Bacteriology of normal frontal sinuses

PURPOSE

The aim of this cross-sectional trial was to identify the bacterial flora and to quantify the level of bacterial presence in healthy adult frontal sinus cavities.

MATERIALS AND METHODS

Ninety five consecutive patients undergoing craniotomy of the anterior cranial fossa were enrolled. All patients were evaluated preoperatively by a sino-nasal questionnaire, nasal endoscopy and CT scan. Exclusion criteria were patients with sinus tumours, presenting a cold in the past 8 weeks, having signs or symptoms suggestive of sinus disease, history suggestive of allergic rhinitis and/or asthma, having undergone hospitalization or an outpatient clinic visit within the past 12 months, patients with known systemic disease, having previous sinus or nose surgery, history of trauma of the sino-nasal region, or having used systemic antibiotics, steroids, or nasal spray in the past 8 weeks. Lavages were obtained from frontal sinuses before craniotomy through trephination of the anterior wall. The sinus was irrigated with sterile saline followed by aspiration. Specimens were inoculated for aerobic and anaerobic organisms.

RESULTS

After applying the exclusion criteria, 42 patients (84 sinuses) were finally included in the study. Bacterial organisms were recovered in 12 of 84 (14.28%) sinuses. However, 85.72% of the sinuses were found to be sterile. Bacteria recovered included three different coagulase-negative staphylococci, one Citrobacter diversus and two Micrococcus spp. No anaerobic organism was isolated.

CONCLUSIONS

This study demonstrated that the majority of frontal sinuses of asymptomatic adults with normal CT and endoscopic appearance are sterile.

[Unilateral frontal sinus aspergillosis: the combined endoscopic and mini-trephination approach]

OBJECTIVE

Aspergillosis is a common fungal infection of the paranasal sinuses. Localization in the frontal sinus is usually secondary to involvement of one of the other sinuses. Isolated frontal sinus aspergillosis is rare and only 5 cases are described in literature.

CLINICAL CASE

We report a case of a patient with a frontal sinus aspergilloma associated with ipsilateral chronic ethmoidal and maxillary sinusitis, successfully treated with a combined endoscopic and mini-trephination approach "Lemoyne technique".

DISCUSSION AND CONCLUSION

The endoscopic approach to the frontal sinus is considered the best way to deal with frontal sinus aspergilloma, but it is sometimes not sufficient to guarantee the complete removal of the fungus ball. In such cases a mini-trephination of the frontal sinus with associated irrigation provides a more accurate visualization and toilette of the sinus.

[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.

Sinonasal tumor in 3 dogs after successful topical treatment for frontal sinus aspergillosis

Three dogs diagnosed with aspergillosis developed sinonasal tumors several months after successful treatment with topical clotrimazole solution. Chronic rhinosinusitis was also detected in all cases prior to diagnosis of sinonasal tumors. The inflammatory response to Aspergillus, clotrimazole treatment, and chronic inflammation after treatment are discussed as possible neoplastic promoting factors.

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

The Role of Ostiomeatal Complex Obstruction in Maxillary Fungus Ball

OBJECTIVE

The aim of this study was to clarify the role of ostiomeatal complex obstruction in maxillary fungus ball.

STUDY DESIGN AND SETTING

Comparative study in a hospital setting of the mean Lund-Mackay scores for the anterior ethmoid and frontal sinuses of 54 versus 48 patients with maxillary fungus ball versus chronic unilateral rhinosinusitis, respectively.

RESULTS

In cases with partial opacification in the maxillary sinus, the anterior ethmoid and frontal sinuses were diseased in the chronic unilateral rhinosinusitis group but not in the maxillary fungus ball group. In cases with total opacification in the maxillary sinuses, all anterior ethmoid and frontal sinuses in both groups were diseased, but the disease condition of the frontal sinuses was significantly less severe in the maxillary fungus ball group (P < 0.001).

CONCLUSION AND SIGNIFICANCE

In this era of evidence-based medicine, we provide statistical data supporting the principle that maxillary fungus ball is not associated with osteomeatal complex obstruction and that another as-yet-unexplained mechanism must be responsible.

EBM RATING

B-3b.

Bacteriology of chronic sinusitis in relation to middle meatal secretion

BACKGROUND

The bacteriology of chronic sinusitis has been studied widely, but some factors may affect the results, such as sample sources and sampling techniques. However, whether the presence of secretion in the middle meatus affects the culture result has been studied rarely.

METHODS

When patients with chronic sinusitis underwent functional endoscopic sinus surgery, swab specimens were taken from the ipsilateral middle meatuses and ethmoid sinuses under endoscopic guidance. While taking specimens from the middle meatuses, we observed the presence of secretions in the middle meatuses. The severity of chronic sinusitis was evaluated by preoperative computed tomography, which was scored by the Lund-Mackay system. The scores of the frontal, anterior ethmoid, maxillary sinus, and ostiomeatal complex were cumulated.

RESULTS

Between March 2001 and February 2004, 210 pairs of specimens were collected. The secretion was present in 82 middle meatuses and was absent in the other 128 middle meatuses. The culture rates of middle meatus and ethmoid sinus specimens were 70.7 and 51.2%, respectively, for patients with secretions in the middle meatuses and 53.1 and 44.5%, respectively, for patients without secretions in the middle meatuses. The culture rate was significantly different for middle meatus specimens (p = 0.011) and the mean cumulated computed tomography score also was significantly higher in patients with secretions in the middle meatuses than in patients without secretions in the middle meatuses (p < 0.001).

