Sinusitis Group Research Articles

Research on the classification model of chronic sinusitis based on VGG

Objective:To build a VGG-based computer-aided diagnostic model for chronic sinusitis and evaluate its efficacy. Methods:①A total of 5 000 frames of diagnosed sinus CT images were collected. The normal group consisted of 1 000 frames（250 frames each of maxillary sinus, frontal sinus, septal sinus, and pterygoid sinus）, while the abnormal group consisted of 4 000 frames（1 000 frames each of maxillary sinusitis, frontal sinusitis, septal sinusitis, and pterygoid sinusitis）. ②The models were trained and simulated to obtain five classification models for the normal group, the pteroid sinusitis group, the frontal sinusitis group, the septal sinusitis group and the maxillary sinusitis group, respectively. The classification efficacy of the models was evaluated objectively in six dimensions: accuracy, precision, sensitivity, specificity, interpretation time and area under the ROC curve（AUC）. ③Two hundred randomly selected images were read by the model with three groups of physicians（low, middle and high seniority） to constitute a comparative experiment. The efficacy of the model was objectively evaluated using the aforementioned evaluation indexes in conjunction with clinical analysis. Results:①Simulation experiment: The overall recognition accuracy of the model is 83.94%, with a precision of 89.52%, sensitivity of 83.94%, specificity of 95.99%, and the average interpretation time of each frame is 0.2 s. The AUC for sphenoid sinusitis was 0.865（95%CI 0.849-0.881）, for frontal sinusitis was 0.924（0.991-0.936）, for ethmoidoid sinusitis was 0.895（0.880-0.909）, and for maxillary sinusitis was 0.974（0.967-0.982）. ②Comparison experiment: In terms of recognition accuracy, the model was 84.52%, while the low-seniority physicians group was 78.50%, the middle-seniority physicians group was 80.50%, and the seniority physicians group was 83.50%; In terms of recognition accuracy, the model was 85.67%, the low seniority physicians group was 79.72%, the middle seniority physicians group was 82.67%, and the high seniority physicians group was 83.66%. In terms of recognition sensitivity, the model was 84.52%, the low seniority group was 78.50%, the middle seniority group was 80.50%, and the high seniority group was 83.50%. In terms of recognition specificity, the model was 96.58%, the low-seniority physicians group was 94.63%, the middle-seniority physicians group was 95.13%, and the seniority physicians group was 95.88%. In terms of time consumption, the average image per frame of the model is 0.20 s, the average image per frame of the low-seniority physicians group is 2.35 s, the average image per frame of the middle-seniority physicians group is 1.98 s, and the average image per frame of the senior physicians group is 2.19 s. Conclusion:This study demonstrates the potential of a deep learning-based artificial intelligence diagnostic model for chronic sinusitis to classify and diagnose chronic sinusitis; the deep learning-based artificial intelligence diagnosis model for chronic sinusitis has good classification performance and high diagnostic efficacy.

Predictors of Non-Rhinogenic Facial Pain or Pressure in Otolaryngology Clinic.

Identify demographic and clinical characteristics that may help differentiate non-rhinogenic facial pain or pressure (NRFP) from sinusitis. Retrospective single-institution study. Tertiary Care Center Rhinology Clinic. All patients presenting with a complaint of facial pain or pressure over a 3-year period were included. Patients were categorized into either NRFP or sinusitis groups based on computed tomographyimaging and nasal endoscopy. Data pertaining to demographics, history, and SNOT-22 questionnaire domains were compared via univariate analysis as well as logistic regression with backwards variable selection. A total of 296 patients met inclusion criteria, of which 128 had NRFP and 168 had sinusitis. A significantly greater percentage of patients in the NRFP group were women of childbearing age (40.6% vs 28.0%, P = .02). Backwards variable selection resulted in a model with four variables predicting a diagnosis of NRFP-female sex (odds ratio [OR] = 2.998, P < .0001), no history of prior sinonasal surgery (OR = 0.340 for history vs no history, P < .01), low nasal domain score (OR = 0.551, P < .0001), and high ear/facial domain score (OR = 1.453, P < .01). Accurately identifying patients with NRFP at initial presentation based on history would help direct patients to the appropriate care pathway and prevent ineffective treatments such as antibiotics and sinus procedures. Our findings suggest that the suspicion for NRFP should be higher in women of child-bearing age as well as patients with greater ear/facial symptoms or lesser nasal symptoms.

Frequency of Accessory Maxillary Ostium in Patients With/Without Sinusitis, and Its Correlation with Anatomical Variations of Paranasal Sinuses: A Cone Beam Computed Tomography Study.

