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General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Sinusitis is an inflammation of the mucosa of one or more of the paranasal sinuses. Acute sinusitis lasts up to four weeks and is almost always of viral or allergic origin; it may develop into chronic bacterial sinusitis, which typically lasts at least 12 consecutive weeks and may persist for years. The disease progresses in the following manner: The ostium of the sinus becomes obstructed from mucosal swelling due to a virus or allergy. The air within the sinus is then absorbed by the mucosal surface, creating a painful negative pressure in the sinus. If the ostium is not reopened, a transudate fluid begins to fill the cavity, providing a medium for bacterial growth. The bacteria attract an exudate of white blood cells and serum, which creates a painful (and dangerous) positive pressure within the sinus.72 Bacterial sinusitis is not a benign disease. Serious complications may arise such as periorbital infections, meningitis, and brain abscess.73
Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Otitis externa is particularly common and all ENT junior doctors will have encountered many cases which require topical therapy and microsuction. Swabbing the ear for culture and sensitivities may guide choice of antibiotic drops and differentiate bacterial from fungal infection. In persistent cases, it is important not to miss an alternative diagnosis of cholesteatoma. In immunocompromised patients, with ear canal granulations and/or pain out of keeping with clinical appearance, one must also consider the possibility of necrotising otitis externa which is a potentially fatal osteomyelitis of the lateral temporal bone. Cross-sectional imaging aids diagnosis in these cases. Potential complications include venous sinus thrombosis, meningitis, intracranial abscesses and lower cranial nerve palsies. Management requires a multidisciplinary team approach and usually requires extended intravenous antibiotics via a long line.
Ear, Nose, and Paranasal Sinus
Published in Swati Goyal, Neuroradiology, 2020
The paranasal sinuses are air-filled spaces between the bones around the nasal cavity. Draining ostia connect four distinct sinuses with the nasal cavity. The anterior ethmoid cells, the frontal sinus, and maxillary sinus drain into the middle meatus. The posterior ethmoid cells and sphenoid sinus drain into the superior meatus. The nasolacrimal duct drains into the inferior nasal meatus.
The Role of Steroids for Pediatric Orbital Cellulitis – Review of the Controversy
Published in Seminars in Ophthalmology, 2023
Jonathan E. Lu, Michael K. Yoon
Infections of the orbit and periorbita are serious conditions requiring aggressive treatments to prevent significant morbidity and mortality, especially in the pediatric population. The etiology is most commonly a bacterial infection arising from the sinuses, but may also occur secondary to trauma, other periocular infection, dental procedures, or hematogenous spread.1,2 The management of pediatric orbital cellulitis classically involves broad-spectrum antibiotics as well as surgical drainage in select cases. While antibiotic treatments may halt the infectious aspect, periorbital inflammation and edema are frequently not directly addressed, which may lead to potentially blinding outcomes such as optic neuropathy from orbital compartment syndrome.3,4 There is ongoing debate about the role and safety for adjuvant corticosteroids in pediatric orbital cellulitis, and this review seeks to summarize the existing evidence for a better understanding of the current state on this important topic.
Successful Treatment of Optic Neuropathy Associated with Sphenoid Sinus Aspergillosis
Published in Ocular Immunology and Inflammation, 2023
Sung-Dong Kim, Hyeshin Jeon, Hee-Young Choi, Kyung Un Choi
Vision loss due to orbital aspergillosis usually has a poor prognosis.5–8 Adulkar et al.6 reported that eight of 20 patients had poor visual outcomes due to optic nerve invasion or central retinal artery occlusion. Five patients presented with non-light perception, and the remaining three patients showed low visual acuity of less than 6/36. In another study, only 33% of patients with visual loss due to fungal sphenoid sinusitis showed improved visual acuity, but the degree of visual improvement was not presented.7 In recently published study, patients with invasive fungal rhinosinusitis showed an irreversible ophthalmological insult.8 These visual disturbances may be due to inappropriate management or aggressive disease with sinus involvement.3 Optic neuropathy may be attributed to direct optic nerve compression, secondary optic nerve inflammation due to the contiguous spread of inflammation, or a vascular obstructive process.7,9 In this case, the visual acuity started to improve 3 days after performing surgery and starting anti-fungal agent according to the biopsy results, rather than immediately after surgery. Considering that the functional deterioration caused by the compression of the optic nerve may be observed immediately after compression has resolved,10 it is presumed that infiltrative, as well as an compressive mechanism, may be involved in optic neuropathy.
Autologous fibrin sealant co-delivered with antibiotics is a robust method for topical antibiotic treatment after sinus surgery
Published in Acta Oto-Laryngologica, 2021
Kasper Aanaes, Kim G. Nielsen, Elisabeth Arndal, Christian von Buchwald, Tania Pressler, Niels Høiby
Comparing this study with our previous study showing that antibiotic sinus irrigations do not cover sinus mucosa for a sufficient period of time to eradicate bacteria [9], we here show that the antibiotics can be applied to all desirable sites and that the antibiotics are present for a much longer period of time using the Vivostat® system with co-polymerization of autologous PRF and antibiotics. We think that this novel treatment may be more efficient in eradicating sinus bacteria compared with antibiotic-nasal-irrigations and systemic treatment. This, however, needs to be studied but is supported by our observation, that nine out of ten patients the pathogenic bacteria found at sinus surgery were not found in the sino-nasal cultures taken at the final visit at approximately 14 days after surgery.