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The diagnosis of chronic sinusitis can be difficult due to the variety and lack of specificity of presenting symptoms. Sinus CT scanning is presently considered the most sensitive and specific diagnostic method, but is expensive. In order to determine whether a combination of patient symptoms and nasal endoscopy could be used to predict which patients would have CT evidence of chronic sinusitis, we conducted a prospective study in which 92 consecutive patients referred for chronic sinusitis were required to fill out a questionnaire detailing their symptoms. Their responses were then correlated with subsequent findings on nasal endoscopy and CT scanning. Briefly, we found that patients with headache or facial pain as their chief complaint were less likely to have evidence of sinusitis than patients whose chief complaint was nasal obstruction or postnasal drip. Also, nasal endoscopy was shown to be moderately sensitive and highly specific in predicting results of CT scanning.
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PMID:Usefulness of patient symptoms and nasal endoscopy in the diagnosis of chronic sinusitis. 965 73

Acute sinusitis frequently follows upper respiratory tract infections. Patients complain of headache, facial pain, fever and purulent rhinorrhoea. Diagnosis is based upon the symptoms, and treatment comprises symptomatic relief with analgesics, topical or systemic decongestants and steam inhalation. If indicated, antibiotics should be given for an adequate period of time. Patients with chronic sinusitis complain of a combination of nasal obstruction, rhinorrhoea and postnasal drip associated with intermittent facial pain, with symptoms persisting for 3 months or more. Predisposition to the condition may be caused by rhinitis (allergic or nonallergic) and anatomical variants. Failure of mucociliary transport and sinus ostial obstruction leads to mucosal oedema, mucous hypersecretion and chronic infection. Current treatment aims are to control rhinitis and improve ventilation and function of the sinuses. Rhinitis may be controlled with the long term use of topical corticosteroids, mast cell stabilisers or antihistamines, either alone or in combination. Secretions may be cleared with steam inhalation and/or saline nasal douching. Failure to control chronic sinusitis with medical treatment may indicate surgery. The aim of surgery is to improve ventilation and facilitate drainage of the sinuses, allowing the restoration of normal function. Removal of nasal polyps, reduction of inferior turbinates or septal straightening may be all that is required. Some patients will need endoscopic ethmoidectomy and middle meatal antrostomy. Improved ventilation in the ethmoid infundibulum may help to resolve disease in maxillary and frontal sinuses. Medical treatment of underlying rhinitis will need to be continued postoperatively, often in the long term, while special consideration needs to be paid to sinusitis in children, in relation to dental disease and in the immunosuppressed. Complications of acute and chronic sinusitis include intraorbital and intracranial sepsis. These potentially lethal complications need urgent evaluation with high resolution computerised tomography (CT) scanning, intravenous administration of broad spectrum antibiotics (including anaerobic and microaerophilic cover) and urgent surgical drainage as appropriate.
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PMID:Recognition and management of sinusitis. 966 99

Plain paranasal sinus radiographs including occipitofrontal and occipitomental views often show abnormal shadows in patients with allergic rhinitis. For that reason, the relationship between chronic sinusitis and allergy has been discussed for many years. Type I allergy is thought to be involved in the sinusitis which is called allergic sinusitis. However, there is not enough information pertaining to this disorder. In order to determine the clinical feature and the characteristics of paranasal sinus effusion in allergic sinusitis, we investigated the differences between 20 patients with allergic sinusitis and 20 with non-allergic chronic sinusitis used as controls. Clinical symptoms (nasal discharge, nasal obstruction, headache, postnasal discharge) and anterior rhinoscopic findings (nasal discharge, nasal edema), clinical examinations (type of x ray maxillary sinus shadow, bacteriology of nasal discharge), and pathological features of the paranasal sinus effusion were examined and compared in the two kind of sinusitis. Pathological findings of the effusion sampled from 14 patients with allergic sinusitis and 15 with non-allergic sinusitis included the number of eosinophils, activated eosinophils and neutrophils, concentrations of interleukin (IL)-1 beta, IL-4, IL-5, IL-8, and concentrations of leukotriene C4/D4/E4 and prostaglandin E2. The incidence and degree of postnasal discharge as a symptom and a nasal finding were lower in allergic sinusitis patients than in the controls. Microorganisms were detected less frequently in the allergic group. The number of eosinophils, activated eosinophils and neutrophils was higher in the paranasal sinus effusion of the patients with allergic sinusitis. The concentrations (ng/mg of protein) of IL-1 beta and IL-8 showed no difference between the two groups, but IL-4, and IL-5 were more prevalent per mg of protein in the effusion of allergic sinusitis patients. These findings suggest that the clinical features of allergic sinusitis include a low incidence and degree of postnasal discharge and a low rate of detection of bacteria, and that the sinus effusion is characterized by the presence of more eosinophils, activated eosinophils, and IL-5 than in those of chronic sinusitis.
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PMID:[Clinical features and characteristics of paranasal sinus effusion in allergic sinusitis]. 971 Oct 83

