Inflammatory Diseases Of Paranasal Sinuses Research Articles

Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study.

Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.

Chemerin and IL-17 are potential predictors and Chemerin silencing alleviates inflammatory response and bone remodeling in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is an inflammatory disease of paranasal sinuses. This study is formulated to explore the roles of pro-inflammatory factors Chemerin and interleukin-17 (IL-17) in CRS. Patients suffering from CRS without/with nasal polyps (CRSsNP/CRSwNP), along with volunteers, were recruited. CRS rabbit models were constructed by Staphylococcus aureus infection and rabbits were injected with lentiviral vectors of short hairpin RNA-targeting Chemerin (shChemerin), followed by micro-computed tomography (CT) scan. Levels of Chemerin and IL-17 were determined, and histopathological lesions were observed in subjects and CRS rabbits. Correlations between Chemerin/IL-17 level and Lund-Mackay/Lund-Kennedy scores of subjects and the predictive value of Chemerin or IL-17 for CRS were analyzed. In CRS patients and rabbits, inflammatory degrees and the level of Chemerin/IL-17 were increased in pathological tissues or plasma, while Chemerin silencing alleviated CRS symptoms of CRS rabbits. Chemerin and IL-17 were mainly located in the immune cells of pathological tissues and presented the positive correlation with Lund-Mackay/Lund-Kennedy score of CRS patients. Also, they showed high predictive value for CRS. Micro-CT scan uncovered that CRS rabbits had increased bone remodeling, which was alleviated by Chemerin silencing. Collectively, Chemerin and IL-17 are potential predictors and Chemerin silencing alleviates inflammatory response and bone remodeling in chronic rhinosinusitis.

The Diagnostic Value of the Leukocyte Shift Index in Purulent-Septic Rhinosinusogenic Complications in Children

The aim of this study was to investigate the diagnostic value of the leukocyte shift index (LSI) in inflammatory pathology of the paranasal sinuses (PNS) with the rhinosinusogenic orbital complications (RSOC) in pediatric patients. Methods and Results: The study involved 50 patients (26 boys and 24 girls) with diseases of the PNS and RSOC (reactive edema of the eyelids, orbital tissue, and purulent-septic complications of the eyelids and orbit) aged from 1 to 17 years (mean age of 6.66±0.63 years). Group 1 included 29 patients (16 boys and 13 girls) with reactive edema of the eyelids and orbital tissue. Group 2 included 21 patients (10 boys and 11 girls) with purulent-septic RSOC. As a marker for determining the activity of the inflammatory process and the disorders of the immunological reactivity of the body, LSI (leukocyte shift index) was calculated. In general, the LSI value was 1.61±0.21 in Group 1 and 3.45±0.49 in Group 2 (P=0.001). Among patients aged between 3 and 12 years, the LSI was 1.66±0.30 in Group 1 and 3.93±0.79 in Group 2 (P=0.012). The results obtained indicate that LSI can be used to predict purulent-septic RSOC in inflammatory diseases of PNS in patients aged between 3 and 12 years. LSI values from 1.36 to 1.96 may predict the development of reactive edema of the eyelids and orbital tissue; from 3.14 to 4.72 - the development of purulent-septic complications of the eyelids and orbit. Conclusion: The results obtained can be useful in predicting the clinical course of the RSOC in inflammatory pathology of PNS in patients in the age group of 3-12 years.

Deficit in Adipose Differentiation in Mesenchymal Stem Cells Derived from Chronic Rhinosinusitis Nasal Polyps Compared to Nasal Mucosal Tissue.

