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April 1967

A Lymphatic Pathway From the Sinuses to the Mediastinum

Author Affiliations

New Haven, Conn
From the Otolaryngology Section, Department of Surgery, Yale University School of Medicine, New Haven, Conn.

Arch Otolaryngol. 1967;85(4):432-444. doi:10.1001/archotol.1967.00760040434017

THE ASSOCIATION of chronic sinusitis and certain lower respiratory tract infections began to gain attention with a series of reports beginning in 1916. The sinobronchial syndrome, as this association came to be regarded, underwent a variety of early descriptions, including "chronic nonspecific cough in children" and "chronic sinusitis associated with cough and mediastinal lymphadenopathy."1

As clinical evidence for the association mounted,2-6 speculation arose on the nature of the clinical relationship. Three possibilities existed: (1) the development of bronchitis as a result of sinusitis, defended by Manges;7 (2) the synchronous appearance of sinus disease and bronchitis, proposed by Wasson;8 and (3) the development of sinusitis as a result of chronic pulmonary disease, defended by Brock.9

The classical observations of E. A. Graham in 1931 exerted considerable influence on the trend of thinking at that time.10 His description revealed in detail some observations on a patient

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