Headache--a Sinonasal Symptom and More… a Review Article

Headaches and facial pain are common complaints. In many cases, patients are referred to an otolaryngologist to determine if head pain is sinus related. In the absence of other nasal or sinus symptoms, some rhinogenic headaches can be overlooked or misdiagnosed. A complete history and thorough ENT examination, including nasal endoscopy with or without coronal CT scans is key to the correct diagnosis.1 Headache resulting from disease of the nose or paranasal sinuses are usually associated with symptoms (congestion, fullness, discharge, obstruction) that point to the site of origin. Occasionally, however nasal or sinus disease can be manifested solely as headache

A Case of Rhinogenic Intracranial Complication: Epidural Abscess

We report a case of acute rhinosinusitis complicated by epidural abscess. A 33-year-old woman consulted her local otorhinolaryngology clinic complaining of left eye pain and left periorbital swelling. After visiting additional clinics and receiving treatment she did not obtain relief from her symptoms. Thereafter, she was referred to our hospital. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) were conducted and it was found that acute rhinosinusitis had caused an epidural abscess in the left frontal tip. The patient was admitted to the hospital and endoscopic sinus surgery (ESS) as well as septoplasty were performed under general anesthesia. A neurosurgeon was consulted regarding the brain lesion and treatment with antibiotics was selected. Intravenous PAPM/BP (panipenem/betamipron) and hydrocortisone sodium succinate were administered postoperatively. On the fifth postoperative day, the patient\u27s condition had improved and the nasal inflammation had almost disappeared. She was discharged from hospital on the tenth postoperative day

HEADACHE--A SINONASAL SYMPTOM AND MORE… A REVIEW ARTICLE

Headaches and facial pain are common complaints.  In many cases, patients are referred to an otolaryngologist to determine if head pain is sinus related.  In the absence of other nasal or sinus symptoms, some rhinogenic headaches can be overlooked or misdiagnosed.  A complete history and thorough ENT examination, including nasal endoscopy with or without coronal CT scans is key to the correct diagnosis.1 Headache resulting from disease of the nose or paranasal sinuses are usually associated with symptoms (congestion, fullness, discharge, obstruction) that point to the site of origin.  Occasionally, however nasal or sinus disease can be manifested solely as headache

Modern approaches to the treatment of chronic polypous rhinosinusitis

Today, the frequency of chronic rhinosinusitis increases exponentially, which makes the question of the modern approach to its treatment the most relevant. It is possible that additional research in this area will solve the issue of searching for both the optimal path of therapy and treatment of CPR in childre

Analysis of pediatric subdural empyema outcome in relation to computerized tomography brain scan

A cross-sectional study was conducted to predict the outcome in patients with subdural empyema, using initial and post-treatment CT scan brain parameters. Data collection was done on those children who were diagnosed to have subdural empyema by CT scan of the brain with contrast, who underwent burrhole evacuation, from February 2000 until April 2002. Numerous factors, such as coma or loss of unconsciousness at diagnosis, age, types of antibiotic, microbiology, extension of empyema, associated cerebral infarction and ventriculitis, were analyzed. Poor prognosis was associated with loss of consciousness, and hypodensity by CT scan at presentation (p < 0.005). Patients with an extensive subdural empyema will have a good outcome if they are treated early and aggressively with antibiotics and burrhole evacuation

Can imaging suggest the aetiology in skull base osteomyelitis? : a systematic literature review

Purpose: To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. Material and methods: A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. Results: Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group - 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidenceof orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. Conclusions: Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement

Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature

Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (>70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol

Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature

Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (&gt;70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol

Respiratory disease in the Middle Nile Valley:A bioarchaeological analysis of the impact of environmental and sociocultural change from the Neolithic to Medieval periods

Today, poor air quality is a major world-wide health burden, causing 4.2 million premature deaths per year globally, including from respiratory disease. Particulate pollution irritates and inflames the respiratory tract, increasing susceptibility to the development of respiratory conditions. Non-specific bone changes in the sinuses and on the visceral surfaces of the ribs have been linked to inflammation of the respiratory tract, caused by sinusitis and lower respiratory tract diseases. Analysis of these changes in archaeological populations is providing an historical perspective on the impact of environment, activities related to occupation, and associated socio-economic factors, such as poor ventilation in living and work spaces and low levels of hygiene, which potentially can all lead to exposure to poor air quality. This study investigates the prevalence of abnormal bony changes to the sinuses and ribs in human skeletons from twelve Sudanese sites, ranging from the Neolithic to the Medieval periods (5000 BC – AD 1500), with a particular focus on the Fourth Nile Cataract area and comparative sites from other regions of the Nile Valley with differing sociocultural and environmental conditions. A total of 493 adults (aged 17+ years) were analysed. Changes in prevalence between sex, age, time period, and geographical region were examined. Prevalence rates of new bone formation on the visceral surfaces of the ribs displayed a general trend towards an increase in later time periods, while the frequency of bony changes associated with maxillary sinusitis remained remarkably consistent at around fifty percent in all Fourth Cataract sites. The data from the comparative sites displayed greater variation. The lowest prevalence rates for bony changes associated with respiratory disease were observed at the Neolithic site (R12) and the highest at the urban Medieval site (Soba East). In Sudan increasing aridity from the Neolithic period until the modern day may have led to a growing exposure to environmental particulate matter from airborne dust and sand. The impact of increasing aridity, agricultural intensification, urbanisation, craft specialisation, and the emergence of visible signs of infectious diseases such as tuberculosis and leprosy, are all discussed in relation to the prevalence rates of respiratory disease between time periods and geographical regions. Changes in the environment in the Middle Nile Valley may have had a distinct effect on the presence of respiratory disease, in conjunction with exposure to other sources of particulate pollution and infectious diseases. This study of respiratory disease in Sudan provides a contextually driven perspective on a problem that is of increasing concern today across the world