Ayub Ahmed Khan, Rizwan Akbar Bajwa, Usman Aslam.
Clinical Correlation between X-Ray Paranasal Sinuses and Proof Puncture in Maxillary Sinusitis.
Pak J Med Health Sci Jan ;12(3):914-6.

Background: Maxillary sinusitis is among the most common diseases, which the otolaryngologist comes across in his practice. Maxillary sinus holds a central place in infection of other sinuses and therefore, accurate diagnosis and treatment of maxillary sinusitis likewise plays a pivotal role in the treatment of other sinusitis. Aims: To make a statistical analysis of the distribution, clinical features and organisms isolated in a series of patients suffering from maxillary sinusitis to find the accuracy of X-ray paranasal sinuses in the diagnosis of maxillary sinusitis. Methods: The prospective clinical study was conducted at Combined Military hospital, Lahore. The study was conducted over a time period of one year in 960 patients selected out of the patients coming to ENT OPD. The selection criterion was the clinical diagnosis of maxillary sinusitis in these patients. Young patients under the age of sixteen and elderly patients over the age of sixty-five were excluded from the study. All patients then underwent plain X-ray paranasal sinuses (Occipitomental or Water's view) and diagnostic proof puncture/antral lavage under local or general anaesthesia to confirm the diagnosis. Results: The results obtained from this study led to the following conclusions. Firstly, maxillary sinusitis is predominantly a disease of young males, with higher distribution in winter months, for lower socioeconomic class and for chronic disease. Secondly, maxillary sinusitis is a multifactorial disease with the most common aetiological factors and concomitant diseases being rhinitis and pharyngeal infection. Thirdly, the disease presented with varied symptoms and signs in acute and chronic stages. The most frequent modes of presentation were nasal obstruction and postnasal discharge. The most frequent clinical finding was swollen inferior turbinates. Fourthly, plain X-ray paranasal sinuses were found to be quite accurate in the diagnosis of maxillary sinusitis. Fifthly, diagnostic proof puncture although more reliable diagnostic procedure but being invasive should preferably be used as a therapeutic modality. Sixthly, the commonest organisms isolated from puncture aspirate were, haemophilus influenzae in acute cases while staphylococcus aureus was commonest in chronic cases. Conclusion: In the end, this study would be incomplete without the finale of recommen dations. It is strongly recommended that the clinical diagnosis of maxillary sinusitis should be routinely investigated with cheap and readily available plain x-ray paranasal sinuses. Acute and chronic cases unresponsive to conservative treatment should be the only patients subjected to the invasive procedure of diagnostic proof puncture/antral lavage.

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