Management Of Chronic Sinusitis Research Articles

A clinical study of Unani formulation in the management of chronic sinusitis: An open randomized, controlled study

A clinical study of Unani formulation in the management of chronic sinusitis: An open randomized, controlled study

Management of Chronic sinusitis through Siddha Treatment - A Case Report

Inflammation of one or more of the paranasal sinuses is called sinusitis. Sinusitis is classified 4 types based on symptoms persist. Bacterial or fungal infections are common causes for Chronic sinusitis One of the eight Indian peoples are affected by chronic sinusitis. According to siddha literature sinusitis is correlated with the symptoms of Peenisam, which is also called mukkataippu. 08/03/2022 a 27- year male patient attend our Muthu Siddha Hospital Seranmahadevi with the complaints of cold, rhinitis, nasal congestion, sneezing at every morning, itching present in both nasal cavity, pain present in nearby both maxillary region since last one month. A patient had a previous history of Chronic sinusitis. Symptoms are significantly reduced were observed under the siddha medicines such as a combination of siddha Sastric chooranam (Thalisathi chooranam, Palagarai parpam, Pavala parpam, Muthucippi parpam), Vasanthakusamakaram tablet for internal and Chukku Thailam is used for external use in oil bath. No recurrence of any chronic sinusitis clinical features like sneezing, nasal congestion and pain was observed during the five months of follow-up of siddha intervention done. To conclude this case report showed siddha medicines are very effective in the treatment of chronic sinusitis.

Can Virechana nasya and Vairechanika dhoomapana manage chronic sinusitis? An experience

Chronic sinusitis is a highly prevalent disease with a large social and economic burden. The pathophysiology of sinusitis is multifactorial. Environmental pollutants play a role in the inflammatory component of the disease process. When sinusitis persists for more than 12 weeks that can be considered chronic sinusitis. The main symptoms include nasal obstruction, nasal discharge, heaviness of the head, and dull headache. The symptoms of chronic sinusitis have proximity to that of Dushta pratishyaya in Ayurveda. A 32-year-old male patient has approached the outpatient department of Shalakya tantra with chief complaints of severe headache associated with heaviness of the head, postnasal dripping, nasal obstruction more toward evening, and mild hyposmia in the past 2 weeks. The symptoms were recurring for the past 3 years. He was managed with internal medicines, Shirovirechana nasya (~medication through the nose for cleansing), and Dhoomapana (~therapeutic smoking). After the treatment of 1 month, he got significant relief. Follow-up was done after 3 months and there was no recurrence of the symptoms inferring that Ayurveda treatment modalities are useful in the management of chronic sinusitis.

A CASE REPORT ON CHRONIC RHINOSINUSITIS

Chronic Rhinosinusitis is defined as persistent symptomatic inflammation of the nasal and sinus mucosa. Ayurvedic treatments are very effective in the management of chronic sinusitis without any deleterious side effects than the conventional treatment options like corticosteroids therapy and endoscopic sinus surgery . The present case 36 year old cut lady, housewife, diabetic referred to Panchakarma OPD of PNNM Ayurveda Medical College with complaints of recurrent episodes of head ache, occasional sneezing, post nasal dripping, nasal congestion and pain on back of eyes since 1 year was diagnosed as Kaphaja sirasoola and managed for 3 months. Medicines with Virechana property and Teekshna guna were selected to enhance mucociliary clearance and improve sinus drainage . So Avapeeda nasya with Tulsi swarasa mixed with Madhu and Saindhavam was administered for 7 consecutive days followed by Anutaila pratimarsa nasya till all the symptoms got relieved. After that Rasayana drugs were given. Follow up was done for 2 years. Overall effect of therapies after the course of treatment showed complete remission and there was no recurrence.

Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study.

