Ventilation Of Paranasal Sinuses Research Articles

A clinical study with changes in microbiological flora in chronic rhinosinusitis

Background: Chronic rhinosinusitis (CRS) is characterized by mucous membrane inflammation that lines the paranasal sinuses and nasal cavity for at least twelve consecutive weeks. Microbes play a major role in pathogenesis. The treatment objectives are to reduce mucosal edema, restore paranasal sinus ventilation, and eliminate infectious pathogens. Aims and Objectives: (1) To study the presenting clinical features of chronic sinusitis. (2) To study the changes in microbiological flora. Materials and Methods: The study was conducted on 202 patients in the Department of ENT and Microbiology (JNMCH) from December 2020 to 2022. Patients above the age of 10 years were evaluated in this study. Those who received antibiotics in the last week of the presentation and those resistant to medical therapy were excluded. Patients were subjected to a detailed history, the clinical examination, and a radiological examination. Under all aseptic precautions and after the patient’s informed consent, the sample was taken from the middle meatus area for culture and sensitivity. Results: The study had a male predominance (71.28%), with the maximum number of patients in the age group 21–30 years (38.11%). The most common clinical features were nasal obstruction (96.03%) and mucopurulent discharge (100%). The most common isolate was Staphylococcus aureus (45.13%). Conclusion: Bacterial infection is a major etiological factor in CRS. Screening for S. aureus carriers may be an alternative to decrease the infection of S.aureus. There is a statistically significant increasing trend for methicillin-resistant S. aureus (19.46%) and fungal sinusitis (13.36%).

A retrospective study on variations of uncinate process of ethmoid bone using cone-beam computed tomography

Background: Uncinate process (UP) is a key landmark in the lateral wall of the nose which plays a vital role in the ventilation of paranasal sinuses and is also the first structure to be resected during functional endoscopic sinus surgery (FESS). The variations in this structure can lead to intraoperative and postsurgical complications during the FESS procedure. Aim: The aim of this study was to evaluate the variations of UP of ethmoid bone using cone-beam computed tomography (CBCT). Materials and Methods: Retrospective data of 100 cone-beam computed radiographic CBCT images of paranasal sinuses were evaluated using CS 3D version 3.10.12 software for variations in the superior attachment of UP (SAUP) using Landsberg and Friedman and the presence of pneumatization of UP. Out of 100 CBCT images, 56 were of males and 44 were of females. Statistical Analysis Used: Chi-square test was used for statistical analysis. Results: In our study, a total of 200 sides in 100 CBCT images were studied and Type I SAUP (51%) was observed as the most common type, followed by Type II (17%), Type IV (11.5%), Type III (10%), Type V (6.5%), and Type VI (4%) is the least common type observed. No statistically significant difference was observed among gender regarding SAUP. Pneumatization of UP was seen in 7% of cases, out of which 4% were in males and 3% were in females. Conclusion: Preoperative analysis of UP variations using CBCT can reduce intraoperative and postoperative complications during FESS with less radiation exposure.

Computational assessment of the nasal air conditioning and paranasal sinus ventilation from nasal assisted breathing therapy

Nasal cannula oxygen therapy is a common treatment option for patients with respiratory failure but needs further investigation to understand its potential for use for assisted breathing. Air with a high oxygen level is introduced into the nasal cavity using a nasal cannula during assisted breathing via oxygen therapy. The treatment impacts the nasal airflow dynamics and air-conditioning function. This study aims to investigate the nasal heat and mass transfer and sinus ventilation during assisted breathing at different operating conditions using computational fluid dynamics simulations. The nasal geometry was reconstructed from high-resolution computed tomography scans of a healthy subject. A constant inhalation flow rate of 15 LPM (liters per minute) was used, and the nasal cannula flow rate was set to between 5 and 15 LPM. The results demonstrated that assisted breathing at a high flow rate impacted sinus ventilation. It also changed the mucosal surface heat and mass transfer, thus inhaled air temperature and humidity. The high flow assisted breathing at 36 °C affected the nasal heat flux the most compared with other breathing conditions, while the low flow assisted breathing had minimal effect and, therefore, could be considered ineffective for any relevant treatment.

Pediatric orbital cellulitis: Case report of an unusual etiology and pathogen.

Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of Streptococcus constellatus/Parvimonas micra, and he received further antibiotics with full recovery.The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.

