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Background: Subtypes of sinusitis have different symptoms and prognoses due to different pathogens. Odontogenic maxillary sinusitis (OMS) mainly occurs unilaterally and is different from chronic rhinosinusitis (CRS) usually occurring bilaterally in terms of clinical characteristics. However, comprehensive microbiological comparisons between OMS and CRS have never been systematically conducted and most comparisons are methodologically biased. This study aims to provide a comprehensive analysis of the microbiology associated with OMS and CRS through a meta-analysis approach in order to provide evidence for differential diagnosis of OMS and CRS from a microbiological perspective., Methods: The databases PubMed and CNKI were searched from their inception to July 2023. A random-effects model was employed to derive the pooled prevalence estimates of the identified bacterial species or genera., Results: The 17 represented studies included 6 concerning OMS, 12 concerning CRS, and 4 concerning normal sinus, yielding 191, 610, and 92 samples, respectively. Though not statistically significant, the prevalence of Peptostreptococcus and Prevotella was generally higher in OMS compared to CRS. Notably, Fusobacterium was identified as the only genus with a significantly higher prevalence in OMS compared to CRS., Conclusion: Fusobacterium was significantly more prevalent in OMS compared with CRS, while Staphylococcus aureus was more prevalent in CRS than in OMS. Such differences in bacterial profile may partly explain the distinct pathology observed and contribute to the development of novel strategies for diagnosis and therapeutic interventions in OMS., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Odontogenic sinusitis (ODS) is more common than historically thought, representing 25% to 40% of all maxillary sinusitis. Due to a lack of widely accepted diagnostic criteria and a specific international diagnostic code, a true overall prevalence is unknown. ODS may be caused by either a multitude of infectious dental pathologies or complications after dental procedures. The most common dental etiologies causing ODS are apical periodontitis (endodontic) and oroantral communication or fistula after dental extraction. Less commonly, ODS can evolve after dental implant or maxillary sinus bone grafting surgeries, infection of odontogenic cysts, or advanced periodontitis., Competing Interests: Disclosure The author has received or receives honoraria for lecturing by the following companies. Straumann, Geistlich, Bego, BFS, Hess Dental, Nobel Biocare, and Quintessence., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The COVID-19 pandemic affected the epidemiology of several diseases. This study aims to compare the incidence of surgically treated odontogenic sinusitis (ODS) before and during the COVID-19 pandemic and identify unique features., Methods: A retrospective chart review of patients who underwent at least maxillary antrostomy at a tertiary referral center was performed. The patients were divided into two cohorts: "pre-COVID" (March 2018 to February 2020) and "COVID" (March 2020 to February 2022). Data on demographics, comorbidities, and treatment interventions were collected and analyzed., Results: Of the 734 patients who underwent maxillary antrostomy, 370 (50.4%) were operated on during the COVID period, with a mean age of 53.1 ± 15.7 years. ODS was found as the etiology of 22 (6%) and 45 (12.2%) of the pre-COVID and COVID cases, respectively (p = 0.006). Although no difference was found in the incidence of diabetes (p = 0.9) or obesity (p = 0.7) between groups, a trend toward higher incidence of immunosuppression was found in the pre-COVID patients (18.2% vs. 0%, p = 0.06). A higher incidence of sphenoid sinus involvement (31.8% vs. 8.9%, p < 0.05) was identified in the pre-COVID group; however, no differences in ethmoid (86.4% vs. 86.7%, p = 0.999) or frontal sinus involvement (54.5% vs. 37.8%, p = 0.3) were found between the groups., Conclusion: There was an increase in the incidence of ODS during the first 2 years of the COVID-19 pandemic compared to the 2 years prior. Similar clinical characteristics were found in both groups. Future studies focusing on specific etiologies to explain ODS preponderance may help determine optimal treatment and prevention strategies., Level of Evidence: 3 Laryngoscope, 134:1597-1602, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Maxillary osteotomies as a component of orthognathic surgery disrupt the normal anatomy and function of the sinus. The osteotomy with advancement of the inferior component of the sinus leaves a bony and mucosal opening in the sinus. Immediately after surgery, nasal drainage is impeded because of intranasal swelling. Acute and chronic maxillary sinusitis would be expected; however, its incidence as an expected complication is not well documented. A systematic review and meta-analysis was completed using PubMed to determine the incidence of sinusitis after maxillary orthognathic surgery. Studies were reviewed by two authors, and incidence data were extracted. Two hundred six articles were identified with 24 meeting the criteria for analysis. The incidence of sinusitis was based on 4213 participants who had undergone orthognathic surgery. Twenty-three studies reported a total number of sinusitis cases, and the results demonstrated a pooled incidence of 3.3% (95% confidence interval: 1.77, 6.06). One study did not report a total number of cases but reported chronic sinusitis survey-duration-based and Lund-Mackay scores. These scores, respectively, worsened from 7.6 to 14.8 and from 1.58 to 2.90 postoperatively. Despite the variability of maxillary surgery, the surgical technique, and the postoperative management, the incidence is low but sinusitis does occur. Prospective studies with validated questionnaires within the context of a specific protocol may further elucidate the causality of sinusitis. Further, patients with sinonasal symptoms postsurgery should be encouraged to consult with an otolaryngologist to ensure prompt treatment., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Introduction: The overall prevalence of maxillary sinusitis of odontogenic origin (MSOO) is still unknown. Therefore, this study aimed to determine the pooled prevalence of MSOO and verify associations between different odontogenic conditions and MSOO., Methods: Six electronic databases and the gray literature were searched on August 25, 2022. Two independent reviewers selected observational studies reporting the prevalence of MSOO and associated conditions in adults. Studies that did not use computed tomography for diagnosis were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Data were analyzed by proportion and association meta-analyses. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach., Results: Thirty-eight studies were included in the qualitative analysis and thirty-one in the meta-analyses. Only 12 studies (31.6%) fulfilled all items of the methodological quality checklist. Overall, the studies reported prevalence measures per maxillary sinus or patient. Thus, the pooled prevalence of MSOO was 51% per sinus (95% confidence interval [CI] [40%-61%]) and 50% per patient (95% CI [41%-59%]). Apical lesion (odds ratio [OR]: 4.03, 95% CI [2.26-7.19]), periodontitis (OR: 5.49, 95% CI [2.27-13.24]), moderate (OR: 2.57, 95% CI [1.85-3.57]) and severe bone loss (OR: 13.80, 95% CI [2.81-67.85] were significantly associated with MSOO. The certainty of the evidence for the associations was very low., Conclusions: The pooled prevalence of MSOO on computed tomography assessment was 51% per maxillary sinus and 50% per patient. Therefore, half of the maxillary sinusitis may be of odontogenic origin. Apical lesion, periodontitis, and moderate and severe bone loss were significantly associated with MSOO., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

Background: Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized., Objective: To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases., Methods: A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed., Results: Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization., Conclusion: ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected.

