Isolated Sphenoid Sinusitis Research Articles

Staphylococcus epidermidis isolated sphenoiditis: a rare cause of recurrent orbital apex syndrome

Isolated sphenoid sinusitis (ISS) is a rare condition that can lead to severe complications, with orbital apex syndrome (OAS) being an exceptionally rare manifestation characterized by visual loss and multiple cranial neuropathies. We report a case of a 41-year-old female presenting with recurrent OAS caused by a chronic Staphylococcus epidermidis infection of the sphenoid sinus. Despite extensive diagnostic workups and multiple surgical interventions, the patient experienced recurrent episodes of OAS, highlighting the challenges in diagnosis and treatment. This report emphasizes the pathogenic potential of S. epidermidis, typically considered a commensal organism, in chronic sinusitis and underscores the importance of a multidisciplinary approach in managing such complex cases.

A Pediatric Case of Bacterial Meningitis by Acute Isolated Sphenoid Sinusitis

A Pediatric Case of Bacterial Meningitis by Acute Isolated Sphenoid Sinusitis

Isolated Sphenoid Sinusitis: Anatomical Features for Choosing a Method of Treatment, a Case-Control Study.

Isolated sphenoid sinusitis (ISS) is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. The gold standard for analyzing and diagnosing ISS is computer tomography. Many researchers have discussed the treatment of patients with ISS variants such as fully opacified sinus, mostly with surgery. A retrospective analysis of clinical data of 59 patients (21 male (35%), 38 female (65%)) with ISS, who were treated in the Otorhinolaryngological Department of Pavlov First Saint Petersburg State Medical University between January 2017 and January 2020, was conducted. All patients were in the first stage of the same medical therapy. In cases where there was no recovery, these patients were referred to surgery. For the control group, we analyzed patients without any disorders according to CT-scan examination. After analyzing the obtained clinical and radiological data, we found indicators that were common in patients who did not recover after medical therapy. According to the reverse regression method statistical model, in male patients with a diffuse headache and nasal discharge it was shown that medical therapy was highly effective (more than 78%). The presence of nasal septum deviation and adenoids in male and female patients leads to the highest risk of surgical treatment (83% probability of the logistic model). The detailed analysis of CT-scans and the complaints of patients with ISS can be the key to determining the preferred therapy choice. Not all cases need to have an endoscopic opening of the sphenoid sinus, according to our research.

Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literature

ObjectiveThis study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition. Data sourcesOvid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar. Study selectionPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications. ResultsTen studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5–17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1–90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported. LimitationsAll studies were retrospective case note reviews. ConclusionsAcute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening.

Two Cases of Acute Isolated Sphenoid Sinusitis in Children

Acute isolated sphenoid sinusitis is a rare disease, and accounts for less than 3% of all sinusitis, especially in young children. Delayed diagnosis or misdiagnosis can occur frequently due to atypical clinical presentations. This can lead to serious complications because of the involvement of anatomically related intracranial structures. Therefore, nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools to confirm the diagnosis. We report two cases of a previously healthy 6-year-old girl and a 13-year-old boy, whose chief complaints were uncontrolled headache and high fever over 38°C. Physical examination and initial laboratory test results of blood, urine, and cerebrospinal fluid were normal. The diagnosis was made after a brain MRI revealed isolated sphenoid sinusitis. The girl was treated with third generation cephalosporins intravenously. The boy, however, had to undergo an emergent endoscopic sinus surgery as his headache and eyeball-pain symptoms did not resolve by medical treatment alone. Both cases had good outcomes, without neurological sequelae.

Bilateral Blindness Due to Acute Isolated Sphenoid Sinusitis- Is It Reversible? A Case Report

Acute isolated sphenoid sinusitis is a rare and is seen in only 3% of all cases of all sinusitis. It is frequently misdiagnosed because of its vague clinical presentation. We report a case of 35year old female who presented to our emergency department with complaints of painless rapidly developing bilateral vision loss. Non contrast computed tomography of paranasal sinuses showed only mild opacification of sphenoid sinus. Endoscopic sphenoidectomy was performed within 4 hrs of presentation. After 48 hrs of surgery the patient vision returned to 6/6 bilaterally. Acute sphenoid sinusitis should be considered in the differential diagnosis of acute vision loss. Awareness, early diagnosis, astute clinical sense and emergent intervention can prevent permanent complication.DOI: http://dx.doi.org/10.3329/jom.v15i2.20700 J MEDICINE 2014; 15 : 146-148

