Intracranial Complications of Pediatric Frontal Rhinosinusitis

Background

The aim of this study was to review the presentation and management of children admitted for intracranial complications arising from frontal rhinosinusitis. We performed a retrospective case series review at two academic tertiary care children's hospitals.

Methods

This study consisted of children <18 years old who presented with intracranial complications from frontal rhinosinusitis between January 1, 1990 and December 31, 2002. Relevant literature was reviewed with the assistance of Medline. Presentation, type of intracranial complication, radiographic evaluations, response to treatment, and prognosis were evaluated.

Results

Sixteen patients were identified with intracranial complications due to frontal rhinosinusitis. Patients were usually older (mean age, 14 years and 3 months), of male gender (M/F, 4.3:1.0), and African American (AA/W, 3.0:1.0). Headache, nasal congestion, and visual changes were the most common early symptoms and neurological findings indicated advanced disease. Subdural (56%), epidural (44%), and cerebral abscesses (19%) were the most common complications. Meningitis alone was identified in 13% and was associated with another intracranial complication in 6%. Multiple intracranial complications were noted in 31%. Polymicrobial cultures were obtained in 50% of patients. Although CT was excellent in identifying orbital pathology, MRI was superior for characterization of intracranial disease.

Conclusion

Intracranial complications of frontal rhinosinusitis are rare in children. Early symptoms often are nonspecific, with neurological findings more commonly seen in advanced disease. Adolescent African American male patients were found to be at highest risk for intracranial complications from frontal rhinosinusitis. Headache and orbital complaints associated with rhinosinusitis in older children failing to respond to initial therapy should prompt an aggressive evaluation including MRI.

Maxillary odontogenic sinusitis, complicated with cerebral abscess--case report

Maxillary sinus inflammation, when untreated or incorrectly treated, may extend locoregionally, the remaining paranasal sinuses being the first affected anatomical structures. This is why the understanding of the inflammatory pathology of the maxillary sinus, and particularly of the complications it can generate, is extremely important. The purpose of this presentation is to point out that inflammations of the paranasal sinuses are susceptible to develop complications in certain conditions and threaten the patient's life due to the proximity of vital structures. This is the case of a 16 years old male patient who developed a left maxillary and frontal sinusitis, complicated with cerebral abscess. Early detection, multidisciplinary approach and proper indication of surgical treatment, as well as early suspicion of complication, especially in young male adolescents, are extremely important.

[A new method for the treatment of acute frontitis in the adult patients]

The objective of the study is to estimate the efficacy of Bioparox (fusafungine) when used for the treatment of the adult patients presenting with acute frontitis. Twenty two of the 45 patients with this condition were given adjuvant therapy using this preparation. It resulted in a decrease of the concentration of Staphylococcus aureus and S. epidermidis to 10 CFU/ml and 500 CFU/ml respectively. S. haemoliticus was completely eradicated. The concentrations of these microorganisms in patients of the control group were higher. The level of interleukin 1-beta in the secretion within 5 days after the onset of therapy was twice lower than in the patients of control group. The concentration of IL 1-beta in the serum of the treated with Bioparox patients was 4 pg/ml compared with 8 pg/ml in the control group. The efficacy of therapy of acute frontitis with fusafungine was confirmed in the X-ray study. It is concluded that the use of Bioparox for the management of acute frontitis increases the efficacy of the treatment and result in the marked improvement of the patients' condition within 5 days after the onset of therapy.

[Pott's puffy tumor--a rare complication of frontal sinusitis]

Pott's puffy tumor is an extremely rare complication of frontal sinusitis. It is most typically found in young men. Streptococci, staphylococci or anaerobic bacteria are usually the causative agents. In our patients the inflammation was caused by Streptococcus milleri and Streptococcus pneumoniae. The treatment should be started with broad-spectrum antibiotics. The antibiotics are administered intravenously for 1 to 2 weeks and thereafter orally for at least four weeks. Paranasal sinuses must be operated, and if necessary, intracranial abscesses are treated neurosurgically.

[A girl with a swelling on her forehead]

A 9-year-old girl presented with headache and swelling of her forehead caused by a Pott's puffy tumour.

