Sinusitis 28598 225946096 2008-07-16T03:48:28Z Jwy 674008 /* Chronic sinusitis */ dab vertigo {{Infobox_Disease | Name = Sinusitis | Image = | Caption = | DiseasesDB = 12136 | ICD10 = {{ICD10|J|01||j|00}}, {{ICD10|J|32||j|30}} | ICD9 = {{ICD9|461}}, {{ICD9|473}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = emerg| eMedicineTopic = 536 | MeshID = D012852 | }} '''Sinusitis''' is an [[inflammation]] of the [[paranasal sinus]]es, which may or may not be as a result of infection, from [[bacteria]]l, [[fungus|fungal]], [[virus|viral]], [[allergy|allergic]] or [[autoimmunity|autoimmune]] issues. Newer classifications of sinusitis refer to it as '''rhinosinusitis''', taking into account the thought that [[inflammation]] of the sinuses cannot occur without some [[inflammation]] of the [[nose]] as well ([[rhinitis]]). ==Classification== ===By location=== There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses. The [[ethmoid sinus]]es can also be further broken down into anterior and posterior, the division of which is defined as the basal [[lamella]] of the middle [[turbinate]]. In addition to the acuity of [[disease]], discussed below, sinusitis can be classified by the sinus cavity which it affects: *'''[[Maxillary sinus|Maxillary]] sinusitis''' - can cause [[pain]] or pressure in the maxillary ([[cheek]]) area (e.g., [[toothache]], [[headache]]) (J01.0/J32.0) *'''[[Frontal sinus|Frontal]] sinusitis''' - can cause pain or pressure in the [[frontal sinus]] cavity (located behind/above eyes), [[headache]] (J01.1/J32.1) *'''[[Ethmoid sinus|Ethmoid]] sinusitis''' - can cause pain or pressure pain between/behind [[eyes]], [[headache]] (J01.2/J32.2) *'''[[Sphenoid sinus|Sphenoid]] sinusitis''' - can cause pain or pressure behind the [[eye]]s, but often refers to the [[vertex (anatomy)|vertex]] of the [[head]](J01.3/J32.3) Recent theories of sinusitis indicate that it often occurs as part of a spectrum of [[disease]]s that affect the [[respiratory tract]] (i.e. - the "one airway" theory) and is often linked to [[asthma]]. All forms of sinusitis may either result in, or be a part of, a generalized [[inflammation]] of the [[airway]] so other [[airway]] [[symptom]]s such as [[cough]] may be associated with it. [[Image:Maxilar sinusites.jpg|thumb|200px|right|Left-sided maxillar sinusitis (Absence of the air transparency of left maxillar sinus)]] ===By duration=== Sinusitis can be ''[[Acute (medical)|acute]]'' (going on less than four weeks), ''[[subacute]]'' (4-12 weeks) or ''[[chronic (medicine)|chronic]]'' (going on for 12 weeks or more). All three types of sinusitis have similar [[symptom]]s, and are thus often difficult to distinguish. ====Acute sinusitis==== [[Acute (medical)|Acute]] sinusitis is usually precipitated by an earlier [[upper respiratory tract infection]], generally of [[virus|viral]] origin. Virally damaged surface tissues are then colonized by [[bacteria]], most commonly ''[[Haemophilus influenzae]]'', ''[[Streptococcus pneumoniae]]'', ''[[Moraxella catarrhalis]]'' and ''[[Staphylococcus aureus]]''. Other [[bacterial]] [[pathogen]]s include other [[streptococci]] [[species]], [[Anaerobic organism|anaerobic bacteria]] and, less commonly, [[gram negative]] bacteria. Another possible cause of sinusitis can be dental problems that affect the maxillary sinus. [[Acute (medical)|Acute]] episodes of sinusitis can also result from [[fungus|fungal]] invasion. These [[infection]]s are most often seen in [[patient]]s with [[diabetes]] or other [[immunodeficiency|immune deficiencies]] (such as [[AIDS]] or [[Organ transplant|transplant]] [[patient]]s on anti-rejection medications) and can be life threatening. In type I diabetes, ketoacidosis causes sinusitis by Mucormycosis. ====Chronic sinusitis==== Chronic sinusitis is a complicated spectrum of diseases that share chronic inflammation of the sinuses in common. The causes are multifactorial