Sinonasal Pathology Research Articles

Sinonasal risk factors for eustachian tube dysfunction: Cross-sectional findings from NHANES 2011-2012.

Sinonasal pathology is frequently cited as a cause of eustachian tube dysfunction (ETD), despite a lack of evidence. Using a large, nationally representative sample, we investigated whether abnormal tympanometry, an objective marker of ETD, was associated with infectious, allergic, and exposure-related sinonasal risk factors. Relevant data were extracted from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Tympanometric types (A, B, and C) were determined using peak pressure and compliance values. Participants with a type B or C tympanogram in at least one ear were classified as having ETD. Demographic and clinicopathologic risk factors with putative associations with ETD were determined. Statistical analysis, including regression modeling, was performed using Stata (version 15.1) to determine the correlation between sinonasal factors and ETD. The final analysis included 1253 subjects and 19 variables. We controlled for demographic data including age, gender, race, and income. In both univariate and multivariate logistic regression, statistically significant correlations were found between abnormal tympanometric values and: (1) having a persistent cold/flu in the last 12 months (univariate: adjusted odds ratio [OR], 2.42; p = 0.006; multivariate: adjusted OR, 2.15; p = 0.006); and (2) experiencing "hay fever" (ie, allergic rhinitis) within the last 12 months (univariate: adjusted OR, 1.95; p = 0.021; multivariate: adjusted OR, 1.71; p = 0.039). Using a large, representative data set, we identified significant correlations between ETD and (1) persistent cold/flu symptoms and (2) self-reported allergic rhinitis.

The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study

BackgroundInferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad.MethodsA retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children’s center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children’s Benefit Inventory (GCBI) was administered by phone to assess QOL improvement.ResultsOne hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication.ConclusionsThis study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.

Prevalence of Dangerous Ethmoid in a Tertiary Center in Eastern Nepal

Endoscopic sinus surgery is a well-known approach for sino-nasal pathologies. Due to close proximity to the brain and orbit, the surgeon should be aware of the sino-nasal anatomy and its associated variations. Detailed preoperative assessment of the sinus computed tomography scans reduces the frequency of severe complications in patients undergoing an endoscopic sinus surgery. So, the aim of this study is to find the prevalence of dangerous ethmoid in a tertiary center in eastern Nepal. A descriptive cross-sectional study was performed in a Computed tomography scan of 50 patients with chronic sinusitis undergoing endoscopic sinus surgery from February 2018 to August 2018 in the department of Otolaryngology and Radiology of BP Koirala institute of health sciences after taking ethical approval from Institutional Review Committee of the institute. Measurements are taken in the coronal plane. The depth of the lateral lamella of the cribriform plate was defined according to the Keros classification which defines the dangerous ethmoid. and side. Data entered in MS excel. Statistical analysis was performed in SPSS version 11.5. Keros type I, II, and III were noted in 17 (17%), 54 (54%) and 29 (29%) of cases respectively. The mean width of the olfactory fossa, medial orbital wall distance and distance from medial nasal concha were 3.57mm, 8.77mm & 17.78mm respectively. The most common type of dangerous ethmoid was keros type II. The most common type of dangerous ethmoid was keros type II.

Rhinolith: Examining the clinical, radiological and surgical features of 23 cases

