Sinusitis doi: 10.3390/sinusitis10010010

Authors: Luca Galassi Niccolò Le Donne Beatrice Faitelli Mattia Onesti Francesca Piacente Gabriele Carioti

Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease traditionally defined and assessed by sinonasal symptoms such as nasal obstruction, rhinorrhea, facial pressure, and olfactory dysfunction. However, the burden of CRS extends beyond the sinonasal compartment, including a range of systemic and functional complaints that are not routinely addressed in standard rhinologic practice. Among these, vestibular symptoms, including dizziness, imbalance, and nonspecific disequilibrium, are frequently reported by patients with CRS, yet remain underrecognized and poorly integrated into current diagnostic frameworks and clinical guidelines, despite being captured as a single, psychometrically limited item within the 22-item Sinonasal Outcome Test (SNOT-22). Clinical observations and limited published data, mostly small observational studies and case reports, suggest that vestibular symptoms may fluctuate in parallel with CRS disease activity and may improve following effective medical or surgical control of sinonasal inflammation. Proposed mechanisms include Eustachian tube dysfunction, immune-mediated and neurogenic pathways, trigemino-vestibular interactions, and altered multisensory integration, although current evidence does not establish a causal relationship between CRS disease activity and measurable peripheral vestibular dysfunction. Comparative observations in allergic rhinitis and post-viral upper-airway inflammation situate CRS within a broader inflammatory upper-airway–vestibular interface. This Commentary highlights vestibular dysfunction as an underappreciated extra-sinonasal dimension of CRS with potential clinical and functional relevance. By drawing attention to this clinical blind spot, we aim to encourage more systematic symptom inquiry, interdisciplinary dialogue, and prospective research into the functional consequences of chronic upper-airway inflammation.

Sinusitis doi: 10.3390/sinusitis10010009

Authors: Hassan Ali Petya Marinova Tsvetelina Velikova

Air pollution represents a critical yet modifiable factor influencing the recurrence and progression of upper-airway infections. This review explores the molecular, immunological, and environmental mechanisms linking airborne pollutants to recurrent sinus and respiratory tract inflammation. Particular focus is placed on pollutant-induced oxidative stress, epithelial barrier disruption, alterations in the microbiome, and immune dysregulation, which collectively heighten disease susceptibility. Integrating recent advances in exposomics, multi-omics, and artificial intelligence, the discussion highlights new approaches to unravel exposure–response pathways and identify predictive biomarkers. Future directions emphasize precision exposure assessment, interventional strategies to improve air quality, and the emerging framework of “clean-air medicine” to guide prevention and policy. Overall, this synthesis underscores the urgent need for multidisciplinary collaboration across environmental science, molecular biology, and clinical research to mitigate the growing burden of pollution-related airway disease and promote sustainable respiratory health.

Sinusitis doi: 10.3390/sinusitis10010008

Authors: Eugenio Errico Laura Terradico Domenica Giunta Sveva Introini Fabio Sovardi Fabio Pagella

Background: Central compartment atopic disease (CCAD) is a recently developed terminology used to describe a specific phenotype of chronic rhinosinusitis (CRS). The aim of this study is to provide a thorough analysis of the clinical and radiological characteristics by assessing the prevalence of symptoms, asthma, allergy, aeroallergen sensitization and radiological sinus involvement. Methods: The authors searched for articles on PubMed, Cochrane, and Embase databases. A review of the articles was carried out following PRISMA guidelines; all articles were assessed for quality according to NICE criteria. Afterwards, the meta-analysis was performed with STATA 18SE software. Studies were also assessed for heterogeneity and risk of publication bias. Mean Lund-Mackay (LMK) score of patients with and without CCAD was compared. Results: A total of 16 studies were included, including 1254 patients with CRS; 537 of these were diagnosed with CCAD. The most prevalent symptoms were obstruction at 78% and congestion at 70%, followed by rhinorrhea at 66%, hyposmia at 54%, and facial pain at 24%. Dust mite at 71% was the most prevalent sensitization. Overall, the prevalence of asthma in patients with CCAD was 26%, prevalence of allergy was 67%. The mean difference in LMK scores was −3.38 in CCAD. Conclusions: Patients frequently present with nasal obstruction and congestion; the most common allergen sensitization is to dust mites. Findings on allergy and asthma prevalence support the “Unified Airway Disease” concept and emphasize the importance of a multidisciplinary approach to managing this phenotype. CCAD patients usually do not develop very high LMK scores; high scores may rule out this diagnosis. PROSPERO registration number: CRD420261361696.

