Comparison of the Findings on Transillumination, X-Ray and Lavage of the Maxillary Sinus

McNeill, Ronald Alastair

doi:10.1017/s0022215100061673

Cited by 47 publications

(11 citation statements)

References 6 publications

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“…17 Acute sinusitis is defined radiologically by the presence of complete sinus opacity, by the air-fluid level, or by marked mucosal thickening (Fig. 2) [18][19][20][21] ; however, radiography cannot be used to differentiate viral from bacterial sinusitis. 22 In a meta-analysis that compared the results of sinus radiography with those of sinus puncture, 23 radiography had moderate sensitivity (76 percent) and specificity (79 percent) for the identification of bacterial sinusitis.…”

Section: Diagnosismentioning

confidence: 99%

Acute Bacterial Sinusitis

Piccirillo

2004

N Engl J Med

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The new england journal of medicine n engl j med 351;9 www.nejm.org august 26, 2004 902 This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.A 43-year-old man has a two-week history of nasal congestion, postnasal drip, and fatigue. He has used an over-the-counter nasal decongestant and acetaminophen, without relief. During the past few days, facial pain and pressure have developed and have not responded to decongestants. In addition, his nasal discharge has turned from clear to yellow. How should he be treated?Acute bacterial sinusitis is an infection of the paranasal sinuses with inflammation of the nose. On the basis of national population surveys and insurance-reimbursement claims, sinusitis is one of the most common health problems in the United States. 1 Acute bacterial sinusitis most commonly develops as a complication of a viral infection of the upper respiratory tract. Approximately 0.5 to 2 percent of cases of viral rhinosinusitis develop into bacterial infections. 2-4 Symptoms include nasal congestion, purulent nasal discharge, maxillary tooth discomfort, hyposmia or anosmia, cough, facial pain or pressure that is made worse by bending forward, headache, fever, and malaise. Physical findings include nasal turbinate edema, nasal crusts, purulence of the nasal cavity and posterior pharynx, and failure of transillumination of the maxillary sinuses. 5 Transillumination is performed in a completely darkened room by placing a flashlight against the skin overlying the infraorbital rim and directing the light inferiorly (Fig. 1). The patient then opens his or her mouth, and the hard palate is examined. The possible results are a palate that appears opaque or dull and a normal palate. However, the value of this procedure is limited; since it is not easy to perform, the clinician cannot differentiate viral from bacterial sinusitis, and results vary depending on the skill of the clinician. A particularly challenging task is to distinguish viral from bacterial sinusitis. In most patients, rhinoviral illness improves in 7 to 10 days 6 ; therefore, a diagnosis of acute bacterial sinusitis requires the persistence of symptoms for longer than 10 days or a worsening of symptoms after 5 to 7 days. Symptoms of viral sinusitis, including fever, mimic those of bacterial sinusitis, although the color and quality of nasal discharge -classically, clear and thin during viral sinusitis and yellow-green and thick during bacterial sinusitis -may help to differentiate the two.Studies over the past two decades have indicated that Streptococcus pneumoniae and Haemophilus influenzae are the major bacterial pathogens in adults with sinusitis. 7 Other species (including b -hemolytic and a -hemolytic streptococci, Staphylococcus aureus, and anaerobes) have also been cultured from adults with sinusitis but are much less frequ...

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Section: Diagnosismentioning

confidence: 99%

Acute Bacterial Sinusitis

Piccirillo

2004

N Engl J Med

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“…16 While low predictability was shown in the studies of McNeil et al (37%), Ezeanolue et al (36.7%), Vourinen (36.4%), Evans et al (26%) and Hinde (16%). [8][9][10]12,14 The present study showed a predictability of 83%.…”

Section: Antral Lavage Findingsmentioning

confidence: 77%

“…8 While in Arruda et al study, maximum showed clear antra (n=42). 11 In the studies by Kurien et al and Sen et al, the commonest finding was haziness.…”

Section: Radiological Appearance Of Maxillary Antramentioning

confidence: 81%

Bacteriology and antibiotics treatment of maxillary sinusitis: a prospective study