ObjectiveRhinolith is a hard nasal mass formed in time by the mineral salts around an endogenous or exogenous-originating nidus. Rhinolith, which is seen rarely, has been reported in the literature as case reports. In this study, we are presenting the demographic and clinical features together with accompanying sinonasal pathologies of 23 rhinolith cases. MethodsThe medical records and radiological findings of 23 cases, who were operated for rhinolith between January 2010 and June 2018 in Tokat State Hospital, were analyzed retrospectively. The age, gender, the side where rhinolith exists, nidus presence, type of surgery and sinonasal pathologies that accompany rhinolith, and accompanying secondary sinonasal surgeries were examined. ResultsA total of 17 (73.2%) of the 23 cases were female, and 6 (26.8%) were male. The mean age was 24.9 years. The symptoms that were seen in the patients were nasal obstruction (100%), rhinorrhea (82.6%), nasal malodor (78.2%), oral malodor (26%), headache (26%), epistaxis (17.3%), face pain (4,3%), respectively. Nidus could be detected in 6 patients. The most frequent localization of rhinolith was between the inferior concha and the nasal septum (n=21). The most common concomitant sinonasal pathology in rhinolith was septum deviation (43.4%); and the second most common pathology was mucosal thickening (30.4%) in the maxillary sinus. The surgery type that accompanied rhinolith at the highest frequency was septoplasty (n=5). Other surgeries were septorhinoplasty (n=1), antrochoanal polyp excision (n=1), adenoidectomy (n=1). ConclusionThe most common symptoms of rhinolith, which is a rare nasal pathology, are nasal obstruction and rhinorrhea. Radiological imaging together with a rigid endoscopy is important especially to evaluate the placement of rhinolith. In addition to this, radiological imaging, evaluation of the sinuses that are not sufficiently evaluated with rigid endoscope are important for planning the type of the operation and secondary surgical procedures which may accompany.

Distinctive expression profiles of Caveolin-1 and Notch-1 protein in patients with nasal polyps or sinonasal inverted papillomas

BackgroundNasal polyposis (NP) and sinonasal inverted papillomas (SIP) are considered benign lesions capable of recurrence or malignant transformation although not with the same prevalence. Since fluctuations of Caveolin-1 and Notch-1 proteins expression have been reported in many pathologies, the current study aimed to investigate their involvement in the epithelial transformation observed in SIPs compared to NP. MethodsImmunohistochemical expression of Caveolin-1 and Notch-1 proteins was assessed in 104 patients with sinonasal lesions (45 NP, 45 SIP and 14 NP with SIP), semiquantively (percentage times intensity). Proteins expression profiles were evaluated statistically for their correlation with patients demographic and clinicopathological variables (grade of dysplasia, inflammation, recurrence) as well as with markers of proliferation (Ki67) and apoptosis (7-AAD) as determined by flow cytometry analysis. ResultsSIP lesions presented increased Caveolin-1 immunopositivity compared to NP (62.2%, vs 40.9%; p = 0.045). Cytoplasmic staining was observed only in epithelium’s basal and suprabasal layers. Caveolin-1 positivity was not related to Ki67 expression, apoptosis, inflammation or dysplasia, eventhough 81.8% of highly immunopositive lesions were dysplastic (p = 0.03). Also, smokers presented significantly increased immunopositivy (p = 0.03). In contrast SIP lesions presented reduced Notch-1 expression compared to NP (68.9% vs 100%; p < 0.001). Dysplastic lesions presented low Notch-1 immunopositivity (p < 0.001). Enhancement of Notch-1 gene expression was also associated with inflammation. ConclusionsThe herein presented data suggest that the expression profiles of Caveolin-1 and Notch-1 proteins in sinonasal pathologies are distinctive and that could be explored as potential targets for the development of alternative therapeutic approaches.

A prospective study of sinonasal and nasopharyngeal pathology in chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) implies a permanent abnormality in the tympanic membrane characterized by irreversible changes in the mucosa of middle ear and mastoid cavity. Diseases of the nose and para nasal sinuses have been implicated in the development of the disease. Hence the present study aims at identifying the risk factors involved and the importance of its management in treating the disease. The objective was to study the correlation between COM and Sino nasal and nasopharyngeal pathology.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 100 patients with chronic otitis media were included in the study. A Detailed history and clinical examination was done using a pre-prepared questionnaire. Diagnostic nasal endoscopy was done in all cases to assess the nasal cavity and nasopharynx along with bacteriological study of ear and corresponding side of nasopharynx. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Symptomatic, clinical and diagnostic profile proved the evidence of sinonasal pathology in 82% of patients with COM. The comparative study of the microbiological flora of both ear and corresponding side of nasopharynx showed 77 % of ear swabs and 91% of nasopharyngeal swabs to be sterile. The results were statistically significant with a p value of 0.003.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study emphasises on a thorough evaluation of nose and paranasal sinuses in all cases of COM for comprehensive management of the disease. Its detection and management is equally important as the ear surgery per se.&lt;/p&gt;

Rhinotillexomania in a Cystic Fibrosis Patient Resulting in Septal Perforation

Cystic fibrosis (CF) is a multisystem disease that can have significant sinonasal manifestations. Viscous secretions are one of several factors in CF that result in chronic sinonasal pathology, such as sinusitis, polyposis, congestion, and obstructive crusting. Persistent discomfort and nasal manifestations of this disease significantly affect quality of life.

