Inflammation Of Paranasal Sinuses Research Articles

Nasal lavage microbiome, but not nasal swab microbiome, correlates with sinonasal inflammation in children with cystic fibrosis

BackgroundCystic fibrosis (CF) is characterized by highly viscous mucus obstructing the lower and upper airways, chronic neutrophil inflammation and infection resulting not only in lung destruction but also in paranasal sinus involvement. The pathogenesis of CF-associated chronic rhinosinusitis (CRS) is still not well understood, and it remains unclear how the microbiome in the upper airways (UAW) influences paranasal sinus inflammation. MethodsIn a cross-sectional study in pediatric patients with CF under stable disease conditions, we examined the microbiome in relation to inflammation by comparing nasal swabs (NS) and nasal lavage (NL) as two UAW sampling methods. The microbiota structure of both NS and NL was determined by 16S rRNA gene amplicon sequencing. In addition, pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and proteases (SLPI, TIMP-1, NE/A1-AT complex) as well as neutrophil elastase activity were measured in NL. ResultsSimultaneous NS and NL samples were collected from 36 patients with CF (age range: 7 – 19 years). The microbiome of NS samples was shown to be significantly lower in α-diversity and evenness compared to NL samples. NS samples were particularly found to be colonized with Staphylococcus species. NL microbiome was shown to correlate much better with the sinonasal inflammation status than NS microbiome. Especially the detection of Moraxella in NL was associated with increased inflammatory response. ConclusionOur results show that the NL microbiome reflects sinonasal inflammation better than NS and support NL as a promising tool for simultaneous assessment of the UAW microbiome and inflammation in children with CF.

Phytochemical Content, Anti-inflammatory, Anti-apoptotic, and Antioxidant Activities of Dwarf Elder (Sambucus Ebulus) Against Nasal Polyposis

Background: Sambucus Ebulus L. (SE) is known as an anti-inflammatory herb in traditional medicine. Nasosinusal polyposis is a common type of chronic nose and paranasal sinus inflammation. It is more common in patients with asthma and aspirin-exacerbated respiratory diseases. Objectives: This study aimed to investigate the apoptotic and anti-inflammatory effects of SE fruit extract on NP. Methods: The extract of SE fruit was prepared and subjected to total phenolic, anthocyanin, and flavonoid content measurement. The antioxidant activity was tested using the DPPH radical scavenging method. Nasal polyp (NP) tissue samples were collected from patients. Different concentrations of the SE extract were exposed to NPT samples for 24 hours. The expression of BAX and BAD proapoptotic markers, IL-5 and GM-CSF levels, and cell apoptosis were evaluated by real-time PCR, ELISA, and TUNEL assay, respectively. Results: The total phenolic and flavonoid contents of the extract were 38.44 (mg GAE/g extract) and 8.62 ± 0.12 (mg QE/g extract), respectively. Moreover, the total anthocyanin content was 0.56 ± 0.01 (mg C3GE/g extract). The IC50 of SE fruit extract in the DPPH radical scavenging assay was 190.78 ± 0.55 µg/mL. Also, BAX and BAD markers and TUNEL-positive cells were observed to increase in NP tissue samples in vitro after treatment with SE fruit extract (P < 0.05). The level of GM-CSF in the treated groups was reduced (P < 0.05). Conclusions: Our results showed that SE fruit extract was a good source of phenolic compounds that can induce anti-inflammatory and anti-apoptotic events in NP tissues, at least partly through increasing the expression of BAD and BAX apoptotic markers and reducing GM-CSF levels. The clinical applicability of SE fruit extract in the treatment of nasal polyps should be investigated in the future.