This perfectly matched, double-blinded, placebo-controlled trial study was performed to investigate the efficacy of triamcinolone acetonide (TAA)-impregnated Gelfoam nasal pack in management of different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS). One hundred and four patients with bilateral CRSwNP undergoing ESS were selected and randomized to receive TAA-soaked nasal packing in one nostril and saline-impregnated dressing contra-laterally. Validated Perioperative Sinus Endoscopy (POSE) scoring system was used to assess the participants' condition at postoperative months 1, 3, 6, 12, and 18. The treatment side of eosinophilic CRSwNP (EosCRSwNP) group had significantly better endoscopic scores than the contralateral control side in all follow-up visits (P < 0.05 for all comparisons) except for the first postoperative month. No significant difference was detected between the TAA- and saline-treated nostrils in the non-eosinophilic CRSwNP (nonEosCRSwNP) subgroup during the follow-up period. Intergroup comparisons revealed a borderline better POSE score for the treatment side of the EosCRSwNP group compared with the treatment nostril of the nonEosCRSwNP group at months 12 (P = 0.041) and 18 (P = 0.044). At the end of the study period, the treatment side of the EosCRSwNP group demonstrated better clinical response than the saline-treated side in terms of the total POSE scores (P = 0.019), middle turbinate synechia (P = 0.008), middle meatal narrowing (P = 0.010), ethmoid polypoid changes (P = 0.039), ethmoid polyposis (P = 0.027), ethmoid cavity secretions (P = 0.042), and sphenoid severity (P = 0.018). TAA-soaked Gelfoam dressing following bilateral ESS was found to be an effective method for treating CRSwNP particularly for the eosinophilic endotype of the disease.

Chronic Rhinosinusitis

Chronic sinusitis (CRS) is a long-standing mucosal inflammatory disease of the sinonasal tract that results in significant impairment in patient quality of life. The pathogenic determinants of disease include chronic mucosal inflammation, local microbial colonization, and mucociliary dysfunction. A thorough understanding of this tripartite model allows for endotyping and tailored therapy. Medical therapy in the form of oral and/or topical therapy is imperative to reduce mucosal inflammation, treat microbial infection, and enhance mucociliary function. Functional endoscopic sinus surgery (FESS) serves to surgically reduce inflammatory load, ventilate the sinuses, augment installation of topical therapy, and provide tissue for endotyping. The end result of well-performed surgery is a unified sinus cavity augmented for improved medical therapy. Newer therapeutics, such as biologic therapies, target TH-2 driven mucosal inflammation and are gaining an emerging role in the management of CRS; however, the role of these therapies is not well defined in the current treatment paradigm. This review contains figures, tables and references Key words: chronic sinusitis, chronic rhinosinusitis, functional endoscopic sinus surgery, topical steroid therapy, endotype, structured histopathology, nasal polyps, biologic therapy, mucociliary dysfunction, biofilms

"In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps".

Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. IV.

Long Term Radiographic Prevalence and Management of Chronic Sinusitis after Endoscopic Skull Base Surgery for Malignancy

Long Term Radiographic Prevalence and Management of Chronic Sinusitis after Endoscopic Skull Base Surgery for Malignancy

Functional Endoscopic Sinus Surgery and Conventional Surgery in the Management of Chronic Sinusitis

