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Fiori T, Lisewski D, Flukes S, Wood C, Gibson D. Lessons learnt from the global iodinated contrast media shortage in head and neck imaging. J Med Imaging Radiat Oncol 2022; 66:1073-1083. [PMID: 36125131 DOI: 10.1111/1754-9485.13472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.
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Affiliation(s)
- Timothy Fiori
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dean Lisewski
- Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Stephanie Flukes
- Department of Otolaryngology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Chris Wood
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Daren Gibson
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Multicenter Observational Study to Evaluate the Diagnostic Value of Sonography in Patients with Chronic Rhinosinusitis. Diagnostics (Basel) 2022; 12:diagnostics12092065. [PMID: 36140467 PMCID: PMC9497823 DOI: 10.3390/diagnostics12092065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
(1) Background: Computed tomography (CT) is considered mandatory for assessing the extent of pathologies in the paranasal sinuses (PNS) in chronic rhinosinusitis (CRS). However, there are few evidence-based data on the value of ultrasound (US) in CRS. This multicenter approach aimed to compare diagnostic imaging modalities in relation to findings during surgery. (2) Methods: 127 patients with CRS were included in this prospective multicenter study. Patients received preoperative US and CT scans. The sensitivity and specificity of CT and US were extrapolated from intraoperative data. (3) Results: CT scans showed the highest sensitivity (97%) and specificity (67%) in assessing CRS. Sensitivities of B-scan US were significantly lower regarding the maxillary sinus (88%), the ethmoid sinus (53%), and the frontal sinus (45%). The highest overall sensitivity was observed for assessing the pathology of the maxillary sinus. (4) Conclusions: We observed high accuracy with CT, confirming its importance in preoperative imaging in CRS. Despite the high US expertise of all investigators and a standardized examination protocol, the validity of CT was significantly higher than US. Ultrasound of the PNS sinuses is applicable in everyday clinical practice but lacks diagnostic accuracy. Nevertheless, it might serve as a complementary hands-on screening tool to directly correlate the clinical findings in patients with PNS disease.
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Pennell DJL, McClelland E, Sayer C, Bhutta MF, Watts SJ. A local guideline reduces inappropriate requests for computed tomography imaging of the paranasal sinuses. Clin Otolaryngol 2019; 44:1128-1130. [DOI: 10.1111/coa.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/01/2019] [Accepted: 06/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Emma McClelland
- ENT Department Brighton and Sussex University Hospital Trust Brighton UK
- ENT Department Medway Maritime Hospital Gillingham UK
| | - Charlie Sayer
- ENT Department Brighton and Sussex University Hospital Trust Brighton UK
| | | | - Simon James Watts
- ENT Department Brighton and Sussex University Hospital Trust Brighton UK
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Evans SS, Banks C, Richman J, Woolley A, Cho DY, Woodworth B. Validation of the Maxillary Sinus Roof as a Landmark for Navigating the Pediatric Skull Base. Ann Otol Rhinol Laryngol 2019; 129:12-17. [PMID: 31394908 DOI: 10.1177/0003489419867967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population. STUDY DESIGN Retrospective analysis. SETTING Tertiary care children hospital. SUBJECTS AND METHODS A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children's hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a P-value of .05 indicating statistical significance. RESULTS Three hundred and seven unique scans were reviewed (38.9% female; n = 122; P = .58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS (P < .001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ = .99 and .98 respectively, P ≤ .001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, P ≤ .001). CONCLUSION Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sean S Evans
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Banks
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Surgery, University of Alabama, Birmingham, AL, USA
| | - Joshua Richman
- Department of Surgery, University of Alabama, Birmingham, AL, USA
| | - Audie Woolley
- Pediatric Ear Nose and Throat Associates of Alabama, Children's Hospital of Alabama, Birmingham, AL, USA
