Sinus Surgery Research Articles

Evaluation of balloon sinuplasty for the treatment of pediatric chronic rhinosinusitis.

This year marks 10 years from the publication of the clinical consensus statement on pediatric chronic rhinosinusitis (CRS). Balloon sinuplasty did not meet criteria for consensus at that time because there was insufficient evidence on its efficacy and safety. The purpose of this review is to summarize the current evidence on balloon sinuplasty treatment for pediatric CRS. Balloon sinuplasty is not a cost-effective measure compared to adenoidectomy and endoscopic sinus surgery (ESS). In the pediatric population, benefits include short operative time, reduced tissue manipulation, and potential for decreased antibiotic courses. Alternatively, balloon dilation has increased equipment costs and there is a lack of robust prospective data that fully elucidates balloon sinuplasty's role in the management of pediatric CRS. Pediatric otolaryngologists should continue to perform first-line adenoidectomy and consider ESS based on imaging and other validated clinical scoring systems. Balloon sinuplasty has not yet been proven as an effective treatment for pediatric CRS and further large-scale investigations are required to overcome its lack of cost-effectiveness.

Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis.

Malignancy in pilonidal sinus disease (PSD) is rare, with squamous cell carcinoma (SCC) being the most common type. This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies. A retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023. Patients with incomplete or missing histopathological data were excluded, and no imputation methods were used for missing data. All specimens underwent histopathological examination to detect malignancies. Two cases (0.13%) of SCC were identified, both in males aged 50 and 58 years without a history of Crohn's disease, HIV, prior radiation, or other cancers. Significant risk factors for malignancy included age over 40 years (OR 3.2, 95% CI 1.1-9.5) and disease duration over 3 years (OR 2.8, 95% CI 1.0-7.6). Both cases were treated surgically and received adjuvant radiotherapy, with both patients being disease-free at the 2-year follow-up. While malignancy in PSD is rare (0.13%), older age and prolonged disease duration are associated with increased risk. Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations.

Chronic rhinosinusitis with nasal polyps: predictors of recurrence 5 years after surgery

Backgrounds Chronic rhinosinusitis with nasal polyps (CRSwNP) is a medical condition characterized by persistent inflammation of the nasal mucosa and sinuses, accompanied by the presence of nasal polyps. When medical treatments prove ineffective, endoscopic sinus surgery (ESS) is recommended, yielding variable outcomes and recurrence rates ranging from 5% to 60%. Aims/Objectives The primary objectives of this study were to evaluate the outcomes of ESS and to identify independent predictors of recurrence and revision surgery. Material and Methods Retrospective cross-sectional study, focusing on patients diagnosed with CRSwNP who underwent ESS with a minimum follow-up period of 60 months. Various variables were collected. Multivariate and regression analyses were employed to assess the predictors associated with both recurrence and revision surgery. Results The study analyzed 130 patients. The 5-year recurrence rate was 35.4%, and 17.7% of patients required revision surgery. These variables included asthma (p < 0.001), frontal sinus involvement (p < 0.001), Lund–Mackay score (p < 0.001), Endoscopic Nasal Polyps Score (p < 0.001), and eosinophilia in peripheral blood (p < 0.001). All the variables mentioned above were identified as predictors of recurrence and revision surgery. Conclusions and Significance Asthma, frontal sinus involvement, increased eosinophilia in peripheral blood, and a higher score on the LM system and NPS are poor prognostic factors in CRSwNP.

Post-operative management following endoscopic sinus surgery in the UK: a survey of The British Rhinological Society.

Post-operative management following endoscopic sinus surgery in the UK: a survey of The British Rhinological Society.

Real-world predictors of dupilumab prescription in patients with chronic rhinosinusitis with nasal polyps.

