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Schwarz C, Bend J, Hebestreit H, Hogardt M, Hügel C, Illing S, Mainz JG, Rietschel E, Schmidt S, Schulte-Hubbert B, Sitter H, Wielpütz MO, Hammermann J, Baumann I, Brunsmann F, Dieninghoff D, Eber E, Ellemunter H, Eschenhagen P, Evers C, Gruber S, Koitschev A, Ley-Zaporozhan J, Düesberg U, Mentzel HJ, Nüßlein T, Ringshausen FC, Sedlacek L, Smaczny C, Sommerburg O, Sutharsan S, Vonberg RP, Weber AK, Zerlik J. [CF Lung Disease - a German S3 Guideline: Pseudomonas aeruginosa]. Pneumologie 2024; 78:367-399. [PMID: 38350639 DOI: 10.1055/a-2182-1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Cystic Fibrosis (CF) is the most common autosomal recessive genetic multisystemic disease. In Germany, it affects at least 8000 people. The disease is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to dysfunction of CFTR, a transmembrane chloride channel. This defect causes insufficient hydration of the airway epithelial lining fluid which leads to reduction of the mucociliary clearance.Even if highly effective, CFTR modulator therapy has been available for some years and people with CF are getting much older than before, recurrent and chronic infections of the airways as well as pulmonary exacerbations still occur. In adult CF life, Pseudomonas aeruginosa (PA) is the most relevant pathogen in colonisation and chronic infection of the lung, leading to further loss of lung function. There are many possibilities to treat PA-infection.This is a S3-clinical guideline which implements a definition for chronic PA-infection and demonstrates evidence-based diagnostic methods and medical treatment in order to give guidance for individual treatment options.
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Affiliation(s)
- Carsten Schwarz
- Klinikum Westbrandenburg GmbH, Standort Potsdam, Deutschland
| | - Jutta Bend
- Mukoviszidose Institut gGmbH, Bonn, Deutschland
| | | | - Michael Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt, Deutschland
| | - Christian Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | | | - Jochen G Mainz
- Klinikum Westbrandenburg, Standort Brandenburg an der Havel, Universitätsklinikum der Medizinischen Hochschule Brandenburg (MHB), Brandenburg an der Havel, Deutschland
| | - Ernst Rietschel
- Medizinische Fakultät der Universität zu Köln, Mukoviszidose-Zentrum, Klinik und Poliklinik für Kinder- und Jugendmedizin, Köln, Deutschland
| | - Sebastian Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Kinderpoliklinik, Allgemeine Pädiatrie, Greifswald, Deutschland
| | | | - Helmut Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg, Deutschland
| | - Marc Oliver Wielpütz
- Universitätsklinikum Heidelberg, Klinik für Diagnostische und Interventionelle Radiologie, Heidelberg, Deutschland
| | - Jutta Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden, Deutschland
| | - Ingo Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg, Deutschland
| | - Frank Brunsmann
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e. V., Deutschland (Patient*innenvertreter)
| | | | - Ernst Eber
- Medizinische Universität Graz, Univ. Klinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Graz, Österreich
| | - Helmut Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde, Pädiatrie III, Innsbruck, Österreich
| | | | | | - Saskia Gruber
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich
| | - Assen Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Kinderradiologie, LMU München, Deutschland
| | | | - Hans-Joachim Mentzel
- Universitätsklinikum Jena, Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena, Deutschland
| | - Thomas Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen, Koblenz, Deutschland
| | - Felix C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Infektiologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Ludwig Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | - Christina Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | - Olaf Sommerburg
- Universitätsklinikum Heidelberg, Sektion Pädiatrische Pneumologie, Allergologie und Mukoviszidose-Zentrum, Heidelberg, Deutschland
| | | | - Ralf-Peter Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | | | - Jovita Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg, Deutschland
