Sinusitis

12 pages, 1003 KiB

Open AccessArticle

Factors Associated with Postoperative Complications Following Resection of Sinonasal Tumors: A NSQIP Analysis

by Raymond J. So, Hannan A. Qureshi, Evelyn M. Leland, Anirudh Saraswathula, Murugappan Ramanathan, Jr., Nyall R. London, Jr. and Nicholas R. Rowan

Sinusitis 2025, 9(1), 8; https://doi.org/10.3390/sinusitis9010008 - 17 Apr 2025

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Abstract

Background: As the surgical repertoire for the management of sinonasal tumors evolves over time, an improved understanding of risks for postoperative complications is imperative. Objectives: To identify factors associated with 30-day postoperative complications following the resection of sinonasal tumors. Methods: The National Surgical [...] Read more.

Background: As the surgical repertoire for the management of sinonasal tumors evolves over time, an improved understanding of risks for postoperative complications is imperative. Objectives: To identify factors associated with 30-day postoperative complications following the resection of sinonasal tumors. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2020 for patients undergoing open or endoscopic surgical resection of sinonasal tumors. A Cox proportional hazards model was used to identify factors associated with postoperative complications. Kaplan–Meier survival analyses and log-rank tests were used to compare time to complication onset. Frailty was defined as a 5-factor modified frailty index score > 2. Results: Of the 859 patients with sinonasal tumors, 539 (62.7%) were male, and the average age (± SD) was 59.3 ± 14.1 years. Postoperative complications were observed in 251 (29.2%) patients. The most common 30-day complications were bleeding requiring transfusions (n = 172; 20.0%) and ventilation longer than 48 h (n = 37; 4.3%). Frailty (aHR [95% CI]: 3.58 [1.80–7.12]), malignancy (3.43 [1.59–7.38]), and maxillary tumor location (2.40 [1.86–3.09]) were associated with greater risk for 30-day postoperative complications. Similarly, patients with frailty (χ² = 7.0; p = 0.008), malignant tumors (χ² = 13.4; p < 0.001), or maxillary sinus tumors (χ² = 34.6; p < 0.001) experienced earlier onset of postoperative complications. Conclusions: Frailty, malignancy status, and tumor location may modulate risk for 30-day postoperative complications following the resection of sinonasal tumors. These results may help to inform preoperative patient counseling and identify individuals at increased risk of postoperative complications. Full article

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10 pages, 1563 KiB

Open AccessArticle

The Effect of the COVID-19 Pandemic on Trends of Complicated Sinusitis in Western Australia

by William Crohan, Phillip Sale and Shyan Vijayasekaran

Sinusitis 2025, 9(1), 7; https://doi.org/10.3390/sinusitis9010007 - 9 Apr 2025

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Abstract

The possible association between COVID-19 and the development of complicated sinusitis in paediatric populations was noted during the COVID-19 pandemic, but understanding of this disease process is still developing. In Perth, Western Australia, a distinctive state of isolation, vaccination status and thorough screening [...] Read more.

The possible association between COVID-19 and the development of complicated sinusitis in paediatric populations was noted during the COVID-19 pandemic, but understanding of this disease process is still developing. In Perth, Western Australia, a distinctive state of isolation, vaccination status and thorough screening methodology led to a unique experience of the pandemic. We conducted a retrospective cohort study of 129 patients admitted to Perth Children’s Hospital from May 2018 to September 2024. Disease factors were studied, including clinical severity, procedure, COVID status, length of stay and inflammatory markers. A surge in patients was noted during the COVID-19 pandemic, with at least 16 having a concurrent diagnosis of COVID-19 at the time of admission. The study demonstrates that whilst COVID-19 infection was associated with the development of complicated sinusitis, it was not associated with increased severity of disease or an increased likelihood of requiring surgical management. A unique subset of patients emerged with unusual presentations, possibly representing a new disease process of suppurative dacryoadenitis. Full article

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15 pages, 694 KiB

Open AccessReview

Utility of Nasal Debridement Following Pediatric Functional Endoscopic Sinus Surgery: A Scoping Review

by Jeeho D. Kim, Bastien A. Valencia-Sanchez, Beau Hsia, Saif A. Alshaka, Gabriel Bitar and Vijay A. Patel

Sinusitis 2025, 9(1), 6; https://doi.org/10.3390/sinusitis9010006 - 9 Apr 2025

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Abstract

The role of second-look endoscopy and debridement (SLED) remains uncertain in children due to the perceived need for additional general anesthesia following their initial functional endoscopic sinus surgery (FESS) while mitigating risks and healthcare costs. This comprehensive review synthesizes current evidence on SLED [...] Read more.