Correlation of anatomical variations in chronic sinusitis with diagnostic nasal endoscopy and CT scan of paranasal sinuses: an observational study

<p class="abstract"><strong>Background:</strong> Drainage and ventilation of paranasal sinuses are important for normal function which depends on effective mucociliary clearance. In present study we tried to emphasize variations in lateral wall of nose and clinical features leading to nose and paranasal sinus disease using diagnostic nasal endoscopy and variations in CT scan of paranasal sinuses. The objectives of the study are to observe various anatomical variations in nose and paranasal sinuses and their clinical presentation using diagnostic nasal endoscopy and CT scan of paranasal sinuses and to compare various anatomical variations in nose and paranasal sinuses.</p><p class="abstract"><strong>Methods: </strong>Present study included 54 patients presenting in Department of ENT, Head and Neck Surgery, during February 2015 to February 2017. </p><p class="abstract"><strong>Results:</strong> Diagnostic nasal endoscopy findings reveal that most common finding was polypoidal changes in nasal mucosa in 36 (66.67%) of patients, followed by mucopurulent discharge in 26 (48.14%), postnasal discharge in 20(37.03%) and 4 (7.40%) patients showed prominent agger nasi cell. CT scan of paranasal sinuses revealed multiple sinus involvement in 41 (75.92%) of patients with partial involvement of sinuses. Complete sinus opacification with pan sinusitis was observed in 9 (16.67%), blockade at osteomeatal complex was observed in 46 (85.18%), paradoxical middle turbinate was observed in 5 (9.25%), Concha bullosa was observed in 12 (22.23%) of patients.</p><p class="abstract"><strong>Conclusions:</strong> Each variation have an anatomic and surgical significance, hence each and every case should be individually studied in detail before undergoing functional endoscopic sinus surgery to maximize patient benefit and to prevent unnecessary complications. Diagnostic nasal endoscopic examination is clinical guide to evaluate disease.</p>

Prevalence and Risk Factors of Chronic Sinusitis among People in Jazan Region' KSA

Background: Chronic Sinusitis results from the impairment of paranasal sinus ventilation. Symptoms of chronic sinusitis include facial pressure, fullness or pain, nasal obstruction, headache, clear or mucopurulent nasal discharge and hyposmia or anosmia. Risk factors of chronic sinusitis involve smoking, allergy, septal deviation, aspirin sensitivity and bronchial asthma. Objective: To determine the prevalence of chronic sinusitis and it’s related risk factor as well as correlation with demographics. Methods: The present study included 867 participants using Monkey survey for investigation which included 20 questions. Results: There were 25.3% of participants had chronic sinusitis, 26.4% of the males and 22.4% of females suffer from the disease. Chronic sinusitis was more prevailed among young, the younger aged participants in addition to those living in rural area. Chronic sinusitis was less prevalent in married persons and those working in a medical job. Presence of any type of allergy was a risk factor for chronic sinusitis. Conclusion: Chronic sinusitis and allergy consider as risk factors for chronic sinusitis.

Clinical applications of dual-energy CT in head and neck imaging.

Dual-energy CT provides insights into the material properties of the tissues and can differentiate between tissues that have similar attenuation on conventional, single energy CT imaging. It has several useful and promising applications in head and neck imaging that an otolaryngologist could use to deliver improved clinical care. These applications include metal artifact reduction, atherosclerotic plaque and tumor characterization, detection of parathyroid lesions, and delineation of paranasal sinus ventilation. Dual-energy CT can potentially improve image quality, reduce radiation dose, and provide specific diagnostic information for certain head and neck lesions. This article reviews some current and potential otolaryngology applications of dual-energy CT.

Aerosinusitis

Aerosinusitis more frequently affects the frontal sinus than the maxillary sinus and mostly occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. In part2, diagnostic measures, drug therapy, balloon dilatation and endoscopic sinus surgery are presented, along with a discussion regarding when flight attendants and pilots are able to resume their work. Endoscopic surgery to expand the natural drainage pathways of the affected sinuses with minimal surgical trauma to the healthy mucous membranes is largely successful.

Bilateral triple concha bullosa: a very rare anatomical variation of intranasal turbinates.

Pneumatization of the intranasal turbinates or concha bullosa is an anatomic variation of the lateral nasal wall. Concha bullosa is defined as the presence of air cells in turbinates. It can be best diagnosed with paranasal sinus computed tomography. Concha bullosa is a possible etiologic factor for recurrent sinusitis due to its negative effect on paranasal sinus ventilation and mucociliary clearance. Concha bullosa is most commonly seen in the middle turbinate and less frequently in the inferior or superior turbinate. Pneumatization of all turbinates is very rare. To our knowledge, there are only two publications about a case with concha bullosa in all turbinates in the current literature. Here, we present a woman with bilateral pneumatization in all three intranasal turbinates.

