Acute Sinusitis:

Role of diffusion-weighted imaging in the discrimination of purulent intrasinusal content: A retrospective study

OBJECTIVES

The objective of this study was to analyse MRI with morphological (T1, T2) and diffusion sequences (DWI, b1000) in patients presenting non-aggressive patterns of sinus opacity and operated on by functional endoscopic sinus surgery (FESS).

DESIGN

A retrospective study.

SETTING

Diffusion imaging in paranasal sinus pathology remains little known. To date, no imaging system is capable of determining the purulent content of a non-enhanced sinus filling.

PARTICIPANTS

We included consecutive patients having undergone FESS in whom MRI of the paranasal sinuses was performed. Subjects were allocated to Case (pus) or Control (no pus) groups depending on sinus content found intraoperatively. FESS was performed for bacterial acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis, non-purulent sinusitis, naso-sinusal polyposis, antrochoanal polyp, isolated polyp, angiomatous polyp and eosinophilic fungal sinusitis. Tumours, mucoceles and fungus balls were excluded.

MAIN OUTCOME MEASURES

We analysed T1, T2, b1000 and MRI sequences and ADC map.

RESULTS

On univariate analysis, intermediate signal in T2 and high signal in b1000 were associated with Cases (P < 0.001) as were low ADC values (P < 0.001). The difference in mean ADC values between Cases and Controls was statistically significant (respectively, 0.518 vs 2.041 × 10^-3  mm² /sec, P < 0.01). On multivariate analysis, MRI with ADC < 0.725 × 10^-3  mm² /sec and b1000_SI > brain was significantly associated with the case group. MRI with b1000_SI < brain and ADC > 1.450 × 10^-3  mm² /sec was significantly associated with the control group.

CONCLUSIONS

Diffusion MRI offers extremely promising results regarding content characterisation of infectious sinus diseases.

[The question about the topical antibiotic therapy of acute rhinosinusitis]

Presented the results of the clinical study of 30 patients with moderate rhinosinusitis (13 (43.3%) men, 17 (56.7%) women, age from 18 to 68 years). Among those patients, the inflammation of one paranasal sinus was observed in 7 (23.3%) cases, polysinusitis was observed in 23 (76. 7%) cases. All patients were randomized into 2 groups of 15 people. In both groups, patients received systemic antibiotic therapy, nasal irrigation therapy, and NSAIDs. In the control group, topical decongestants were used; in the experimental group the antimicrobial drug Polydexa with phenylephrine was used as a local therapy. The purpose of the study was to evaluate the clinical efficacy of Polydexa with phenylephrine in the complex treatment of moderate acute rhinosinusitis. The evaluation criteria were statistically significant comparison of clinical and laboratory parameters of both groups. Confirmed the anti-inflammatory, antimicrobial effects of the drug, made conclusions about the significant clinical efficacy, tolerability, positive effect on mucociliary clearance and safety of nasal spray Polydexa with phenylephrine.

Cyclamen europaeum extract for acute sinusitis

BACKGROUND

Acute sinusitis is a common reason for primary care encounters. It causes significant symptoms including facial pain, congested nose, headache, thick nasal mucus, fever, and cough and often results in time off work or school. Sinusitis treatment focuses on eliminating causative factors and controlling the inflammatory and infectious components. The frozen, dried, natural fluid extract of the Cyclamen europaeum plant delivered intranasally is thought to have beneficial effects in relieving congestion by facilitating nasal drainage, and has an anti-inflammatory effect.

OBJECTIVES

To assess the effectiveness of topical intranasal Cyclamen europaeum extract on clinical response in adults and children with acute sinusitis.

SEARCH METHODS

We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, and trials registers (ClinicalTrials.gov; WHO ICTRP) in January 2018. We also searched the reference lists of included studies and review literature for further relevant studies and contacted trial authors for additional information.

SELECTION CRITERIA

Randomised controlled trials comparing Cyclamen europaeum extract administered intranasally to placebo, antibiotics, intranasal corticosteroids, or no treatment in adults or children, or both, with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by nasal endoscopy or by radiological evidence.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed trial quality. We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included two randomised controlled trials that involved a total of 147 adult outpatients with acute sinusitis confirmed by radiology or nasal endoscopy who were assigned to Cyclamen europaeum nasal spray or placebo study arms for up to 15 days. The risk of selection and detection bias was unclear, as allocation concealment and blinding of outcome assessors were not reported in either study. Attrition was high (60%) in one study, although dropouts were balanced between study arms.Neither study reported our two primary outcomes: proportion of participants whose symptoms resolved or improved at 14 days and 30 days. No serious adverse events or complications related to treatment were reported; however, more mild adverse events such as nasal and throat irritation, mild epistaxis, and sneezing occurred in Cyclamen europaeum group participants (50%) compared to placebo group participants (24%) (risk ratio 2.11, 95% confidence interval 1.35 to 3.29); moderate-quality evidence.

AUTHORS' CONCLUSIONS

The effectiveness of Cyclamen europaeum for people with acute sinusitis is unknown. Although no serious side effects were observed, 50% of participants who received Cyclamen europaeum reported adverse events compared with 24% of those who received placebo.

[Management of Rhinosinusitis in Primary Care]

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin.

Frequency of Bacterial Agents Isolated From Patients With Chronic Sinusitis in Northern Iran

Background:

Sinusitis is a disease with significant health problems. Diagnosis of sinusitis is clinical. The golden standard for detection of microorganisms that cause sinusitis is the culture of sinus drainage discharge.

Objectives:

Due to the high prevalence of sinusitis in Iran, especially in Mazandaran province, in this study, bacteriological survey of patients with chronic sinusitis were done in order to help physicians in choosing better antibiotics for the empiric therapy of sinusitis.

Methods:

This was a descriptive study. The population of the study consisted of 100 patients with chronic sinusitis caused by bacteria admitted to the Avicenna teaching hospital. Sampling for bacterial culture was performed by the endoscopy method from middle meatus (a curved anteroposterior passage in each nasal cavity that is situated below the middle nasal concha and extends along the entire superior border of the inferior nasal concha) and the opening of the maxillary sinus. Also sampling of nasal cavity was performed to determine the microbial flora. Identification of the bacteria causing chronic sinusitis was performed according to the standard microbiological procedures. Antimicrobial susceptibility testing method, the disk diffusion (Kirby-Bauer) was performed according to the CLSI (Clinical and Laboratory Standards Institute) standards. Data were analyzed using SPSS17 software. Also Fisher exact test and descriptive statistics were used to analyze the data.

Results:

Among the 100 evaluated patients, 58% were male. The average age was 34.2±1.1. The most common complaint of patients were nasal congestion and post-nasal drip. The most common bacteria found in the nasopharynx were Gram-positive bacillus, coagulase negative Staphylococcus and Staphylococcus aureus with rates of 20%, 16% and 15% respectively. Bacteria isolated from opening sinus were Gram-positive bacillus 24%, Enterobacter aerogenes 10%, coagulase negative Staphylococcus 18% and Staphylococcus aureus 19%.

Conclusions:

Antibiotic prescription is often empiric in treatment of sinusitis. In our study resistance to some antibiotics such as penicillin subgroups that are used in treatment of chronic sinusitis was high. Due to the fact that the etiology of chronic sinusitis is not clearly understood, the frequency of all the common causative agents of this disease must be determined.