and may include allergy, environmental factors such as dust or pollution, bacterial infection, or fungus (either allergic, infective, or reactive). Non allergic factors such as [[Vasomotor rhinitis]] can also cause chronic sinus problems. Abnormally narrow sinus passages, which can impede drainage from the sinus cavities, can also be a factor. Symptoms include: [[Nasal congestion]]; facial pain; [[headache]]; [[fever]]; general [[malaise]]; thick green or yellow [[Rhinorrhea|discharge]]; [[Vertigo (medical)|vertigo]]; [[blurred vision]], feeling of facial 'fullness' or 'tightness' which worsens on bending over; aching teeth, and [[halitosis]]. Very rarely, chronic sinusitis can lead to [[Anosmia]], the inability to [[olfaction|smell]] or detect odors.{{Fact|date=February 2007}} In a small number of cases, chronic [[maxillary]] sinusitis can also be brought on by the spreading of bacteria from a dental infection. Attempts have been made to provide a more consistent nomenclature 6 for subtypes of chronic sinusitis. A task force for the American Academy of Otolaryngology - Head and Neck Surgery / Foundation along with the Sinus and Allergy Health Partnership broke Chronic Sinusitis into two main divisions, Chronic Sinusitis without polyps and Chronic Sinusitis with polyps (also often referred to as Chronic Hyperplastic Sinusitis). Recent studies which have sought to further determine and characterize a common pathologic progression of disease have resulted in an expansion of proposed subtypes. Many patients have demonstrated the presence of [[Eosinophil granulocyte|eosinophils]] in the mucous lining of the nose and paranasal sinuses. As such the name Eosinophilic Mucin RhinoSinusitis (EMRS) has come into being. Cases of EMRS may be related to an allergic response, but allergy is often not documentable, resulting in further subcategorization of allergic and non-allergic EMRS. A more recent, and still debated, development in chronic sinusitis is the role that [[fungus]] may play. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis, but can also be found in healthy people as well. It remains unclear if fungus is a definite factor in the development of chronic sinusitis and if it is, what the difference may be between those who develop the disease and those who do not. =====Role of biofilms===== [[Biofilm]]s are complex aggregates of extracellular matrix and inter-dependent [[microorganism]]s from multiple species, many of which may be difficult or impossible to [[bacterial culture|isolate]] using standard [[medical microbiology|clinical laboratory]] techniques. [[Bacteria]] found in biofilms may show increased [[antibiotic resistance]] when compared to free-living bacteria of the same species. It has been hypothesized that biofilm-type [[infection]]s may account for many cases of [[antibiotic]]-refractory chronic sinusitis.<ref>{{cite journal |author=Palmer JN |title=Bacterial biofilms: do they play a role in chronic sinusitis? |journal=Otolaryngol. Clin. North Am. |volume=38 |issue=6 |pages=1193–201, viii |year=2005 |pmid=16326178 | doi = 10.1016/j.otc.2005.07.004 <!--Retrieved from CrossRef by DOI bot-->}}</ref> A recent study found that biofilms were present on the [[mucosa]] of 3/4 of patients undergoing [[surgery]] for chronic sinusitis.<ref>{{cite journal | author = Sanclement J, Webster P, Thomas J, Ramadan H | title = Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis. | journal = Laryngoscope | volume = 115 | issue = 4 | pages = 578–82 | year = 2005 | pmid = 15805862}}</ref> ==Sinus headache vs. migraine== {{expert}} Headache/facial pain (characteristic of Sinusitis pain are dull, constant, aching pain over the affected frontal or sphenoid sinus area) is one of the general symptom complained during acute or chronic stages of Sinusitis (Sinusitis = tender face + [[coryza]] + post nasal drip).