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Due to rhinosinusitis symptoms severity and relatively high treatment resistance, excipients, supplementing basic pharmacological and surgical treatment, have played a significant role in the recent years. Phytotherapy is one of the most dynamically developing studies which focuses on implementing natural active substances into the treatment. 2012 EPOS Report pinpoints the benefits of using substances of natural origin in patients with acute rhinosinusitis. Sinupret drug has been proven effective in clinical trials, as a drug for both acute and chronic rhinosinusitis, in children and adults. Sinupret is a multidirectional drug, which significantly alleviates the symptoms of rhinosinusitis., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Chronic sinusitis is one of the most common presenting complaints of all doctor visits in the United States and Europe, with more than 13% of people affected in any given year. This disease has a wide range of impact on communities. Patients with recurrent or chronic sinusitis report a deteriorative sense of general health and vitality, when compared to general population. In our Department we perform about 600 functional endoscopic sinus surgeries (FESS) per year. Chronic rhinosinusitis represents a spectrum of inflammatory and infectious processes concurrently affecting the nose and paranasal sinuses. Among chronic paranasal sinusitis one must single out paranasal sinusitis with and without polyps. In the paranasal sinusitis patomechanism the blockage of natural ostium plays one of the most important roles. The closure of sinus proper ventilation passages leads to the triggering of many pathological occurrences within mucous membrane of this region. The treatment of paranasal sinusitis is diversified and involves a surgical procedure as well as anti-inflammatory and antiallergic drugs (medications) and mucolytics. Its purpose is to clear the nose through the elimination of bacterial infection, liquidating and removal of lying discharge and the restoration of the proper muco-ciliary transportation, and through this the improvement of local condition and faster recovery. In this work the usage of carboxycysteine to treat paranasal sinus conditions has been presented., (Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Introduction: Intracranial or orbital complications after chronic and acute rhinosinusitis are rare, but could be dangerous. The complications of acute rhinosinusitis more often are observed in young patients. The combination of both intracranial and orbital complications together is found after acute inflammation., Material and Methods: We present a case of a patient with primary developed orbital complication during acute rhinosinusitis followed by intracranial abscess during the same treatment period., Results: One week after intravenous antibiotic therapy with good outcome we observed an aggravated inflammation process with osteitis of frontal bone and brain abscess formation. We performed an external approach for frontal sinus surgery combined with neurosurgical brain abscess evacuation. Swabs taken during surgery were positive for: Streptococcus constellatus and Parvimonas micra sensitive for penicillin and metronidazol. We observed a good recovery after two weeks of treatment., Conclusions: We recommend performing a complementary CT of the sinus and CT of the brain with contrast when complications of acute rhinosinusitis are suspected. The coexistence of intracranial and orbital complications could be observed in younger patients mostly after acute sinusitis.

Overuse of antibiotics is a major cause of bacterial resistance. Inappropriate and unnecessary antibiotic therapies are particularly frequent in the treatment of respiratory tract infections, which are viral in origin in about 80% of cases. This review work presents the principles of rational antibiotic therapy of acute upper respiratory tract infections, namely pharyngotonsillitis, otitis media and sinusitis according to Polish Recommendations 2010.

Background: Chronic rhinosinusitis with nasal polyps is observed in 1-4% persons during rhinoscopy. While the occurrence of their problems is connected with smell sense, still not enough attention is paid to the malfunctioning of their taste sense., Aim: The purpose of this study was estimation of taste sense functioning in patients with chronic rhinosinusitis with nasal polyps, treated with oral glucocorticosteroid., Material and Methods: The study included 82 persons. The 31 of them were patients of Otolaryngology Department of Warsaw Military Institute with chronic rhinosinusitis with nasal polyps' diagnosis, who were treated with systemic--oral glucocorticosteroid for three weeks. There were 51 healthy people as a control group. Both prior to the treatment and one month after it was finished, all patients had the taste examination. The taste functioning was examined with two methods: the gustometry by Bornstein and impulse bipolar electrogustometry method. Subjective nasal patency was noted based on analogical scale. The smell function was assessed with the Elsberg-Levy olfactometry in Pruszewicz's modification., Results: Before treatment the taste disturbances were observed, depending on kind of taste, in 6-16 cases (19.4-51.6%) in gustometry and for 10 patients (32.26%) in electrogustometry. Before treatment the taste examination results in chronic rhinosinusitis with nasal polyps' cases were statistically significantly different than in the control group. After treatment with glucocorticosteroid the taste disturbances were observed, depending on kind of taste, in 0-9 cases (0-29%) in gustometry and for 4 patients (12.9%). in electrogustometry. Statistically, glucocorticosteroid therapy also decreased the smell threshold and was effective in restoration of the nose patency., Conclusions: Statistically, therapy with glucocorticosteroid significantly improved both the taste and smell perception in patients with chronic rhinosinusitis with nasal polyps

