How To Cure Your Sinus Infection

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Read What A Chronic Sinusitis Sufferer Wants To Share That You Always Wanted. How He Has Treated Himself For Sinus Pain, Headaches, Bad Breath, Facial Pain And Sore Throat Without Any Nasal Spray.The Real Truth Is Something Which Your Eyes Have Not Seen, Your Ears Have Not Heard More here...

KillSinus Sinus Treatment Doctor Say Buy This Treatment Summary


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Your Complete Drug Free Treatments For Sinusitis

Heres what you'll discover inside: The real cause of your sinus problems (acute & chronic) and how you can make just 5 simple changes to stop them from coming back. How to clear your sinus congestion naturally and holistically. Its not a treatment where you have to wait and sit for hours at the doctors waiting room. 4 stimulation techniques to release your body's own natural pain killers and to open up your nasal cavities. Why costly antibiotics and corticosteroid can do more harm than good causing yeast infection that you dont want! What never to eat during the healing process certain food may contain natural chemicals that can aggravate your existing problems. How to make your own natural sinus spray for relief safely and effectively with simple ingredients. How you can change a few of your habits to treat, control and prevent future flare-up. Why 37 million Americans and many people worldwide are affected with severe sinus problems and the numbers are growing every year. How to find the right health practitioner who cares and wants to know. How to make simple home-made nasal irrigation without preservative.

Your Complete Drug Free Treatments For Sinusitis Summary

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Bacteriology of Chronic Sinusitis

Although the etiology of the inflammation associated with chronic sinusitis is uncertain, bacteria can be isolated in the sinus cavity in these patients (18,19). Bacteria are believed to play a major role in the etiology and pathogenesis of most cases of chronic sinusitis, and antimicrobials are often prescribed for the treatment of this infection. Numerous studies have examined the bacterial pathogens associated with chronic sinusitis. However, most of these studies did not employ methods that are adequate for the recovery of anaerobic bacteria. Studies have described significant differences in the microbial pathogens present in chronic as compared with acute sinusitis. S. aureus, Staphylococcus epidermidis, and anaerobic gram-negative bacilli (AGNB) predominate in chronic sinusitis. The pathogenicity of some of the low virulence organisms, such S. epidermidis, a colonizer of the nasal cavity is questionable (4,20). Gram-negative enteric rods were also reported in recent studies...

Chronic Bacterial Sinusitis Antiinflammatories

Long-term, low dose macrolide therapy represents one attempt at controlling the inflammation associated with chronic sinusitis (80). Medicines that have anti-inflammatory properties and are well tolerated are sought to help ease the reliance on systemic corticosteroids that affect both the number and function of inflammatory cells. When used in a topical form, nasal steroid sprays have been shown to be safe and effective in reducing the symptoms of alleric rhinitis (81). Their use in patients with chronic sinusitis can decrease the size of nasal polyps, and diminish sinomucosal edema (82). There are no set guidelines for the duration of use, and the expected side effects from long-term use are not yet known. Experience in using oral steroids for the treatment of chronic sinusitis is only anectodal. The extended use of oral steroid may result in serious side effects that include muscle wasting and osteoporosis. Because of the side effects, steroids are tapered and given in short...

Antimicrobial Treatment of Acute Sinusitis

Amoxicillin can be appropriate for the initial treatment of acute uncomplicated mild sinusitis. (Table 6). However, antimicrobials that are more effective against the major bacterial pathogens (including those that are resistant to multiple antibiotics) may be indicated as initial therapy and for the re-treatment of those who have risk factors prompting a need for more effective antimicrobials (Table 7) and those who had failed amoxicillin therapy. These agents include amoxicillin and clavulanic acid, the newer or respiratory quinolones (e.g., levofloxacin, gatifloxacin, and moxifloxacin), and some of the 2nd & 3rd generation cephalosporins (cefdinir, cefuroxime-axetil, and cefpodoxime proxetil). A number of antimicrobial agents have been studied in the therapy of acute sinusitis over the past 25 years, with the use of pre- and post-treatment aspirate cultures. Those studied were ampicillin, amoxicillin, amoxicillin-clavulanic acid, cefuroxime axetil, cefprozil, loracarbef,...

