S. milleri was the most common pathogen found among the children with severe complication and surgery. ConclusionsThere is a relative high risk of severe complications in children between five to 18 years that are admitted due to acute rhinosinusitis. There is a need for prospective studies to further analyze the pathogens involved in complications due to acute rhinosinusitis.

Odontogenic causes complicating the chronic rhinosinusitis diagnosis

ObjectivesChronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This study aimed to explore how often odontogenic causes are considered when diagnosing CRS.Materials and methodsPatient records from 374 new CRS patients treated at a tertiary-level ear, nose, and throat (ENT) clinic were selected. Entries and radiological reports were assessed exploring how often dentition was mentioned and OS was suspected, how often radiologists reported maxillary teeth, and how commonly typical OS microbial findings and unilateral symptoms occurred.ResultsAlthough 10.1% of the CRS diagnoses were connected to possible dental issues, teeth were not mentioned for 73.8% of patients. Radiological reports were available from 267 computed or cone beam computed tomographies, of which 25.1% did not mention the maxillary teeth. The reported maxillary teeth pathology was not considered in 31/64 (48.4%) cases. Unilateral symptoms associated with apical periodontitis (OR = 2.49, 95% CI 1.27–4.89, p = 0.008). Microbial samples were available from 88 patients, for whom Staphylococcus aureus was the most common finding (17% of samples).ConclusionsOdontogenic causes are often overlooked when diagnosing CRS. To provide adequate treatment, routine assessment of patient’s dental history and status, careful radiograph evaluation, and utilization of microbial findings should be performed. Close cooperation with dentists is mandatory.Clinical relevanceDental professionals should be aware of difficulties medical professionals encounter when diagnosing possible OS. Thus, sufficient knowledge of OS pathology is essential to both medical and dental professionals.

Rhinosinusitis without nasal polyps in COPD.

The validity of the united airway disease concept for rhinosinusitis (RS) and chronic obstructive pulmonary disease (COPD) has been questioned because of methodological limitations in previous studies. In this study we investigated the prevalence of RS without nasal polyps (RSsNP) and the severity of sinonasal symptoms in COPD and a corresponding control group. We also evaluated the diagnostic accuracy of these symptoms for RSsNP in COPD. 90 COPD patients and 93 controls were included in an observational cross-sectional study where globally accepted diagnostic criteria of RS and COPD (EPOS 2012 and GOLD) were incorporated; symptomatic and endoscopic criteria for the diagnosis of RS, and spirometry with reversibility for diagnosis of COPD. RS symptoms were identified by responses to the sinonasal outcome test (SNOT-22), nasal endoscopy identified signs of sinonasal disease and discriminated between RS with and without nasal polyps, and visual analogue scales (VAS) rated the severity of sinonasal symptoms. We found RSsNP in 51% of our COPD patients which is threefold greater than in the control group (p<0.001). Nasal discharge (72%) and nasal obstruction (62%) were the two most frequently reported symptoms in COPD. The diagnostic accuracy for RSsNP is better for the composite VAS for rhinological symptoms than for facial symptoms. We conclude that RSsNP is present in 51% of our COPD patients, which is significantly more prevalent compared to a corresponding control group. These results suggest that COPD is associated with RS.

Indication and outcome of endoscopic sinus surgery among patients with chronic rhinosinusitis with or without nasal polyps in the national ear care centre, Kaduna

Context: Endoscopic sinus surgery is a minimally invasive and currently the treatment of choice for acute/intermittent and chronic/persistent rhinosinusitis (RS) unresponsive to conservative medical treatment. Aims: To evaluate the indications and outcomes of treatment of RS with or without nasal polyps. Methods and Material: This was a retrospective review of all cases of endoscopic sinus surgery done at the National Ear Care Centre. The information extracted from the case notes of patients included the demographic profile, clinical radiologic and endoscopic findings, the surgery offered and outcome of surgery. Statistical analysis used: All information was entered into SPSS version 20.0. Results: Out of 116 patients had endoscopic sinus surgery, only 107 (92%) had complete information for the analysis. Their age ranged from 9 to 72 years with a mean age of 35.9 ± 1.9 years. Up to 105 of the patients presented nasal discharge alternating with nasal obstruction while 65% (70) of them had bilateral disease. Computed tomography scan revealed abnormalities in 66.4% (71) patients. The preoperative diagnosis of chronic RS (CRS) with simple nasal polyp was made in 66 patients, had functional endoscopic sinus surgery with polypectomy in 64.5% (69) patients and intraoperative findings revealed a mixture of mucosal diseases with sinonasal polyps in 73.8% and fungal sinus diseases in 18 (16.8). Majority of the patients (53.3%) were discharged home on the 2nd postoperative day. About 71% of the patients had resolution of their disease after months of followup. Conclusion: Endoscopic sinus surgery is higher among young adult in third and fourth decades of life. There is female preponderance and preoperative radiology assessment and the intraoperative findings revealed strong relationship. The outcome of treatment revealed recurrent disease in 10.5% with nasal adhesion, epistaxis and excessive nasal crust formation.

THE LATENT OF RHINOSINUSITIS AS A MANIFESTATION OF NEURO-IMMUNE INTERACTIONS

Purpose: to determine the role of a pain symptom in the diagnosis of rhinosinusitis on the background of immune deficiency. 240 patients with rhinosinusitis without pain symptom were divided into 3 groups: group 1 - patients with acute viral rhinosinusitis (AVRS), group 2 - patients with acute bacterial sinusitis (ABRS), group 3 (n = 32) - control. All patients underwent a complete otorhinolaryngological examination, assessment of the pain symptom, an immunogram, the level of SP in the blood serum. At SP &gt; 100 pg/ml in group 1, the change in indicators was typical for viral infection, in group 2, for bacterial infection. With an SP &lt; 100 pg/ml, the cytokine balance is predominantly biased towards anti-inflammatory cytokines, and the direction of differentiation of Th-1/Th-2 lymphocytes towards the Th-2 pathway, which is manifested by immune deficiency, which leads to severe or prolonged course of the disease, which may indicate impaired neuro-immune interactions.