Background &amp; objective: The interest in functional endoscopic sinus surgery (FESS) in the management of chronic sinusitis is increasing day by day. The proponents of FESS for the treatment of chronic sinusitis claim that it is superior to conventional sinus surgery in the management of the disease, but there are limited studies addressing the issue. The present study was undertaken to make a comparative evaluation between FESS and conventional surgery in the treatment of chronic sinusitis.&#x0D; Materials &amp; Methods: This prospective study was conducted between October 2005 to March 2006 in the Department of ENT and Head-Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Dhaka Medical College Hospital (DMCH), Dhaka. A total of 60 patients of chronic sinusitis with failed conservative treatment or chronic sinusitis with polyps admitted for surgical treatment were included. Selected patients irrespective of age and sex were randomly assigned to either FESS (n=30) or conventional surgery (n=30) followed by respective interventions. Baseline clinical characteristics, image findings and outcome variables were studied.&#x0D; Result: Majority of the patients (around 70%) in either group was in their second and third decades of life. Males were a bit higher in the FESS group. Nasal obstruction was the predominant complaints (75%) followed by nasal discharge (68.3%) and headache (66.7%). X-ray of paranasal sinuses showed opacity in maxillary antrum and nasal fossa in 90% and mucosal thickening in maxillary antrum in 58.3% cases. CT scan showed isodense shadow in ethmoid region and nasal fossa (86.7%) with blocked osteomeatal complex (OMC) on both sides (73.3%) and mucosal thickening in maxillary antrum (46.7%). The indications for FESS were chronic sinusitis with ethmoidal polyp (73.3%), while that for conventional surgery was chronic sinusitis alone (56.7%). Majority (83.3%) of the FESS group and two-thirds (66.7%) of the conventional group had unilateral operation. Most (90%) of the FESS group required nasal or antral packing during procedure than that of the conventional group (43.3%) (p&lt;0.001). Complete recovery was significantly higher in the former group (70%) than that in the latter group (40%) (p = 0.047). Shorter hospital stay (up to 2 days) was observed in majority of the former group patients (0.001). In terms of complications, periorbital oedema was appreciably lower and numbness of the cheek was completely absent in FESS group than those in the Conventional group (p &lt; 0.001 and p = 0.005 respectively).&#x0D; Conclusion: Functional endoscopic sinus surgery offers higher success and lower morbidity than conventional surgery in the management of chronic sinusitis with or without polyp. However, proper training is mandatory to acquire proficiency in FESS.&#x0D; Ibrahim Cardiac Med J 2014; 4(1): 16-21

Long Term Radiographic Prevalence and Management of Chronic Sinusitis after Endoscopic Skull Base Surgery for Malignancy

Long Term Radiographic Prevalence and Management of Chronic Sinusitis after Endoscopic Skull Base Surgery for Malignancy

Oral antibiotics and the management of chronic sinusitis

Chronic rhinosinusitis affected 12.5% of the general population in the United States, making it one of the most common causes for patients to seek medical care. Despite a lack of compelling evidence, antibiotics are the most frequently prescribed class of medications for the treatment of chronic sinusitis, demonstrating a deeply rooted belief that bacteria are in some way responsible for the disease. Despite the high prevalence of sinusitis, the cause of chronic rhinosinusitis remains elusive despite multiple attempts to determine the underlying cause. Theories have come and gone throughout the years with fungi, bacteria, host immunological defects, allergy, structural and functional defects, gastroesophageal reflux disease, environmental chemicals, and bacterial biofilms being blamed for this chronic inflammatory state of the sinonasal mucosa. Recent literature has continued to explore these various theories. To date, there is no high-quality evidence that antibiotic therapy has any effect on the long-term management of chronic rhinosinusitis. No randomized placebo-controlled studies evaluating the utility of antibiotics have as yet been conducted. There remains an urgent need for a high-quality, prospective clinical trial to determine the proper role of antibiotics in the treatment of chronic rhinosinusitis.

Homeopathy in chronic sinusitis: a prospective multi-centric observational study

The primary objective was to ascertain the therapeutic usefulness of homeopathic medicine in the management of chronic sinusitis (CS). Multicentre observational study at Institutes and Units of the Central Council for Research in Homoeopathy, India. Symptoms were assessed using the chronic sinusitis assessment score (CSAS). 17 pre-defined homeopathic medicines were shortlisted for prescription on the basis of repertorisation for the pathological symptoms of CS. Regimes and adjustment of regimes in the event of a change of symptoms were pre-defined. The follow-up period was for 6months. Statistical analysis was done using SPSS version 16. 628 patients suffering from CS confirmed on X-ray were enrolled from eight Institutes and Units of the Central Council for Research in Homoeopathy. All 550 patients with at least one follow-up assessment were analyzed. There was a statistically significant reduction in CSAS (P=0.0001, Friedman test) after 3 and 6months of treatment. Radiological appearances also improved. A total of 13 out of 17 pre-defined medicines were prescribed in 550 patients, Sil. (55.2% of 210), Calc. (62.5% of 98), Lyc. (69% of 55), Phos. (66.7% of 45) and Kali iod. (65% of 40) were found to be most useful having marked improvement. 4/17 medicines were never prescribed. No complications were observed during treatment. Homeopathic treatment may be effective for CS patients. Controlled trials are required for further validation.