<ref> Oxford Handbook of Clinical Medicine 15th edition, page 330)</ref> This pain (i.e. facial pain (pressure), headache) is typically localised to the involved sinus and is worsened when the affected person bends over or when in supine position. Rarely, sphenoid or Ethmoid sinusitis causes severe frontal or retroorbital pain and advanced frontal sinusitis can present as [[Pott's puffy tumour]]. During Acute sinusitis thick purulent nasal discharge (usually green in colour and with or without blood) and typical localised headache ([[toothache]]) are present. Whereas in [[Migraine]] (Migraine = episodic typical [[unilateral]] headache + often Vomiting + [[visual disturbances]])<ref> </ref> [[photo phobia]], [[phono phobia]] and [[Triad]] 1. premonitory visual ([[scotoma]] or [[scintillations]]) sensory or motor symptoms, 2. unilateral throbbing headache, 3. [[nausea]] and [[vomiting]] are present.<ref> Harrison's Manual of Medicine 16/e </ref> === Recent studies on sinusitis and migraine === Headache is a common symptom of sinusitis and "sinus headache" rarely but can be a misdiagnosis of a [[migraine]]. Acute sinusitis can cause pressure within the sinus cavities of the head, but this typically has associated pain to palpation of the sinus area and purulent greenish discharge from the nose. The use of the term ''sinus headache'' therefore is often misleading and results in underdiagnosis of migraine. Recent studies indicate that up to 90% of "sinus headaches" are migraine<ref>{{cite journal |author=Schreiber C, Hutchinson S, Webster C, Ames M, Richardson M, Powers C |title=Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache |journal=Arch. Intern. Med. |volume=164 |issue=16 |pages=1769–72 |year=2004 |pmid=15364670 | doi = 10.1001/archinte.164.16.1769 <!--Retrieved from CrossRef by DOI bot-->}}</ref><ref name="pmid16213917">{{cite journal |author=Mehle ME, Schreiber CP |title=Sinus headache, migraine, and the otolaryngologist |journal=Otolaryngology&mdash;head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery |volume=133 |issue=4 |pages=489–96 |year=2005 |pmid=16213917 |doi=10.1016/j.otohns.2005.05.659}}</ref> This confusion occurs in part because migraine involves activation of the [[trigeminal nerves]] which innervate both the sinus region but also the meninges which surround the brain. As a result, direct determination of the site of pain origination can be confused on a cortical level. Additionally, nasal congestion is not an uncommon result of migraine headaches, further confusing the issue. A recent study further demonstrated that most patients with "sinus headache" respond to triptan migraine medications, and state dissatisfaction with their treatment when they are treated with decongestants or antibiotics.<ref>{{cite journal| author= Ishkanian, G|title= Efficacy of sumatriptan tablets in migraineurs self-described or physician-diagnosed as having sinus headache: A randomized, double-blind, placebo-controlled study|journal=Clin Ther |year=2007 |month=Jan |volume=29 |issue=1 |pages=99–109|doi= 10.1016/j.clinthera.2007.01.012}}</ref> The subtlety is that while most patients with sinusitis have some sort of facial pain, pressure, or headache, not all patients who attribute the symptom of headache to their sinuses may have legitimate diseases of the sinus. Acute and chronic sinusitis can cause pressure within the sinus cavities of the head, but this is associated with pain on palpation of the sinus area. ==Predisposing factors== [[Image:Fungal tounge.jpg|thumb|upright|right|Asymmetric growth of tongue plaque due to drainage from a fungal sinus infection.]] Factors which may [[predispose]] to developing sinusitis include: [[allergy|allergies]]; structural problems such as a [[deviated septum]] or small [[sinus ostia]]; smoking; [[nasal polyp]]s; carrying the [[cystic fibrosis]] gene (research is still tentative); prior bouts of sinusitis as each instance