Surgical treatment of multiple bilateral brain abscesses and subdural empyas in a 6-year-old child with purulent rhinosinusitis

Introduction. Bacterial brain abscesses and subdural empyema are often rare complications of rhinosinusitis, which is especially important in pediatric practice. Intracranial purulent clusters are life-threatening diseases which require urgent, and as a rule, surgical management.
 Purpose. To illustrate successful surgical treatment of a patient with multiple bilateral brain abscesses and subdural empyemas as a result of purulent inflammation - paranasal sinusitis, which had not been diagnosed at the prehospital stage.
 Material and methods. A case of a 6-year-old boy with multiple bilateral brain abscesses and subdural empyemas is described in the article. The patient had antibacterial therapy; paranasal sinuses were sanitized; all intracranial purulent foci were removed with minimally invasive approaches and accurate calculations based on findings of MRI examination.
 Results. It had been confirmed that abscesses and subdural empyemas in the described patient was a complication of purulent inflammation in paranasal sinuses. To control treated foci and to exclude development of new purulent intracranial clusters in dynamics, multiple MRI examinations of the brain were performed. For successful management of purulent foci, the technique of incision, drainage, sanitation with antiseptic solutions and intraoperative exudate aspiration was applied.
 Conclusion. Abscesses and empyemas of children’s brain are serious, life-threatening pathologies that always require hospitalization and emergency measures. Multiple abscesses and subdural empyemas is, as a rule, complication of rhinosinusitis. Multiple dynamic CT/MRI examinations of the brain is of a key importance, both for controlling removed foci and for excluding development of new purulent intracranial clusters. Active surgical tactics in the combination with antibacterial therapy leads to successful outcomes in patients with intracranial purulent lesions complicating the course of rhinosinusites.

Diversity and Surgical Management of Intracranial Fungal Infections.

Intracranial fungal infection is a rare entity. This disease is mainly concentrated in dry and hot climates, such as India, Africa, California, and usually occurs in patients with immune deficiency. Now, we retrospectively analyzed the clinical manifestations, pathologic manifestations, imaging features, surgical methods, and prognosis of 4 patients with fungal infection who were confirmed by postoperative pathology. Intermittent pricking on the right face was presented in 2 patients, headache in 2 patients, orbital apex syndrome in 2 patients, and 1 patient presented with fever. Imaging showed the lesions of all patients were located in the right temporal, including 2 patients involving the right orbital, 1 patient involving the right trigeminal semilunar ganglion, 1 patient involving the right brainstem and tentorium cerebellum, 1 patient involving the right internal carotid artery. Craniotomy was performed in 2 patients, endoscopic biopsy in 1 patient, and stereotactic surgery in 1 patien. Aspergilloma was the most common pathogenic bacteria. One patient relapsed repeatedly and died. Secondary aneurysm complicated with subarachnoid hemorrhage occurred in 1 patient. Therefore, the author confirmed that intracranial fungal infection has diverse clinical, imaging, and pathologic manifestations. Neurosurgeons should be aware of the possibility of intracranial fungal infection when they find abnormal intracranial lesions, neurologic deficits, and inflammation of paranasal sinuses. Combining multiple clinical data may help doctors to improve the accuracy of diagnosis. Individualized and diversified surgical protocols should be selected for diverse lesions. Notably, secondary intracranial fungal vasculitis is common, with high mortality and disability rates.

5-Item sino-nasal outcome test and 22-item sino-nasal outcome test relationship with endoscopic and radiologic scores in chronic rhinosinusitis with nasal polyps

BackgroundThe 22-item sino-nasal outcome test (SNOT-22) is a frequently used patient-recorded outcome measure in patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Objective findings of nasal polyps and paranasal sinus inflammation are frequently graded using nasal polyp score (NPS) and Lund-Mackay Score (LMS), respectively. ObjectiveTo evaluate a novel, abbreviated, rhinology-focused, five-domain SNOT-5 questionnaire because we had anecdotally noticed a relative disconnect between SNOT-22 and endoscopy and imaging scores. MethodsWe performed a retrospective, cross-sectional, single-center review of patients with CRSwNPs who had filled out a SNOT-22, along with post hoc–derived SNOT-5 scores, which were then assessed in relation to NPS and LMS. ResultsA total of 129 patients were included in the analysis. SNOT-5 but not SNOT-22 scores significantly correlated vs either NPS (P < .005) and LMS (P < .001), whereas only SNOT-5 differed significantly when comparing the cohort's lowest and highest tertiles for mean LMS: 11.8 vs 16.8 (95% CI, 1.5-8.4; P < .01) and for mean NPS 12.4 vs 15.6 (95% CI, 0.5-5.9; P < .05). ConclusionIn a retrospective, real-life cohort study of CRSwNP, there was a relative disconnect between the significant association of SNOT-5 but not SNOT-22 in relation to objective endoscopy and imaging measures. We, therefore, propose that further prospective intervention studies are indicated in CRSwNP to evaluate the SNOT-5 score including establishing the minimal clinically important difference.

