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INTER COLLEGAS, VOL. 6, No.1 (2019) ISSN 2409-9988
AGE FEATURES OF BONE TISSUE DENSITY IN THE POSTERIOR
AND INFERIOR WALLS OF THE FRONTAL SINUS
Gargin V.V., Lupyr A.V., Alekseeva V.V.,Yurevych N.O.
Kharkiv National Medical University, Ukraine
Chronic rhinosinusitis is a significant social, medical and economical problem. Elderly patients
are unique among all groups of patients. The purpose of our study was to determine
physiological variability of frontal sinus in the posterior and inferior walls and to compare it
with variability in purulent-polypous rhinosinusitis. Subjects and methods: The study involved
SCT examination of 40 male patients: 10 tomograms of patients aged 30–40 and 10 of
patients aged 75–85. The tomograms of patients without ENT diseases were used for the
control group. The study group included tomograms of patients aged 30–40 and 75–85 with
chronic rhinosinusitis. Results. An average bone density of the posterior and inferior walls
of the frontal sinuses was calculated. The bone density of the group aged 30–40 was
191.5±11.6 Hu in the inferior wall, 176.6±21 Hu in the posterior and 169.1±16.8 Hu and
164±21 Hu in the group aged 75–85 according to the above order. The study showed
pronounced changes in the bone density in purulent-polypous frontal sinusitis. In the group
aged 30–40 it was as follows: 120.1±8.3 Hu, 162.1±24 Hu in the inferior wall and 101.4±6.95 Hu,
127.4.8±15.4 Hu in the posterior wall. Conclusions: It can be assumed that the decrease in
the bone density is associated with age. And it is more severe in case of chronic frontal
sinusitis.
Key words: Frontal sinus, CT, elderly, bone density.
THEORETICAL MEDICINE
Corresponding Author:
Tetyana Chaychenko, MD, PhD,
Professor of Department of Pediatrics 1
and Neonatology of Kharkiv National
Medical University, Ukraine.
E-mail: tatyana.chaychenko@gmail.com
Introduction
Chronic rhinosinusitis represents a significant
social, medical and economic problem [1].
According to some reports, the incidence of this
disease can be equal to diabetes and heart
diseases [12] and accounts for 10.9% of the urban
population in Europe and 12.5% of the United
States population [5]. The course of chronic
rhinosinusitis has distinct age-specific features,
which also affect the methods of further
treatment [7]. Elderly patients occupy a special
place among all groups of patients. The incidence
of complications of rhinosinusitis at this age is
much greater than in younger patients, although
clinical presentation of inflammatory diseases
affecting the perineal sinuses is less severe due
to changes in the immune status, hormonal age
changes, concomitant diseases, changes in
behavior, namely predisposition to depressive
states. The most severe intracranial and
intraorbital complications are associated with
frontal sinusitis [13]. Bone alteration is, in
particular, one of the most significant links in
the development of chronic rhinosinusitis in
general and chronic frontal infections and is
associated with demineralization, disappearance
of trabecula, cortical destruction and focal
sclerosis. These changes may correlate with the
severity of the disease [2]. There are ways to
predict the probability of complications by bone
thickness according to the Global Osteitis
Scoring Scale (GOSS) by Georgalas and others,
which is based on bone thickness measurement,
but this indicator does not always reflect the
degree of destruction. [3].
2. Purposes, subjects and methods:
2.1 Purpose – to determine the physiological
age variability of the posterior and inferior walls
of the frontal sinus and to compare it with those
in chronic purulent-polypous frontal sinusitis.
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ISSN 2409-9988 INTER COLLEGAS, VOL. 6, No.1 (2019)
THEORETICAL MEDICINE
2.2 Subjects & Methods
The study was carried out within the
framework of the planned comprehensive
research carried out at Kharkiv National Medical
University on the topic "Morphological features
of organs and systems of the human body at the
stage of ontogenesis", state registration number
0144U004149.
Spiral computed tomography (SCT) is one of
the most informative non-invasive intravital
method for examination of paranasal sinuses [8].