Abstract: Posttraumatic chronic maxillary sinusitis deleteriously affects the life quality of patients with recurrent episodes and related discomfort. However, few studies have been performed to investigate the prevalence of chronic maxillary sinusitis after surgery of mid-facial fracture and related risk factors. The early prevention and cure of posttraumatic chronic maxillary sinusitis have received little attention. This study aimed to investigate the prevalence of chronic maxillary sinusitis after surgery for mid-facial fracture and to identify related risk factors. The authors retrospectively collected the medical history, radiographic examination, and clinical examination of patients with mid-facial fracture (experimental group) and patients with mandibular cyst (control group) in our department between January 2015 and December 2020. A total of 298 patients (416 maxillary sinuses) in the experimental group and 172 patients (344 maxillary sinuses) in the control group were included for analyses. The prevalence of chronic maxillary sinusitis in the experimental group and control group were, respectively, 9.14% and 2.04% ( P < 0.05). History of sinusitis/rhinitis (odds ratio = 63.70, P = 0.000) was an independent risk factor for posttraumatic chronic maxillary sinusitis. In conclusion, these findings showed that the prevalence of chronic maxillary sinusitis after surgery for midfacial fracture was significantly higher than that in the control group and long-term follow-up may be beneficial for these patients. Moreover, patients with a history of sinusitis/rhinitis should be informed of the increased risk., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Objective: This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites., Materials: The analysis focused on 145 10 th -12 th -century adults with at least one preserved maxillary sinus., Methods: Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis., Results: Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases., Conclusions: Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out., Significance: This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations., Limitations: Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results., Suggestions for Further Research: Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions., Materials: 481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE-CE 1500)., Methods: Bony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria., Results: There were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease., Conclusions: Factors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis., Significance: Prior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today., Limitations: Poor preservation of skeletons and a lack of archaeological settlement data for some sites., Future Research: Investigation of a greater range of populations from different environments/climates., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described., Objective: This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS)., Methods: 42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery., Results: SSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery., Conclusion: These data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.

Background: Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]., Methods: CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed., Results: Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18-65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT., Conclusions: The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm., (© 2021. The Author(s).)

Background: Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature., Objective: Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT., Methods: A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses., Results: Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered., Conclusion: With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.

Objective: The aim of the study was to study the structure of odontogenic sinusitis and identify iatrogenic etiological factors., Material and Methods: A retrospective analysis of the case histories of patients operated from 2015 to 2019 with a diagnosis of «Sinusitis» in the Clinical City Emergency Hospital in Tashkent, Republic of Uzbekistan in the department of emergency maxillofacial surgery was carried out. The total number of patients was 333 people: 105 (31.5%) men and 228 (68.5%), the average age of patients was 39.4 years., Results: When analyzing the reasons for the development of sinusitis, in 73% of the total number of operated patients, there was an associated lesion of the teeth. When detailing the sources of odontogenic infection, it was determined that periapical foci of inflammation (granulomatous, granulating periodontitis, cystogranulomas) accounted for 26%, foreign bodies (teeth, roots of teeth, filling materials removed into the maxillary sinus during endodontic treatment) 31%, fistulous passages after removal teeth and attempts to eliminate perforation by surgery 43%. Other etiological factors were found: chronic polypous rhinosinusitis 14%, benign tumors 8%, allergic fungal sinusitis 5%., Conclusion: Clinical analysis showed that the development of most cases of odontogenic sinusitis is associated with the mistakes of dentists and is of iatrogenic origin. To prevent the development of odontogenic iatrogenic sinusitis, prior to dental interventions on the teeth of the upper jaw, it is necessary to carry out a topical diagnosis of their ratio with the maxillary sinus.

Among humans, superiorly located maxillary sinus ostia (MSO) result in drainage complications and maxillary sinus (MS) disease. While previous studies investigate maxillary sinusitis frequency or MSO-position relative to specific nasal landmarks, few explore MSO-position to overall MS dimensions. This study investigates whether MSO-position relates to MS size/shape and if sex-based differences exist. Twenty-nine landmarks, placed on magnetic resonance images (MRIs) of 109 individuals (males = 57; females = 52), captured maximum dimensions of the cranium, MS, nasal cavity, and MSO-position relative to the MS floor (MSO&#95;MSF) and nasal floor (MSO&#95;NCF). Landmark coordinates were used to calculate centroid sizes and 13 linear distances; distances were size standardized by cranial centroid-size. Principal components analysis (PCA) on 3D-coordinates indicates that variation in MSO-position relates to superior-inferior MS positioning within the face (PC1 22% variance) and MS height (PC2 12% variance). Regression analyses indicate that MS size (r 2 = 0.502; P < 0.001) and height (r 2 = 0.589; P < 0.0001) strongly contribute to MSO&#95;MSF: larger, taller MSs exhibit greater MSO&#95;MSFs. Sex-based differences were not evident in PC shape-analyses nor among size-standardized dimensions. However, Mann-Whitney U-tests indicate females have absolutely smaller MSs (P = 0.001) and MSO&#95;MSF distances (P = 0.001). Further, regressions indicate females exhibit lower MSO&#95;MSFs for a similar MS height. Overall, MSOs superiorly placed relative to the MS floor correlate with larger, taller MSs and/or sinuses positioned inferiorly within the face. While craniofacial surgeons/clinicians should be aware of potential sex-based differences in MS size and MSO position, this study does not suggest that higher incidences of female-reported sinusitis relate to sex-based differences in MS anatomy. Anat Rec, 302:917-930, 2019. © 2018 Wiley Periodicals, Inc., (© 2018 Wiley Periodicals, Inc.)