Analysis of Sinus Inflammation Associated With Maxillary Sinus Fungal Ball Based on CT Imaging.

Background: Paranasal sinus fungal balls usually occur unilaterally, and the maxillary sinus is most commonly involved. However, other sinuses could be concomitantly inflammed, and this phenomenon is rarely discussed. Aims/Objectives: To evaluate the severity of maxillary sinus fungal ball (MSFB) and the occurrence of sinus inflammation in paranasal sinuses according to the image findings and analyze the potential correlations. Material and Methods: A total of 1226 cases of MSFB were divided into 2 groups according to ostiomeatal complex obstruction on computed tomography. The potential correlations between sinus inflammation and MSFB in these groups were analyzed. Results: The patients were divided into 2 groups: those with obstructed ostiomeatal complex (OOMC) and those with clear ostiomeatal complex (COMC). The incidences of sinus inflammation in the ipsilateral sinuses of MSFB were higher in the OOMC group than in the COMC group, and there were no differences in the contralateral sinuses of MSFB. In the OOMC group, sinus inflammation was more common in all ipsilateral sinuses of MSFB than in the contralateral sinuses. In the COMC group, the incidences of sinus inflammation in the ipsilateral ethmoid and frontal sinuses of MSFB were higher than that in the contralateral sinuses. However, no significant difference was observed in the sinus inflammation incidence of bilateral sphenoid sinuses in the COMC group. The incidence of nasal polyps was higher in the ipsilateral nasal cavity in the OOMC group. Conclusions and Significance: MSFB stimulated sinus inflammation and nasal polyps in the adjacent sinuses through local factors.

Pembrolizumab-associated chronic rhinosinusitis: A new endotype and management considerations.

Patients treated with pembrolizumab experience an increase in paranasal sinus inflammation Use of topical triamcinolone in carboxymethylcellulose is a treatment option for such patients.

Associations of Microbial Diversity with Age and Other Clinical Variables among Pediatric Chronic Rhinosinusitis (CRS) Patients.

Chronic rhinosinusitis (CRS) is a heterogenous disease that causes persistent paranasal sinus inflammation in children. Microorganisms are thought to contribute to the etiology and progression of CRS. Culture-independent microbiome analysis offers deeper insights into sinonasal microbial diversity and microbe-disease associations than culture-based methods. To date, CRS-related microbiome studies have mostly focused on the adult population, and only one study has characterized the pediatric CRS microbiome. In this study, we analyzed the bacterial diversity of adenoid tissue, adenoid swab, maxillary sinus, and sinus wash samples from 45 pediatric CRS patients recruited from the Johns Hopkins All Children's Hospital (JHACH) in St. Petersburg, FL, USA. The alpha diversity in these samples was associated with baseline nasal steroid use, leukotriene receptor antagonist (LTRA) use, and total serum immunoglobulin (Ig) E (IgE) level. Streptococcus, Moraxella, and Haemophilus spp. were most frequently identified from sinus cultures and the sequenced 16S rRNA gene content. Comparative analyses combining our samples with the samples from the previous microbiome study revealed differentially abundant genera between patients with pediatric CRS and healthy controls, including Cutibacterium and Moraxella. Additionally, the abundances of Streptobacillus and Staphylococcus were consistently correlated with age in both adenoid- and sinus-derived samples. Our study uncovers new associations of alpha diversity with clinical parameters, as well as associations of specific genera with disease status and age, that can be further investigated.

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital. MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system. ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020). ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.