may result in increased inflammation of the nasal or sinus mucosa and potentially further narrow the openings. ==Diagnosis== ===Acute sinusitis=== Usually Sinusitis is diagnosed clinically. Clinically bacterial and Viral [[Acute]] sinusitis are difficult to distinguish however, disease duration less than 7 days is considered as a Viral whereas more than 7 days are considered as a bacterial sinusitis (usually 30% to 50% are Bacterial sinusitis). *In suspected Acute [[Fungal]] Sinusitis - Multiple [[biopsy]] of involved area are performed to confirm [[etiological diagnosis]]. *[[Nosocomial]] Acute sinusitis is confirmed with the help of [[CT scan]] of the sinuses. ===Chronic sinusitis=== In Chronic sinusitis (lasting more than 12 weeks) [[CT scan]], tissue sample for [[Histology]] and [[Cultures]] can be used for diagnosis. *In Chronic Bacterial sinusitis [[CT scan]] is used to define the range, extent of the disease and response of the [[treatment course]]. [[Tissue sample]]s for [[Histology]] and [[culture]] is obtained to confirm a diagnosis. *Allergic [[fungal]] sinusitis are often seen in a person with asthma and [[nasal polyp]]s. Multiple [[Biopsy]] is informative to confirm the diagnosis.<ref> Harrison's Manual of Medicine 16/e </ref> When imaging techniques are required for diagnosis [[Computed tomography|CT scanning]] is the method of choice. If allergies are suspected, allergy testing may be performed. ENT specialists utilize a procedure known as nasal endoscopy (if nasal endoscopy is indicated) to diagnose sinus infection. This involves inserting a flexible fiber-optic tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses. This is generally a completely painless procedure which takes between 5 to 10 minutes to complete. ==Treatment== ===Acute sinusitis=== There are over the counter medicines that can relieve some of the symptoms associated with sinusitis, such as headaches, pressure, fatigue and pain. Usually these are a combination of some kind of [[antihistamine]] along with [[decongestant]] or pain reliever. Seeing a doctor will usually result in a prescription for antibiotics and a recommendation for rest. Therapeutic measures range from the medicinal to the traditional and may include [[nasal irrigation]] or [[jala neti]] using a warm saline solution, hot drinks including [[tea]] and [[chicken soup]], over-the-counter decongestants and nasal sprays, and getting plenty of rest. Analgesics (such as [[aspirin]], [[paracetamol]] (acetaminophen) or [[ibuprofen]]) can be used, but caution must be employed to make sure the patient does not suffer from [[Samter's triad|aspirin-exacerbated respiratory disease]] (AERD) as this could lead to [[anaphylaxis]]. If sinusitis doesn't improve within 48 hours, or is causing significant pain, a doctor may prescribe [[antibiotic]]s ([[Amoxicillin]] usually being the most common) with amoxicillin/clavulanate ([[Augmentin]]/Co-Amoxiclav) being indicated for patients who fail amoxicillin alone. [[Fluoroquinolones]], and less frequently [[Doxycycline]] are used in patients who are allergic to penicillins. {{Fact|date=April 2007}} A recent British study has found that for most cases of acute sinusitis, antibiotics and nasal [[corticosteroids]] work no better than a placebo.<ref>{{cite journal | author=Ian G. Williamson et al. | title= Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis | journal = JAMA | year=2007 | volume =298| pages =2487–2496 | doi= 10.1001/jama.298.21.2487 | pmid= 18056902}}</ref> ===Chronic sinusitis=== ===Simple measures === '''[[Nasal irrigation]] and flush''' promotes sinus cavity health, and patients with chronic sinusitis including symptoms of facial pain, headache, [[halitosis]], cough, anterior rhinorrhea (watery discharge) and nasal congestion found nasal irrigation to be "just as effective at treating these symptoms as the drug therapies." In other studies, "daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis," and is "recommended as an effective adjunctive treatment of chronic sinonasal symptoms."