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Meier M, Schuurmans MM, Vital D, Inci I, Holzman D, Soyka MB. Impact of extended sinus surgery on allograft infection, allograft function and overall survival in cystic fibrosis lung transplant recipients. Eur Arch Otorhinolaryngol 2023; 280:4501-4507. [PMID: 37249595 PMCID: PMC10477110 DOI: 10.1007/s00405-023-08028-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Studies investigating the impact of sinus surgery for cystic fibrosis (CF) patients performed early after lung transplantation (Ltx) are scarce. Recent studies evaluating frequency of respiratory infections and graft outcomes are not available. OBJECTIVES/HYPOTHESIS To determine whether there is a difference in allograft infection, allograft function and overall survival among CF lung transplant recipients with and without concomitant sinus surgery. STUDY DESIGN Retrospective single-center study. METHODS We examined 71 CF patients who underwent Ltx between 2009 and 2019 at our center. Fifty-nine patients had sinus surgery before or/and after transplantation and twelve did not undergo sinus surgery. We assessed the survival, the diagnosis of chronic allograft dysfunction (CLAD) and all elevated (> 5 mg/l) c-reactive protein episodes during the observed period. The infectious events of the upper and lower airways were categorized in mild infections (5-15 mg/l CRP) and severe infections (> 15 mg/l CRP). RESULTS There was no difference in the long-time overall survival (p = 0.87) and no benefit in the short-term survival at 4 year post-transplant (p = 0.29) in both groups. There was no difference in both groups concerning CLAD diagnosis (p = 0.92). The incidence of severe upper and lower airway infections (CRP > 15 mg/l) was significantly decreased in the sinus surgery group (p = 0.015), whereas in mild infections there was a trend to decreased infections in the sinus surgery group (p = 0.056). CONCLUSIONS CF patients undergoing Ltx benefit from extended endoscopic sinus surgery (eESS) in terms of frequency of severe infectious events of the upper and lower airways. There was no difference in overall survival and frequency of CLAD in the two groups.
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Affiliation(s)
- Manuel Meier
- Department of Otorhinolaryngology, University Hospital Zurich USZ, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Macé M. Schuurmans
- Department of Pulmonology, University Hospital Zurich USZ, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Domenic Vital
- Center for Head and Neck Surgery AG, Hirslanden Clinic Cham, Cham, Switzerland
| | - Ilhan Inci
- FEBTS, FCCP, University of Zurich, Zurich, Switzerland
- Thoracic Surgery, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - David Holzman
- Department of Otorhinolaryngology, University Hospital Zurich USZ, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael B. Soyka
- Department of Otorhinolaryngology, University Hospital Zurich USZ, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Wucherpfennig L, Triphan SM, Wege S, Kauczor HU, Heussel CP, Schmitt N, Wuennemann F, Mayer VL, Sommerburg O, Mall MA, Eichinger M, Wielpütz MO. Magnetic resonance imaging detects improvements of pulmonary and paranasal sinus abnormalities in response to elexacaftor/tezacaftor/ivacaftor therapy in adults with cystic fibrosis. J Cyst Fibros 2022; 21:1053-1060. [DOI: 10.1016/j.jcf.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
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Sharma S, Durgaprasad BK, Vijayalakshmi P. A case of Kartagener's syndrome with combined aplasia of frontal and sphenoid sinuses and hypoplasia of maxillary and ethmoid sinuses. J Family Community Med 2021; 28:129-132. [PMID: 34194278 PMCID: PMC8213105 DOI: 10.4103/jfcm.jfcm_304_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Kartagener's syndrome (KS), characterized by a triad of bronchiectasis, chronic sinusitis, and situs inversus, is a subset of an autosomal recessive hereditary disorder of primary ciliary dyskinesia. We report the case of a 35-year-old male who presented with a history of intermittent episodes of productive cough, breathlessness, and cold since childhood. High resolution computed tomography of chest revealed bronchiectatic changes, dextrocardia, and right-sided aortic arch. Computed tomography (CT) scan of the abdomen revealed situs inversus. CT of the paranasal sinuses revealed combined aplasia of bilateral frontal and sphenoid sinus with sinusitis. Based on these findings, a diagnosis of KS was made. There was no complaint of infertility, which usually accompanies KS, even though an analysis of his seminal fluid revealed reduced count and reduced motility of sperms. The uniqueness of our case is that our patient was a male aged 35 years; besides, the third decade is an unusual age for presentation of combined aplasia/agenesis of bilateral frontal and sphenoid sinuses with hypoplasia of maxillary and ethmoid sinuses. Even though these findings have been reported in children and young adults, there are very few case reports of such a presentation in adults in literature.