Expert Opinion on Biological Treatment of Chronic Rhinosinusitis with Nasal Polyps in the Gulf Region.

Chronic rhinosinusitis (CRS) is defined as the inflammation of nose and paranasal sinuses, affecting the patients’ quality of life and productivity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a principal clinical entity confirmed by the existence of chronic sinonasal inflammation and is characterized by anterior or posterior rhinorrhea, nasal congestion, hyposmia and/or facial pressure or facial pain. Several epidemiologic studies have revealed wide variations in the incidence of CRS among regions globally ranging from 4.6% to 12%. The Gulf countries are also witnessing an unprecedented burden of CRSwNP. According to the current clinical guidelines, glucocorticosteroids and antibiotics are the principal pharmacotherapeutic approaches. Endoscopic sinus surgery is recommended for those who have failed maximal pharmacotherapy. Recently, biologics are considered as an alternative best approach due to the complications associated with medical therapy and surgery. However, precise data on the clinical position of biologic agents in the management of CRSwNP in the Gulf region is not available. The present review article addresses the current diagnostic and management approaches for CRSwNP and also emphasizes the role of emerging biologics in the current treatment strategies for CRSwNP in the Gulf region. Further, a consensus protocol was convened to rationalize the guideline recommendations, strategize the best practices with biologics, and develop clinical practice guidelines for all primary-care specialists in the Gulf region. The consensus-based report will be a useful reference tool for primary-care physicians in primary-healthcare settings, regarding the appropriate time for the initiation of biological treatment in the Gulf region.

Prevalence and Risk Factor of Chronic Rhinosinusitis and the Impact on Quality of Life in Students of the Medical Faculty Christian University of Indonesia in 2018

Chronic Rhinosinusitis (CRS) is an inflammation of nasal mucose dan paranasal sinuses with ≥ two symptoms, one of which should be nasal blockage/ obstruction or nasal discharge (anterior/ posterior nasal drip) that happened for ≥ 12 Weeks. CRS affects 5-15% adult population in Europe and the United States of America, with a prevalence of 2-4% that doctors have diagnosed. The risk factors of CRS that quite often happened on CRS is allergic rhinitis. CRS also often happened in women. CRS also impact the patient's quality of life. This study aims to know the prevalence and risk factor of CRS and the impact on quality of life on 160 students of the Medical Faculty Christian University of Indonesia uses a validated questionnaire and SNOT-22 questionnaire. This study uses a descriptive method with a cross-sectional approach. The results of CRS prevalence in this study are 71 students (44,4%), with a gender distribution are 52 students (53,2%). The correlation of allergic history suspect with CRS is proven by a statistic test using chi-square with results P=0,003 (P&gt;0,05) with a majority of the distribution is allergic rhinitis are 60 students (90,1%). All respondents answered that CRS impacts their quality of life with most of the symptoms: nasal blockage/ obstruction and 36 students (57,7%).&#x0D; Keywords: Chronic Rhinosinusitis, Nasal Mucosa Inflammation, Allergic History, Allergic Rhinitis, Gender, Quality of Life.

The impact of Sambucus nigra L. extract on inflammation, oxidative stress and tissue remodeling in a rat model of lipopolysaccharide-induced subacute rhinosinusitis

