Persistent Sinusitis Research Articles

Aspergillus brain abscess presents as sinusitis in immunosuppressed and hyperglycemic patient

Introduction: There are currently very few documented case reports of Aspergillus brain abscesses in the setting of persistent sinusitis symptoms and comorbid conditions of Type II Diabetes Mellitus and steroid treatment. Many cases of intracranial aspergillosis are secondary to a disseminated invasive Aspergillus infection or primary pulmonary aspergillosis. This case illustrates the importance and vitality of considering the rare but potentially lethal diagnosis of Aspergillus fumigatus brain abscess in the differential of persistent sinusitis, even in the absence of systemic symptoms. Case Report: A 73-year-old female with risk factors of Type II Diabetes Mellitus (T2DM) and steroid treatment presented to the hospital with persistent sinusitis symptoms lasting three months. She subsequently was diagnosed with Aspergillus brain abscess after bicoronal bifrontal craniotomy with pericranial flap. The patient was treated with voriconazole and amphotericin B for 3–6 months post-resection and follow-up with neurosurgery to monitor abscess reduction. She was admitted five more times after initial diagnosis for sequelae related to the brain abscess. The initial abscess did decrease in size but then began to worsen. The patient unfortunately passed away six months after initial presentation and diagnosis. Conclusion: Few cases of invasive rhino-orbito-cerebral Aspergillus brain abscesses secondary to Aspergillus sinus infections have been documented. If missed it can be lethal. Therefore, when a patient presents with persistent sinusitis, in the relevant context, Aspergillus brain abscesses are an important differential diagnosis that warrant consideration.

The relationship between superior attachment of the uncinate process of the ethmoid and varying paranasal sinus anatomy: an analysis using computerised tomography

Objective: The purpose of this research was to examine how attachment of the uncinate process superiorly (SAUP) relates to possession of an agger nasi cell, pneumatisation of the middle turbinate and the measurements of the base of the skull anteriorly. The study was carried out using computerised tomography (CT). Methods: The study involved CT imaging captured from 727 individuals with persistent sinusitis- 1454 images in total, featuring coronal section of the paranasal sinus. The frequency of SAUP, existence of an agger nasi cell, pneumatisation of the middle turbinate and how high the lamella measured laterally, were all noted. Landsberg and Friedman’s classification scheme for SAUP was utilised. Statistical analysis used the chisquared test. Results: In 1.65% of cases, SAUP was not identifiable. With regard to class of SAUP, the most frequent was type 2, then, in descending order of frequency, types 1, 4, 3, 5 and 6. The frequencies noted were 27.6%, 19.8%, 15.4%, 14.5%, 12.0% and 9.0%, respectively. An agger nasi cell was visualised in 894 images (61.07%). There was pneumatisation of the middle turbinate in 395 images (27.17%). The lamina cribrosa measured 5.58mm on average. Conclusion: There were significant correlations between the type of SAUP and the existence of agger nasi cells or of concha bullosa. However, the type of SAUP was not statistically significant in predicting the height of the lamina cribrosa.

Adrenal Insufficiency Caused by Paracoccidioidomycosis: Three Case Reports and Review

Fungal infections can affect the adrenal glands, causing primary adrenal insufficiency (PAI). Although endemic to South America, paracoccidioidomycosis (PCM), which can lead to PAI, has gained global relevance with the increase in international travel and migration. The present report describes 3 patients with PAI caused by PCM. Patients in cases 1 and 2 both reported indisposition, asthenia, nausea, hyperpigmentation of the skin, hypotension, and weight loss. Complementary exams confirmed PAI due to PCM. Case 1 was serologically diagnosed. In contrast, the definitive diagnosis of case 2 was only reached by computed tomography (CT)-guided adrenal biopsy after negative serologies for PCM. Case 3, with diabetes mellitus, had a history of asthenia, nausea and weight loss after persistent sinusitis. Initially, serologic results were negative for PCM and the patient's CT-guided biopsy resulted in insufficient tissue to obtain a definitive diagnosis. Contrary to the initial hypothesis of invasive aspergillosis, since the only etiological evidence for the patient's clinical condition were positive serologies for Aspergillus fumigatus, histopathologic examination of the specimen provided by a left adrenalectomy finally confirmed PCM as the etiology for PAI in this case as well. The 3 cases illustrate the necessity to investigate PAI whenever there are suspicious clinical findings. They also show that fungal infections should be considered among the diagnostic hypotheses during the etiological investigation of PAI. Finally, they teach us that definitive diagnosis of PCM may require direct visualization of the pathogen.