This study assessed the frequency of accessory maxillary ostium (AMO) in patients with/without sinusitis and its correlation with anatomical variations using cone-beam computed tomography (CBCT).In this cross-sectional study, 244 CBCT scans were evaluated in two groups: with maxillary sinusitis having > 2mm mucosal thickening and without max sinusitis as a normal group having normal or less than 2mm mucosa. The CBCT scans of each group were carefully evaluated for the presence/absence of AMO, patency/obstruction of the primary maxillary ostium (PMO), and the presence of anatomical variations of the paranasal sinuses. Data were analyzed by independent t-test, Pearson Chi-square test, and Fisher's exact test (alpha = 0.05).CBCT scans of 134 females (54.9%) and 110 males (45.1%) with a mean age of 34.16 ± 19.01 years were evaluated. The presence of AMO had no significant correlation with maxillary sinusitis (P = 0.104). The two groups had no significant difference in the frequency of Haller cell, nasal septal deviation, and concha bullosa (P > 0.05). However, the frequency of paradoxical concha (PC; P < 0.001) and bifid concha (BC; P = 0.017) was significantly higher in the normal group, and the frequency of PMO obstruction was significantly higher in the sinusitis group (P < 0.001). AMO had no significant correlation with any anatomical variation in any group (P > 0.05). Gender had a significant effect on the presence of AMO (P = 0.013).The presence of AMO had no significant correlation with maxillary sinusitis. However, its frequency was significantly higher in females in normal group and males with sinusitis. The presence of AMO had no significant correlation with anatomical variations.

Effect of TFF3 on tight junction protein in eosinophilic chronic sinusitis and its related mechanism

Objective: To study the effect of trefoil factor family (TFF) 3 on the expression of tight junctions (TJs) in the nasal mucosa epithelium of eosinophilic chronic rhinosinusitis (eCRS) and its mechanism. Methods: From September to December 2020, eligible patients from the Department of Otorhinolaryngology of the First Affiliated Hospital of Nanchang University were recruited, including 11 control patients and 37 patients with chronic rhinosinusitis with nasal polyps (CRSwNP), from whom nasal mucosa and nasal polyp tissue samples were collected. Immunohistochemistry (IHC) was used to detect the localization and expression intensity of TFFs (TFF1, TFF2 and TFF3) and TJs (occudin, claudin-1 and ZO-1) in nasal mucosa. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and western blot (WB) were used to detect the mRNA and protein expression. A cell model of tight junction injury in human nasal epithelial cells (HNECs) through stimulation with interleukin (IL)-13 was also established. The optimal modeling concentration and time for HNECs were determined, which were subsequently treated with TFF3 and/or a phosphoinositide 3-kinase (PI3K)-specific inhibitor (LY294002). Finally, RT-qPCR and WB were used to assess the effects of TFF3 on tight junctions and the PI3K/serine/threonine kinase (Akt) signaling pathway. Data were analyzed statistically using GraphPad Prism 7 software. Results: IHC results showed that the expression of TFF1 and TFF3 in nasal mucosa of eCRS group was significantly higher than that of control group (t=4.62, P=0.002; t=5.89, P<0.001), respectively, mainly expressed in goblet cell. The expression of occludin, claudin-1 and ZO-1 in the nasal mucosa of the eCRS group was lower than that of the control group (occludin t=3.98, P=0.019; claudin-1 t=5.15, P=0.002; ZO-1 t=5.42, P=0.001), respectively. WB results showed that the expression of TFF3 in non-eosinophilic chronic sinusitis (Non-eCRS) group and eCRS group was higher than that in the control group (t=3.62, P=0.036; t=5.93, P<0.001). The expression of occludin, claudin-1 and ZO-1 in eCRS group was lower than that in the control group (occludin t=5.14, P=0.002; claudin-1 t=6.35, P<0.001; ZO-1 t=6.64, P<0.001), respectively. The RT-qPCR results showed that compared with the control group, the levels of TFF1 and TFF3 mRNA were increased in the nasal mucosal epithelium of the Non-eCRS and eCRS groups (TFF1 t=3.98, P=0.046, t=4.89, P=0.002; TFF3 t=3.50, P=0.044, t=6.78, P<0.001). There was no statistically significant difference in TFF2 mRNA levels between the Non-eCRS and eCRS groups (t=1.34, P=0.061; t=3.37, P=0.055). Compared with the control group, Non-eCRS and eCRS groups showed a decrease in the mRNA levels of occludin, claudin-1 and ZO-1 (occludin t=4.27, P=0.011, t=5.61, P=0.007; claudin-1 t=3.62, P=0.036, t=6.80, P<0.001; ZO-1 t=3.47, P=0.047, t=7.86, P<0.001). The mRNA levels of TFF3 and TJs in eCRS nasal mucosa tissue showed a moderate positive correlation (occludin r=0.661, claudin-1 r=0.614, ZO-1 r=0.548, all P<0.001); TFF1 showed a low degree of positive correlation with the expression of occludin, claudin-1 and ZO-1 (occludin r=0.467, P=0.040; claudin-1 r=0.362, P=0.012; ZO-1 r=0.425, P=0.025). The establishment of cell models showed that compared with normal HNECs, the mRNA expression of TFF3 was most significantly increased at a concentration of 50 ng/ml stimulated by IL-13 (t=3.72, P=0.013); The mRNA expression of occludin, claudin-1 and ZO-1 decreased (occludin t=3.18, P=0.031; claudin-1 t=3.86, P=0.010; ZO-1 t=5.16, P=0.002). The expression of TFF3 mRNA increased most significantly after 15 hours of IL-13 stimulation (t=3.14, P=0.034); The mRNA expression of occludin, claudin-1 and ZO-1 decreased (occludin t=3.97, P=0.010; claudin-1 t=4.78, P=0.004; ZO-1 t=5.16, P=0.004). TJs damage model could be established by treating HNECs with 50 ng/ml IL-13 for 15 hours. Intervention experiments showed that compared with the IL-13 group, the IL-13+TFF3 group showed an increase in TJs mRNA expression (occludin t=6.10, P=0.009; claudin-1 t=5.90, P=0.013; ZO-1 t=9.44, P=0.007). Compared with the IL-13 group, the expression of TJs protein in the IL-13+TFF3 group increased (occludin t=3.23, P=0.013; claudin-1 t=9.40, P=0.017; ZO-1 t=2.23, P=0.032); The expression of TJs protein decreased in the IL-13+TFF3+LY294002 group (occludin t=4.73, claudin-1 t=8.77, ZO-1 t=3.51, all P<0.001). Compared with the IL-13+TFF3 group, the IL-3+TFF3+LY294002 group showed a decrease in PI3K and p-Akt/Akt protein expression (PI3K t=13.29, p-Akt/Akt t=10.30, all P<0.001). The increased mRNA and protein expression of occludin, claudin-1 and ZO-1 induced by TFF3 were also inhibited by LY294002. Conclusion: TFF3 can up-regulate the expression of occludin, claudin-1, and ZO-1 through PI3K/Akt pathway, and has a certain protective effect on the nasal mucosal epithelial barrier, providing a new idea for treating eCRS.