Despite increasing dupilumab use for chronic rhinosinusitis with nasal polyps (CRSwNP), little is known about the factors influencing its use in real-world practice. We aimed to identify factors that may predict dupilumab prescription in CRSwNP patients who have undergone endoscopic sinus surgery (ESS). A single-institution, retrospective cohort study of patients who underwent ESS for CRSwNP between 2015 and 2023 was conducted. Demographics, comorbidities, 22-item sinonasal outcome test (SNOT-22) scores, and dupilumab prescription date were extracted from patient records. Intraoperative nasal mucus cytokine levels were measured using a multiplex bead assay. Univariate logistic regression analysis was performed to identify factors associated with dupilumab prescription, and multivariate logistic regression was used to adjust for surgery date. A total of 299 CRSwNP patients were included, including seventy (23.4%) who were prescribed dupilumab postoperatively. Patients were more likely to be prescribed dupilumab if they had asthma (odds ratio [OR] 2.304), aspirin-exacerbated respiratory disease (AERD, OR 3.375), elevated tissue eosinophils (OR 1.005), and higher 3-month postoperative SNOT-22 scores (OR 1.027). Patients prescribed dupilumab also had greater odds of having elevated mucus interleukin (IL)-5 (OR 1.128) and IL-13 (OR 1.213). When adjusting for surgery date, associated factors included: asthma (OR 2.444), AERD (OR 3.750), allergic rhinitis (OR 1.833), higher tissue eosinophils (OR 1.005), elevated 3-month SNOT-22 scores (OR 1.028), and higher IL-5 (OR 1.123) and IL-13 (OR 1.202) levels. Asthma, AERD, allergic rhinitis, and elevated tissue eosinophil, IL-5, and IL-13 levels are predictive of dupilumab prescription in CRSwNP patients. These may serve as clinical and inflammatory biomarkers and can aid in counseling patients about expected disease trajectory.

Clinical Control and Quality of Life in Patients With Chronic Rhinosinusitis With Asthma: A Study on the Effects of Endoscopic Sinus Surgery.

To determine the impact of endoscopic sinus surgery (ESS) on chronic rhinosinusitis with asthma (CRSwA) patients' clinical control and quality of life. A randomized controlled trial involving 150 CRSwA patients, equally divided into surgical and control groups. Participants were matched for age, gender, illness duration, and computed tomography (CT) grading of the sinuses. Random allocation was conducted using a computer-generated table. The surgical group exhibited significant symptom score improvements across all metrics (P < .001). Lung function parameters showed substantial gains, with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratios significantly higher than the control group (P < .001). Quality of life scores, measured by RQLQ and AQLQ, improved significantly in the surgical group (P < .001). At 6 months, correlations between lung function and CT grading of the sinuses were evident, with negative and positive correlations, respectively (P < .05). Inflammatory markers and medication usage were notably reduced (P < .001, P < .05), with low adverse event rates (1%). ESS is effective in enhancing clinical outcomes and quality of life for CRSwA patients, reducing inflammation and medication needs, thus supporting its use as a beneficial treatment.

Comparing the Effect of Topical Lignocaine and Bupivacaine in Nasal Packs for Pain Relief in Post Operative Nasal Surgery Patients

This randomized controlled trial compared the analgesic efficacy of lignocaine, bupivacaine, and placebo nasal packs in patients undergoing nasal surgeries, including septoplasty and functional endoscopic sinus surgery (FESS). A total of 100 patients, aged 18–60 years, were randomly assigned into three groups: lignocaine (n=34), bupivacaine (n=33), and placebo (n=33). Postoperative pain was assessed using the Visual Analog Scale (VAS) over 24 hours. Additional analgesic requirements, side effects, recovery time, and length of hospital stay were recorded. Bupivacaine provided significantly lower pain scores at all intervals compared to lignocaine and placebo (p &lt; 0.05). The bupivacaine group had a lower need for additional analgesics (39.4%) compared to lignocaine (76.5%) and placebo (81.8%) (p = 0.041). Side effects such as nausea and vomiting were similar across all groups. The bupivacaine group experienced a shorter hospital stay (2.0 days) compared to the lignocaine (2.5 days) and placebo (3.0 days) groups (p = 0.038). In conclusion, bupivacaine-soaked nasal packs offer superior pain relief, reduce the need for additional analgesics, and shorten hospital stays, making it a preferable option for postoperative pain management in nasal surgeries.