Our aim was to investigate the prevalence of Haller cells in a group of patients listed for sinus lifting, and to assess the correlation between postoperative maxillary sinusitis and their presence. A total of 102 patients (150 sides) were evaluated retrospectively on cone-beam computed tomography (CT). The presence and dimensions of Haller cells were noted on the scans. The development of postoperative maxillary sinusitis was recorded. Fisher's exact test was used for statistical evaluation and probabilities of less than 0.05 were considered significant. Maxillary sinusitis developed after sinus lifting in five patients, and Haller cells were found in three of them. However, there was no correlation between the presence of Haller cells and postoperative maxillary sinusitis (p=0.638). The cells were larger in patients with postoperative maxillary sinusitis, and the greater dimensions may be a potential risk factor for developing it after a sinus lift., (Copyright © 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Odontogenic maxillary sinusitis has now increasing incidence in dental and otorhynolaryngological practice. Its incidence varies from 10-12 % to 50-75 %, according to different authors. Literature study showed that odontogenic maxillary sinusites are mostly unilateral, and significantly differ in complaints, clinical signs, and diagnostic and treatment measures from other types of sinusitis. This should be taken into account, because often odontogenic maxillary sinusitis is misdiagnosed with common sinusitis, and only in 77 % such patients are examined by both dental specialist and otorhynolaryngologist. Study of causes of odontogenic maxillary sinusitis revealed that now iatrogenic impact prevails over other causes, which had been previously considered as main causes of odontogenic maxillary sinusitis. Especially endodontic treatment and implantation surgery are major causes of odontogenic maxillary sinusitis in present time, due to increasing incidence of perforation and damage of sinus by filling materials, bone or tooth particles, and implants. Anatomical structure of dental-sinus border area, and volume of endodontic treatment and implanting procedures, determines last ones as causative triggers due to development of complications and inflammatory processes. Microbial flora is mostly presented by anaerobic microorganisms; at the same time aerobic and fungal organisms are found in the microscopy of histology of patients with odontogenic maxillary sinusitis. At the same time, polymicrobial associations show high resistance to wide spectrum of antimicrobial medications. In past years theory of microbial biofilms is considered leading in explanation of recurrent and persistent odontogenic sinusitis. Such polymicrobial associations are covered with complex shield of different compounds, providing protection and nutrients. This significantly complicates treatments and can cause recalcitrant and recurrent infections.

Objective: The pathogenesis of MSFB development remains unclear, but it has been suggested that poor sinus ventilation is associated with disease development; such a ventilation is influenced by anatomical variation of the paranasal sinuses. Thus, we sought to determine whether sinonasal anatomical variations were associated with MSFB development., Methods: Thirty-one patients with MSFB and 28 gender-matched control patients were included in the present study. The presence or absence of Haller cells and a concha bullosa were scored, and the angle of septal deviation and the minimal and maximal lengths of the infundibulum were measured on preoperative computed tomography images., Results: In the MSFB group, both a concha bullosa (61.3% vs. 28.6%, p=0.006) and Haller cells (41.9% vs. 30.4%) were present at higher frequencies than in the control group, although the between-group difference in Haller cell occurrence was not statistically significant (p=0.348). In addition, MSFB patients had a significantly lower mean infundibular width (3.23±0.69mm vs. 3.99±1.17mm, p<0.001) and a longer infundibular length (9.71±1.43mm vs. 8.23±1.72mm, p<0.001) than controls., Conclusions: Sinonasal anatomical variations, especially the presence of a concha bullosa, and/or a narrow and long infundibulum, may play roles in the development of maxillary sinus fungal balls (MSFBs)., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction and Objectives: The fungus ball is the most frequent type of fungal rhino-sinusitis. The objective of this study is to analyze the clinical and surgical features of our patients., Methods: Retrospective analysis of 35 patients with fungus ball treated in our centre between 2006 and 2014., Results: Mean age was 55 years old. 49% were men and 51% women. 75% involved the maxillary sinus, whereas 25% involved the sphenoid. 69% of our patients showed microcalcifications in the CT study. All the patients were surgically treated, with no cases of recurrence., Conclusions: Clinical manifestations of fungus ball are non-specific, therefore endoscopy and image study are mandatory. The definitive diagnosis is made by histopathological study of the lesion. Endoscopic sinus surgery is the treatment of choice, with opening of the diseased sinus and complete removal of the fungus ball. The frequency of complications is very low. No oral or topical antimycotic treatments are necessary., (Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Background: The sinus lift was first described in 1974 and it has proven to be a predictable procedure ever since. The complications of this surgical procedure are reported in the literature to be low, and can include acute maxillary sinusitis, scattering of the grafting material into the sinus cavity, wound dehiscence and Schneiderian membrane perforations. We aimed to evaluate the rate of acute maxillary sinusitis after sinus lift procedures and the appropriate management strategies., Methods: Between 2013 and 2015, 245 dental implants were placed in 116 patients (76 males and 40 females) with concomitant bone augmentation of the maxillary sinus floor. The sinus lifting procedure was bilateral in 35 patients and unilateral in 81 patients (a total of 151 sinuses)., Results: Maxillary sinusitis occurred in 5 patients (4.3 %). The clinical signs of infection were: headache, locoregional pain, cacosmia, inflammation of the oral buccal mucosa and rhinorrhea or unilateral nasal discharge. A mucosal fistula was observed during inspection in one patient. The management included only the removal of the grafting material in 3 patients, in 1 patient the grafting material was removed together with all the implants, and in 1 patient only 2 implants and the grafting material were removed, 1 implant being left in place. The sinus cavity was irrigated with metronidazole solution and antibiotic therapy with clindamycin and metronidazole was prescribed for 10 days. Subsequently, all signs of infection disappeared within 5 to 7 days and normal sinus function and drainage were restored., Conclusions: Although sinus lift is regarded as a safe and reliable procedure, acute sinusitis is a possible complication which has to be managed immediately in order to reduce the risk of further complications like pansinusitis, osteomyelitis of the maxillary bone, and spreading of the infection in the infratemporal space or orbital cavity. To minimize risk, caution must be taken with all the steps of the procedure, in order not to obliterate the ostium, impairing maxillary sinus clearance.