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Affiliation(s)
- Sonica Sharma
- Department of Radio Diagnosis, GITAM Institute of Medical Sciences and Research (GIMSR), Visakhapatnam, Andhra Pradesh, India
| | - Bhamidipaty K Durgaprasad
- Department of Radio Diagnosis, GITAM Institute of Medical Sciences and Research (GIMSR), Visakhapatnam, Andhra Pradesh, India
| | - Payala Vijayalakshmi
- Department of Microbiology, GITAM Institute of Medical Sciences and Research (GIMSR), Visakhapatnam, Andhra Pradesh, India
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Magnetic Resonance Imaging Detects Chronic Rhinosinusitis in Infants and Preschool Children with Cystic Fibrosis. Ann Am Thorac Soc 2021; 17:714-723. [PMID: 32142375 DOI: 10.1513/annalsats.201910-777oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Chronic rhinosinusitis (CRS) contributes to disease burden of patients with cystic fibrosis (CF). However, its onset and progression in infants and preschool children with CF remain poorly understood.Objectives: To determine the prevalence and extent of CRS in young children with CF using magnetic resonance imaging (MRI).Methods: MRI was performed in sedation in 67 infants and preschool children with CF (mean age 2.3 ± 2.1 yr; range 0-6 yr) and 30 non-CF control subjects (3.5 ± 2.0 yr; range 0-6 yr). Paranasal sinus dimensions and structural abnormalities, including mucosal swelling; mucopyoceles; and nasal polyps of the maxillary, frontal, sphenoid, and ethmoid sinuses; and, in addition, medial maxillary sinus wall deformation, were assessed using a dedicated CRS MRI scoring system.Results: Pneumatization and dimensions of paranasal sinuses did not differ between the two groups. MRI detected an increased prevalence of mucosal swelling (83% vs. 17%; P < 0.001), mucopyoceles (75% vs. 2%; P < 0.001), polyps (26% vs. 7%; P < 0.001), and maxillary sinus wall deformation (68% vs. 2%; P < 0.001) in infants and preschool children with CF compared with age-matched control subjects. Furthermore, the extent of these abnormalities was also increased with a MRI sum score of 22.9 ± 10.9 in CF compared with 4.5 ± 7.6 in non-CF control subjects (P < 0.001).Conclusions: MRI detected normal dimensions of paranasal sinuses, and a high prevalence and severity of paranasal sinus abnormalities due to CRS in infants and preschool children with CF without radiation exposure. Our results support the development of MRI for sensitive noninvasive diagnosis and monitoring of CRS in young children with CF, and as outcome measures for clinical trials.Clinical trial registered with www.clinicaltrials.gov (NCT00760071).
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Abstract
Background: Paranasal sinus pneumatization is a complex process, and numerous computed tomography (CT) studies document developmental variations in the setting of underlying sinus disease. The purpose of this study was to investigate variation in paranasal sinus pneumatization in a population of nondiseased subjects using a metric validated for tracking individual anatomic variants as well as total sinus volume. Methods: A total of 591 consecutive sinus and maxillofacial CT scans were considered for study inclusion. After patients with inflammatory sinus or respiratory disease were excluded, 323 CT scans were scored using the Assessment of Pneumatization of the Paranasal Sinuses (APPS) instrument, and relevant demographic data were recorded for each scan. APPS findings were compared according to demographic characteristics and laterality. Results: Laterality and sex were associated with differences in paranasal sinus pneumatization in a nondiseased population. Based on APPS score, the left side (4.95) was more pneumatized than the right (4.74, P=0.006), and males (10.16) were more extensively pneumatized than females (9.18, P=0.005). We found no correlation of age with sinus pneumatization (ρ=0.025). The probability of perceptible asymmetry in any given individual's paranasal sinus pneumatization was 69%, and the probability of left-sided dominance was 53%. Conclusion: Substantial anatomic variation exists in paranasal sinus anatomy, even among patients without sinus disease. Significant differences are found between males and females and between the left and right sides. Continued systematic research of paranasal sinus anatomy may facilitate a standard for CT sinus assessment that will aid clinician evaluation of anatomic variation and surgical decision making.