CONCLUSION

The results of this study suggest that the presence of secretion in the middle meatus indicates more severe disease in the anterior group of paranasal sinuses.

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.

Characteristics of bony erosion in allergic fungal rhinosinusitis

OBJECTIVES

Erosion of bone with or without extension of disease into adjacent anatomic spaces is observed among some patients with allergic fungal rhinosinusitis (AFRS). The objective of this report is to further define these findings as they relate to this disease.

STUDY DESIGN

Retrospective chart review of 142 patients with AFRS diagnosed using the Bent-Kuhn criteria. All patients were treated at a single institution.

RESULTS

Approximately 20% of patients with AFRS demonstrated bone erosion on CT scan. The ethmoid sinus was the most commonly eroded site. The orbit and anterior cranial fossa were the most common adjacent anatomic spaces to exhibit disease extension. Sinus expansion, not the specific organism identified, was associated with the presence of bone erosion. Surgical management with endoscopic techniques was successful for all patients without any major perioperative complications.

CONCLUSION

Bone erosion can be related to AFR. Recognition of this possibility is important because bone erosion can be interpreted as an indication of invasive pathosis. In the presence of bone erosion or disease extension, endoscopic techniques can be used to surgically manage this disease.

The observation of reactive thrombocytosis in New Zealand white rabbits in response to experimental Pasteurella multocida infection

Reactive thrombocytosis is an increase in the circulating thrombocyte count secondary to a physiologic process within the body, often an infection. Reactive thrombocytosis is different than primary or essential thrombocytosis which is usually related to myeloproliferative neoplasia. Essential thrombocytosis is most common in adults, whereas reactive thrombocytosis is most frequently observed in children. Reactive thrombocytosis has been occasionally reported in cats, dogs and horses but has not been previously reported in the rabbit. Rabbits were challenged with virulent Pasteurella multocida. Hematologic, clinical, and culture assessments were performed prior to challenge, enabling each animal to serve as its own control. The questions asked were whether reactive thrombocytosis was a consistent phenomena and whether its presence and/or intensity was related to disease severity. All challenged rabbits demonstrated some degree of thrombocytosis in response to the infection, but individual rabbits were varied in their pattern of thrombocytosis. Elevations varied from intense to mild to undulating with durations of 1 to 11 days above 500 x 10(9)/L and 0 to 5 days above 650 x 10(9)/L. Correlation analysis was unable to demonstrate significant association between thrombocytosis, body temperature, leukocyte count, or the granulocyte lymphocyte ratio (all r < 0.2). No significant association between intensity of thrombocytosis and degree or type of pathologic lesions was observed. Thrombocytosis does not appear predictive of disease intensity or outcome. The data indicate that in the rabbit thrombocytosis is a consistent response to infection with P. multocida. Rabbits may serve as a model for the study of reactive thrombocytosis, in humans especially in children infected with Haemophilus sp., which are also a members of the bacterial family Pasteurellaceae.

Exophthalmos associated with frontal sinus osteomyelitis in a puppy

A three-month-old, male Great Dane puppy developed progressive left exophthalmos, epiphora, and swelling of the left frontal bone. Radiographs revealed obliteration of the left frontal sinus by a bone-like density, and lateral sinus wall thickening with extension into the left orbit. On surgical exploration and trephination, the left frontal sinus was filled with soft bone which contained multiple pockets of mucopurulent material. Cytologic examination confirmed the presence of a large number of neutrophils, osteoclasts, and osteoblasts; and both extracellular and intracellular, filamentous, beaded bacteria. The involved bone was debrided, and the defects in the orbital wall and sinus were reconstructed successfully with a temporalis muscle flap.

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.

Mycoplasma mycoides recovered from the frontal sinus of an ox

The isolation of M. mycoides from the frontal sinus of an ox is recorded. The possibility that this observation may reflect a true carrier state and be responsible for field outbreaks of obscure origin is considered.

Bacteriologic features of chronic sinusitis in children

Aspiration of chronically inflamed sinuses was aseptically performed in 40 children. The median age was 11 years (range, 6 to 16 years). The sinuses were the maxillary (15 cases), ethmoid (13), and frontal (seven). Pansinusitis was present in five patients. All aspirates were cultured for aerobes and anaerobes and yielded bacterial growth in 37 patients. A total of 121 isolates (97 anaerobic and 24 aerobic) were recovered, accounting for 2.7 anaerobes and 0.6 aerobes per specimen. Anaerobic organisms were recovered from all 37 culture-positive specimens, and in 14 cases (38%) they were mixed with aerobic organisms. The predominant anaerobic organisms were Bacteroides species (36), anaerobic Gram-positive cocci (28), and Fusobacterium species (13). The predominant aerobic isolates were alpha-hemolytic streptococci (seven), Staphylococcus aureus (seven), and Haemophilus species (four). These findings indicate the major role of anaerobic organisms in the polymicrobial cause of long-term sinusitis in children.

Skrjabingylus lutrae n. sp. (Nematoda: Metastrongyloidea) from otter (Lutra canadensis)

Skrjabingylus lutrae n. sp. from otter in Ontario is distinguished from other members of the genus by its short spicules (239–275 μ long) with globe-shaped tips, and a small buccal capsule. It is the only sinus worm known from otter (Lutrinae). First-stage larvae from the uteri of female worms and third-stage larvae from experimentally infected gastropods (Mesodon roemori) are described.