CLINICAL COURSE OF ACUTE MAXILLARY SINUSITIS DOCUMENTED BY SEQUENTIALMRI SCANNING

A prospective study was designed to assess clinical and mucosal change s that occur during resolution of acute maxillary sinusitis. Thirteen previously healthy subjects with symptoms of acute sinusitis and radio graphic opacification of at least one maxillary sinus were entered int o the study and treated with amoxicillin/clavulinate potassium. Assess ment Of clinical symptoms, clinical examination, and magnetic resonanc e imaging (MRI) of the maxillary sinuses were performed at baseline an d at days 3, 7, 10, 14, 21, 28 and 56 after initiation of therapy. The T2 values from the MRI scans were analyzed to approximate the more vi scous and more fluid-like components of the maxillary sinus contents. After three days of antibiotic therapy, there was marked improvement i n facial tenderness, thickness of nasal discharge, volume of nasal dis charge, headache, and nasal congestion. Ten to 14 days of treatment we re required, however, for improvement in nasal patency. MRI analysis o f the volume percentage of air in the involved sinuses showed that by 10 days, only half of the opacification (fluid and thickened mucosa) h ad resolved. By 56 days, the sinuses were only about 80% aerated. This improvement was attributed mainly to resolution of the more fluid-lik e component. This study shows that: (1) tissue/fluid changes in sinusi tis can be followed with MRI, and (2) although treatment of acute maxi llary sinusitis generally results in clinical resolution of symptoms w ithin one week, mucosal changes can persist for 8 weeks or more.