Excellent local control and survival after postoperative or definitive radiation therapy for sarcomas of the head and neck.

BackgroundTo report our results with postoperative or definitive radiation therapy in head and neck sarcomas.MethodsWe performed a retrospective analysis of 26 patients suffering from head and neck sarcomas, who received postoperative or definitive radiation therapy between 2003 and 2012. Median age was 64 years (19–88) and 69 % were male. Tumor locations were skull (including skin) in 31 %, paranasal sinus/orbita in 27 % and neck (including pharynx/larynx) in 42 %. Median tumor size was 4.6 cm (1-12 cm). 22 patients (85 %) presented in primary situation. Stage at presentation (UICC 7th for soft tissue sarcomas) was as follows: Ia:4 %, IIa:50 %, IIb:15 %, III:31 %. All except one patient suffered from high grade lesions (G2/3 FNCLCC), predominantly angiosarcoma (35 %), MFH (19 %) and synovial sarcoma (15 %). Surgery was performed in 21 pts (81 %), resulting in free margins in 10 (38 %), microscopically positive margins in 6 (23 %) and gross residual disease in 5 (19 %). Median dose to the primary tumor region was 66Gy (45-72Gy) in conventional fractionation, using 3D-CRT in 65 %, IMRT in 27 % and electrons in 8 %. 50 % of the patients also received sequential chemotherapy.ResultsMedian follow up was 39 months (8–136). We observed three local recurrences, transferring into estimated 3- and 5-year local control rates of 86 %. One additional patient failed distantly, resulting in 3- and 5-year freedom from treatment failure rates of 82 %. Four patients have deceased, transferring into 3- and 5-year overall survival rates of 88 % and 82 %, respectively. Only two of the four deaths were sarcoma related. Maximum acute toxicity (CTCAE 3.0) was grade 1 in 27 % of the patients, grade 2 in 50 % and grade 3 in 23 %. Severe acute toxicity was mainly represented by mucositis and dysphagia. Maximum late toxicity was grade 1 in 31 %, grade 2 in 15 % and grade 3 in 19 % of the patients. Severe late toxicity included skin ulceration (n = 1), dysphagia with persistent tube dependency (n = 1), persistent sinusitis (n = 1) and hearing loss (n = 2).ConclusionExcellent local control and overall survival rates can be achieved with postoperative or definitive radiation therapy with acceptable acute and late toxicities in patients suffering from sarcomas of the head and neck region.

Prevalencia de intolerancia a salicilatos en pacientes con poliposis nasosinusal

Salicylates intolerance is related to alteration in the metabolism of arachidonic acid leading to increased leukotrienes. The condition may be manifested with respiratory, skin or systemic symptoms or associated with sinonasal polyposis. Salicylates are present in anti-inflammatory drugs, cosmetics products and food. To determine the prevalence of salicylates intolerance in patients with sinonasal polyposis presenting to Clinical Immunology and Allergy and Otolaryngology Service, CMN 20 Noviembre, Mexico City. An observational, descriptive, cross sectional study included patients with sinonasal polyposis. The sample size was 49 patients, and variables were compared using STATISTICA 8.0. The prevalence of sinonasal polyposis was 4% of the study group, predominantly in females; only 24% of the population had an ideal weight, the salicylates intolerance prevalence was 53%, and the Samter triad was 31%. Sinonasal polyposis has an inflammatory disease pattern. Its pathophysiology is not yet fully established and in this study was related to obesity and persistent sinusitis. The most feared complication recurrence is associated with salicylates intolerance. The study found a slight increase of recurrence in the group of intolerance, with no statistically significant difference, possibly related to the sample size.

