Article

The Value of the Occipitomental (Waters') View in Diagnosis of Sinusitis: A Comparative Study with Computed Tomography

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Abstract

Sinus X-rays are still frequently used in the evaluation of paranasal sinusitis. Many radiology departments nowadays provide the referring doctors with a single Waters' projection. Our purpose was to evaluate the diagnostic accuracy of a single Waters' view vs high resolution computed tomography (CT) in the diagnosis of paranasal sinusitis. A total of 134 patients with suspected paranasal sinusitis underwent a Waters' view X-ray and high resolution CT on the same day. The radiographs were evaluated independently by nine experienced radiologists, who observed each sinus separately. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated for each sinus and for each observer, using the CT findings as a 'gold standard'. The weighted mean sensitivity for diagnosis of any abnormality in the maxillary sinus was 67.7%, specificity 87.6%, accuracy 78.6%, positive predictive value 82.5% and negative predictive value 76.9%. For this sinus the variation between observers was small, however, the sensitivity for diagnosis of any disease in the frontal and ethmoid sinuses varied widely between observers (range 1.9-54.0% and 0-58.9%, respectively). The sensitivity for the sphenoid sinus was very low (range 0-3.8%), even in radiographs which seemed to demonstrate it well. The Waters' view has its limits in the diagnosis of sinusitis of the maxillary sinuses and its contribution for diagnosing lesions in the remaining sinuses is very poor. Whenever access to CT is available, a low dose high-resolution CT study of the paranasal sinuses is highly recommended.Konen, E. (2000). Clinical Radiology55, 856-860.

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... Numerous studies have investigated various modalities for maxillary sinusitis but there is relatively little research on the diagnostic utility of a combination of modalities for odontogenic maxillary sinusitis (1,4,10). To our knowledge, there are no studies comparing the diagnostic accuracy of panoramic imaging, Waters' E181 projection, and a combination of the two (combination imaging) for odontogenic maxillary sinusitis. ...
... Although Waters' projection is commonly used as a screening test for maxillary sinusitis, we confirmed that the accuracy and AUC of Waters' projection are nearly the same as those of panoramic imaging (Tables I and II). These findings are consistent with those of other studies (4,10) and indicate that the accuracy of Waters' projection is equivalent to that of panoramic imaging for diagnosing maxillary sinusitis. ...
... The discrepancy in diagnostic ability between CT imaging and other plain X-ray techniques is attributable to the following three reasons. First, a clear sinus on a Waters' projection does not consistently rule out maxillary mucosal inflammatory disease (1,4,10). It is difficult to detect the opacity of the sinus floor when mucosal thickening is limited on the sinus floor because it is overlapped by the maxillary bone on the Waters' projection image (9,24). ...
Article
The purpose of this study was to evaluate the usefulness of adding Waters' projection to panoramic imaging compared with panoramic imaging or Waters' projection alone. Maxillary sinusitis in 106 patients (206 sinuses) was retrospectively assessed with panoramic imaging, Waters' projection, and computed tomography imaging by two oral radiologists. The diagnostic performance was assessed with computed tomography imaging as the gold standard. Receiver operating characteristic curves and area under the curve values were obtained. Inter- and intra-observer agreement was quantified using weighted kappa coefficients. Observer A performed the same procedure twice (A1 and A2 for the first and second observations, respectively). The accuracies of observers A1, B, and A2 with combination imaging were 0.699, 0.636, and 0.718, respectively. Their area under the curve values with combination imaging were 0.746, 0.640, and 0.771, respectively. Inter-observer agreement was good for Waters' projection (κ, 0.650), and poor for panoramic imaging (κ, 0281). Intra-observer agreement was good for Waters' projection (κ, 0.752), and moderate for panoramic imaging (κ, 0.597). Panoramic imaging was equivalent to Waters' projection for diagnosing maxillary sinusitis. Combination imaging comprising panoramic imaging and Waters' projection can contribute to the diagnosis of odontogenic maxillary sinusitis because of its high sensitivity.
... But, the view could be ineffective to reveal the degree of chronic inflammatory diseases especially for ethmoid sinuses [6]. Yet some findings such as opacification of the sphenoid sinus in mucocele, the radiographic identification is usually possible [7]. Such inconstancies emphasize the need for more detailed tomography [5][6][7]. ...
... Yet some findings such as opacification of the sphenoid sinus in mucocele, the radiographic identification is usually possible [7]. Such inconstancies emphasize the need for more detailed tomography [5][6][7]. ...
... A variety of CT scans such as conventional and/or cone beam CT techniques offer certain advantages and disadvantages even in comparison with other imaging techniques. Therefore, a primary concern to the clinician evaluating the paranasal sinuses should be conceiving an effective methodology [6][7][8]. ...
Chapter
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Paranasal sinuses located in the bones surrounding the nasal cavity are called maxillary, ethmoid, frontal and sphenoid sinus. In relation with their location this sinuses contribute to the development of the facial structures, jaws and upper airway. During the developmental process of the paranasal sinuses, anatomic variations can occur in consequence of intra and extramural migration of the ethmoid air cells, overpneumatization or hypoplasia of the sinuses and bulging of the neurovascular structures to the sinuses. Some of these anatomic variations may affect the drainage patways, pave the way for chronic infections and cause difficulties when performing paranasal sinuses surgery. Therefore the aim of this chapter was to examine the paranasal sinus anatomic variations with CBCT.
... (R. Zojaji). tool for this purpose [5] but its sensitivity and specificity are relatively low in comparison to conventional CT-scan [5] although an agreement of 75.3% has been reported between conventional radiography and CT-scan findings [6]. ...
... (R. Zojaji). tool for this purpose [5] but its sensitivity and specificity are relatively low in comparison to conventional CT-scan [5] although an agreement of 75.3% has been reported between conventional radiography and CT-scan findings [6]. ...
... Conventional CT-scan has high sensitivity and specificity in the diagnosis of CRS [5,7] but its application is limited by its high price and considerable radiation exposure compared to plain radiographs [5,7]. ...
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La rhinosinusite chronique (RSC) est une maladie chronique répandue dans le monde. La tomodensitométrie standard est la méthode de choix pour le diagnostic de la RSC, mais son prix élevé et l’importance de l’exposition aux radiations limitent son utilisation. Le principal objectif de cette étude était d’évaluer la précision de la tomodensitométrie limitée à 4 coupes dans le diagnostic de la RSC.
... (R. Zojaji). tool for this purpose [5] but its sensitivity and specificity are relatively low in comparison to conventional CT-scan [5] although an agreement of 75.3% has been reported between conventional radiography and CT-scan findings [6]. ...
... (R. Zojaji). tool for this purpose [5] but its sensitivity and specificity are relatively low in comparison to conventional CT-scan [5] although an agreement of 75.3% has been reported between conventional radiography and CT-scan findings [6]. ...
... Conventional CT-scan has high sensitivity and specificity in the diagnosis of CRS [5,7] but its application is limited by its high price and considerable radiation exposure compared to plain radiographs [5,7]. ...
Article
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Chronic rhinosinusitis (CRS) is a common chronic health condition worldwide. Standard CT-scan is the method of choice for diagnosis of CRS but its high price and considerable radiation exposure have limited its application. The main goal of this study was to evaluate the accuracy of limited four-slice coronal CT-scan in the diagnosis of CRS. This cross-sectional study was conducted on 46 patients with CRS, for one year, based on American Society of Head and Neck Surgery criteria. All patients received the preoperative standard and four-slice CT-scans, after which endoscopic sinus surgery was performed. Findings of four-slice CT-scans were compared with those of conventional CT-scan and the sensitivity and specificity of four-slice CT-scan and its agreement with conventional CT-scan was calculated. In this study, 46 patients including 32 males (69.6%) and 14 females (30.46%) with a mean age of 33 and standard deviation of 9 years, were evaluated. Sensitivity and specificity of four-slice CT-scan were 97.5% and 100%, respectively. Also, positive predictive value (PPV) and negative predictive value (NPV) of four-slice CT was 100% and 85.71%, respectively. There was a strong agreement between four-slice CT and conventional CT findings. Considering the high sensitivity and specificity of four-slice CT-scan and strong agreement with conventional CT-scan in the diagnosis of CRS and the lower radiation exposure and cost, application of this method is suggested for both diagnosis and treatment follow-up in CRS. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
... The maxillary sinuses can often be observed on conventional dental radiographs such as periapical radiographs, upper occlusal radiographs, and orthopantomograms (OPTGs) as well as cranial imaging techniques such as Water's, Caldwell, lateral sinus, and submentovertex radiographs. However, it is not possible to reveal small changes or examine the maxillary sinuses in depth with these methods [1]. ...
Chapter
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Oral and maxillofacial surgical procedures, such as tooth extractions, surgical treatment of odontogenic maxillary sinus pathologies, dental implant surgery, orthognathic surgery, and sinus lift procedures, often correlate with the maxillary sinuses, due to anatomical proximity. For instance, in Le Fort I osteotomy, which is the predominant surgical technique preferred for the treatment of dentofacial deformities of the maxilla, the osteotomy line includes maxillary sinus and nasal walls. Maxillary sinus-lifting surgery is performed to regenerate bone in the posterior maxilla for dental implant placement. Additionally, maxillary sinus pathologies of odontogenic origin, such as sinusitis, cysts, and neoplasms, can impact the oral and maxillofacial region, and surgical intervention may be required to manage these conditions. Proper diagnosis, treatment planning, and surgical techniques are essential to optimize patient outcomes and minimize complications related to the maxillary sinuses in oral and maxillofacial surgical procedures.
... Localisation of the tooth before surgical removal is often necessary. CT scans are reported (11) to the goal standard in this role . Combinations of panoramic x-rays and lateral cephalometric x-rays have ( 2) also been used successfully for this role in literature . ...