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Marino MJ, Riley CA, Wu EL, Weinstein JE, McCoul ED. The Unified Airway: Does Asthma Influence Paranasal Sinus Pneumatization? EAR, NOSE & THROAT JOURNAL 2019; 99:89-93. [PMID: 31064242 DOI: 10.1177/0145561319848992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Asthma has been implicated as a driving force in lower airway remodeling; however, its effect on upper airway development has not been studied. Clinical disease, particularly cystic fibrosis (CF), has been associated with anatomical paranasal sinus variation, although the mechanism for these variations remains unclear. The purpose of this study was to determine whether asthma is associated with altered sinus pneumatization. Five hundred ninety-one computed tomography scans, including 303 adolescents (age 13-18) and 288 adults (age > 18), were evaluated using the Assessment of Pneumatization of the Paranasal Sinuses (APPS) instrument. The APPS score is validated for assessing anatomical variation and total sinus volume. A diagnosis of asthma was ascertained from the medical record, and patients with CF were included as a positive control group. Patients with asthma had mean APPS score of 9.66, compared to 9.85 for participants without asthma (P = .585). Subgroup analysis demonstrated similar findings among adults (P = .817) and adolescents (P = .585). Patients with a diagnosis of CF had significant sinus hypoplasia according to a mean APPS scores of 3.50 (P < .001). Sinus hypoplasia persisted in both adults (P < .001) and adolescents (P < .001) with CF. The presence of asthma is not associated with altered paranasal sinus pneumatization. In contrast, CF is associated with significantly reduced sinus pneumatization. These findings suggest that aberrant sinus pneumatization may not be a feature of asthma and that chronic mucosal respiratory disease is not a generalizable cause for altered paranasal sinus pneumatization.
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Affiliation(s)
- Michael J Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, AZ, USA
| | - Charles A Riley
- Division of Otolaryngology, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Eric L Wu
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jacqueline E Weinstein
- Benioff Children's Hospital, Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, LA, USA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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Morlacchi LC, Greer M, Tudorache I, Blasi F, Welte T, Haverich A, Mainz JG, Gottlieb J. The burden of sinus disease in cystic fibrosis lung transplant recipients. Transpl Infect Dis 2018; 20:e12924. [DOI: 10.1111/tid.12924] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/29/2018] [Accepted: 04/01/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Letizia Corinna Morlacchi
- Internal Medicine Department; Respiratory Unit and Cystic Fibrosis Adult Centre; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano; Milan Italy
- Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - Mark Greer
- Department of Respiratory Medicine; Lungentransplantation; Hannover Medical School; Hanover Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery; Hannover Medical School; Hanover Germany
| | - Francesco Blasi
- Internal Medicine Department; Respiratory Unit and Cystic Fibrosis Adult Centre; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano; Milan Italy
- Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - Tobias Welte
- Department of Respiratory Medicine; Lungentransplantation; Hannover Medical School; Hanover Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH); German Centre for Lung Research (DZL); Hanover Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery; Hannover Medical School; Hanover Germany
| | - Jochen G. Mainz
- CF-Centre for Children and Adults; Department of Paediatrics; Jena University Hospital; Jena Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine; Lungentransplantation; Hannover Medical School; Hanover Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH); German Centre for Lung Research (DZL); Hanover Germany
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Woodworth BA, Ahn C, Flume PA, Schlosser RJ. The Delta F508 Mutation in Cystic Fibrosis and Impact on Sinus Development. ACTA ACUST UNITED AC 2018; 21:122-7. [PMID: 17283574 DOI: 10.2500/ajr.2007.21.2905] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. Methods This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients ≥18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. Results Forty-five patients were identified with an average age of 32 years (range, 18–48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). Conclusion CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.
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Affiliation(s)
- Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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Kang SH, Meotti CD, Bombardelli K, Piltcher OB, de Tarso Roth Dalcin P. Sinonasal characteristics and quality of life by SNOT-22 in adult patients with cystic fibrosis. Eur Arch Otorhinolaryngol 2016; 274:1873-1882. [DOI: 10.1007/s00405-016-4426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Are Chronic Rhinosinusitis and Paranasal Sinus Pneumatization Related? SINUSITIS 2016. [DOI: 10.3390/sinusitis1010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Marino MJ, Weinstein JE, Riley CA, Levy JM, Emerson NA, McCoul ED. Assessment of pneumatization of the paranasal sinuses: a comprehensive and validated metric. Int Forum Allergy Rhinol 2015; 6:429-36. [DOI: 10.1002/alr.21671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/23/2015] [Accepted: 10/02/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Michael J. Marino
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
| | - Jacqueline E. Weinstein
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
| | - Charles A. Riley
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
| | - Joshua M. Levy
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
| | - Noah A. Emerson
- Department of Radiology; Ochsner Clinic Foundation; New Orleans LA
| | - Edward D. McCoul
- Department of Otolaryngology-Head and Neck Surgery; Tulane University School of Medicine; New Orleans LA
- Department of Otorhinolaryngology-Head and Neck Surgery; Ochsner Clinic Foundation; New Orleans LA
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Khanduri S, Singh N, Bhadury S, Ansari AA, Chaudhary M. Combined Aplasia of Frontal and Sphenoid Sinuses with Hypoplasia of Ethmoid and Maxillary Sinuses. Indian J Otolaryngol Head Neck Surg 2015; 67:434-7. [PMID: 26693466 DOI: 10.1007/s12070-015-0877-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022] Open
Abstract
The paranasal sinuses are air filled spaces. The process of development of paranasal sinuses begins prenatally. The agenesis of paranasal sinuses in an unusual clinical condition and that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses is extremely rare along with hypoplasia of other sinuses. Agenesis of sphenoid sinus is also rare in incidence. We report a case of a 54 years old female, who presented with complains of persistent headache with nasal blockage and found to have combined aplasia of bilateral frontal and sphenoid sinus with hypoplasia of bilateral maxillary and ethmoid sinus with unusual age of presentation. The findings were confirmed on non-contrast computed tomography scan of paranasal sinuses.
