Sinusitis

7 pages, 220 KB

Open AccessArticle

Profile of Patients with Primary and Secondary Chronic Rhinosinusitis Treated at a Specialized Outpatient Clinic in Brazil

by Yuri de Medeiros Alcântara, Priscila Novaes Ferraiolo, Natasha Caroline Cristina de Aguiar, Fabiana Chagas da Cruz, Marise Marques, Sérgio Duarte Dortas Junior and Cláudia Maria Valete-Rosalino

Sinusitis 2025, 9(2), 24; https://doi.org/10.3390/sinusitis9020024 - 17 Dec 2025

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Abstract

Objective: To describe the sociodemographic profile and prevalence of different phenotypes of patients with chronic rhinosinusitis (CRS) treated at a specialized outpatient clinic of a university hospital in Brazil. Methods: A cross-sectional retrospective study was conducted on patients treated at a [...] Read more.

Objective: To describe the sociodemographic profile and prevalence of different phenotypes of patients with chronic rhinosinusitis (CRS) treated at a specialized outpatient clinic of a university hospital in Brazil. Methods: A cross-sectional retrospective study was conducted on patients treated at a clinic in Brazil. The following were evaluated: sex, age, age at symptom onset, primary CRS phenotype, etiology of secondary CRS, and severity of symptoms. Results: A total of 342 patients were included, of whom 45.61% were men and 8.24% had secondary CRS. The median age of all patients with CRS was 61 years. Nasal polyps were present in 86.22% of patients. The median age at symptom onset was 41 years. The prevalence of primary CRS phenotypes was chronic eosinophilic rhinosinusitis (eCRS) (75%), anti-inflammatory drug exacerbated respiratory disease, which was considered a subgroup of eCRS (19.40%), chronic non-eosinophilic rhinosinusitis (18.66%), central compartment atopic disease (4.1%), and allergic fungal rhinosinusitis (2.24%). The most prevalent diagnoses of secondary CRS were allergic bronchopulmonary aspergillosis (ABPA) (27.59%), immunodeficiencies (20.69%), and vasculitis (13.79%). Conclusions: Patients diagnosed with CRS are predominantly women over 60 years of age who began experiencing nasal symptoms in their fifth decade of life. Most patients have CRS with nasal polyps, primary CRS, and a predominant eCRS phenotype. Secondary CRS accounted for 8.4% of cases, and the most prevalent diagnoses of secondary CRS were Allergic Bronchopulmonary Aspergillosis, immunodeficiencies, and vasculitis. Full article

7 pages, 545 KB

Open AccessArticle

Endoscopic Management of Sinus Neoplasia: An Experience of a Dedicated Sinus Centre in Image-Guided Surgery of Inverted Papillomata

by Gabija Klyvyte, Shyam Gokani, Lavandan Jegatheeswaran, Louis Luke, Jeremy Jonathan Wong and Carl Philpott

Sinusitis 2025, 9(2), 23; https://doi.org/10.3390/sinusitis9020023 - 6 Nov 2025

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Abstract

Previous evidence indicates that the endoscopic approach is the gold standard treatment for sinonasal inverted papillomata (IP). Our objectives were to evaluate the rate of complications and recurrence of IP after management using image-guided endoscopic techniques. This retrospective cohort included patients who underwent [...] Read more.

Previous evidence indicates that the endoscopic approach is the gold standard treatment for sinonasal inverted papillomata (IP). Our objectives were to evaluate the rate of complications and recurrence of IP after management using image-guided endoscopic techniques. This retrospective cohort included patients who underwent tumour resection between 2011 and 2022 in a single sinus-surgery-dedicated centre. In total, 40 patients were treated for IP using endoscopic techniques. The most common site for IP was the maxillary sinus (35%). Cases were managed endoscopically, with 30% having a medial maxillectomy and 15% managed by Draf IIb/III. The rate of complications was 5%, which included 1 case of intra-operative cerebrospinal fluid leak and 1 case with facial numbness. A total of 21 cases had a recurrence—6 (27%) out of the total of 22 primary cases and 15 (83%) out of the total of 18 secondary cases. The difference between the two groups was statistically significant c2(1) = 12.48 and p = 0.0004. The odds ratio was 13.33 (confidence interval, CI 95%: 2.82 to 63.12) with a relative risk of 3.06 (CI 95%: 1.50–6.24). This highlights that the risk and rate of recurrence are higher in secondary cases. As a possible explanation for the results could be that secondary cases were operated by a non-rhinologist ENT (Ears, Nose, and Throat) surgeon. Our results demonstrate that cases operated by a non-rhinologist at first presentation have higher recurrence rates even once a rhinologist was able to manage them. Therefore, IPs managed by a fellowship-trained rhinologist may have superior outcomes in terms of recurrence. Full article