<!-- Try gargling with a Mouthwash - like Savacol. It seems to kill the bacteria - and helps you from sneezing! --><ref>{{cite journal | author = Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R | title = Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. | journal = J Fam Pract | volume = 51 | issue = 12 | pages = 1049–55 | year = 2002 | pmid = 12540331}}</ref><!-- --><ref>{{cite journal | author = Rabago D, Pasic T, Zgierska A, Mundt M, Barrett B, Maberry R | title = The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. | journal = Otolaryngol Head Neck Surg | volume = 133 | issue = 1 | pages = 3–8 | year = 2005 | pmid = 16025044 | doi = 10.1016/j.otohns.2005.03.002 <!--Retrieved from CrossRef by DOI bot-->}}</ref><!-- --><ref>{{cite journal | author = Tomooka L, Murphy C, Davidson T | title = Clinical study and literature review of nasal irrigation. | journal = Laryngoscope | volume = 110 | issue = 7 | pages = 1189–93 | year = 2000 | pmid = 10892694 | doi = 10.1097/00005537-200007000-00023 <!--Retrieved from CrossRef by DOI bot-->}}</ref> [[Image:SinuPulse Pulsating Nasal Irrigation System.jpg|thumb|150px|Pulsating nasal irrigator.]] Some people use bulb syringes, squirt bottles, and neti pots. Others use pulsating irrigation devices that deliver an intermittent pulsing saline rinse to remove bacteria, purulent material, and help restore ciliary function. Some published medical reports indicate pulsatile lavage is more effective at cleansing and removing bacteria than non-pulsating nasal wash products like bulb syringes, neti pots and squeeze bottles, which rely simply on gravity and conventional flow.<ref name=" Brown LL ">{{cite journal | last = Brown | first = LL | coauthors = Shelton HT, Bornside GH, Cohn I Jr | title = Evaluation of wound irrigation by pulsatile jet and conventional methods | journal = Ann Surg. | volume = 187 | issue = (2) | pages = 170–73 | publisher = |date=1978 February | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=343735 | pmid = 343735 | accessdate = }}</ref><ref name=" Anglen J ">{{cite journal | last = Anglen | first = J | coauthors = Apostoles S, Christensen G, Gainor B. R | title = The efficacy of various irrigation solutions and methods in removing slime-producing staphylococcus | journal = J Orthop Trauma | volume = 8 | issue = (2) | pages = 390–6 |date=1994 October | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=7996321 | pmid = 7996321 | accessdate = | doi = 10.1097/00005131-199410000-00004 }}</ref><ref name=" Svoboda SJ">{{cite journal | last = Svoboda | first = SJ | authorlink = | coauthors = Bice TG, Gooden HA, Brooks DE, Thomas DB, Wenke JC | title = Comparison of bulb syringe and pulsed lavage irrigation. | journal = J Bone Joint Surg Am | volume = 88 | issue = (10) | pages = 2167–74 |date=2006 October | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=17015593 | doi = | pmid = 17015593 | accessdate = | unused_data = |publisher }}</ref> A pulsating nasal irrigation device delivers a controlled flow with pressure control that may be adjusted for individual comfort. Medical reports support that positive pressure irrigation retains a larger volume of solution and irrigates the sinuses more consistently than other methods.<ref name=" Olson DE">{{cite journal | last = Olson | first = DE | coauthors = Rasgon BM, Hilsinger, RL Jr. | title = Radiographic comparison of three methods for nasal saline irrigation | journal = Laryngoscope. | volume = 112 | issue = (8 Pt 1) | pages = 1394–98 | publisher = |date= 2002 August | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12172251 | pmid = 12172251 | accessdate = | doi = 10.1097/00005537-200208000-00013 }}</ref> ===Medical approaches=== For chronic or recurring sinusitis, referral to an [[Otolaryngology|otolaryngologist]] may be indicated for more specialist assessment and treatment, which may include '''nasal surgery'''. However, for most patients the surgical approach is not superior to appropriate medical treatment. Surgery should only be considered for those patients who do not experience sufficient relief from optimal medication.