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. 2012 Jul-Aug;78(4):35-41.
doi: 10.1590/S1808-86942012000400008.

The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis

[Article in English, Portuguese]
José Arruda Mendes Neto  1 , Viviane Maria Guerreiro, Elcio Roldan Hirai, Eduardo Macoto Kosugi, Rodrigo de Paula Santos, Luis Carlos Gregório
Affiliations

The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis

[Article in English, Portuguese]
José Arruda Mendes Neto et al. Braz J Otorhinolaryngol. 2012 Jul-Aug.

Abstract

Rhinosinusitis is one of the most common causes of fever of unknown origin in critically ill patients and should be systematically searched.

Objective: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital.

Materials and methods: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture.

Results: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii.

Conclusion: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and therapeutic tool for critically ill patients.

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Figures

Figure 1
Figure 1
Left inferior meatus. 1: Inferior nasal concha; 2: Hasner's valve; 3: Site of puncture on the lateral wall of the left inferior meatus.
Figure 2
Figure 2
Study organizational flowchart. n = number of subjects.
Figure 3
Figure 3
Distribution of paranasal sinuses with radiological sings of rhinosinusitis. n = number of nasal cavities.
Figure 4
Figure 4
Distribution of antibiotics administered to patients diagnosed with infective rhinosinusitis.
Figure 5
Figure 5
Distribution of microbiological analyses of maxillary sinus aspirates.
See this image and copyright information in PMC

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