Pott's puffy tumor in a premature neonate: the new youngest case reported in the post-antibiotic era

An extreme premature infant born at 25 weeks post menstrual age (PMA) presented at PMA of 32 weeks with non-multiresistant methicillin resistant Staphylococcus aureus (MRSA) Pott's puffy tumor (PPT) involving both orbital and intracranial extension is described here. This is the youngest case of PPT ever reported in the antibiotic era.

Fine needle aspiration in aspergilloma of frontal sinus: a case report

BACKGROUND

The increased incidence of fungal diseases in humans is most likely due to indiscriminate use of broad-spectrum antibiotics and increased numbers of immunocompromised patients. Although Aspergillus species are ubiquitous and normally nonpathogenic, they can be opportunistic pathogens in immunocompromised individuals.

CASE

A 22-year-old immunocompetent man presented with a gradually increasing subcutaneous swelling near the root of his nose for previous 6 months. The mass was soft to firm, solid, nontender and immobile. There was no superficial skin ulceration and no local signs of inflammation. Proptosis of the left eye was present without any visual impairment. An osteolytic lesion that was contiguous with the subcutaneous mass, with the opacities of both the fontal sinuses was observed radiographically. Fine needle aspiration cytology (FNAC) demonstrated presence of branching hyphae in the cytoplasm of multinucleated giant cells along with mixed inflammatory cells. The species was identified by culture in Sabouraud's agar with chloramphenicol and wet mount with lactophenol cotton blue stain.

CONCLUSION

Aspergillosis can remain dormant over a long period. Although uncommon, it can occur in immunocompetent patients. FNA is a very useful tool in establishing the diagnosis

Comparison of swabs versus suction traps for endoscopically guided sinus cultures

BACKGROUND

Knowledge of the causative organism(s) in bacterial rhinosinusitis has become the cornerstone of adequate medical and surgical management. Little uniformity and data exist for the best method of obtaining sinus cultures. Most otolaryngologists tend to use the nasal swab for obtaining transnasal middle meatal cultures. A prospective study was carried out to compare the effectiveness of standard nasal swabs versus suction traps in obtaining bacterial isolates under endoscopic guidance.

METHODS

Fifty-two patients with purulence in the middle meatus or frontal recess were included in the study. All patients were cultured using nasal wire swabs. Twenty-five of these patients also had the purulence suctioned into a Xomed Sinus Secretion Collector (XSSC) (Xomed Surgical Products, Jacksonville, FL), and 27 patients had the purulence suctioned into a standard Leukens trap (Busse Hospital Disposables, Hauppauge, NY). All specimens were sent to the hospital microbiology laboratory within 1 hour of capture.

RESULTS

The average number of bacteria cultured per patient was 1.21 for the swab, 1.37 for the XSSC trap, and 1.08 for the Leukens trap. The agreement between bacteria captured from the wire swab and suction trap was 76.9%, with significant agreement being observed by all isolates with the exception of coagulase-negative Staphylococcus and the other gram-positive bacteria group consisting of Streptococcus viridans, beta-hemolytic streptococcus, and alpha-hemolytic streptococcus.

CONCLUSION

This study suggests that the wire swab appears to be as efficacious at obtaining endoscopically guided cultures as the Xomed and Leukens suction devices.

Management of allergic fungal sinusitis with intracranial spread

Allergic fungal sinusitis (AFS) is a form of paranasal nasal disease if not managed early often involves bone destruction and extension into the orbit and anterior skull base. We present our study of patients with AFS with intracranial, exdradural extension. This study includes our experience of 26 patients with the histological and immunological diagnosis of AFS based on findings of branching septate fungi interspersed with eosinophilic mucin and Charcot-Leyden crystals without fungal invasion of soft tissue, with intracranial extension. All had erosion of bone, which was observed on computerized tomography (CT) scans, extending intracranially and eight had disease that additionally involved the lamina papyracea. The average age of patients in this study was 25 years (range 9-46). There were 20 male and 6 female patients. All patients were immunocompetent. Skin test against aspergillin showed all patients had Type 1 hypersensitivity. All patients underwent transnasal and/or transmaxillary endoscopic approaches for debridement and eight underwent orbital decompression. No patient underwent craniotomy for removal of intracranial extradural disease. No patient had a cerebrospinal fluid leak. Postoperatively, all 26 were treated with a course of corticosteroids. The follow-up period ranged from 2 to 5 years. We conclude AFS is a unique form of fungal disease that might mimic anterior skull base and paranasal sinus tumors. Most cases can be successfully managed with transnasal and/or transmaxillary endoscopic techniques.