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13 pages, 4205 KB

Open AccessCase Report

Pott’s Puffy Tumor: Two-Case Series and Contemporary Management Approach

by Mert Burak Koci, Onur Belen and Gözde Orhan Kubat

Sinusitis 2025, 9(2), 22; https://doi.org/10.3390/sinusitis9020022 - 3 Nov 2025

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Abstract

Pott’s Puffy Tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, characterized by subperiosteal abscess formation and frontal bone osteomyelitis. Although predominantly seen in adolescents, adult cases are increasingly recognized. Early diagnosis is essential to prevent severe orbital and intracranial [...] Read more.

Pott’s Puffy Tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, characterized by subperiosteal abscess formation and frontal bone osteomyelitis. Although predominantly seen in adolescents, adult cases are increasingly recognized. Early diagnosis is essential to prevent severe orbital and intracranial sequelae. We present two patients with distinct clinical features: a 31-year-old female with chronic frontal sinusitis complicated by sequestrated bone extrusion through a cutaneous fistula, and a 16-year-old male with an acute presentation of subperiosteal abscess, nasal polyp-related obstruction of the osteomeatal complex (OMC), and orbital cellulitis. Both patients underwent combined surgical and medical management, including broad-spectrum intravenous antibiotics, functional endoscopic sinus surgery, and external drainage. In the adult, necrotic bone was excised, and the anterior frontal wall was reconstructed with titanium mesh to restore sinus anatomy and drainage, while in the adolescent, early abscess drainage and polyp removal ensured frontal recess patency and prevented osteomyelitis. Postoperative follow-up demonstrated complete resolution without recurrence. These cases highlight that PPT can occur in both acute and chronic settings of chronic rhinosinusitis with nasal polyps, emphasizing the importance of prompt imaging, multidisciplinary evaluation, and individualized surgical strategies to optimize outcomes and minimize life-threatening complications. Full article

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9 pages, 4162 KB

Open AccessCase Report

The Unseen Threat: Paediatric MRSA Acute Rhinosinusitis Leading to Orbital Complication

by Farid Syamil Ramli, Anna Fariza Jumaat and Farah Dayana Zahedi

Sinusitis 2025, 9(2), 21; https://doi.org/10.3390/sinusitis9020021 - 16 Oct 2025

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Abstract

Acute rhinosinusitis in children is typically caused by viral or bacterial infections. However, methicillin-resistant Staphylococcus aureus (MRSA) is increasingly linked to recurrence and severe complications, including orbital involvement. We present a case of a 6-year-old boy with periorbital swelling, proptosis, and fever following [...] Read more.

Acute rhinosinusitis in children is typically caused by viral or bacterial infections. However, methicillin-resistant Staphylococcus aureus (MRSA) is increasingly linked to recurrence and severe complications, including orbital involvement. We present a case of a 6-year-old boy with periorbital swelling, proptosis, and fever following upper respiratory symptoms. Imaging revealed pansinusitis with a subperiosteal orbital abscess. He was treated empirically with intravenous ceftriaxone and metronidazole, followed by endoscopic sinus surgery. Intraoperative cultures confirmed MRSA, leading to a switch to vancomycin. The patient recovered fully without complications. This case illustrates the clinical challenges posed by MRSA sinusitis and emphasises its public health implications. Integrating antimicrobial stewardship, promoting community hygiene, ensuring early diagnostics and healthcare access, and enhancing epidemiological surveillance can play a pivotal role in reducing the burden of MRSA-related complications in children. Full article