This multicenter post-marketing surveillance study examined the course of characteristic signs and symptoms and the tolerability of myrtol standardized (Gelomyrtol/Gelomyrtol forte) in 511 children (4 to 12 years of age) with acute and chronic sinusitis, bronchitis and sinubronchitis. The choice of dose and formulation (120 mg or 300 mg myrtol stand) accounted for the patients' age and body weight. The following signs and symptoms were evaluated before and after 1 and 2 weeks of treatment: impaired nasal respiration (blocked-up nose), pain upon pressure on the trigeminal nerve endings, headache, sensitivity of the paranasal sinuses, presence of mucus in the pharynx. At the end of the observation period, the physicians, the patients themselves and their parents judged efficacy of the medication. In more than 90% of the children, trigeminal pain, headache, paranasal sensitivity, and mucus in the pharynx had disappeared after two weeks of treatment. In more than 60%, impaired nasal respiration and difficulty to evacuate sputum were no longer observed. The incidence of adverse drug reactions was low: less than 1%. The efficacy was judged to be very good or good by the majority of physicians, patients and parents. In spite of their young age, most children (> 80%) experienced no difficulty in swallowing the capsules.
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PMID:[Myrtol standardized in the treatment of acute and chronic respiratory infections in children. A multicenter post-marketing surveillance study]. 982 16

Third-party payers typically use patients' discharge diagnoses to determine "appropriate" Emergency Department (ED) usage. This analysis compared the resource intensity involved in ED evaluation for "inappropriate" and all other ED visits. In this retrospective database review, 11 discharge diagnoses (DX11) (chronic nasopharyngitis; chronic sinusitis; chronic pharyngitis; rhinitis; constipation; head cold; hemorrhoids; toothache; flu; headache; and tension headache) were identified by a third party payor as being "inappropriate" for ED evaluation. The chief complaints of all patients seen in 1994 and 1995 with one of the DX11 were identified along with their E & M billing level, ED length of stay (LOS), and the frequency of consultation. In this urban, university trauma center, 1994 and 1995 visits totaled 120,402. Eighty-two different chief complaints were associated with a final diagnosis of DX11; 79% of all ED patients presented with one of the chief complaints (AllCC). Four percent of patients with DX11 were admitted, and the AllCC group had comparable resource utilization to the entire ED population. Patients' presenting complaints are incapable of predicting diagnosis or disposition. Retrospective denial of payment by discharge diagnosis is inappropriate.
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PMID:Retrospective denial of emergency department payments is inappropriate. 995 Mar 81

Headache interpreted as treatment failure may be encountered after FESS or pharmacological treatment for chronic sinusitis. This persistent symptom may lead, even in the presence of minimal sinus disease, to frequent office visits, medical treatment, primary surgery, and revision procedures. A prospective study of patients with a documented history and imaging-verified sinus disease with persistent atypical refractory headache were evaluated. Diagnostic measures included injection of local anesthetic and response to carbamazepine. Severe neuralgia of the supraorbital nerve was identified in 11 patients with chronic sinusitis, treated either medically or surgically before inclusion in the study. Eight of the patients underwent surgery for sinus disease, and five of them had revision surgery because of persisting complaints. All patients responded favorably to the local injection, and eight were treated with carbamazepine. In certain cases, headache in sinusitis patients may be caused or aggravated by supraorbital neuralgia. Sinus disease is possibly a causative factor but conceivably plays the role of a "red herring." This readily diagnosed and treated coexistence may be more prevalent than recognized formerly.
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PMID:Coincidental supraorbital neuralgia and sinusitis. 1063 3

