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Sinusitis of the maxillary antrum.

F O Evans, J B Sydnor, W E Moore

    The New England Journal of Medicine
    |October 9, 1975
    PubMed
    Summary
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    Sinusitis diagnosis is improved by correlating transillumination and radiological findings with maxillary antrum aspirates. Abnormal findings strongly indicate infection, guiding effective antibiotic use in acute sinusitis.

    Area of Science:

    • Otolaryngology
    • Infectious Diseases
    • Diagnostic Imaging

    Background:

    • Sinusitis diagnosis often relies on clinical symptoms.
    • Accurate differentiation between acute and chronic sinusitis is crucial for treatment.
    • Microbiological confirmation of sinusitis can be challenging.

    Purpose of the Study:

    • To evaluate the diagnostic accuracy of maxillary sinus transillumination and radiological findings.
    • To correlate direct sinus aspirate analysis with clinical presentation and imaging.
    • To assess the utility of antibiotic therapy based on in vitro sensitivity.

    Main Methods:

    • Sixty-five needle punctures of the maxillary antrum were performed in 24 adults with sinusitis.
    • Sinus aspirates were analyzed for leukocytes and microbial cultures.

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  • Transillumination and Water's view radiography were used to assess sinus status.
  • Correlation of clinical findings, aspirate results, and imaging was performed.

    • Main Results:

    • Opaque sinuses and marked mucosal thickening strongly correlated with abnormal aspirates (P < 0.001).
    • High leukocyte counts in aspirates indicated infection (bacterial titers > 10^5/mL or virus/fungus isolation).
    • Anterior nasal swab cultures showed poor correlation with direct sinus aspirates.
    • Commonly isolated organisms included Haemophilus influenzae, Streptococcus pneumoniae, and anaerobes.

    Conclusions:

    • Maxillary sinus transillumination and radiography are valuable adjuncts in diagnosing sinusitis.
    • Direct sinus aspiration provides reliable microbiological data for guiding treatment.
    • Antibiotic therapy is effective in acute sinusitis when guided by in vitro organism sensitivity (P < 0.001).