Purpose: The purpose of the present study was to investigate the association between Le Fort I osteotomy and the anatomic, radiologic, and symptomatic modifications of the maxillary sinus., Materials and Methods: Subjects who had undergone Le Fort I osteotomy from January 2008 to December 2013 were enrolled in a retrospective cohort study. The eligibility criteria were the availability of a cone beam computed tomography (CBCT) scan taken before and 12 to 24 months after the procedure. The exclusion criteria were the unavailability of CBCT scans, the use of tobacco, and previous orthognathic procedures. The primary predictor variable was time (pre-vs postoperative). The primary outcome variables were the sinus volume, mucosal thickening, iatrogenic alterations in the sinus anatomy, and rhinosinusitis symptoms, evaluated using the Sino-Nasal Outcome 20-item Test (SNOT-20). Descriptive statistics were computed for each variable, and paired analyses were used to compare the pre- and postoperative values., Results: The data from 64 subjects (mean age 27; 59.4% were female; median follow-up 32.4 months, range 13 to 66 months) were studied. Postoperatively, 1.6% of the sample (0% preoperatively) had moderate-to-severe and 15.6% (3.1% preoperatively) had mild-to-moderate sinusitis symptoms. The rest of the sample presented with mild to no symptoms. The increase in the SNOT scores after surgery was statistically significant (P = .016). Radiologic evidence of postoperative inflammatory processes affecting the paranasal sinuses was found in 27.3% of the sinuses (9.4% preoperatively). The postoperative Lund-Mackay scores were significantly greater (P = .0005). A 19% decrease was found in the mean postoperative sinus volume, with a 37% incidence of iatrogenic injury., Conclusions: The study results indicate that Le Fort I osteotomies can have an important impact on sinus health. The postoperative radiologic evidence of maxillary sinus inflammatory processes and the incidence of rhinosinusitis symptoms and iatrogenic damage in these patients have led us to conclude that CBCT scans and the SNOT-20 questionnaire should be used routinely during postoperative monitoring. Larger long-term studies are warranted to clarify the postoperative outcomes and complications., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: To analyze treatment modalities and results in patients with severe odontogenic maxillofacial infections during a 10-y period., Methods: Medical records of 1,077 patients hospitalized because of severe odontogenic maxillofacial infections during 2003-2012 were reviewed. The sample consisted of the records that matched inclusion criteria. For each patient the following data were collected: Age, gender, presence of systemic diseases, length of hospital stay, causal tooth, location of inflammation, treatment, results of bacteriologic sampling, and anti-bacterial susceptibility., Results: Male to female ratio was 1.4:1. Two or more anatomic spaces were involved in 42.9% of cases, 37.3% of which involved the floor of the mouth. Penicillin in combination with gentamicin or metronidazole was prescribed in 69% of cases. Sixty-two different micro-organism species were identified with predominance of Streptococcus haemolyticus (42.9%). The microbial analysis showed the highest susceptibility of predominant micro-organisms to penicillin was 76.9% and the highest resistance was to metronidazole (27.9%)., Conclusions: The frequency of odontogenic maxillofacial infection remained almost unchanged during a 10-y period. Single-space infections were more common (57.1%) than infections involving two or more spaces. Susceptibility to penicillin remains relatively high; therefore, penicillin can remain part of the armamentarium for treatment of odontogenic maxillofacial infections.

Objectives/hypothesis: The aim of this study was to evaluate the nature and incidence of long-term maxillary sinus adverse events related to endosseous implant placement with protrusion into the maxillary sinus., Study Design: Retrospective cohort study., Methods: All patients who underwent placement of endosseous dental implants with clinical evidence of implant penetration into the maxillary sinus with membrane perforation were included in this study. Only patients with a minimum follow-up of 5 years after implant placement were included in this study. Maxillary sinus assessment was both clinical and radiological., Results: Eighty-three implants with sinus membrane perforation in 70 patients met the study's inclusion criteria. Mean age was 65.96 years ± 14.23. Twelve patients had more than one implant penetrating the maxillary sinus, and seven of them had bilateral sinus perforation. Estimated implant penetration was ≤ 3 mm in all cases. The average clinical and radiological follow-up was 9.98 years ± 3.74 (range 60-243 months). At the follow-up appointments, there were no clinical or radiological signs of sinusitis in any patient., Conclusion: This long-term study, spreading over a period of up to 20 years, indicates that no sinus complication was observed following implant penetration into the maxillary sinus. Furthermore, absence of occurrence of such complications is related to the maintenance of successful osseointegration. A contrario, and in the presence of an acute or chronic maxillary sinusitis, the differential diagnosis must always consider other potential odontogenic and nonodontogenic etiologies., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Maxillary sinusitis is a frequent ear-nose-throat (ENT) infection. The purpose of this study was to determine the prevalence of maxillary sinusitis in the ENT department of a teaching hospital in Cotonou, Benin, and to report the clinical findings, together with the results of complementary examinations and treatment outcomes., Patients and Methods: This was a retrospective descriptive analysis of patients seen at our hospital from January 1, 2004 to December 31, 2008 for maxillary sinusitis., Results: Over the 5-year study period, 1752 cases of maxillary sinusitis were treated in the ENT department of the teaching hospital, which works out to 350 or 351 cases per year. The overall prevalence was 19.3%. There were 759 patients (83.1%) aged 16-50 years, and 984 patients (56.2%) were men. Factors favoring maxillary sinusitis were: dry season with dust (n=1051 patients, 60%); and atmospheric pollution (87.6%). Maxillary sinusitis was acute for 528 patients (30.1%) and chronic for 1224 patients (69.9%). A rhinogenic cause was identified for 960 patients (54.8%), an allergic cause for 668 patients (38.1%) and a dental cause for 96 patients (55.5%). In cases of chronic sinusitis, the infection was predominantly staphylococcal (29.3%) and pneumococcal (21.9%). Basically, medical treatment was given by combining local treatments for rhinopharyngeal disinfection or vasoconstriction. In cases with a dental origin, dental care was also delivered. For allergy-related sinusitis, nasal sprays with corticosteroids and antihistamine agents were prescribed. Outcomes were favorable for 89.7% of patients., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

On the basis of a detailed analysis of the clinical picture of odontogenic maxillary sinusitis the peculiarities of its flow in elderly and senile patients are demonstrated. The causes of odontogenic inflammation of the maxillary sinuses, the clinical features of inflammation of the maxillary sinus in older age groups, including those with oroantral communication are shown.

Purpose: The aims of this study were to evaluate the incidence of maxillary sinusitis associated with the sinus elevation procedure and to analyze the influence of maxillary sinusitis on the prognosis of dental implants., Materials and Methods: Data were collected from medical records and dental radiographic findings of patients who received dental implant therapy along with a sinus elevation procedure at Seoul National University Bundang Hospital from June 2003 to December 2008., Results: A total of 338 sinus elevation cases (643 implants) were included in this study, out of which maxillary sinusitis was reported in 33 cases (9.8%). The type of surgical approach used and the occurrence of sinus membrane perforation could be considered factors affecting maxillary sinusitis associated with the sinus elevation procedure. The implants at the site of the maxillary sinusitis associated with the sinus elevation procedure showed lower survival rates in male patients. Better clinical outcomes were achieved in the group receiving combined medical and surgical therapy for sinusitis associated with the sinus elevation procedure., Conclusions: Postoperative maxillary sinusitis decreased the survival rates of implants, whereas early diagnosis and combined medical and surgical therapy had the opposite effect.