Sixth cranial nerve palsy in isolated sphenoid sinusitis: a case report

In January 2013, a 78-year-old woman presented with diplopia due to a left abducens nerve palsy. She also mentioned a progressive left retro-orbital pain since 2 weeks, which she had already experienced 4 months earlier but resolved after steroid therapy for 10 days. She was known with diabetes mellitus type two and was treated with oral antidiabetics. Further neurological examination was normal. Fundoscopic examination could not reveal papillary edema. Magnetic resonance imaging (MRI) of the brain, orbits and sinuses demonstrated no parenchymatous or orbital pathology, but revealed an isolated sphenoid sinusitis (ISS), probably due to a fungal infection. The fungus seemed to have invaded the clivus at the site where the left abducens nerve enters Dorello’s canal (Fig. 1a–c). An urgent endoscopic sphenoidotomy was performed. Cultures showed growth of Scedosporium Apiospermum, a common soil fungus. Biopsy excluded malignancy. The patient was treated with intravenous voriconazole for 3 weeks. One month after surgery, her complaints had resolved. Clinical and ophthalmological examination revealed a complete recovery of the left abducens nerve palsy. Subsequently performed cone-beam computed tomography evaluation of the paranasal sinuses in March and April 2013 showed a progressive resolution of the sphenoid sinusitis with only some residual mucosal thickening in June. At that moment, she was still being treated with oral voriconazole 200 mg twice daily. In October 2013 voriconazole was stopped without clinical or radiological signs of disease recurrence up till now.

An intracranial complication of acute isolated sphenoid sinusitis

Fossa navicularis magna is a congenital anomaly representing persistent dehiscence of the basiocciput. This tract from the nasopharynx to the brain is common and carries a potential risk for infection. Nevertheless reports on such dissemination are very rare. We present a child with brain infection via a fossa navicularis magna, the first description to our knowledge, and review the literature on this anomaly.

An intracranial complication of acute isolated sphenoid sinusitis

Intracranial complications of acute sphenoid sinusitis are a rare, but severe condition. Due to subclinical and non-specific symptomatology it is usually diagnosed with delay or after neurological manifestation is present. A case of temporal epidural abscess secondary to isolated sphenoid sinusitis in a 14-year-old boy is presented. Immediate endoscopic sinus surgery was performed. Early diagnosis and aggressive therapy to guarantee drainage of the sinus is recommended.

Ostre izolowane zapalenie zatoki klinowej – opis 4 przypadków

IntroductionIsolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications. AimDescribe four patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of medical or surgical management. Two patients do not required surgical intervention and medical treatment was sufficient. One patient had sphenoidotomy due to meningitis. One patient was performed surgical intervention after fail of medical therapy. Acute isolated sphenoid sinusitis appears to be difficult to diagnose. It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Medical therapy focused on infection, inflammation, and obstruction may be adequate for resolution, but surgical intervention may be required in certain situations.

Isolated Sphenoid Pyocele with Thornwaldt's Cyst of Nasopharynx.

Isolated sphenoid sinusitis (ISS) is a rare entity. ISS accounts for about 1-2% of all sinus infections. Isolated sphenoid sinus involvement may include mucoceles, pyoceles and isolated mycotic infections. We report a case of isolated sphenoid pyocele in a 35year-old female who presented in August 2007 with frontal and occipital headache, post nasal discharge and bilateral nasal obstruction for 6years. CT scan showed isolated right sphenoid sinusitis. Diagnostic nasal endoscopy showed a streak of post nasal discharge on right side above the torus tubaris confirming right sphenoiditis. A cyst in the nasopharynx was incidentally detected which was confirmed by fluid aspiration to be Thornwaldt's cyst (TC). TCs have reported prevalence of 0.2-5% and though most are asymptomatic their location renders them vulnerable to infection. Sphenoidotomy was done and the cyst in the nasopharynx was removed and marsupialised. Postoperative course was uneventful.

Carotid Artery Spasm Secondary to Acute Isolated Sphenoid Sinusitis

Isolated sphenoid sinus disease is rare, affecting only 1% to 2.7% of all patients diagnosed as having paranasal sinus disease. 1 The condition is even less common in the pediatric population, in that only 15% of patients with isolated sphenoid disease are of pediatric age. 2 Further complicating the diagnosis of isolated sphenoid sinus disease is that the symptoms are often vague, and patients may go undiagnosed until they develop neurologic complications. Acute isolated sphenoid sinusitis (AISS) represents a subset of isolated sphenoid disease that requires distinct management from other types of acute sinusitis. We report 3 cases of AISS, while highlighting 1 patient whose course was complicated by spasm of the internal carotid artery (ICA).

Lemierre syndrome caused by acute isolated sphenoid sinusitis and its intracranial complications

Classically, Lemierre syndrome is a rare clinical entity in which acute oropharyngeal infection causes septic internal jugular vein thrombosis and leads to septic lesions to distant organs, such as the lung. Lemierre syndrome also presents with odontogenic infections, mastoiditis, parotitis, and sinusitis. We report the first case of Lemierre syndrome following acute isolated sphenoid sinusitis that was complicated with cavernous sinus thrombophlebitis and bilateral infectious aneurysms of the intracavernous internal carotid artery. Treatment with endoscopic sphenoidotomy, culture-directed antibiotics, heparinization, and endovascular GDC coiling were performed and the patient recovered without major neurologic morbidity. Immediate and intensive treatment with careful evaluation to localize the primary infectious focus of the head and neck, including the paranasal sinus, improves the prognosis of patients with rhinogenic Lemierre syndrome.