Article
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Ectopic eruption of teeth into the maxillary sinus is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, osteomeatal complex and halitosis. However most cases are asymptomatic and are only discovered by chance especially through panoramic A case of a 29 year old female who presented with a 5 year history of chronic sinusitis and halitosis radiography who had done several periapical x-rays and had used various antibiotics to no effect. An ectopic tooth was discovered through an OPG and with removal of the tooth all symptoms subsided.
... The diagnostic sensitivity of the paranasal sinus view is very low due to the opacification of the bone by overlapping with some anatomical structures [5]. Waters' view has its limitations in the diagnosis of sinusitis of the maxillary sinuses and its contribution to the diagnosis of lesions in the other maxillary sinuses is very poor [6]. Therefore, CT of the paranasal sinuses has become the gold standard for sinus imaging in complicated sinus disease [4]. ...
Article
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Computed tomography (CT) is undoubtedly the most reliable and the only method for accurate diagnosis of sinusitis, while X-ray has long been used as the first imaging technique for early detection of sinusitis symptoms. More importantly, radiography plays a key role in determining whether or not a CT examination should be performed for further evaluation. In order to simplify the diagnostic process of paranasal sinus view and moreover to avoid the use of CT scans which have disadvantages such as high radiation dose, high cost, and high time consumption, this paper proposed a multi-view CNN able to faithfully estimate the severity of sinusitis. In this study, a multi-view convolutional neural network (CNN) is proposed which is able to accurately estimate the severity of sinusitis by analyzing only radiographs consisting of Waters’ view and Caldwell’s view without the aid of CT scans. The proposed network is designed as a cascaded architecture, and can simultaneously provide decisions for maxillary sinus localization and sinusitis classification. We obtained an average area under the curve (AUC) of 0.722 for maxillary sinusitis classification, and an AUC of 0.750 and 0.700 for the left and right maxillary sinusitis, respectively, using the proposed network.
... 6,8,9 Bu nedenle özellikle sinüs cerrahisi düşünülen hastalarda Water's projeksiyonunun yerine düşük radyasyon dozuyla alınan Bilgisayarlı Tomografi (BT) veya Konik Işınlı Bilgisayarlı Tomografinin (KIBT) kullanılması gerekmektedir. 10 Lateral grafiler maksiller sinüsün kemik çevrelerini gösterir. Lateral görünümde zigomatik girintinin ön ve arka duvarları maksiller sinüs üzerine süperpoze olmuş V şeklinde görüntü ile karakterizedir. ...
Article
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Maxillary sinuses, the largest of the paranasal sinuses, are pyramid-shaped cavities that are bilaterally localized within the maxillary bone. The base wall of this pyramid, towards the zygomatic process, is the lateral wall of the nasal cavity. They are closely related to nasal cavity, upper airway and jawface development to know the normal volume, anatomy and variations of the maxillary sinuses is very important for implant applications in the maxilla posterior region. In this review, maxillary sinus imaging methods and pathologies and image evaluations in maxillary sinuses are discussed.
... Anatomik varyasyonlar, osteomeatal üniteler ve tümöral patolojilerde direkt grafinin tanısal değerinin düşük olması sebebiyle ek görüntüleme yöntemlerine başvurmak gerekmektedir. Bu amaçla ilk tercih edilecek yöntem ise Bilgisayarlı Tomografi (BT)'dir (3) . Özellikle 80'li yılların başından itibaren BT tekniğindeki hızlı gelişmeler sayesinde çekim sürelerinin kısalması, ince kesit taramaların yapılabilmesi, bu sayede multiplanar reformat görüntüler elde edilebilmesi ve en önemlisi düşük doz görüntüleme yapılabilmesi sebepleriyle, PNS ve nazal kavite görüntülemesinde BT, Direkt radyogramın yavaş yavaş yerini almaya başlamıştır. ...
Chapter
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Burun ve paranazal sinüslerin (PNS) görüntülemesinde radyolojik yöntemlerden ultrasonografi, direkt grafi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme kullanılmaktadır. Bu görüntüleme yöntemlerinin her biri farklı tanısal özelliklerine bağlı olarak farklı hastalık gruplarında ön plana çıkmaktadır. Farklı endikasyonlarda uygun görüntüleme yönteminin belirlenmesi, gereksiz tetkiklerin önlenmesi açısından olduğu kadar, erken tanı ve tedaviye olanak sağlaması açısından önem arz etmektedir. Bu bölümde, görüntü özellikleri tanımlanarak radyolojinin hastalıkları tanımlamada nasıl yardımcı olduğu anlatılmıştır.
... According to the current guidelines, it is mandatory before functional endoscopic sinus surgery (FESS) to visualize individual anatomic variants and the extension of the disease [8]. The computed tomography (CT) scan of the paranasal sinuses have superseded the conventional standard radiography as it offers more precise anatomic information to the surgeon on the complex anatomy of the sinus cavities and their drainage pathways, in particularly the ostiomeatal complex [9,10]. To adhere to the ALARA principle ("as low as reasonably achievable") different approaches to lower radiation exposure in parasinus CT have been proposed like low kV scanning and spectral shaping [11,12]. ...
Article
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Besides X-ray and fluoroscopy, a previously introduced X-ray scanner offers a 3D cone beam option (Multitom Rax, Siemens Healthcare). The aim of this study was to evaluate various scan parameters and post-processing steps to optimize image quality and radiation exposure for imaging of the parasinus region. Four human cadaver heads were examined with different tube voltages (90–121 kV), dose levels (DLs) (278–2180 nGy) and pre-filtration methods (none, Cu 0.2 mm, Cu 0.3 mm and Sn 0.4 mm). All images were reconstructed in 2 mm slice thickness with and without a metal artifact reduction algorithm in three different kernels. In total, 80 different scan protocols and 480 datasets were evaluated. Image quality was rated on a 5-point Likert scale. Radiation exposure (mean computed tomography volume index (CTDIvol) and effective dose) was calculated for each scan. The most dose-effective combination for the diagnosis of sinusitis was 121 kV/DL of 278/0.3 mm copper (CTDIvol 1.70 mGy, effective dose 77 µSv). Scan protocols with 121 kV/DL1090/0.3 mm copper were rated sufficient for preoperative sinus surgery planning (CTDIvol 4.66 mGy, effective dose 212 µSv). Therefore, sinusitis and preoperative sinus surgery planning can be performed in diagnostic image quality at low radiation dose levels with a multipurpose X-ray system.
... respectively while the sensitivity for the sphenoid sinus was very low ranging from 0-3.8%. 8 In our study, the sensitivity for detection of sinusitis on PNS radiograph was highest for maxillary sinus (89.2%), followed by ethmoid(69.7%) and frontal sinus (61.5%) while it was least for sphenoid sinus (41.1%). ...
Article
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Introduction: Radiography of the paranasal sinuses is commonly used diagnostic modality. However, the trustworthiness of plain radiographic findings of paranasal sinuses is debatable. The intention of this study was to weigh the diagnostic soundness of plain radiograph of the paranasal sinuses to that of computed tomogram scan. Methods: This is a descriptive cross sectional study carried out in 110 participants in Department of Radiology of Gandaki Medical College from November 2017 to April 2018. Ethical approval is obtained from Institution review board (Ref. No.39/074/075). Sample size was calculated taking confidence level of 95%, expected prevalence of 14% and precision of 6.5% in population of 492098 in Province 4 of Nepal. Random sampling method was used. Data was enter in Statistical Package for the Social Sciences version 17 software and analysed. Results: A total of 110 participants are included in this study of which 62 (56.4%) are females and 48 (43.6%) are males with an overall mean age of 34.5 years. The commonly involved sinus was maxillary 56 (50.9%) followed by ethmoid 33 (30%) sinus. The overall sensitivity and specificity of detecting sinusitis by sinus radiography is higher for maxillary sinus (89.7% and 87%) followed by ethmoid (69.7% and 96.1%) and frontal (61.5% and 96.9%) sinuses. Conclusions: Sinus radiography is more sensitive for detecting pathologies in maxillary sinuses, while it is moderate for frontal, ethmoid sinuses and least for sphenoid sinuses. Diagnostic accuracy of computed tomogram scan is more, hence should be recommended to characterize the complex pathology and anatomy of the osteomeatal complex.
... The appropriate modality for radiography imaging might either be plain radiography (X-Ray) or computed tomography (CT). The coronal sinus CT (SCT) provides the gold standard for diagnosing maxillary sinusitis because of its superiority in image quality compared to the occipitomental-view X-Ray (SXR) [3] that often suffers from texture ambiguities caused by the overlapping structures or because of low contrast ratio [4]. ...
Article
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Maxillary sinuses are the most prevalent locations for paranasal infections on both children and adults. Common diagnostic material for this particular disease is through the screening of occipitomental-view skull radiography (SXR). With the growing cases on paranasal infections, expediting the diagnosis has become an important innovation aspect that could be addressed through the development of a computer-aided diagnosis system. As the preliminary stage of the development, an automatic segmentation over the maxillary sinuses is required to be developed. This study presents a computer-aided detection (CAD) module that segments maxillary sinuses from a plain SXR that has been preprocessed through the novel texture-based morphological analysis (ToMA). Later, the network model from the Transferable Fully Convolutional Network (T-FCN) performs pixel-wise segmentation of the maxillary sinuses. T-FCN is designed to be trained with multiple learning stages, which enables re-utilization of network weights to be adjusted based on newer dataset. According to the experiments, the proposed system achieved segmentation accuracy at 85.70%, with 50% faster learning time.