Combined maxillary sinus floor elevation and endonasal endoscopic sinus surgery for coexisting inflammatory sinonasal pathologies: a one-stage double-team procedure.

To report our experience with combined one-stage double-team maxillary sinus floor elevation (SFE) and endonasal endoscopic sinus surgery (ESS) procedure for concomitant inflammatory sinonasal pathologies. Clinical records of all patients that underwent maxillary SFE in conjunction with endonasal ESS for the treatment of inflammatory sinonasal pathologies between 2011 and 2013 were retrospectively reviewed. All included patients had a sinonasal-related pathology that was first suggested by the referring physician and was later confirmed clinically and radiographically by our combined team comprised of otorhinolaryngologist and maxillofacial surgeons. Fifteen combined SFE+ESS surgeries were performed using either xenograft-allograft mixture or autograft-xenograft-allograft mixture. The study group included seven males and eight females, whose median age was 55years (range, 45-78years). Seven patients underwent a unilateral SFE, and eight patients underwent bilateral SFEs. During the same session, four patients also underwent septoplasty for deviated nasal septum, five patients underwent bilateral maxillary antrostomy, 10 patients underwent unilateral maxillary antrostomy, and six patients underwent maxillary sinus cyst resection. Seven combined procedures were performed under active infection. There were no intra-operative complications, and all SFE+ESS combined procedures were successful. Three patients required extended postoperative antibiotic treatment for persistent sinusitis. One patient reported infraorbital hypoesthesia. We first report the promising outcomes of the double-team one-stage SFE+ESS procedure performed by a combined team of otorhinolaryngologist and maxillofacial surgeons, including on patients presenting with an infection of the sinuses at the time of surgery.

Decreased PLUNC expression in nasal polyps is associated with multibacterial colonization in chronic rhinosinusitis patients

PLUNC (palate, lung, and nasal epithelium clone) is an epithelium-secreted protein that plays a crucial role in the host's defense against bacterial infection. The function of PLUNC in the sinus remains poorly understood. To examine whether the expression levels of PLUNC could serve as a predictive outcome biomarker for patients with CRSwNP and bacterial colonization, we investigated the association of PLUNC expression levels with bacterial colonization in the sinuses. A total of 174 patients who underwent sinus surgery for chronic rhinosinusitis with nasal polyps (CRSwNP) were enrolled in this study. The tissue samples obtained from patients were examined using preoperative sinus computed tomography (CT) scans, postoperative bacterial cultures, and nasal polyp examinations. PLUNC mRNA and protein expression were quantified using RT-PCR and immunohistochemistry. We identified that decreased PLUNC expression is associated with multibacterial colonization (P = 0.0001), specifically those mediated by Staphyloccocus aureus (P = 0.037) and Pseudomonas aeruginosa (P = 0.002). The patients who required repeated sinus surgeries for recurrent or persistent sinusitis also presented much lower PLUNC expression than those who did not require repeated sinus surgery (P = 0.001). However, gender, age, and CT scores were not associated with PLUNC expression. These results suggest that reduced PLUNC expression is associated with bacterial colonization as well as treatment outcome in CRSwNP patients. Investigation of the association between PLUNC expressions and chronic rhinosinusitis may lead to the development of a novel biomarker for treatment outcome in CRSwNP patients.

