Jouko Suonpää

Sinusitis in the common cold

Abstract Background: Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections. Objective: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults. Methods: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed. Results: On day 7, 39% of patients with the common cold in the placebo group (n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects. Conclusion: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur. (J Allergy Clin Immunol 1998;102:403-8.)

BIOACTIVE GLASS S53P4 IN FRONTAL SINUS OBLITERATION: A LONG-TERM CLINICAL EXPERIENCE

Synthetic, osteoconductive, and antimicrobial bioactive glass (BAG) has been used in many surgical applications.

Obliteration of the frontal sinus cavity with bioactive glass

Bioactive glass (BG) is a glass ceramic material. It has been used as surgical bone replacement material in ear and oral surgery, orthopedics, and dentistry.

Rhinomanometry before Septoplasty: An Approach to Clinical Material with Diverse Nasal Symptoms:

Preoperative and postoperative rhinomanometry was performed on 102 patients referred for septoplasty. Nasal resistance was calculated according to the Broms method at radius 200 and at 150 Pascal pressure gradient. Because the latter could be calculated in only 62% of the recordings during normal nasal breathing, the Broms method is used in the analysis and also recommended for clinical practice. Results show that in cases with airway obstruction as the cause for surgery, the increase of nasal patency achieved with the operation was larger than in cases with other indications. The level of subjective satisfaction was highest among those patients whose nasal resistance was changed to normal limits. Rhinomanometry gives valuable data in cases where the patients symptom is obstruction, but its value is not as clear in other indication groups. Rhinomanometry clearly shows cases where surgery has failed to correct the nasal obstruction and is, therefore, a good method of quality control. Preoperative rhinomanometry helps to avoid unnecessary septal operations.

The Effect of the Nasal Cycle on the Interpretation of Rhinomanometric Results in a Nasal Provocation Test

A nasal provocation test was carried out in two groups of adults: patients with birch pollen allergy (n = 25) and a group of healthy volunteers with no nasal allergy (n = 25). An endonasal provocation test was performed using increasing concentrations of birch pollen extract. The maximal duration of the test was 1 hour. The physiologic changes in the nasal patency in both groups were studied at a separate session at 10-minute intervals during 1 hour. The nasal patency was recorded with a computerized rhinomanometer using the anterior active method. The statistical analysis of the results shows that modern rhinomanometry is a reliable method of objectively evaluating the alternations in nasal obstruction during a nasal provocation test. The rhinomanometric findings correlate well with the rhinoscopic findings and the subjective symptoms of the patients. The changes in the nasal resistance values during the provocation were significantly larger than the physiologic ones. The individual biologic rhythmicity of nasal airway patency cannot hide the real positive result of a rhinomanometric provocation test, but it must be considered as an important factor in interpreting the results in nasal challenge.