Enlarged Frontal Sinusotomy and Chronic Rhinosinusitis with Nasal Polyps: An Effective Strategy to Control the Disease.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a strong impact on the quality of life (QoL) which treatment is based on local intranasal corticosteroids (ICS) and iterative courses of systemic corticosteroids (SCS) in case of relapse. When medical treatment is insufficient, surgery is indicated. We investigated the impact of enlarged frontal sinusotomies (EFS: Draf IIb or Draf III) on QoL and annual SCS consumption of patients with severe uncontrolled CRSwNP. This is a retrospective cohort study of 38 patients, who underwent EFS at Lariboisière University Hospital (CHU) in Paris, France, between 2006 and 2020. All patients were asked to complete SNOT-22 questionnaires concerning pre- and post-op status. Patients' medical and sinus surgery history as well as the number of SCS treatments per year before and after surgery were also collected. Of the 38 patients, 33 underwent a Draf III procedure and 5 a Draf IIb, with no major complications reported. Surgery resulted in a significant improvement in SNOT-22 scores (-32.7 ± 19.3, P < 0.001), with 19/22 items improving significantly. The number of annual SCS treatments decreased significantly from a mean of 4.8 ± 4.3 to 0.6 ± 1.2 (P < 0.001). During the follow-up (mean 88 months), 95% of our patients showed a satisfying disease control and only 2 patients required revision surgery for poor disease control 5 years after EFS. EFS appears to be an effective and durable therapeutic option to improve the QoL of patients with severe CRSwNP and to reduce their SCS consumption without major complications.

Topical Therapies for Management of Olfactory Dysfunction in Chronic Rhinosinusitis with Nasal Polyps: Steroid-Eluting Stents.

Steroid-eluting stent implantation after endoscopic sinus surgery (ESS) effectively alleviates postoperative symptoms and polyp recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the efficacy of steroid-eluting stents for the treatment of olfactory dysfunction in CRSwNP and the influencing factors therein have not been studied. Fifty-nine patients with CRSwNP with olfactory dysfunction from Peking University Third Hospital who were hospitalized for ESS were recruited and randomly divided into a stent group (n = 30) and a control group (n = 29), and were assessed for symptom scores, olfactory function, endoscopic findings, and type 2 inflammatory mediators (IL-4, IL-5, IL-13, IL-33, eotaxin-3, periostin) expression. Postoperative olfactory Visual Analogue Scale (VAS) scores, T&T olfactometer scores, SNOT-22 scores, and Lund-Kennedy (LK) scores were reduced in patients with CRSwNP (P < .01). Postoperative olfactory VAS scores, T&T olfactometer scores, SNOT-22 scores, and LK scores, IL-5, IL-13, and periostin were significantly lower in the stent group than in the control group (P < .05). Correlation analysis was performed and found that the postoperative olfactory VAS scores were strongly correlated with IL-5 and IL-13 (r = .496, P < .001 and r = .289, P = .026), and the postoperative T&T olfactometer scores were strongly correlated with IL-5 and IL-13 (r = .553, P < .001 and r = .398, P = .002). Steroid-eluting stent implantation after ESS is an effective treatment for olfactory deficits in patients with CRSwNP and may be related to the stent's more effective reduction of local type 2 inflammatory mediators in the nasal cavity.

Anatomical Variation of the Olfactory Fossa According to Keros and Yenigun Classifications in Karachi, Pakistan.