... Occipito-mental view is most favorable to know the maxillary sinus diseases ( Fig. 3.9). Change in radio-opacities in maxillary sinus determines extent and severity of maxillary sinus pathology [22]. It is moreover useful to know the extent and severity of pathology and trauma involving orbit, coronoid process, and zygoma. ...
Chapter
In the context of oral diseases, the diagnosis essentially consists of an analysis of clinical case history and evaluation of diagnostic records complemented by the results of relevant investigations so as to confirm the presence of disease, identification of its type and the cause of its initiation. Oral imaging plays an integral and vital role in the assessment of oral diseases, thereby facilitating treatment planning. Newer imaging techniques have progressed beyond the confines of conventional radiological techniques to encompass even the non-radiological techniques in its ambit. Modern imaging techniques have been able to bring in speed, detail and precision at the same time to bring in a paradigm shift in oral care.
... In another study undertaken by Konen et al. 18 a high resolution CT was used as a reference and compared with a solitary waters' view for the diagnosis of paranasal sinusitis. In their research, a total of 134 patients participated. ...
... However, the Water view has also been shown to have a 32% false-negative rate and a 49.2% false-positive rate as compared to CT. In addition, most of the abnormalities in the ethmoid and sphenoid sinuses are not detected on the Water view [64]. The Caldwell and Water projections have also been shown to be limited in the detection of ethmoid disease [54]. ...
Article
Sinusitis is common in children that usually resolves spontaneously. Imaging is not part of the standard of care for initial diagnosis, however may be necessary in cases with persistent or chronic sinusitis to guide surgical intervention, or to rule out intracranial and vascular complications of sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the leading imaging modalities. In this article, appropriateness in use of imaging modalities are discussed under common/clinically relevant scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
... For many years, conventional X-rays, like panoramic and Water`s radiography, have been used to investigate the paranasal sinuses 3 . However, 2D radiographic images are difficult to interpret because of the overlapping of ostiomeatal complex and osseous structure 8,9 . Generally, they are efficient to display the regional morphology, character- ize the extent and localization of disease and describe anatomical variants of paranasal sinuses 10 ; however, radiographic images allows limited value in the diagnosis of maxillary sinusitis and is less sensitive for detecting abnormalities in other sinuses 3 . ...
Article
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Image methods such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT) are powerful tools to help clinicians on diagnosis and preoperative planning. They provide an accurate view of regional anatomy, anatomical variations and the presence of diseases. Compared to CT, CBCT produces images with adequate spatial resolution with smaller fields of view at lower radiation doses. It has emerged as a potential alternative for obtaining 3D evaluation of the paranasal sinus at relatively modest costs. The aim of this review was to verify whether CBCT images offer an additional value to the evaluation of paranasal sinus.
... Various studies reported the sensitivity and specificity of the X-ray PNS in diagnosing sinusitis, which ranges from 41%-95% and 30%-85%, respectively [12][13][14][15]. But the diagnostic ability of the X-ray PNS with respect to individual sinuses was not studied. ...
Article
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Introduction Thermography is a form of radiography that images the skin surface temperature. Thermograms are pictorial representations of thermal maps of the entire body’s outer surface. Thermography was applied as an attempt to evaluate its usefulness in the diagnosis of chronic sinusitis (CS). Hence, this study was done to determine the diagnostic value of thermography for patients suffering from CS. Methodology Patients attending the Department of Otorhinolaryngology and Head and Neck Surgery over a two years' duration with symptoms suggestive of CS were included in this diagnostic evaluation study. X-ray paranasal sinuses (PNS) and nose, thermography of head and neck, and computed tomography (CT) of PNS and nose (axial and coronal sections) were performed on them. The thermograms and X-ray sinuses obtained were compared with the computed tomography of PNS findings. Results The study population consisted of 167 patients (75 males and 92 females) and the mean age of the study population was 38.6 years. The sensitivity and specificity of thermography of the head and neck in diagnosing frontal, ethmoidal, maxillary, and sphenoidal sinusitis were 92.59% and 68.58%, 100% and 66.32%, 70.06% and 85.88%, 99.18% and 0%, respectively. Whereas the sensitivity and specificity of the X-ray PNS and nose in diagnosing frontal, ethmoidal, maxillary, and sphenoidal sinusitis were 92.59% and 77.88%, 73.61% and 81.05%, 89.19% and 98.92%, 74.44% and 99.18%, respectively. Conclusion Thermography is better than X-rays in diagnosing frontal and ethmoidal sinusitis and as good as X-ray PNS and nose in diagnosing maxillary sinusitis. Thermography failed to pick up sphenoidal sinusitis. The advantages of thermography are that it is a radiation-free, non-invasive, and cost-effective method for diagnosing CS.
... When compared with the existing imaging techniques such as Computed tomography and Plain radiography; NIR sensors differentiate normal, acute and chronic sinus disease with variation in air-fluid level, partial or complete opacification. 21,22 Near infrared sensing technique have numerous benefits. NIR sensing device can be used as a bedside monitoring device or at the clinical settings to readily diagnose the existence and severity of the device and to reduce the adverse effects of prescribing antibiotics in an inappropriate manner. ...
Article
p class="abstract"> Background: Sinusitis is a chronic infection or inflammation which affects the paranasal sinus cavities and the associated nasal cavities. As the symptoms of sinusitis greatly resemble upper respiratory infections, diagnosing sinusitis clinically is a major issue. Though imaging techniques serves as a standard in confirming the diagnosis of chronic sinusitis, the availability at the primary care settings, affordability and diagnosing acute cases calls upon an alternative technique in practice. Recent researches confirming the diagnosis of sinusitis using Near-infrared imaging gives us hope in taking up the research using optical sensing. The objective of the study was to successfully diagnose sinusitis using NIR-LED optical sensor and to signal process the data obtained from the patients using Dyadic Wavelet Transform (DyWT) to confirm and to validate diagnosis using regression analysis. The study also correlates the plain radiographic findings with the NIR device sensing to make the device feasible. Methods: This was a one year pilot study (June 2014–May 2015) conducted with forty patients suspected of sinusitis and with clinical history along with ten healthy individuals as controls. Results: Patients age ranged from 18-65 years were included in the study. Results from NIR sensing device well correlate with the radiographic examination of the registered candidates. The regression result perfectly matches with the dyadic wavelet results of the patients, confirming the diagnosing of sinusitis using near- infrared sensor. Radiographic examination well correlates with the results from the NIR diagnostic device providing a valuable evidence of the hardware. Conclusions: NIR-LED sensor device can provide qualitative evidence in differentiating the mild and severe patients based on air-fluid level present in the sinus. The results strongly recommend that NIR sensing device can be a best alternative in case of frequently sinus affected patients and for the unaffordable patients without the risk of radiation.</p
... Likewise, in Cho and Jung's research [18] there is no definition of pathology inclusion criteria. Cerrah et al. [22] and Konen et al. [23] studies, which had higher frequencies, are researches performed in otolaryngology clinics including patients with sinonasal complaints. Mucosal thickening was the most common sinus pathology in our study and our results are concordant with other works [11,13,21]. ...
Article
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Introduction: Although obstruction of osteomeatal area was not accepted as an important factor in the pathogenesis of sinus infections for years, recent studies point out the importance of this area. For the maintenance of normal functions of paranasal sinuses, ventilation and drainage of this area is necessary. The purpose of this study was to determine the effect of anomalies of the osteomeatal area on sinus diseases. Methods: This study included cone beam computed tomography scans of 200 patients. Osteomeatal area anomalies were classified as concha bullosa, septal deviation, paradox middle concha, deviation of uncinate process, uncinate bulla, Haller cells and Agger nasi cells. Ethmoid infundibulum and presence of sinus pathologies were recorded. Results: Pathologies were not determined in 243 (60.8%) of the evaluated 400 sinuses while detected in 157 (39.3%) sinuses. Pathologies were found to be more frequent in males than females (p<0.05). Sinus diseases were more prevalent in patients with an obstructed ethmoid infundibulum (p<0.05). Septum deviation was found in 64.5%, concha bullosa in 47%, Haller cells in 17%, paradox middle concha in 8%, deviation of uncinate process in 5.5%, over pneumatisation of agger nasi in 5%, and uncinate bulla in 5% of the investigated patients. Although we found a statistically significant link between ethmoid infundibulum clarity and pathology presence; there was no statistically significant relationship between sinus pathologies and evaluated anomalies. Conclusion: Although we found no relationship between these anomalies and sinus diseases, further studies including the dimensions of the osteomeatal area anomalies will be helpful to determine the effect of these anomalies on sinus diseases.
... They are therefore not recommended by the major societies [7], [8]. In a pro-spective study of 134 patients who underwent CR and computed tomography (CT) examinations of the paranasal sinuses on the same day, Konen et al. found CR to be inferior to CT in diagnostic accuracy [9]. The sensitivity of CR for the detection of inflammatory changes of the maxillary sinus was 67.7%, but only 14.6% and 3.8% for the ethmoid and sphenoid sinus, respectively, compared to low-dose CT (ldCT) (Figure 1). ...
Article
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A variety of imaging techniques are available for imaging the midface and orbits. This review article describes the different imaging techniques based on the recent literature and discusses their impact on clinical routine imaging. Imaging protocols are presented for different diseases and the different imaging modalities.
... Water's view) radiograph can single-handedly be an essential diagnosis material under few limitations. Konen et al. [7] specified those limitations as image ambiguities caused by the overlapping bone structures on sinuses and the low image contrasts. Prior to [6], Hussein et al. [8] also found that single Waters' view might be utilized with foremost image quality (i.e. ...