| | - Do Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bradford Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Wabnitz DA, Nair S, Wormald P. Correlation between Preoperative Symptom Scores, Quality-of-Life Questionnaires, and Staging with Computed Tomography in Patients with Chronic Rhinosinusitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900116] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background This study evaluates the correlation between preoperative symptoms, quality-of-life questionnaires (chronic sinusitis survey and 20-Item Sinonasal Outcome Test [SNOT-20]), and staging on computer tomography (CT). It consisted of a prospective cohort study of all consecutive patients undergoing surgery for medically nonresponsive chronic sinusitis, which took place at a tertiary care center. Methods Two hundred twenty-one patients completed the Chronic Sinusitis Survey (CSS) questionnaire and the SNOT-20. A visual analog scale (VAS) symptom score was completed also. The average age of the patients was 44.5 years and the male/female ratio was 1.3:1. The symptom scores of all three questionnaires were compared with the Lund-MacKay CT scan score of the sinuses. Results The median Lund-MacKay CT score was 12 (mean ± SD, 12.7 ± 5.7). There was no significant correlation between the SNOT-20 questionnaire and the Lund-MacKay CT score (p = 0.026; p = 0.764) and between the CSS and the Lund-MacKay CT score (p = —0.158; p = 0.058). Furthermore, there was no significant correlation between a single VAS symptom score relating to overall sinonasal symptom severity and the Lund-MacKay CT scan score (p = 0.135; p = 0.121). However, a weak but statistically significant correlation was found between the VAS score based on the sum of five sinonasal symptoms and the Lund-MacKay CT scan score (p = 0.197; p = 0.020). Conclusion The score, based on the sum of five sinonasal VAS symptoms, correlates to the disease severity as measured by the Lund-MacKay CT scan score. The SNOT-20 questionnaire and the CSS symptom score do not correlate to the Lund-MacKay CT scan score, although a correlation was found between the CSS score and the Lund-MacKay CT score in various subgroups of our patient population.
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Affiliation(s)
- David A.M. Wabnitz
- Department of Surgery–Otolaryngology, Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
| | - Salil Nair
- Department of Surgery–Otolaryngology, Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
| | - P.J. Wormald
- Department of Surgery–Otolaryngology, Head and Neck Surgery, Adelaide and Flinders Universities, South Australia, Australia
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Rathor A, Bhattacharjee A. Clinical-radiological correlation and role of computed tomography staging in chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 2017. [PMID: 29516063 PMCID: PMC5829301 DOI: 10.1016/j.wjorl.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective This study aimed to determine whether there is a clinical-radiological correlation in chronic rhinosinusitis (CRS), to compare operative findings with those of computed tomography (CT) imaging, and to determine the importance of a CT score and staging in management of CRS. Methods This study is a prospective study. Adult patients meeting diagnostic criteria for CRS were prospectively studied using the Lund–Mackay (LM) symptom score and sinus CT scan. The symptom scores were correlated with CT stage according to the Kennedy and LM staging systems. Similarly, the intraoperative findings were correlated with the Kennedy staging system. The spectrum of anatomical variations in our study population was compared with the findings of symptomatic patients in various other studies. Results Thirty-four adult patients (13 females, 21 males, mean age: 33 years) met our inclusion criteria. Most of the patients presented with nasal obstruction, headache, and hyposmia. Nasal polyposis was the most common finding in CT scans, with many cases of retention cysts reported as polyps. In total, 50% of patients had a deviated septum. Concha bullosa was the most common finding among the various anatomical variations encroaching the ostiomeatal complex (OMC). In 60%–70% of cases, the CT scan grading correlated with operative findings. LM symptoms scores showed a poor correlation with both LM CT scores and the Kennedy stage. Conclusions Although CT provided detailed information on sinus involvement; its relation with symptom severity is not reliable. The Kennedy CT staging system correlated better with CRS symptoms. Thus, use of Kennedy staging could be useful to endoscopic sinus surgeons as it provides an insight into the pathophysiology, can guide treatment, and facilitate prognosis prediction in CRS.
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Affiliation(s)
- Aakanksha Rathor
- Division of Rhinology, Department of Otolaryngology- Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Otolaryngology, Silchar Medical College and Hospital, Assam, India
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Singhal P, Sonkhya N, Mishra P, Srivastava SP. Impact of anatomical and radiological findings for consideration of functional endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg 2011; 64:382-5. [PMID: 24294585 DOI: 10.1007/s12070-011-0351-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 11/10/2011] [Indexed: 11/28/2022] Open
Abstract
Endoscopic sinus surgery is being done more accurately and with better diagnosis and planning with the help of high resolution CT scan. It has played an invaluable role in the delineation of the sinonasal pathology and anatomic variations preoperatively. To correlate the CT scan findings with endoscopic findings with respect to anatomical variants and pathology and evaluation of its impact on surgical planning. A prospective study conducted on 300 patients who presented to the ENT out patient department with sinonasal diseases and underwent Functional endoscopic sinus surgery. There is a need to evaluate and correlate the findings to deduce the extent of relations CT findings have to that of findings observed during endoscopy as they really affect the surgical planning and outcomes.