The impact of nasal airflow on sinus mucosa: A radiographic review

BackgroundChronic rhinosinusitis (CRS) is a disease of widespread prevalence and high morbidity. Many suggest that the introduction of toxins and allergens via nasal airflow plays a significant role in the development of CRS. In patients who have undergone total laryngectomy, nasal airflow is disrupted, providing an opportunity to examine the role of nasal airflow in sinonasal pathology. MethodsAll patients who received a total laryngectomy between 2002 and 2012 with preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. The Lund-Mackay (LM) score for each sinus was recorded for both scans. The assessment of differences in pre-operative and post-operative LM scores was analyzed utilizing paired t-tests. Results56 patients underwent total laryngectomy and had both preoperative and postoperative CT scans. There were no significant differences in the LM scores between pre-operative and post-operative scans within each sinus (frontal sinus, p = 1.0; anterior ethmoid sinus, p = 0.77; posterior ethmoid sinus, p = 0.45; maxillary sinus, p = 0.90; sphenoid sinus, p = 0.63; ostiomeatal complex, p = 0.78) or in the total LM scores (p = 0.97). Furthermore, patients with pre-operative sinonasal mucosal thickening (total LM score > 0) showed no significant change in their total LM score post-operatively (p = 0.13). ConclusionIn total laryngectomy patients, studies demonstrate that a disruption in nasal airflow is correlated to altered sinonasal physiology and decreased subjective symptoms. However, our study shows that the disruption of nasal airflow results in no significant change in radiographic evidence of sinonasal mucosal thickening.

Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches

IntroductionRadiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. ObjectiveThe goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. MethodsThis retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. ResultsLamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14mm, 147.88° and 9.6mm, 152.72°, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3mm, 7.2cm2, 6.89cm2, 4.51cm2 and 12.46cm2 respectively. The orbital height and width were measured as 35.9mm and 39.2mm respectively. The mean orbital cavity depth was 46.3mm from optic foramen to the orbital entrance and the orbital volume was 19.29cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. ConclusionPrecise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.

Optical imaging with a high-resolution microendoscope to identify sinonasal pathology

ObjectivesHigh-resolution microendoscopy (HRME) is an optical imaging modality that allows real time imaging of epithelial tissue and structural changes within. We hypothesize that HRME, using proflavine, a contrast agent that preferentially stains cell nuclei and allows detection of cellular morphologic changes, can distinguish sinonasal pathology from uninvolved mucosa, potentially enabling real-time surgical margin differentiation. Study designEx vivo imaging of histopathologically confirmed samples of sinonasal pathology and uninvolved, normal sinus epithelium. SettingSingle tertiary-level institution. Subjects and methodsFive inverted papillomas, one oncocytic papilloma, two uninvolved sinus epithelia specimens, and three inflammatory polyps were imaged ex vivo with HRME after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation. ResultsResults show that sinonasal pathology and normal sinus epithelia have distinct HRME imaging characteristics. Schneiderian papilloma specimens show increased nuclear-to-cytoplasmic ratio, nuclear crowding, and small internuclear separation, whereas normal sinus epithelia specimens show small, bright nuclei with dark cytoplasm and relatively large internuclear separation. Inflammatory polyps, however, have varying imaging characteristics, that resemble both Schneiderian papilloma and normal sinus epithelia. ConclusionsThis study demonstrates the feasibility of HRME imaging to discriminate sinonasal pathology from normal sinus epithelia. While the system performed well in the absence of inflammation, discrimination of inflamed tissue was inconsistent, creating a significant limitation for this application. Novel imaging systems such as HRME with alternative contrast agents may assist with real-time surgical margin differentiation, enabling complete surgical resection of inverted papilloma and reducing recurrence rates.

Origin of polyps and accompanying sinonasal pathologies in patients with antrochoanal polyp: Analysis of 22 patients.