Aerosinusitis

The relevance of aerosinusitis stems from the high number of flight passengers and the impaired fitness for work of the flight personnel. The frontal sinus is more frequently affected than the maxillary sinus and the condition generally occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. Part1 presents the pathophysiology, symptoms, risk factors, epidemiology and prophylaxis of aerosinusitis. In part2, diagnosis, conservative and surgical treatment will be discussed.

Endoscopic evaluation of therapeutic effects of "Anuloma-Viloma Pranayama" in Pratishyaya w.s.r. to mucociliary clearance mechanism and Bernoulli′s principle

The current endeavor intended to evaluate the effectiveness and mode of action of Anuloma-Viloma Pranayama (AVP), i.e., alternate nasal breathing exercise, in resolving clinical features of Pratishyaya, i.e., rhinosinusitis. The present study was directed to validate the use of classical “saccharin test” in measuring the nasal health by measuring mucociliary clearance time. This study also highlights the effects of AVP by application of Bernoulli principle in ventilation of paranasal sinuses and surface oxygenation of nasal and paranasal sinuses ciliary epithelium. Clinically, endoscopically and radiologically diagnosed patients of Pratishyaya, i.e., rhinosinusitis, satisfying the inclusion criteria were selected to perform AVP as a breathing exercise regularly for 30 min every day in order to evaluate the effectiveness of AVP in resolving features of rhinosinusitis. Saccharin test was performed before and after completion of 40 days trial to assess the nasal ciliary activity, which has been proved to be directly related to the health of ciliary epithelium and nasal health overall as well. AVP may be regarded as a catalyst to conspicuously enhance ventilation and oxygenation of the paranasal sinuses and the positively effect the nasal respiratory epithelium by increasing better surface availability of oxygen and negative pressure in the nasal cavity itself.

Sonic aerosol therapy to target maxillary sinuses

Intranasal aerosol administration of drugs is widely used by ENT specialists. Although clinical evidence is still lacking, intranasal nebulization appears to be an interesting therapeutic option for local drug delivery, targeting anatomic sites beyond the nasal valve. The sonic nebulizer NL11SN associates a 100Hertz (Hz) sound to the aerosolization to improve deposition in the nasal/paranasal sinuses. The aim of the present study was: to evaluate in vivo the influence of associating a 100Hz sound on sinus ventilation and nasal and pulmonary aerosol deposition in normal volunteers, and; to quantify in vitro aerosol deposition in the maxillary sinuses in a plastinated head model. Scintigraphic analysis of (81m)Kr gas ventilation and of sonic aerosol ((99m)Tc-DTPA) deposition using the NL11SN was performed in vivo in seven healthy volunteers. In parallel, NL11SN gentamicin nebulization was performed, with or without associated 100Hz sound, in a plastinated human head model; the gross amount of gentamicin delivered to the paranasal sinuses was determined by fluorescence polarization immunoassay. Associating the 100Hz sound to (81m)Kr gas ensured paranasal sinus ventilation in healthy volunteers. (99m)Tc-DTPA particles nebulized with the NL11SN were deposited predominantly in the nasal cavities (2/3, vs 1/3 in the lungs). In vitro, the use of NL11SN in sonic mode increased gentamicin deposition threefold in the plastinated model sinuses (P<0.002); the resulting antibiotic deposit would be sufficient to induce a local therapeutic effect. The NL11SN nebulizer ensured preferential nasal cavity aerosol deposition and successfully targeted the maxillary sinuses.

Does balloon catheter sinuplasty have a role in the surgical management of pediatric sinus disease?