Aim: To explore the detection rate of chlamydia infection and immunological features of children with acute maxillary sinusitis., Patients and Methods: Clinical epidemiologic characteristics of the course of acute maxillary sinusitis were studied in the way of medical examination provided for 58 children in the ages from 3 to 15 years, patients of ENT department. In order to identify Chlamydia structures and specific antibodies we used direct (polymerase-chain reaction, direct immune fluorescence) and indirect (immune enzyme analysis) methods. The research for cellular link of immunity was carried out by indirect immune fluorescence technique, using monoclonal antibodies., Results: The authors report on high level of Chlamydia infection in epithelium of nasal mucosa, and also type structure of verified Chlamydia, clinical signs and peculiarities of immune response in children with acute maxillary sinusitis associated with this infection., Conclusions: Chlamydia was detected in 48% of children with acute maxillary sinusitis infection with prevalence of Chlamydophila pneumoniae. Optimal for detection of chlamydia infection is a disease duration not exceeding 2 weeks. The special features of clinical and immunological manifestations in children with acute sinusitis, paired with Chlamydia infection are the more frequent complaints of pain in the affected sinuses, expressed symptoms of intoxication, and the presence of an imbalance in cellular immunity, manifested a relative lymphopenia and activation of T-lymphocytes CD8+.

Purpose: The frequency of maxillary sinusitis of dental origin (MSDO) is under estimated. The medical and surgical treatment has improved thanks to endoscopic guidance. We report our experience and strategy in the treatment of MSDO., Patients and Methods: Twenty-two patients presenting with MSDO were treated between 1998 and 2008. The results were evaluated on clinical, functional, sinusal, and odontologic signs., Results: MSDO accounted for 16% of surgically managed sinusitis. CT was performed in 95% of cases. The etiologies were apical leakage in seven patients, migration of a tooth or root during extraction, or presence of ectopic tooth in the sinus in nine patients, a cyst in three patients, and oroantral communication in three patients. Surgery was performed after antibiotic and NSAID treatment. The first surgical step was the treatment of the odontogenic source. The second step was sinus drainage by endoscopic treatment in 64%, Caldwell-Luc in 23%, and drainage by oroantral communication enlarged then closed in the same operative time in 13%. The follow up ranged from 3 months to 10 years. Early postoperative superinfection was observed in two patients. Two patients presented with recurrent sinusitis. The postoperative sequels were hyposmia in three patients, dental pulpotomy, and trigeminal neuralgia in five patients treated by Caldwell-Luc surgery., Discussion: Nasal endoscopy has improved the surgical management of MSDO. It makes curettage and exclusion of sinus cavities obsolete. It is reliable and has a low rate of complications. The best treatment remains prevention., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: This study aims to determine the frequency of maxillary sinusitis in the patients with traumatic head injury and nostrils free of any foreign body. In addition, the sensitivity and specificity of ultrasonography (US) for the detection of the presence of fluid in maxillary sinuses were evaluated., Patients and Methods: Forty patients with severe traumatic head injury were included in the study. The patients who had displaced maxillary sinus fracture at the medial wall and naso-tracheal and/or naso-gastric tube were excluded. Paranasal computed tomography (CT) was performed along with the routine cranial CT scanning or in case of unknown source of infection and compared with the results of ultrasonographic examination of maxillary sinuses performed by a single radiologist who was unaware of the CT results. In the patients, who had clinical and radiological signs of sinusitis, a trans-nasal puncture was performed using sinoject (SinoJect, ATOS Medical, Sweden), a spring-activated puncture instrument, to take a sample for microbiologic examination and to drain maxillary sinuses., Results: Eighty-five percent of the patients were tracheotomised on the fifth day (on average) of their intensive care unit (ICU) stay. The frequency of sinusitis in the study group was found to be 32.5% (13 patients). The most frequently isolated species were Pseudomonas spp. (37.5%), Escherichia coli (20.8%) and Peptostreptococcus (16.7%). Five of the aspirates were polymicrobial. The sensitivity, specificity, positive predictive value and negative predictive value of B-mode US, compared with CT for the detection of fluid presence in maxillary sinuses in a 100 maxillary sinus examinations, were 92.2%, 81.6%, 83.9% and 90.9%, respectively., Conclusion: Maxillary sinusitis should be considered as a source of infection or sepsis in patients with traumatic head injury because of its high frequency. US is likely to be used as the first-line diagnostic tool for the determination of fluid in maxillary sinuses, especially in patients who do not require CT or cannot be transported to a radiology unit for CT., (2009 Elsevier Ltd. All rights reserved.)

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

Objective: To identify radiographic features of odontogenic acute maxillary sinusitis and to determine the frequency of a causative dental infection in patients with radiographic evidence of maxillary sinus fluid., Study Design: Retrospective review of 101 sinus computed tomography scans with unilateral or bilateral maxillary sinus fluid., Methods: Each maxillary sinus was graded for extent of fluid, degree of mucosal thickening, and presence of dental pathology. Univariate chi-square analysis was used to identify potential radiologic and demographic features predictive of sinus fluid. Multivariate logistic regression was then used to determine which features were independently predictive., Results: 124 of the 202 maxillary sinuses (61%) had sinus fluid. Univariate analysis excluded age, gender, and prior surgery as predictive features. The multivariate analysis included the radiographic features of oroantral fistula, periapical abscess, periodontal disease, projecting tooth root, and dental caries. Of these, only oroantral fistula and the combination of periodontal disease with either a projecting tooth root or periapical abscess were identified as significant sources of maxillary sinusitis. In sinuses that were <1/3 opacified by fluid, 17% had a dental source of infection. In sinuses with 1/3 to 2/3 fluid opacification, 53% had an identifiable dental source, and in sinuses that were >2/3 opacified by fluid, 79% had an identifiable dental source. Mucosal thickening demonstrated a similar relationship with dental sources, so that sinuses having both >2/3 fluid opacification and moderate mucosal thickening were 86% likely to have an identifiable dental source., Conclusions: Odontogenic infections are often the source of acute maxillary sinusitis, especially if the radiographic findings of sinusitis are severe.