OBJECTIVE:Solitary, benign soft tissue masses originating at the maxillary sinus and extending to the nasopharynx are called antrochoanal polyps (ACP). The aim of the study was to determine the origins of ACP accompanying sinonasal pathologies and the effectiveness of endoscopic sinus surgery in patients with ACP.METHODS:Twenty-two patients (13 men, 9 women; age range: 6–50; average age: 28.3±13.3) who were treated for ACP using endoscopic sinus surgery between January 2014 and September 2017 were included in the study. The patient’s age, sex, symptom at presentation to the clinic, sinonasal pathologies accompanying the ACP, and adhesion site of ACP inside the maxillary sinus were retrospectively examined.RESULTS:The most frequently encountered symptom in patients was nasal congestion (95.4%). This was followed by snoring and sleeping with an open mouth (31.8%), nasal discharge (22.7%), headache (18.1%), feeling of a foreign body in the throat (9.1%), and epistaxis (4.5%). When the adhesion site of ACP in the maxillary sinus was checked, it was seen that it was the most frequently located in the medial wall (27.2%), followed by the posterior (18.1%) and lateral wall (13.6%). One patient (4.54%) developed recurrence.CONCLUSION:Although the origin of ACP cannot be detected in the paranasal sinus tomography scan, accompanying sinonasal pathologies should be preoperatively identified. Development of angled endoscopes and angled instruments enabling easy removal of cystic lesions renders endoscopic sinus surgery sufficient for the treatment of ACP.

Upper airway involvement in bronchiectasis is marked by early onset and allergic features.

The association of bronchiectasis with chronic rhinosinusitis (CRS) has been reported. However, apart from primary ciliary dyskinesia (PCD) and cystic fibrosis (CF), predisposing conditions have not been established. We aimed to define clinical and laboratory features that differentiate patients with bronchiectasis with upper airway symptoms (UASs) and without PCD from patients without UASs.We reviewed charts of adults with bronchiectasis, excluding CF and PCD. UASs were defined as nasal discharge most days of the year, sinusitis or nasal polyps. Laboratory data included IgG, total IgE, blood eosinophils, sputum bacteriology and lung function. A radiologist blinded to UAS presence scored bronchiectasis (Reiff score) and sino-nasal pathology (Lund–Mackay score).Of 197 patients, for the 70 (35%) with UASs, symptoms started earlier (34±25 versus 46±24 years; p=0.001), disease duration was longer (median 24 versus 12 years; p=0.027), exacerbations were more frequent (median 3 versus 2 per year; p=0.14), and peripheral blood eosinophil (median 230 versus 200 μL−1; p=0.015) and total IgE (median 100 versus 42 IU·mL−1; p=0.085) levels were higher. The sinus computed tomography score was independently associated with exacerbations, with 1 point on the Lund–Mackay score associated with a 1.03-fold increase in the number of exacerbations per year (95% CI 1.0–1.05; p=0.004).These findings may implicate a higher disease burden in patients with UASs. We hypothesise that UASs precede and may in some cases lead to the development of bronchiectasis.

Nasal epithelial barrier disruption by particulate matter ≤2.5 μm via tight junction protein degradation.

Upper airway diseases including sinonasal disorders may be caused by exposure to fine particulate matter (≤2.5 μm; PM2.5), as proven by epidemiological studies. PM2.5 is a complex entity whose chemical constituents and physicochemical properties are not confined to a single, independent "particle" but which in this study means a distinctive environmental "toxin." The mechanism whereby PM2.5 induces nasal epithelial barrier dysfunction leading to sinonasal pathology remains unknown. In the present study, human nasal epithelial cells were exposed to non-cytotoxic doses of PM2.5 to examine how PM2.5 affects the nasal epithelial barrier. Tight junction (TJ) integrity and function were assessed by transepithelial electric resistance and paracellular permeability. The expression levels of TJ proteins such as zona occludens-1, occludin and claudin-1 were assessed by immunofluorescence staining and western blot. PM2.5 exposure induced epithelial barrier dysfunction as reflected by increased paracellular permeability and decreased transepithelial electric resistance. TJ proteins zona occludens-1, occludin and claudin-1 were found to be downregulated. Pretreatment with N-acetyl-l-cysteine alleviated PM2.5-mediated reactive oxygen species generation in RPMI 2650 cells, further preventing barrier dysfunction and attenuating the degradation of TJ proteins. These results suggest that PM2.5 induces nasal epithelial barrier disruption via oxidative stress, and N-acetyl-l-cysteine counteracts this PM2.5-mediated effect. Thus, nasal epithelial barrier disruption caused by PM2.5, which leads to sinonasal disease, may be prevented or treated through the inhibition of reactive oxygen species.