Acute isolated sphenoid sinusitis in a 4-year-old child: a rare case with an atypical presentation

Acute, isolated, sphenoid sinusitis is unusual, especially in children. Its incidence is about 2.7% of all sinus infections and is even rarer in children under the age of six years. It is frequently misdiagnosed because of its atypical presentation and it can cause serious complications because of the sphenoid sinus' anatomical relations with many intracranial structures. We report a case of a previously healthy 4 year old boy, whose sole symptom at presentation was drowsiness. Physical examination and initial laboratory investigations were normal. Diagnosis was made after computed tomography of the head revealed left sphenoiditis. Although under treatment, the child manifested meningism during the first day of hospitalization, which subsided the next day. He was treated with ceftriaxone plus clindamycin and had a good outcome, without compli- cations or neurological sequelae.

The clinical behavior of isolated sphenoid sinusitis

We sought to study the clinical behavior and treatment outcome of isolated sphenoid sinusitis (ISS). We conducted a retrospective study of patients diagnosed with ISS in a tertiary medical center over 20 years. Of 72 patients with ISS, 79 percent had acute symptoms, 15 percent had chronic symptoms, and 6 percent had incidental radiological findings. Fifteen percent were children. Most patients were diagnosed between January and April (P < 0.01), and increasing incidence was noted over the years (P < 0.001). Headache was the most common presenting symptom (85%). Chronic patients complained also of nasal symptoms (82%). Six patients had a major complication of sinusitis (none of them were children), and two patients died. Immunocompromised patients had more major complications (P <or= 0.001) and increased mortality (P <or= 0.01). Most patients need conservative treatment alone. However, life-threatening complications are not infrequent. Close observation and early surgical intervention, if needed, provide the mainstay of treatment. This is the first large series that focuses on the clinical behavior, complications, and treatment of ISS.

Acute isolated sphenoid sinusitis in children

Acute infection of the sphenoid sinus usually affects both pre-adolescent and adolescent subjects and is associated with infections of the other paranasal sinuses. Acute isolated sphenoiditis, though uncommon, is frequently misdiagnosed as symptoms are vague and there are few clinical findings. Indeed, it is not usually diagnosed until the patient develops neurological complications. The aim of this report is to discuss our cases of acute isolated sphenoiditis and compare them with those reported in the International literature. We reviewed our 10-year records of paediatric patients affected by acute isolated sphenoid sinusitis, as confirmed by nasal endoscopy and/or CT scan, and compared them with paediatric cases of sphenoid sinusitis reported in literature. In particular, we focused on clinical findings, associated risk factors, diagnostic approach, and treatment. As previously stated at the Brussels Consensus Meeting, patients can be separated into two groups on the basis of clinical findings: the first including patients affected by severe acute sphenoiditis presenting fever and headache, and frequently associated with neurological symptoms, with swimming and diving as possible predisposing factors. The second group includes patients with non-severe acute sphenoiditis, mainly associated with headache, allergic rhinitis being a possible predisposing factor. Acute isolated sphenoid sinusitis appears to be difficult to diagnose, and there are few reports in peer-reviewed paediatric journals. We wish to alert paediatricians and ENT specialists of the importance of this rare but still potentially devastating disorder.

Acute Isolated Sphenoid Sinusitis

Introduction: Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. It is frequently misdiagnosed because of its vague symptoms and the paucity of clinical findings. We report 2 cases of isolated acute isolated sphenoid sinusitis with unusual presentations. Clinical Picture: Both patients presented with acute headache, eye pain and fever, and were provisionally diagnosed as meningitis. In 1 case, the symptoms were on the contralateral side of the sphenoid infection. Intracranial complications were also present. Treatment: Treatment included intravenous antibiotics and endoscopic sphenoidotomy. Outcome: Both patients recovered with no residual neurological disability. Conclusion: Acute sphenoiditis usually presents with subtle symptoms and elusive physical findings and hence a high index of suspicion is necessary. Complications may arise due to the close proximity of important structures to the sphenoid sinus. Uncomplicated cases can resolve with optimal antibiotic therapy if diagnosed and treated early. Persistence or progression of disease with development of intracranial complications are indications for immediate surgical drainage.

The intracranial complication of acute isolated sphenoid sinusitis

Acute isolated sphenoid sinusitis is a rare, potentially destructive entity, which has indistinct clinical findings and non-specific symptoms. Hence, it can be easily be misdiagnosed. We present and discuss a case of an isolated sphenoiditis with intracranial complication.

Acute isolated sphenoid sinusitis in children.

Acute isolated sphenoid sinusitis in children.

Acute isolated sphenoid sinusitis: a disease with complications

A case of acute isolated sphenoid sinusitis is described in a twelve year old boy who presented with ophthalmic complications. The literature is reviewed to emphasize the potential dangers of this condition.