The role of second-look endoscopy and debridement (SLED) remains uncertain in children due to the perceived need for additional general anesthesia following their initial functional endoscopic sinus surgery (FESS) while mitigating risks and healthcare costs. This comprehensive review synthesizes current evidence on SLED in children, focusing on its practice pattern and treatment outcomes. This review was designed and performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Protocol. Independent queries of the PubMed Central, MEDLINE, and Bookshelf databases were performed. A total of 53 relevant, unique articles were initially identified; 12 articles were ultimately deemed appropriate for inclusion in final analysis. The most common indication for FESS was chronic rhinosinusitis or recurrent sinus infections while that for SLED under general anesthesia varied from institutional practice patterns to surgeon preference. No meaningful comparison of outcomes was possible as the “success rates” of FESS with or without SLED were largely based on unvalidated questionnaires and equally subjective surgeon assessments. Even when looking at outcomes based on revision rates, FESS with SLED was considered successful between 60.5% and 95.6% of the time, with a mean of 84.2%, while FESS without SLED was successful between 71.0% to 96.4% of the time, with a mean of 86.3%. However, no randomized, controlled studies were available in the pediatric literature pertaining to FESS with or without SLED. Moreover, it became apparent that previous conclusions on the utility of SLED were based on the outcomes of FESS following one single SLED under general anesthesia vs. no SLED. As such, there is an unmet need to examine the utility of serial, office-based SLED in children to better elucidate its utility in pediatric FESS. Full article

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8 pages, 606 KiB

Open AccessBrief Report

Association Between Staphylococcal Enterotoxin-Specific IgE and House-Dust-Mite-Specific IgE in Brazilian Patients with Chronic Rhinosinusitis with Nasal Polyps

by Priscilla Campos, Sérgio Duarte Dortas Junior, Solange Oliveira Rodrigues Valle, Nathalia Novello Ferreira, Fabiana Chagas da Cruz, Priscila Novaes Ferraiolo and José Elabras Filho

Sinusitis 2025, 9(1), 5; https://doi.org/10.3390/sinusitis9010005 - 18 Mar 2025

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Abstract

Chronic Rhinosinusitis (CR) is a common inflammatory condition with complex pathophysiology involving multiple interleukins. In times of precision medicine, it is mandatory to cluster our patients to offer the best tailored treatment with the lowest cost possible. Therefore, some triage markers can be [...] Read more.

Chronic Rhinosinusitis (CR) is a common inflammatory condition with complex pathophysiology involving multiple interleukins. In times of precision medicine, it is mandatory to cluster our patients to offer the best tailored treatment with the lowest cost possible. Therefore, some triage markers can be used towards this goal, without raising much financial burden. The aim of this study was to identify the association of staphylococcal enterotoxin (SE)-specific IgE of types A, B, C, and TSST-1 (toxic shock syndrome toxin-1); and total IgE (tIgE) and specific IgE for Dermatophagoides pteronyssinus (DP), Dermatophagoides farinae (DF), and Blomia tropicalis (BT) in Brazilian patients with CRSwNP. Thirty-six patients with CSRwNP were analyzed for serum IgE levels: tIgE and specific IgE for: DP, DF, BT, and SE types A, B, C, TSST-1 by ImmunoCAP^®. The mean value of tIgE in SE-specific IgE-positive patients was 767 IU/mL and in house-dust-mite (HDM)-positive patients, the mean tIgE was 319 IU/mL (p < 0.005). A total of 86% of patients who had high tIgE levels but were SE-specific IgE-negative had positive specific IgE for at least one of the HDMs tested. The Fisher exact test statistic value for this association was significant (p < 0.05/p = 0.014). We found an association between high levels of tIgE and SE-specific IgE in patients with CRSwNP, possibly related to local and peripheric polyclonal IgE production. The mean value of tIgE—with a suggested cutoff point of tIgE levels of 767 IU/mL—can be used as a triage biomarker for positive SE-specific IgE in CRSwNP patients. Full article

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8 pages, 4343 KiB

Open AccessCase Report

Unmasking the Fungal Menace: A Case Report of Chronic Granulomatous Invasive Fungal Sinusitis of Maxilla

by Swathi Krishna, Vivekanand Ashok, Shahseena Abdulla, Rosmy John and Prathap Ramalingam

Sinusitis 2025, 9(1), 4; https://doi.org/10.3390/sinusitis9010004 - 12 Feb 2025

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Abstract

Chronic granulomatous invasive fungal sinusitis (CGIFS) is an uncommon type of invasive sinusitis that is characteristically seen in immunocompetent individuals. Common clinical manifestations of this condition include proptosis, cheek swelling, and headache. The pathogenic organism is Aspergillus in the majority of reported cases. [...] Read more.