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9 pages, 3434 KB

Open AccessCommunication

Equine Skull Fractures: A Review of 13 Cases Managed Conservatively (2018–2022)

by Melanie Perrier, Maty Looijen and Gabriel Manso-Diaz

Sinusitis 2025, 9(2), 20; https://doi.org/10.3390/sinusitis9020020 - 15 Oct 2025

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Abstract

This retrospective study reviews the clinical features, computed tomography (CT) findings, complications and outcomes of horses with skull fractures involving the facial bones. Medical records from the Royal Veterinary College, Hatfield, United Kingdom, and the Universidad Complutense, Madrid, Spain, were reviewed to identify [...] Read more.

This retrospective study reviews the clinical features, computed tomography (CT) findings, complications and outcomes of horses with skull fractures involving the facial bones. Medical records from the Royal Veterinary College, Hatfield, United Kingdom, and the Universidad Complutense, Madrid, Spain, were reviewed to identify horses presented for head CT with a history of skull fracture involving the facial bones between 2018 and 2022. Thirteen horses were included. Secondary sinusitis was present in 10 of the horses with the rostral maxillary, caudal maxillary and ventral conchal sinuses being the most commonly affected. There was associated fracture of dental structures in three cases. Treatment was conservative in seven cases, while in six horses some minimal surgical intervention was undertaken and included the removal of loose bony fragments and trephination for sinoscopy in two cases, fragment removal and sinus flush through a Foley catheter in three cases and dental extraction in one case. Prognosis was reported to be good to excellent in 10 horses. Among the most common complications, cosmetic sequalae was recorded in three cases. Overall conservative management of skull fracture should be considered a viable option for cases where perfect cosmetic results are not expected and where economics may be a limitation. Full article

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22 pages, 998 KB

Open AccessReview

Clinical Significance of Endotypes of Asian Chronic Rhinosinusitis: A Review and Expert Commentary

by Sean Bo Jie Loh, Nevin Yi Meng Chua, Lee Fang Ang, Francesco Di Pierro and Chew Lip Ng

Sinusitis 2025, 9(2), 19; https://doi.org/10.3390/sinusitis9020019 - 9 Oct 2025

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Abstract

Chronic rhinosinusitis (CRS) is increasingly recognized as a heterogeneous condition characterized by distinct inflammatory endotypes. In Western populations, CRS is mostly type 2 (T2) eosinophilic. In contrast, Asian cohorts show higher rates of non-T2 endotypes, posing unique challenges and limiting the applicability of [...] Read more.

Chronic rhinosinusitis (CRS) is increasingly recognized as a heterogeneous condition characterized by distinct inflammatory endotypes. In Western populations, CRS is mostly type 2 (T2) eosinophilic. In contrast, Asian cohorts show higher rates of non-T2 endotypes, posing unique challenges and limiting the applicability of Western treatment models. This expert commentary and scoping review explores endotype-driven care in CRS, synthesizes current research on Asian CRS cohorts, and examines existing gaps in our understanding, particularly in non-T2 CRS. Endotype-driven care improves treatment precision and minimizes therapeutic failure. However, most models remain largely Western-centric. Establishing Asia-specific criteria, accessible diagnostics, and therapies for non-T2 disease is essential. Full article

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21 pages, 293 KB

Open AccessReview

Orbital Complications of Chronic Rhinosinusitis: A Contemporary Narrative Review of the Ophthalmologic Impact and Therapeutic Role of Functional Endoscopic Sinus Surgery

by Zacharias Kalentakis, Nikolaos Garifallos, Georgia Baxevani, Kyriaki Panagiotou, Evangelos Spanos, Ioannis Vlastos and Alexandre Karkas

Sinusitis 2025, 9(2), 18; https://doi.org/10.3390/sinusitis9020018 - 24 Sep 2025

Viewed by 3496

Abstract

Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the paranasal sinuses. While the burden of CRS on quality of life and respiratory health is well recognized, its potential impact on orbital structures is an area of growing clinical attention. The orbit is [...] Read more.

Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the paranasal sinuses. While the burden of CRS on quality of life and respiratory health is well recognized, its potential impact on orbital structures is an area of growing clinical attention. The orbit is separated from the ethmoid and frontal sinuses by only thin bony laminae. Chronic sinus disease can therefore easily extend beyond the sinuses to involve the orbit, leading to ophthalmologic complications that range from eyelid edema changes to severe, sight-threatening emergencies. Traditionally, orbital complications are more commonly associated with acute sinusitis (particularly in children), but contemporary evidence highlights that chronic rhinosinusitis and its sequelae—including mucoceles, chronic infections (bacterial or fungal), and protracted inflammation—can likewise produce significant orbital consequences. This narrative review synthesizes the current literature on the orbital complications of chronic rhinosinusitis, highlighting clinical, relevant anatomical/pathophysiological pathways, preoperative versus postoperative findings, and the therapeutic impact of FESS. Through this review, clinicians in both otolaryngology and ophthalmology can gain an updated understanding of this interdisciplinary topic, guiding prompt recognition and effective management of CRS patients with orbital involvement. Full article

10 pages, 230 KB

Open AccessReview

Main Findings from Retrospective Studies on the Comorbidity of Asthma and Sinusitis and Their Implications for Clinical Practice

by Nathalia Silveira Finck and Erick Gomes Perez

Sinusitis 2025, 9(2), 17; https://doi.org/10.3390/sinusitis9020017 - 4 Sep 2025

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Abstract

Asthma and chronic rhinosinusitis (CRS) are prevalent chronic inflammatory conditions of the airways that frequently occur together, contributing to increased disease burden and reduced quality of life. This study aimed to synthesize findings from retrospective research to better understand the clinical and pathophysiological [...] Read more.

Asthma and chronic rhinosinusitis (CRS) are prevalent chronic inflammatory conditions of the airways that frequently occur together, contributing to increased disease burden and reduced quality of life. This study aimed to synthesize findings from retrospective research to better understand the clinical and pathophysiological interrelations between these two conditions. A narrative review was conducted, including studies (2002–2025) assessing prevalence, lung function, biomarkers, quality of life, and treatment outcomes in patients with confirmed asthma and/or CRS. The results revealed a high prevalence of comorbidity, particularly in patients with CRS with nasal polyps (CRSwNP), where asthma co-occurrence exceeds 50% in certain phenotypes. Shared type 2 inflammatory mechanisms, including eosinophilic infiltration, cytokine overexpression (IL-4, IL-5, and IL-13), and tissue remodeling via matrix metalloproteinases, were frequently identified. These findings support the unified airway model and highlight the systemic nature of inflammation in these patients. Biologic therapies demonstrated effectiveness in reducing exacerbations and improving clinical outcomes, especially in patients with more severe phenotypes. The inclusion of dentistry and oral health as components of the systemic inflammatory burden offers an innovative perspective and reinforces the importance of holistic, interdisciplinary care. This study underscores the need for a multidisciplinary, phenotypically guided approach to treatment. Recognizing and systematically addressing this comorbidity can improve disease control and enhance patient quality of life. Full article

12 pages, 1872 KB

Open AccessArticle

Apical Periodontitis and Maxillary Sinus Alterations: Results of an Exploratory Cross-Sectional Tomographic In Vivo Study

by Thaïs Coutinho, Lucio Gonçalves, Marilia Fagury Videira Marceliano-Alves, Vivian Ronquete Figueiredo, Josué da Costa Lima Junior, Rafael Vidal Peres and Fábio Vidal

Sinusitis 2025, 9(2), 16; https://doi.org/10.3390/sinusitis9020016 - 26 Aug 2025

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Abstract

Odontogenic sinusitis is a highly prevalent yet frequently overlooked condition. Since anatomically, the roots of the upper molars and premolars may be in proximity to the maxillary sinus, apical periodontitis affecting these teeth may lead to the development of sinus membrane thickening suggestive [...] Read more.

