| 1. |
- Abul-Kasim, Kasim, et al.
(författare)
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Low-dose computed tomography of the paranasal sinuses: radiation doses and reliability analysis.
- 2011
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Ingår i: American Journal of Otolaryngology. - : Elsevier BV. - 1532-818X .- 0196-0709. ; 32, s. 47-51
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The study aimed to (1) optimize the radiation doses of computed tomography (CT) of paranasal sinuses, (2) compare the radiation doses of different CT protocols with that of plain radiography, and (3) evaluate the reliability of low-dose CT in the detection of pathology and characterization of the detected pathology. MATERIALS AND METHODS: A head phantom was examined with different scan parameters to define a cutoff value to which the radiation dose can be reduced without negative impact on image quality. Kruskal-Wallis test and Wilcoxon W test were performed to compare the effective doses of the plain radiography in 30 patients with that of 3 different CT protocols in a total of 90 patients. The interobserver and intraobserver agreement in the detection of pathologic findings and in characterization of the pathology was estimated by calculating kappa value. RESULTS: The effective doses of plain radiography and low-dose CT were 0.098 and 0.045 mSv, respectively (P < .001). The effective dose of standard CT of sinuses (0.371 mSv) was 3.8 times higher than that of plain radiography and 8.2 times higher than that of low-dose CT (P < .001). The interobserver and intraobserver agreement on CT with regard to detection of pathology and pathology characterization was almost perfect (kappa values 0.81-1) compared to fair (kappa values 0.38-0.39) in plain radiography. CONCLUSIONS: The here proposed low-dose CT means significant dose reduction and is a reliable method in the investigation of the paranasal sinuses.
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| 2. |
- Ehnhage, Anders, et al.
(författare)
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Treatment of idiopathic rhinitis with kinetic oscillations : a multi-centre randomized controlled study
- 2016
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 136:8, s. 852-859
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Tidskriftsartikel (refereegranskat)abstract
- Conclusions: The potential effects of KOS are still uncertain regarding the most effective air pressure to be used as well as the physiological effects on the nasal mucosa. The results of the study do not support a convincing treatment effect by KOS on IR.Objectives: Idiopathic rhinitis (IR) is a common disorder, affecting ∼10-20% of the population. A new method for treating IR, Kinetic Oscillation Stimulation (KOS), has been reported to have beneficial effects on total vasomotor symptom scores (TVRSS). The primary objective with this study was to evaluate if a mean pressure of 65 mbar, pressure amplitude of 100 mbar, and 68Hz treatment with KOS had a positive effect on total vasomotor symptom scores (TVRSS), as compared with a mean pressure of 65 mbar, pressure amplitude of 4 mbar, and 68Hz treatment in patients with idiopathic rhinitis.Methods: Two hundred and seven patients were randomized (Full Analysis Set, FAS) in the study, including five visits and lasting for approximate to 25 weeks. All patients had two treatment episodes, and all patients had at least one treatment, meant as active, with high amplitude pressure for 10min in each nostril. Group 1 had two such treatments, and Group 2 had one treatment with low amplitude pressure, initially meant as placebo, on one occasion. Because of numerical improvements in these two groups, a new control group, Group 3, was introduced. They had one new control treatment where the balloon was inserted into the nose, without any air inflation and without oscillations.Results: KOS treatment with high amplitude pressure did not have significant beneficial effects as compared to low amplitude pressure on TVRSS. Numerical improvements in TVRSS and SNOT 22 were found when comparing high and low amplitude pressure treatments with uninflated balloon treatment. However, this part of the study was initially single-blinded, and these results were secondary objectives.
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| 3. |
- Hallén, Tobias, et al.