Rhinosinusitis is a common disorder related to inflammation of paranasal sinuses and nasal cavity mucosa. Herbal medicinescould be an option in the treatment of rhinosinusitis due to their anti-inflammatory and anti-oxidative properties. The study aims to investigate the effect of intranasal Sambucus nigra L. subsp. nigra (SN) extract against inflammation, oxidative stress, and tissue remodeling in nasal and sinus mucosa, but also in serum, lungs, and brain, in Wistar rat model of subacute sinonasal inflammation induced by local administration of lipopolysaccharides (LPS), from Escherichia Coli. The cytokines (TNF-α, IL-1β, IL-6) and oxidative stress (malondialdehyde) in nasal mucosa, blood, lungs, and brain were analyzed. In addition, a histopathological examination was performed, and NF-kB, MMP2, MMP9, TIMP1 expressions were also evaluated in nasal mucosa. Both doses of LPS increased the production of cytokines in all the investigated tissues, especially in the nasal mucosa and blood (p < 0.01 and p < 0.05), and stimulated their secretion in the lungs, and partially in the brain. Malondialdehyde increased in all the investigated tissues (p < 0.01 and p < 0.05). In parallel, upregulation of NF-kB and MMP2 expressions with downregulation of TIMP1, particularly at high dose of LPS, was observed. SN extract reduced the local inflammatory response, maintained low levels of IL-6, TNF-α, and IL-1β. In lungs, SN reduced all cytokines levels while in the brain, the protective effect was noticed only on IL-6. Additionally, SN diminished lipid peroxidation and downregulated NF-kB in animals exposed to a low dose of LPS, with increased TIMP1 expression, while in animals treated with a high dose of LPS, SN increased NF-kB, MMP2, and MMP9 levels. In conclusion, SN extract diminished the inflammatory response, reduced generation of reactive oxygen species (ROS) and, influenced MMPs expressions, suggesting the benficial effect of SN extract on tissue remodeling in subacute rhinosinusitis and on systemic inflammatory response.

DIAGNOSTICS OFPATIENTS WITH THROMBOEMBOLIC COMPLICATIONS OF THE VISUAL ORGAN OF RHINOSINUSOGENIC ETIOLOGY AT COVID 19

Cavernous sinus thrombosis is one of the most severe infections of the face, orbit, ear, paranasal sinuses and oral cavity. The studyaims to analyse clinical cases of carotid-cavernous sinus thrombosis in patients with complications of COVID 19. An analysis of 2 clinicalcases with a diagnosis of cavernous sinus thrombosis in the presence of COVID 19 was carried out. General ophthalmic research methods (visometry, external examination, the study of pupillary reactions, ophthalmoscopy, palpation measurement of intraocular pressure), MRI, MSCT of the brain and chest,general blood test, coagulogram, biochemical blood test. These clinical examples show that cavernous sinus thrombosis develops as a complication of coronavirus infection. The cause of cavernous sinus thrombosis was inflammation of the paranasal sinuses, dry blood, diabetes mellitus. The cause of death was the development of multiple organ failure due to concomitant diseases and a decrease in patients' immune status

Impact of baseline clinical and radiological features on outcome of chronic rhinosinusitis in granulomatosis with polyangiitis

BackgroundGranulomatosis with polyangiitis (GPA) causes a recurring inflammation in nose and paranasal sinuses that clinically resembles chronic rhinosinusitis (CRS) of other aetiologies. While sinonasal inflammation is not among the life-threatening features of GPA, patients report it to have major negative impact on quality of life. A relatively large proportion of GPA patients have severe CRS with extensive damage to nose and sinus structures evident by CT, but risk factors for severe CRS development remain largely unknown. In this study, we aimed to identify clinical and radiological predictors of CRS-related damage in GPA.MethodsWe included GPA patients who had clinical data sets from time of diagnosis, and two or more paranasal sinus CT scans obtained ≥12 months apart available for analysis. We defined time from first to last CT as the study observation period, and evaluated CRS development across this period using CT scores for inflammatory sinus bone thickening (osteitis), bone destructions, and sinus opacifications (here defined as mucosal disease). In logistic regression, we applied osteitis as main outcome measure for CRS-related damage.ResultsWe evaluated 697 CT scans obtained over median 5 years observation from 116 GPA patients. We found that 39% (45/116) of the GPA patients remained free from CRS damage across the study observation period, while 33% (38/116) had progressive damage. By end of observation, 32% (37/116) of the GPA patients had developed severe osteitis. We identified mucosal disease at baseline as a predictor for osteitis (odds ratio 1.33), and we found that renal involvement at baseline was less common in patients with severe osteitis at last CT (41%, 15/37) than in patients with no osteitis (60%, 27/45).ConclusionsIn this largely unselected GPA patient cohort, baseline sinus mucosal disease associated with CRS-related damage, as measured by osteitis at the end of follow-up. We found no significant association with clinical factors, but the data set indicated an inverse relationship between renal involvement and severe sinonasal affliction.