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Affiliation(s)
- Sachin Khanduri
- Department of Radiodiagnosis, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi Road, Lucknow, 226003 India
| | - Nidhi Singh
- Department of Radiodiagnosis, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi Road, Lucknow, 226003 India
| | - Samarjit Bhadury
- Department of Radiodiagnosis, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi Road, Lucknow, 226003 India
| | - Azeem Ahmad Ansari
- Department of Radiodiagnosis, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi Road, Lucknow, 226003 India
| | - Mriganki Chaudhary
- Department of Radiodiagnosis, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi Road, Lucknow, 226003 India
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Dammann F, Bootz F, Cohnen M, Hassfeld S, Tatagiba M, Kösling S. Diagnostic imaging modalities in head and neck disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:417-23. [PMID: 24980674 DOI: 10.3238/arztebl.2014.0417] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Because of the complex anatomy of the head and neck region, conventional projection radiography alone is unreliable and carries a high risk of misdiagnosis. The poor risk-benefit ratio of conventional radiography has led to their replacement by tomographic imaging for nearly all studies in this region. METHOD This review is based on pertinent articles retrieved by a selective search in the PubMed database (January 1980 to May 2013) as well as on the relevant guidelines from Germany and abroad. RESULTS The indication for diagnostic imaging in the anatomically complex head and neck region should be established for a specific type of imaging study on the basis of a thorough clinical examination. Conventional films, though easy to obtain, often cannot answer the diagnostic question and may yield confusing information leading to misdiagnosis. Computed tomography (CT) has the best risk-benefit profile and a high diagnostic value, but low-dose protocols have not yet been put into use in all centers. Magnetic resonance imaging (MRI) is best for bone and soft-tissue diagnosis, but consumes more resources. Digital volume tomography (DVT) is another type of three-dimensional, sectional imaging with high local resolution; the associated radiation exposure and image quality are generally both low, but may vary depending on the apparatus used. DVT cannot be used to evaluate the soft tissues. Ultrasonography can be used to evaluate superficial structures in the head and neck region; nuclear imaging can be used to evaluate thyroid disease and cancer. CONCLUSION Inflammatory, traumatic, and neoplastic diseases of the head and neck are best evaluated with cross-sectional imaging (CT, MRI) in accordance with current guidelines. Conventional x-rays should, in general, only be used for dental evaluation, with rare exceptions.
