Abstract :
[en] Introduction and Aim: Nosocomial airway infections are common and associated with high morbidity and mortality in Intensive Care Unit. Endotracheal intubation duration is an independent risk factor for maxillary sinusitis, which is a frequent gateway for pneumoniae, meningitis or sepsis. Diagnosis remains challenging, as CT imaging is not easily repeated in the daily assessment of unstable patients. Our aim was to evaluate the efficiency of transcutaneous ultrasound to screen maxillary sinus infection.
Material and Methods: Patients presenting to our ENT department with a same-day sinus CT scan were prospectively included in this pilot study. Maxillary transcutaneous ultrasounds were performed by two independent examiners and scored in supine and sitting positions, blindly to the CT imaging, the clinical and endoscopic evaluations. Ability to diagnose sinusitis, repeatability in different positions and inter-examiners comparison were studied. Ultrasound scores were compared to Lund-Mackay-derived CT scores.
Results: 7 patients (5 men and 2 women, median age 60 [56-64]) were enrolled in this experiment. In total, 14 left and right maxillary sinus were studied by same-day sinus CT scan and ultrasound in prone and sitting positions by 2 blind and independent examiners. Ultrasound was able to detect maxillary pathology the majority of the cases, with a sensitivity of 71.4% and a specificity of 87.5% in sitting position. However, sensitivity dropped to 46.8% in prone position, with a preserved specificity of 84.4%. Agreement between examiners was observed in 85.7% cases.
Conclusion: Transcutaneous ultrasound was capable of screening for maxillary sinus disease compared with conventional sinus CT scan. A special attention should be paid to patient position, as sitting position improved the screening accuracy. Agreement between examiners could be improved. Moreover, despite its limitations, it is an attractive method for the screening of maxillary disease, allowing the ability to screen and/or monitor infection in unstable patients.