Article
This paper aims to present an algorithm that specifically enhances maxillary sinuses using a novel contrast enhancement technique based on the adaptive morphological texture analysis for occipitomental view radiographs. First, the skull X-ray (SXR) is decomposed into rotational blocks (RBs). Second, each RB is rotated into various directions and processed using morphological kernels to obtain the dark and bright features. Third, a gradient-based block segmentation decomposes the interpolated feature maps into feature blocks (FBs). Finally, the histograms of FBs are equalized and overlaid locally to the input SXR. The performance of the proposed method was evaluated on an independent dataset, which comprises of 145 occipitomental view-based human SXR images. According to the experimental results, the proposed method is able to increase the diagnosis accuracy by 83.45% compared with the computed tomography modality as the gold standard.
... In definitive, this and other studies show that the diagnostic performances of Waters' projection are able to maintain a role for radiography in the diagnosis. On the other hand, magnetic resonance imaging provides data in three dimensions, offering very valuable information in doubtful cases, being especially useful for viewing ethmoidal and sphenoidal sinuses [9][10][11][12][13]. ...
Article
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Here, we present a review of the development of paranasal sinuses and pathologies associated to them, allergic and/or infectious sinusitis, in children. A review of 200 medical records of children and adolescents affected with respiratory disease is carried out. 66 patients (33%) were diagnosed with sinusitis, six of which did not present any other respiratory processes. Of the remainder, association with rhinitis, asthma, or wheezy bronchitis, and one case with immune deficiency, was found. Other associated pathologies, such as cystic fibrosis, bronchiectasis, and other processes described as associated with sinusitis, were not detected in any case.
... duża grupa (20%) zdjęć niediagnostycznych, zarówno tych nieostrych ruchowo, jak i niejednoznacznych z uwagi na początkowy okres rozwoju zatok, była powodem braku możliwości udzielenia pewnej odpowiedzi na stawiane przez klinicystów pytania. Podkreślić należy, że w wieloośrodkowych badaniach potwierdzono, że czułość zdjęć rtg zatok jest niska i sięga do 67,7%, zaś ich swoistość -87,6%; wartość predykcyjna wyniku dodatniego wynosi 82,5%, a negatywna -76,9% [10,11]. ...
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The paranasal sinus X-ray is often an essential diagnostic tool in acute and chronic sinusitis in children. It is also performed to look for outbreaks of infection. Such proceeding is justified only in selected clinical situations. In many cases it should be replaced by CT with regard to the ALARA principles. Objectives. The aim of the study was to analyze the X-rays and CT scans of paranasal sinuses, the relevance of their implementation and their diagnostic value. Material and methods. The analysis included 2030 X-rays and 120 CT scans of paranasal sinuses performed in patients between 1-18 years of age from July 2009 to July 2012. Results. 25% of the X-rays were performed in children younger than 6 years of age, including 1 in 5 rated as nondiagnostic: blurred (movement) or shaded due to lack of aeration of the sinuses because of the initial stage of development. In 776 patients the paranasal X-rays were performed to search for infection source. In this group 22% of radiographs were normal. The use of CT was limited to the preoperative indications in chronic sinusitis or in the search of orbital or intracranial complications of sinusitis. Conclusions. Low diagnostic value of sinus radiographs particularly among children below 6 years of age, overuse of indications to perform them, lack of knowledge of the exposure to ionizing radiation, with ever growing possibilities of using CT with reduced mAs (low dose) leads to a discussion about the modification of algorithms for diagnostic imaging procedure in sinusitis in children.
... 1 However, a study performing Waters' view radiography, and high resolution CT, in the same day in 134 patients, and using CT fi ndings as the gold standard, plain radiography had a sensitivity of 68% and a specifi city of 87% and in a survey on 91 children with clinically signifi cant chronic sinusitis, a sensitivity and a specifi city against CT of 76% and 81%, respectively, were observed; and was suggested as the fi rst step to achieve a diagnosis by imaging in subjects with clinical symptoms suggesting CRS. 53 However, it has to be noted that plain radiography is inadequate to assess the anterior ethmoid, and the infundibular, middle meatus and frontal recess air passages. 54 Computed tomography scanning is considered the gold standard of CRS diagnosis by imaging, because it provides superior resolution of bone and soft tissue and removes superimposed overlapping structures that are present in conventional radiography. ...
... They are therefore not recommended by the major societies [7], [8]. In a pro-spective study of 134 patients who underwent CR and computed tomography (CT) examinations of the paranasal sinuses on the same day, Konen et al. found CR to be inferior to CT in diagnostic accuracy [9]. The sensitivity of CR for the detection of inflammatory changes of the maxillary sinus was 67.7%, but only 14.6% and 3.8% for the ethmoid and sphenoid sinus, respectively, compared to low-dose CT (ldCT) (Figure 1). ...
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A variety of imaging techniques are available for imaging the midface and orbits. This review article describes the different imaging techniques based on the recent literature and discusses their impact on clinical routine imaging. Imaging protocols are presented for different diseases and the different imaging modalities. © Georg Thieme Verlag KG Stuttgart · New York.
... Axial and coronal views also allow visualizing periapical odontogenic abscess close to the sinus floor defect and diseased sinus tissue. CT should be preferred when clinical findings strongly suggest sinusitis but direct X-rays fails to detect sinusitis [19]. ...
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Intelligent systems’ capabilities have noticeably improved in image analyzing and learning the visual patterns. Integration of such progressions with recent advancements in diagnostic imaging techniques (i.e., panoramic radiography, computed tomography (CT), cone beam computed tomography (CBCT), surface scanners, and digital photographs) has significantly increased the artificial intelligence (AI) entrance opportunity into the field of oral and maxillofacial surgery. Today, various models have been designed to assist clinicians with an early and accurate diagnosis of the lesions. These models can predict the need for surgery as well as surgical outcomes and prognostic factors. By adding up the visual data with the omics, intelligent architectures would be able to create customized surgical and treatment plans. The objectivity of these plans increases the interventions’ consistency. In this chapter, first, we will discuss the recent advances in artificial intelligence applications in medicine generally. The further sections will explain the AI entrance in the field of dentistry and, more extensively, oral and maxillofacial surgery.KeywordsArtificial intelligenceMachine learningDeep learningDentistryMaxillofacial surgeryDiagnosisOrthognathic surgeryCosmetic surgeryCraniofacial surgery
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Objectives To clarify the performance of transfer learning with a small number of Waters’ images at institution B in diagnosing maxillary sinusitis, based on a source model trained with a large number of panoramic radiographs at institution A.Methods The source model was created by a 200-epoch training process with 800 training and 60 validation datasets of panoramic radiographs at institution A using VGG-16. One hundred and eighty Waters’ and 180 panoramic image patches with or without maxillary sinusitis at institution B were enrolled in this study, and were arbitrarily assigned to 120 training, 20 validation, and 40 test datasets, respectively. Transfer learning of 200 epochs was performed using the training and validation datasets of Waters’ images based on the source model, and the target model was obtained. The test Waters’ images were applied to the source and target models, and the performance of each model was evaluated. Transfer learning with panoramic radiographs and evaluation by two radiologists were undertaken and compared. The evaluation was based on the area of receiver-operating characteristic curves (AUC).ResultsWhen using Waters' images as the test dataset, the AUCs of the source model, target model, and radiologists were 0.780, 0.830, and 0.806, respectively. There were no significant differences between these models and the radiologists, whereas the target model performed better than the source model. For panoramic radiographs, AUCs were 0.863, 0.863, and 0.808, respectively, with no significant differences.Conclusions This study performed transfer learning using a small number of Waters’ images, based on a source model created solely from panoramic radiographs, resulting in a performance improvement to 0.830 in diagnosing maxillary sinusitis, which was equivalent to that of radiologists. Transfer learning is considered a useful method to improve diagnostic performance.
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Flexible rhinolaryngoscopy is an underutilized procedure that can provide allergists-immunologists and other physicians with several benefits over existing imaging techniques. In this article, we highlight the many benefits of flexible rhinolaryngoscopy and expand on its safety, cost-effectiveness, and convenience. This article also covers current procedure techniques and assesses the most common indications and relevant clinical findings for which flexible rhinolaryngoscopy can be used to evaluate the nasopharyngeal tract. Videos for the clinician on some of the most common findings are included.
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Description of the Problem: The risk of osteoporosis and fractures is considerably higher in middle-aged postmenopausal women. Osteoporosis creates a significant burden of morbidity and mortality worldwide and has recently become a significant public health problem. In postmenopausal women, the amount of estrogen in the body is significantly reduced. This situation; can lead to significant health problems, such as a decrease in bone mineral density, increase in abdominal fat and fracture risk, and deterioration in psychological status. Aim: The aim of this review is to pay attention to the point that pilates exercises are an effective approach to prevent osteoporosis and improve general health status in postmenopausal women. Theoretical Framework: Adequate intake of calcium, vitamin D and protein, quitting alcohol and smoking, and various exercise approaches can reduce the prevalence of osteoporosis and fracture risk in women. Therefore, developing programs that promote lifestyle changes in postmenopausal women is necessary to reduce the risk of osteoporosis. Pilates is a combination of exercises that focus on lumbopelvic stabilization and the deep muscles of the trunk, creating a complete connection between mind and body. Pilates exercises performed under expert supervision are recommended for all individuals regardless of physical condition, age or gender. Studies have reported that pilates improves various health parameters, such as pain, muscle strength, balance, body composition, lipid profile, blood glucose level, functional status and quality of life in postmenopausal women. Conclusion: Pilates is considered an effective and safe method for postmenopausal women, especially as it improves balance and reduces the fear of falling.
