Ethmoid Sinus Involvement Research Articles

Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients.

Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. 4 Laryngoscope, 134:4232-4238, 2024.

Common Characteristics of Sinonasal Inflammation Associated with IgG4-Related Disease and Other Chronic Inflammatory Diseases: A Retrospective Observational Study

Plain Language SummaryImmunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by elevated serum IgG4 levels and tissue IgG4-positive cells. A part of IgG4-RD patients has sinonasal lesions. Because other inflammatory diseases also have features common to IgG4-RD, accurate knowledge of IgG4-RD is required. However, very little is known about IgG4-related rhinosinusitis. This study retrospectively analyzed clinicopathological features of IgG4-related rhinosinusitis and compared IgG4-related rhinosinusitis with other inflammatory diseases. Seven patients with sinonasal lesions and high serum IgG4 levels were retrospectively reviewed. Six of 7 patients were diagnosed with IgG4-RD, while one was diagnosed with granulomatosis with polyangiitis (GPA). In the 6 patients with IgG4-RD, intranasal findings showed nasal polyps in 3 patients (50%) and computed tomography showed ethmoid sinus involvement in 5 patients (83%), which shared common features with eosinophilic sinusitis (ECRS). However, no patients showed histopathological eosinophil infiltration. Although the patient with GPA revealed tissue infiltration of IgG4-positive cells in the nasal biopsy, the patient also had saddle nose and positivity of myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA), which indicated GPA. We diagnosed the patient with GPA, which is a known mimicker of IgG4-RD. In this study, the patients with IgG4-related rhinosinusitis had clinical and pathological characteristics similar to those of ECRS and GPA. IgG4-related rhinosinusitis should be diagnosed based on not only tissue infiltration of IgG4-positive cells but also systemic findings including nasal findings and serum ANCA levels. IgG4-RD should be ruled out in patients with eosinophilia without histopathological eosinophil infiltration.

A Multi-Institutional Database Review of Orbital Complications and Survival Outcomes in Adult Patients with Invasive or Non-Invasive Fungal Rhinosinusitis.

Invasive fungal rhinosinusitis (IFS) with orbital complications has remained a challenging disease over the past few decades. Only a few studies have been conducted to investigate the factors associated with orbital complications in fungal rhinosinusitis (FRS). We aimed to review the characteristics between IFS and non-invasive fungal rhinosinusitis (NIFS) and determine clinical factors associated with orbital complications and overall survival. A multi-institutional database review study was conducted using the Chang Gung Research Database (CGRD) from January 2001 to January 2019. We identified FRS patients using International Classification of Diseases diagnosis codes and SNOMED CT. We categorized patients into IFS and NIFS groups and analyzed the demographic data, underlying diseases, clinical symptoms, laboratory data, image findings, fungal infection status, and survival outcomes. We included 1624 patients in our study, with 59 IFS patients and 1565 NIFS patients. The history of an organ or hematopoietic cell transplantation had a significant prognostic effect on the survival outcomes, with surgical intervention and high hemoglobin (Hb) and albumin levels recognized as positive predictors. Posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were risk factors of orbital complications. In NIFS patients, orbital complications were found to be associated with old age, a high WBC count, high blood glucose, and a high CRP level. For the risk factors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were recognized as predictors. Among IFS patients, a history of organ or hematopoietic cell transplantation was a risk factor for poor survival, while, conversely, surgical intervention and high Hb and albumin levels were related to improved survival. As predictors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling upon the first visit should raise attention, with close monitoring.