Sinusitis doi: 10.3390/sinusitis10010007

Authors: Krystof Zuska Jakub Fuksa Mikuláš Knotek Michal Sisák Petr Schalek

Computed tomography (CT) of the paranasal sinuses is essential in diagnosing odontogenic chronic rhinosinusitis. Treatment primarily targets the dental focus, with endoscopic sinus surgery (ESS) indicated when necessary. Assessing CT findings using the Lund–Mackay score (LMS) may guide therapeutic decisions. This study retrospectively compared LMS, dental pathology type, and reported symptoms with treatment choices in patients treated for odontogenic chronic rhinosinusitis between 2012 and 2022 at a tertiary otorhinolaryngology center. Of 2067 chronic rhinosinusitis patients, 61 had an odontogenic cause. LMS was determined in 57 patients and correlated with treatment strategy. Dental pathology subtypes and presenting symptoms were also analyzed. A control group of 25 patients with localized, non-odontogenic chronic rhinosinusitis was included. Fifteen patients not undergoing ESS had lower LMS values (median one), while 42 surgical patients had higher scores (median six). Periapical pathology (47.4%) and oroantral fistula (26.3%) were the most common causes. Nasal discharge and pain were the most frequent symptoms. Neither dental pathology type nor symptoms significantly influenced treatment decisions. The extent of CT-detected pathology, reflected by LMS, can serve as a key criterion in determining treatment for odontogenic chronic rhinosinusitis, independent of symptoms or specific dental pathology type.

Sinusitis doi: 10.3390/sinusitis10010006

Authors: Felipe Castillo-Farias Javier Duran Pamela Bustos Pilar Fernandez Francisca Becker Alberto Landaida Gustavo Cañar-Parra Jolie Crespo Cristobal Langdon Paula Mackers

Background: Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) frequently coexist, sharing inflammatory and anatomical pathways consistent with the “United Airway”. This review examines the synergistic dysfunction linking these conditions. Methods: We conducted a narrative review synthesizing literature on the epidemiology, pathophysiology—including cytokine cascades and microbiome dysbiosis—and therapeutic outcomes of surgical and medical interventions for comorbid CRS and OSA. Results: Large-scale datasets confirm CRS as an independent risk factor for OSA. Pathophysiologically, the disorders are linked by mechanical obstruction, systemic cytokine spillover (IL-6, TNF-a), and nasopharyngeal microbiome dysbiosis (e.g., S. aureus biofilms). Therapeutically, Endoscopic Sinus Surgery (ESS) significantly improves subjective sleep quality (SNOT-22) and reduces CPAP pressure requirements, although it yields only trivial reductions in the Apnea-Hypopnea Index (AHI). Biologics like Dupilumab demonstrate rapid efficacy in improving sleep domains for CRS with nasal polyps. Conclusions: CRS and OSA are inextricably linked via mechanical and inflammatory mechanisms. A holistic “United Airway” management approach—optimizing nasal patency to facilitate CPAP adherence and reduce systemic inflammatory burden—is critical for improving patient outcomes.

Sinusitis doi: 10.3390/sinusitis10010005

Authors: Vivekanand Ashok Mikash Mohan Shruthi Sasidharan Theertha V. Mampally Sama Sajeed Anna Juline

Chronic rhinosinusitis (CRS) is a persistent inflammatory disorder of the nasal and paranasal mucosa, typically attributed to local infection or anatomical obstruction. However, recent evidence suggests that CRS may also reflect systemic inflammatory dysregulation influenced by the gut microbiome, establishing a potential ‘gut–sinus axis’. This systematic review aims to synthesise current evidence linking gut microbiome alterations to the pathogenesis and clinical course of CRS and to explore emerging therapeutic strategies targeting this axis. Five databases were comprehensively searched for studies published between January 2000 and October 2025. Data were extracted and evaluated for quality using the JBI and SYRCLE tools. A total of 441 records were retrieved, of which 20 studies met the inclusion criteria. Human studies consistently showed gut dysbiosis in CRS, characterised by reductions in Roseburia, Bifidobacterium, Faecalibacterium and Akkermansia species. These microbial shifts correlated with increased levels of systemic cytokines, such as interleukin-6, interleukin-17 and tumour necrosis factor-α, and disease severity. Animal and interventional studies confirmed that high-fibre diets and short-chain fatty acid (SCFA) supplementation modified airway inflammation, whereas antibiotic-induced dysbiosis exacerbated it. Current evidence substantiates a gut–sinus axis mediated by immune, metabolic and neuroendocrine pathways. Dysbiosis-driven reductions in SCFA-producing bacteria appear central to systemic pro-inflammatory signalling implicated in CRS.