Chronic rhinosinusitis of the nasal mucosa is an inflammatory disease of paranasal sinuses, which causes rhinorrhea, nasal congestion, and hyposmia, and in some cases, it can result in the development of nasal polyposis. Nasal polyps are benign lobular-shaped growths that project in the nasal cavities; they originate from inflammation in the paranasal mucous membrane and are associated with a high expression of interleukins (IL)-4, IL-5, IL-13, and IgE. Polyps derive from the epithelial–mesenchymal transition of the nasal epithelium resulting in a nasal tissue remodeling. Nasal polyps from three patients with chronic rhinosinusitis as well as control non-polyp nasal mucosa were used to isolate and cultivate mesenchymal stem cells characterized as CD73+, CD90+, CD105+/CD14−, CD34−, and CD45−. Mesenchymal stem cells (MSCs) cultures were induced to differentiate toward adipocytes, where lipid droplets and adipocyte genes PPARγ2, ADIPO-Q, and FABP4 were observed in control non-polyp nasal mucosa-derived mesenchymal cells but were scarcely present in the cultures derived from the nasal polyps, where apoptosis was evident. The modulation of the response to adipogenic stimulus in polyps represents a change in the molecular response that controls the cascade required for differentiation as well as possible means to specifically target these cells, sparing the normal mucosa of the nasal sinuses.

Nasal Polyposis: Insights in Epithelial-Mesenchymal Transition and Differentiation of Polyp Mesenchymal Stem Cells.

Chronic rhinosinusitis is a common inflammatory disease of paranasal sinuses, which causes rhinorrhea, nasal congestion, and hyposmia. The genetic predisposition or the exposure to irritants can sustain the inflammatory response and the development of nasal polyposis. Nasal polyps are benign and teardrop-shaped growths that project in the nasal cavities, and originate from the ethmoid sinuses. This inflammatory process is associated with high expression of IL-4, IL-5 and IL-13 and IgE. Antibodies targeting these cytokines or receptors represent a therapeutic strategy in the treatment of nasal polyposis in combination with corticosteroids. The molecular pathogenesis of nasal polyps in chronic rhinosinusitis (CRS) patients is associated with remodeling transition, a process in which epithelial cells lose their typical phenotype, acquiring a mesenchymal-like aspect. TGFβ/SMAD, ERK, and Wnt/β-catenin pathways are altered during the nasal tissue remodeling. miRNA and inhibitor molecules targeting these signaling pathways are able to interfere with the process; which could lead to alternative therapies. Nasal polyps are an alternative source of mesenchymal stem cells, which can be isolated from surgical biopsies. A molecular understanding of the biology of PO-MSCs will contribute to the delineating inflammatory process underlying the development of nasal polyps.

Study of Relation between Vitamin D Serum Level and Biomarkers of Human Sinonasal Fibroblast Proliferation in Patient with Chronic Rhinosinusitis with Nasal Polyposis

Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of paranasal sinuses and nasal coverage, which reduces the quality of life and overall health. Vitamin D regulates many cellular functions, including anti-inflammatory and immune-modulating functions. There is an increasing evidence of the relative role of fibroblasts in the accumulation of inflammatory cells in chronic rhinosinusitis. The aim of this study was to investigate the relationship between vitamin D levels and the proliferation of sinonasal fibroblasts in patients with chronic rhinosinusitis with nasal polyposis and its therapeutic role. Material and Method: In this case-control study blood and tissue samples were extracted from patients with CRSwNP (n=30). Control subjects with non-inflammatory conditions underwent endoscopic and non-endoscopic surgery (n=30). The serum level of 1,25 dihydroxyvitamin D (1,25(OH)2D) and proliferation of fibroblasts sampled from nasal and sinus tissue using ki 67 and vimentin were evaluated and analyzed using SPSS® 23 software. Results: The average level of vitamin D was 23.1±7.36 ng/ml in the case group and 31.19±7.02 ng/ml in control group, which was significantly lower in case group (P=0.008). The proliferation of sinonasal fibroblasts were positive in all cases patients and only in 20% of control patients using vimentin. The proliferation of sinonasal fibroblasts were negative in all control patients while only 10% of the case patients were negative using Ki 67. The level of vitamin D decreased with the increased rate of Ki 67. Conclusion: The results of this study indicate a reversed relation between vitamin D levels and the proliferation of sinonasal fibroblasts.Thus vitamin D has both prophylactic and therapeutic effects in chronic rhinosinusitis with nasal polyposis.