Rhinosinusitis is a common complication in patients with nasopharyngeal carcinoma (NPC) who receive radiotherapy. An impaired mucociliary clearance due to this treatment may be the major cause of rhinosinusitis in these irradiated patients. The relative frequency with which various pathogens cause rhinosinusitis in these patients is unknown. This study investigates the bacteriology of acute rhinosinusitis in irradiated NPC patients by maxillary sinus puncture. From October 2001 through July 2006, 20 irradiated NPC patients with radiograph-proven acute maxillary sinusitis received maxillary sinus punctures. Aspirate contents of the sinuses were collected for aerobic and anaerobic cultivation. A total sampling of 26 sides was performed in the 20 patients. The culture rate was 85%. Frequently identified aerobes and facultative anaerobes included alpha-hemolytic streptococcus (n = 8), Staphylococcus aureus (n = 5) and Pseudomonas aeruginosa (n = 3). Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, however, are far less common. This may provide important information about the antibiotic therapy in irradiated NPC patients with acute rhinosinusitis.

Background: The odontogenic maxillary sinusitis is the consequence of the distribution of an inflammatory or infectious process of a tooth in sinuses mucous membranes., Aim: The purpose of our work is to study epidemiological profile, clinical and radiological characteristics allowing the diagnosis of this pathology as well as the various therapeutic strategies adopted., Methods: We report a retrospective study of 31 observations of odontogenic maxillary sinusitis brought together in the service of ORL and of CMF of Rabta hospital over a period of 12 years., Results: In our series, the frequency of this pathology was considered at 42.5% among the group of all maxillary sinusitis brought together during the same period, the average age was of 38 years with a sex ratio of 1.04. The dental antecedents are obvious in 80% of cases, the iatrogenic was found in 64% of cases. Dental causes were dominated buy para-apical cysts (29%), and the movement of the dough canalaire (23%) especially in fongic forms of sinusitis.

Maxillary sinusitis was studied as an indicator of poor air quality. Seven skeletal samples were examined from North America, England, and Nubia, and selected to represent different geographic locations, environments, and subsistence economies. Frequency rates varied from 17.2 to 51.5% of individuals affected with one or both sinuses preserved. Hardin Village had the highest frequency (51.5%), followed by the Aleuts (42.9%), "Illinois" (38.6%), Indian Knoll (38.5%), Kulubnarti (21.8%), Christchurch, Spitalfields (18.0%), and "South Dakota" (17.2%). Male frequencies ranged from 16.7 to 36.7%, but the female frequency ranged more widely from 18.0 to 76.5%. At most sites female rates exceeded male. The effect of urban and rural environment on sinusitis occurrence, and also subsistence economy, biological sex, and social status were explored, and comparative sites also considered; urban agricultural sites had a mean frequency of 48.5%, rural agricultural sites had a mean frequency of 45.0%, and hunter-gatherer sites had a mean frequency of 40.0%. In the urban sites male and female frequencies were near equal, but in the rural agricultural and hunter-gatherer sites female frequencies exceeded male frequencies. Dental disease was not found to have much impact on sinusitis frequency. The importance of the link between poor air quality and respiratory health is highlighted in clinical studies in both developed and developing countries, but also in bioarcheological studies.

Introduction: The incidence of mycotic infections and the diversity of pathogenic fungi have increased dramatically in recent years. Fungal sinusitis should be considered in all the patients with chronic maxillary sinusitis (CMS), especially in association with certain clinical features that serve as clue to the diagnosis. Aspergillus is the most common fungal pathogen in maxillary sinus., Methodology: A total of 100 patients those who fulfilled the diagnostic criteria (Lanza and Kennedy, 1992) for chronic rhinosinusitis were eligible for this open level and randomized prospective study. Only those above 14 years of age were included., Results: Fungal maxillary sinusitis was seen in 14% of all cases of chronic maxillary sinusitis in eastern part of Nepal. We identified Acremonium and Candida species as commonest fungi involved in fungal maxillary sinusitis (FMS). To the best of our knowledge this is the first such study conducted in eastern Nepal.

The objective of the study was to compare the proportions of the recovery of pathogens of acute maxillary sinusitis in adults in the 4-year period prior to the 5-year period that followed the introduction of vaccination of children with the 7-valent pneumococcal vaccine (PCV7). Cultures were obtained through endoscopy from 385 adults with acute maxillary sinusitis, 156 between 1997 and 2000, and 229 between 2001 and 2005. One hundred and seventeen potentially pathogenic organisms were isolated from the cultures obtained between 1997 and 2000. The predominant organisms were Streptococcus pneumoniae (54 or 46 % of all isolates), Haemophilus influenzae non-type b (42 or 36 %), Moraxella catarrhalis (7 or 6 %), Streptococcus pyogenes (8 or 7 %) and Staphylococcus aureus (6 or 5 %). One hundred and sixty-seven potentially pathogenic organisms were isolated from the cultures obtained between 2001 and 2005. The most predominant organisms were H. influenzae non-type b (71 or 43 % of all isolates), Strep. pneumoniae (58 or 35 %), M. catarrhalis (13 or 8 %), Strep. pyogenes (12 or 7 %) and Staph. aureus (13 or 8 %). Significant statistical differences were noted in the rates of recovery of H. influenzae non-type b (P < 0.05) and Strep. pneumoniae (P < 0.05). A decrease occurred in the recovery of Strep. pneumoniae resistant to penicillin from 41 to 29 %, and an increase was noted in the isolation of beta-lactamase-producing H. influenzae from 33 to 39 %; however, neither change was statistically significant. These data illustrate that a significant shift occurred in the causative pathogens of acute maxillary sinusitis in adults in the 5 years after the introduction of vaccination of children with the PCV7 compared to the previous 4 years.