The goal of our research is to assess the olfactory fossa anatomical variation through Keros and Yenigun classification by computed tomography (CT) scan of paranasal sinuses (PNS), as in order for surgeons to prevent major complications, they must be familiar with its variations in anatomy during functional endoscopic sinus surgery (FESS) related to anterior ethmoidal artery injury, as its course varies with depth and length of the olfactory fossa. At Karachi's Dow University of Health Sciences (DUHS), retrospective research was carried out. From anterior to posterior, sequential coronal and axial pictures were examined, and the existence and location of further anatomical characteristics were documented. A consultant radiologist used the picture archiving and communication system (PACS) software to do the review. The depth of the olfactory fossa and anterior-posterior length were measured. We utilized OpenEpi version 3 to compute the sample size findings. The estimated sample size was calculated as 249 by taking the prevalence of 63.5% for type 2 Keros classification, with a margin of error of 6% and a confidence level. The median length for the olfactory fossa depth (Keros) for the left and right sides were 6.2 (2.2-10.9) mm and 6.0 (2.8-10.4) mm, respectively. The median anteroposterior length of the cribriform plate (Yenigun) for the left and right sides were 11.4 (6.1-19.2) mm and 11.2 (6.0-18.0) mm, respectively. According to Keros Classification, type 2 was observed as the most prevalent category on the right side for both females and males, with 97/122 (79.5%) and 106/127 (83.5%) individuals, respectively. The chi-square test was applied for the analysis of gender and classification. Keros type 2 was observed to be the most prevalent in both males and females. Similarly, type 2 was also seen to be the most prevalent in the Yenigun classification in both genders. No statistical difference was found in both classifications (p = 0.39). In most of the literature, type 2 has been the most commonly dominated type. The reason seems due to the variation in genes and anatomy of the human PNS. Preoperative planning should take the morphological characteristics of the ethmoidal roof into account. Understanding the ethmoidal roof morphology among populations may be improved by looking at bigger patient groups and meta-analyses that compile different study findings on this topic.

Sinus mucocele leads to unilateral proptosis in an infant patient with cystic fibrosis; a literature review and a case report study

Introduction and Importance: Cystic fibrosis (CF) is a widespread life-shortening recessive genetic disease and can present with sinus mucocele. Sinus mucocele is a rare condition, with limited prevalence data on unilateral proptosis. Case presentation: We present a case of a 19-month-old boy with CF who experienced worsening proptosis and exotropia in his right eye. A brain and orbit MRI revealed diffuse polypoid mucosal thickening, possible dense fungal deposit, deformity of the mid face, especially on the right side, with more prominent bulging of medical and inferior walls of the right lobe, a right ethmoidal mucocele causing ocular globe displacement, medial rectus compression, and optic nerve. An examination of the eye fundus showed disc edema and vascular congestion. Endoscopic sinus surgery successfully drained the mucocele, and treatment with antibiotics and corticosteroids led to symptom improvement and resolution of proptosis within three weeks. Clinical Discussion: Mucoceles represent an uncommon complication associated with CF in pediatric patients. Consequently, any child presenting with this issue should undergo evaluation for CF. Investigating this infrequent condition’s underlying mechanisms and consequences may improve treatment approaches and outcomes for those impacted. Conclusion: Sinus mucocele with unilateral proptosis in CF patients is uncommon, and endoscopic sinus surgery appears to be an effective cure for this complication, even in the pediatric population at high risk, like CF patients.

Orbital and peri-ocular parffinoma: case series and literature review

BackgroundParaffinoma is a rare and intriguing condition in medicine. In this disorder, an orbital lipogranulomatosis reaction is caused by the penetration of mineral oils (particularly paraffin) into the tissues surrounding the eye.MethodsIn this report, we discuss six cases of paraffinoma affecting the eye socket following sinus surgery. For previous cases literature review, we obtained articles from searching in the PubMed, Scopus, Scholar Google and, Science of Web databases.ResultsAfter the reporting of 6 paraffinoma cases and literature review, the data related to the disease were categorized into the categories of disease definition, differential diagnosis, clinical manifestation, radiological manifestation, and histopathological diagnosis and treatment methods.ConclusionsParaffinoma is a rare and time-delayed diagnosis after various surgeries and therefore may challenge the physician to make the correct diagnosis at first. It is necessary for ophthalmologists to consider this diagnosis in cases of masses around the eyelid and orbit in patients with a history of sinus and nose surgery in other differential diagnoses.

Comparison of the effects of perioperative intravenous infusions of esmolol and lidocaine on the quality of postoperative recovery in patients undergoing functional endoscopic sinus surgery: a randomized, double-blind, noninferiority study.