ПРИЧИНЫ, ДИАГНОСТИКА И ЛЕЧЕНИЕ ВЕРХНЕЧЕЛЮСТНОГО СИНУСИТА, СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ

Object. Patients with inflammatory diseases of paranasal sinuses make up about 1/3 of the total number of patients admitted to hospitals with diseases of the upper respiratory tract. 
 The aim of the study was to describe the causes and methods of treatment of maxillofacial sinusitis according to the Department of maxillofacial surgery and otorhinolaryngology SB "SOKB № 1" AND compare them for the periods from 2006 to 2007 and from 2015 to 2018 g.
 Methodology. A retrospective study of nosology according to the annual reports and protocols of operating journals, patient histories of the Department of maxillofacial surgery and otorhinolaryngology SB "SOKB № 1" FOR the periods from 2006 to 2007, and from 2015 to 2018. 
 Results. Over the investigated period, the proportion of hospitalized patients with sinusitis increased 1.9 times. Between 2016 and 2017, 2.7 times more patients with chronic sinusitis and rhinosinusitis were hospitalized than in 2006-2007. The number of hospitalized patients with acute sinusitis decreased significantly (9.5 times). The frequency of chronic inflammation in the maxillary sinus is 3.3-7.4 times higher than in other paranasal sinuses. Women predominate among patients with sinusitis. The age of patients with sinusitis is varied, but middle-aged and young people make up the majority. Analysis of factors of infection of the maxillary sinus showed that the most common cause of inflammation of the maxillary sinus in hospitalized patients were foreign bodies and perforations of the bottom of the sinus when removing the upper teeth. The analysis of surgical treatment methods of chronic maxillary sinusitis in different years showed that in 2006-2007 Caldwell—Luke sinusotomy prevailed, and now – endoscopic sinusotomy.
 Conclusion. Pathology of maxillary sinuses requires a comprehensive approach of an otorhinolaryngologist, dentist and maxillofacial surgeon in matters of diagnostic and therapeutic tactics.

The status of mucociliary activity of ostiomeatal complex mucous membrane in prediction of inflammatory diseases of paranasal sinuses

It is well known that a disorder of mucociliary system of the nasal cavity mucous membrane plays a significant role in recurrence of the paranasal sinuses chronic inflammatory diseases. The article provides the algorithms and results of the study of motional activity of ostiomeatal complex ciliated epithelium in the patients with chronic purulent rhinosinusitis. The results obtained prove the significant role of disorder of functional activity of ostiomeatal complex ciliated epithelium in the pathogenesis of paranasal sinuses chronic inflammatory diseases.

The Possible Role of Endoscopy in Diagnosis of Benign Tumors of the Nasal Cavity

Benign tumors of the nasal cavity represent a large variety of different histopathological entities. Although advances in nasal endoscopy over the past couple of decades have made it possible to detect the vast majority of these lesions, accurate diagnosis and proper management can be delayed since they are misdiagnosed as inflammatory paranasal sinus disease or simple epistaxis. The aims of the present study are to determine the relative incidence of benign tumor of the nasal cavity and to provide typical endoscopic features of common tumors. This information can potentially improve clinicians' comprehension of benign tumors of the nasal cavity and be helpful in making provisional diagnosis. The present study included 32 patients (25 males, 7 females) with benign tumor of the nasal cavity, which was pathologically confirmed. The most common symptom was nasal obstruction (12/37.5%), followed by recurrent epistaxis (7/21.9%). The most common involving site was anterior nasal septum (17/53.1%), followed by nasal vestibule (7/18.8%) and inferior turbinate (4/12.5%). The most common pathology was squamous papilloma (12/37.5%), followed by lobular capillary hemangioma (7/21.9%). The provisional diagnosis was easily made by nasal endoscopy in 19 (59.4%) patients with typical endoscopic features, especially squamous papilloma, lobular capillary hemangioma, and verruca vulgaris. Clinicians should keep in mind that benign tumors of the nasal cavity are included in the differential diagnosis of unilateral nonspecific nasal symptoms such as nasal obstruction and epistaxis. Also, clinicians should be familiar with the endoscopic findings of various benign tumors and perform the diagnostic approaches with the provisional diagnosis on the basis of those findings.