A fungal granuloma of the frontal sinus in a llama

A 12-year-old, castrated male llama (Lama glama) presented with a 12-cm diameter cranial mass. Computed tomography and postmortem examination revealed that the mass invaded the calvarium and compressed the rostral part of the brain. Light microscopic examination confirmed a fungal granuloma.

Primary frontal sinus aspergillosis: an uncommon occurrence

Primary frontal sinus aspergillosis is extremely uncommon with only few cases reported in the English literature. Isolated frontal sinus aspergillosis is usually asymptomatic and produces symptoms due to orbital or intracranial involvement. We report two cases of primary frontal sinus aspergillosis, presenting as frontoethmoidal mucocele and mimicking a 'Pott's puffy tumor,' respectively. Forehead swelling produced by frontal sinus aspergillosis will be the first to be reported in the English literature.

The place of Riedel's procedure in contemporary sinus surgery

Many operative procedures have been described to treat frontal sinus disease with varying results. Obliteration of the frontal sinus is attempted when drainage procedures fail. Most large series of patients undergoing sinus obliteration have reported recurrent disease yet the management of these patients is rarely discussed. We believe Riedel's procedure has an important role in the management of these patients. Riedel's procedure can help eradicate frontal sinus disease and symptoms when drainage and obliteration have failed and where there is persistent disease involving the anterior wall of the frontal sinus or the sinus itself. Whilst cranialization has a role in the removal of the mucosa or contents of the frontal sinus in craniofacial resection, the morbidity associated with it make Riedel's procedure preferable for dealing with chronic infection or locally invasive disease. Riedel's procedure also maintains a barrier in the form of the posterior wall of the frontal sinus and the intracranial contents. Post-operative disfigurement, the main criticism of this procedure, can be reduced to some extent by chamfering the margins of the frontal sinus along with the supraorbital rims and reconstructing the anterior wall at a later date if necessary. The authors are aware that any report about frontal sinus surgery should be judged after several years follow-up, and whilst not all these cases have been asymptomatic for a decade, several have been reviewed for many years.

Evidence of bacterial biofilms on frontal recess stents in patients with chronic rhinosinusitis

BACKGROUND

Bacterial biofilms have been documented on middle ear mucosa, tonsils, and cholesteatoma. We hypothesize that bacterial biofilms are present in mucosa of patients with chronic sinusitis. We believe that frontal sinus stents may serve as a reservoir for biofilms.

EXPERIMENT

We studied silicone frontal sinus stents removed from six patients 1 to 4 weeks after FESS with scanning electron microscopy (SEM).

RESULTS

We identified evidence of bacterial biofilms on the frontal recess stents in six of six patients under SEM. Five of these patients had sinus cultures positive for Staphylococcus aureus. Bacterial biofilms were identified by evidence of glycocalyx, water channels, and three-dimensional structure. These images were similar to other images of known biofilms.

CONCLUSIONS

This is evidence of the possible presence of bacterial biofilms on frontal sinus stents in patients with chronic sinusitis. Further study into the role of bacterial biofilms in perpetuating chronic sinusitis is warranted.

[Subdural empyema of sinus origin caused by Gemella morbillorum, a strange etiology]

We present a case of frontal sinusitis complicated with a subdural empyema, in which the identified microorganism was Gemella morbillorum, a frequent host of the aerodigestive tract and occasionally related to infections. The problem was resolved successfully using endoscopic surgery and an external approach of the sinus. Afterwards it was completed with a subdural drainage through craniotomy. Subdural empyema is a rare complication of sinusitis although very severe. We want to emphasize the importance of early diagnosis of intracranial complications, the need of a detailed microbiology test the method used to obtain samples, and the convenience of a combined approach by the otolaryngologists and the neurosurgeons for its complete drainage.

