In vitro studies and safety assessment of Doppler ultrasound as a diagnostic tool in rhinosinusitis

We have previously proposed the use of Doppler ultrasound to noninvasively stage a sinus infection. In this study, we first investigated the acoustic properties of nonpurulent and mucopurulent sinus secretions. The density, viscosity, speed of sound and attenuation of 18 samples of sinus fluid were examined. We then assessed the safety of the method by determining the temperature increase when ultrasound is transmitted through a bone sample of the same thickness as the anterior wall of the maxillary sinus. As a measure of the probability to generate acoustic streaming, we determined the ratio of sound attenuation over the viscosity of the sinus fluid and compared this with the value obtained from acoustic streaming measurements on a model system. The results indicated that detectable levels of acoustic streaming can be generated in serous sinus fluid, which has a low viscosity, but is very unlikely in mucopurulent secretions. The attenuation of the mucopurulent sinus fluid was 10 times higher than that of the serous cyst fluid, but the viscosity of the mucopurulent secretion was a thousand times higher than that of serous fluid. The safety experiments gave a temperature increase of the bone of <1.5°C at I(spta) of 640 mW/cm(2), below the temperature increase considered to be harmful by the World Federation for Ultrasound in Medicine and Biology.     

真菌感染与慢性鼻窦炎合并鼻息肉的关系

目的：探讨真菌与慢性鼻窦炎鼻息肉发病的关系。方法：对2007年1月—2008年12月84例慢性鼻窦炎鼻息肉患者鼻腔分泌物进行真菌涂片和培养,与健康志愿者50人进行比较。结果：慢性鼻窦炎鼻息肉组息肉表面分泌物Gomori染色涂片的真菌检出率为67.9%（57/84）,正常组鼻黏膜分泌物涂片真菌检出率为34%（17/50）;慢性鼻窦炎鼻息肉组息肉表面分泌物真菌培养阳性率为61.9%（52/84）,正常组鼻黏膜分泌物真菌培养阳性率为48%（24/50）,2组差异有统计学意义。结论：真菌感染与慢性鼻窦炎鼻息肉的发病关系密切。     

经鼻内镜鼻中隔偏曲矫正同期行鼻窦手术的疗效观察

目的探讨经鼻内镜鼻中隔偏曲矫正同期行鼻窦开放术的疗效。方法对72例鼻中隔偏曲合并鼻窦炎患者,经鼻内镜鼻中隔偏曲矫正同期行鼻窦开放术,并观察疗效。结果随访6个月至2年,治愈60例(83.33%),好转12例(16.67%),总有效率为100%。所有患者鼻中隔矫正居中,无一例鼻腔粘连、鼻中隔穿孔等并发症。结论经鼻内镜鼻中隔偏曲矫正同期行鼻窦开放手术安全可行,疗效确切。     

慢性鼻窦炎的成因探讨

目的：探讨慢性鼻窦炎的成因。方法：分析80例慢性鼻窦炎患者的病史、体征、CT表现及手术中所见。结果：慢性鼻窦炎患者中伴有过敏性鼻炎者占40％，窦口鼻道复合体（ostimeatal complex，OMC）阻塞者占55％，鼻中隔偏曲者占67％，上呼吸道感染者占20％，复发性鼻息肉者占13％。结论：慢性鼻窦炎的发病是由变态反应、OMC阻塞、鼻中隔偏曲、感染等诸因素共同作用的结果。     

钩突与中鼻甲骨性距离的影像学测量

目的观察鼻窦炎病人与非鼻窦炎病人骨性中鼻道宽度是否有差异。方法对90例鼻窦炎病人与30例非鼻窦炎病人测量钩突与中鼻甲的最短骨性距离。结果鼻窦炎组与非鼻窦炎组之间，中鼻道骨性宽度的差异无统计学意义（P〉0．05）。结论慢性鼻窦炎病人的钩突与中鼻甲之间的骨性距离可能并不小于其他人。     

Transnasal puncture based on echographic sinusitis evidence in mechanically ventilated patients with suspicion of nosocomial maxillary sinusitis

Objective The aim of this prospective study was to evaluate the value of sinus echography results to directly indicate a transnasal puncture in intubated patients with suspicion of nosocomial maxillary sinusitis.Design prospective clinical investigation.Setting medical intensive care unit.Patients sixty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of maxillary sinusitis with purulent nasal discharge.Interventions 120 sinuses were examined by sinus ultrasound. The image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: (1) a partial sinusogram was defined as the visualization of the hyperechogenic posterior wall of the sinus; and (2) a complete sinusogram was defined as the hyperechogenic visualization of posterior wall and the extension by the internal and external walls of the sinus. When sinus ultrasound was positive, a transnasal puncture was performed the same day. The transnasal puncture was positive if a fluid was obtained from sinus aspiration. The transnasal puncture was negative if there was no aspirated material. Measurements and results sinus ultrasound was positive in 84 cases (54 complete sinusograms and 30 partial sinusograms). Seventy-eight of 84 transnasal punctures were positive. Sensitivity of a sinusogram for obtaining positive transnasal puncture was 100%, and specificity was 86% (100% in case of complete sinusogram) in a clinically selected population. The only six negative transnasal punctures were performed in patients with partial sinusogram. Conclusions Ultrasound sinusitis evidence seems to be of value to indicate and perform a transnasal puncture directly, avoiding CT exam.     

B-mode ultrasound in the diagnosis of maxillary sinusitis in intensive care unit

Radiological maxillary sinusitis (RMS) is not an easily diagnosed in Intensive Care Unit (ICU). B-mode ultrasound of paranasal sinuses, validated for the ambulatory patients, was evaluated in a prospective study. One hundred fifty three ultrasound examinations were performed on 30 critically ill patients and compared to CT scan or radiography (Blondeau's view). Two levels of positive echographia are described: positive echographia corresponding with a moderate lesion, cupuliform echographia when the lesion is more significant. Its good predictive negative value when the echographia is negative and its predictive positive value of 100 % when the echographia is cupuliform allow to recommend B-mode ultrasound as the best investigation for the diagnosis of maxillary sinusitis in a ICU. Diagnostic ultrasound represents a rapid, painless, innocuous and easily reproducible means of monitoring. Received:21 May 1997 Accepted: 4 September 1997