Malashetti

Havle

Karembelkar

2017

Int J Otorhinolaryngol Head Neck Surg

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Background: Sinusitis is one of the commonest causes of patients visit to the otorhinolaryngologist, around one in five cases. The prevalence of sinusitis (146/1000) has been reported. Estimates suggest that clinical condition of sinusitis is more widespread than arthritis and/or hypertension. Sinusitis significantly impacts quality of life, even in comparison to chronic debilitating diseases such as diabetes and congestive heart failure. Sinusitis is the fifth most common medical diagnosis for which antibiotics are prescribed. Sinusitis is usually managed with a 10 days complete course of appropriate sensitive antibiotics. To achieve this goal, there should be some diagnostic modalities which guide towards exact diagnosis as well as safe intervention and cost effective. Over past decade, x-ray paranasal sinuses (Water’s view) and nasal endoscopy have been used successfully as diagnostic modalities in sinus disease.Methods: 100 patients presenting with complaints of sinusitis to the ENT OPD KIMSDU Karad, Maharashtra India were selected randomly (more than 12 yrs of age). All of them were examined clinically and subjected to X -ray PNS (Water’s view) and diagnostic nasal endoscopy [DNE]. Antral lavage was done for all the patients and returning fluid sent for culture and sensitivity. Results were evaluated by statistical analysis using chi square test and evaluating p value tabulated and compared. Appropriate antibiotics were advised orally for 10 days, on the basis of culture reports, such as Amoxcillin-Clavulinate 625 mg BD, Cefpodoxime proxetil 200 mg BD, Levofloxacin 500 mg OD, Ciprofloxacin-Tinidazole (500:600 mg) BD.Results: Majority of the patients were in the age group of 20-29 years (46%) and females (53%). Most common organisms causing maxillary sinusitis was- S.aureus (coagulase+29%). It was found that Amoxicillin-Clavulinate has highest efficacy as compared to other antibiotics.Conclusions: According to our study, most common organisms causing acute maxillary sinusitis in this study are S aureus (coagulase+), S pnemoniae and Enterobacteriacae. Most common organisms isolated are anaerobic Peptostreptococcus, coagulase positive S. aureus and fusobacterium in chronic rhinosinusitis. Efficacy of Amoxicillin-Clavulinic acid was 96% clinically, 94% based on results on DNE findings and 87% by radiological success rate which is statistical more significant than other class of antibiotics. So amoxicillin clavulinic acid can be considered as first line of drug for treating bacterial rhinosinusitis.

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“…Diaphanoscopy is an easy method which requires great ex perience and which does not allow any refined diagnosis (Ballantyne and Rowe, 1949;McNeill, 1963). The method may be useful in open care without radio logical service.…”

Section: Discussionmentioning

confidence: 99%

Symptoms and Signs of Acute Maxillary Sinusitis

Axelsson

Runze

1976

ORL

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Symptoms and signs of acute maxillary sinusitis have seldom been specifically analyzed. Since there is a gradual transition from rhinitis to sinusitis it can be expected that many symptoms are common for the two diseases. However, since sinusitis requires drainage measures and/or antibiotic treatment, both of which seldom are actual for rhinitis, the differential diagnosis is important. The present investigation confirms most of the symptoms presented previously in textbooks. However, most of these symptoms which conventionally are supposed to indicate sinus disease were found to be just as common in radio-logically normal sinuses and in sinuses with pronounced changes. The subjective or objective finding of purulent nasal secretion was more helpful in the differentiation between rhinitis and sinusitis. It appears that the patient’s symptoms do not constitute a reliable diagnostic basis for the confident differentiation between the two diseases. The simplest and least discomfortable means of demonstrating sinusitis is by radiology.

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Comparison of the Findings on Transillumination, X-Ray and Lavage of the Maxillary Sinus

Cited by 47 publications

References 6 publications

Acute Bacterial Sinusitis

Acute Bacterial Sinusitis

Bacteriology and antibiotics treatment of maxillary sinusitis: a prospective study

Symptoms and Signs of Acute Maxillary Sinusitis

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