Diagnosis and clinical outcomes for Rhino-Cerebral/ Orbital Mucormycosis: An experience sharing

Aim: Rhino-Orbito-Cerebral Mucormycosis (ROCM) is an invasive fungal infection. An under diagnosed and underreported disease in India, it is rapidly fatal without an early diagnosis and treatment. We report the survival rate in our hospital, significant association with sinus involvement and therapy Methods: The clinical and laboratory data collected retrospectively from patients with a diagnosis of invasive zygomycosis, over a four and half year period (January 2015-July 2019) were combined and analysed from medical records. We analyzed clinical features, results of laboratory and radiological examinations, nasal endoscopy, treatment management outcomes of all cases. Results: A total of sixteen cases of invasive ROCM were diagnosed and treated at St Stephens Hospital, Delhi, from January 2015 to July 2019 of which ten were males (62.5%). All were diabetic (100%), DKA (Diabetic Keto Acidosis) and renal impairment was seen in 11 (68.75%) patients. All were given L-Amphotericin B (100%). Thirteen (81.2%) cases underwent surgical procedure. Duration of treatment with L-Amphotericin was significantly associated with improved outcomes (p=0.03). Maxillary and ethmoid sinus involvement was significantly associated with improved outcomes (p=0.02). Diagnosis was based on direct microscopic findings, mycology culture and histopathology findings (EORTC/MSG Consensus Group). Survival rate was 57.25% (9 improved and 7 expired). Conclusion: Duration of treatment with L Amphotericin and maxillary sinus involvement were associated with improved outcomes. In an otherwise lethal disease, rapid administration of Amphotericin B with surgery can go a long way in improving the survival rate in proven/probable mucormycosis.

Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences.

Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. Methods: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. Results: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 μL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. Conclusion: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.

Histopathological Pattern and Different Stages of Sinonasal Carcinoma Patients: A Study on 40 Cases in Bangladesh

Background: Sino-nasal carcinoma has various histological types presented with different stages.
 Objectives: The purpose of this present study was to see the histopathological types and stages of sinonasal carcinoma patients in tertiary level hospital.
 Methodology: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2008 to December 2009 for a period of two (02) years.All consecutive cases of sinonasal carcinoma admitted in hospital and outpatient department during the study period. Suspected cases of sinonasal carcinoma was diagnosed from history and clinical examination proved by CT-scan, MRI and histopathological examination.
 Result: A total number of 40 cases of sino-nasal carcinoma were recruited for this study. Among these single site involvement was reported in 11 cases and the rest 29 cases were involved in multiple sites. Regarding multiple sites involvement maxillary sinus with nasal cavity involvement was reported in 15(51.72%) cases. Maxillary sinus, nasal cavity with ethmoid sinus involvement was found in 10(34.48%) cases. The presentation of the sinonasal carcinoma at stage T4 was 16(40.05) cases followed by T3, T2, and T1 which were 13(32.5%) cases, 7(17.5%) cases and 4(10.0%) cases respectively. Squamous cell carcinoma was found in 25(63%) cases followed by adenocarcinoma andadenoid cyst carcinoma which were 7 cases, 5 cases respectively.
 Conclusion: In conclusion majority of the sino-nasal carcinoma are squamous cell carcinoma involving the multiple sites in the T4 stage.
 Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 110-113

Naso- or Orbitocutaneous Fistulas after Free Flap Reconstruction of Orbital Exenteration Defects: Retrospective Study, Systematic Review, and Meta-Analysis.

Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement ( p < 0.05) and minor wound break down ( p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.

CT differential diagnosis of fnngal ball in paranasal sinus caused by different mycotic pathogenic agents