Bacteriology of Sinusitis in the Immunocompromised Hosts

Sinusitis occurs in a wide range of immunocompromised hosts including neutropenics, diabetics, patients in critical care units, and patients infected with HIV. Fungal and P. aeruginosa are the most common forms of sinusitis in neutropenic patients. Aspergillus spp. is frequently the causative organism, although mucor, rhizopus, alternaria, and other molds have been implicated (50). Fungi and S. aureus, streptococci and gram-negative enterics are the most common isolates in diabetics (51). The organisms most commonly isolated in nosocomial sinusitis are gram-negative enteric bacteria (such as P. aeruginosa, K. pneumoniae, Enterobacteriaceae, P. mirabilis, and S. marcescens) streptococci and staphylococci (52) and anaerobic bacteria (53). The causative organisms in patients with HIV infection included P. aeruginosa, S. aureus, streptococci, anaerobes, and fungi (Aspergillus, Cryptococcus, and Rhizopus) (54). Refractory parasitic sinusitis caused by Microsporidium, Cryptosporidium, and...

Bacteriology of Acute Exacerbation of Chronic Sinusitis

Brook et al. (46) also compared the microbiology of maxillary AECS in 30 patients with the microbiology of chronic maxillary sinusitis in 32 individuals. The study illustrated the predominance of anaerobic bacteria and polymicrobial nature of both conditions (2.5-3 isolates sinus). However, aerobic bacteria that are usually found in acute infections (e.g., S. pneumoniae, H. influenzae, and M. catarrhalis) emerged in some of the episodes of AECS.

Bacteriology of Sinusitis of Odontogenic Origin

Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10 to 12 of cases of maxillary sinusitis. Brook (16) studied the microbiology of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection. Polymicrobial infection was very common with 3.4 isolates specimen and 90 of the isolates were anaerobes in both acute and chronic infections. The predominant anaerobic bacteria were AGNB, Peptostreptococcus spp., and Fusobacterium spp. The predominant aerobes were alpha-hemolytic streptococci, microaerophilic streptococci, and S. aureus. S. pneumoniae, H. influenzae, and M. catarrhalis, the predominate bacteria recovered from acute maxillary sinusitis not of odontogenic origin (12,18), were mostly absent in acute maxillary sinusitis that was associated with an odontogenic origin. In contrast, anaerobes predominated in both acute and chronic sinusitis. The microorganisms recovered from odontogenic infections generally...

Antimicrobial Therapy of Chronic Sinusitis

TABLE 6 Empirical Antimicrobial Therapy in Acute Bacterial Sinusitis No history of recurrent acute sinusitis During summer months Risk factors prompting a need for more effective antimicrobials3 Bacterial resistance is likely Antibiotic use in the past month, or close contact with a treated individual(s) Resistance common in community Failure of previous antimicrobial therapy Infection in spite of prophylactic treatment Child in daycare facility Winter season Smoker or smoker in family Presence of moderate-to-severe infection Presentation with protracted (more than 30 days) or moderate-to-severe symptoms Complicated ethmoidal sinusitis Frontal or sphenoidal sinusitis Patient history of recurrent acute sinusitis Presence of co-morbidity and extremes of life Co-morbidity (i.e., chronic cardiac, hepatic or renal disease, diabetes) Immunocompromised patient Younger than two years of age or older than 55 years Allergy to penicillin Allergy to penicillin or amoxicillin Prevotella and...

Microbiology of Acute Sinusitis

Anaerobic Microbiology

Viral infection (mostly Rhino, influenza, adeno, and para-influenza viruses) is the most common predisposing factor for URTIs, including sinusitis. Viral infection can also concur with the bacterial infection. The mechanism whereby viruses predispose to sinusitis may involve viral-bacterial synergy, induction of local inflammation that blocks the sinus ostia, increase of bacterial attachment to the epithelial cells, and disruption of the local immune defense. The bacteria recovered from pediatric and adult patients with community-acquired acute purulent sinusitis, using sinus aspiration by puncture or surgery, are the common respiratory pathogens (S. pneumoniae, H. influenzae, M. catarrhalis, and Group A beta-hemolytic streptococci) and Staphylococcus aureus (Table 1) (7-12). Following the introduction of vaccination of children with the 7-valent pneumococcal vaccine on 2000 in the U.S.A., the rate of S. pneumoniae FIGURE 2 Viral and bacterial causes of sinusitis. FIGURE 2 Viral and...

