Leonardo Lopes Balsalobre Filho

Rhinosinusitis: evidence and experience. A summary

as Mild, Moderate or Severe. Disease severity isclassified through the Visual Analog Scale (VAS) (Fig. 1), from0 to 10cm. The patient is asked to quantify from 0 to 10 thedegree of discomfort caused by the symptoms; zero meaningno discomfort, and 10, the greatest discomfort. Severity isthen classified as follows: Mild: 0---3 cm; moderate: >3---7 cm;Severe: >7---10cm.

Safety of sphenoid aspiration for diagnosis and treatment of intensive care unit rhinosinusitis.

Background In intensive care units (ICUs), critically ill patients may be exposed to several risk factors for developing acute rhinosinusitis, including nasogastric tubes, mechanical ventilation, and prolonged periods in the supine position. The incidence of acute rhinosinusitis can be as high as 83%, the third or fourth most frequent ICU infection and it increases the risk of developing ventilator-associated pneumonia. Diagnosis and therapeutic approaches should be more aggressive than in non-ICU patients. Antral puncture plays a central role in the diagnosis and treatment of these patients. This study was designed to show the development of a method for sphenoid puncture in the diagnosis and treatment of acute infectious rhinosinusitis in critically ill patients, analyzing safety and complications. Methods Patients in ICUs with endoscopic and radiological diagnosis of acute rhinosinusitis were included. Maxillary puncture was performed through the inferior meatus; sphenoid puncture was performed by endoscopic identification of the sphenoethmoidal recess. An aspiration probe was introduced into the natural sphenoidal ostium, followed by aspiration of secretions and saline irrigation. Results Twenty-nine patients were included. Twenty-seven patients (93.1%) presented with sphenoidal sinusitis, 24 patients (82.7%) had maxillary sinusitis, 21 patients (72.4%) had ethmoidal sinusitis, and 13 patients (44.8%) had frontal sinusitis. Forty-seven sphenoidal and 39 maxillary punctures were performed. No major bleeding or other complications were recorded. Conclusion The sphenoid puncture is a possible procedure to be performed in an ICU and might complement the paranasal puncture in cases of acute rhinosinusitis.

Rinossinusite nosocomial em Unidade de Terapia Intensiva: estudo microbiológico

UNLABELLED Nosocomial sinusitis is a common complication of patients in ICUs. Its diagnosis is important, and early treatment is required to avoid serious complications such as pneumonia, sepsis, meningitis, and intracranial abscesses. AIM To identify the germs causing sinusitis in ICUs by nasal swabs and maxillary sinus puncture, and to correlate these results. METHODS ICU patients with a diagnosis (CT confirmed) of maxillary sinusitis underwent nasal swab and puncture of the sinus to collect material for culture and antibiogram. RESULTS This study evaluated 22 patients. The microbial agent isolated in the swab correlated with the agent in the puncture in 14 of 22 cases (63%). Gram-negative bacteria were the most frequent, as follows: Pseudomonas aeruginosa (29% of punctures), following by Proteus mirabillis (26%) and Acinetobacter baumanni (14%). The resistance index in the antibiogram was high to antibiotics. CONCLUSION Maxillary sinus puncture of ICU patients with sinusitis appears to be the best method for identifying bacteria; antibiograms demonstrate resistance to therapy. The swab has little diagnostic value; the correlation was 63%. It may be used when sinus puncture is contraindicated.

Retrograde Guided Balloon Dilatation Eustachian Tuboplasty

Objective: Evaluate a new option for treatment of patients with Eustachian tube stenosis. Method: Prospective surgical study. Three patients with unilateral intractable Eustachian tube stenosis (after surgical procedures) underwent retrograde illumination with Relieva Luma Sentry from middle ear to nasopharyngeal area and with endoscopic nasal approach to balloon dilatation to that area under general anesthesia. The procedures were done between 2010 and 2011. Results: By following the light that was dissected through the stenosis tissue until we could have the Relieva Luma Sentry, we then inserted it retrograde inside a sphenoid balloon catheter and inserted the balloon inside a tubal lumen. After that, the balloon was inflated for 2 minutes with 10 atm to tubal dilatation. The approach to the middle ear was done transtympanically. Balloon catheters had success in dilatation in all cartilaginous Eustachian tubes. Balloon dilatation was not difficult to perform. Patients reported a very good improvement of hearing levels and a good dilatation comparing the tomography before and two months after the procedure. Conclusion: Retrograde guided balloon dilatation of the nasopharyngeal Eustachian tube ostia showed good results. Larger studies are now needed to show the real role of this surgery.

S287 – Microbiological Study of Nosocomial Sinusitis in ICU:

Objectives 1) Identifying the bacteria causing sinusitis in an intensive care unit (ICU) through the nasal swab and puncture of maxillary sinus. 2) Comparing their results with the cultures and antibiograma. Methods 22 patients in the ICU with uni- or bilateral maxillary sinusitis diagnosed by computed tomography were submitted to nasal swab and puncture of the maxillay sinus. The materials were sent to culture and antibiograma and their results were compared. Results The present study evaluated 22 patients. There was exact correlation among the isolated microbial agent in the swab and in the puncture in 14 of the 22 cases (63%). The prevalence of the aerobic gram negative was: Pseudomonas aeruginosa (29%), Proteus mirabillis (26%) and Acinetobacter baumanni (14%). The antibiograma presented a high index of resistance to the antibiotics used in daily practice. Conclusions The nasal swab was of little value to the diagnosis, while the direct puncture of the maxillary sinus could assess the specific bacterial agents, allowing a right-to-the-point therapeutic. The early and specific treatment decreases the morbi-mortality in these patients.