BACKGROUND The surgical management of chronic recurrent sinusitis (CRS) recalcitrant to medical therapy in the pediatric population has traditionally consisted of adenoidectomy and functional endoscopic sinus surgery (FESS), depending on age and imaging findings. Adenoidectomy relieves nasopharyngeal airway obstruction as well as potentially eradicates a bacterial reservoir. FESS, as in adults, promotes paranasal sinus ventilation and drainage. Pediatric FESS most commonly consists of uncinectomy, maxillary antrostomy, and/or ethmoidectomy due to the relative underdevelopment of the sphenoid and especially the frontal sinuses in preadolescent children. FESS is generally considered to be safe, with major complications such as cerebrospinal fluid leak, meningitis, or orbital violation occurring in <1% of cases. Initial concerns that FESS in the pediatric population may lead to retardation of facial growth have proven to be unsubstantiated. Balloon catheter sinuplasty (BCS) was first introduced as a therapeutic modality of CRS in adults in 2006. In BCS a guidewire, passed into the target maxillary, sphenoid, or frontal sinus under endoscopic visualization with either fluoroscopic or fiberoptic light confirmation, is used to position a deflated oblong balloon across the natural sinus ostium. This balloon is subsequently inflated to a maximum diameter of 5 to 7 mm, dilating the natural ostium. In contrast to FESS, BCS does not involve tissue removal and theoretically is mucosal sparing. Purported limitations of BCS include the inability to address alternative predisposing anatomical abnormalities (the uncinate process, for example, is not removed in maxillary procedures) or to treat concurrent ethmoid sinus disease. The efficacy of BCS in adults with frontal, sphenoid and maxillary sinus disease is reported to be on par with FESS, suggesting a potential role for BCS in the treatment armamentarium of pediatric rhinosinusitis as well.

Ventilation and aerosolized drug delivery to the paranasal sinuses using pulsating airflow aeuro" a preliminary study

Although there is a high incidence of nasal disorders including chronic sinusitis, there is limited success in the topical drug delivery to the nose and the paranasal sinuses. This is caused by the nose being an efficient filter for inhaled aerosol particles and the paranasal sinuses being virtually non-ventilated. The objective of this study was to visualize the efficiency of sinus ventilation in healthy volunteers using dynamic 81mKr-gas imaging in combination with pulsating airflows. Furthermore, the deposition and retention of 99mTc-DTPA aerosol particles was assessed. The ventilation of the maxillary and frontal sinuses could be visualized by gamma camera imaging during pulsating airflow. In addition, using pulsating airflow, between 3% and 5% of nasally deposited aerosols penetrated into the paranasal sinuses while during application without pulsation aerosol deposition was below 1%. Furthermore pulsation increased aerosol deposition in the nasal airways by a factor of three. The study demonstrates the high efficiency of a pulsating airflow in paranasal sinus ventilation and aerosolized drug delivery. This proves that topical drug delivery to the paranasal sinuses in relevant quantities is possible and indicates further clinical studies are necessary.

Paranasal sinus ventilation by humming

The gas nitric oxide (NO) is generated in the human paranasal sinuses and can be measured in nasally exhaled air. During humming, a marked increase in exhaled NO content has been observed. The acoustic phenomenon responsible for this evacuation of NO gas from the sinuses was analyzed. A tube model was constructed with a syringe containing NO gas attached radially. This tube was excited with an air stream modulated by a sine wave. Increased evacuation was observed whenever the syringe was not located at a pressure node of the exciting sine wave. A computer model of the system showed a good matching of observed pressure versus frequency data in the syringe resonator. The results thus suggest that the alternating pressure in the nasal cavity forces the air plug in the ostium of the paranasal sinus resonators to vibrate, thus expelling from the cavity NO gas, which is transported to free air by the exhalatory air stream.

Washout of 133-xenon as an objective assessment of paranasal sinus ventilation in endoscopic sinus surgery.

Endoscopic sinus surgery (ESS) is today a common method for the treatment of chronic rhinosinusitis. Assessment of the results has been based mainly upon subjective evaluation, and only a few reports present objective measurements. In the present study, the 133-xenon washout technique was used for preoperative and postoperative evaluation of paranasal sinus ventilation in 12 patients selected for ESS. The postoperative half-times (T1/2) of 133-xenon washout were lower in the sinuses with abnormal preoperative half-times (T1/2), especially in the maxillary sinuses, where the postoperative T1/2 was 44 (22 to 150) minutes (median and quartiles, Q1-Q3) as compared with a preoperative T1/2 of 202 (94 to 278) minutes. The postoperative evaluation included a questionnaire and a follow-up visit with endoscopy and measurements of nasal nitric oxide. The results showed that patients who declared a marked reduction in symptoms exhibited significantly improved sinus ventilation. However, no direct correlation was found between improvement in ventilation and symptom improvement. Nine of the 12 patients showed improvement on endoscopy, and these patients also exhibited improved sinus ventilation. The postoperative nasal nitric oxide levels were within the normal range in 11 of the 12 patients; the other patient showed pathological T1/2 values for all paranasal sinuses. The 133-xenon washout technique is thus a method that can be used for objective evaluation of the ventilation of the paranasal sinuses before and after ESS procedures. However, the technique cannot be used to evaluate sinuses with totally obstructed ostia or postoperative sinuses with very wide neoostia, as rapid washout may lead to no activity remaining at the time of measurement.