Perioperative intravenous lidocaine infusion can improve the quality of recovery (QoR) in patients undergoing functional endoscopic sinus surgery (FESS), but the effect of esmolol on recovery has been rarely studied. The aim of this study to compare the effects of esmolol and lidocaine on the QoR in patients with FESS. A total of 60 patients were randomly divided into Group E: intravenous esmolol (0.5mg/kg for 1min, followed by 3.0mg/kg/h); Group L: intravenous lidocaine (2.0mg/ kg for 10min, followed by 2mg/kg/h). The quality of recovery-15 (QoR-15) score was compared. Other parameters compared were the numeric rating pain scale (NRS), haemodynamic data, Surgical fieldconditions, intraoperative drug dosages, number of cases of remedial analgesia, time toawakening and incidence of postoperative sore throat (POST) as well aspostoperative nausea and vomiting (PONV). The mean difference in the QoR-15 score between Group E and Group L on postoperative day 1 (POD1) was - 1.37 (95% CI - 2.75 to 0.01; P < 0.001for noninferiority), indicating the noninferiority of esmolol. Haemodynamic changes and intraoperative nitroglycerine dosages were significantly lower in Group E than in Group L (P < 0.05). The scores of surgical field quality (SSFQ) was higher in Group E than in Group L (P < 0.05). Intravenous infusion of esmolol is not inferior to lidocaine in the quality of postoperative recovery in patients with FESS, and is more advantageous in terms of the quality of the surgical field, attenuation of intraoperative haemodynamic fluctuations, and postoperative awakening.

Comparative Analysis of Artificial Intelligence Platforms in Generating Post-Operative Instructions for Rhinologic Surgery

AbstractRecently, artificial intelligence (AI) platforms such as ChatGPT and Google Gemini have progressed at a rapid pace. To allow for optimal medical outcomes and patient safety, it is crucial that patients have clearly written post-operative instructions. Patients are increasingly turning to AI platforms for medical information. Our objective was to evaluate the ability of ChatGPT versus Gemini to develop accurate and understandable post-operative instructions for patients undergoing endoscopic sinus surgery (ESS). Postoperative instructions on ESS, balloon sinuplasty, Caldwell Luc surgery, and septoplasty were generated using ChatGPT and Gemini. Measures of readability were calculated. The Patient Education Materials Assessment Tool was utilized to determine Understandability and Actionability. ChatGPT and Gemini were capable of generating understandable post-operative instructions but were poor for actionability and readability. While AI has a promising ability to generate accessible medical information, patients should be aware of its drawbacks especially when seeking postoperative instructions.

Efficacy of Clarithromycin Combined with Fluticasone Propionate on Nasal Function, Nasal Mucociliary Transport Function, and Serum Inflammatory Markers in Chronic Rhinosinusitis Patients After Functional Endoscopic Sinus Surgery.

Objective: This study aims to assess the efficacy of clarithromycin (CAM) combined with fluticasone propionate (FP) in patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS), focusing on nasal function, nasal mucociliary transport (MCT) function, and serum inflammatory markers. Methods: The control group (n = 48) was treated with FESS alone, while the study group (n = 48) was treated with FESS plus CAM combined with FP. The clinical effects, symptom scores, nasal function, nasal MCT function, serum inflammatory marker levels, and the occurrence of adverse reactions were compared. Results: The total efficacy rate of the study group (95.83%) was significantly higher than that of the control group (83.33%). After treatment, the study group showed lower symptom scores for nasal congestion, runny nose, sneezing and dizziness, and headache compared to those in the control group. The study group also had lower nasal airway resistance, shorter distance from the minimal cross-sectional area to the nostril, and lower T&T olfactory scores. In contrast, their nasal cavity volume and minimal cross-sectional area were higher than those of the control group. Additionally, the nasal mucociliary clearance and MCT rates were higher in the study group. Serum levels of interleukin-6, interleukin-8, tumor necrosis factor-α, and procalcitonin were significantly lower in the study group compared to the control group (all P < .05). Conclusion: The use of CAM combined with FP in patients after FESS for CRS is effective, leading to the relief of clinical symptoms, improvement of nasal function, enhancement of MCT function, and reduction of inflammatory response, without increasing the incidence of adverse reactions.

