Maxillary Sinus Wall Thickening in Silent Sinus Syndrome

Abstract

The study aimed to demonstrate a hidden influence of the bacterium Helicobacter pylori in the pathogenesis of the silent maxillary sinus syndrome. Sinusitis is a disease with significant discomfort affecting health and quality of the patient's life, it is one of the most common chronic diseases involving different age groups. Diagnosis of sinusitis is clinical and the standard of choice for the detection of micro-organisms that cause sinusitis is culture of sinus discharge drainage. The etiology of chronic sinusitis is not completely known and due to the fact that there is no standard treatment for the disease, routine cultures are often made to assist empirical antibiotic prescribing therapy. As the etiology of chronic sinusitis is not clearly understood, the frequency of all causative agents of the disease must be adequately determined. H. pylori could migrate or get forced to migrate to the maxillary sinus under the influence of antibiotic violence leading to local tissue inflammatory reaction. H. pylori was detected in the nasal and maxillary sinus tissue specimens of some patients with chronic sinusitis associated with gastric existence of H. pylori. The study of H. pylori DNA extracted from patients with gastric reflux disease and chronic rhino-sinusitis emphasized prevalence of H. pylori in the oral and nasal cavities and similarity of the same H. pylori strain genotype among the same family but whether the strain genotype of gastric H. pylori is mostly identical with that of the oro-nasal strains and whether H. pylori is leading to chronic rhino-sinusitis or its existence in the maxillary sinus is a result of rino-sinusitis remained rather indefinite for some investigators. Sixteen middle aged patients with resistant symptoms of recurrent maxillary sinusitis in spite of adequate medications and sinus drainage were included in the study. H. pylori DNA extraction was done for the drained sinus discharge. Patients who proved positive for existence of H. pylori in the maxillary sinus discharge were encouraged for following the traditional habit of using the chewing stick even after every small bite of food in order to interfere with the nutrition of H. pylori from remnants of food particles in the mouth. Inhalation of the smell of white vinegar once or twice per day and daily mouth wash with diluted white vinegar was requested from them in order to disappoint H. pylori from the atmosphere of its new secondary habitat in the oro-nasal cavity. H. pylori was detected in the maxillary sinus drainage in fourteen patients. All patients showed improvement of symptoms within three days while twelve of them demonstrated disappearance of all symptoms in one week with clearance of the maxillary sinus in X-ray. Interestingly, the two patients where H. pylori was not detected in the sinus preferred also to follow the same traditional therapy and they quit after reasonable improvement of their symptoms. On conclusion, H. pylori could migrate and exist in the maxillary sinus as a secondary habitat particularly in those pati...