The frequency of fungal etiology of sinusitis contains between 9 and 49 % according to different authors. Fungal rhinosinusitis has been divided into noninvasive and invasive forms. Noninvasive infections include fungus ball (mycetoma) and allergic fungal rhinosinusitis. Invasive infections include acute (or fulminates) fungal rhinosinusitis and invasive chronic rhinosinusitis. The case of chronic invasive rhinosinusitis was presented. Patient performed surgery--Functional Endoscopic Sinus Surgery and paranasal sinuses operation from subcranial approach. Surgery procedures were followed by antifungal pharmacotherapy (Orungal and Worykonazol). The presented case of fungal invasive chronic rhinosinusitis was treated according to recommended procedures with surgery followed by adequate antifungal farmacotherapy. In this case we have reached a successful outcome.

The autors present the diagnostic and therapeutical difficulties of acute (fulminant) invasive mycotic rhinosinusitis. A case report of mycotic rhinosinusogenes meningitis in 50 years old woman is described in this paper. The intensive pharmacological and surgical treatment was performed. The result was successful, however the optical nerve was damaged.

Sarcoidosis is a granulomatous disease of unknown etiology. In sarcoidosis almost all organs can be involved but the disease most often affects the lungs and intrathoracic lymph nodes. Isolated extrapulmonary organs involvement occurs very seldom. We present two cases of sarcoidosis limited to upper respiratory tract--a young woman with laryngeal sarcoidosis and recurrent throat pain, and a woman with disease of the sinuses and pharynx and clinical symptoms of chronic sinusitis poorly responsive to conventional treatment.

Introduction: Chronic sinusitis presents important problem in children. General approach in chronic sinusitis in children consists of: findings the proper diagnosis, optimal pharmacotherapy (oral or intravenous antibiotics), treatment coexisting allergic or systemic diseases and considering employing surgical treatment. The main surgical procedures in the treatment of chronic sinusitis in children are adenoidectomy and functional endoscopic sinus surgery (FESS)., Material and Methods: 32 children with chronic sinusitis treated in ENT Department Silesian Medical University in Zabrze in the years 2000-2005 were presented in this study. 26 patients were treated surgically and 6 children by pharmacotherapy. In the surgically treated patients we performed 10 Functional Endoscopic Sinus Surgery, 4 unilateral and 8 bilateral sinusoscopy of maxillary sinus, and in 4 cases we removed choanal polyps., Results: In the group of 26 surgically treated children we did not observed the recurrence of symptoms in the 24 months follow-up period.

The paper presents different forms of sinusitis in children and adults as well as the patomechanism of sinusitis of infective and non-infective origin. The role of bacterial infection has been discussed. Participation of major pathogens of URTI such as S. pneumoniae, H. influenzae and M. catarrhalis has been highlighted and the factors influencing growth of their antibiotic-resistant stains. Guidelines concerning antibiotic therapy in children and adults, depending on disease course, age and factors influencing growth of resistant stains have been presented. Causes of failure in treatment of sinusitis have been analysed eg. in case of bacterial biofilm growth or non-neutrophilic inflammation forms. Antimicrobial treatment concerns mainly acute and aggravated infections. In case of chronic sinusitis, antibiotic therapy is complementary to surgical treatment.

We started therapy sinusitis of our patients with antibiotics cefuroxime axetil (Zinnat, GSK), clarithromycin (Klacid Uno, Abbott) and orally given steroid-prednisone in one group (A+S) 56 patients. Second group of 60 patients were cured only with antibiotics (A). We compare effects of this therapy. There were 50% totally cured patients in the first group (A+S) and 46.6% cured in the second group. Percentage totally cured patients with (A+S) is 3.4% better that cured only with antibiotics in the same time. It is statistically important. We present benefits for patients who were operated in the next step. Post therapy with the use of antibiotics and steroids there were less bleeding from the mucosal membrane, and there was no edema. It is a good method of therapy if patients have no contraindications.