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Affiliation(s)
- Pawan Singhal
- Department of ENT & Head Neck Surgery, SMS Medical College and attached Hospitals, 266, Mahaveer Nagar-I, Tonk Road, Durgapura, Jaipur, Rajasthan India
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Anzai Y, Paladin A. Diagnostic imaging in 2009: update on evidence-based practice of pediatric imaging. What is the role of imaging in sinusitis? Pediatr Radiol 2009; 39 Suppl 2:S239-41. [PMID: 19308394 DOI: 10.1007/s00247-008-1128-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshimi Anzai
- Department of Radiology, University of Washington Medical Center, 1959 N.E. Pacific St., Box 357115, Seattle, WA 98195-7115, USA.
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Scadding GK, Durham SR, Mirakian R, Jones NS, Drake-Lee AB, Ryan D, Dixon TA, Huber PAJ, Nasser SM. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2007; 38:260-75. [PMID: 18167126 DOI: 10.1111/j.1365-2222.2007.02889.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This guidance for the management of patients with rhinosinusitis and nasal polyposis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The recommendations are based on evidence and expert opinion and are evidence graded. These guidelines are for the benefit of both adult physicians and paediatricians treating allergic conditions. Rhinosinusitis implies inflammation of the nose and sinuses which may or may not have an infective component and includes nasal polyposis. Acute rhinosinusitis lasts up to 12 weeks and resolves completely. Chronic rhinosinusitis persists over 12 weeks and may involve acute exacerbations. Rhinosinusitis is common, affecting around 15% of the population and causes significant reduction in quality of life. The diagnosis is based largely on symptoms with confirmation by nasendoscopy. Computerized tomography scans and magnetic resonance imaging are abnormal in approximately one third of the population so are not recommended for routine diagnosis but should be reserved for those with acute complications, diagnostic uncertainty or failed medical therapy. Underlying conditions such as immune deficiency, Wegener's granulomatosis, Churg-Strauss syndrome, aspirin hypersensitivity and allergic fungal sinusitis may present as rhinosinusitis. There are few good quality trials in this area but the available evidence suggests that treatment is primarily medical, involving douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines. Endoscopic sinus surgery should be considered for complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment. Further well conducted trials in clearly defined patient groups are needed to improve management.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose & Ear Hospital, Gray's Inn Road, London, UK
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Danielsen A, Reitan E, Olofsson J. The role of computed tomography in endoscopic sinus surgery: a review of 10 years’ practice. Eur Arch Otorhinolaryngol 2006; 263:381-9. [PMID: 16456692 DOI: 10.1007/s00405-005-1032-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 08/15/2005] [Indexed: 10/25/2022]
Abstract
CT scans from 100 patients undergoing endoscopic sinus surgery (ESS) were primarily re-examined in order to assess the quality of the radiological examinations and the information it could provide years later. The material comprised the cases of patients who had undergone ESS by one surgeon (AD) in the 1990s. The indications for surgery were acute recurrent or chronic sinus infections, polyposis of the nasal and paranasal cavities, mucoceles and sinogenic headache. All examinations were described using a scheme modified according to Stoney et al., evaluating the opacity/mucosal thickening, drainage/pathways, the lateral nasal walls, septum and other bony walls. This study has been re-evaluated and an additional group of 20 patients consecutively operated on in 2002/2003 has been added. The initial radiological examinations often proved incomplete, with insufficient descriptions of either the drainage/pathways, the lateral nasal wall or the septum and bony walls, which all are structures of great value to evaluate preoperatively for the endoscopic surgeon. The operative findings correlated well with the CT if taken between 4-6 weeks before the operation. The structural pathology correlated with preoperative endoscopic findings independently of the time lapse between the scans taken and the date of surgery. The development and the gradual implementation of the picture archiving and communication system (PACS) certainly represent huge advantages in radiological assessment. The need for CT scans to be available in the operating room calls for specific computer installations to make PACS readily available peroperatively and in an easily workable way for the surgeon.