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Affiliation(s)
- Florian Dammann
- Institute of Radiology and Nuclear Medicine, Alb Fils Kliniken, Klinik am Eichert, Göppingen, Department of Otolaryngology (ENT)/ Head & Neck Surgery, Bonn University Hospital, Institute of Clinical Radiology, Städtische Kliniken Neuss-Lukaskrankenhaus-GmbH, Neuss, Department of Craniomaxillofacial Surgery-Plastic Surgery-Universität Witten/Herdecke, Klinikum Dortmund gGmbH, Klinikzentrum Nord, Department of Neurosurgery, University Hospital Tübingen, Department of Diagnostic Radiology, Martin Luther University Halle-Wittenberg
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15
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Ferril GR, Nick JA, Getz AE, Barham HP, Saavedra MT, Taylor-Cousar JL, Nichols DP, Curran-Everett D, Kingdom TT, Ramakrishnan VR. Comparison of radiographic and clinical characteristics of low-risk and high-risk cystic fibrosis genotypes. Int Forum Allergy Rhinol 2014; 4:915-20. [PMID: 25224556 DOI: 10.1002/alr.21412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/13/2014] [Accepted: 08/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) exhibit a wide range of disease severity, and can be broadly stratified into high-risk and low-risk groups based on cystic fibrosis transmembrane conductance regulator (CFTR) mutation class. Patients with a low-risk genotype are often diagnosed as adults, with milder disease and lower sweat chloride values. The aim of the current study was to better understand radiographic and clinical characteristics of sinus disease in adult CF patients within this risk category. METHODS Adult CF patients were retrospectively compared to a control group of patients with chronic rhinosinusitis. CF diagnostic testing and pulmonary characteristics were compared between high-risk and low-risk CF groups, and sinus CT findings were compared among all 3 groups. RESULTS When comparing CF cohorts (n = 25 and 30, respectively), earlier age at diagnosis (p < 0.001), higher sweat chloride values (p < 0.001), lower forced expiratory volume in 1 second (FEV1 ) values (p < 0.001), and a higher prevalence of pulmonary infection with Pseudomonas aeruginosa (p = 0.001) were found in the high-risk genotype group. A significantly increased incidence of sinus hypoplasia/aplasia and bony sclerosis was seen when comparing both CF groups to the control cohort (n = 30), as well as when comparing the high-risk and low-risk CF genotype cohorts. CONCLUSION The current study describes clinicopathologic findings of sinus disease in adult CF patients in the context of genotype severity. Our data demonstrate that while patients within a low-risk genotype cohort have generally milder lung disease, they retain classic radiographic findings of CF sinus disease that can help raise the index of suspicion for undiagnosed CF.
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Affiliation(s)
- Geoffrey R Ferril
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
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16
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Aanæs K. Bacterial sinusitis can be a focus for initial lung colonisation and chronic lung infection in patients with cystic fibrosis. J Cyst Fibros 2014; 12 Suppl 2:S1-20. [PMID: 24064077 DOI: 10.1016/s1569-1993(13)00150-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A major purpose of treating patients with cystic fibrosis (CF) is to prevent or delay chronic lung infections with CF-pathogenic Gram-negative bacteria. In the intermittent stage, bacteria can usually be eradicated from the lungs with antibiotics, but following eradication, the next lung colonisations often occur with bacteria of identical genotype. This may be due to re-colonisation from the patient's paranasal sinuses. In our study, we found that approximately two-thirds of CF patients having sinus surgery (FESS) had growth of CF-lung-pathogenic Gram-negative bacteria in their sinuses (Pseudomonas aeruginosa, Achromobacter xylosoxidans, Burkholderia cepacia complex). The environment in the sinuses is in many ways similar to that of the lower respiratory tract, e.g. low oxygen concentration in secretions. Sinus bacteria are more difficult to eradicate than in the lungs, thus, having good conditions for adapting to the environment in the lungs. In the presence of bacteria, the environment of the sinuses differs from that of the lower respiratory tract by having a higher immunoglobulin A (IgA): IgG ratio, and reduced inflammation. We found a significant correlation between the concentration of IgA against P. aeruginosa (standard antigen and alginate) in nasal secretions and saliva and CF patients' infection status (not lung colonised, intermittently colonised or chronically lung-infected with P. aeruginosa). This supports the hypothesis that infections often originate in the sinuses and can be a focus for initial lung colonisation or for maintaining lung infections in CF patients. We are confident that anti-P. aeruginosa IgA can be used as an early supplementary tool to diagnose P. aeruginosa colonisation; P. aeruginosa being the microorganism causing most morbidity and mortality in CF patients. This is important since urgent treatment reduces morbidity when CF patients are early colonised with P. aeruginosa, however, there is a lack of diagnostic tools for detecting the early colonisation in the lungs and in the sinuses. We initiated a treatment strategy for CF patients to prevent sino-nasal bacteria being seeded into the lower airways: we recommended extensive functional endoscopic FESS with creation of sufficient drainage from all involved sinuses with subsequent i.v. antibiotics and at least 6 months of twice daily nasal irrigation with saline and antibiotics. By this strategy, sinus bacteria could be eradicated in a large proportion of patients. Essentially, growth of CF-pathogenic bacteria from the lower respiratory tract was decreased following the treatment. Furthermore, a number of patients have been free from CF-pathogenic bacteria for more than one year after FESS, and thus re-classified as "not lung colonised". We also corroborated that CF patients obtain an improved quality of life and reduction in their symptoms of chronic rhinosinusitis after FESS. It is primarily intermittently lung colonised CF patients with CF-pathogenic bacteria in their sinuses that seem to benefit from the treatment strategy. This is in accordance with the fact that we did not see a significant increase in lung function and only a small decrease in specific antibodies after FESS; a high systemic immune and inflammatory response and a decreasing lung function is generally not present in patients who primarily have sinus CF-pathogenic bacteria. It is important that guidelines are created for how CF patients with CF-pathogenic bacteria in the sinuses are to be treated, including criteria for who may likely benefit from FESS, and who may be treated exclusively with conservative therapy, e.g. saline and antibiotic irrigations.