Chronic granulomatous invasive fungal sinusitis (CGIFS) is an uncommon type of invasive sinusitis that is characteristically seen in immunocompetent individuals. Common clinical manifestations of this condition include proptosis, cheek swelling, and headache. The pathogenic organism is Aspergillus in the majority of reported cases. Diagnosis is made by histopathological and microbiological examination of tissue specimens. Due to its expansible nature, bone erosion is also associated with this condition. Treatment is surgical clearance/debulking followed by long-term antifungal therapy. Here, we report the case of a 31-year-old male presented with right-side cheek swelling. The patient underwent a medial maxillectomy and was diagnosed with CGIFS. The patient was put on oral voriconazole for 3 months. To conclude, CGIFS is a rare variant of invasive fungal sinusitis that may mimic malignancy or granulomatous diseases such as tuberculosis, rhinoscleroma, and syphilis. Accurate diagnosis is of utmost importance in providing management for CGIFS. Full article

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4 pages, 153 KiB

Open AccessCommentary

The Impact of Churg–Strauss Syndrome on Nasal Function and Quality of Life: An Underexplored Dimension

by Luca Galassi and Federica Facchinetti

Sinusitis 2025, 9(1), 3; https://doi.org/10.3390/sinusitis9010003 - 30 Jan 2025

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Abstract

Eosinophilic Granulomatosis with Polyangiitis (EGPA)/Churg–Strauss syndrome is a systemic vasculitis that often causes chronic nasal dysfunction, including anosmia, nasal obstruction, and sinusitis. Anosmia, affecting up to 20% of EGPA patients, has a significant negative impact on quality of life (QoL). The loss of [...] Read more.

Eosinophilic Granulomatosis with Polyangiitis (EGPA)/Churg–Strauss syndrome is a systemic vasculitis that often causes chronic nasal dysfunction, including anosmia, nasal obstruction, and sinusitis. Anosmia, affecting up to 20% of EGPA patients, has a significant negative impact on quality of life (QoL). The loss of smell disrupts daily activities, reduces enjoyment of food, and impairs social interactions, leading to feelings of isolation, depression, and anxiety. These psychosocial consequences, combined with persistent physical symptoms, contribute to a marked decline in overall well-being and are among the strongest predictors of poor QoL in EGPA patients. Early diagnosis and intervention are essential to mitigate these effects and improve patient outcomes. A multidisciplinary approach that combines pharmacological treatment, surgical options, and psychosocial support is critical to managing both the physical and emotional challenges of nasal dysfunction in EGPA. However, further research is needed to explore long-term management strategies, optimize therapeutic approaches, and better address the complex interplay between physical symptoms and QoL in EGPA patients. Full article

5 pages, 1322 KiB

Open AccessCase Report

Sinonasal Mass in the Setting of Prior Maxillofacial Surgery and Solid Organ Malignancy

by Yihuai Qu, Jeffrey C. Mecham and Michael J. Marino

Sinusitis 2025, 9(1), 2; https://doi.org/10.3390/sinusitis9010002 - 25 Jan 2025

Viewed by 632

Abstract

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a [...] Read more.

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB. Full article

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8 pages, 3460 KiB

Open AccessCase Report

Odontogenic Sinusitis of Endodontic Origin: Successful Management Through Endodontic Treatment

by Marcelo Rolla, Karem Paula Pinto, Luciana Moura Sassone and Emmanuel João Nogueira Leal Silva

Sinusitis 2025, 9(1), 1; https://doi.org/10.3390/sinusitis9010001 - 9 Jan 2025

Viewed by 1162

Abstract

Odontogenic sinusitis is a maxillary sinus infection arising from dental pathology, primarily involving posterior maxillary teeth due to their anatomical proximity to the sinus floor. Endodontic infections are a significant etiological factor, yet the condition is frequently underdiagnosed due to its overlapping presentation [...] Read more.

Odontogenic sinusitis is a maxillary sinus infection arising from dental pathology, primarily involving posterior maxillary teeth due to their anatomical proximity to the sinus floor. Endodontic infections are a significant etiological factor, yet the condition is frequently underdiagnosed due to its overlapping presentation with sinonasal sinusitis. The present cases illustrate the diagnosis, management, and outcomes of maxillary sinusitis of endodontic origin through endodontic interventions. Two patients with histories of recurrent maxillary sinusitis underwent dental evaluations after conventional medical therapies failed. Cone-beam computed tomography confirmed the dental etiology in all cases, identifying inadequately treated second mesiobuccal (MB2) canals or significant periapical pathology. Endodontic retreatments were employed to address the underlying dental causes, followed by resolution of sinus symptoms within days. Follow-up imaging demonstrated ongoing bone healing and resolution of sinus involvement. These cases underscore the importance of addressing the dental etiology in maxillary sinusitis of endodontic origin to achieve complete symptom resolution and minimize recurrence. Cone-beam computed tomography proved instrumental in diagnosing and planning treatment, enabling precise management of periapical and sinus conditions. The cases highlight the necessity of a multidisciplinary approach, involving dental and medical professionals, to optimize outcomes. Full article

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Sinusitis, Volume 9, Issue 1 (June 2025) – 8 articles

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