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Aim: Today, chronic pain is a universal problem in societies in terms of severe deterioration of the psychosocial status and functionality of individuals. The aim of this study is to determine the relationship between the pain beliefs of individuals with chronic diseases and their level of adaptation to the disease. Methods: The research was conducted in descriptive and cross-sectional type. The sample of the study consisted of 71 individuals with chronic diseases between 01.09.2021 and 15.09.2021. An online survey form was prepared to collect the data. Data were collected using the personal information form, the Pain Beliefs Scale, and the Chronic Disease Adaptatıon Assessment Scale. Ethics committee approval was obtained to conduct the study. In the evaluation of the data; means, percentile distributions and Pearson correlation analyzes were used. Results: While the level of assessment of adaptation to the disease of individuals with chronic disease (69.70±7.02) was found to be above the moderate level, it was determined that it was at a moderate level in psychological beliefs (3.11±1.47) and organic beliefs (4.19±0.78). Conclusion: It was determined that there was no significant relationship between the levels of adaptation to the disease and organic and pain beliefs of individuals with chronic disease. It can be recommended that this study be performed with different patient groups. Key words: Belief, chronic. pain, patient
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Description of the problem: Orthorexia Nervosa (ON) is a condition that is also known as 'healthy eating obsession', but has not yet been accepted as a pathology with international diagnostic and treatment criteria. It is important to have information about the diagnosis and treatment strategies of Orthorexia Nervosa in the light of the recently published literature data and to interpret the obtained data correctly. Objective: In this review study, it is aimed to evaluate the current literature on Orthorexia Nervosa. Theoretical framework: It has been reported that individuals with Orthorexia Nervosa generally pay attention to being "healthy and natural" rather than the amount of food, spend more than 3 hours a day for healthy nutrition, and energy and some macro and micronutrient deficiencies can be seen. In addition, it cannot be said that ON only causes medical complications. When they adapt their lives according to the strict dietary rules they set, deterioration in their social relations can also be observed. It has been reported that they may develop prejudices against the eating habits of others and prefer not to eat with them. Loneliness and social isolation are the most common symptoms. However, it should be noted that these diagnostic criteria were created only by certain researchers and have not yet been approved by the American Psychiatric Association. Conclusion: When the current literature is examined, it is seen that the number of studies on Orthorexia Nervosa is quite high. Orthorexia Nervosa has not yet been defined as a separate eating disorder. However, studies show that it shows different symptoms from other eating disorders and that it is a separate eating disorder. More clinical studies are needed to fully and accurately determine the diagnostic criteria and to develop treatment methods, and highsensitivity measurement tools are needed to diagnose Orthorexia Nervosa.
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Background . Sinonasal diseases are widespread in childhood. Radiological studies, including computer tomography, are an optimal and effective method of diagnosis. The child's body is more sensitive to radiation exposure than adults. The threshold of exposure, which may induce internal organs injury in children, requires a precise selection of the radiological method with minimal radiation dose. There is currently no unified position in the professional community on the appropriateness of the use of ultra-low-dose computed tomography in pediatrics. We reviewed the data on the appropriateness and effectiveness of paranasal low-dose computed tomography in pediatrics. Materials . 57 domestic and foreign publications, for the period from January 2001 to November 2019. In order to achieve the objective, we analyzed relevant domestic and foreign publications in scientific libraries e-LIBRARY, PubMed, Google Scholar per the keywords: “low-dose CT”, “children”, “paranasal sinus”, “pediatric”, “diagnosis”, “children”, “low-dose computed tomography”, “sinusitis”, “paranasal sinuses”. Results . The analysis of the available literature allowed summarizing the current data on pediatric paranasal disease diagnostics and the use of computed tomography, as well as to identify possible options for reducing radiation dose. Conclusions . Conducting many radiological examinations in a child leads to the risk of cancer. However, these examinations are an effective way to diagnose paranasal diseases, and a CT scan is the “gold standard”. The actual task is to develop a CT technique with reduced radiation exposure without compromising image quality. The need to review and optimize the standard protocols of radiological studies to determine the efficacy and feasibility of studies with minimal radiation exposure to children is justified.
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Background and Objective: Now-a-days computed tomography (CT) has become the investigation of choice for the diagnosis of the paranasal sinuses (PNS) pathologies. This study was designed with an aim to determine the role of computed tomography in classification the spectrum of PNS pathologies in Saudi patients. Materials and Methods: A total of 100 PNS CT patients were prospectively examined during the period extending from October 2018 to October 2019. A 128 detector CT scanner (Workstation Intellispace ISP; Philips, Netherlands), was applied to investigate patients with suspected PNS abnormalities at Radiology and Medical Imaging Department at King Khalid Hospital and Prince Sultan Center for Health Services in Al-Kharj, Saudi Arabia. Results: Out of the 100 patients – 56% males and 44% females with male to female ratio of 1.3:1 – Maxillary sinuses were the most sinuses that affected by sinusitis (68%) and the frontal sinuses was the last one (30%). The most common pathology seen was sinusitis in 79% cases. Atrophy, polyp and hypoplastic disease were detected in (1%) of cases. Most common anatomical variations were closed osteomeatal complex (86%), inferior nasal turbinates muscle hypertrophy (54%) and deviated nasal septum (83%). Conclusion: The CT was able to characterize the PNS diseases along with their extension. The most common pathology was sinusitis with 68, 55, 35 and 30% in the maxillary, ethmoid, sphenoid and frontal sinuses, respectively. Most common anatomical variant seen was nasal septum defect while the most commonly sinus involved was maxillary. It proves the better sensitivity (98.04%), specificity (80%) and accuracy (97.02%) of CT in the evaluation of various sinonasal pathologies.
Chapter
Each new imaging modality developed within the last 30 years in sinonasal imaging has reduced the functionality of the previous one and provided comparatively more valuable guidance for clinicians. Presently, x-rays, which were used for a wide range of applications in the past, have been largely replaced by computed tomography (CT). CT has become an easily accessible, an easily and quickly applicable, and a widely used diagnostic tool for nose and paranasal sinus pathologies. Paranasal sinus CT presents very useful information for the evaluation of obstructive structural problems, trauma, inflammatory pathologies, and, especially, detailed imaging of bony structures. CT has been widely used for preoperative imaging, perioperative image-guided surgery, and guidance for surgical planning using preoperative multiplanar reconstructions. Magnetic resonance imaging (MRI) provides more detailed information through its advanced resolution for soft tissues in the evaluation of extra-sinus, soft tissue involvement of inflammatory diseases, sinonasal tumors, and sinonasal fungal diseases. In this section, we discuss the current information on sinonasal imaging, extending from conventional radiographies to advanced imaging techniques, using common diseases and examples. Currently, tomography is the first choice and most widely used diagnostic tool for nasal and paranasal sinus imaging because of its high resolution, ability to define the bony structures clearly, and preoperative guidance. With paranasal sinus CT, thin-sliced axial sections, parallel to the orbitomeatal unit or hard palate, are usually obtained, and coronal and sagittal reformattings are reconstructed to better define the sinonasal anatomy. In particular, the coronal sections are more important for preoperative evaluation because they provide more similar images with an endoscopic view. This chapter discusses radiologic assessment of nose and paranasal sinuses.
Chapter
Nasal examination, mainly nasal endoscopy, is necessary in patients with severe rhinitis, specially in those showing resistance to medical treatment
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Çalışmamızda kronik ürtiker (KÜ)’e neden olabilecek faktörlerin tespitinde anamnez, klinik bulgular, rutin tanısal testler ile otolog serum ve plazma deri testlerinin (OSDT ve OPDT) yeterliliği ve gerekliliğininin değerlendirilmesi amaçlandı. Çalışmaya altı haftadan uzun süre ürtiker ve/veya anjioödem semptomları tarifleyen 52 erişkin hasta dahil edildi. Tüm hastalar allerjik, otoimmün, enfeksiyöz ve dahili hastalıklar açısından tetkik edildi. Ürtiker- ürtikeryal vaskülit (ÜV) ayrımında kesin tanı histolopatolojik değerlendirme ile konuldu. Otolog serum ve plazma deri testi 51 hasta ve 28 sağlıklı gönüllüye uygulandı. Hastaların %32,7’sinde fiziksel ürtiker (FÜ) tespit edildi. Emosyonel stres, en sık (%75) tetikleyici olarak belirlendi. Kronik spontan ürtiker (KSÜ)’li hastalarda OSDT ve OPDT sırasıyla %55,5 ve %16 oranında pozitif bulundu ve aradaki fark istatistiksel olarak anlamlı idi (p=0,021). Tiroid otoantikorları ile OSDT pozitifliği arasında istatistiksel olarak anlamlı ilişki tespit edildi (p=0,031). Fiziksel ürtiker, kronik ürtikeryal semptomlarla başvuran hastalarda öncelikle dışlanması gereken ürtiker alt tipidir. Hastalığın yönetiminde emosyonel stres kontrolü göz önünde bulundurularak hastalara gereken psikososyal destek sağlanmalıdır. Otolog serum deri testi pozitif olan hastaların tiroid otoimmünitesi açısından değerlendirilmesi gerekmektedir. Rutin ve geniş laboratuvar incelemelerinin yerine anamnez ve fizik muayene ile elde edilmiş verilere dayanılarak etyolojik araştırmalar planlanmalıdır.