The still present problem of choice of a treatment method in chronic sinusitis was introduced in this study. The heterogenous etiology of chronic sinusitis and its treatment consequences were presented. The main current options in the treatment of chronic sinusitis were shown. The functional endoscopic sinus surgery was emphasized as the most important. The different courses of antibiotic therapy: nebulization, oral and intravenous were introduced as a method of choice in exacerbation of chronic process. The intravenous antibiotics were analyzed in details and it was especially based on the bacterial biofilms theory according to the newest literature. The obtaining results were good enough. They were better in children than in adults and in patients with shorter history of sinusitis, however they were not free from complications. Thrombophlebitis, allergic reaction, neutropenia were indicated as most frequent complications that caused the break in the therapy. In the conclusion the intravenous antibiotic therapy was estimated as a useful procedure, but not highly recommended due to a possibility of complications.

Long-term, low-dose macrolide therapy is effective in the treatment of chronic airway inflammation. It is believed that macrolide antibiotics produce this benefit through an antiinflammatory effect that is separate from their antibiotic effect. Eosinophils are key mediators in the inflammation seen in chronic rhinosinusitis. The effect of macrolides on eosinophilic inflammation is presented. In vitro studies recently have suggested that macrolides increase eosinophil apoptosis and reduce production of eosinophil chemotactic cytokines and adhesion molecules. In vivo studies have shown a reduction in eosinophil count and activity in asthma and chronic rhinosinusitis. Further in vitro and clinical studies are required to investigate this subject. The authors present preliminary results of clinical trial.

During this randomized, double blind study versus placebo efficacy of 3 month treatment of patients with chronic sinusitis was assessed. Main efficacy criterion was defined as the change in computed tomography of paranasal sinuses, measured in V. Lund scale. In fenspiride group, overall score changed from 8.54 to 7.57 points (0.97 points i.e. 11.4% decrease, p=0.008), while in placebo group no statistically significant change was observed (change from 9.25 to 9.27 points--0.02 points i.e. 0.2% increase). Percentage of patients who experienced worsening (defined as at least 1 point increase between the beginning and the end of the study) in the placebo group was twice as big as in the fenspiride group (35.4% and 15.2% respectively; p=0.025). Clinical symptoms of chronic sinusitis--sneezing, itchy nose and purulent character of sputum--were decreasing in the fenspiride group significantly more than in the placebo group. Data from previous studies demonstrated beneficial effect of fenspiride treatment of patients with chronic sinusitis. During this study fenspiride treatment was proved to be relatively effective in terms of computed tomography results, and well tolerated during three month therapy.

The case of extensive, invasive fungal sinusitis in 72 years old man was presented in this paper. The surgical treatment was performed in this patient--rightsided maxillectomy with orbitotomy. Results of histological and mycological examinations of postoperative material shoved evidence of Aspergillus Fumigatus. The additional pharmacotherapy with Amphotericin B and Orungal was attached. Despite of such aggressive treatment patient died 9 months after the last operation.

In our study the ability of the isolated microorganisms to produce beta-lactamase was determined. These microorganisms were isolated from sinus punctures of 115 patients before (evaluation I) and after the treatment finished (evaluation III). During first evaluation 93 microorganisms with potential ability to beta-lactamase production were isolated. 24 of them (25.81%) produced beta-lactamase, 69 (74.19%) didn't do it. 57 patients were qualified for amixycillin with potassium clavulanate treatment (subgroup A) and 58 patients for cefuroxime axetil treatment (subgroup B). After the treatment (evaluation III) in the group of 21 isolated microorganisms 6 produced beta-lactamase. The microorganisms producing beta-lactamase were isolated only from the patients where the amoxycillin with potassium clavulanate was administered.

The results of treatment of acute rhinosinusitis in children are presented. The study was based on retrospective analysis of data of 34 children treated with clarithromycin (Fromilid). The clinical efficacy of this drug was confirmed by the study.

A case report of acute invasive fungal rhinosinusitis in 28 year old woman with acute myeloid leukemia is described in this paper. The diagnosis of the fungal disease was based on clinical presentation, endoscopic evaluation of nasal cavity, computed tomography and magnetic resonance imaging of the paranasal sinuses and histopathological findings. An aggressive treatment including antifungal therapy (amphotericin B), antibiotics and the surgery of paranasal sinuses was implemented. Unfortunately the underlying disease and the fungal invasion progressed rapidly and the patient died on the forth week post-op due to cardiorespiratory failure.