Introduction: Sinusitis is a very common disease in childhood. Clinical manifestations in childhood sinusitis are different than in adult. Information in childhood sinusitis in Thailand is limited. We performed a prospective descriptive study to determine clinical characteristics of childhood sinusitis in Thailand, Material and Method: One hundred pediatric patients with clinical diagnosis of sinusitis attending pediatric allergy clinic, pediatric outpatient clinic, and pediatric ENT clinic were recruited. Clinical diagnosis was defined by presence of symptoms indicating upper respiratory infections with exudates at middle meatus by anterior rhinoscopy. Thorough history taking and physical examinations were conducted with findings recording into sinusitis questionnaire. Sinus radiographs were taken in 77 patients and were read blindly a single radiologist who was unaware of clinical conditions of patients. Allergy skin prick tests were performed with a panel of common aeroallergens in Thailand., Results: Age range of the 100 patients were between 1.7 to 12.4 years with a mean (+/- SD) of 6 +/- 2.72 years. History of atopic disease among patients and their families was positive in 49% and 47% respectively. Four most common clinical manifestations were rhinorrhea (95%), nocturnal and productive cough (91%), nasal congestion (74%) and posterior nasal dripping (66%). The three most common signs were obstruction of middle meatus (100%), swelling of turbinates (92%) and granular pharynx (48%). All paranasal sinuses X-rays were abnormal with maxillary sinus being the most commonly involved sinus (99%) followed by ethmoid sinus (91%). The majority of patients had involvement of more than one sinus. Skin prick tests were positive in 53.6%. The two most common sensitizing allergens were dust mites (57.7) and cockroaches (18.6%)., Conclusion: The presence of symptoms of rhinorrhea, cough, nasal congestion and posterior nasal drip should alert physicians for diagnosis of sinusitis in pediatric patients. Maxillary and ethmoid sinus were the most common sinuses involved. Atopic predisposition is present in up to 53.6% in this population.

Background: To date, there is an increasing trend of prescribing antibiotics that cover beta-lactamase-producing bacteria as the first line drug for sinusitis patients in Thailand This practice dose not only increases the treatment cost but might also induce resistance to antimicrobial agents., Objective: To determine the prevalence of the pathogenic bacteria in acute and chronic maxillary sinusitis as well as the prevalence of beta-lactamase-producing bacteria., Material and Method: The maxillary aspiration fluid specimens of 52 acute and chronic sinusitis patients at Phramongkutklao Hospital, Bangkok, Thailand during May 2002-May 2003, were collected. Aerobic and anaerobic cultures were performed and the beta-lactamase activities of isolated bacteria were determined., Results: Of 58 specimens, 44 (75.9%) and 14 (24.1%) specimens were collected from acute and chronic maxillary sinusitis patients, respectively. Of 44 specimens of acute maxillary sinusitis, the predominant isolates were Haemophilus influenzae (13, 29.5%), Streptococcus pneumoniae (4, 9%), Streptococcus viridan (4, 9%), and Klebsiella pneumoniae (4, 9%). 6 (13.6%) of them were beta-lactamase-producing bacteria. Of 14 specimens of chronic maxillary sinusitis, the predominant isolates were Pseudomonas aeruginosa (3, 16.6%), Staphylococcus spp (3, 17.5%) and Streptococcus spp. (2, 11.6%). 1 (7.1%) Haemophilus influenza isolate from this group was beta-lactamase-producing bacteria. The percentage of anaerobe was 8.9%, 23.3% for acute and chronic maxillary sinusitis, respectively., Conclusion: The present study was indicated that the common organisms in acute maxillary sinusitis were Haemophilus influenzae and Streptococcus pneumoniae, Streptococcus viridians which were similar to a previous study. But the authors found an increased prevalence of anaerobe bacteria in acute maxillary sinusitis and also found beta-lactamase-producing bacteria, 21.4% Hemophilus influenzae less than the previous studies (which found beta-lactamase-producing bacteria around 50% to 70%). The authors found 23.3% anaerobe bacteria in the chronic maxillary sinusitis, less than the previous studies, and the authors also found 8.9% anaerobe in acute maxillary sinusitis.

Objectives: To study the management of acute maxillary sinusitis (AMS) in Finnish primary care and to compare it both to recommendations in national guidelines and to the management of other upper respiratory tract infections (URTI)., Design: A cross-sectional multi-centre epidemiological survey., Setting: Thirty primary care health centres in Finland., Subjects: 7284 patients with symptoms of possible acute rhinosinusitis during one week in both November 1998 and November 1999., Main Outcome Measure: Symptoms and their duration, use of diagnostic tools, choice of antibiotics, patient outcomes., Results: A total of 1601 patients were diagnosed as having AMS (12% of all patients with infectious disease). In 45% of cases the differentiation between AMS and URTI was based on clinical examination alone. Sinus ultrasound was the most common diagnostic tool used (38%). Sinus radiography or blood tests (CRP or leukocytes) were both studied in 8% of cases. AMS was diagnosed and treated with antibiotics also in the early stages of URTI when viruses are the most likely explanation. In total, 83% of patients with AMS received a prescription for antibiotics; the most common choice was amoxycillin (37%), doxycycline was used in 29% of cases, and macrolides in 15%., Conclusions: Antibiotics are prescribed for AMS 2 to 5 times more often than true disease incidence would suggest in Finland. The choice of antibiotics follows the guideline recommendations; however, use of macrolides is higher than recommended. Physicians feel strong pressure from patients to prescribe antibiotics for AMS. Primary care physicians need better support in the accurate diagnosis of AMS.

Epidemiological and clinical data are discussed dealing with a possible influence of inflammatory changes of the nasal and especially the paranasal tissue on lower airway disease like asthma, the so-called "sinobronchial syndrome". Even though there is clear evidence of an association of the upper with the lower airway diseases, a causal relationship and a possible work of action are still up for discussion. The literature has been reviewed, and different theories are discussed. Generally speaking, a branch of differently accentuated mechanisms seems to play a role.

Aim: Sinus image abnormalities are common among children examined for indications other than sinus disease. The purpose of this study was to determine the frequency of sinus abnormalities among otherwise healthy children attending school., Methods: Magnetic resonance imaging (MRI) was performed on 24 children aged 8-9 y, 18 of whom were re-examined after 6-7 mo., Results: Sinus abnormalities were common. An abnormality was seen in 12 of the children [50%, 95% confidence interval (95% CI) 29-71%], and 9 (38%, 95% CI 19-59%) had abnormalities in the maxillary sinuses. As many as 8 (42%, 95% CI 20-67%) of the asymptomatic children (lacking clinical symptoms or findings) had abnormalities in the maxillary or ethmoidal sinuses. The follow-up examination showed that about half of the abnormal sinus MRI findings had resolved or improved without any intervention., Conclusion: Abnormal sinus MRI findings are common both among otherwise healthy children attending school and in totally asymptomatic children. As incidental findings, these should be interpreted as normal and do not indicate any need for treatment in children imaged for purposes other than sinus disease.

Previous studies have shown that cystic fibrosis (CF) gene mutations are linked to several severe chronic infections. Chronic sinusitis is one condition that may well be influenced by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. We studied two prevalent CF mutations (AF508 and 394delTT) in a population with a low incidence of CF. The carrier frequency of the CF mutations in the Finnish population is approximately 1 in 80. We examined DNA specimens from 127 chronic sinusitis patients and found one patient who was heterozygous for 394delTT gene mutation. None of the DNA specimens had any AF508 mutation. This study shows that in a population with a low incidence of CF there was no abnormal carrier distribution of the two most common CF gene mutations in a group of chronic sinusitis patients. Routine screening of sinusitis patients for CF mutations provides no additional information on the etiology of chronic sinusitis.