Bacteriology of Nosocomial Sinusitis

Nosocomial sinusitis often develops in patients who require extended periods of intensive care (postoperative patients, burn victims, and patients with severe trauma) involving prolonged endotracheal or nasogastric intubation. P. aeruginosa and other aerobic and facultative gramnegative rods are common in sinusitis of nosocomial origin (especially in patients who have nasal tubes or catheters), the immunocompromised, patients with human immune deficiency viral infection and patients who suffer from cystic fibrosis (17,47). Nasotracheal intubation places the patient at a substantially higher risk for nosocomial sinusitis than orotracheal intubation. Approximately 25 of patients requiring nasotracheal intubation for more than five days develop nosocomial sinusitis (48). In contrast to community-acquired sinusitis, the usual pathogens are gram-negative enterics (i.e., P. aeruginosa, K. pneumoniae, Enterobacter spp., P. mirabilis, Serratia marcescens) and aerobic gram-positive cocci...

Adjuvant Therapies Acute Bacterial Sinusitis

Patients with a viral URTI may benefit from symptomatic therapy, aimed at improving their quality of life during the acute illness. The use of normal saline as a spray or lavage can provide symptomatic improvement by liquefying secretions to encourage drainage. The short-term (three days) use of topical alpha-adrenergic decongestants can also provide symptomatic relief, but their use should be restricted to older children and adults due to the potential for undesirable systemic effects in infants and young children. Topical glucocorticosteroids may also be useful in reducing nasal mucosal edema, mostly in those cases where a patient who has seasonal allergic rhinitis develops the complication of an acute URTI. The antipyretic and analgesic effects of nonsteroidal anti-inflammatory agents can relieve or ameliorate the associated symptoms of fever, headache, generalized malaise, and facial tenderness. Until the clinical diagnosis of acute bacterial sinusitis is established, management...

Chronic Sinusitis

Symptoms of chronic sinusitis vary considerably. Fever may be absent or be of low grade. Frequently symptoms are protracted and include malaise, easy fatigability, difficulty in mental concentration, anorexia, irregular nasal or postnasal discharge, frequent headaches, and pain or tenderness to palpation over the affected sinus.


Sinusitis is defined as an inflammation of the mucous membrane lining the paranasal sinuses (Fig. 1). Sinusitis can be classified chronologically into five categories (1) acute sinusitis recurrent acute sinusitis subacute sinusitis chronic sinusitis acute exacerbation of chronic sinusitis (AECS). Acute sinusitis is a new infection that may last up to four weeks and can be subdivided symptomatically into severe and non-severe. Recurrent acute sinusitis is diagnosed when four or more episodes of acute sinusitis, which all resolve completely in response to antibiotic therapy, occur within one year. Subacute sinusitis is an infection that lasts between 4 and 12 weeks, and represents a transition between acute and chronic infection. Chronic sinusitis is diagnosed when signs and symptoms last for more than 12 weeks. AECS occurs when the signs and symptoms of chronic sinusitis exacerbate but return to baseline following treatment. Sinuses are involved in most cases of viral upper respiratory...

Virulence of Anaerobic Bacteria and the Role of Capsule

Anaerobic Organisms

Clinical and animal studies showed bacterial synergy between anaerobic and aerobic or other anaerobic bacteria (12,13). Data derived from therapy of mixed infection also provided support for the importance of anaerobic bacteria. Polymicrobial infection involving aerobic and anaerobic bacteria responded to therapy directed at the eradication of only the anaerobic component of the infection with either metronidazole or clindamycin (14). However, for complete eradication of the infection, animal and patient studies have demonstrated that unless therapy is directed against both aerobic and anaerobic bacteria, the untreated organisms will survive (15-18). Bartlett et al. (15) demonstrated in an intra-abdominal abscess model in rats that combined therapy of clindamycin and gentamicin was needed to prevent mortality caused by Escherichia coli sepsis and abscesses caused by B. fragilis. Thadepalli et al. (16) showed that in patients with intra-abdominal trauma, clindamycin and kanamycin were...