Effects of Oxymetazoline on the Ventilation of Paranasal Sinuses in Healthy Subjects

Impairment of sinus ostial function is considered an important factor in the pathophysiology of sinus disease. The use of the decongestants such as alpha2-agonists is thought to improve sinus ostial function. Previous studies have shown an effect of alpha2-agonists on maxillary sinus ostial function only when administered in nasal bellows, but not as a nasal spray or nasal drops. The effect of decongestants on ventilation of the frontal and posterior ethmoidal and sphenoidal sinuses has not been studied to date. In this study, the 133-xenon washout method was used to determine ventilation for all paranasal sinuses before and after administration of oxymetazoline as nasal drops in eight subjects and from nasal bellows in nine healthy subjects. No significant effect of oxymetazoline on sinus ventilation was seen in either group. The results indicate that alpha2-agonists do not have any effect on sinus ventilation in healthy subjects. However, one cannot exclude that decongestants improve sinus ventilation in patients suffering from sinus disease and this requires further studies.

Dynamic assessment of paranasal sinus ventilation using xenon-enhanced computed tomography.

Disease of the paranasal sinuses is a common and costly condition. Evaluation of the efficacy of either medical or surgical methods of treatment is limited by the lack of quantitative methods to characterize sinus ventilation, which may be an important determinant of the baseline physiological state of the sinuses. Xenon-enhanced computed tomography (Xe-CT) measurement of sinus ventilation provides a noninvasive method of quantifying maxillary sinus ventilation using the nonradioactive, radiodense gas Xe as a tracer. Study subjects breathed a mixture of Xe gas and oxygen through a close-fitting nasal mask during serial CT imaging of a single radiographic plane through the maxillary sinuses--a generally well-tolerated protocol. Analysis of the sinus density-time curves allowed calculation of first-order exponential time constants from which specific ventilation rates could be determined for individual sinuses. Previously developed data analysis techniques were used to assess the statistical significance of the data and determine confidence intervals, allowing examination of the effects of noise in the data, and to demonstrate areas for further study protocol refinement. We conclude that Xe-CT measurement of sinus ventilation is a potentially valuable noninvasive technique for the diagnostic imaging of the human maxillary sinus.

Paranasal Sinus Ventilation in Healthy Subjects and in Patients with Sinus Disease Evaluated with the 133-Xenon Washout Technique

Ventilation of the paranasal sinuses is of great importance in sinus pathophysiology. Therefore, methods of measuring sinus ventilation are important for the evaluation of patients with sinus disease. In the present study, a 133-xenon washout technique was used to evaluate the ventilation of the paranasal sinuses in 34 healthy subjects and in 13 subjects with sinus disease (5 patients with nasal polyposis and 8 patients with chronic sinusitis). For this purpose, a 133-xenon-air mixture was insufflated in each nostril and the washout of the radioactive gas from the paranasal sinuses was monitored with a dynamic single-photon-emission computed tomography camera. The half-time (+/-SD) was found to be 18 +/- 18 minutes for the maxillary sinus, 10 +/- 8 minutes for the frontal sinus, and 18 +/- 23 minutes for the posterior ethmoid and sphenoid sinuses in the healthy subjects. Repeated measurements in 18 of the healthy subjects indicated that the method had acceptable reproducibility according to a Bland-Altman plot. The 133-xenon washout was not influenced by insufflation pressure, nasal patency, or body position. The subjects with sinus disease exhibited half-times of 77 +/- 101 minutes for the maxillary sinus, 91 +/- 124 minutes for the frontal sinus, and 60 +/- 60 minutes for the posterior ethmoid and sphenoid sinuses. For patients with nasal polyposis, the half-time was significantly longer than that in healthy subjects, while patients with chronic sinusitis did not differ from healthy subjects in this respect.

Measurement of paranasal sinus ventilation by xenon-enhanced dynamic computed tomography.

Ventilation of the paranasal sinuses plays an important role in the etiology of acute and chronic sinusitis. We present a new method to determine sinus ventilation. Two to three liters of pure stable xenon are insufflated into the sinus system, and the xenon washout is measured subsequently by dynamic CT. Gas exchange parameters for the different sinuses are obtained from the washout curves by an exponential fit. We report our preliminary clinical results. The method proved to be reliable and easy to apply. Compared with existing procedures it is the only noninvasive quantitative method for the determination of the ventilation of all paranasal sinuses.