Correlation between chronic sinusitis subtypes and basophil levels in peripheral blood

Objective:To explore the clinical correlation between peripheral blood basophil levels and chronic sinusitis （CRS） subtypes. Methods:One hundred and twenty-six patients with CRS and 103 healthy cases from physical examination admitted to the First Affiliated Hospital of Soochow University from January 2021 to October 2022 were retrospectively analyzed. According to the histopathological classification, CRS patients were divided into eosinophilic chronic sinusitis （eCRS） group （47 cases） and non eosinophilic chronic sinusitis （non-eCRS） group （79 cases）. The differences among the three groups in peripheral blood inflammation cell counts, eosinophils-to-basophils ratio（bEBR）, basophils-to-neutrophils ratio（BNR）, basophils-to-lymphocytes ratio（BLR）, basophils-to-monocytes ratio（BMR） were compared, and study the correlation between each index and Lund-Mackay score, and the correlation between basophils in peripheral blood and other inflammatory cells. Results:The counts of basophils in the peripheral blood of the healthy control group, eCRS group and non-eCRS group were 0.03±0.01, 0.04±0.02, 0.03±0.02, respectively, the eosinophils-to-basophils ratio（bEBR） were 5.64±4.22, 8.38±5.95, 4.55±3.90, the basophils-to-neutrophils ratio（BNR） were 0.01±0, 0.01±0.01, 0.01±0.01, and the basophils-to-lymphocytes ratio（BLR） were 0.01±0.01, 0.02±0.01, and 0.02±0.01, respectively, the basophils-to-monocytes ratio（BMR） were 0.08±0.04, 0.11±0.06, and 0.08 ±0.04 respectively. There was a statistically significant difference between eCRS group and healthy control group, non-eCRS group（P<0.01）, while there was no statistically significant difference between non-eCRS group and healthy control group（P>0.05）. Basophil counts （r=0.185 5, P<0.05）, BLR（r=0.226 9, P<0.05）, BMR（r=0.228 1, P<0.01） in patients with CRS were positively correlated with Lund Makey score. In addition, basophils were also positively correlated with eosinophils（r=0.479 2, P<0.01）, lymphocytes（r=0.259 4, P<0.01）, and monocytes（r=0.256 4, P<0.01） in patients with CRS. Conclusion:The peripheral blood basophil count, BLR and BMR were significantly increased in eCRS, and were significantly positively correlated with Lund -Makey score. It has the potential to develop into disease biomarkers and new therapeutic targets of eCRS.