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.

Invasive fungal sinusitis: A case report

Fungal sinusitis is the mucosal inflammation of paranasal sinuses (PNSs) due to fungus etiology. The entity remained underdiagnosed earlier because of the non-existence and non-availability of imaging modalities. There is a wide range of clinical symptomatology. Fungal sinusitis requires precise evaluation and decision in type and diagnosis for the correct and appropriate management by an otorhinolaryngologist. The reason for this is being unique radiological features in fungal sinusitis in computerized tomography (CT) and magnetic resonance (MRI). We present the case of a 16-year-old boy who presented with a chronic history of nasal blockage and running nose of 3 months duration and now with fever and headache for the past 2 weeks. He underwent plain X-ray, NCCT, and MRI of PNS. He was diagnosed as having invasive fungal sinusitis on the basis of clinical and classical CT findings supplemented with MRI. He had further been advised surgical contemplation for the total cure as medical management is not the answer. Radiological modalities can precisely differentiate the different subtypes of fungal sinusitis. Otorhinolaryngologists make the management decision and precision on the type of fungal sinusitis keeping in view of involving the neighboring structures.

Chronic rhinosinusitis and its correlation with endoscopic anatomy of nose and paranasal sinuses: a cross-sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic rhinosinusitis (CRS) is a common condition characterized by inflammation of nose and paranasal sinuses and is associated with significant morbidity and healthcare expenditure. The study was undertaken to evaluate the endoscopic findings in different cases of CRS and correlating those findings with the clinical features and severity of symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study was carried out at the outpatient Department of Otorhinolaryngology, R. G Kar Medical College and Hospital, Kolkata in a span of 18 months. A total of 56 patients who attended the outpatient department during the study period and met the inclusion criteria as well gave consent for participating in the study were taken as the sample size. The data was collected using history taking proforma. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 56 patients, 51.8% were female, the most commonly affected age group was 31-40 years with 28.57% of patients. Majority of the patients 30.40% presented within one year of onset of symptoms, all the variables of clinical symptoms shows positive correlation statistically with the endoscopic findings, the most common anatomical variation was deviated nasal septum (DNS) present in 51.78% patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A more extensive and detailed study needs to be done to determine conclusively whether the severity of symptoms can be used to predict the severity of disease in patients diagnosed as having chronic rhinosinusitis&lt;/p&gt;

Volumetric assessment of paranasal sinus opacification on computed tomography can be automated using a convolutional neural network.

Computed tomography (CT) plays a key role in evaluation of paranasal sinus inflammation, but improved, and standardized, objective assessment is needed. Computerized volumetric analysis has benefits over visual scoring, but typically relies on manual image segmentation, which is difficult and time-consuming, limiting practical applicability. We hypothesized that a convolutional neural network (CNN) algorithm could perform automatic, volumetric segmentation of the paranasal sinuses on CT, enabling efficient, objective measurement of sinus opacification. In this study we performed initial clinical testing of a CNN for fully automatic quantitation of paranasal sinus opacification in the diagnostic workup of patients with chronic upper and lower airway disease. Sinus CT scans were collected on 690 patients who underwent imaging as part of multidisciplinary clinical workup at a tertiary care respiratory hospital between April 2016 and November 2017. A CNN was trained to perform automatic segmentation using a subset of CTs (n = 180) that were segmented manually. A nonoverlapping set (n = 510) was used for testing. CNN opacification scores were compared with Lund-MacKay (LM) visual scores, pulmonary function test results, and other clinical variables using Spearman correlation and linear regression. CNN scores were correlated with LM scores (rho = 0.82, p < 0.001) and with forced expiratory volume in 1 second (FEV1 ) percent predicted (rho = -0.21, p < 0.001), FEV1 /forced vital capacity ratio (rho = -0.27, p < 0.001), immunoglobulin E (rho = 0.20, p < 0.001), eosinophil count (rho = 0.28, p < 0.001), and exhaled nitric oxide (rho = 0.40, p < 0.001). Segmentation of the paranasal sinuses on CT can be automated using a CNN, providing truly objective, volumetric quantitation of sinonasal inflammation.