Efficacy and safety of mometasone furoate nasal spray in the treatment of chronic rhinosinusitis

This study evaluated the efficacy and safety of mometasone furoate nasal spray (MFNS) in patients with chronic sinusitis. In this double-blind, placebocontrolled, multicenter, parallel-group study, 60 patients with persistent sinusitis symptoms were randomized to receive either MFNS 200 μg twice daily or placebo, for 16 weeks (112 days). Eventually, 53 patients terminated the study in regular course. Total Symptom Scores (TSS) in patients receiving MFNS changed by a mean of -7.27 (95% CI -9.71, -4.84), versus -5.35 (95% CI -6.73, -3.96) in the placebo group (P=0.51). MFNS reduced nasal congestion and discharge scores, and improved patients' olfactory function. There were few side effects. Considerably more patients in the MFNS group were satisfied with the treatment than those who had received placebo (P<0.05). Also, more patients would take the medication again in the event of symptoms, compared with those who had taken placebo (P<0.05). Furthermore, the MFNS patients would recommend it to others. The positive patient assessment and few side effects are reflected in the efficacy evaluation performed by the physicians. The endoscopic results under MFNS were always numerically more favorable than those under placebo, and the overall difference reached statistical significance (P<0.01). MFNS offers an effective and safe treatment for chronic rhinosinusitis.

Extraction of cheek teeth using a lateral buccotomy approach in 114 horses (1999-2009)

There are few published data regarding the success rates of cheek tooth (CT) removal by lateral buccotomy in the horse. A retrospective study of 114 horses admitted to 2 private equine referral hospitals over a 10 year period (1999-2009), which underwent CT removal via a lateral buccotomy. Hospital records were analysed and details including case details, presenting complaint and results of all diagnostic tests and surgical reports were documented. Information obtained during post operative reassessment was also available for analysis. Long-term follow-up information (>2 months) was obtained for 112 horses. Short-term complications (<2 months) occurred in 24/77 horses (31%) undergoing exodontia of the maxillary CT and 10/37 horses (27%) involving mandibular CT, with the majority arising from partial wound dehiscence and infection following 16 extractions (47%). All healed well by second intention. Other complications included both temporary (n = 6) and permanent (n = 3) facial nerve paralysis, myositis (n = 4) and the inadvertent establishment of an oroantral fistula (n = 4). One myositis case was subjected to euthanasia 24 h post operatively. Five horses had persistent sinusitis following surgery due to dental remnants (n = 2) and excessive packing material (n = 1) found in the sinuses. No inciting cause could be found in the remaining 2 horses. One further horse suffered a fatal cardiac arrest at induction of anaesthesia. Of all horses, 92% operated on had returned to their previous level of work after >2 months with no complications. Horses with CT removal by a lateral buccotomy have a reasonable prognosis for long-term outcome. Performing a lateral buccotomy is a justified treatment alternative for the surgical removal of equine CT following unsuccessful attempts by standing oral extraction, offering advantages over alternatives such as retropulsion, endodontic therapy and periapical curettage.

Initial Clinical Experience with Balloon Dilation in Revision Frontal Sinus Surgery

The purpose of this study was to determine whether balloon dilation is effective in revision frontal sinus surgery. We retrospectively reviewed all patients who had previously undergone endoscopic frontal sinus surgery and had persistent sinusitis. All patients then underwent balloon dilation of the frontal ostium. Outcome measurements included endoscopic patency of the frontal ostium, Lund-Mackay scores, culture-positive postoperative infections, and subjective persistence of symptoms. Twenty-four frontal ostia and recesses were dilated in 13 patients. The mean follow-up was 13 months (range, 7 to 19 months). During follow-up, 21 of 24 ostia (86%) remained patent and 3 required additional procedures. Postoperative computed tomography scans were performed an average of 12 months after dilation (range, 6 to 18 months) in 9 patients (17 sinuses). The average Lund-Mackay score was 1.35 before dilation and 0.87 at follow-up (p = 0.0076), with 41% of sinuses (7 of 17) displaying radiographic improvement. The average number of postoperative infections was 2.07 (range, 0 to 7). Frontal headaches persisted in 38% of patients (5 of 13) at follow-up. Balloon dilation of the frontal ostia has a posttreatment patency rate comparable to those of other endoscopic revision techniques. Although it may not fully address the frontal sinus disease of all patients, it is a less invasive technique that may be helpful for some patients.

Failures of Adenoidectomy for Chronic Rhinosinusitis in Children: For Whom and When Do They Fail?