1660-P: Rhinosinusitis, Diabetes Mellitus, and Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study

Background: The association between atrial fibrillation (AF) and inflammation has been established. Diabetes mellitus (DM) is associated with increase inflammation and is an independent important risk factor of AF. Moreover, rhinosinusitis is an inflammation of the paranasal sinuses and nasal cavity. However, the association of rhinosinusitis as a risk factor of AF is unknown. The present study aimed to examine the association between rhinosinusitis, DM and AF. Methods: A total of 229,100 patients with the diagnosis of rhinosinusitis were identified as the study cohort from the Taiwan National Health Insurance Research Database from January 1, 2001, through December 31, 2012. The comparison cohort consisted of patients without rhinosinusitis and were match for age and sex with the study cohort at a ratio of 1:1. Incidence and hazard ratio (HR) of AF were calculated by Multivariable Cox regression models. Results: The incidence rate of AF was 142.4 per 10,000 person-years (95% CI 136.8-148.0) for the study cohort and 116.5 (95% CI 111.4-121.6) for the comparison cohort. Adjusted HR was 1.17 (95% CI 1.11-1.25) for the total study cohort, 1.18 (95% CI 1.11-1.25) for patients with acute sinusitis and 1.14 (95% CI 1.00-1.31) for chronic sinusitis. In subgroup analysis, HR for patients with DM was 1.23 (95% CI 1.09-1.39) for total study cohort, 1.20 (95% CI 1.06-1.37) for acute sinusitis and 1.44 (95% CI 1.13-1.84) for chronic sinusitis. The risk was less significant for patients with metformin use more than 28 days. HR 1.09 (95% CI 0.94-1.26) for total study cohort, 1.08 (95% CI 0.93-1.26) for acute sinusitis and 1.18 (95% CI 0.85-1.63) for chronic sinusitis. Conclusion: Rhinosinusitis was associated with the risk of AF. Sinusitis patients with DM had a higher risk than patients without DM. The use of metformin might reduce the risk of AF in DM patients. Further clinical investigation is warranted. Disclosure H. Liu: None. Y. Fang: None. T. Lee: None. J. Liu: None.

Serious complications due to acute rhinosinusitis in children up to five years old in Stockholm, Sweden – Still a challenge in the pneumococcal conjugate vaccine era

ObjectivesThe aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. MethodsThis was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003–2007. ResultsA total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. ConclusionsComplications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.

Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients.

Survival rates of solid organ transplant recipients are steadily increasing. Chronic immunosuppression is a key to sustain the transplanted organ. Thus, these patients are at a higher risk for fulminant disease and severe complications of rhinosinusitis (RS). Surprisingly, this has been scarcely discussed in the literature. To analyze the characteristics and disease course of RS in solid organ transplant recipients. Retrospective study. Medical records of all solid organ transplant recipients with a diagnosis RS treated at a national transplant center between the years 2001 and 2016 were reviewed. Of 4562 solid organ transplant recipients, a documented diagnosis of RS was identified only in 61 (1.3%) patients. Sixty-four patients presented with posttransplantation RS; of them, 54.5% had chronic RS (CRS) and the remaining 45.5% patients were diagnosed with acute RS. Microbial cultures grew almost exclusively bacterial pathogens. A documented invasive fungal infection was noted in only 2 patients. A total of 24 (40%) patients underwent endoscopic sinus surgery, the majority (22) for CRS. On subgroup analysis, surgical intervention was more frequent in lung transplant recipients ( P = .005). Neither specific disease nor surgical complications were found. Interestingly, acute fulminant infection or sinusitis complications in solid organ transplant patients were much lower than expected. CRS in this patient group was less frequent than expected as well. Whether chronic immunosuppression minimizes the likelihood for CRS deserves further investigation. A more surgically oriented approach in CRS patients may be favored early in the management course of medically refractory patients in light of patients excellent outcomes.

Orbital complications of acute rhinosinusitis

Introduction. Rhinosinusitis is the infection and inflammation of at least one of the 4 paranasal sinuses (frontal, maxillary, ethmoid and sphenoid). Their correct diagnosis is generally determined by examining the patient clinically and by rhinosinusal endoscopic examination. There are also cases that show complications or continued evolution despite the correct treatment, and then we will use some imaging investigations to find out more about affection(radiography of anterior sinuses of the face, sinus computerized tomography, sinus magnetic resonance imaging). In particular, acute rhinosinusitis should be carefully managed to avoid complications such as the local ones: orbital cellulitis, orbital abscess, osteomyelitis, cavernous sinus thrombosis; and intracranial complications: meningitis, epidural abscess, subdural abscess, cerebral abscess. Materials and methods. There will be presented all orbital complications according to the cases treated in the ENT Clinic of the Coltea Clinical Hospital. Conclusions. Diagnosis of rhinosinusitis is largely clinical and endoscopic. When complications of the condition arise, these should be investigated imagistically to determine their exact extent and to institute the correct treatment as soon as possible. The complications of rhinosinusitis are medical and surgical life-threatening emergencies, which is why in order to diagnose and correct and quickly institute therapy requires a multidisciplinary approach.