Chronic sinusitis, especially maxillary sinusitis is a common disorder in humans. Seromucous sinusitis is rarely described in the literature. The present study deals with the clinical and laboratory characteristics of a group of patients suffering from the above disorder. During the last 10 years, 32 patients suffering from seromucous maxillary sinusitis were enrolled in the study. Patients' charts were reviewed and tabulated according to age, sex, history, clinical symptoms and laboratory findings. Treatment was based on punction and drainage of the seromucous effluent. Results were also statistically evaluated. Flight trips and atypical episodes of nasal infection were the predisposing factors for seromucous maxillary sinusitis. The only clinical manifestation was coughing, for at least 12 weeks before diagnosis. Sinus effluent was composed by serous and mucous constituents with glue like structure. There were no differences between sexes in predisposing factors, or x-ray findings. The treatment is paracentesis and drainage and in one case of recurrence, middle meatotomy and sinus endoscopy.

Chronic infectious respiratory disease in a past human population is investigated through the quantification of maxillary sinusitis among Iroquoian horticulturists. Three hundred forty-eight right and left maxillae of a Southern Ontario Iroquoian skeletal sample, Uxbridge Ossuary, ca. AD 1440, were examined for evidence of chronic infection (minimum number of individuals = 207: 114 adults, 22 adolescents, 38 juveniles and 33 infants). Modern clinical criteria were applied to differentiate lesions of respiratory and dental origin. Osseous lesions of the maxillary sinuses were observed in 50% of the individuals examined. These lesions are morphologically consistent with nonspecific lesions observed in other past populations that have been attributed to the presence of pathogens. The prevalence of maxillary sinusitis increases with age. Osseous changes suggestive of maxillary sinusitis of respiratory origin are at a maximum prevalence in juveniles and adolescents. In adults, infection of dental origin becomes a confounding factor in the identification of sinusitis of respiratory origin. Fifteenth century Iroquoians were experiencing high airborne pathogen levels and poor indoor air quality. The prevalence of maxillary sinusitis and the exploration of the origin of tissue injury may contribute to our reconstruction of the quality of life and the respiratory health status of past human populations., (Copyright 2000 Wiley-Liss, Inc.)

To examine trends in the incidence of chronic maxillary sinusitis that require surgical treatment in northern Finland, a retrospective population-based survey from 1974 through 1995 was conducted. Data on surgical cases and on various demographic factors and on variables describing medical care in the area were collected for every third year. The overall crude incidence rate (per 100,000 person-years) of chronic maxillary sinusitis requiring surgical therapy was 44 for children and 76 for adults. The age-standardized incidence rate dropped by 78% in children, and by 66% in adults during the period. The changes found to have taken place in the population and in medical care and which could have promoted the decrease were higher educational level and mean income, smaller families, improved level of hygiene, a higher number of physicians and an expanded use of broader-spectrum antibiotics. In conclusion, the most serious forms of chronic maxillary sinusitis, that require operative treatment, are decreasing in both children and adults in northern Finland.

EMPIRICAL STRATEGY: Antibiotic therapy of upper and lower respiratory tract infections is based on an empirical strategy. However, arguments favoring the probability of a given bacteria may be lacking and, since resistance of Streptococcus pneumoniae and Haemophilus influenzae against conventional antibiotics is becoming increasingly frequent, therapeutic strategies must be revisited. SINUSITIS: H. influenzae and S. pneumoniae are the most frequent causal agents in acute maxillary sinusitis. For chronic sinusitis, beta-lactamase producing anaerobic bacteria, S. aureus and peni-resistant pneumococci and H. influenzae must also be considered. ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS: The main causal agents are H. influenzae and S. pneumoniae, followed by M. catarrhalis, S. aureus, enterobacteriaceae, and beta-hemolytic streptococci. COMMUNITY ACQUIRED PNEUMONIA: There are a wide range of pathogens, half of which are identified in different studies. RESISTANCES: For pneumococci, penicillin resistance is currently evidenced in 48% of the strains. For H. influenzae, 30% of the strains are ampicillin resistant.

The 77 cases of sinusitis seen in 72 patients admitted to the Briançon Hospital between January 1, 1993, and June 30, 1996, were studied. One or both maxillary sinuses were involved in 96.8% of cases. Sinus aspiration was done in 95 cases. All aspirates were subjected to microbiological studies. Of the 45 aspirates that yielded positive cultures, 36 grew one or more pathogenic organisms. The most commonly isolated bacteria were Pseudomonas aeruginosa (n = 7), Streptococcus pneumoniae (n = 5), and Haemophilus influenzae (n = 5). Nosocomial sinusitis defined on a set of criteria including hospital stay duration at onset and an acute tempo of evolution contributed 32.5% of cases overall, 55.2% in the intensive care unit and 18.7% in all other departments combined. Nosocomial cases in the intensive care unit were associated with well-known risk factors, namely tracheal intubation with ventilation and presence of a nasogastric tube. Other study criteria included the type of organism recovered by culture and whether patients ventilated via a tracheal tube had the same organism in their sinus and tracheal tube aspirates. Some nonintensive care patients had none of the known risk factors for sinusitis; prompt diagnosis and treatment of these cases of sinusitis is important to avoid infectious complications, which are, however, less common than in intensive care patients.

Alternaria alternata, Aspergillus spp., Bipolaris spicifera, Curvularia lunata, Epicoccum nigrum and Fusarium solani were isolated repeatedly from groups of patients among 96 diagnosed with allergic fungal sinusitis (AFS). Epicoccum nigrum was obtained consistently from four patients, one of whom yielded mycelial masses consistent in morphology with E. nigrum. Fifteen of the predominant fungi recovered from air samples from selected patients' residences included the same species isolated from the mucin of its inhabitants. Air samples from other buildings, whose occupants (non-AFS individuals) complained of poor indoor air quality or of symptoms of the sick building syndrome (SBS), yielded some of the same species involved in AFS. An association of SBS with AFS was not established. Eight of the species implicated in AFS were found to colonize the surfaces of indoor construction and finishing materials at sites other than the residence of the patient. To our knowledge, this is the first report that E. nigrum can colonize nasal sinuses and cause AFS.