Ramadan HH, Tiu J. Laryngoscope. 2007;117(6):1080–1083 PURPOSE OF THE STUDY. To determine which children who undergo adenoidectomy for chronic rhinosinusitis will subsequently undergo endoscopic sinus surgery. STUDY POPULATION. Children who had adenoidectomy for treatment of refractory chronic rhinosinusitis over a 10-year period at a tertiary pediatric facility were included in the study. Excluded children were those with immunodeficiency, cystic fibrosis, or previous sinus surgery. All patients had an extensive preoperative workup to rule out allergy, immunodeficiency, and cystic fibrosis. METHODS. Charts were reviewed, and data were collected retrospectively. All patients underwent adenoidectomy via the suction electrocautery technique. Children were followed monthly for 3 months after adenoidectomy and then every 3 months. Data collected included age, presence of allergy or asthma, severity of sinusitis as indicated on computed tomography (CT) scans, and dates of adenoidectomy and subsequent sinus surgery. Endoscopic sinus surgery was performed for persistent symptoms despite adenoidectomy and medical management with radiographic evidence of sinusitis on CT scans. RESULTS. A total of 143 children had adenoidectomy for sinusitis, and follow-up data were available for 121 children. Adenoidectomy failed for 61 (50%) children, with data available from 55 who had subsequent endoscopic sinus surgery. The mean time between adenoidectomy and endoscopic sinus surgery was 24 months (range: 4.4–77.4 months). Children with asthma had a mean of 19 months between surgeries, whereas those without asthma had an interval of 28 months (P = .04). Children younger than 7 years of age had sinus surgery a mean of 15 months after adenoidectomy, compared with an interval of 27.5 months between surgeries for children ≥7 years (P = .01). The presence of allergy, severity of sinusitis as indicated by CT scans, and gender did not seem to affect the time of failure of adenoidectomy. CONCLUSIONS. At least 50% of children with rhinosinusitis will benefit from an adenoidectomy without the need for subsequent sinus surgery. Children who have persistent sinusitis that requires endoscopic sinus surgery after adenoidectomy tend to be younger children and/or children with asthma, with a mean of 24 months between surgeries. REVIEWER COMMENTS. Adenoidectomy is a simple procedure that is effective for treating children with rhinosinusitis whose conditions fail medical therapy, but a number of children do go on to have more extensive surgical procedures. The retrospective nature of this study and limited information on how sinusitis symptoms were stratified, as well as how treatment failure was defined, affect our ability to generalize the conclusions of this study. The shorter interval between adenoidectomy and endoscopic sinus surgery in children with asthma may reflect a more aggressive approach to surgical management of sinusitis in the presence of pulmonary disease rather than an actual difference in the natural history of sinusitis in these children. The shorter interval between adenoidectomy and endoscopic sinus surgery in the younger children suggests more severe sinus symptoms in this group, although it may just reflect the natural history of sinusitis and upper respiratory infections in children, with eventual resolution expected for many older children regardless of treatment.

T/NK cell lymphoma presenting as a “blocked nose”

We present the case of a 63-year-old Caucasian male who complained of persistent rhinitis and sinusitis accompanied by a total left-sided nasal blockage. The diagnosis nasal T/NK cell lymphoma was established by histopathological investigation. This case was diagnosed as stage IE lymphoma as no other sites were involved. The patient was treated with CHOP (cyclophosfamide, doxorubicin, vincristin and prednisone) chemotherapy and involved-field radiotherapy. The nasal T/NK cell lymphoma is a rare malignancy, which is known to have an extremely aggressive and destructive course. The mainstay of treatment is locoregional radiotherapy combined with chemotherapy, depending on disease stage. A high index of clinical suspicion is imperative to ensure early diagnosis and ultimately improve disease outcome.