The prevalence of headshaking in horses with primary and secondary dental sinusitis and computed tomographic evidence of infraorbital canal pathology.

Sinusitis is a common disease of horses yet there are a limited number of reports in the literature that describe the prevalence of infraorbital canal (IOC) pathology and headshaking behaviour in horses diagnosed specifically with primary sinusitis and secondary dental sinusitis. Given the impact that these behaviours can have on horses' intended athletic use, investigation is warranted. To determine the occurrence of IOC pathology in horses with concurrent primary or secondary dental sinusitis based on computed tomography (CT) findings and to assess whether the frequency of headshaking behaviour is influenced by the presence of IOC pathology. Retrospective case series. Computed tomography studies were assessed for sinusitis (unilateral or bilateral), IOC pathology (unilateral or bilateral) and description of IOC disease including displacement, deformation, periosteal proliferation, hyperostosis, osteolysis and infraorbital nerve exposure. Behaviour outcome was determined by client questionnaire five or more years following CT scan. A total 65 out of 66 horses diagnosed with primary or secondary dental sinusitis demonstrated IOC changes on CT. Hyperostosis (86%), periosteal proliferation (85%) and osteolysis (86%) were common CT findings. Hyperostosis was frequently found to involve both the IOC and supporting bone structure. Five cases were euthanized immediately after CT acquisition or during hospitalisation following diagnostic investigations. Follow-up was obtained in 48/61 cases, with five horses showing headshaking behaviour. Infraorbital nerve histopathology was not performed. The limited number of cases with no IOC pathology prevented direct comparison between sinusitis groups both with IOC pathology and without IOC changes. The client questionnaire carries a memory bias. Computed tomography changes involving the IOC may not predict headshaking behaviours in sinusitis secondary to dental disease. This finding is important in the context that these behaviours render some horses unusable and unsafe for their intended riding discipline.

Limits of stability among patients with Chronic Maxillary Sinusitis: A Cross-sectional Comparative study

Background: Sinusitis also known as Rhino sinusitis is the inflammation of sinuses that involves one or more cavities that could be due to bacterial or viral infection or even due to allergies. The patients may experience pain and tenderness around eyes, cheeks, nose and forehead, facial swelling, headache may be severe with nasal congestion. The secretions could have an impact on the vestibular apparatus which possibly may cause balance impairment. This study is intended to analyze the effect of chronic maxillary sinusitis (CMS) on balance. Objective: The aim of the study is to analyze the impact of CMS on the limits of stability. Materials and Methods: Thirty participants within the age group 20-40 were selected. Group A consisted of 15 patients with chronic maxillary sinusitis (CMS). Group B were matched controls (n=15) with the same age group, as that of the sinusitis group. Both male and female subjects within the age group of 20-40 years were included. Subjects with any other illness like trigeminal neuralgia, tension type headache, cervicogenic headache and other types of sinusitis were excluded. Functional Reach Test (FRT) between two groups were analysed Results: The mean FRT in patient with CS is 32.5 ± 9.5 cm. While in matched controls is 36.8 ± 7.9 cm. There exists significance difference (p=0.002) between them. Conclusion: Patient with chronic maxillary sinusitis has less functional reaching capability and thereby decreased limits of stability when compared to the matched peers.

The Ground-Glass Ethmoid Sinus Sign" May be the Sole Indicator for Acute Sinusitis on CT: A New Sign at Paranasal Sinus CT Images

Objective: In this retrospective study we aimed to investigate the diagnostic value of “Ground-Glass Ethmoid Sinus Sign” (GGESS) in ethmoid cells in patients with clinical acute sinusitis. Patients and Methods: Between January 2018-December 2018, 440 CT of the paranasal region taken for any reason in our clinic were evaluated. Mucosal thickening of the paranasal sinus wall, secretion levels, secretion bands, and Ground-Glass Signs on Ethmoid cellular walls (GGESS) were evaluated by two radiologists. The diagnostic significance of GGESS in patients with clinically positive findings and those without a diagnosis of sinusitis was statistically analyzed. Results: Patients were included in the study classified as having acute sinusitis (Group 1-103 cases) and without a clinical history of acute sinusitis (Group 2-337 cases). In the diagnosis of acute sinusitis, GGESS had a positive predictive value of 79%, a negative predictive value of 95%, a sensitivity of 86%, and a specifity of 93%. The GGESS finding was found to be significantly higher in the acute sinusitis group as 86%, while it was 7% in the asymptomatic group (p&lt;0.001). Conclusion: The presence of “GGESS” on paranasal sinus CT images is associated with acute sinusitis significantly more than any other sinus inflammation findings.

