Search

Objective: To illuminate the pathophysiology of acute rhinosinusitis (ARS) with sequential monitoring of inflammatory biomarkers during an ARS episode and to clarify their diagnostic usability in bacterial ARS., Study Design: Inception cohort study with 50 conscripts with ARS., Methods: We collected peripheral blood high-sensitive C-reactive protein (hs-CRP), white blood cell (WBC), procalcitonin, and nasal nitric oxide (nNO) counts at 2 to 3 and 9 to 10 days of symptoms during an ARS episode. We simultaneously gathered various clinical parameters and microbiological samples. Bacterial ARS was confirmed with a positive culture of sinus aspirate., Results: Reciprocal correlations and a significant change in biomarker levels between the two visits suggest that ARS involves a local and systemic inflammatory response that was strongest at 2 to 3 days. High-sensitive CRP and nNO reflected responses best (52% had increased CRP levels at 2-3 days; 66% had decreased nNO levels). White blood cell and procalcitonin counts rarely exceeded the reference range. Increased local and systemic inflammatory response were linked to multiple, adenoviral, or influenza A viral etiology or the detection of bacterial ARS. Local response correlated with imaging findings of wide paranasal sinus involvement and ostiomeatal complex occlusion. At 9 to 10 days, elevated (≥ 11 mg/L) and moderately elevated (≥ 49 mg/L) hs-CRP predicted bacterial ARS well (likelihood ratio [LR]+ 3.3 and LR+ 15.8, respectively), but the sensitivity for both findings remained low., Conclusion: Acute rhinosinusitis (particularly bacterial ARS) involves a local and systemic inflammatory response that is strongest at the beginning of symptoms. Elevated hs-CRP supports the diagnosis of bacterial ARS., Level of Evidence: 4. Laryngoscope, 2016 127:E55-E61, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To evaluate with imaging the course of acute rhinosinusitis (ARS) and the associations between paranasal imaging results, symptoms, bony anatomic variations, and culture-proven bacterial ARS., Study Design: Inception cohort study with 50 conscripts with ARS., Methods: During a single ARS episode, we collected symptoms daily and took sequential cone-beam computed tomography (CBCT) scans of the paranasal sinuses of the same patients 2 to 3, 5 to 6 and 9 to 10 days after the onset of symptoms. Culture-proven bacterial ARS was verified with maxillary sinus aspiration and bacterial culture at 9 to 10 days., Results: At 2 to 3 days, 38% of the patients had major abnormalities, 42% had minor abnormalities in their paranasal sinuses, and 68% had an occluded ostiomeatal complex (OMC). At 5 to 6 days and 9 to 10 days, these proportions remained essentially the same. At 2 to 3 days, patients with bacterial ARS had slightly higher CBCT scores than those without bacterial ARS. Later, the CBCT and symptom scores gradually increased in patients with bacterial ARS and decreased in those without bacterial ARS. The CBCT and symptom scores had only a weak correlation (rs = 0.36), and anatomic variations were not related to development of bacterial ARS., Conclusions: Paranasal mucosal abnormalities and occlusion of the OMC do not develop gradually during ARS, but are present when symptoms begin and remain fairly constant in most patients both with and without bacterial ARS. This indicates that the spread of the disease process to the paranasal sinuses and obstruction of the OMC may not be etiological factors in the development of bacterial ARS., Level of Evidence: 4 Laryngoscope, 126:1965-1970, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To evaluate the diagnostic accuracy of symptoms, the symptom progression pattern, and clinical signs in identifying bacterial acute rhinosinusitis (ARS)., Study Design: We conducted an inception cohort study among 50 military recruits with ARS., Methods: We collected symptoms daily from the onset of symptoms to approximately 10 days. At 9 to 10 days, standardized data on symptoms and physical findings were gathered. A positive culture of maxillary sinus aspirate was considered to be the reference standard for bacterial ARS., Results: At 9 to 10 days, the presence or deterioration after 5 days of any of the symptoms could not be used to diagnose bacterial ARS. Toothache had an adequate positive likelihood ratio (positive likelihood ratio [LR+] 4.4) but was too rare to be used for screening. In contrast, several physical findings at 9 to 10 days were of more diagnostic use and frequent enough for screening. Moderate or profuse (vs. none/minimal) amount of secretion in nasal passage seen in anterior rhinoscopy satisfactorily either ruled in, if present (LR+ 3.2), or ruled out, if absent (negative likelihood ratio 0.2), bacterial ARS. If any secretion was seen in the posterior pharynx or middle meatus, the probability of bacterial ARS increased markedly (LR+ 5.3 and LR+ 11.0, respectively)., Conclusion: We found symptoms or their change to be of little use in identifying bacterial ARS. In contrast, we observed several clinical findings after 9 to 10 days of symptoms to predict bacterial ARS quite accurately., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)