“Deciphering The Enigma Of Nasal &amp; Paranasal Anatomy Through Computed Tomography (CT) Imaging”

Introduction: the paranasal sinuses are mucosa-lined structures physically contiguous with the nasal cavity that aid in insulation, reducing cranial weight, heating &amp; humidifying the air, imparting resonance to the voice, providing airway defense and simply to replace functionless bone. Sinusitis is rarely life threatening, but the complex anatomy of the facial planes, the associated venous and lymphatic spread and the close location to the central nervous system can lead on to serious complications. It is, therefore, important to understand the normal anatomy of the paranasal sinuses in order to understand the pathogenesis of sinus disease. Hence, the aim of the present study was deciphering the role of ct as the investigation of choice for the preoperative evaluation of the nose &amp; paranasal sinuses and for delineation of obstructive inflammatory sinus disease to aid in the diagnosis and management of recurrent &amp; chronic disease and to define the bony anatomy before surgery. Materials and methods: prospective cross-sectional study was conducted on 100 asymptomatic patients who were getting investigated by computed tomography for non-sinus indications in whom the paranasal sinus region could be included in the field of study referred to department of radio-diagnosis and imaging from indoor and outdoor departments of jan sewa hospital of dr. S. S. Tantia medical college, sri ganganagar. Results: the majority of patients were in the age group of 21-40 years (42.3%) with 70% being male. Patients in the age group equaling or more than 61 years &amp; with diabetes had the most number of incidental findings (68.2 %) agger nasi was the commonest anatomical paranasal sinus variant (82.9 %) followed by concha bullosa (39.3 %), deviation of the nasal septum (35.4 %), onodi cells ( 12.2 %) &amp; haller cells ( 11.8 %). Incidental paranasal sinus abnormality in the form of mucosal thickening, sinus secretions or polyps were detected in 51.9 % patients, mucosal thickening being most common (40.1 %) followed by secretions (31.9 %) and mucosal polyps ( 3.0 %). Incidental paranasal abnormalities were most commonly noted in the ethmoid sinuses (36.7 %) followed by the maxillary sinuses, sphenoid sinuses and then frontal sinuses in descending order of involvement. Conclusion: computed tomography (ct) provides a “road map” for diagnosis and management of recurrent &amp; chronic paranasal sinus disease and to delineate the bony anatomy before sinus surgery and to get an insight into anatomical variants apropos of their clinical relevance &amp; impact on sinus disease.

“Deciphering The Enigma Of Nasal &amp; Paranasal Anatomy Through Computed Tomography (CT) Imaging”

Introduction: the paranasal sinuses are mucosa-lined structures physically contiguous with the nasal cavity that aid in insulation, reducing cranial weight, heating &amp; humidifying the air, imparting resonance to the voice, providing airway defense and simply to replace functionless bone. Sinusitis is rarely life threatening, but the complex anatomy of the facial planes, the associated venous and lymphatic spread and the close location to the central nervous system can lead on to serious complications. It is, therefore, important to understand the normal anatomy of the paranasal sinuses in order to understand the pathogenesis of sinus disease. Hence, the aim of the present study was deciphering the role of ct as the investigation of choice for the preoperative evaluation of the nose &amp; paranasal sinuses and for delineation of obstructive inflammatory sinus disease to aid in the diagnosis and management of recurrent &amp; chronic disease and to define the bony anatomy before surgery. Materials and methods: prospective cross-sectional study was conducted on 100 asymptomatic patients who were getting investigated by computed tomography for non-sinus indications in whom the paranasal sinus region could be included in the field of study referred to department of radio-diagnosis and imaging from indoor and outdoor departments of jan sewa hospital of dr. S. S. Tantia medical college, sri ganganagar. Results: the majority of patients were in the age group of 21-40 years (42.3%) with 70% being male. Patients in the age group equaling or more than 61 years &amp; with diabetes had the most number of incidental findings (68.2 %) agger nasi was the commonest anatomical paranasal sinus variant (82.9 %) followed by concha bullosa (39.3 %), deviation of the nasal septum (35.4 %), onodi cells ( 12.2 %) &amp; haller cells ( 11.8 %). Incidental paranasal sinus abnormality in the form of mucosal thickening, sinus secretions or polyps were detected in 51.9 % patients, mucosal thickening being most common (40.1 %) followed by secretions (31.9 %) and mucosal polyps ( 3.0 %). Incidental paranasal abnormalities were most commonly noted in the ethmoid sinuses (36.7 %) followed by the maxillary sinuses, sphenoid sinuses and then frontal sinuses in descending order of involvement. Conclusion: computed tomography (ct) provides a “road map” for diagnosis and management of recurrent &amp; chronic paranasal sinus disease and to delineate the bony anatomy before sinus surgery and to get an insight into anatomical variants apropos of their clinical relevance &amp; impact on sinus disease.