Association between sinusitis and relapse and changes in the myeloperoxidase-antineutrophil cytoplasmic antibody in microscopic polyangiitis.

Previous studies have evaluated the risk factors for relapse of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and the biomarkers of AAV for predicting relapse. However, little is known about the association between the presence of sinusitis and relapse and changes in the ANCA levels in AAV. This single-center, retrospective cohort study included 104 consecutive patients who were newly diagnosed with myeloperoxidase (MPO)-ANCA-positive microscopic polyangiitis (MPA) between 2006 and 2018 and were treated at the Aichi Medical University Hospital in Japan. The relationships between sinusitis and relapse of vasculitis and elevated MPO-ANCA levels were assessed using multivariate Cox proportional hazards models that were adjusted for clinically relevant factors. During the entire follow-up period (median, 24 months; interquartile range, 7–54 months), 93 (89.4%) patients achieved remission. After achieving remission, 38 (40.9%) patients experienced at least one relapse (13 [65.0%] in the sinusitis group; 25 [34.3%] in the non-sinusitis group). Sinusitis was identified as a significant predictor of relapse (adjusted hazard ratio: 2.41, 95% confidence interval [CI]: 1.19–4.88; P = 0.015). Furthermore, sinusitis was more likely to be associated with elevated MPO-ANCA levels (adjusted hazard ratio: 2.59, 95% CI: 1.14–5.92; P = 0.024). In conclusion, sinusitis was associated with a higher risk of relapse and elevated MPO-ANCA levels in MPA patients, suggesting that careful management may be required to reduce the risk of relapse in patients with sinusitis. Further studies are needed to elucidate the optimal treatment strategy for these patients.

Role of specific IgE on staphylococcal enterotoxin B in chronic rhinosinusitis severity.

To investigate the clinical significance of specific IgE-staphylococcal enterotoxin B (IgE-SEB) in CRS (chronic rhinosinusitis). Retrospective analysis of patients who were positive for specific IgE-staphylococcal enterotoxin B. Tertiary rhinology clinic. A total of 965 patients who were tested for specific IgE-staphylococcal enterotoxin B from December 2016 to December 2017. We retrospectively reviewed the records of 965 patients who were tested for specific IgE-staphylococcal enterotoxin B from December 2016 to December 2017. Patient demographics, titre-specific IgE to staphylococcal enterotoxin B levels, MAST, serologic test and medical records were reviewed. IgE-SEB (KU/L) was higher in CRS patients than non-CRS patients (0.13±0.37 vs 0.08±0.22, respectively; P-value: .044), and the IgE-SEB (+, ≥0.35) rate was also higher (10.06% vs 4.46%, respectively; P-value: .030). IgE-SEB(KU/L) was higher in the CRS group than in the fungal sinusitis group (0.13±0.37 vs 0.03±0.05, respectively; P-value: <.001), and the IgE-SEB (+, ≥0.35) rate was also higher (10.06% vs 0%, respectively; P-value: .015). Between the CRSsNP (chronic rhinosinusitis without nasal polyps) and CRSwNP (chronic rhinosinusitis with nasal polyps) groups, there were no differences in IgE-SEB (KU/L) or IgE-SEB (+) rates. IgE-SEB positivity was not associated with the presence of polyps, concomitant asthma or postoperative recurrence. As the values of IgE-SEB (KU/L) and the IgE-SEB (+, >0.1) rate increased, the CRS severity also increased. IgE-SEB showed a positive correlation with Lund-Mackay CT severity score, but not with postoperative recurrence or nasal polyps. Further studies are needed to obtain clear evidence that IgE-SEB can be considered as an independent CRS endotype.

Asymmetry of Height and Width of Ethmoid Sinus and Its Association with Chronic Sinusitis: A Cross Sectional Study.

Background: In this study, we aimed to investigate the association between chronic anterior sinusitis with the width and height of ethmoid sinus and also assess the ethmoid length and roof asymmetry in the Iranian adult population. Material and Methods: This cross-sectional study was carried out on 422 patients who were referred with clinical signs of rhinosinusitis to the ENT Center of Tabriz University of Medical Sciences. Study participants were divided into healthy and sinusitis groups based on the level of sinus involvement. Computed tomography images were applied to calculate ethmoid height and width. A paired t-test was used to assess the roof and width asymmetry and an independent t-test was used to investigate the association between ethmoid height and width with the incidence of rhinosinusitis. Results: The mean age of sinusitis and healthy groups was 42.5±18.9 and 38.4±17.1 years, respectively. Of a total 422 subjects, 63.4% of whom were men. The overall prevalence of rhinosinusitis was 28.0%. We observed a statistically significant difference in terms of ethmoid height, and in both healthy and sinusitis group right ethmoid roof was statistically lower (P<0.05). However, no statistical difference was observed between the left and right side regarding the ethmoid sinus width (P>0.05). We also estimated correlation coefficients for rhinosinusitis score and ethmoid sinus height and width, which were not statistically significant (P>0.05). Conclusion: Our study shows that the right side of the ethmoid roof was lower in comparison to the left side, and it should be fully understood and regarded in rhino sinus surgery. We also observed no association between sinusitis score and height and width of the ethmoid sinus.