A method of noninvasive diagnostics of frontal sinusitises

Inflammatory diseases of paranasal sinuses are among the most common medical conditions frequently occurring in ENT practice. Rhinosinusitises account for more than 2/3 of all visits to otorhinolaryngologist. Early instant diagnostics of inflammatory diseases of paranasal sinuses is one of the priority tasks of the present-day otolaryngology. The authors have developed and clinically tested a device for the differential diagnostics of frontal sinusitises, the use of which makes no radiation exposure on the patient. The device has a simple design and provides screening of the frontal sinuses of the patient, making a definite diagnosis and determining the form of the inflammatory process.

Peculiarities of the acute sinusitis course in patients with chronic vasopathy

This article deals with a modern view of the pathophysiology and the course of acute inflammatory diseases of the paranasal sinuses, complicated by the presence in a patient of chronic rhinitis of vasomotor etiology. The article covers various clinical situations and factors predisposing to chronic angiopathy, special emphasis is placed on differential diagnostics of chronic vasomotor and allergic rhinitis, as well as on the need for adequate and science-based selection of pathogenetic therapy. The article provides a detailed clinical picture of chronic rhinitis, including chronic vasomotor rhinitis with the indication of characteristic symptoms. We also offer the algorithm for treatment of acute inflammatory diseases of paranasal sinuses, complications of chronic vasomotor rhinitis tested in our clinic. During 2016 under our supervision there were 42 patients with chronic vasomotor rhinitis and acute sinusitis. The patients were divided into 2 groups. Each patient received as etiotropic therapy antibiotics of the protected penicillins group, as a basic system component of pathogenetic therapy – a blocker of histamine receptors, a gentle diuretic herbal tea and Afobazol. Additionally, patients received local therapy: in the experimental group – Otrivin® Complex spray; in the control group – a hypertonic solution of sea water in the form of a spray.

Headache and importance of traditional x-ray diagnostics in diseases of paranasal sinuses

The number of inflammatory diseases of paranasal sinuses, despite the improvement of quality and the scope of diagnostic and medical actions, does not decrease over time. The article describes the diagnostic role of supplementary diagnosis methods in diseases of paranasal sinuses, their merits and demerits. The authors describe the researches, carried out at the Chair of ENT-Diseases at different periods. It is pointed out that nowadays pain symptom in paranasal sinusitis is not the main differential and diagnostic manifestation of the disease, and sometimes it may not constitute the basis of the process of diagnostics. Up to the present, the main method of paranasal sinuses supplementary research is X-ray diagnostics, providing quite clear presentation of the form, internal structure, transparency changes, existence of cavities, semi­septa, intersinus septa features, interrelation of sinuses and sinuses and adjacent structures of skull and facial skeleton structures. Establishing of the final diagnosis calls for improvement of supplementary examination methods, like digital X-ray diagnostics, CT and MRT. Differential diagnostics by means of conventional plan radiography and tomography does not always make it possible to determine the exact contours of the neoplasms. The possibility of improved visualization depends on setup method, the choice of tomography plane, exposition, section thickness, the method of enhancement of normal and modified structures of maxillary sinuses. The perfect section is 2 mm due to the fact that partial loss of anatomic information inevitably occurs in thicker layers in view of the partial volume effect. CT examination makes it is possible to objectively estimate the nature of pathological process and to carry out differential diagnostics between inflammatory and tumoral process, and presumably evaluate its nonmalignant or malignant nature.