Bacteriology of acute and chronic frontal sinusitis

Aspirates of 15 acutely and 13 chronically infected frontal sinuses were processed for aerobic and anaerobic bacteria. A total of 20 isolates (1.3 per specimen) were recovered from the 15 cases of acute frontal sinusitis, 16 aerobic and facultative isolates (1.1 per specimen) and 4 anaerobic isolates (0.3 per specimen). Aerobic and facultative organisms alone were recovered in 13 specimens (87%), and mixed aerobic and anaerobic bacteria were recovered in 2 (13%). The predominant aerobic and facultative organisms were Haemophilus influenzae (6), Streptococcus pneumoniae (5), and Moraxella catarrhalis (3). A total of 32 isolates were recovered from the 13 cases (2.5 per patient) of chronic frontal sinusitis, 12 aerobic and facultative isolates (0.9 per specimen) and 20 anaerobic isolates (1.5 per specimen). Aerobic and facultative organisms only were recovered in 3 instances (23%), anaerobes only in 7 instances (54%), and mixed aerobic and anaerobic bacteria in 3 instances (23%). The predominant aerobic bacteria were gram-negative bacilli (H influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa). The predominant anaerobes included Prevotella species (8), Peptostreptococcus species (6), and Fusobacterium species (4). These findings illustrate the microbiologic features of acute and chronic frontal sinusitis.

Microbiology of chronic frontal sinusitis

OBJECTIVES

To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis.

STUDY DESIGN

Retrospective, nonrandomized study.

METHODS

Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis.

RESULTS

Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase-negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase-negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery.

CONCLUSIONS

This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase-negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.

Complications of frontal sinusitis and their management

Because of the anatomic location and venous drainage pattern of the frontal sinus, complications commonly involve intracranial structures but can involve the orbit and adjacent bony and soft tissue structures also. Evaluation of patients by a thorough history and physical examination, culture of purulent discharge or infected bone, and axial and coronal CT scanning with contrast is important for diagnosis and treatment planning. Treatment of complications uniformly involves the use of intravenous antibiotics and appropriate drainage procedures to arrest the infection and allow for resolution of the inflammatory complication. Significant morbidity and mortality from complications can occur despite aggressive medical and surgical treatment.

Allergic fungal sinusitis: CT findings

PURPOSE

To determine the computed tomographic (CT) findings in patients with allergic fungal sinusitis.

MATERIALS AND METHODS

The authors retrospectively reviewed CT scans and surgical and histopathologic reports in 45 patients (27 male, 18 female; age range, 8-68 years) with allergic fungal sinusitis from multiple institutions. The median age (25 years) and demographics of the patients were determined. Two head and neck radiologists together evaluated the CT scans for the presence of intrasinus high-attenuation areas, extent of sinus involvement, bone expansion and thinning, bone erosion, and extension of disease into the adjacent soft tissues.

RESULTS

Allergic fungal sinusitis was more common in male patients and in patients aged 20-30 years. All patients had increased intrasinus attenuation at non-contrast material-enhanced CT. Multiple sinus involvement occurred in 43 patients. Bilateral involvement was more common than unilateral disease. Forty-four patients had complete opacification of at least one of the involved sinuses; 43 of these patients had expansion of an involved sinus, 42 had remodeling and thinning of the bony sinus walls, and 41 had erosion of the sinus wall.

CONCLUSION

Allergic fungal sinusitis is a distinct clinical entity with nonspecific symptoms that may be initially suggested by the CT findings. These findings should alert the clinician to the possibility of allergic fungal sinusitis and prompt other diagnostic studies to establish the diagnosis and treatment plan.

High serum levels of somatomedin-C and diabetes mellitus caused by obstructive hydrocephalus: case report

OBJECTIVE AND IMPORTANCE

This case demonstrates a relationship between hydrocephalus with a huge diverticulum of the third ventricle and high serum levels of somatomedin-C. Somatomedin-C levels become high when the secretion of growth hormone from the adenohypophysis increases, and previous reports state that hydrocephalus decreases the secretion of growth hormone.

CLINICAL PRESENTATION

The patient suffered from diabetes mellitus and obesity, and serum somatomedin-C levels were high. A pituitary adenoma or ectopic growth hormone-producing tumor was suspected. Magnetic resonance imaging did not reveal either of these abnormalities but indicated hydrocephalus with a diverticulum of the third ventricle.

INTERVENTION

After ventriculoperitoneal shunt placement, the blood glucose and serum somatomedin-C levels of the patient decreased toward normal. Six months later, the shunt tube became obstructed and serum somatomedin levels increased. The levels decreased again after shunt revision.