Collection Transportation and Processing of Specimens for Culture

Transport Specimen For Culture Test

Because anaerobic bacteria frequently can be involved in various infections, ideally, all properly collected specimens should be cultured for these organisms. The physician should make special efforts to isolate anaerobic organisms in infections in which these organisms are frequently recovered, such as abscesses, wounds in and around the oral and anal cavities, chronic otitis media and sinusitis, aspiration pneumonia, and intraabdominal and obstetrical and gynecological infections among others.

Bacteroides fragilis Group

Bacteroides Fragilis Group

Prevotella oralis is part of the normal flora of the mouth and vagina. Unlike B. fragilis, however, strains of P. oralis generally are susceptible to penicillin and the cephalosporins, although more strains of P. oralis have shown resistance to these drugs. P. oralis almost never is found in pure culture in clinical infection. This organism can possess a capsule (67). It has been recovered from almost all types of respiratory tract and subcutaneous infections, including aspiration pneumonia (38), lung abscess (61), chronic otitis media (14), and sinusitis (15), and subcutaneous abscesses around the oral cavity (58). organisms that are capable of supplying this need Pigmented Prevotella and Porphyromonas are part of the normal oral and vaginal flora and are the predominant anaerobic gram negative bacilli isolated from respiratory infections. These include aspiration pneumonia (38), lung abscess (61), chronic otitis media (14), and chronic sinusitis (15). These organisms have been...

Introduction to Anaerobes

Gram Stai Bilophila

Respiratory tract, intra-abdominal and subcutaneous infections Sinusitis, brain abscesses Clostridia strains (C. perfringens, C. butyricum, and C. difficile) have been recovered from blood and peritoneal cultures of necrotizing enterocolitis and from infants with sudden death syndrome (8-10). Strains of Clostridium were recovered from children with bacteremia of gastrointestinal origin (11) and with sickle cell disease (12). Clostridial strains have been recovered from specimens obtained from patients with acute (13) and chronic (14) otitis media, chronic sinusitis and mastoiditis (15,16), peritonsillar abscesses (17), peritonitis (18,19), liver and spleen abscesses (20), abdominal abscesses (21), and neonatal conjunctivitis (22,23). Eubacterium spp. are part of the flora of the mouth and the bowel. They have been recognized as pathogens in chronic periodontal disease (29) and in infections associated with intra-uterine devices (30), and have been isolated from patients with...

BL in Clinical Infections

BL activity was detected in 46 of 88 (55 ) ear aspirates that contained BLPB (184). Brook et al. found BL activity in ear aspirates of 30 of 38 (79 ) children with chronic otitis media (209), in 17 of 19 (89 ) ear aspirates of children with acute otitis media who failed amoxicillin (AMX) therapy (210), and in 12 sinus aspirates (three acute and nine chronic infection) of the 14 aspirates that contained BLPB. The predominant BLPBs in acute sinusitis were H. influenzae, and Moraxella catarrhalis those in chronic sinusitis were S. aureus, Prevotella spp., Fusobacterium spp., and B. fragilis (see Table 5, chapter 14) (211).

The CF Disease and the CFTR Gene

Cystic fibrosis (CF) is an autosomal recessive lethal disease affecting 1 in 2,500 newborns among Caucasians (though rare among Orientals at 1 90,000) (Collins 1992 Welsh 1995). The major clinical characteristics of CF are progressive lung disease, caused by thick and dehydrated airway mucus frequently infected with Pseudomonas and Staphylococcus, leading to respiratory failure and CF mortality, and exocrine pancreatic insufficiency, of which CF is the most common cause in childhood. In addition, most males are infertile, due to congenital bilateral absence of the vas deferens (CBAVD). Other CF characteristics include bile duct obstruction, reduced fertility in females, high sweat chloride, intestinal obstruction, nasal polyp formation, chronic sinusitis, liver disease, and diabetes (Collins 1992 Welsh 1995).