A Comparative Study Between Endoscopic Middle Meatal Antrostomy and Caldwell-Luc Surgery in the Treatment of Chronic Maxillary Sinusitis

Functional endoscopic sinus surgery (FESS) has almost completely replaced the radical Caldwell-Luc approach. About 20years after its origin of FESS a comparative study with Caldwell-Luc Surgery (C-L) definitely should be on cards to validate the previous results. To compare the effectiveness of endoscopic middle meatal antrostomy and Caldwell-Luc's surgery in the management of Chronic Maxillary Sinusitis. This is a prospective randomized comparative study based on the analysis of eighty patients who were diagnosed to have chronic, unilateral, maxillary sinusitis and underwent surgery, after a failed trial of conservative management. One year after surgery 44% of the C-L patients and 89% of the FESS patients reported distinct improvement of their symptoms. Both are effective in the management of chronic sinusitis. Endoscopic middle meatal antrostomy is superior to Caldwell-Luc in intraoperative and postoperative parameters.

An open clinical observational study on the usefulness of pre-defined homoeopathic medicines in the management of chronic sinusitis

Objective: To ascertain the usefulness of 17 pre-defined homoeopathic medicines in the management of chronic sinusitis. Methods: This is an interim analysis of the open clinical observational study conducted by the Regional Research Institute (Homoeopathy), at Shimla (Himachal Pradesh) under Central Council for Research in Homoeopathy from October 2005 to March 2009. Ninety seven patients suffering from chronic sinusitis were enrolled in the study; 51 patients completed the treatment and follow up period of 6 months and were assessed using chronic sinusitis symptom score (CSSS). Seventeen pre-defined medicines in centesimal scale of potencies (30C, 200C and 1M) were prescribed. Results: Outcome assessment of patients reflects 88 % improvement in varying degrees; marked improvement in 31(61%) patients, moderate in 10 (20%) patients and mild improvement in 4 (8%) patients. Silicea, Kali bichromicum and Calcarea carbonica were frequently indicated, were prescribed in 30C & 200C potencies and improved 34 (88.23%), 6 (100%) and 7 (86%) patients respectively. Conclusion: The data of this interim analysis of the study though shows positive effects of homoeopathic medicines in patients suffering from chronic sinusitis, the outcome of the final multicentre study on this disease will help in reaching at certain conclusion.

Microbiology and antimicrobial management of sinusitis

Sinusitis generally develops as a complication of viral or allergic inflammation of the upper respiratory tract. The bacterial pathogens in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, while anaerobic bacteria and Staphylococcus aureus are predominant in chronic sinusitis. Pseudomonas aeruginosa has emerged as a potential pathogen in immunocompromised patients and in those who have nasal tubes or catheters, or are intubated. Many of these organisms recovered from sinusitis became resistant to penicillins either through the production of beta-lactamase (H. influenzae, M. catarrhalis, S. aureus, Fusobacterium spp., and Prevotella spp) or through changes in the penicillin-binding protein (S. pneumoniae). The pathogenicity of beta-lactamase-producing bacteria is expressed directly through their ability to cause infections, and indirectly through the production of betalactamase. The indirect pathogenicity is conveyed not only by surviving penicillin therapy, but also by 'shielding' penicillin-susceptible pathogens from the drug. The direct and indirect virulent characteristics of these bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections. The antimicrobials that are the most effective in management of acute sinusitis are amoxycillin-clavulanate (given in a high dose), the newer quinolones (gatifloxacin, moxifloxacin) and the second generation cephalosporins (cefuroxime, cefpodoxime, cefprozil or cefdinir). The antimicrobials that are the most effective in management of chronic sinusitis are amoxycillinclavulanate, clindamycin and the combination of metronidazole and a penicillin.