<!-- --><ref>{{cite journal | author =Fokkens W, Lund V, Mullol J | title =European Position Paper on Rhinosinusitis and Nasal Polyps 2007 | journal =Rhinol Suppl. | volume = | issue =20 | pages =67 | year =2007 | pmid =17844873}}</ref><!-- --><ref>{{cite web |url=http://www.sinuses.com/faq.htm#surgery |title= FAQ - Sinusitis - WS Tichenor M.D. |accessdate=2007-10-28 |last=Tichenor |first=Wellington S. |coauthors= |date=2007-04-22 |work= |publisher=}}</ref> A relatively recent advance in the treatment of sinusitis is a type of surgery called '''[[Functional Endoscopic Sinus Surgery|FESS]]''' - functional [[Endoscope|endoscopic]] sinus surgery, whereby normal clearance from the sinuses is restored by removing the anatomical and pathological obstructive variations that predispose to sinusitis. This replaces prior open techniques requiring facial or oral incisions and refocuses the technique to the natural openings of the sinuses instead of promoting drainage by gravity, the idea upon which the '''Caldwell-Luc surgery''' was based.[http://www.fasthealth.com/dictionary/c/Caldwell-Luc_operation.php] Another '''recently developed treatment is [[sinuplasty (procedure)|balloon sinuplasty]]'''. This method, similar to [[balloon angioplasty]] used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the openings of the sinuses in a less invasive manner. Its final role in the treatment of sinus disease is still under debate but appears promising. Based on the recent theories on the role that fungus may play in the development of chronic sinusitis, newer medical therapies include '''topical nasal applications of [[antifungal]] agents'''. Much of the original research indicating fungus took place at the [[Mayo Clinic]] and they have since patented this treatment option.<ref>{{cite web | title=Resources on Chronic Rhinosinusitis | url=http://www.sinusacademy.com | year=2004 | publisher=Accentia Biopharmaceuticals Company and Mayo Clinic}}</ref> Although there are some licensing battles taking place over these drugs as a result of the patent, they are currently available for other uses and therefore can be compounded by pharmacies or even by the patient.{{Fact|date=November 2007}} === Surgical approach and treatment === {{expert}}{{Refimprovesect|date=January 2008}} A number of surgical approaches can be used, either by [[endoscopy]] or conventional [[incision]] generally through nose or mouth. *Endoscopic nasal Surgery allows more functional approach than by radical antrostomy. *Intranasal endoscopic operations permits minimal trauma to adjacent tissues and precise removal of the diseased mucosa. If [[fibrosis]] of the [[antrum]] is present (natural ostium can be completely obstructed) by infection and inflammation; [[intranasal inferior meatal antrostomy]] can be used to ease drainage from the antrum. Or, intranasal indoscopic techniques can be used to create a [[middle meatal antrostomy]] (e.g. middle turbinate is lifted and infundibulum is localised and enlarged anteriorly, generally excision of anterior end of the unicate process is not required, antrum can be inspected through antrostomy by the use of 30 and 70 degree rigid endoscopy.) For persisting Sinusitis [[Caldwell-Luc radical antrostomy]] can be used (e.g. incision in the upper [[gum]], opening in the anterior wall of the antrum, removal of the entire diseased [[maxillary sinus mucosa]] and drainage is allowed into inferior meatus by creating a large window in the lateral nasal wall.)