Diagnostic criteria for eosinophilic chronic rhinosinusitis: Comparative analysis and novel scoring system.

Accurate identification of eosinophilic chronic rhinosinusitis is essentialg because its treatment and prognosis substantially differ from other subtypes. This retrospective observational study included 640 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis in a single tertiary center from January 2021 to December 2022. Receiver operating characteristic curves were generated to compare accuracy, sensitivity, specificity of the novel scoring system, and previous diagnostic criteria (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis, European Forum for Research and Education in Allergy and Airway Diseases, European Position Paper on Rhinosinusitis and Nasal Polyps, and Sakuma etal.) for predicting eosinophilic chronic rhinosinusitis (ECRS) by tissue eosinophil count ≥70 per high power field. Patients were randomly divided into estimation (n=430) and validation (n=210) groups. The area under the receiver operating characteristic curve for the novel score was 0.753 (95% confidence interval [CI], 0.670-0.835) in the estimation group, 0.729 (0.629-0.830) in the validation group, and 0.661 (0.584-0.738) in the 20-fold cross-validation with the entire dataset. We propose a novel scoring system that incorporates three key parameters: "novel score=blood eosinophil (%) + total Lund-Mackay score of anterior ethmoid sinuses + 2 if nasal polyp present" greater than 7 can be reliably used for diagnosing ECRS. This system can facilitate decision-making processes regarding the administration of oral steroids and biologics targeting type 2 inflammation prior to surgical intervention.

Abducens nerve palsy secondary to allergic fungal sinusitis

Abstract Allergic fungal rhinosinusitis (AFRS) stands out as the predominant form of fungal sinusitis, primarily attributable to a hypersensitive response to fungal invasion. AFRS Characterized by symptoms of rhinosinusitis. The expanding mass in the disease leads to bony restructuring and implicating adjacent anatomical structures. AFRS may extend beyond the sinus cavities, leading to compression of nearby structures like the orbit, optic and abducens nerves which leads to many complications such as nerve palsies and proptosis. Diagnosis of AFRS typically necessitates radiographic assessment initially, with histopathological examination serving as the confirmatory modality. The management of AFRS typically entails a multifaceted approach integrating surgical intervention alongside medical therapy. This case report illustrates a distinctive manifestation of abducens nerve palsy secondary to allergic fungal sinusitis which had dramatic improvement and resolution of the diplopia after the Endoscopic sinus surgery. Steroids and nasal saline irrigation have been prescribed post operatively to prevent the recurrence.

Effect of severe periodontitis of maxillary molars on the maxillary sinus and the treatment principles of periodontitis related maxillary sinusitis

Maxillary sinus is located in the maxilla bone with the largest volume in all sinuses and is closest to the roots of maxillary posterior teeth, especially the mesiobuccal root of the maxillary second molar. The thickness of the normal maxillary sinus mucosa is about 1 mm. When stimulated or infected, it shows thickening of the mucosa. Periodontitis is one of the most common oral diseases in human beings, and the complex root anatomy of the maxillary molars aggravates the difficulty of inflammation control. Severe periodontitis of maxillary molars without effective treatment can affect the maxillary sinus, increasing the possibility of the mucosa thickening, and is also one of the reasons for the occurrence of odontogenic maxillary sinusitis (OMS). There are many different schemes for the treatment of OMS caused by severe periodontitis of maxillary molars. Extraction of teeth with severe periodontal disease without retention value or successful periodontal treatment can significantly reduce the thickness of maxillary sinus mucosa. For the patients with uncontrollable sinusitis by using drug treatment and eliminating odontogenic causes, or ones with severe symptoms, periodontal treatment and endoscopic sinus surgery can be combined to effectively control the periodontitis related maxillary sinusitis.