Odontogenic sinusitis is a highly prevalent yet frequently overlooked condition. Since anatomically, the roots of the upper molars and premolars may be in proximity to the maxillary sinus, apical periodontitis affecting these teeth may lead to the development of sinus membrane thickening suggestive of odontogenic sinusitis. The present cross-sectional study aimed to investigate the relationship between images suggestive of apical periodontitis and alterations in the maxillary sinus. One hundred and thirty Cone Beam Computed Tomographies (CBCTs) of the posterior maxilla were examined for the presence of apical radiolucent lesions and thickening of the sinus membrane. The relationship between the distance of the lesions from the sinus and the prevalence of sinus alterations was described and compared using a chi-squared test and logistic regression models. In the sample studied, 16.12% and 45.96% of the sinus images suggested mucositis and sinusitis, respectively. The mere presence of radiolucent apical lesions was not related to sinus alterations. However, lesions breaking through the cortical floor of the sinus were associated with a larger mucosal thickness, reaching statistical significance on the left side. Estimation of the magnitude showed that increasing the sample size would lead to a statistical difference on the right side as well. Thus, it can be concluded that, in cases where lesions suggesting apical periodontitis are closely related to the sinus floor, breaking though the cortical bone of the maxillary sinus floor, the prevalence of sinus mucosal thickening, indicating mucositis or sinusitis, is greater. Full article

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9 pages, 4473 KB

Open AccessCase Report

Cholesterol Granuloma of the Frontal Sinus Complicated by Mycetoma: A Rare Case Report

by Chiara Rustichelli, Alessandro Serrone, Giovanni Cavallo, Antonino Maniaci and Gian Luca Fadda

Sinusitis 2025, 9(2), 15; https://doi.org/10.3390/sinusitis9020015 - 25 Aug 2025

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Abstract

Cholesterol granuloma is an uncommon inflammatory lesion whose etiology is still unclear. It is thought to originate from blood accumulation in a pneumatized space, probably after bleeding. The most frequent site is the petrous apex of the temporal bone, whilst it is very [...] Read more.

Cholesterol granuloma is an uncommon inflammatory lesion whose etiology is still unclear. It is thought to originate from blood accumulation in a pneumatized space, probably after bleeding. The most frequent site is the petrous apex of the temporal bone, whilst it is very uncommon in the paranasal sinuses. We present a clinical case of an 80-year-old female patient with intense frontal headache and diplopia who underwent a neuro-navigated endoscopic sinus surgery. The histological diagnosis was a cholesterol granuloma of the frontal sinus, contaminated by Aspergillus Fumigatus hyphae. Cholesterol granuloma of the frontal sinus is a rare finding in clinical practice, but it should be taken into account in the diagnostic path in presence of rapidly increasing sight alterations and headache, even without rhinological symptoms. Full article

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11 pages, 12405 KB

Open AccessArticle

An Analysis of Frontoethmoid Cell Types According to the International Frontal Sinus Anatomy Classification in the Korean Population and Their Relation to Frontal Sinusitis

by Jasmine Pei Ying Kho, Sakinah Mohammad and Chae-Seo Rhee

Sinusitis 2025, 9(2), 14; https://doi.org/10.3390/sinusitis9020014 - 28 Jul 2025

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Abstract

Background: The International Frontal Sinus Anatomy Classification (IFAC) is a consensus created to simplify the classification of cells affecting frontal sinus drainage. Our study aims to determine the prevalence of the frontal cell variants using the IFAC and to identify their association with [...] Read more.

Background: The International Frontal Sinus Anatomy Classification (IFAC) is a consensus created to simplify the classification of cells affecting frontal sinus drainage. Our study aims to determine the prevalence of the frontal cell variants using the IFAC and to identify their association with the development of FS in the Korean population. Methods: A total of 1060 computed tomography scans of paranasal sinuses (PNS CT) were reviewed. Patient demographics were recorded, and the presentation of types of IFAC cells and presence of frontal sinusitis (FS) were documented. Results: The mean age of the subjects’ scans is 49.8 ± 17, ranging from 16 to 94 years old. The frequency of cells presents from most common to least common are agger nasi cells (ANCs) at 97.1%, suprabullar cells (SBCs) at 73.8%, supraagger cells (SACs) at 38.1%, supraorbital ethmoid cells (SOECs) at 23.3%, frontal septal cells (FSCs) at 19.2%, suprabullar frontal cells (SBFCs) at 16.3% and supraagger frontal cells (SAFCs) at 10.1%. A total of 183 (17.7%) frontal sinuses had an infection, of which the majority were male 67.2%. The presence of SAFCs and/or SBFCs is significantly associated with the development of FS with OR_SAFC = 1.646 and OR_SBFC = 4.483, respectively. Conclusion: The presence of SAFCs and SBFCs statistically increased the probability of developing FS. Full article