CONCLUSION

To our knowledge, this is the first published report of obstructive hydrocephalus with a diverticulum of the third ventricle compressing the hypothalamus and increasing the serum levels of somatomedin-C.

Paranasal sinus fungus balls

BACKGROUND

Paranasal sinus fungus balls (mycetomas) are a form of fungal sinus infection distinct from allergic fungal sinusitis, fulminant invasive fungal disease, and paranasal aspergillus granulomas.

METHODS

The Mayo Clinic surgical pathology files of inflammatory sinus specimens from 1984 to 1994 were examined. Twenty-nine paranasal sinus fungus balls were identified. Cases of allergic fungal sinus and invasive fungal disease were excluded.

RESULTS

The fungus ball occurred in 11 men and 18 women, with an age range of 28 to 86 years, mean 64 years. Sinuses involved included maxillary (20 cases), sphenoid (10 cases), ethmoid (9 cases), and frontal (6 cases). In 12 patients, multiple sinuses were involved in a variety of combinations. By culture the most common pathogens were Aspergillus fumigatus and Aspergillus flavus. Treatment was by a variety of surgical procedures. Follow-up in 28 patients showed two recurrences and three deaths due to intracerebral bleed as a complication of surgery. These deaths occurred in patients with sphenoid sinus fungus balls.

CONCLUSIONS

Paranasal sinus fungus balls occurs in an elderly population and have a female predominance. They have a low morbidity and recurrence rate. Death can occur in sphenoid sinus lesions as a complication of surgery.

Chronic sinusitis refractory to standard management in patients with humoral immunodeficiencies

Chronic refractory sinusitis is a common feature in patients with primary immunodeficiencies. The efficacy of standard therapeutic strategies is questionable. In an open trial we evaluated the efficacy of azithromycin, N-acetylcysteine and topical intranasal beclomethasone (100 microg twice daily for 6 weeks) in 16 patients with primary immunodeficiencies (median age 13.5 years, range 5-32 years). All patients suffered from chronic sinusitis despite regular immunoglobulin replacement therapy every 3 weeks. Magnetic resonance imaging (MRI) scans were performed before and after 6 weeks of treatment to evaluate morphological changes in the paranasal sinuses. Nasal swabs and washings were taken for microbial analysis and measurement of inflammatory mediators (IL-8, tumour necrosis factor-alpha (TNF-alpha), eosinophilic cationic protein (ECP)) before and post therapy. Inflammatory mediators in nasal secretions were significantly elevated in patients: IL-8 median 2436 pg/ml (range 441-5435 pg/ml), TNF-alpha 37.3 pg/ml (3.75-524 pg/ml) and ECP 33 ng/ml (1.5-250 ng/ml) versus age-matched healthy controls: IL-8 median 212 pg/ml (99-825 pg/ml), TNF-alpha 3.77 pg/ml (2.8-10.2 pg/ml) and ECP 1.5 ng/ml (1.5-14.8 ng/ml) (P < 0.0001). Inflammation of the maxillary sinuses was confirmed by MRI scans in all patients, additionally infection of the ethmoidal and frontal sinuses was recorded in five patients. Bacterial growth appeared in 11 out of 16 cultures. In spite of therapy, no improvement in sinal inflammation visualized by MRI was achieved. Moreover, no significant decrease in pathogens and levels of inflammatory mediators could be detected (IL-8 1141 pg/ml, 426-4556 pg/ml; TNF-alpha 13.9 pg/ml, 4.1-291.6 pg/ml; ECP 32.3 ng/ml, 3.7-58.4 ng/ml). Our results demonstrate that conventional management of sinusitis is of little benefit in patients with chronic refractory sinusitis with an underlying immunodeficiency. More studies are needed to test antibiotic regimens, probably combined with surgical drainage and anti-inflammatory agents.

Intracranial complications of sinusitis

Intracranial suppurative complications of sinusitis remain a challenging and contemporary topic. To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995. There were 203 patients with 212 suppurative intracranial infections. Sinogenic sources were identified in 12 patients with 19 infections. Most patients had ethmoid or frontal sinusitis. We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases. The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses. The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae.