Asymmetry of Height and Width of Ethmoid Sinus and Its Association with Chronic Sinusitis: A Cross Sectional Study

Background: In this study, we aimed to investigate the association between chronic anterior sinusitis with the width and height of ethmoid sinus and also assess the ethmoid length and roof asymmetry in the Iranian adult population. Materials and Methods: This cross-sectional study was carried out on 422 patients who were referred with clinical signs of rhinosinusitis to the ENT Center of Tabriz University of Medical Sciences. Study participants were divided into healthy and sinusitis groups based on the level of sinus involvement. Computed tomography images were applied to calculate ethmoid height and width. A paired t-test was used to assess the roof and width asymmetry and an independent t-test was used to investigate the association between ethmoid height and width with the incidence of rhinosinusitis. Results: The mean age of sinusitis and healthy groups was 42.5±18.9 and 38.4±17.1 years, respectively. Of a total 422 subjects, 63.4% of whom were men. The overall prevalence of rhinosinusitis was 28.0%. We observed a statistically significant difference in terms of ethmoid height, and in both healthy and sinusitis group right ethmoid roof was statistically lower (P&lt;0.05). However, no statistical difference was observed between the left and right side regarding the ethmoid sinus width (P&gt;0.05). We also estimated correlation coefficients for rhinosinusitis score and ethmoid sinus height and width, which were not statistically significant (P&gt;0.05). Conclusion: Our study shows that the right side of the ethmoid roof was lower in comparison to the left side, and it should be fully understood and regarded in rhino sinus surgery. We also observed no association between sinusitis score and height and width of the ethmoid sinus. [GMJ.2020;9:e1748]

P107 SINUSITIS IS A RISK FOR SUBSEQUENT INFLAMMATORY BOWEL DISEASE

Abstract Introduction The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterized by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analysis from our group (ACG 2019) identified an increased prevalence of sinusitis among patients with IBD, but that work did not include a stratified analysis of IBD patients with sinusitis based on the order in which these conditions were diagnosed. Methods This is a retrospective study at our tertiary IBD center. We utilized our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between January 2000 and May 2019 and age ≥18 years were included. Demographic and disease related information were collected, including dates of diagnosis for both sinusitis and IBD. Categorical variables were analyzed using Fisher’s exact test and continuous variables were analyzed using Wilcoxon rank sum test. Results Of 14,366 patients with IBD, 386 patients (2.69%) were diagnosed with both IBD and sinusitis (IBD+S). The average age of IBD diagnosis in the IBD only group was 37.30 (18.76) years and IBD+S group was 38.36 (19.81) years (p = 0.27). Of the 386 patients with IBD+S, 268 (69.4%) were diagnosed with IBD before sinusitis and 118 (30.6%) were diagnosed with IBD after sinusitis (Table 1). The average age of IBD diagnosis in the IBD before sinusitis group was 33.2 ± 17.3 years, which was significantly younger than patients in the IBD after sinusitis group of 50.2 ± 20.2 years (p &amp;lt; 0.001). The average time between diagnoses was significantly more in the group diagnosed with IBD before sinusitis compared with the group diagnosed with IBD after sinusitis (7.64 ± 8.89 years vs 3.73 ± 3.16 years, respectively; p &amp;lt; 0.001). In addition, patients diagnosed with IBD after sinusitis were significantly less likely to be of white race, never smokers, have Crohn’s disease, bowel obstruction, or be receiving immunosuppressive medications. Conclusions There are significant differences in the characteristics of patients with IBD and sinusitis from IBD only patients, and even greater differences when stratifying the IBD+S group based on the order of diagnoses. Within the subgroup of IBD+S, most notably, patients with sinusitis first have an older age of IBD diagnosis. These findings suggest that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent risk of IBD.

Clinicopathological and Radiological Features of Chronic Rhinosinusitis with Eosinophilic Mucin in Chungcheong Province of Korea.