Article
Objectives: The aim of this study was to compare the diagnostic performance of a deep learning algorithm with that of radiologists in diagnosing maxillary sinusitis on Waters' view radiographs. Materials and methods: Among 80,475 Waters' view radiographs, examined between May 2003 and February 2017, 9000 randomly selected cases were classified as normal or maxillary sinusitis based on radiographic findings and divided into training (n = 8000) and validation (n = 1000) sets to develop a deep learning algorithm. Two test sets composed of Waters' view radiographs with concurrent paranasal sinus computed tomography were labeled based on computed tomography findings: one with temporal separation (n = 140) and the other with geographic separation (n = 200) from the training set. Area under the receiver operating characteristics curve (AUC), sensitivity, and specificity of the algorithm and 5 radiologists were assessed. Interobserver agreement between the algorithm and majority decision of the radiologists was measured. The correlation coefficient between the predicted probability of the algorithm and average confidence level of the radiologists was determined. Results: The AUCs of the deep learning algorithm were 0.93 and 0.88 for the temporal and geographic external test sets, respectively. The AUCs of the radiologists were 0.83 to 0.89 for the temporal and 0.75 to 0.84 for the geographic external test sets. The deep learning algorithm showed statistically significantly higher AUC than radiologist in both test sets. In terms of sensitivity and specificity, the deep learning algorithm was comparable to the radiologists. A strong interobserver agreement was noted between the algorithm and radiologists (Cohen κ coefficient, 0.82). The correlation coefficient between the predicted probability of the algorithm and confidence level of radiologists was 0.89 and 0.84 for the 2 test sets, respectively. Conclusions: The deep learning algorithm could diagnose maxillary sinusitis on Waters' view radiograph with superior AUC and comparable sensitivity and specificity to those of radiologists.
Chapter
Sinusitis is diagnosed and managed based on clinical grounds and imaging is not indicated for initial diagnosis of uncomplicated sinusitis. CT remains the primary imaging study of choice for patients with acute and chronic sinusitis. CT is indicated when patients do not respond to medical management as patients may have a structural abnormality or obstructive lesion. Imaging is also indicated in patients who are suspected of having sinusitis related to orbital and intracranial complications, to immunocompromised state, or for pre-operative surgical planning.
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Objectives: New digital 2D imaging systems are considered as an easy accessible modality for sinonasal evaluation. The aim of this study was to investigate the diagnostic efficacy of digital Waters and Caldwell radiographs. Materials and Methods: A total of 273 patients fulfilling the inclusion criteria were enrolled in this descriptive-analytical study. Complete opacification or mucosal thickening of frontal, ethmoid and maxillary sinuses and nasal septum deviation were assessed on digital Waters and Caldwell images. Considering CBCT as the gold standard, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were obtained for the plain films. Results: The sensitivity and specificity for the diagnosis of complete opacification were 89.47% and 95.66% (for frontal sinus), 100% and 97.59% (for ethmoid air cells), 100% and 96.42% (for maxillary sinus), respectively. Regarding mucosal thickening, the sensitivity and specificity were 51.43% and 90.70% (for frontal sinus), 60.84% and 84.80% (for ethmoid air cells), 81% and 74.74% (for maxillary sinus), respectively. The sensitivity of Waters and Caldwell for detecting nasal septum deviation was 84.31% and 87.25%, respectively; whereas their specificity was 100%. Conclusion: Digital Caldwell performs well in detecting frontal and ethmoid opacification and nasal septum deviation. It has a moderate efficacy in assessing frontal and ethmoid mucosal thickening, while its performance is better in diagnosing healthy cases. Digital Waters is a reliable modality for maxillary sinus evaluation.
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The widespread use of dental implants and reconstructive procedures for their positioning has led to an increase in sinonasal complications of dental disease and treatment (SCDDT). Diagnosis requires accurate dental and rhinological evaluation, including computed tomography (CT). The aim of this study is to investigate a multidisciplinary approach for the treatment of SCDDT by combining endoscopic endonasal surgery (EES) and an intraoral approach on the basis of a preliminary classification system already proposed by other authors. Moreover, we analysed the percentage of odontogenic maxillary sinusitis extending to the anterior ethmoidal sinuses and bacteria involved in the pathogenesis of SCDDT. Between January 2012 and August 2015, in our series of 31 patients, 16/31 patients (51.6%) were treated with EES, 3/31 patients (9.7%) with an intraoral approach and 12/31 patients (38.7%) with a combined approach. All patients reported improvement in sinusitis symptoms confirmed by clinical examinations and CT scan. No significant complications were recorded and revision surgery was not required. Finally, the results of this preliminary study suggest that a multidisciplinary approach to SCDDT from diagnosis to therapy allows more precise diagnosis and comprehensive therapy to achieve a rapid recovery and minimise the risk of recurrence. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.
Chapter
Until recently, radiological evaluation of the soft tissue was best accomplished with expensive, time-intensive modalities, like magnetic resonance imaging and computer tomography. With the advent of bedside ultrasound the provider can rapidly image the soft tissue space with remarkable clarity and at little cost to the patient, both in terms of money and in radiation exposure. As the use of ultrasound has expanded throughout the medical field so too has its use in soft tissue applications. Today, soft tissue ultrasound comprises an entire field of medical ultrasonography. In this text we will only be covering the highlights of soft tissue ultrasound. These areas include (1) evaluation of soft tissue infections, (2) localization of foreign bodies, (3) musculoskeletal imaging, (4) evaluation of abdominal wall hernias, (5) fracture assessments, (6) evaluation of maxillary sinusitis, (7) and assessment of the airway.
Article
Acute or chronic sinusitis is a common illness among adults and children. Sinus radiography is the primary imaging study that most otolaryngologists utilize when diagnosing sinusitis. In this study, we recruited 42 patients (26 males and 16 females) with age ranging from 5 to 83 years (average: 52.3 years) without a history of trauma or neoplasm, between January 2008 and July 2009. Upon receiving a diagnosis of sinusitis, the patients received sinus radiography followed by computed tomography (CT) within two weeks. Images of both sinus radiography and CT were reviewed retrospectively and compared with each other. The results showed that CT confirmed sinus fluid accumulation in all 42 patients, 39 of them were identified with sinus fluid accumulation or opacification by sinus radiography alone, the sensitivity of 92.9%. For individual paranasal sinus, the sensitivities of sinus radiography for discerning fluid accumulation or opacification in maxillary, frontal, ethmoid, and sphenoid sinuses were 88.6%, 88.9%, 57%, and 28.6%, respectively. Our study confirmed that sinus radiography had a higher sensitivity in detecting fluid accumulation or opacification in the maxillary and frontal sinuses, sinus radiography remains a useful imaging modality in assessing sinusitis in clinical settings.
Article
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Chronic rhinosinusitis is a common condition in medical practice. It is defined as inflammation of the mucosa of nose and paranasal sinuses, the fluids within these cavities, and/or the underlying bone that has been present with or without treatment for at least 12 weeks duration. In 1997, a detailed definition of the syndrome was developed by the Rhinosinusitis Task Force of the American Academy of Otolaryngology-Head and Neck Surgery, consisting of the major and minor diagnostic criterias. To study the role of conventional radiography, nasal endoscopy and computed tomography in the early diagnosis of chronic rhinosinusitis. The study was carried out in the Department of Otorhinolaryngology, Saraswati Institute of Medical Sciences. A total of 100 patients with clinical evidence of sinonasal diseases were evaluated with conventional radiography, Nasal endoscopy and computed tomographic evaluation. Out of 100 patients; 58 were male and 42 were female. M:F ratio = 1.38:1. Majority of the patients were being in the age group of 21–30 years (30 %). The most common finding on conventional radiography was opacification of maxillary sinus (42 %) followed mucosal thickening (26 %), haziness of the maxillary sinus (19 %) followed by air-fluid level (13 %). Five basic radiological patterns of sinonasal inflammatory disease are identified among 100 patients. These were (1) Infundibular 16 %, (2) Ostiomeatal unit 32 %, (3) Sphenoethmoidal 8 %, (4) Sinonasal polyposis 28 %, (5) Unclassified 16 %. The sensitivity and specificity of plain film radiography for detecting sinus opacifications was unacceptably low for paranasal sinuses, hence conventional radiography should not be used as a single diagnostic tool in preoperative evaluation. Nasal endoscopy having sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure may reduce unnecessary diagnostic CT scanning procedures. It allows an unparalleled vision with brilliant illumination of nose and paranasal sinuses. Endoscopic directed procedures have high accuracy due to vision controlled and incomparable guidance in treatment of nasal and nasopharyngeal pathologies. CT scan can be reserved as second level investigation for the subgroup of patients with negative endoscopy who remain symptomatic on follow up.
Article
Efficient management of chronic sinusitis remains a great challenge for primary care physicians. Unlike ENT specialists using Computed Tomography scans, they lack an affordable and safe method to accurately screen and monitor sinus diseases in primary care settings. Lack of evidence-based sinusitis management leads to frequent under-treatments and unnecessary over-treatments (i.e. antibiotics). Previously, we reported low-cost optical imaging designs for oral illumination and facial optical imaging setup. It exploits the sensitivity of NIR transmission intensity and their unique patterns to the sinus structures and presence of fluid/mucous-buildup within the sinus cavities. Using the improved NIR system, we have obtained NIR sinus images of 45 subjects with varying degrees of sinusitis symptoms. We made diagnoses of these patients based on two types of evidence: symptoms alone or NIR images along. These diagnostic results were then compared to the gold standard diagnosis using computed tomography through sensitivity and specificity analysis. Our results indicate that diagnosis of mere presence of sinusitis that is, distinguishing between healthy individuals vs. diseased individuals did not improve much when using NIR imaging compared to the diagnosis based on symptoms alone (69% in sensitivity, 75% specificity). However, use of NIR imaging improved the differential diagnosis between mild and severe diseases significantly as the sensitivity improved from 75% for using diagnosis based on symptoms alone up to 95% for using diagnosis based on NIR images. Reported results demonstrate great promise for using NIR imaging system for management of chronic sinusitis patients in primary care settings without resorting to CT.
