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Einarsson Oskar M.D.; Wirth, Joel A. M.D.
Clinical Pulmonary Medicine: July 1996
Colleagues in Respiratory Medicine: PDF Only

The sinopulmonary syndromes result from diseases that affect both the paranasal sinuses and the lower respiratory tract. The association between sinusitis and asthma has been highlighted in the last decade. Although experimental studies in humans have failed to confirm the presence of a sinusitis-mediated broncho-constriction, numerous clinical studies have demonstrated an improvement in asthma severity after medical and surgical treatment of sinus disease. Recently, functional endoscopic sinus surgery has been introduced to treat recalcitrant sinusitis and focuses on restoring the patency of the ostiomeatal complex. In the difficult-to-treat asthmatic patient where sinus disease is of concern, CT scan of the paranasal sinuses is the diagnostic test of choice, especially when endoscopic sinus surgery is being considered. Frequent sinopulmonary infections that lead to bronchiectasis characterize the sinopulmonary syndromes associated with both ciliary dyskinesia and hypogammaglobulinemia. Ultrastructural ciliary defects can lead to a spectrum of functional disorders from immobility to dysmotility. Patients who are suspected to have ciliary dyskinesia can present with isolated defects that involve the cilia of the respiratory tract. The first step in evaluating patients who are suspected to have ciliary dysfunction is a functional and structural analysis of the nasal epithelial cilia, and when nondiagnostic, bronchial biopsies are often required. Cystic fibrosis and Young's syndrome are other examples of sinopulmonary syndromes characterized by obstructive azoospermia in men. Various humoral immunodeficiencies have been associated with sinusitis and bronchiectasis. Whereas agammaglobulinemia presents during the first years of life, other forms such as immuno-globulin G subclass deficiencies can manifest themselves later in childhood and early adulthood.

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