Unlabelled: The aim of the study was to estimate by means of acoustic rhinometry (AR) the nasal blockade in 37 patients (5-73 years old, mean 32) with upper airways infections treated by fusafungine. The examinations were carried out on the first (D1) and seventh day (D7) of observation. Cross-sectional area (CA) mean values of 3 cm sector laid back to C notch of AR curves (CA-C3) were selected to the analysis., Results: The mean value of CA-C3: in all patients it was 2.61 cm2 on D1 and 2.8 cm2 on D7; in rhinitis and sinusitis patients--2.23 cm2, in others--3.16 cm2; without nasal discharge--3.48 cm2, in others (with severe or medium)--2.53 cm2 and 2.48 cm2 respectively. 29 patients had nasal blockade (78.4%) with mean CA-C3 = 2.34 cm2 (others--3.56, p < 0.05). During seven days the following enlargement of CA-C3 was reported: 14.9% in all patients (p < 0.01); in viral infections 24% (n = 14, p < 0.01), bacterial 14.3% (n = 11, NI); in nasal blockade patients--15.22%, others--13.55% (p < 0.01). Mean value of CA-C3 increased by 37.7% in patients who demonstrated, according to the physicians, "very good improvement", 5.7%--"good", 1.5%--"weak" (p < 0.05). There was also enlargement of nasal cavities in CA-C3 in non-sneezers (p < 0.05) and medium discharge symptom patients (p < 0.05). There was no statistical difference in clinical and acoustic rhinometry results between patients treated with fusafungine together with non-steroid anti-inflammatory drugs and patients treated with fusafungine., Conclusion: AR is a good instrument to be used in the objective assessment of the nasal blockade changes in people with infection of the nasal mucosa and showed positive efficacy of fusafungine in the treatment of upper airway infection.

The majority of publications in the recent years emphasizes the importance of mucolytic preparations in the upper respiratory tract diseases. There have been very few report about the important role which mucolytic drugs may play in the diseases of the upper respiratory tract. This paper undertakes the task of attempting to evaluate the usefulness of Mucosolvan preparation in laryngological diseases. The main condition of the successful treatment of otolaryngological diseases is maintaining the efficient mechanism of the clearing of upper respiratory tract. This is achieved by means of the mucocilia apparatus, namely cilia and mucosa protecting the epithelium from harmful factors. Tests were carried out on 60 patients with paranasal sinuses and ear diseases. The first group comprised 45 patients who were qualified on the basis of inflammatory changes in paranasal sinuses. The second group comprised 12 children and 3 adults with otitis media with effusion. Mucosolvan which was used in the supplementary treatment fulfilled our expectations. The use of the mucolytic drug accelerated the healing process, proper regeneration of the epithelium and the reduction of the period of drug administration.

In recent years there has been observed an increase in the infections of nose cavity and paranasal sinuses. This phenomenon is connected with a multidirectional alergization of the environment also with the insufficiency of conservative and surgical treatment. Messerklinger's research concerning cilial movements of mucosa in nasal and paranasal sinuses together with his endoscopic experiments are the basic for modern therapy of nasal and paranasal sinuses. In this paper 40 cases of acute and chronic inflammation of paranasal sinuses in children between 3 and 16 years of age were presented. In all cases regardless of the used method of conservative or surgical treatment children were given mucolytic preparations in the form of Mucosolvan by Boehringer Ingelheim. In all observed cases we noticed the shortening of the normal period of the antiinflammatory antibiotic treatment. A part from that, mucolitic preparations due to the decrease of mucous adhesiveness to the walls of paranasal sinuses allow for its evacuation largely decreasing the pain. After FESS treatment, the administration mucolytic preparations causes a factor regeneration of cilial epithelium, proper functioning of cilia and the speeding of mucocilial trnasport, which makes the recovery of an ill child much quicker.

Moraxella catarrhalis in responsible for a considerable number of bronchopulmonary infections in adults, as well as otitis media and sinusitis in children. Many strains of Moraxella catarrhalis produce beta-lactamase and are resistant to many beta-lactam antibiotics. When Moraxella catarrhalis in considered to be a causative organism, the choice for an empiric antimicrobial therapy should be beta-lactamase-resistant antibiotics.