Dakriyosistorinostominin başarısız olduğu hastalarda endoskopik inceleme ve paranazal bilgisayarlı tomografi bulgularının değerlendirilmesi

Objective: The aim of this study is to evaluate endoscopic and paranasal computed tomography (PNCT) findings in cases of failed dacryocystorhinostomy (DCR). Methods: This study included 30 cases of failed DCR (18 females, 12 males; mean age: 49.9±18.9 years) and 30 successful DCR patients (20 females, 9 males; mean age: 56.3±15.9 years). The reasons for the recurrence of the disease were evaluated using preoperative endoscopic examination and PNCT findings. Results: Endoscopic pathology was identified in 24 out of 30 failed cases (80%), while endoscopic pathology was identified in 12 out of 30 successful cases (40%) (p<0.05). PNCT revealed nasal pathology in 24 out of 30 failed cases (80%), and in 15 out of 30 successful cases (50%) (p<0.05). Conclusion: Endonasal and sinonasal pathologies may be associated with DCR failure. Before the commencement of revision DCR, endoscopic examination and PNCT may provide valuable information regarding the underlying etiology.

Resonancia magnética en el diagnóstico y seguimiento de la patología nasosinusal

Introduction and objective: Magnetic resonance imaging (MRI) is not commonly used as the first technique in the study of sinonasal pathology, it is usually complementary to computed tomography (CT), however it is useful for the assessment of some pathology and response to treatment. Method: Updated review and study of the protocols and the most representative cases carried out in our department during the last 5 years. Results: The main advantages and utilities of MRI in the diagnosis and monitoring of disease sinonasal are explained. The anatomy of the sinuses and nasal cavity through MRI in different planes is explicated. MRI sequences employed are analyzed, the indications of diagnostic imaging technique are shown according to the pathology and the imaging features in MRI are explained for both, inflammatory pathology and paranasal neoplasms. Conclusions: Although MRI is behind the TC in the study of sinonasal pathology is particularly useful for assessing tumor pathology because of its ability to distinguish between different tissues and facilitate the diagnosis extension of neoplasms. In addition MRI is usually the technique of choice for the post-treatment evaluation.

Thirty years of endoscopic sinus surgery: What have we learned?

Prior to adaptation of endoscopic approaches for sinonasal pathology, patients regularly endured significant morbidity from open approaches to the sinonasal cavity that were often fraught with failure. With improvements in transnasal endoscopy, functional endoscopic sinus surgery subsequently emerged from the work of Messerklinger and other pioneers in the field. The popularity of endoscopic sinus surgery quickly escalated and expanded to pathology other than inflammation. Here, we discuss the evolution of endoscopic sinus surgery as it relates to improvements in understanding disease pathogenesis, improvements in instrumentation and expansion of indications.

Virtual Mapping of the Frontal Recess: Guiding Safe and Efficient Frontal Sinus Surgery.

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Sinonasal imaging findings in granulomatosis with polyangiitis (Wegener granulomatosis): A systematic review.

