In a comparative study on the efficacy of two surgical treatment procedures, 90 patients diagnosed with chronic maxillary sinusitis received antimicrobial prophylaxis. Maxillary sinus fluid samples were taken from these 90 patients before the initiation of antimicrobial prophylaxis, and were cultured for aerobic and anaerobic bacteria. In 81% of all samples, bacterial growth was present. Anaerobic bacteria were present in 29% of the cases (5% pure anaerobic and 24% mixed aerobic and anaerobic). Predominant aerobic bacteria were staphylococci, in 42% of all samples (mainly coagulase-negative), and streptococci (32%). Predominant anaerobic bacteria were Propionibacterium species (18%) and Gram-negative rods (9%). The antimicrobial susceptibility was determined for 20 antibiotics, and the beta-lactamase production was investigated. The prevalence of beta-lactamase-producing bacteria was unexpectedly high (isolated from 36% of all patients). The findings in this study indicate that not all antimicrobial agents used against upper respiratory tract infections are suitable for treatment of this group of patients when the susceptibility of bacteria present in sinus fluid is taken into account. The high prevalence of beta-lactamase-producing bacteria could influence the course of the disease, due to the breakdown of antibiotics by such strains. Recommendations are given for criteria to use when choosing antimicrobial agents to treat bacterial infections it) patients with chronic maxillary sinusitis.

Sinus irrigation is the traditional treatment for chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) restores aeration and allows secretions to be removed from an infected sinus. This study compares the efficacy of sinus irrigation with that of sinus irrigation followed by FESS in 89 patients. We measured the effects by way of sinus radiographs, nasendoscopic findings, and patient complaints. When we analyzed the data in terms of intent to treat, we found significantly favorable results for sinus irrigation followed by FESS at the end point, though only for loss of smell and purulent rhinitis. Treatment consisting of sinus irrigation alone prevented surgery in 58% of all patients for 1 year. Both treatment methods were combined with a 10-day course of loracarbef, which might have contributed to the outcome. We conclude that a good option for treatment of chronic maxillary sinusitis seems to be sinus irrigation in combination with a broad-spectrum antibiotic followed by FESS.

Resourcing real-world evidence (RWE) is becoming an increasingly important asset in developing novel therapies for cancer. In this article, an overview of the benefits and challenges of using these data is provided. Through several case examples we highlight future applications and potential.

No abstract

Variability between observers and specificity of sinus radiographic findings are subject to discussion. The aim of this study was to assess interobserver variability, between four physicians, two otolaryngologists and two radiologists, in the evaluation of 100 maxillary sinus radiographs. Equal agreement was found within the specialties when rating radiographs as normal or abnormal (80%). Kappa values for interobserver agreement were 0.45 for otolaryngologists and 0.58 for radiologists, both representing fair to good agreement. Otolaryngologists reported more abnormalities (67 vs, 57). Agreement on specific findings (complete opacity, fluid level and mucosal swelling) was fair to good (kappa values between 0.38 and 0.83). Agreement between the four physicians was lower on all outcomes. It is concluded that interobserver variability is within acceptable limits and justifies the continued use of conventional sinus radiographs for confirmation of maxillary sinus disease.