Sinusitis

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.

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.

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.