Trends in the Management of Pediatric Chronic Sinusitis: Survey of the American Society of Pediatric Otolaryngology

The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS. A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children. A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty-five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy-two percent of practitioners do not routinely perform a second-look surgery. The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.

Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma.

To investigate the efficacy of endoscopic sinus surgery (ESS) in the management of chronic sinusitis and asthma in patients with nasal polyps and steroid-dependent asthma. Retrospective chart review. The study included 17 patients who underwent ESS with nasal polyps, steroid-dependent asthma with or without aspirin sensitivity and a minimum of 1 year postoperative follow-up. Nine patients were ASA sensitive, and eight patients were ASA tolerant. Chronic sinusitis and asthma were evaluated using subjective (patient complaints) and objective (computed tomography scans, pulmonary function tests, steroid doses) criteria. Preoperative data were compared with data obtained 12 to 18 months postESS. Tissue samples were graded for degree of inflammation and edema. Thirteen of the 17 (76.5%) patients reported improved clinical symptoms postESS. The postoperative Lund-Mackay scores were statistically lower for the 17 patients (P <.0001). The group experienced improvement in postoperative forced expiratory volume at 1 second (FEV1) (P <.014). Twelve of 17 (70.6%) experienced reduction in systemic steroid usage (P <.048). The ASA sensitive patients did not have a statistical improvement in postoperative FEV1 (P >.08) and sinonasal symptoms (P >.16) compared with the ASA tolerant group. Polyp tissue from the ASA sensitive patients demonstrated more edema and more inflammation on average than ASA tolerant polyps, but the results were not statistically significant. ESS demonstrates a beneficial effect on the sinonasal and asthma symptomatology in patients with nasal polyps and asthma using objective measures. Subset of aspirin-tolerant patients have statistically better outcome for sinonasal symptoms and pulmonary function testing than aspirin-sensitive patients.

The Microbiology and Management of Acute and Chronic Rhinosinusitis.

Although most cases of rhinosinusitis are benign, the disruption of quality of life due to disease symptoms leads patients to seek early medical care. Ongoing debates dispute the definition, bacteriology, and medical management of chronic sinusitis, while the criteria for acute sinusitis are relatively well established. Chronic rhinosinusitis remains poorly categorized, and authors differ in opinions of symptoms, time course, and bacteriology of the infections, as well as proper medical management. Recent studies from the Mayo Clinic even question the idea that chronic sinusitis is a bacterial disease and document the presence of fungal pathogens that are responsible for the inflammatory reaction and mucosal response. In general, medical management is based on physiologic principles of re-establishing natural mucociliary function and restoring proper aeration of the paranasal sinuses after an inflammatory insult. Injudicious use and indiscriminate overprescription of antibiotics has fostered the rapid development of penicillin-resistant organisms over the past two decades. Drug-resistant Streptococcus pneumonia and b-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis are becoming the norm, forcing the need to consider alternatives in antibacterial management. Appropriate medical management of this common problem requires a systematic approach and consideration of adjunctive therapy. This article examines the current bacteriology of these common infections and reviews the management of acute and chronic infections.

Tips for the novice nasal endoscopist

Functional endoscopic sinus surgery has been a major advance in management of chronic sinusitis and other sinonasal diseases. However before one embarks on this surgery, the surgical anatomy of this region and its variations should be clearly understood by the surgeon, and the surgical steps of every stage of uperation should be mastered by adequate practice on cadavers. One has to proceed from simple endoscopic surgery to the advanced ones for better results.

Functional endoscopic sinus surgery- a newer surgical concept in the management of chronic sinusitis

Two hundred and ten patients suffering from chronic hyperplastic rhinosinusitis refractory to medical treatment were subjected to Functional Endoscopic Sinus Surgery using the classical Messerklinger technique ( MT FESS). Of these, 147 (70%) had complete relief of symptoms, 39 (18.5%) had partial relief of symptoms and 15(7.17%) had no/poor relief of symptoms in the follow-up period varying from 6-33 months (Mean 18.3 months). Sine (4.2%) patients were lost to follow-up. The merits and demerits of Functional Endoscopic Sinus Surgery are discussed.