Objective To evaluate CT characteristics of fungal ball in paranasal sinus caused by different fungi and to enhance differential diagnosis.Methods CT results and clinical data of 74 patients with fungal ball arising from the paranasal sinuses proved by histopathology from 2007 to 2009 were analyzed retrospectively.The CT characteristics of fungal ball in paranasal sinus caused by different fungi were compared using x2 test with P ＜ 0.05 considered statistically significant.Results Among 74 mycotic pathogenic agents,aspergillus was found in 58 cases (including 36 cases with aspergilhs flavus,15 cases with aspergillus fumigatus and 7 with aspergillus versicolor),the others including 5 cases with penicillium,6 cases with schizophyllum commune,and 5 cases with scedosporium apiospermum.There were significant differences in the number of sinus involved ( single sinus involvement was seen in 29 cases caused by aspergillus group and 2 cases caused by non-aspergillus-group,respectively,with x2 =7.245,P =0.007 ),the incidence of fungus ball in ethmoid sinus [ 39.7％ ( 23/58 ) of cases caused by aspergillus group and 81.3 ％ ( 13/16 ) of cases caused by non-aspergillus-group,respectively,with x2 =8.685,P =0.003 ] and calcification (40 of 58 cases caused by aspergillus group and 5 of 16 cases caused by non-aspergillus-group,respectively,with x2 =7.485,P =0.006 ),the location of calcification ( 26 of 40 cases with central calcification and 14 of 40 cases with peripheral calcification in cases caused by aspergillus group,while all of 5 cases caused by non-aspergillus-group with peripheral calcification,x2 =7.697,P =0.006).However,there was no significant difference in the incidence of bilateral lesions ( x2 =1.002,P =0.317 ),maxillary sinus involvement ( x2 =0.020,P =0.888 ),sphenoidal sinus involvement ( x2 =0.704,P =0.401 ),frontal sinus involvement ( x2 =0.126,P =0.723 ),bony sclerosis ( x2 =2.024,P =0.155 ),lamellar calcification (x2 =2.045,P =0.153 ),complication of nasal polyps( x2 =0.018,P =0.893) and submucosal cyst( x2 =0.779,P =0.378 ).Conclusions The common CT characteristics of fungal ball in paranasal sinus are unilateral sinus involvement with inhomogeneous high-density soft tissue and lamellar calcification.The CT findings of fungal ball caused by non-aspergillus-group are ethmoid sinus involvement and calcification located on the periphery instead of the center of fungal ball. Key words: Paranasal sinus; Fungi; Tomography, X-ray computed

Dev frontal piyomukosel

Giant mucoceles of the frontal sinus are rare but their recognition is important in the differential diagnosis of proptosis and fronto-orbital lesions. We describe a patient with frontal giant mucocele with intracranial as well as orbit and ethmoid sinus involvement. A 53-year-old male was admitted with headache, right exophthalmos and ophthalmoplegia. Computed tomography and magnetic resonance imaging demonstrated a giant frontal sinus mucocele with extension into the left anterior cranial fossa and orbit. The mucocele was treated with a transcranial and endoscopic transnasal approach.

Aneurysmal bone cyst of ethmoid sinus: Uncommon manifestation of a rare case

Aneurysmal bone cyst (ABC) is a cystic vascular benign tumor of bone which primarily involves the metaphyseal ends of the long bones. It has been reported to arise from the Sino nasal cavities, but involvement of the ethmoid sinuses is extremely rare. Only ten such cases of involvement of ethmoid sinuses were reported in literature till 2007(1). We present another such case in a 10 year old boy, along with review of literature and use of imaging modalities.

Paranasal computed tomography results in asthma patients: Association between sinus sites and allergen types

Chronic rhinosinusitis (CRS) is a common comorbidity of asthma. The aim of this study was to investigate the relationships between the presence of rhinosinusitis, sinus site involvement, and total computed tomography (CT) sinus scores and the presence of allergy, allergen type, and severity of disease. Asthma patients (128 subjects), consisting of 57 allergic and 71 nonallergic patients, were included in the study. Presence of rhinosinusitis and sinus scores were evaluated by CT. CRS was determined in 45 (78.9%) allergic asthma patients and 44 (62.0%) nonallergic asthma patients (p<0.05). Ethmoid sinus involvement was higher among allergic asthma patients compared with nonallergic patients (68.4% versus 43.7%; p=0.005). House-dust mite allergy (71.4% versus 46.5%; p=0.008) and pollen allergy (73.5% versus 47.9%; p=0.01) showed positive correlations with ethmoid sinus involvement. No correlation was found between severity of disease and mean total CT sinus scores (p>0.05). The present study has shown the prevalence of chronic sinusitis to be higher in patients with allergic asthma, particularly in patients allergic to house-dust mites and pollens, with no correlation between severity of disease and presence of CRS. Investigating chronic sinusitis together with allergen sensitivity early in asthma diagnosis may contribute positively to patient treatment.