<ref> Bailey and Love </ref> Once incissional entry is gained into the paranasal sinus, surgery can be extended to another sinus or other adjacent anatomical structures. e.g. [[internal maxillary artery]], [[pterygopalatine fossa]] and [[sphenopalatine ganglion]]. ===Other approaches=== [[Phage therapy]]: Since the discovery of spontaneous bacterial lysis (from [[bacteriophages]]) by [[Frederick Twort]] and by [[Felix d'Herelle]], [[phage therapy]] (treatment with bacterial viruses) has been used extensively with miscellaneous bacterial infections in the areas of [[otolaryngology]], [[stomatology]], [[ophthalmology]], [[dermatology]], [[pediatrics]], [[gynecology]], [[surgery]] (especially against wound infections), [[urology]], and [[pulmonology]].<!-- --><ref name=jctb>{{cite journal | author=N Chanishvili, T Chanishvili, M. Tediashvili, P.A. Barrow | title=Phages and their application against drug-resistant bacteria | journal=J. chem. technol. biotechnol. | year=2001 | volume=76 | pages=689–699 | url=http://cat.inist.fr/?aModele=afficheN&cpsidt=1096871 | doi=10.1002/jctb.438 }}</ref><!-- --><ref name="pmid8571474">{{cite journal |author=Perepanova TS, Darbeeva OS, Kotliarova GA, ''et al'' |title=[The efficacy of bacteriophage preparations in treating inflammatory urologic diseases] |language=Russian |journal=Urol. Nefrol.|volume= |issue=5 |pages=14–7 |year=1995 |pmid=8571474 |doi=}}</ref><!-- --><ref>{{cite journal | title=Application of Phages in Urology | author=Tsulukidze AP | journal=Urology | volume=XV(1) | pages=10–13 | year=1938}}</ref> Treatment with phages was developed in the Soviet Union in parallel to the western development of antibiotics. Currently phage therapy for chronic Sinusitis is available at the Phage Therapy Center, Tbilisi, Republic of Georgia,<!-- --><ref>[http://www.phagetherapycenter.com/pii/PatientServlet?command=static_sinusitis]</ref> or in Poland.<!-- --><ref>[http://www.iitd.pan.wroc.pl/phages/phages.html]</ref> ==References== {{refbegin}} * {{cite journal | author = Ramadan H, Sanclement J, Thomas J | title = Chronic rhinosinusitis and biofilms. | journal = Otolaryngol Head Neck Surg | volume = 132 | issue = 3 | pages = 414–7 | year = 2005 | pmid=15746854 | doi = 10.1016/j.otohns.2004.11.011 <!--Retrieved from CrossRef by DOI bot-->}} * {{cite journal | author = Bendouah Z, Barbeau J, Hamad W, Desrosiers M | title = Biofilm formation by Staphylococcus aureus and Pseudomonas aeruginosa is associated with an unfavorable evolution after surgery for chronic sinusitis and nasal polyposis. | journal = Otolaryngol Head Neck Surg | volume = 134 | issue = 6 | pages = 991–6 | year = 2006 | pmid=16730544 | doi = 10.1016/j.otohns.2006.03.001 <!--Retrieved from CrossRef by DOI bot-->}} {{refend}} ==Footnotes== {{reflist|2}} ==External links== * [http://www.medterms.com/script/main/art.asp?articlekey=32138 Sinus Headache - Medterm.com] * [http://www.medicinenet.com/sinusitis/article.htm Sinus infection - MedicineNet.com]. * [http://www.mayoclinic.com/invoke.cfm?id=DS00170 Acute sinusitis - MayoClinic.com], from the Web site of the [[Mayo Clinic]]. * [http://www.mayoclinic.com/health/chronic-sinusitis/DS00232 Chronic sinusitis - MayoClinic.com], from the Web site of the [[Mayo Clinic]] * [http://www.niaid.nih.gov/factsheets/sinusitis.htm NIH] * [http://www.nhsdirect.nhs.uk/en.aspx?articleID=338 NHS Direct] {{Respiratory pathology}} {{Common Cold}} [[Category:Rhinology]] [[Category:General practice]] [[Category:headaches]] [[Category:Inflammations]] [[ar:التهاب الجيوب]] [[bg:Синуит]] [[de:Sinusitis]] [[es:Sinusitis]] [[fr:Sinusite]] [[ko:부비강염]] [[hr:Sinusitis]] [[id:Sinusitis]] [[it:Sinusite]] [[nl:Bijholteontsteking]] [[ja:副鼻腔炎]] [[no:Bihulebetennelse]] [[pl:Zapalenie zatok przynosowych]] [[pt:Sinusite]] [[ro:Sinuzită]] [[ru:Синусит]] [[sq:Sinuziti]] [[fi:Poskiontelontulehdus]] [[sv:Bihåleinflammation]] [[th:ไซนัสอักเสบ]] [[vi:Viêm xoang]] [[tr:Sinüzit]] [[zh:鼻竇炎]]