Inverted papilloma is associated with greater radiographic inflammatory disease than other sinonasal malignancy.

The pathogenesis of inverted papilloma (IP) has not been fully elucidated. However, chronic paranasal sinus inflammation has been anecdotally observed in sites distant from tumor obstruction in IP patients, suggesting an association between inflammation and IP tumorigenesis. This study assesses the association between sinonasal inflammation found in IP and compares this to the level of inflammation observed in other sinonasal tumors. A retrospective chart review was performed identifying patients with unilateral IP. Pertinent clinical data was obtained and comparative analysis of preoperative computed tomography (CT) imaging and histopathology was performed. A sample of unilateral, sinonasal, non-IP and non-squamous cell tumors was used as the control. The Lund-Mackay scoring system was used to assess radiologic sinonasal inflammation both ipsilateral and contralateral to the tumor. Seventy-one patients were included; 58.9% of patients with IP had evidence of contralateral sinusitis at the time of presentation. In the control group, 26.7% had evidence of contralateral inflammation. When comparing contralateral sinus inflammation between the 2 study groups, the IP patients had significantly higher Lund-Mackay scores than the control group (1.9 vs 0.26, p < 0.001). When comparing ipsilateral sinus inflammation, no significant difference was found in Lund-Mackay scores (5.44 vs 4.00, p < 0.184). In this study, unilateral IPs were associated with a higher level of contralateral sinonasal inflammation when compared to control. This suggests that IP may be associated with inflammation that is independent of obstruction by the tumor. Further studies are needed to better understand the temporal relationship between chronic inflammation and tumorigenesis.

Characteristics of immune response in patients with acute chronic maxillary sinusitis associated with intra-cellular bacterial infections

Currently, chronic inflammatory pathology of paranasal sinuses mostly affecting maxillary antrum is one of the pressing issues for health care. Over the last two decades, a great etiological importance in inducing inflammation in paranasal sinuses was referred to bacterial intracellular infections caused by Mycoplasma and Chlamydia. In particular, Chlamydia, whose life cycle is closely linked to residence inside host cells defines them as pathogenic obligate intracellular gram-negative bacteria, whereas Mycoplasma is a membrane-associated microorganism able to self-replication and long persistence on host cellular membranes. Increased incidence of chronic pathology in paranasal sinuses associated with intracellular infection is shaped by a range of circumstances, primarily increased prevalence of immunocompromised subjects, worsened social and ecological conditions, uncontrolled and unjustified administration of available of antimicrobials and anti-septic agents, hormone preparations altering community of extracellular microbe populations (microbiocenoses), inhabiting natural biotope in the upper respiratory tract mucosa. These factors contribute to the lowering colony resistance, entrance and propagation of Chlamydia and Mycoplasma as a monoor mixed infection. Upon that, mixed variants of Chlamydia-Mycoplasma infection are characterized by development of more severe sinusitis accompanied with diverse complications in the lower respiratory tract, digestive tract, urinary and nerve system. There were examined 189 subjects for assessing epidemiologic characteristics and features of systemic and mucosal immune responses in patients with exacerbated chronic maxillary sinusitis associated with intracellular bacterial infection. Presence of intracellular bacterial infection was confirmed by laboratory tests: direct immune fluorescent analysis and PCR. It was found that high prevalence of Сhlamydia trachomatis, Chlamydophila pneumoniae and Mycoplasma pneumoniae in patients with exacerbated chronic inflammatory pathology of paranasal sinuses. Comparing laboratory test data for patients with identified intracellular bacterial pathogens vs. those with negative results revealed a common trend in pathologic immune-related changes that fits to typical host anti-infection response manifested by inflammatory process. Besides, we described features of immune reactivity in patients with verified Chlamydia infection including more pronounced unbalance in Т cell immunity as well as evelated parameters of humoral immunity in patients with verified Chlamydia and Mycoplasma infection.