Eosinophilic angiocentric fibrosis of the orbit

A 30-year-old woman complained of right-sided epiphora for 2 years. She also reported diplopia on certain gaze positions and felt a hard mass behind the right medial inferior orbital rim. Magnetic resonance imaging studies demonstrated a relatively well-delineated mass in the right inferomedial orbit with minimal ethmoid sinus involvement. Histopathological evaluation following a large incisional biopsy showed massive eosinophilic infiltration and fibrosis with the final diagnosis of eosinophilic angiocentric fibrosis. She was then discovered to have significant peripheral eosinophilia and elevated serum IgE levels and clinical findings of allergic rhinitis and sinusitis. She was treated with systemic fluorocortolon and desloratadin for 4 months. She remained stable without recurrence for 32 months. The patient with this exceptionally rare tumour of the orbit benefited from debulking surgery followed by systemic corticosteroids and antihistaminics.

Endoscopic sinus surgery for maxillary sinus mucoceles

BackgroundMaxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles.MethodsBetween 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed.ResultsThere were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery.ConclusionThe most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome.

MRI of local disease in nasopharyngeal carcinoma: tumour extent vs tumour stage.

The purpose was to use MRI to study in detail local tumour extension in patients presenting with nasopharyngeal carcinoma (NPC) and to compare the extent of local disease with the current T-stage classification. MR images of 150 patients with newly diagnosed nasopharyngeal carcinoma were obtained on a 1.5 T unit. 10 extranasopharyngeal sites were analysed for tumour involvement. The number of concurrently involved sites was determined. The extent of tumour invasion was compared with staging as defined by the fifth edition of the AJCC classification. The T-stage distribution was T1 21%, T2 16%, T3 41% and T4 22%. The frequencies of tumour invasion into an individual site, and the mean number of other concurrently involved sites were as follows: skull base 63%, 3.9 sites; parapharyngeal 56%, 3.9 sites; nasal cavity 53%, 4.0 sites; oropharyngeal 17%, 5.2 sites; sphenoid sinus 27%, 5.6 sites; cranium 21%, 5.7 sites; infratemporal fossa 2%, 6.3 sites; ethmoid sinus 14%, 6.5 sites; orbit 5%, 7.0 sites; maxillary sinus 5%, 7.1 sites; and hypopharynx 0%, 0 sites. Extranasopharyngeal extension commonly occurred superiorly into the skull base rather than inferiorly to the oropharynx (p < 0.0001). Anatomical sites defined within the same T-stage category had different frequencies of involvement and different frequencies of concurrently involved sites. Oropharyngeal involvement (T2 stage) was associated with a number of concurrently involved sites comparable to structures in the T3 category. Maxillary and ethmoid sinus involvement (T3 stage) were associated with a number of involved sites comparable to the T4 stage. Invasion of the maxillary antrum and orbit are markers of the most bulky form of NPC.

Study of ethmoid sinus involvement in multibacillary leprosy.

The nasal mucosal involvement in lepromatous leprosy is well recognized. Currently interest has centred around the involvement of paranasal sinuses in leprosy. They act as a reservoir and constant source of reinfection to the nasal mucosa. In the present prospective study 25 untreated patients with multi-bacillary leprosy were included. Clinical examination, computed tomography (CT) scan of paranasal sinuses, ethmoid sinus endoscopy and biopsy were carried out in all patients, to investigate the involvement of the paranasal sinuses in leprosy. Ethmoid sinus involvement was noted in 20 patients on CT scan. Bilateral involvement was more common (65 per cent). Anterior ethmoids were more commonly affected (65 per cent). On ethmoid sinus endoscopy abnormal mucosa was noted in 17 patients (68 per cent). Ethmoid sinus biopsy was confirmative in 16 patients (64 per cent). Statistically significant correlation was found between CT findings, sinus endoscopy and sinus biopsy findings.

Craniofacial Resection for Paranasal Sinus Cancer

Paranasal sinus cancer usually presents at an advanced stage to the neurosurgeon, with ethmoid sinus involvement and incipient or actual invasion of the anterior cranial fossa floor; in the past this has usually been associated with a poor prognosis. Our experience with 67 patients using craniofacial resection at the Royal Melbourne Hospital, Australia, between June 1983 and June 1995 has produced a 5-year survival of 80% with no deaths and a low rate of serious complications. This appears to represent a significant improvement in the long-term results compared to conventional surgery and radiotherapy. We believe that a major improvement in tumor control can be achieved using careful surgical techniques, and we place special emphasis on the use of a vascularized pericranial flap in the reconstruction of the floor of the anterior cranial fossa. An overview of paranasal sinus cancer is presented, with particular emphasis on our experience with craniofacial resection for these tumors.