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Affiliation(s)
- Arild Danielsen
- Department of Otorhinolaryngology, Axess Medical Hospital, Hjalmar Brantingsv. 8, 0581, Oslo, Norway.
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Bradley DT, Kountakis SE. Correlation between computed tomography scores and symptomatic improvement after endoscopic sinus surgery. Laryngoscope 2005; 115:466-9. [PMID: 15744159 DOI: 10.1097/01.mlg.0000157840.55659.62] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of the study was to determine the correlation between preoperative computed tomography scores and the improvement of symptom scores in patients treated with functional endoscopic sinus surgery. STUDY DESIGN Retrospective analysis of prospectively collected data. METHODS Retrospective analysis of prospectively collected data of patients undergoing functional endoscopic sinus surgery at a tertiary care medical center over a 2-year period for rhinosinusitis refractory to medical therapy was performed. Computed tomography scans were graded according to the Lund-Mackay system. Patient symptom scores were recorded from the 20-item sinonasal outcome test (SNOT-20) inventory preoperatively and at 3, 6, and 12 months postoperatively. Correlation was assessed by the Pearson correlation coefficient (r). RESULTS One hundred thirteen patients were identified with 1-year follow-up. The mean preoperative computed tomography grade was 13.2 with a mean SNOT-20 symptom score of 30.6. Preoperative CT scores did not correlate with preoperative symptom scores (r = 0.314). The SNOT-20 symptom scores improved 72%, 75%, and 77% at 3-, 6-, and 12-month follow-up, respectively, from preoperative values. In addition, there was no correlation between preoperative computed tomography scores and percentage of improvement at 3-, 6-, and 12-month follow-up (r = -0.003, r = -0.015, and r = -0.059, respectively). CONCLUSION The severity of rhinosinusitis on preoperative computed tomography scan does not predict the severity of symptoms as assessed by the SNOT-20 inventory in patients undergoing functional endoscopic sinus surgery. Further, computed tomography scores fail to predict the amount of symptomatic improvement after functional endoscopic sinus surgery. Patients receive a mean reduction in symptom scores of 77% after treatment with functional endoscopic sinus surgery.
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Affiliation(s)
- Dewayne T Bradley
- Department of Otolaryngology-Head and Neck Surgery, University of Oregon, Portland, Oregon, USA
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Kountakis SE, Arango P, Bradley D, Wade ZK, Borish L. Molecular and cellular staging for the severity of chronic rhinosinusitis. Laryngoscope 2005; 114:1895-905. [PMID: 15510011 DOI: 10.1097/01.mlg.0000147917.43615.c0] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To correlate objective and subjective clinical parameters with molecular, cellular, and histologic markers and to acknowledge the importance of these basic science parameters in a severity classification system for chronic rhinosinusitis (CRS). STUDY DESIGN Retrospective analysis of prospectively collected data of consecutive patients undergoing endoscopic sinus surgery for CRS in an academic institution. METHODS The preoperative computed tomography (CT) scans of all patients with CRS scheduled for surgery were graded according to Lund and Mackay. The patients completed a Sino-Nasal Outcome Test (SNOT)-20 questionnaire and had a preoperative nasal endoscopy performed, which was graded by assigning an endoscopy score according to Lanza and Kennedy. Subjects had a medical questionnaire regarding presence of aspirin sensitivity, allergic rhinitis, asthma, and medication usage. Subjects also underwent pulmonary function testing and had skin tests for allergies. At the time of surgery, blood was drawn to determine the level of peripheral eosinophilia and the degree of polymorphisms of the leukotriene C4 synthase gene. Sinus mucosal and polyp tissue was examined pathologically for the number of eosinophils per high-powered filed (HPF) and was stained for EG2 to determine the portion of activated eosinophils. Leukotriene C4 levels (pg/g of tissue) were determined using a sensitive competitive enzyme immunoassay. Endoscopy and SNOT-20 scores were reevaluated 1 year after surgery. Data were analyzed for disease-severity correlation to recommend a severity classification system for CRS that incorporates the contribution of clinical, molecular, cellular, and