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Affiliation(s)
- Kasper Aanæs
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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17
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Kang SH, Piltcher OB, Dalcin PDTR. Sinonasal alterations in computed tomography scans in cystic fibrosis: a literature review of observational studies. Int Forum Allergy Rhinol 2014; 4:223-31. [PMID: 24415497 DOI: 10.1002/alr.21266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/14/2013] [Accepted: 11/19/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Almost all cystic fibrosis (CF) patients reveal upper airway involvement in computed tomography (CT) scans. Sinonasal pathology has become a challenging issue because there are few studies to guide appropriate management. The objective of this study was to provide information about paranasal sinus CT manifestations in CF patients, mainly in adulthood. METHODS We performed a literature review of descriptive studies about CT sinonasal findings in CF patients using the following databases: MEDLINE, EMBASE, Web of Science, LILACS, Scielo, and Cochrane. RESULTS Eighteen articles were included in this review. There was a high variability in methodological aspects for most of the studies. The most prevalent findings reported were opacification of sinuses, presence of frontal and sphenoidal aplasia or hypoplasia, underdevelopment of paranasal sinuses, and medial bulging of the lateral nasal wall in CT scans. CONCLUSION There are few studies in the CF adult population regarding sinonasal CT alterations. Many studies report specific pathological features in CF upper airways that could help in the diagnosis of doubtful cases.
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Affiliation(s)
- Suzie Hyeona Kang
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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18
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Chaaban MR, Kejner A, Rowe SM, Woodworth BA. Cystic fibrosis chronic rhinosinusitis: a comprehensive review. Am J Rhinol Allergy 2013; 27:387-95. [PMID: 24119602 PMCID: PMC3899543 DOI: 10.2500/ajra.2013.27.3919] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Advances in the care of patients with cystic fibrosis (CF) have improved pulmonary outcomes and survival. In addition, rapid developments regarding the underlying genetic and molecular basis of the disease have led to numerous novel targets for treatment. However, clinical and basic scientific research focusing on therapeutic strategies for CF-associated chronic rhinosinusitis (CRS) lags behind the evidence-based approaches currently used for pulmonary disease. METHODS This review evaluates the available literature and provides an update concerning the pathophysiology, current treatment approaches, and future pharmaceutical tactics in the management of CRS in patients with CF. RESULTS Optimal medical and surgical strategies for CF CRS are lacking because of a dearth of well-performed clinical trials. Medical and surgical interventions are supported primarily by level 2 or 3 evidence and are aimed at improving clearance of mucus, infection, and inflammation. A number of novel therapeutics that target the basic defect in the cystic fibrosis transmembrane conductance regulator channel are currently under investigation. Ivacaftor, a corrector of the G551D mutation, was recently approved by the Food and Drug Administration. However, sinonasal outcomes using this and other novel drugs are pending. CONCLUSION CRS is a lifelong disease in CF patients that can lead to substantial morbidity and decreased quality of life. A multidisciplinary approach will be necessary to develop consistent and evidence-based treatment paradigms.