Anterior Transcranial (Craniofacial) Resection of Tumors of the Paranasal Sinuses: Surgical Technique and Results

Transfacial approaches, traditionally used for malignant tumors of the paranasal sinuses, provide limited exposure when several sinuses are involved and are unsuitable for tumors that erode through the floor of the anterior cranial fossa. A transcranial approach may aid in the removal of such lesions. To better understand the risks and benefits of this surgical approach, we reviewed all patients (n = 76) who underwent a transcranial approach as part of the excision of paranasal sinus lesions between 1984 and 1993 at our institution. The spectrum of disease included adenocarcinoma (13 patients), squamous cell carcinoma and olfactory neuroblastoma (11 patients each), adenoid cystic carcinoma and poorly differentiated forms of carcinoma (6 patients each), melanoma (5 patients), and miscellaneous others (24 patients). Most patients had ethmoid sinus involvement; tumors were also commonly found in the cribriform plate, sphenoid sinus, and nasal fossa. In each patient, a bifrontal craniotomy was performed with extradural dissection to the floor of the anterior fossa and osteotomies for resection of involved elements. In 47 patients (62%), disease in the orbit, the anterior nasal cavity, or the soft tissues of the face required transfacial as well as transcranial resections. Bony defect in the anterior fossa floor was repaired with a pedicled pericranial flap. Patients with major complications included six patients with epipericranial and/or epidural hematomas requiring evacuation, three with transient cerebrospinal fluid leaks, two who developed bifrontal cerebral infarcts, and one who died soon after surgery. No meningitis was seen. To date, 26 patients (34%) have died; of those living (mean follow-up, 34 mo), 42 (84%) remain in full remission. The transcranial approach can achieve removal of erosive, invasive tumors from this area with predictable morbidity and may be considered whenever sinus tumors breach the anterior cranial base or extend beyond the reach of conventional transfacial approaches.

Computed Tomography Study of Sinus Involvement in Ozena

Atrophic rhinitis or ozena is a chronic nasal disease characterized by formation of foul smelling nasal crusts with subsequent turbinate mucosal atrophy and resorption of the underlying bone. This symptom complex involves nasal and sinus mucosa with resultant mucosal atrophy, as well as reduced or absent mucocilliary function. The question of the presence of sinusitis in ozena is yet unanswered. Mucosal atrophy may lead to widely patent sinus ostia, but it may well be that the nasal mucosal disease also involves the sinus mucosa with reduced ciliary motility and ensuing sinusitis. We have undertaken a prospective CT study of 11 ozena patients in order to define the occurrence of sinusitis in this entity. These studies, corroborated in part by nasal endoscopies, demonstrate a 70% ethmoid sinus involvement. The sphenoid, frontal, and maxillary sinuses are not usually involved. Other CT criteria of ozena are described.

Inflammatory Airways Disease in Ulcerative Colitis

Inflammatory airways disease is an uncommon but recognized complication of ulcerative colitis (UC). The present study was undertaken to determine the computed tomographic (CT) and high-resolution CT appearances of this entity. A retrospective review was performed of the radiographs and CT scans of seven patients (ages 24 to 54 years) with UC who presented with cough and recurrent respiratory infections. Four patients had total colectomies, and one had sigmoid colectomy. Fiberoptic bronchoscopy in six subjects showed diffuse mucosal erythema and edema that was most severe in the proximal airways. Sinus radiographs revealed maxillary sinus mucosal thickening in four patients and ethmoid sinus involvement in two. Chest radiographs showed bronchiectasis in two patients and bronchial wall thickening in three; radiographs were normal in two patients. CT features included bronchiectasis in six patients, peripheral airways involvement in four, and airway stenosis in three.