Microbiology of Acute Sinusitis in Mexican Patients

Acute bacterial sinusitis is a common disorder affecting children and adults. We performed a study to assess the bacteriology of acute sinusitis in a community hospital in Mexico City. Patients with an acute exacerbation of persistent sinusitis or acute sinusitis were enrolled. Aspiration of sinus secretions was performed and aspirates were sent for culture. All patients received antibiotic treatment for the infection based on microbiologic sensitivity reports. Follow-up consultation included endoscopy and a computed tomography scan of paranasal sinuses to assess response to treatment. A total of 110 patients were enrolled for evaluation. Forty nine percent of patients were women; median age was 31 years. A total of 136 cultures were recovered for analysis. Twenty seven percent of cultures were negative. Isolated organisms were Haemophilus influenzae (26%), Moraxella catarrhalis (15%), Streptococcus pneumoniae (14%), methicillin-sensitive Staphylococcus aureus (7%), enterobacteriaceae (6%), Pseudomonas aeruginosa (2%) and miscellaneous (3%). Twenty eight percent of H. influenzae strains were resistant to ampicillin. Penicillin-sensitive S. pneumoniae (PSSP) and penicillin-intermediate-resistant S. pneumoniae (PISP) accounted for 21% and 79% of the S. pneumoniae strains, respectively. H. influenzae was the most common isolated organism. About 55% of those isolates were found in patients <18 years old and only 25% were resistant to ampicillin. Sinus endoscopy continues to be a useful diagnostic tool in addition to imaging studies in sinus infection and should be pursued by the clinician whenever feasible.

Allergic fungal sinusitis presenting as visual loss and facial dysmorphia in New York City

RATIONALE: Allergic fungal sinusitis (AFS) is a chronic allergic reaction to ubiquitous fungi which causes thick mucoid accumulation in the sinuses. AFS is commonly diagnosed in humid regions such as the southeastern and southwestern United States. AFS occurs in immunocompetent young atopic adults with nasal polyps and persistent sinusitis, despite adequate medical/surgical treatment. The diagnosis requires fungal elements in allergic mucin without tissue invasion. Most patients have elevated total and fungal specific IgE levels.

Anatomic findings in patients undergoing revision endoscopic sinus surgery

Objective To report the anatomic findings that contribute to persistent sinusitis in patients requiring revision functional endoscopic sinus surgery (FESS). Methods Data were collected prospectively on consecutive patients requiring revision FESS at a tertiary institution over a 2-year period. Patients were evaluated with endoscopic examination of the sinonasal cavities, and computed tomography of the sinuses was performed after patients failed prolonged medical therapy for sinusitis. Information was also collected during the revision surgery. Results The most common anatomic factor associated with primary surgery failure was lateralization of the middle turbinate (78%) followed by incomplete anterior ethmoidectomy (64%), scarred frontal recess (50%), incomplete posterior ethmoidectomy (41%), and middle meatal antrostomy stenosis (39%). In addition, retained agger nasi and retained uncinate process were identified in 49% and 37% of the patients, respectively. Recurrent polyposis was seen in 37% of the patients. Other factors such as persistent sphenoid disease and sphenoid ostium stenosis were less frequent. Conclusion Failure of primary FESS is most often associated with anatomic obstruction in the area of the ostiomeatal complex. Meticulous attention in this area during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary FESS.

Persistent sinusitis from recirculating mucus after inferior turbinectomy

Recirculation of mucus between adjacent openings into the maxillary antrum is a relatively common cause of persistent sinusitis in either the pre- or postsurgical patient.It is particularly prone to occur if intranasal sinus surgery is performed without the use of angled telescopes. In this situation, the natural ostium is often out of direct vision, and an antrostomy is created in the posterior fontanelle separate from the natural ostium, thus setting the scene for recirculation of mucus with resultant persistent infection.The phenomenon also occurs commonly between a middle meatal opening and an inferior meatal antrostomy usually created at a prior operation, if the inferior turbinate has been significantly excised. The presence of an intact inferior turbinate usually acts as a deflecting baffle to prevent the recirculation process.Recirculation may also be relevant for persistent sinusitis in the sphenoid and frontal sinuses.