The impact of a patient's age on the clinical presentation of inflammatory paranasal sinus disease

ObjectiveTo determine the change in the clinical presentation of inflammatory paranasal sinus disease as a function of a patient's age. Study Design and MethodsThis is a prospective study of 514 adult patients who presented with inflammatory paranasal sinus disease. The patients were divided into three age groups: group 1 (age: 18–39years; n=203), group 2 (age: 40–59years; n=213) and group 3 (age greater than 60years; n=98). The following data were collected: presenting symptoms, co-morbidities, nasal endoscopy and CT findings, diagnosis, and the outcome of endoscopic sinus surgery (ESS). Statistical analysis was performed using chi-square test, with statistical significance set at p<0.05. ResultsAmong the presenting symptoms, facial pain and rhinorrhea were most common in group 1 (p<0.05), while dysosmia was most common in group 3 (p<0.05). Environmental allergy, but not asthma, was more prevalent in groups 1 and 2 (p<0.05). Anatomic abnormalities that obstructed the ostiomeatal unit (OMU) were more common in groups 1 and 2 (p<0.05). Chronic rhinosinusitis (CRS) without polyposis was the most common diagnosis in group 1 and CRS with polyposis was the most common diagnosis in groups 2 and 3 (p<0.05). Patients in group 1 reported higher rate of improvement in olfactory function while patients in group 3 reported higher rate of improvement in rhinorrhea following ESS (p<0.05). ConclusionsPatients in the 18–39-year age group and diagnosed with CRS are more likely to present with facial pain, suffer from environmental allergy, have anatomic abnormalities in the OMU region, and report improvement in their olfaction following ESS. Patients who are 60years or older are more likely to present with dysosmia, be diagnosed with CRS with nasal polyposis, and report improvement in rhinorrhea following surgery.

Histopathologic characteristics of inferior turbinate vs ethmoidal polypin chronic rhinosinusitis

It seems apparently that the 2 separate anatomical areas (nasal cavity and paranasal sinus mucosa) are indeed one single unit with an identical behavior during inflammatory process. Similar histopathologic evidence in long-term condition could emphasize on the concept of rhinosinusitis in patients with inflammatory paranasal sinus disease. Prospective study was performed on 50 consecutive patients with polyposis in 2 different groups, one with and the other without asthma. Inferior turbine and polyp with ethmoid sinus origin were selected to compare the histopathologic findings of the surgical specimens from the 2 sites (affected sinus vs apparently unaffected nose). The general degree of inflammation, epithelial thickening, and inflammatory cell count were measured. The degree of inferior turbinate inflammation correlated with that of the ipsilateral polyp of ethmoid sinus in both groups. In addition, the total inflammatory cell count was comparable. There was no statistically significant difference in total polymorphonuclear, lymphocyte, and eosinophil count between the 2 sites in each group (P > .05). The ethmoid sinus inflammation in polypoid chronic sinusitis is accompanied by a proportionate inferior turbinate inflammation, not only in the patients with asthma but also in those with isolated sinonasal polyposis.

Ethmomaxillary sinus

Ethmomaxillary sinus is a variation of the posterior ethmoid cells. It is formed by the extension of the posterior ethmoid cells into the maxillary sinus and drains into superior nasal meatus. It is incidentally seen on paranasal sinus computerized tomography (CT) scans. Its prevalence has been reported as 0.7 and 2% in two studies. In this study, paranasal CT scans of 466 patients were investigated for the presence of ethmomaxillary sinus. The patients had paranasal CT with the preliminary diagnoses of septal deviation, chronic inflammatory paranasal sinus disease and nasal turbinate disorders. The ethmomaxillary sinus was present in nine of those patients (1.93%). It was septated in one of them. The CTs were further investigated for other anatomical variations and co-existent mucosal disease of the paranasal sinuses.