Patient Assessment Case History

Endoscopic examination of the nasal passage is performed to ensure adequate access to the operation site by excluding, among others, a markedly deviated nasal septum, nasal polyposis, chronic rhinosinusitis, and neoplastic lesions. If any nasal conditions are found, then a preliminary or concurrent management of such conditions is planned with the proposed DCR. Surgery is contraindicated in active Wegener's granu-lomatosis.

Guidelines for Empirical Therapy

Because the magnitude of PK PD parameters determined in animal infection models can be predictive of antimicrobial efficacy in human infections, it is easy to understand why pharmacodynamics is being used more and more in establishing guidelines for empirical therapy. Recently published guidelines for otitis media, acute bacterial rhinosinusitis, and community-acquired pneumonia have used the ability of antimicrobials to reach the magnitude of PK PD parameters required for efficacy for both susceptible pathogens and those with decreased susceptibility to rank or select antimicrobials for empirical therapy of these respiratory infections 36,50,78 .

Diagnostic Nasal Endoscopy

Computed tomography (CT) can be helpful in assessing the structures intimately associated with the na-solacrimal drainage system (Fig. 3.10). The CT scanning is used mainly when an extrinsic disease is suspected and is of great help to the patients with paranasal sinus or facial pathology associated with the lacrimal system (tumor, rhinosinusitis, facial trauma, following facial surgery, etc.) 14 .

Abscesses Of The Head And Neck General Considerations

Staphylococcus aureus and Group A beta-hemolytic streptococci (GABHS) were established as the predominant pathogens in abscesses of the head and neck in most studies done until 1970 (1). However, when methodologies suitable for recovery of anaerobic bacteria were used, these organisms were found to predominate especially in infections that originated from sites where these organisms are the predominant flora (i.e., dental, sinus, and tonsillar infections) (2,3). The recovery of anaerobes from abscesses and other infections of the head and neck is not surprising because anaerobic bacteria outnumber aerobic bacteria in the oral cavity by a ratio of 10 1 (4). Furthermore, these organisms were recovered from chronic upper respiratory infections such as otitis and sinusitis, and from periodontal infections (1).

Cranial nerves and painful conditions a checklist

Orbital disease pseudotumor, sinusitis, ophthalmoplegic migraine Posterior fossa aneurysm posterior cerebellar artery (PCA), basilar Metastases nasopharyngeal, squamous cell carcinoma, lymphoma, multiple myeloma Inflammatory Fungal mucormycosis mucocele, periostitis, sinusitis Viral herpes zoster, spirchochetal Bacterial mycobacterial Others eosinophilic granuloma, sarcoid, Tolosa Hunt syndrome, Wegener's

Preoperative abnormalities

Asthma, hypereosinophilia ( 1.5 X 109l-1), necrotising vasculitis, extravascular granulomas, and allergic rhinitis.The vasculitis involves two or more extrapulmonary organs.The combination of late onset asthma with severe, recurrent sinusitis that requires surgery, particularly if there are abnormal paranasal sinus X-rays, may give a clue to the presence of the disease (D'Cruz et al 1999).

Postoperative Considerations

PTLD is an uncommon but serious event in children following liver transplantation. Its incidence is 4 to 9 in most series, and mortality rates reach 50 . Most cases are related to infection with Epstein-Barr virus (EBV). The spectrum of PTLD varies, ranging from polyclonal lym-phoid proliferation to true lymphoma. one of the more common presentation sites is in the head and neck region in the form of tonsillar hypertrophy, cervical lym-phadenopathy, or sinusitis. PTLD often presents with fever, malaise, and loss of weight and can be associated with hepatic allograft dysfunction and intestinal perforation from small bowel involvement.

Cladosporium Herbarum Nasal Problems Mexico

Curvularia lunata was found to be a cause of allergic bronchopulmonary disease (Halwig et al., 1985). Epicoccum nigrum was reported to be able to colonize nasal sinuses and cause allergic fungal sinusitis (Noble et al., 1997). Sooty molds caused allergies ranging from rhinitis to asthma in the eastern United States (Santilli et al., 1985).