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9 pages, 553 KB

Open AccessCommunication

Addition of In-Clinic Cone-Beam CT Imaging to a Public Hospital Rhinology Clinic: Early Experience

by Thitapon Uiyapat, Aideen Ni Mhuineachain and Andrew James Wood

Sinusitis 2025, 9(2), 13; https://doi.org/10.3390/sinusitis9020013 - 11 Jul 2025

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Abstract

Cone-beam computed tomography (CBCT) offers low radiation, cross-sectional imaging that is a suitable alternative to conventional fan-beam computed tomography (FBCT). The initial experience using in-clinic CBCT in the Rhinology outpatient clinic at Waikato Hospital, New Zealand, is described. The first 5 months of [...] Read more.

Cone-beam computed tomography (CBCT) offers low radiation, cross-sectional imaging that is a suitable alternative to conventional fan-beam computed tomography (FBCT). The initial experience using in-clinic CBCT in the Rhinology outpatient clinic at Waikato Hospital, New Zealand, is described. The first 5 months of CBCT use for Rhinologic imaging was compared to FBCT use in the equivalent 5-month period one year prior. Data relating to 61 CBCTs and 115 FBCTs was analysed. We compared the time and number of hospital visits required for a confirmed treatment decision (CTD) to be made and the duration of the clinic appointment at which the scan was requested between the two groups. The CBCT group required significantly less time (171 vs. 316 days, p < 0.001) and fewer hospital visits (1.5 vs. 3.2 visits, p < 0.001) before a CTD was made, but a longer appointment duration (86 vs. 53 min, p < 0.001). The use of in-clinic CBCT in Rhinology was therefore associated with reduced time and fewer hospital visits before definitive management was decided, but longer clinic appointments were observed. Increased access to CT imaging may result in increased demand. Expertise is required to optimise the quality of imaging, and we recommend that a dedicated Radiographer be allocated. Full article

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7 pages, 731 KB

Open AccessCase Report

Nasal-Type Natural Killer/T-Cell Extranodal Lymphoma

by Mustapha Sellami, Sofiane Amazigh Akbal, Lycia Zaidi and Abderrahmane Akacha

Sinusitis 2025, 9(2), 12; https://doi.org/10.3390/sinusitis9020012 - 22 Jun 2025

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Abstract

Nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is a rare, aggressive non-Hodgkin lymphoma associated with the Epstein–Barr virus (EBV). It predominantly affects middle-aged men and is most common in East Asia and Latin America. Due to its nonspecific symptoms, including nasal obstruction and discharge, [...] Read more.

Nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is a rare, aggressive non-Hodgkin lymphoma associated with the Epstein–Barr virus (EBV). It predominantly affects middle-aged men and is most common in East Asia and Latin America. Due to its nonspecific symptoms, including nasal obstruction and discharge, ENKTL is frequently misdiagnosed as chronic rhinosinusitis or fungal infection, leading to delays in diagnosis and treatment. This case report presents a 46-year-old Algerian male with persistent nasal obstruction, foul-smelling nasal discharge, and progressive midfacial destruction. Multiple biopsies initially suggested chronic rhinosinusitis with fungal infection, delaying the definitive diagnosis. Subsequent deep biopsies confirmed ENKTL through histopathological and immunohistochemical analysis. ENKTL is characterized by its locally invasive nature, leading to necrotizing lesions and midfacial destruction. Histopathological confirmation through multiple well-targeted biopsies is crucial to prevent misdiagnosis. However, the prognosis remains poor, with a 5-year survival rate ranging from 20% to 65%. Full article

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Sinusitis, Volume 9, Issue 2 (December 2025) – 13 articles

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