Sinonasal imaging

CT is the initial imaging of choice for patients with symptoms of inflammatory paranasal sinus disease. The aim of imaging the paranasal sinuses is to confirm diagnosis, localize the disease, characterize the extent of pathology and describe any anatomical variations. An understanding of the anatomy is important for surgical planning and some normal variants can impair functional drainage pathways. As well as imaging findings in acute and chronic rhinosinusitis, there are five patterns of inflammatory disease. This classification helps the surgeon to elucidate whether surgery has a role and the type of surgery to perform. Beware of mimics of inflammatory disease such as tumours, odontogenic disease and cephalocoeles. A wide variety of neoplasms, both benign and malignant, may arise in the sinonasal cavity. Use the pattern of bony modelling to help distinguish aggressive and non aggressive masses. MRI is complementary to CT. T2 weighted imaging is used for differentiating tumour and inflammatory mucosal secretions. Orbital, infratemporal, intracranial and perineural spread of disease is important. The purpose of imaging the paranasal sinuses is to confirm diagnosis, localize the disease, characterize the extent of pathology and describe any anatomical variations. In this review article, we aim to demonstrate the complex anatomy, its variations and the appropriate imaging techniques. We will describe and illustrate the wide spectrum of disorders affecting the paranasal region and provide useful imaging features which are important for surgical planning and aid the differential diagnosis of sinonasal abnormality.

The Delta F508 Mutation in Cystic Fibrosis and Impact on Sinus Development

Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients > or =18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. Forty-five patients were identified with an average age of 32 years (range, 18-48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.

Correlation between Middle Turbinate and Ipsilateral Ethmoid Histopathology in Chronic Rhinosinusitis

Study the concept of "rhinosinusitis" in patients with inflammatory paranasal sinus disease (IPSD). Prospective case control series in a tertiary care facility. Twenty-two consecutive patients with IPSD without polyposis were enrolled. A partial middle turbinectomy and ethmoidectomy were performed and the histopathologic findings of the surgical specimens from the 2 sites was studied. The general degree of inflammation, epithelial thickening, and inflammatory cell count were measured. The degree of middle turbinate inflammation correlated with that of the ipsilateral ethmoid sinus (Spearman's rho coefficient = 0.450; P < 0.05). Epithelial thickness was more prominent in the ethmoid sinus. The total inflammatory cell count was comparable. There was a statistically significant correlation among total inflammatory cell count, plasma cell count, and eosinophil count between the 2 sites. The ethmoid sinus inflammation in IPSD is accompanied by a commensurate ipsilateral middle turbinate inflammation. The data support the use of the term "rhinosinusitis."

Evaluation of paranasal sinus mucosa in coal worker's pneumoconiosis: a computed tomographic study.

To evaluate by computed tomographic scanning the paranasal mucosal changes of coal workers with and without pneumoconiosis. Examination of images and scores from paranasal computed tomographic scans. The study participants were 26 coal workers with pneumoconiosis, 29 coal workers without pneumoconiosis, and 20 controls. All were men. The extent and patterns of inflammatory paranasal sinus disease were evaluated on computed tomographic scans by 2 radiologists using the terminology and definitions of Newman and associates. Interobserver agreement for the presence of abnormalities was from good to excellent (kappa, 0.63-0.89). The mucosal scores of individuals and groups were higher for coal workers than for control subjects. Both scores were significantly higher in the pneumoconiosis group than in the 2 other groups. This study shows that paranasal sinuses were affected more severely in coal workers than in control subjects. In coal workers with pneumoconiosis, the affection was most severe. The relationship between coal dust exposure and paranasal mucosal changes needs further study.

State of the Art. Diagnostic imaging of paranasal sinus diseases

The following article describes a diagnostic concept of paranasal sinus imaging, based on more than 10 years close collaboration of the authors. CT and MR are the primary imaging modalities for investigating paranasal sinus lesions. Conventional X-ray images add little information due to insufficient sensitivity. Angiography is restricted to those patients who require preoperative tumor embolization or emergency treatment of intractable epistaxis. After thorough medical treatment of inflammatory paranasal sinus disease, CT becomes the method of choice to clearly depict preoperative osseous anatomy and to distinguish between benign and malignant intraosseous lesions. In cases where trauma is involved, CT easily identifies anterior skull base fractures. Moreover, CT will be the first step to localize early or late CSF rhinorrhea. MR, with its ability to distinguish between different soft tissues, compliments CT. This holds particularly true for inflammatory or neoplastic disease close to the skull base, orbital apex and cavernous sinus. The signal intensity in T(1) and T(2) weighted images provides additional information with respect to cellularity and vascularization of lesions, which has important diagnostic and therapeutic implications.