Odontogenic Infections

The complexity of the oral and gingival flora has prevented the clear elucidation of specific etiologic agents in most forms of oral and dental infections. In the gingival crevice, there are approximately 1.8 X1011 anaerobes per gram (1). Because anaerobic bacteria are part of the normal oral flora and outnumber aerobic organisms by a ratio of 1 10 to 1 100 at this site, it is not surprising that they predominant in dental infections. There are at least 350 morphological and biochemically distinct bacterial groups or species that colonize the oral and dental ecologic sites (1). Most odontogenic infections result initially from the formation of dental plaque (2). Once pathogenic bacteria become established within the plaque, they can cause local and disseminated complications including bacterial endocarditis, infection of orthopedic or other prosthesis, pleuropulmonary infection, cavernous sinus infection, septicemia, maxillary sinusitis, mediastinal infection, and brain abscess (3).

Causes and Symptoms of Smell Disorders

The third large group of patients who seek counseling for olfactory problems are patients suffering from concomitant sinunasal problems. Approximately 20 of all patients in smell and taste consultations have lost or impaired olfactory function due to a nasal problem 124 . Nasal polyposis has been known for a long time to decrease olfactory abilities due to the mechanical obstruction of nasal cavity restricting the airflow to the olfactory cleft 77, 129, 147-151 . During the last two decades, as a result of better olfactory tests, mild olfactory impairments could also be identified in other groups of patients with sinunasal diseases such as allergic and uncomplicated chronic rhinosinusitis 77, 152, 153 . In contrast to posttrau-matic and post-URTI olfactory dysfunctions, these patients rarely exhibit parosmia or phantosmia.

Role of Beta LactamaseProducing Bacteria

Bacterial resistance to the antibiotics used for the treatment of sinusitis has consistently increased in recent years. Production of the enzyme beta-lactamase is one of the most important mechanisms of penicillin resistance. Several potential aerobic and anaerobic BLPB occur in sinusitis. BLPB have been recovered from over a third of patients with acute and chronic sinusitis (8-11,18). H. influenzae and M. caterrhalis are the predominate BLPB in acute sinusitis (18) and S. aureus, pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp., predominate in chronic sinusitis (8-11). The actual activity of the enzyme beta-lactamase and the phenomenon of shielding were demonstrated in acutely and chronically inflamed sinuses fluids (72). BLPB were isolated in 4 of 10 acute sinusitis (Table 5) and in 10 of 13 chronic sinusitis aspirates. The predominate BLPB isolated in acute sinusitis were H. influenzae and M. catarrhalis, and those found in chronic sinusitis were Prevotella and...

Ear Nose and Throat Disease

GERD may be associated with a number of ENT syndromes, including recurrent hoarseness, throat clearing, sore throat, and globus, and signs, such as laryngitis, vocal cord granulomas, ulcers, leukoplakia, sinusitis, and even laryngeal cancer. These patients are usually diagnosed by our ENT colleagues based upon symptoms and signs of inflammation involving the posterior third of the vocal cords and interarytenoid areas, which are both in close proximity to the upper esophageal sphincter. However, the specificity of these findings has recently been questioned our study in 100 healthy volunteers without ENT complaints found signs associated with reflux laryngitis in 86 of these subjects (Hicks et al, 2002). In these individuals, other causes could usually be found, including smoking, alcohol, excessive voice use, allergies, or asthma.

Surgical Risks to the Olfactory System

Chronic rhinosinusitis is the most common chronic inflammatory disease and is frequently associated with impaired sense of smell 198, 199 . When symptomatic patients do not improve on medical treatment, endoscopic sinus surgery (ESS) may be proposed. Nasal polyposis is considered as the ultimate stage of chronic rhinosinusitis for which the mainstay of treatment is medical, but in which ESS plays a part in the majority of cases resistant to medication. Assessment of preoperative olfactory function is important since patients suffering from chronic rhinosinusitis are not always aware of their olfactory dysfunction, and occurrence of olfactory loss or disorders after endonasal surgery has been reported to be as high as 1 183, 200, 201 . Nevertheless, this may be an overestimation, as recent studies suggested 184, 185 . Regarding bilateral choanal atresia, surgical repair at relatively advanced ages (8-10 years) was not associated with olfactory improvement 202 . This observation...