histologic parameters. RESULTS The presence of polyps resulted in higher preoperative CT scores and higher preoperative and postoperative symptom scores. Average preoperative CT scores were significantly higher in asthmatics and allergy patients and correlated with endoscopy scores. Patients with more than five eosinophils/HPF of sinus tissue had higher frequency of polyps and asthma and higher CT and endoscopy scores than patients without sinus tissue eosinophilia (less than or equal to 5 cells/HPF sinus tissue). The subgroup of patients with eosinophilic nasal polyps (eosinophilic hyperplastic rhinosinusitis) had more severe disease by CT and endoscopy than the subgroup of patients with nasal polyps (hyperplastic rhinosinusitis) but without eosinophilia. Similarly, patients without polyps but with tissue eosinophilia had more severe disease than patients without polyps and without eosinophilia. Leukotriene C4 levels were elevated in all patient groups. Symptom scores did not correlate with any of the parameters. CONCLUSION We suggest the following severity classification system for CRS: 1) eosinophilic chronic hyperplastic rhinosinusitis (ECHRS): patients with polyps and sinus tissue eosinophilia; 2) noneosinophilic chronic hyperplastic rhinosinusitis (NECHRS): patients with polyps but without sinus tissue eosinophilia; 3) eosinophilic chronic rhinosinusitis (ECRS): patients without polyps but with sinus tissue eosinophilia; 4) noneosinophilic chronic rhinosinusitis (NECRS): patients without polyps and without sinus tissue eosinophilia.
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Affiliation(s)
- Stilianos E Kountakis
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA 30912, USA.
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13
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Marshall AH, Jones NS. The Utility of Radiologic Studies in the Diagnosis and Management of Rhinosinusitis. Curr Infect Dis Rep 2003; 5:199-204. [PMID: 12760816 DOI: 10.1007/s11908-003-0074-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The past two decades have seen the development of computed tomography scanning as the principal investigation for paranasal sinus disease. This article describes the benefits and limitations of computed tomography scanning in the assessment of rhinosinusitis. It also discusses the role of magnetic resonance imaging as a further diagnostic tool in the assessment of rhinosinusitis and in particular its complications. Other imaging modalities such as plain radiographs and ultrasound have limited use in this field. The introduction of image guidance techniques as an aid to surgical treatment and possible future developments are outlined.
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Affiliation(s)
- Andrew H. Marshall
- Department of Otolaryngology, Head and Neck Surgery, University Hospital, Nottingham NG7 2UH, UK.
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Jones NS. CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2002; 27:11-7. [PMID: 11903365 DOI: 10.1046/j.0307-7772.2001.00525.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Computerized tomography (CT) of the paranasal sinuses provides valuable information but this should be interpreted in the context of the history and examination as the prevalence of incidental mucosal changes in an asymptomatic population is approximately 30%. A review of the presence or extent of the various anatomical variations that are found in the paranasal sinuses does not differ between a symptomatic and an asymptomatic population. This makes it unlikely that these are very important in either initiating or sustaining paranasal sinus disease. CT provides an excellent map to help the sinus surgeon operate. CT provides information about the extent of mucosal disease but this correlates poorly with symptoms, surgical findings and histopathology. CT does provide invaluable information to help in the diagnosis of atypical sinus infections, malignancy and in the management of the complications of rhinosinusitis. A normal CT in a patient with facial pain should make the doctor consider another diagnosis. In essence, CT helps to support a clinical diagnosis but it should not be interpreted out of context, and it is therefore vital that doctors communicate the clinical picture to their radiological colleagues, and that they learn to interpret the radiographs.
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Affiliation(s)
- N S Jones
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Nottingham NG7 2UH, UK.
