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

Journal Description

Sinusitis

Sinusitis (Volume 3, Issue 3 - 2018 was published with Sinusitis and Asthma) is a peer-reviewed, open access journal which focuses on medical research about sinusitis, and is published semiannually online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 36.7 days after submission; acceptance to publication is undertaken in 3.8 days (median values for papers published in this journal in the first half of 2025).
Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Sinusitis is a companion journal of JCM.

Imprint Information Journal Flyer Open Access ISSN: 2673-351X

Latest Articles

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

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

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

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

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

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

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

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

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

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

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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17 pages, 3394 KB

Open AccessReview

Sinusitis Complications—A Comprehensive Review of Management from the Primary to the Tertiary Level

by Domen Vozel

Sinusitis 2025, 9(1), 11; https://doi.org/10.3390/sinusitis9010011 - 18 Jun 2025

The paranasal sinuses are in close anatomical contact with the nasal and oral cavities, the orbit, the skull base, the brain, and important neurovascular structures, so complications of sinusitis can have serious and life-threatening consequences. Roughly, complications are divided into extracranial and intracranial. [...] Read more.

The paranasal sinuses are in close anatomical contact with the nasal and oral cavities, the orbit, the skull base, the brain, and important neurovascular structures, so complications of sinusitis can have serious and life-threatening consequences. Roughly, complications are divided into extracranial and intracranial. Of the extracranial complications, orbital complications are the most common. In addition to clinical examination and immediate referral to hospital, diagnostic imaging methods, particularly CT, are important in the diagnosis of complications. The treatment of complications of sinusitis is mainly multidisciplinary and may involve pediatricians, family physicians, emergency physicians, otorhinolaryngologists, neurologists, neurosurgeons, ophthalmologists, neuroradiologists, and infectious disease specialists. The cornerstone of treatment is early targeted antimicrobial therapy and surgery for abscess, visual impairment, or involvement of critical neurovascular structures. This paper reviews sinusitis complications and provides study material for physicians who manage this disease. Full article

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6 pages, 913 KB

Open AccessCase Report

Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis

by Tessa K. Suttle, Johan Grobbelaar, Ursula Lesar, Razaan Davis, Leon Janse van Rensburg and Shaun E. Adam

Sinusitis 2025, 9(1), 10; https://doi.org/10.3390/sinusitis9010010 - 21 May 2025

This case report presents the clinical evaluation of an 11-year-old boy with a unilateral polypoid nasal mass causing nasal obstruction, facial asymmetry, and intermittent epistaxis. His clinical picture raised concerns of a juvenile nasopharyngeal angiofibroma; however, further imaging and histopathological evaluation ultimately confirmed [...] Read more.

This case report presents the clinical evaluation of an 11-year-old boy with a unilateral polypoid nasal mass causing nasal obstruction, facial asymmetry, and intermittent epistaxis. His clinical picture raised concerns of a juvenile nasopharyngeal angiofibroma; however, further imaging and histopathological evaluation ultimately confirmed the diagnosis of allergic fungal rhinosinusitis (AFRS). Although this patient was younger in age than those traditionally associated with AFRS, classical features present on both computed tomography (CT) and magnetic resonance imaging (MRI) aided in his diagnosis and management. This case underscores the importance of a comprehensive diagnostic approach when evaluating unilateral sinonasal masses in paediatric patients, specifically in atypical presentations where the diagnosis of AFRS may not initially be considered. It highlights the critical role of imaging as a diagnostic tool, specifically CT and MRI, which were pivotal in the work-up and management of this case. Additionally, the need for caution during biopsies of sinonasal masses in children is emphasised, as there is potential for catastrophic bleeding in vascularised masses such as juvenile nasopharyngeal angiofibroma. This case demonstrates that AFRS can occur in younger children, highlighting the need to include this in the differential diagnosis, even in patients outside of the traditionally described age group. Full article

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12 pages, 3929 KB

Open AccessArticle

The Effect of Age and Gender on the Distance Between the Maxillary Sinus Cortical Bone and Maxillary Molars: A Cone-Beam Tomography Analysis

by Thaysa Menezes Constantino, Marília Fagury Videira Marceliano-Alves, Vivian Ronquete, Ana Grasiela da Silva Limoeiro, Pablo Andres Amoroso-Silva, Mariano Simon Pedano, Tchilalo Boukpessi, Fábio Vidal and Thais Machado de Carvalho Coutinho

Sinusitis 2025, 9(1), 9; https://doi.org/10.3390/sinusitis9010009 - 16 May 2025

Apical periodontitis may be associated with odontogenic sinusitis in cases where the apex of the root is close to, or even within, the maxillary sinus. This study investigated the anatomical relationship between the cortical sinus floor and the root apices of maxillary molars [...] Read more.

Apical periodontitis may be associated with odontogenic sinusitis in cases where the apex of the root is close to, or even within, the maxillary sinus. This study investigated the anatomical relationship between the cortical sinus floor and the root apices of maxillary molars in relation to age and gender. Two hundred cone-beam computed tomography exams (FOV 5 × 5 cm or 8 × 8 cm) were evaluated to determine the proximity of the roots of the molars to the maxillary sinus, according to age group and gender. The maxillary second molar is the tooth with the closest contact with the maxillary sinus, mainly the mesial–buccal root. In maxillary first molars, the palatal root is the nearest one and sometimes lies inside the sinus. Considering the age factor, in the elderly group, lower distances were found for all roots for the male group. In the elderly group, the only difference was found in the female distobuccal root of tooth 16, which was found to be shorter than the males (p < 0.05). In conclusion, the distance between the cortical bone of the maxillary sinus and the root apices varies considerably, and smaller distances were found in older females and for the upper second molar, especially the mesial–buccal root. Full article

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12 pages, 1003 KB

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

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 KB

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

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 KB

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

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 KB

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

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 KB

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

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 KB

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

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 KB

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

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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