Treatment of Olfactory Disorders

Antibiotics Putrid acute sinusitis is most frequently the result of infection by streptococcus pneumoniae, haemophilus influenzae, and moraxella catarrhalis which are relatively sensitive to antibiotic therapy. However, in the chronic form of putrid sinusitis, staphylococcus aureus and pseudomonas aeruginosa are much more important. Whenever possible, antibiotic therapy should only be started after the bacteria have been identified and tested for resistance to antibiotics. It is important to note that in chronic putrid sinusitis antibiotic treatment is not always successful.

Pathogenesis and Microbiology

The adenoids are believed to play a role in several infectious and noninfectious upper airway illnesses. They may be implicated in the etiology of otitis media (87-91), rhinosinusitis (92,93), adenotonsillitis (94), and chronic nasal obstruction due their hypertrophy (95,96).

Studies in Adults

The presence of anaerobic bacteria in chronic sinusitis in adults is clinically significant. Finegold et al. (25) in a study of chronic maxillary sinusitis, found recurrence of signs and symptoms twice as frequent when cultures showed anaerobic bacterial counts above 103 colony-forming units per milliliter. Anaerobes were identified in chronic sinusitis in adults whenever techniques for their cultivation were employed (24,33). The predominant isolates were pigmented Prevotella, Fusobacterium, and Peptostreptococcus spp. The predominant aerobic bacteria were S. aureus, M. catarrhalis, and Haemophilus spp. A summary of 13 studies of chronic sinusitis done since 1974, including 1758 patients (133 were children) is shown in Table 2 (7,25,32,34-42). Anaerobes were recovered in 12 to 93 . The variability in recovery may result from differences in the methodologies used for transportation and cultivation, patient population, geography, and previous antimicrobial therapy. Brook and Frazier...

Otitis Externa

The bacterial organisms causing Otitis externa are usually Pseudomonas, Staphylococcus, Proteus, Enterobacter, or other Gram-negatives. On the other hand, the bacterial offenders for acute otitis media are usually Pneumococcus, Haemophilus influenza, and Morax-ella catarrhalis, the ones that are often seen in acute sinusitis or other bacterial respiratory infections. This generalization is quite reliable and implies a different treatment for each entity.

Adjunctive Therapy

Leukotriene inhibitors are systemic medications that block the receptor and or production of leukotrienes, potent lipid mediators that increase eosinophil recruitment, goblet cell production, mucosal edema, and airway remodeling. Their role in chronic sinusitis and nasal polyposis is not yet well established (84).

Wound Botulism

Wound botulism has been associated with major soil contamination through compound fractures, severe trauma, lacerations, puncture wound, and hematoma. Of the pediatric cases in the U.S.A. more than half have been associated with compound fracture (10,21,28). Wound botulism was rare in the U.S.A. until the early 1990s. Since that time the incidence increased mostly in the western U.S.A. among deep tissue injectors (skin popping) of black tar heroin (29-32). Minor skin abscesses and paranasal sinusitis (in a heavy user of intranasal cocaine) were the speculated or proved sources of infection and toxin production. Spores may be a contaminant of the drug or from skin (in infection-related cases). The disease has occurred primarily in young males between March and November, the period of maximum outdoor activity. Most cases have been associated with type A toxin-producing organism, although some cases have been associated with type B.

Anaerobic Bacteria

Retrograde Thrombophlebitis

Sinus infection when not treated promptly and properly may spread via anastomosing veins or by direct extension to nearby structures (Fig. 5). Orbital complication was categorized by Chandler et al. (67) into five separate stages according to its severity (see chapter 11). Contiguous spread could reach the orbital area, resulting in periorbital cellulitis, subperiosteal abscess, orbital cellulitis, and abscess. Orbital cellulitis may complicate acute ethmoiditis if a thrombophlebitis of the anterior and posterior ethmoidal veins leads to a spread of infection to the lateral, or orbital, side of the ethmoid labyrinth. Sinusitis may extend also to the central nervous system, causing cavernous sinus thrombosis, retrograde meningitis, and epidural, subdural, and brain abscesses (67,85,86). Monitoring for possible intracranial complication is therefore warranted. Orbital symptoms frequently precede intracranial extension of the disease (27,86). The most common pathogens in cellulitis and...