From 1989 to 1999, 237 consecutive patients with chronic sinusitis and/or nasal polyposis entered a prospective study on the effect of functional endoscopic sinus surgery (FES). Nasal stenosis associated with massive nasal polyposis was the most frequent problem found in 61% of the patients. The rest had long-lasting symptoms of chronic sinusitis. Duration of symptoms averaged 9.3 years. Most frequent symptoms preoperatively were: nasal stenosis, chronic secretion, anosmia, frontal pain, headache and maxillary pain. All patients had the operation performed under general anaesthesia. 86% of the patients have been operated bilaterally. In 72% the posterior ethmoid was opened, and in 54% the sphenoid was opened. The maxillary ostium has been enlarged in 82% of the patients and the frontal recess opened in 51% of the cases. No serious complications were registered. Annoying bleeding was experienced in 21%, hampering the intended procedure. In three patients rhinoliquore was observed. One case was treated during the procedure; the last two patients were in no need of surgical treatment. At the 1-year follow-up study, 45% of the patients were totally satisfied with the results and without symptoms, and 44% were definitely feeling better.
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PMID:Functional endoscopic sinus surgery in chronic sinusitis--a series of 237 consecutively operated patients. 1090 8

Fever, facial pain, nasal discharge, headache, and congestion, common symptoms for both HIV-negative and HIV-positive populations, can generally be managed in both groups. In HIV-positive persons, however, sinusitis can become chronic and serious, even life-threatening. The physiology of the sinus cavities is illustrated, and the increasing severity of the condition is discussed. A number of unusual pathogens can cause chronic sinusitis in those with HIV disease. Treatment regimens usually include antibiotics and decongestants. Holistic interventions are also effective in some people.
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PMID:Sinusitis. 1136 17

Allergic rhinitis is a common disease with a prevalence of 10-20% in western countries. Allergic rhinitis may be complicated by the possible restriction of quality of life and can lead to sequelae like sinusitis, headache or even allergic asthma. The treatment of allergic rhinitis is mainly based on allergen avoidance, pharmacological treatment and specific immunotherapy. For mild symptoms of seasonal or perennial allergic rhinitis topical or nonsedating second generation oral H1-antihistamines or chromones are advised. If the patient presents symptoms of long duration or nasal obstruction is dominant, intranasal steroids should be used, which have proved to be an effective and safe form of therapy for allergic rhinitis. A combination of oral antihistamines and steroids are possible and recommended if one of these agents alone does not provide sufficient relief. If necessary this regimen is supplemented with topical antihistamines or chromone eyedrops. In cases of severe nasal obstruction, a short course of oral steroids or topical decongestants, which both should not be given longer than ten days, is recommended. Intramuscular corticosteroids should not be given, due to the suppression of adrenal glands. In addition it is important to prevent exposure to the allergen. If the treatment is not effective, further investigations should be done to exclude other nasal diseases (polyposis nasi, anatomical anomalies, chronic sinusitis). This article summarizes the recommended medications with their possible side-effects and their place in therapy management of allergic rhinitis in adults and children.
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PMID:[Therapy of allergic rhinitis]. 1140 33

Anaerobic bacterial infections in chronic sinusitis are well described in literature. We present what is believed to be the first reported case of Clostridium perfringens presenting as the causative pathogen in paranasal sinusitis. This patient presented with severe headaches and, with CT and MRI findings of unilateral sphenoid sinus opacification, with bone demineralization and intrasinus calcification. This patient responded to endoscopic debridement and long-term antibiotics without sequelae.
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PMID:Sphenoid sinusitis caused by Clostridium perfringens. 1145 24


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