(författare)
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Sinonasal Symptoms and Self-Reported Health before and after Endoscopic Pituitary Surgery-A Prospective Study
- 2022
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Ingår i: Journal of Neurological Surgery, Part B: Skull Base. - : Georg Thieme Verlag KG. - 2193-634X .- 2193-6331. ; 83:suppl. 2
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Tidskriftsartikel (refereegranskat)abstract
- © 2021 Thieme Medical Publishers, Inc.. All rights reserved. Objectives Despite the limited invasiveness of endoscopic transsphenoidal surgery (ETSS), some degree of nasal structure destruction is unavoidable. Our objective was to evaluate sinonasal morbidity and self-reported health before and 6 months after ETSS for pituitary tumors, and to identify possible predictive factors for deterioration in sinonasal health. Design Prospective observational cohort study. Setting University tertiary referral hospital. Participants Totally 109 consecutive adult patients undergoing ETSS for pituitary tumors between 2015 and 2019. Main Outcome Measures Sinonasal symptoms and self-reported health before and 6 months after ETSS, assessed by the Sinonasal Outcome Test (SNOT-22) and the EQ-5D questionnaire. Predictive factors for postoperative deterioration in sinonasal symptoms. Results The overall SNOT-22 score did not change, but the score of the rhinologic domain of SNOT-22 worsened from 6.0 ± 5.9 before to 8.0 ± 7.4 6 months after surgery (p = 0.011). The EQ-5D visual analog scale improved from 64.0 ± 22.9 before to 71.1 ± 18.7 6 months after surgery (p = 0.00088). Univariate and multivariable regression analyses showed that prior sinonasal surgery was associated with a significant worsening in rhinologic symptoms 6 months after surgery (p = 0.046 and p = 0.020, respectively). Conclusions Although self-reported overall health improved, significant deterioration of rhinologic symptoms was seen 6 months after ETSS. This information is important for preoperative patient counselling. Further refinement of the surgical technique and follow-up strategies to reduce postoperative sinonasal morbidity could be of value, especially in patients who have undergone prior sinonasal surgery.
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| 4. |
- Jansson, Tomas, et al.
(författare)
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Ultrasound Doppler for improved diagnosis of disease in the paranasal sinuses
- 2005
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Ingår i: Proceedings - IEEE Ultrasonics Symposium. - 1051-0117. - 0780393821 ; 2, s. 839-841
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Konferensbidrag (refereegranskat)abstract
- We propose a method to improve the diagnosis of infection in the paranasal sinuses, distinguishing between mucous and serous cases. The method utilizes a previously published method whereby the viscosity in a sealed container may be measured using an ultrasound Doppler method. As ultrasound propagates in a liquid medium, due to attenuation, the resulting pressure gradient will cause the liquid to move in the propagation direction - the wellknown effect of acoustic streaming. The streaming velocity will, for a given acoustic output, be proportional to the viscosity of the fluid. In this study, we verify that acoustic streaming can be induced in an anthropomorphic sinus phantom cast from a human cranium. The sinus phantom was made from agar with added graphite providing sound attenuation prior to the sinus cavity corresponding to an in vivo situation. A number of water-glycerol solutions with scattering particles, were prepared to mimic a clinically interesting range of viscosities (7-47 mPas). Using a 4.2 MHz continuous wave Doppler probe, clearly detectable mean Doppler shifts in the range of 6.5 to 20 Hz were recorded A linear relationship was found between the Doppler shifts and 1/viscosity (R2=0.94, corrected for the square-law dependence of sound speed variation due to varying glycerol concentration).
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| 5. |
- Jönsson, Peter, et al.