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SynonymsAcute rhinosinusitis; Acute sinusitis; Chronic rhinosinusitis; Chronic sinusitis; Recurrent acute rhinosinusitis; Rhinosinusitis; Sinusitis; Subacute rhinosinusitisDefinitionIn 1996, the Task Force on Rhinosinusitis, which included representatives from the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Otolaryngic Allergy, and the American Rhinologic Society, recommended the term rhinosinusitis replace the more commonly used term sinusitis.Rhinitis is the term used to define inflammation of the nasal cavity. Likewise, sinusitis is the term for inflammation of the paranasal sinuses. Inflammation of the nasal cavity usually precedes and accompanies inflammation of the paranasal sinuses. For this reason, the term rhinosinusitis is preferred (Lanza and Kennedy 1997).EpidemiologyThe 2009 Summary Health Statistics for U.S. Adults National Health Interview Survey notes that over 29.3 million adults in the United States r ...
Chapter
The term “sinusitis” technically refers to inflammation of the mucosa of the paranasal sinuses. Under normal circumstance, the paranasal sinuses are assumed to be sterile. However, the paranasal sinuses are continuous to nasal mucosa or nasopharynx that is heavily colonized with bacteria. These bacteria are present in low density and removed by the normal mucociliary function of the paranasal sinuses. Normal mucous secretions contain antibodies and, together with mucociliary clearance, work to clear bacteria from the paranasal sinuses. Thus, maintaining the mucociliary flow and an intact local mucosal surface are key host defenses against infection [1]. Sinusitis is classified as acute, subacute, or chronic, based on the duration of the illness. Acute sinusitis refers to sinusitis symptoms lasting fewer than 4 weeks, and chronic sinusitis refers to sinusitis lasting more than 12 weeks. Subacute sinusitis falls in between these two.
Article
Sinusitis is an important source of morbidity and loss of income and may exacerbate chest disease.1 2 3 Most uncomplicated acute sinusitis is managed in Britain in primary care, whereas most chronic sinusitis is managed by rhinologists. Patients commonly seek advice on recurring symptoms of rhinorrhoea, congestion, intermittent facial pain, and postnasal drip, and it is important to distinguish chronic sinusitis from rhinitis.The course and character of sinusitis are influenced by (a) repeated episodes of mucosal oedema and hypersecretion in response to infection or allergy; and (b) anatomical variants which may impair sinus ventilation and mucociliary clearance. A broader understanding of these factors helps to direct medical management either alone or with surgery.4 Paranasal sinuses The paranasal sinuses comprise four paired cavities: the frontal, maxillary, ethmoid, and sphenoid sinuses. Each is lined with ciliated pseudostratified columnar epithelium and has a narrow ostium that opens into the nasal cavity. The ostia of the frontal, maxillary, and anterior ethmoid sinuses open into the ostiomeatal complex, which lies in the middle meatus, lateral to the middle turbinate. The posterior ethmoid and sphenoid sinuses open into the superior meatus and sphenoethmoid recess respectively. The anatomy is variable and has been extensively reviewed.5 A protective mucous blanket, which envelops bacteria and other irritants, covers the respiratory cilia and is moved constantly along predetermined pathways to the sinus ostia. In the frontal sinus mucus passes up along the intersinus septum, then across the roof of the sinus before returning across the sinus floor to the frontal recess and the middle meatus.6 In the maxillary sinus mucus is moved from the floor of the sinus radially and up the walls of the sinus to the superiorly placed ostium (fig 1). FIG 1 Mucociliary pathways in the maxillary and frontal sinuses Summary points Summary pointsSinusitis is an …
Article
To develop guidelines for the diagnosis and management of acute sinusitis. Diagnostic clinical criteria and imaging techniques, the role of antimicrobial therapy and duration of treatment, and the role of adjunct therapy, including decongestants, glucocorticosteroids and nasal irrigation. Improved accuracy of clinical diagnosis, better utilization of imaging techniques and rational use of antimicrobial therapy. A MEDLINE search for relevant articles published from 1980 to 1996 using the MeSH terms "sinusitis," "acute sinusitis," "respiratory infections," "upper respiratory infections," "sinusitis" and "diagnosis," "sinusitis" and "therapy," "sinusitis" and "etiology," and "antimicrobial resistance" and search for additional articles from the reference lists of retrieved articles. Papers referring to chronic sinusitis, sinusitis in compromised patients and documented nonbacterial sinusitis were excluded. The evidence was evaluated by participants at the Canadian Sinusitis Symposium, field in Toronto on April 26-27, 1996. A hierarchical evaluation of the strength of evidence modified from the methods of the Canadian Task Force on the Periodic Health Examination was used. Strategies were identified to deal with problems for which no adequate clinical data were available. Recommendations arrived at by consensus of the symposium participants were included. Increased awareness of acute sinusitis, accurate diagnosis and prompt treatment should reduce costs related to unnecessary investigations, time lost from work and complications due to inappropriate treatment. As well, physicians will be better able to decide which patients will not require antimicrobial therapy, thus saving the patient the cost and potential side effects of treatment. Clinical diagnosis can usually be made from the patient's history and findings on physical examination only. Five clinical findings comprising 3 symptoms (maxillary toothache, poor response to decongestants and a history of coloured nasal discharge) and 2 signs (purulent nasal secretion and abnormal transillumination result) are the best predictors of acute bacterial sinusitis (level I evidence). Transillumination is a useful technique in the hands of experienced personnel, but only negative findings are useful (level III evidence). Radiography is not warranted when the likelihood of acute sinusitis is high or low but is useful when the diagnosis is in doubt (level III evidence). First-line therapy should be a 10-day course of amoxicillin (trimethoprim-sulfamethoxazole should be given to patients allergic to penicillin) (level I evidence) and a decongestant (level III evidence). Patients allergic to amoxicillin and those not responding to first-line therapy should be switched to a second-line agent. As well, patients with recurrent episodes of acute sinusitis who have been assessed and found not to have anatomic anomalies may also benefit from second-line therapy (level III evidence). The recommendations are based on consensus of Canadian and American experts in infectious diseases, microbiology, otolaryngology and family medicine. The guidelines were reviewed independently for the advisory committee by 2 external experts. Previous guidelines did not exist in Canada.
Article
To determine whether a single Waters view (occipito-mental) radiograph could be substituted for a four-view sinus series to diagnose sinusitis, and to determine the inter- and intraobserver variabilities for sinus radiography. Radiographs were interpreted by radiologists blinded to the clinical history, and results were recorded on a standardized form. Veterans Affairs Medical Center. Participants: Staff attending radiologists, an attending radiologist with special training in skull radiology, and a senior radiology resident. The agreement between the Waters view and the four-view sinus series was moderate to substantial (simple agreement = 75-84%, kappa = 0.5-0.68). However, agreement varied by sinus and, after correction for chance agreement, was substantial only for the maxillary sinuses (kappa = 0.72-0.87). Intraobserver agreement (kappa = 0.72-0.84) was superior to interobserver agreement (kappa = 0.49-0.59) for the four-view sinus series. Substituting a single Waters view for a four-view sinus series may be an acceptable strategy for diagnosing maxillary sinusitis.
Article
Computed tomography (CT) is the gold standard for exact delineation of inflammatory sinus disease, especially before endoscopic surgical treatment, and in cases of postoperative recurrences. In routine CT studies, the radiation dose to the patient is not negligible. Therefore, the authors evaluated prospectively the CT scans of 44 patients with inflammatory disease of the paranasal sinuses, to define the imaging ability of low-dose CT (i.e. 60 mA-3 s, 30 mA-3 s, and 30 mA-2 s), comparatively with the standard mAs settings (130 mA-3 s). In all cases, the exact extent of the disease was correctly assessed on each of the low-dose settings, with no false negative study. The increasing graininess of low mAs sections did not induce errors of interpretation, despite a less pleasant appearance to the eyes. In cases of extensive sinus disease, the thickness and integrity of the ethmoid septa were sometimes more difficult to evaluate on low-dose CT sections. The authors recommend the use of low mAs settings in the evaluation of inflammatory disease of the sinuses, complemented, if necessary, in cases of extensive abnormalities, by one or two sections obtained with standard mAs settings, focused on questionably abnormal bone septa.
Article
CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection. (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases. Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven. Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis. The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.
Article
A prospective study of 100 adult patients undergoing paranasal sinus radiography was performed. Two experienced radiologists independently assessed a single occipitomental view and, at a later date, the traditional three projections, i.e. occipitomental, occipitofrontal and lateral. There was 99% intra-observer agreement between the diagnosis on a single projection compared with all three films. In five cases, the frontal sinuses were difficult to assess mainly due to poor radiography, and in defined circumstances additional views may be required occasionally. We conclude that with greater attention to radiographic technique the occipitomental view alone is sufficient for diagnostic purposes.
Article
Sixty-two patients, presenting to the Nasal Dysfunction Clinic at the University of California, San Diego, were radiographically examined with plain sinus x-rays and computed tomographic (CT) scans. The x-rays were evaluated independently, and the reported findings were compared. In maxillary sinuses the CT and plain film observations corresponded poorly with a concordance of 77%. There was a tendency to overread the plain films. In the ethmoid sinuses the lack of concordance between CT scans and plain films was 76%, and a tendency to under-read the plain films was noted. In the lower nasal compartment the correspondence between CT and plain film readings was 57%, with a notable tendency to overread the plain films. In the olfactory recess, the CT/plain film concordance was 66%. At our institution, a sinus CT series costs $400; a conventional sinus series costs $102. The CT radiation dose is 5.2 to 6.5 cGY compared with 1.4 cGY for plain films. We conclude that plain films are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information. Exceptions may include children and some cases of sinus disease isolated to a single sinus.