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Rosbe KW, Jones DT, Rahbar R, Lahiri T, Auerbach AD. Endoscopic sinus surgery in cystic fibrosis: do patients benefit from surgery? Int J Pediatr Otorhinolaryngol 2001; 61:113-9. [PMID: 11589977 DOI: 10.1016/s0165-5876(01)00556-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the effects of endoscopic sinus surgery on the pulmonary status of cystic fibrosis (CF) patients through the objective parameters of steroid use, pulmonary function tests (PFTs), and inpatient hospital days (IHDs). METHODS Retrospective chart review of all patients with CF who underwent endoscopic sinus surgery from 1993 to 1999 at a tertiary care children's hospital. Preoperative pulmonary function, inhaler and steroid use, and IHDs were compared to postoperative parameters within a 1-year period. RESULTS Sixty-six patients, including eight lung transplant patients, underwent a total of 112 endoscopic sinus surgery procedures; 25 patients underwent more than one procedure. Patients were taking oral steroids preoperatively in 28% of procedures and inhaled steroids in 40%. Postoperatively, there was no statistically significant change in oral or inhaled steroid use, or in postoperative pulmonary function. If the index hospitalization, which was often for reasons not related to sinus disease, was considered part of the preoperative time period, endoscopic sinus surgery (ESS) was noted to result in a marked reduction (9.5 days (adjusted), P=0.001) in hospital days during the subsequent 6 months. If the date of the procedure alone was used to define pre- and postoperative time periods, the reduction in postoperative days was more modest and not statistically significant (3.5 days (adjusted), P=0.21). CONCLUSIONS Although we found no statistically significant difference in PFTs, or steroid requirements following ESS, ESS may have resulted in a reduced need for hospitalization in the 6 months following the procedure. Future prospective studies in a larger number of patients and using more detailed outcome measures are needed to better evaluate the effects of endoscopic sinus surgery in pediatric patients with CF.
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Affiliation(s)
- K W Rosbe
- Southern California Permanente Medical Group, Department of Head and Neck Surgery, 6th Floor, 4900 Sunset Boulevard, Los Angeles, CA 90027, USA
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Abstract
The body of literature regarding imaging inflammatory diseases of the sinonasal cavity is extensive. This article will not recapitulate standard imaging protocols, osteomeatal complex (OMC) anatomy, or drainage pathways to any significant extent. Clinical and radiographic topics that create confusion for radiologists will be covered in some depth to include the pathophysiology of rhinosinusitis and bone response to inflammation. Fungal sinusitis is covered elsewhere in this issue. Clinical imaging issues will be followed by a discussion of common surgical procedures, their complications, and postoperative recurrent disease. The role of MRI as a problem-solving modality will be emphasized.
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Chong VF, Fan YF, Lau D, Sethi DS. Functional endoscopic sinus surgery (FESS): what radiologists need to know. Clin Radiol 1998; 53:650-8. [PMID: 9766718 DOI: 10.1016/s0009-9260(98)80291-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The place of coronal computed tomography (CT) in the assessment of patients prior to functional endoscopic sinus surgery (FESS) is well established. The ability to accurately correlate radiological and surgical anatomy enhances precision and safety during FESS. This pictorial essay reviews the conceptual anatomical framework that forms the basis of FESS.
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Affiliation(s)
- V F Chong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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Moses RL, Cornetta A, Atkins JP, Roth M, Rosen MR, Keane WM. Revision Endoscopic Sinus Surgery: The Thomas Jefferson University Experience. EAR, NOSE & THROAT JOURNAL 1998. [DOI: 10.1177/014556139807700309] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since its introduction, functional endoscopic sinus surgery (FESS) has demonstrated success rates of 76% to 98%. A small group of the patients in whom initial FESS and optimal medical therapy fail require revision endoscopic sinus surgery (RESS). This group has recently been studied by several authors, and we have evaluated a group of 90 RESS patients selected from 753 consecutive primary FESS patients. Patients were followed for a mean of 22.8 months. Extent of disease, history of polyps, allergy, previous traditional endonasal sinus surgery, male gender, chronic steroid use, and the presence of a deviated septum all appeared to adversely affect RESS outcome. The surgeon's knowledge of the sinus anatomy is critical, especially in revision sinus cases in which landmarks are distorted or absent. In our review, RESS was associated with a 1% major complication rate and was successful in 67% of patients. Computer-assisted endoscopic sinus surgery integrates preoperative imaging with realtime endoscopic visualization, augments the surgeon's knowledge of anatomy, and helps to minimize patient risk.
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Affiliation(s)
- Ron L. Moses
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Anthony Cornetta
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Joseph P. Atkins
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Maurice Roth
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Marc R. Rosen
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - William M. Keane
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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