(författare)
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Feasibility of measuring acoustic streaming for improved diagnosis of rhinosinusitis
- 2008
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 34:2, s. 228-238
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Tidskriftsartikel (refereegranskat)abstract
- No noninvasive methods exist currently with the capability of distinguishing between various stages of a sinus infection. We studied a method based on induced acoustic streaming in the accumulated fluid within the maxillary sinuses. The hypothesis was that acoustic streaming will not be induced at clinically acceptable intensity levels in infectious mucous fluid because of its high viscosity, whereas detected acoustic streaming is a strong indication that the sinus content is a noninfectious serous fluid. As a model, an anthropomorphic sinus phantom with bovine cortical bone to mimic the bone surrounding the maxillary sinus was constructed. Milk (1.5% fat content) was used as model fluid. From fluid and bone attenuation measurements, an ultrasound frequency of about 5 MHz was estimated to produce the highest acoustic streaming in the sinus phantom. Simulations of the acoustic streaming in a sealed cavity also showed that the width of the ultrasound beam should be about half the size of the cavity to optimize the streaming velocity. With a 4.9-MHz continuous-wave transducer operating at a spatial peak temporal average intensity of 640 mW/cm(2), an acoustic streaming velocity of 0.19 cm/s was generated and detected in the sinus phantom.
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| 6. |
- Sahlstrand Johnson, Pernilla, et al.
(författare)
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A multi-centre study on quality of life and absenteeism in patients with CRS referred for endoscopic surgery
- 2011
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Ingår i: Rhinology. - 0300-0729. ; 49:4, s. 420-428
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study summarises the health-related quality of life (HRQOL) scores and absenteeism caused by sinus problems in patients awaiting surgery with the diagnoses recurrent acute rhinosinusitis (RARS), chronic rhinosinusitis with nasal polyps (CRS+NP) or CRS without nasal polyps (CRS-NP), in a prospective multi-centre study. Methodology: Two hundred and seven patients with RARS, CRS+NP or CRS-NP were enrolled. EP3OS definitions of CRS and NP were used. The patients completed the 22 Sinonasal Outcome Test (SNOT-22), the short-form 36-item questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HAD) and a total Visual Analogue Scale (VAS) regarding rhinosinusitis symptoms. Results: SNOT-22 and VAS scores indicated severe disease. Comparison of the HRQOL scores in the three rhinosinusitis subgroups showed statistical differences in nine of the SNOT-22 items and in the SF-36 subscale of bodily pain. Mean scores of SF-36 were significantly lower than that of the normal Swedish population. According to the HAD scores, 28% of the patients had probable or possible anxiety or depression disorder. Fifty-seven percent of the patients reported absenteeism from work due to sinus problems. Conclusions: RARS, CRS+NP and CRS-NP significantly decrease HRQOL. Some statistically significant differences in HRQOL were found between the three rhinosinusitis subgroups. Absenteeism due to chronic sinus conditions is considerable.
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| 7. |
- Sahlstrand Johnson, Pernilla, et al.
(författare)
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Computed tomography measurements of different dimensions of maxillary and frontal sinuses.
- 2011
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Ingår i: BMC Medical Imaging. - : Springer Science and Business Media LLC. - 1471-2342. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- We have previously proposed the use of Doppler ultrasound to non-invasively stage sinus infection, as we showed that acoustic streaming could be generated in nonpurulent sinus secretions and helped to distinguish it from mucopurulent sinus secretions. In order to continue this development of a clinically applicable Doppler equipment, we need to determine different dimensions of the paranasal sinuses, especially the thickness of the anterior wall of the maxillary sinus (at the canine fossa). To the best of our knowledge, this is the first report on the thickness of the canine fossa. This study aimed to (a) estimate different dimensions of the maxillary and frontal sinuses measured on computed tomography (CT) of the head, (b) define cut-off values for the normal upper and lower limits of the different measured structures, (c) determine differences in age, side and gender, (d) compare manually and automatically estimated maxillary sinuses volumes, and (e) present incidental findings in the paranasal sinuses among the study patients. METHODS: Dimensions of 120 maxillary and frontal sinuses from head CTs were measured independently by two radiologists. RESULTS: The mean value of the maxillary sinus volume was 15.7 ± 5.3 cm3 and significantly larger in males than in females (P = 0.004). There was no statistically significant correlation between the volume of maxillary sinuses with age or side. The mean value of the bone thickness at the canine fossa was 1.1 ± 0.4 mm. The automatically estimated volume of the maxillary sinuses was 14-17% higher than the calculated volume. There was high interobserver agreement with regard to the different measurements performed in this study. Different types of incidental findings of the paranasal sinuses were found in 35% of the patients. CONCLUSION: We presented different dimensions of the maxillary and frontal sinuses on CTs. We believe that our data are necessary for further development of a clinically applicable Doppler equipment for staging rhinosinusitis
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| 8. |
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| 9. |
- Sahlstrand Johnson, Pernilla, et al.