Article
We performed a prospective study of 70 infants and children with recurrent sinusitis. We compared plain radiographs with coronal CT scans of the sinuses to determine if plain radiographs can be used to accurately diagnose and localize residual sinus disease amenable to endoscopic surgery. This residual disease is thought to be important in the pathogenesis of recurrences of sinusitis. The patients were taking antibiotics and were clinically well at the time of the two examinations (performed on the same day). Findings on slightly over 80% of the CT scans were abnormal. In about 75% of the patients, the findings on plain radiographs did not correlate with those on CT scans. About 45% of the patients had normal findings on plain radiographs of at least one sinus with an abnormality of that sinus shown on CT scans. Almost 35% of the patients had what was interpreted as an abnormality of at least one sinus on plain radiographs, but that sinus was normal on CT scans. Sinusitis in infants and children is often underdiagnosed or overdiagnosed on the basis of findings on plain radiographs of the sinuses. Plain radiographs cannot be used to determine the need for, or to guide, endoscopic surgery on the sinuses.
Article
Antroscopy: its place in clinical practice. A comparison of antroscopic findings with radiographic appearances of the maxillary sinus One hundred and fifteen patients with chronic nasal symptoms underwent both radiological and antroscopic investigation of their maxillary sinuses. A total of 193 antra were studied. The radiological diagnosis completely correlated with the antroscopic findings in only 44% of the cases. The reasons for this discrepancy are discussed as well as the additional limitations of radiology in the diagnosis of the opaque antrum and the accurate detection of sinus fluid. Antroscopy provides accurate information about the nature of mucosal changes, the presence of secretions and the state of the natural ostium. This technique therefore ensures a precise diagnosis on which appropriate primary treatment can be based as well as offering the most reliable means of selecting patients who require surgery. The potential for detecting early antral tumours is stressed. It is concluded that antroscopy is the most useful investigation in the management of chronic conditions of the maxillary sinus. However, radiology still has its place as a primary screening test, particularly when the radiographic findings are negative.
Article
The prevalence of subacute, occult maxillary sinusitis in children undergoing adenoidectomy, adenotonsillectomy or tympanostomy was 27 per cent as confirmed by antral puncture. A-mode ultrasound examination and radiographic examination with the occipito-mental projection were used as preoperative screening tests for the detection of maxillary sinus discharge. 135 children aged 4--10 years were examined. An abnormal radiographic finding was found in 40 per cent of children. When punctured these sinuses yielded discharge in 62 per cent of cases. A normal radiographic finding proved to be reliable (98 per cent). The total agreement between puncture and radiographic finding was 73 per cent. The total agreement between puncture and A-mode ultrasound finding was 94 per cent. The A-scan was positive in 88 per cent of the sinuses with discharge. A-mode ultrasonic examination proved to be a simple, non-ionizing reliable means of monitoring retained secretion within maxillary sinuses of children.
Article
To determine the sensitivity and specificity of sinus x-rays of patients clinically diagnosed as having acute sinusitis. Thirty consecutive adult, nonpregnant emergency department (ED) patients clinically diagnosed as having acute sinusitis and meeting study criteria were entered into the study. Sinus x-rays were obtained immediately after study entry and sinus computed tomography (CT) scans were done within 72 hours. Radiologic criteria for sinusitis were defined as more than 3 mm of mucoperiosteal thickening (MPT), an air/fluid (A/F) level, or opacification. All films were read in a blinded fashion [CT scans by two radiologists and plain film by two emergency medicine (EM) staff members and the same radiologists]. A third radiologist 'interpreted Ct scans when the initial radiologists disagreed. Sinus CT scans were obtained for 29 of 30 patients. Radiologists interpreted 28 of 29 CT scans identically, with 21 being positive for sinusitis. Sensitivity and specificity of x-rays were 57% and 88%, 62% and 88%, 67% and 75%, and 48% and 100% for the two radiologists and the two EM physicians, respectively. Four ethmoid, five frontal, and five sphenoid sinuses were opacified or had A/F levels on CT scan. No ethmoid, frontal, or sphenoid sinus was interpreted as being opacified or having an A/F level on plain film. Sensitivity and specificity of maxillary sinus opacification or A/F level on x-ray were 70% and 100%, and 70% and 100%, and 70% and 96%, and 70% and 96% for the two radiologists and the two EM physicians, respectively. Mean concordances (kappa) of x-ray and CT scan interpretations for the four reviewers were 0.34 (range, 0.30-0.39) for the diagnosis of sinusitis and 0.77 (range, 0.74-0.79) for maxillary sinus opacification or A/F level. Sinus x-rays are less sensitive than sinus CT scans for demonstration of radiographic changes consistent with acute sinusitis. Sinus plain films may not be reliable enough to assist with clinical decision making. If severity of patient illness requires diagnostic certainty, more sensitive imaging studies, such as CT scans of the sinuses, should be considered.
Article
This study shows how to obtain maximum likelihood estimates of test sensitivities and specificities in case of lack of an external standard, using the Expectation Maximisation (EM) algorithm. This method is used to compare four diagnostic tests in patients suspected of acute maxillary sinusitis. Data were analyzed from published studies. Antral aspiration is the test with the highest diagnostic value. The diagnostic value of a positive clinical examination (according to explicit criteria) and of a positive radiograph or ultrasound are comparable. A negative radiograph is of more diagnostic value than a negative clinical examination or ultrasound. The width of the confidence intervals may be too small, due to model deviations which may give incorrect standard errors. However, the estimated likelihood ratios adequately reflect the relative value of the diagnostic tests considered, even when the assumption of independence is dropped.
Article
Recent guidelines published by the Royal College of Radiologists suggest that plain sinus radiography is not indicated in the routine management of sinusitis and should be requested only by specialists.1 This approach may be justified by the large radiation exposure (equivalent to five chest x ray procedures) and by the finding of abnormalities on x ray films of the sinus in up to half of the population.2,3 We assessed the prevailing use of sinus x ray films by general practitioners and surveyed current practice in sinus examination in radiology departments in the United Kingdom. ### and results All 694 general practitioners in Greater Glasgow were sent a postal questionnaire asking about their use and interpretation of sinus x ray films. The routine sinus x ray views used in 50 hospitals throughout the United Kingdom (19 teaching, …
Article
The diagnosis of chronic sinusitis is dependent on the radiographic evidence of sinus disease. We evaluated the performance of radiographs and computed tomographic (CT) scans for the examination of the paranasal sinuses of 91 patients of both sexes, ranging in age from 2 to 17 years, who had chronic upper respiratory tract symptoms for at least 3 months. The CT scan findings were categorized as no disease; minimal disease, and mild, moderate, and severe sinusitis. Fifty-eight patients (63%) had chronic sinusitis: CT scan abnormalities were minimal in 17%, mild in 19%, moderate in 21%, and severe in 43%. There was a statistically significant correlation between rhinorrhea (r = 0.25, p = 0.01), cough (r = 0.27, p = 0.009), and the severity of sinus abnormality as determined by CT scan. Clinical presentation in the mild, moderate, and severe sinusitis groups (p < 0.05) was significantly different from that of the no disease group, whereas the minimal disease group had subclinical presentation (p = 0.11). Clinically significant chronic sinusitis often occurred at multiple sites: 44% of patients had pansinusitis, 50% had disease involvement of at least two sinuses, and 6% had disease in a single sinus. When sinus radiographs were compared with CT scans (n = 70 cases), radiographs could not identify minimal disease. For clinically significant sinusitis, sinus radiographs detected disease in 1 of 5 (20%) frontal sinuses, 0 of 12 (0%) sphenoidal sinuses, and 17 of 31 (54%) ethmoidal sinuses. With the minimal criteria of 40% to 50% opacification or fluid level filling of the maxillary antrum, radiographs detected disease in 37 of 49 (75%) cases. The sensitivity and specificity for a Waters view to confirm clinically significant chronic sinusitis without specifying the sites and severity were acceptable at 76% and 81%, respectively. When limited sinus CT scans were compared with full CT evaluation (n = 49 cases), limited studies detected 5 of 5 (100%) frontal, 9 of 11 (82%) sphenoidal, 14 of 19 (73%) ethmoidal, and 39 of 40 (97%) cases of maxillary sinusitis. The overall agreement was 88%. A single Waters view is an acceptable part of the initial evaluation of pediatric chronic sinusitis; however, a limited CT scan is a better alternative.
Article
Changes in imaging sinonasal inflammatory disease have paralleled changes in the treatment of chronic sinusitis. As functional endoscopic sinus surgery has become a more widespread technique, coronal computed tomography (CT) has become the primary imaging modality, replacing plain radiography. Knowledge of the plethora of sinonasal anatomic variations and the inherent surgical implications is critical to the interpretation of the CT scans and to the safe performance of endoscopic surgery. Currently, the role of magnetic resonance imaging is restricted to the evaluation of complicated sinusitis, intraorbital and intracranial manifestations of aggressive sinusitis, and sinonasal neoplasms.
Article
The diagnosis of maxillary sinusitis can be difficult, with clinical signs and symptoms leading to a correct diagnosis in only approximately half of cases. This study compared ultrasound and plain radiography of 50 maxillary antra (25 patients) with clinically suspected maxillary sinusitis. Ultrasound showed 100% concordance with plain radiographs reported as normal, and was abnormal in all cases where plain films were reported as showing complete opacification or an air fluid level, the only reliable plain film indicators of an inflamed antrum. We conclude that ultrasound can provide an alternative to plain radiography in the initial investigation of maxillary sinusitis.
Article
Imaging studies for sinusitis add little to the clinical management of the pediatric patient in most instances. The findings shown by paranasal sinus imaging are nonspecific and need to be correlated with clinical findings. Coronal CT is recommended for complications or for recurrent or persistent sinus disease.
Low dose CT and in¯ammatory disease of the paranasal sinuses403±406. 23 Dunham ME. Evaluating the limited sinus computed tomography scan in children
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