Chronic rhinosinusitis (CRS) with eosinophilic mucin is considered rare in Korea. The object of this study was to categorize CRS patients with eosinophilic mucin into several groups and compared the groups based on their clinicopathological and radiological features. In total, 105 CRS patients with eosinophilic mucin from four tertiary medical centers which are located at Chungcheong province of Korea were included for this study. The patients were divided into four groups for analysis, based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin. The following were the four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F-), eosinophilic fungal rhinosinusitis (EFRS, A-F+), and eosinophilic mucin rhinosinusitis (EMRS, A-F-). Their clinical manifestation, the presence of associated disease, radiological finding, treatment, and treatment outcome were reviewed and compared. There were no patients in the AFRS-like sinusitis group, 47 patients were assigned to the AFRS group, 27 to the EFRS group, and 41 to the EMRS group. Patients of AFRS group showed a significantly higher association with allergic rhinitis than did the other groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. In the AFRS group and EFRS group, 67.6% and 74.1% had unilateral disease, respectively, in contrast to the EMRS group (4.9%). The mean Hounsfield unit values of the area of high attenuation in the AFRS patients were significantly higher than those in the other groups. Significant clinicopathological differences existed among the subgroups of CRS with eosinophilic mucin. AFRS tends to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi might play a role in the disease. EMRS is thought to be unconnected with fungal allergies, and it showed different form compared with the AFRS and EFRS groups.

Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis

IntroductionChronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. ObjectivesTo compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. MethodsTotal of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund–Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). ResultsThere was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund–Mackay scores. However in Group 1, the results of the comparison of postoperative Lund–Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. ConclusionThe success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.

Assessment of endoscopic sinus surgery in management of sinonasal diseases

Background: functional endoscopic sinus surgery (FESS) has revolutionized surgical care, opening new horizons in the management of chronic rhinosinusitis and other paranasal sinus disorders Messerklinger established and reinterated the importance of the sinus ventilation and pattern of mucociliary clearance. FESS was first described independently by both Messerklinger in German literature and Wigand. Aim of the work: this study aimed to assess the efficacy, safety and benefits of FESS in cases of chronic recurrent rhinosinusitis with or without nasal polyposis, fungal sinusitis,septal and turbinate pathology and CSF rhinorhea in terms of morbidity, mortality and recurrent of disease. Patients and Methods: This study was conducted in Bab Elshaerea University Hospital and Hearing and Speech Institute from July 2017 to August 2018. A total of 50 patients with clinical evidence of sinonasal diseases were categorized into 4 groups (Chronic recurrent rhinosinusitis with or without nasal polyposis (20 patients) ,fungal sinusitis (10 patients),septal and turbinate pathology(10 patients) and CSF rhinorhea(10 patients)). Patients were evaluated with nasal endoscopy and computed tomographic (CT) evaluation prior to FESS. Results: out of 50 patients, 26 were male and 24 were female in the present study. Male: female ratio was 52:48. Depending on symptoms, endoscopic examination and CT scanning, three patients only had a recurrence (Two patients from group of chronic recurrent rhinosinusitis with or without nasal polyposis and one patient from fungal sinusitis group). Conclusion: FESS provided an excellent and safe method for treating sinonasal disease. The success rates were encouraging, but because of the nature and chronicity of the disease, longer follow-up was necessary to truly assess the surgical effectiveness of the procedure.

Assessment of endoscopic sinus surgery in management of sinonasal diseases

Background: functional endoscopic sinus surgery (FESS) has revolutionized surgical care, opening new horizons in the management of chronic rhinosinusitis and other paranasal sinus disorders Messerklinger established and reinterated the importance of the sinus ventilation and pattern of mucociliary clearance. FESS was first described independently by both Messerklinger in German literature and Wigand. Aim of the work: this study aimed to assess the efficacy, safety and benefits of FESS in cases of chronic recurrent rhinosinusitis with or without nasal polyposis, fungal sinusitis,septal and turbinate pathology and CSF rhinorhea in terms of morbidity, mortality and recurrent of disease. Patients and Methods: This study was conducted in Bab Elshaerea University Hospital and Hearing and Speech Institute from July 2017 to August 2018. A total of 50 patients with clinical evidence of sinonasal diseases were categorized into 4 groups (Chronic recurrent rhinosinusitis with or without nasal polyposis (20 patients) ,fungal sinusitis (10 patients),septal and turbinate pathology(10 patients) and CSF rhinorhea(10 patients)). Patients were evaluated with nasal endoscopy and computed tomographic (CT) evaluation prior to FESS. Results: out of 50 patients, 26 were male and 24 were female in the present study. Male: female ratio was 52:48. Depending on symptoms, endoscopic examination and CT scanning, three patients only had a recurrence (Two patients from group of chronic recurrent rhinosinusitis with or without nasal polyposis and one patient from fungal sinusitis group). Conclusion: FESS provided an excellent and safe method for treating sinonasal disease. The success rates were encouraging, but because of the nature and chronicity of the disease, longer follow-up was necessary to truly assess the surgical effectiveness of the procedure.