The study involved 40 male patients (to exclude
the impact of factors occurring during menopause,
women were excluded from this study). The
study implied evaluation of SCT findings of
10 patients aged 30–40 years and 10 patients aged
75–85 years who underwent this examination in
connection with a disorder not related to ENT
organs (a tomography was performed to determine
the presence of an unconfirmed stroke). The study
also included 20 patients with chronic purulent-
polypous frontal sinusitis, who underwent
examination in accordance with the order of the
Ministry of Health of Ukraine No. 181 as of
24 March 2009 "On approval of medical treatment
protocols in the field of otorhinolaryngology". Ten
of these patients were aged 30–40 years and ten
were aged 75–85 years. The Hounsfield scale
[6] showed that the density of the posterior wall
was potentially dangerous for the development
of intracranial complications [4], and the inferior
wall of the frontal sinus was dangerous for the
development of intraorbital complications [9]. The
obtained digital data were statistically processed
using the Student-Fisher method, the mean value
for each variation series (X), the mean-square
deviation, and the mean error (m) were
determined. Statistical processing was performed
on a personal computer using Microsoft Office
Excel 2010 (US). Statistically significant results
were considered p <0.05.
Conflict of interests. There is no conflict
of interests.
3 Results and discussion
The results of calculations are presented in
tables 1–4.
Physiological mean density of the posterior
wall of the frontal sinus was calculated as follows:
in the group of people aged 30–40 it was 191.5.1
±11.6 Hu, and in the group aged 75–85 – 169.1±
16.8 Hu in the inferior wall and 176.6.1±21 Hu
and 164±21 Hu, respectively, in the region of the
posterior wall (table 1, 3). The inferior wall
density was 165±18.8 Hu and 137.6±14.4 Hu in
accordance with the above order. The study
showed that the density of bone tissue significantly
(p<0.05) decreased with age.
In chronic purulent-polypous sinusitis, the
density was 120.1±8.3 Hu and 101.4±8.3 Hu in
the inferior wall and 162.1±24 Hu and 127.4±
15.4 Hu in the posterior wall in accordance with
the above order.
Calculation and comparison of densitometric
indices of different groups under investigation
showed that the density of bone tissue significantly
depended on age (p <0.05). It decreased with
age both in physiological conditions p = 0.00035
and p = 0.0016 in the region of the inferior and
posterior walls, respectively, and in conditions of
chronic purulent-polypous maxillary sinusitis
p = 0.002 and p = 0.0016 according to the
specified order.
Physiological density of the inferior and
posterior walls of the frontal sinus in was
calculated two different age groups. The density
of the posterior wall was found to be greater in
the group of people aged 75–85. Moreover,
physiological density decreased not only with age,
but also in chronic inflammation. However, at
young age, these changes were more pronounced,
by 26% as opposed to the age group of 75–85 years,
where it decreased by only 9%. Such a more
severe response is likely to be due to the increased
tension of the immune response to the
inflammatory process and the uniqueness of the
immune response to the pathological process in
the elderly [10].
Thus, age has a significant meaning not only
in the course of chronic rhinosinusitis, but also in
the physiological density of bone tissue in general
and frontal sinus in particular. Older people
undergo rearrangements in the structure and
Age
(years) 12345678910xM
30–40 195 183 195 178 197 215 172 194 186 200 191,5 11,6
75–85 142 173 179 157 198 182 154 182 175 149 169,1 16,8
Table 1
Physiological density of bone tissue of the inferior wall of the frontal sinus
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INTER COLLEGAS, VOL. 6, No.1 (2019) ISSN 2409-9988
microarchitectural structure of the bones due to
the shortage of steroid hormones in this age
category [11], which has been repeatedly proven
for the femur in elderly. Our study allows us to
assume the correctness of this statement for bone
tissue.
Thus, elderly patients should be treated with
extreme caution, since the density of bone tissue
of the frontal sinus is physiologically lower,
although its reduction under the action of purulent-
polypous process is less severe than in the group
of younger patients. It has been shown that the
inferior wall density in patients aged 75–85 is
reduced more than that of the posterior wall,
suggesting higher probability of intraorbital than
intracranial complications in this group of patients.