(författare)
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IN VITRO STUDIES AND SAFETY ASSESSMENT OF DOPPLER ULTRASOUND AS A DIAGNOSTIC TOOL IN RHINOSINUSITIS
- 2010
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 36:12, s. 2123-2131
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Tidskriftsartikel (refereegranskat)abstract
- We have previously proposed the use of Doppler ultrasound to noninvasively stage a sinus infection. In this study, we first investigated the acoustic properties of nonpurulent and mucopurulent sinus secretions. The density, viscosity, speed of sound and attenuation of 18 samples of sinus fluid were examined. We then assessed the safety of the method by determining the temperature increase when ultrasound is transmitted through a bone sample of the same thickness as the anterior wall of the maxillary sinus. As a measure of the probability to generate acoustic streaming, we determined the ratio of sound attenuation over the viscosity of the sinus fluid and compared this with the value obtained from acoustic streaming measurements on a model system. The results indicated that detectable levels of acoustic streaming can be generated in serous sinus fluid, which has a low viscosity, but is very unlikely in mucopurulent secretions. The attenuation of the mucopurulent sinus fluid was 10 times higher than that of the serous cyst fluid, but the viscosity of the mucopurulent secretion was a thousand times higher than that of serous fluid. The safety experiments gave a temperature increase of the bone of
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| 10. |
- Sahlstrand Johnson, Pernilla
(författare)
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On Health-Related Quality of Life and Diagnostic Improvements in Rhinosinusitis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rhinosinusitis is defined as an inflammatory process involving the mucosa of the nose and one or more of the paranasal sinuses. The aims of the work presented in this thesis were to investigate the degree to which rhinosinusitis affects the health-related quality of life (HRQOL), and to determine whether the diagnosis of this condition can be improved using Doppler ultrasound. The HRQOL of 207 patients divided into three subgroups, one with recurrent acute rhinosinusitis, and two with chronic rhinosinusitis, with or without nasal polyps, was evaluated with the 22 Sinonasal Outcome Test (SNOT-22), the 36-item short-form questionnaire (SF-36), the Hospital Anxiety and Depression (HAD) scale and a total visual analogue scale (VAS). These patients’ HRQOL was significantly decreased compared to normative values. Some significant differences in HRQOL scoring were found between the three subgroups. The study cohort reported 8-14 days of absenteeism per year due to their sinus problems. SNOT-22 and the total VAS appeared to be appropriate outcome measures in cases of rhinosinusitis in the Swedish population. It is not possible to differentiate serous sinus fluid (with a low viscosity) from mucopurulent sinus secretions (with high viscosity) with computed tomography (CT) or ultrasound. A means of determining the properties of sinus secretions non-invasively would, however, be of value, as bacteria are often found in mucopurulent secretions in rhinosinusitis. In order to improve the diagnosis of these patients, the ultrasound technique was further developed. In this thesis, it was demonstrated that it is possible to induce acoustic streaming in a sinus model, and that the acoustic properties of a fluid can be determined with Doppler ultrasound. The appropriate frequency of the ultrasound was found to be ~5 MHz. The anatomical dimensions of the maxillary and frontal sinuses were studied on computed tomography images in order to be able to develop a clinically useful Doppler instrument. It was shown how serous sinus fluid can be distinguished from mucopurulent sinus secretion with Doppler ultrasound, without exposing the patient to a harmful increase in temperature.
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