Characteristics of sinus-related pain

Objectives: The goal of this study was to determine possible distinctive features of facial pain when caused by chronic sinusitis and to validate the pain characteristics previously described in the literature. Methods: Included were 82 patients with radiographic and endoscopic evidence of chronic sinusitis and significant facial pain who underwent functional endoscopic sinus surgery and were available for 1-year follow-up. A modified McGill pain questionnaire was filled out before surgery, and follow-up data were obtained at 1 year. Results: At 1 year 38% of patients had persistent facial pain despite the lack of any evidence of persistent sinusitis. A consistent use of pain adjectives and other distinctive features was noted in patients reporting improvement of headache. There was no correlation between the severity of pain and the extent or location of mucosal disease. The site of pain did not correlate with the site of disease. Conclusions: Sinusitis-related pain has distinctive features that set it apart from primary headache disorders and other causes of facial pain. Nonsinus causes account for the headache in 1 of 3 patients undergoing sinus surgery. (Otolaryngol Head Neck Surg 2000;122:842-7.)

Diagnosis and management of sinusitis in children

Acute bacterial sinusitis is a common clinical problem. The usual predisposing events are either viral upper respiratory infection or allergic inflammation. Patients present with either persistent or severe respiratory symptoms. Subacute and chronic sinusitis are characterized by very protracted respiratory symptoms that include nasal discharge, cough, or both. A precise diagnosis of bacterial sinusitis is made when sinus aspiration is performed and yields pus and bacteria in high colony count. Images, either plain radiographs or computer tomographic scans, can be used to confirm the diagnosis of bacterial sinusitis in patients whose signs and symptoms suggest the diagnosis. Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis are the usual pathogens retrieved from patients with acute, subacute, and recurrent acute sinusitis. These same pathogens cause acute exacerbations of chronic sinusitis. In patients with chronic persistent sinusitis, the role of bacterial agents is less clear. The prescription of antimicrobials is the backbone of the medical management of acute bacterial sinusitis. Clinical improvement is prompt in nearly all children treated with an appropriate agent.

• Management of Patients with Persistent Sinusitis Following Aggressive Medical and/or Surgical Therapy

Otolaryngology–Head and Neck SurgeryVolume 117, Issue 2 p. P105-P105 Original Article • Management of Patients with Persistent Sinusitis Following Aggressive Medical and/or Surgical Therapy William E. Davis MD, William E. Davis MD ModeratorSearch for more papers by this authorCharles W. Gross MD, Charles W. Gross MD SpeakersSearch for more papers by this authorJack M. Gwaltney MD, Jack M. Gwaltney MDSearch for more papers by this author William E. Davis MD, William E. Davis MD ModeratorSearch for more papers by this authorCharles W. Gross MD, Charles W. Gross MD SpeakersSearch for more papers by this authorJack M. Gwaltney MD, Jack M. Gwaltney MDSearch for more papers by this author First published: 01 August 1997 https://doi.org/10.1016/S0194-59989780167-2 Supported by.Ortho-McNeil Pharmaceutical Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume117, Issue2August 1997Pages P105-P105 RelatedInformation

Management of patients with persistent sinusitis following aggressive medical and/or surgical therapy

Otolaryngology–Head and Neck SurgeryVolume 117, Issue 2 p. P105-P105 Original Article • Management of Patients with Persistent Sinusitis Following Aggressive Medical and/or Surgical Therapy William E. Davis MD, William E. Davis MD ModeratorSearch for more papers by this authorCharles W. Gross MD, Charles W. Gross MD SpeakersSearch for more papers by this authorJack M. Gwaltney MD, Jack M. Gwaltney MDSearch for more papers by this author William E. Davis MD, William E. Davis MD ModeratorSearch for more papers by this authorCharles W. Gross MD, Charles W. Gross MD SpeakersSearch for more papers by this authorJack M. Gwaltney MD, Jack M. Gwaltney MDSearch for more papers by this author First published: 01 August 1997 https://doi.org/10.1016/S0194-59989780167-2 Supported by.Ortho-McNeil Pharmaceutical Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume117, Issue2August 1997Pages P105-P105 RelatedInformation