Bacteriological evaluation of 194 adult patients with acute frontal sinusitis and findings of simultaneous maxillary sinusitis

In a prospective study bacteriological findings from frontal and maxillary sinus secretes were analyzed. Frontal sinus trephination was performed to 103 and maxillary irrigation to 192 patients. Main pathogens in the frontal as well as in the maxillary sinus secretes were Haemophilus influenzae and Streptococcus pneumoniae. beta-lactamase production of H. influenzae was found in 17% of frontal and in 16% of maxillary sinus samples. Bacteriological findings were supported by the staining results. The portion of anaerobic pathogens in cultures were poor, though Bacteroides fragilis antigen was detected in 8 frontal and 6 maxillary sinus samples. The acute frontal sinusitis should be treated with respective antibiotics. Complications seem not to develop in the acute phase and the disease can primarily be treated conservatively. It should however be controlled properly to avoid prolonged disease and late complications.

[Tuberculosis of the otorhinolaryngologic region: laryngeal and extra-laryngeal forms]

BACKGROUND

The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis.

METHODS

All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed. All cases of cervical adenitis were not included.

RESULTS

Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal). In the laryngeal forms, all patients were male except for one, and all were smokers. The duration of the symptoms was greater than 3 months in all the cases. Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord. Twenty-nine percent did not present with coincident pulmonary tuberculosis. None of the extra-laryngeal forms showed pulmonary involvement. All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis. The evolution with medical treatment was favorable in all cases. During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital.

CONCLUSIONS

Tuberculosis of the upper respiratory tract is infrequent. Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms. Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy. Response to medical treatment is usually good.

Efficacy and tolerability of brodimoprim and roxithromycin in acute sinusitis of bacterial origin in adults

In two ear, nose and throat (ENT) divisions, 74 patients affected by acute sinusitis of bacterial origin were selected and, after randomization in two balanced groups following an open parallel group design, assigned to treatment with brodimorprim and roxithromycin. At the beginning, after 3 days, 7 days and at the end of treatment the following symptoms were evaluated, using a four-step score: intensity of facial pain, headache, nasal stiffness, hyposmia, nasal secretion. The mean treatment period was 8.7 days. Tolerability was evaluated through registration and analysis of side effects and laboratory blood tests. The comparison between groups showed a better activity of brodimoprim on facial pain, headache, nasal stiffness and nasal secretion. The presence of resistant bacterial strains was greater in the group treated with roxithromycin (30.8%) when compared with the brodimoprim group (12.5%). Side effects were reported in 5 patients treated with brodimoprim and in 3 patients in the control group. Lab tests did not show serious variations.

[Infectious sinusitis in HIV infection. Clinical and therapeutic data on 20 patients]

To assess the clinical presentation and outcome of infectious sinusitis in HIV-infected patients, we analyzed in a retrospective study, the records of HIV-infected patients hospitalized from June 1986 to November 1989. Twenty-eight episodes of infectious sinusitis, defined by radiological signs, were recorded in 20 HIV-infected patients. Clinical presentation suggestive of acute sinusitis was inconstant and in 6 episodes a persistent fever was the only symptom. Concomitant pneumonia was detected in 8 episodes. Bacteria were isolated in 8 episodes, and in 4 of them, Haemophilus influenzae was identified. Clinical relapses occurred in 8/20 patients, requiring a surgical drainage in 3 cases. The frequency of relapses and the possibility of chronicity justify a more prolonged and aggressive therapy in infectious sinusitis occurring in HIV-infected patients.

Increase of acute frontal sinusitis in southwestern Finland

The number of patients hospitalized for acute infection in the frontal sinuses at the Department of Oto-Rhino-Laryngology of Turku University Hospital has increased markedly during the last decade. Causes for this increase were evaluated by comparing the backgrounds and medical findings of the 134 patients treated in the years 1977-81 and those of the 421 patients treated in the years 1982-86. Nasal polyps and history of allergic rhinitis were considerably more common in the latter patient group. The disease also seems to recur increasingly in the same patients. Of the aerobic bacteria Streptococcus pneumoniae and Haemophilus influenzae were the most common pathogens and the share of H. influenzae increased slightly, becoming the commonest pathogen in the latter 5-year period. Increasing air pollution in the city area of Turku is worth consideration and should be investigated further.