Adenoidectomy May Not Be Effective to Reduce the Number of Hospital Visits for Sinusitis.

BackgroundThe objective of this study was to compare post-operative (post-op) visits for sinusitis between adenoidectomy and non-adenoidectomy participants (control).MethodsUsing the national cohort study from the Korean Health Insurance Review and Assessment Service, we used 1:4 matching to select 2,593 adenoidectomy participants and 10,372 control participants. Post-op visits for sinusitis were measured from post-op 1 year through post-op 9 years. Equivalence testing was used. Margin of equivalence of difference was set as −0.5 to 0.5 in this study.ResultsThere were trivial differences between the two groups from post-op 1 to 2 years. However, there was no difference between the two groups from post-op 3 through 9 years. Visits for sinusitis gradually decreased in both groups. In the rare and frequent pre-operative sinusitis group, there were minor differences in both groups from post-op 1 to 2 years. In contrast, there were no differences between the two groups in rare and frequent pre-operative sinusitis groups from post-op 3 through 9 years. In the 0–4 years old group, there were minor differences between both groups from post-op 1 to 2 years. However, no differences in the number of visits for sinusitis were found between the two groups during follow up periods from post-op 3 through 9 years. Additionally, there were no differences between the two groups during the entire follow up period.ConclusionAdenoidectomy does not reduce post-op visits for sinusitis. Sinusitis decreased over time whether adenoidectomy was performed or not.

Oral corticosteroid prescribing habits for rhinosinusitis: The American Rhinologic Society membership.

In the field of otolaryngology, oral corticosteroids (OCS) are widely prescribed for rhinosinusitis. Although there is evidence in the literature regarding specific OCS dosing protocols, it is not known to what extent these recommendations are being followed. To examine the current state of OCS prescribing habits for rhinosinusitis by American Rhinologic Society members. An anonymous online survey was sent to all American Rhinologic Society members. Dosing, frequency, tapering, and overall prescribing habits for OCS were assessed in chronic rhinosinusitis with polyposis (CRSwP) and in chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis. The CRSwP group was subdivided into aspirin-exacerbated respiratory disease, allergic fungal sinusitis, and not otherwise specified. Results were compared with current guidelines. Descriptive statistics were used to analyze data. Ninety-three surveys were completed (response rate, 12.9%). Prednisone was the most common OCS prescribed. In the CRSwP-aspirin-exacerbated respiratory disease group (n = 86), the median starting dose was 60 mg (range, 4-80 mg) and the average duration was 8 days (range, 2-28 days). In the CRSwP-allergic fungal sinusitis group (n = 81), the median starting dose was 50 mg (range, 20-60 mg), and the average duration was 6 days (range, 2-35 days). In the CRSwP-not otherwise specified group (n = 84), the median starting dose was 50 mg (range, 20-80 mg) and the average duration was 5 days (range, 1-21 days). OCS were prescribed for chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis by 66.0 and 62.4% of respondents, respectively. Significant heterogeneity existed in OCS prescribing habits for rhinosinusitis. Discrepancies were observed between survey results and evidence-based recommendations. Developing standardized OCS treatment protocols for rhinosinusitis may improve the quality of care by optimizing clinical outcomes and reducing the risk of complications.

Management of frontal sinusitis–associated subperiosteal abscess in children less than 9 years of age

To investigate practice patterns for cases of subperiosteal abscess (SPA) with concomitant frontal sinusitis to identify factors favorable to medical management in children <9years of age. The medical records of all pediatric cases of orbital and periorbital cellulitis admitted at a tertiary care center from 1999-2014 were reviewed retrospectively. Cases were included if radiography demonstrated sinusitis-associated SPA in children <9years of age. Cases of SPA with ipsilateral frontal sinusitis were compared to cases of SPA without ispilateral frontal sinus involvement. A total of 21 cases with ipsilateral frontal sinusitis and 76 without were included. Patients with frontal sinusitis had a higher incidence of nonmedial SPA compared to those without frontal sinus involvement (6/21 vs 5/76, P=0.01). Yet a majority of SPAs in the frontal sinusitis group were located medially (15/21 [71%]). All patients with superior or superomedial SPA underwent early surgical intervention. However, 14 of 15 patients (93%) in the frontal sinusitis cohort with medial SPAs were managed successfully with medical therapy alone. Medical management of frontal sinusitis-associated SPA appears safe for select children <9years of age with medial abscess. Although frontal sinusitis is cited as a criterion for surgical drainage of SPA, this criterion should be refined to frontal sinusitis with superiorly located abscesses.