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Affiliation(s)
| | | | - Steven M. Rowe
- Medicine, and
- the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradford A. Woodworth
- From the Departments of Surgery/Division of Otolaryngology and
- the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
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19
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Rasmussen J, Aanæs K, Norling R, Nielsen KG, Johansen HK, von Buchwald C. CT of the paranasal sinuses is not a valid indicator for sinus surgery in CF patients. J Cyst Fibros 2011; 11:93-9. [PMID: 22018629 DOI: 10.1016/j.jcf.2011.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/16/2011] [Accepted: 09/26/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND No guidelines comprise when or to what extent sinus surgery should be done in patients with cystic fibrosis (CF) or how a CT scan of the paranasal sinuses should influence the decision. Symptoms of rhinosinusitis and/or eradication of pathogenic bacteria from the sinuses are reasons for sinus surgery. METHODS In this observational cross sectional study, 55 CF cases had their preoperative CT scans scored according to the Lund Mackay- and the Nair-system. Correlations between the CT scans, symptoms, surgical findings and cultures obtained during sinus surgery were made. RESULTS There was no significant correlation between the CT score and detection of pus, pathogenic bacteria or symptoms. Pus and pathogenic bacteria were found in several cases without sinus opacification on the CT scan. Non pathogenic and sterile cultures were also found in sinuses with opacification. CONCLUSIONS A CT scan is not a valid criterion for sinus surgery in CF patients.
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Affiliation(s)
- Jacob Rasmussen
- Department of Otolaryngology-Head & Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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20
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Abstract
Food allergy is a recognized public health concern, for which preventative strategies are required. Although an intervention that adequately protects against the development of food allergy has still to be identified, limited benefits have been shown for the prevention of related allergic conditions such as eczema, and to a lesser extent asthma and rhinitis; these benefits are usually limited to at-risk populations. Prevention strategies need to be tested using randomized controlled study designs that account for the numerous methodological challenges, safety concerns, and necessary ethical limitations.
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Affiliation(s)
- George Du Toit
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' National Health Service Foundation Trust, Medical Research Council, London, UK.
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21
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Orlandi RR, Wiggins RH. Radiological sinonasal findings in adults with cystic fibrosis. Am J Rhinol Allergy 2009; 23:307-11. [PMID: 19490807 DOI: 10.2500/ajra.2009.23.3324] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Care of cystic fibrosis (CF) patients has extended the expected survival far into adulthood. The morphological changes of adult CF patients' paranasal sinuses have not been thoroughly addressed. METHODS A retrospective review was performed of computed tomography imaging of adult CF patients at an academic medical center. Developmental changes, bone sclerosis, mucoceles, and degree of inflammation (using a modified Lund-Mackay scoring system) were assessed. RESULTS Forty-five patients were included in the study. The majority of frontal and sphenoid sinuses were either aplastic or hypoplastic. Maxillary hypoplasia was less commonly seen. Seven patients had mucoceles. Sclerosis of the sinuses was a common finding, affecting 84.4% of patients. Inflammation of the sinuses was also common, with a median modified Lund-Mackay score of 15.0 (out of a median 20 possible). CONCLUSION Poor development of the sinuses seen in pediatric CF patients persists into adulthood. Inflammation of the sinuses is a common finding. Bone sclerosis, likely caused by chronic inflammation, affects a large majority of these patients.
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Affiliation(s)
- Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
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22
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Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol 2006; 16:872-88. [PMID: 16391905 DOI: 10.1007/s00330-005-0068-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 10/09/2005] [Accepted: 10/14/2005] [Indexed: 10/25/2022]
Abstract
Paranasal sinus development and pneumatisation variants are described, and rhinosinusitis and different patterns of inflammatory sinonasal diseases are reviewed. Other inflammatory sinonasal diseases, e.g., fungal sinusitis, mucocele, pyocele and sinonasal manifestations in systemic diseases, are briefly described. Computed tomography (CT) is the primary modality in diagnosing and mapping suspected inflammatory sinonasal disease. Magnetic resonance (MR) imaging is complementary to CT if fungal sinusitis, pyocele or malignancy are suspected.
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Affiliation(s)
- H B Eggesbø
- Department of Radiology, Aker University Hospital, Oslo, Norway.
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23
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Haktanir A, Acar M, Yucel A, Aycicek A, Degirmenci B, Albayrak R. Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary and ethmoid sinus hypoplasia. Br J Radiol 2005; 78:1053-6. [PMID: 16249610 DOI: 10.1259/bjr/38163950] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We describe CT scans of a case with bilateral aplasia of frontal and sphenoid sinuses with symmetrical hypoplasia of the ethmoid cellules and maxillary sinuses. This case appears to be first in the English-language literature with these combined findings.
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Affiliation(s)
- A Haktanir
- Departments of Radiology, Afyon Kocatepe University, Faculty of Medicine, Mavi Hastane, 03120, Afyon, Turkey
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