Age
(years) 12345678910xM
75–85 105 93 98 89 94 108 109 107 108 103 101,4 6,95
30–40 116 113 124 128 121 139 112 117 115 116 120,1 8,3
Table 2
Density of the inferior wall of the frontal sinus in chronic purulent – polypous sinusitis
Age
(years) 12345678910xM
30–40 190 140 210 165 168 196 178 167 152 200 176,6 21
75–85 168 154 216 141 173 155 157 151 151 174 164 21
Table 3
Physiological density of the bone tissue of the posterior wall of the frontal sinus
Age
(years) 12345678910xM
30–40 172 165 159 178 163 140 154 135 178 177 162,1 24
75–85 135 158 93 138 145 107 118 137 154 89 127,4 15,4
Table 4
Density of the posterior wall of the frontal sinus in chronic purulent – polypous sinusitis
Conclusions. Thus, the following
conclusions can be drawn from the research:
1. Physiological density of the posterior wall
is more than that of the inferior in people aged
75–85.
2. The density of the inferior and posterior
walls of the frontal sinus significantly (p <0.05)
varies with age.
3. The density of both inferior and posterior
walls, equally decreases with age by 9.9% and
6.4% respectively.
4. Under the influence of pathological
process, the posterior wall density is more stable
in the group of people aged 75–85 and is reduced
only by 9%, whereas in patients aged 30–40
by 26%.
References:
1. Adouly T, Adnane C, Khallouk A, et al. (2017). Moroccan adaptation and validation of the
rhinosinusitis quality-oflife survey. Eur Arch Otorhinolaryngology, 274(3):1507–1513.
2. Carr T.F.(2016). Complications of sinusitis. Am J Rhinol Allergy, Vol. 30 (4). – Ð. 241–245.
3. Dong Y,Zhou B, Niu YT, Wang ZC (2011). [CT evaluation of bone remodeling in rabbit models with
rhinosinusitis]. [Article in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi., 46(10):848–53.
4. Freeman JL, Winston KR. (2015). Breach of Posterior Wall of Frontal Sinus: Management with
Preservation of the Sinus. World Neurosurg,.83(6):1080-9. doi: 10.1016/j. Dec 18..12.023. wneu.2014.
5. Halawi AM, Smith SS, Chandra RK. (2013). Chronic rhinosinusitis: epidemiology and cost. Allergy
Asthma Proc, 34(4):328–334
6. Hofer M. CT Teaching Manual - A Systematic Approach to CT Reading, 2nd Ed.P. 20.
7. Renteria AE, Mfuna Endam L, Desrosiers M.Do (2017). Aging Factors Influence the Clinical
Presentation and Management of Chronic Rhinosinusitis? Otolaryngol Head Neck Surg., 156(4):598–
605. doi: 10.1177/0194599817691258.
8. Schaafs LA, Pfeil J, K?hlitz T, Hamm B, Niehues SM. (2018). Low-dose computed tomography
of the paranasal sinuses: performance of two different iterative reconstruction algorithms Radiat Prot
Dosimetry., Aug 25. doi: 10.1093/rpd/ncy153].
THEORETICAL MEDICINE
61
ISSN 2409-9988 INTER COLLEGAS, VOL. 6, No.1 (2019)
9. Shumway CL., Wade M. (2018). Anatomy Head and Neck, Orbit Bones StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; Sep 25.
10.Stanojcic M, Chen P, Xiu F, Jeschke MG. (2016). Impaired Immune Response in Elderly Burn
Patients: New Insights Into the Immune-senescence Phenotype. Ann Surg., 264(1):195-202. doi: 10.1097/
SLA.0000000000001408].
11.Torremade-Barreda J, Rodriguez-Tolra J, Roman-Romera I, Padro-Miquel A, Rius-Moreno J,
Franco-Miranda E. (2013). [Testosterone-deficiency as a risk factor for hip fracture in eldery men].
[Article in Spanish] Actas Urol Esp., 37(3):142-6. doi: 10.1016/j.acuro.2012.06.009. Epub 2012 Dec 13.
12.Kucuksezer UC., Ozdemir C., Akdis M., Akdis CA. (2018). Chronic rhinosinusitis: pathogenesis,
therapy options, and more. Expert Opinion on Pharmacotherapy. 2018 Nov;19(16):1805–1815. doi:
10.1080/14656566.2018.1527904. Epub 2018 Oct 20.
13. Volkov AG, Stagnieva IV. (2012). Ostryj i hronicheskij frontit: tekushhee sostojanie problemy
[Acute and chronic frontitis: the current view of the problemi]. Vestn Otorinolaringol., (6):98–102.
Received: 23-Jan-2019
Accepted: 17-Mar-2019
THEORETICAL MEDICINE