Bacterial infections

Upper respiratory tract infections and pyogenic bacterial infection (sinusitis, bronchitis and pneumonia) occur more often in HIV-infected individuals than in the general population. Bacterial infections are particularly common in HIV positive intravenous drug users. The most commonly isolated organisms are Streptococcus pneumoniae and Haemophilus influenzae. Severe pneumonia due to Staphylococcus aureus or Gram negative bacteria such as Pseudomonas aeruginosa also occurs, especially in the later stages of AIDS. Respiratory infection may occur with rapid onset, the patient complaining of a cough with or without sputum and fever with chills patients are frequently bacteraemic. There is a high rate of complications including intrapulmonary abscess formation and empyema. A rapid response usually occurs to treatment with appropriate antibiotics but relapse may occur. Some groups recommend that all HIV positive patients should be immunised with polyvalent pneumococcal polysaccharide...

Human Infections

Bacteriological cure in patients with acute otitis media and acute maxillary sinusitis provides a sensitive model for determining the relationship between outcome and time above MIC for multiple P-lactam antibiotics. A variety of clinical trials have included pretherapy and repeat sinus puncture or tympanocentesis of middle ear fluid after 2-7 days of therapy to determine whether the initial organism isolated had been eradicted 25,32,33,48,54,77,79 . Figure 6 demonstrates the Commonly used parenteral doses of ceftriaxone, cefotaxime, penicillin G, and ampicillin provide free-drug concentrations above the MIC90 for penicillin-intermediate strains of S. pneumoniae for at least 40-50 of the dosing interval. A variety of clinical trials in severe pneumococcal pneumonia including bacter-emic cases have demonstrated that these P-lactams are as effective against these organisms as against fully susceptible strains 43,50,72 . Thus, the magnitude of the PK PD parameter determining efficacy for...


Moxifloxacin, 4, is a methoxyfluoroquinolone which is already available and approved for the treatment of acute respiratory infections such as community-acquired pneumonia, intra-abdominal infections, acute sinusitis, and skin infections. It is an inhibitor of DNA gyrase, which is an enzyme important in bacterial growth and

Studies in Children

Anaerobes were recovered in three studies, the only one that employed methods for their isolation (7,31,32). Brook (7) studied 40 children with chronic sinusitis. The sinuses infected were the maxillary (15 cases), ethmoid (13), and frontal (7). Pansinusitis was present in five patients. A total of 121 isolates (97 anaerobic and 24 aerobic) were recovered. Anaerobes were recovered from all 37 culture-positive specimens, and in 14 cases (38 ) they were mixed with aerobes. The predominant anaerobes were AGNB (35), gram-positive cocci (27), and Fusobac-terium spp. (13). The predominant aerobes were alpha-hemolytic streptococci (7), S. aureus (7), and Haemophilus spp. (4). Brook et al. (31) correlated the microbiology of concurrent chronic otitis media with effusion and chronic maxillary sinusitis in 32 children. Two-third of the patients had a bacterial etiology. The most common isolates were H. influenzae (9 isolates), S. pneumoniae (7), Prevotella spp. (8), and Peptostreptococcus spp....

Rr Microbiology

Similar organisms were isolated from aspirate of pus from five periapical abscesses of the upper jaw and their corresponding maxillary sinusitis (23). Polymicrobial flora was found in all instances, where the number of isolates varied from two to five. Anaerobes were recovered from all specimens. The predominant isolates were Prevotella spp., Porphyromonas spp., F. nucleatum, and Peptostreptococcus spp. Concordance in the microbiological findings between periapical abscess and the maxillary sinus flora was found in all instances. However, certain organisms were only present at one site and not the other

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