Granulomatosis with polyangiitis (GPA) (Wegener granulomatosis) frequently presents in the head and neck, and the sinonasal cavity is among the most common areas affected. Although the clinical findings, histologic appearance, and laboratory workup have been described, characteristic findings and the distribution of disease on sinonasal imaging are not well established. The appropriate imaging modality to evaluate for sinonasal involvement is also unclear. To describe the imaging characteristics, distribution, and location of sinonasal pathology in patients with GPA as noted on computed tomography and magnetic resonance imaging modalities. A systematic review was conducted of English language articles, by using appropriate search terms, which reported the computed tomography and magnetic resonance imaging findings specific to sinonasal disease in adult subjects with GPA. Studies were included only when they focused primarily on specific imaging results in patients with GPA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of 50 articles were identified on an initial search of medical literature data bases. There were seven articles that comprised 224 patients who met inclusion criteria. All the articles were retrospective case series and descriptive in nature. A high incidence of patients with GPA who were imaged showed evidence of pathologic findings. The prevalence of key radiographic findings in patients with GPA were the following: mucosal thickening (87.7% of patients), bony destruction (59.9%), and septal erosion (59.4%). There were no randomized or prospective studies that compared imaging findings between patients with GPA and the controls, and no studies that correlated imaging findings with prognosis. Sinus imaging in GPA revealed a spectrum of nonspecific findings. The constellation of septal erosion, mucosal thickening, and bony changes should raise suspicion for GPA. The current literature was insufficient to make any comments on the time course of sinonasal disease and imaging manifestations. Further comparative studies are needed to determine a role for sinonasal imaging in the diagnosis and prognosis of GPA.

RECENT OPTIONS IN MEDICAL TREATMENT OF PATIENTS WITH MODERATE TO SEVERE BACTERIAL RHINOSINUSITIS

Despite the fact that in the majority of cases rhinosinusitis is known to be viral, bacterial infections still play their role. Bacterial etiology for sinonasal pathology usually means more severe condition, chronic forms and frequent recurrence. Treatment of acute bacterial rhinosinusitis with systemic antibiotics is a challenging question. Unappropriate use of systemic antibiotics not only leads to individual treatment failure, but also causes global epidemiologic issues such as antibiotic resistance. The article reviews the role of respiratory fluoroqionolones in medical treatment of patients with moderate to severe bacterial rhinosinusitis.

Association of the Laterality of Chronic Suppurative Otitis Media with the Laterality of Sinonasal Disease Based on Temporal Bone CT - Scan Results and Lund Mackay Scoring System

Objective: To determine the association between the laterality of chronic suppurative otitis media (CSOM) and the laterality of sinonasal disease, based on temporal bone ct-scan results and Lund-Mackay Scoring system, among patients admitted for ear surgery in a tertiary government hospital in Metro Manila.&#x0D; Method:&#x0D; Design: Retrospective review of records&#x0D; Setting: Tertiary Government Hospital&#x0D; Patients: Ninety-eight patients diagnosed with chronic suppurative otitis media admitted for otologic surgery in the Department of Otorhinolaryngology – Head and Neck Surgery from January 2011 to June 2014 were considered for inclusion. Hospital charts and temporal bone ct-scan results were retrieved and analyzed for ear and sinonasal radiographic abnormalities and laterality. Excluded were those without CT-scan plates, who underwent temporal bone surgery for reasons other than chronic suppurative otitis media, and those with incomplete records. The Lund-Mackay Scoring System was used to grade sinonasal findings which were compared to CSOM complications. Data was analyzed using t-test, ANOVA for homogenous numerical data, Kruskal-Wallis for heterogenous numerical data, and chi-square test for nominal type of data. &#x0D; Results: Of the 64 patients included in the study, 12 or 18.75% had radiographic sinonasal abnormalities. There was no significant association between the laterality of ear disease and the laterality of sinonasal pathology as there was no significant difference in the proportion of subjects with sinonasal disease according to laterality of CSOM (p=.32). When site of nose pathology was compared to Lund-Mackay graded scores, it was found that bilateral nose pathology generally had a higher Lund-Mackay score of 8.60 ± 5.60. However, there was no significant difference in the Lund-Mackay score according to the nose pathology site (p=.20). An association was seen between total LMS and patients with ear pathologies, but no significant difference was noted (p=.44). Although patients with ear complications had higher LM scores, this was not statistically significant.&#x0D; Conclusion: Laterality of ear disease was not associated with the laterality of sinonasal disease, although CSOM complications were associated with high Lund-Mackay scores. Future, better-designed studies may shed more light on these associations.&#x0D; Keywords: chronic suppurative otitis media, sinonasal disease, Lund-Mackay, Temporal Bone CT-Scan