Sinusitis doi: 10.3390/sinusitis10010004

Authors: Owen Tsung Wen Ho Alex Chengyao Tham Kok Yuen Ho

Previous cases of trigeminal neuralgia (TN) caused by fungal sinusitis have been reported, but mainly in immunocompromised patients. We present a case of fungal sinusitis masquerading as trigeminal neuralgia in an immunocompetent patient and discuss the potential implications of these two diseases. The patient is a 59-year-old male who presented with a four-year duration of left facial pain. He had been diagnosed and treated for trigeminal neuralgia by a pain specialist but was subsequently referred to ENT after a MRI of the brain showed left maxillary sinusitis. Nasoendoscopy findings and a CT scan of the paranasal sinuses were concordant with left maxillary sinusitis. The patient underwent left functional endoscopic sinus surgery and recovered uneventfully. Our study shows that even in immunocompetent patients who present with non-resolving or worsening facial pain resembling the original diagnosis of TN, clinicians should remain vigilant for the possibility of alternative underlying pathologies including fungal sinusitis.

Sinusitis doi: 10.3390/sinusitis10010003

Authors: Kenny Nguyen Noah D. Bogart Alexa N. Pearce Lindsay E. Blake Brendan Sweeney Vijay A. Patel Robert A. Saadi

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder of motile cilia that leads to impaired mucociliary clearance and recurrent airway infections. Children with PCD often present with ear and sinus disease resembling common pediatric conditions, yet the true burden and management remain incompletely defined. To address this gap, a systematic search for pediatric cohort studies published between 2020 and 2025 reporting otologic and sinonasal features of PCD was performed. Searches of PubMed, Embase, Scopus, and Web of Science identified 12 eligible studies, encompassing 524 children with confirmed PCD. Data extracted focused on demographics, otologic and sinonasal manifestations, vestibular findings, radiographic imaging, and interventions. Across studies, 60.3% had a history of otitis media and 39.1% had hearing loss, predominantly conductive. Tympanostomy tubes were utilized in more than half of patients, with many requiring multiple sets over time due to recurrent effusions or tube occlusion. Sinonasal disease was nearly universal, with 78.5% demonstrating chronic rhinosinusitis and most reporting nasal congestion and rhinorrhea; nasal polyps were uncommonly noted. Vestibular symptoms were also infrequently assessed but present in some patient cohorts. In conclusion, otologic and sinonasal disease are highly co-prevalent in pediatric PCD, highlighting the need for early recognition, regular surveillance, and standardized outcome reporting to guide long-term management of this complex chronic disease.

Sinusitis doi: 10.3390/sinusitis10010002

Authors: Daniel Lopez-Hernandez Leticia Brito-Aranda Karina Ayala-Lopez Tania Castillo-Cruz Guadalupe Vanessa Vazquez-Guzman Maria Clara Hernandez-Almazan Tabata Gabriela Anguiano-Velazquez Edgar Cruz-Aviles Luis Beltran-Lagunes Christian David Sevilla-Mendoza Luis Angel Herrerias Colin

Asthma is a multifactorial respiratory condition affected by demographic, clinical, and lifestyle factors. Recognizing sex-related differences in risk factors may help develop personalized preventive strategies and ultimately enhance clinical outcomes. This study aims to compare the characteristics of male and female patients with asthma and to identify the primary risk factors linked to the condition in each group as well. A comparative analysis was conducted using regression models to evaluate the association between asthma and potential risk factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate the strength of associations for men and women separately. In females, obesity (OR, 1.85; 95% CI, 1.24–2.75), chronic obstructive pulmonary disease (COPD) (OR, 3.37; 95% CI, 1.77–6.43), chronic sinusitis (OR, 4.37; 95% CI, 1.02–18.64), and hypothyroidism (OR, 1.79; 95% CI, 1.09–2.94) were significantly associated with asthma. In males, COPD was the strongest predictor (OR, 4.35; 95% CI, 1.18–15.97), while other factors showed weaker or non-significant associations. Age was not a significant predictor in either sex. The findings highlight important sex differences in the risk profile for asthma. These results underscore the need for sex-specific approaches in the prevention, diagnosis, and management of asthma.

Sinusitis doi: 10.3390/sinusitis10010001

Authors: Maayan S. Kahan Benjamin S. Bleier Mansoor M. Amiji Alan D. Workman

Environmental microplastic pollution is rising, and the recent literature reflects these conditions primarily by focusing on the effects of microplastics in the human lung and gut region. Despite the specific prevalence of airborne microplastics, the bulk of the existing literature neglects the point of initial contact of microplastics with the human body, namely the upper airway, specifically the nasal region. This review aims to highlight recent findings surrounding the effects of microplastics in the nose in both in vitro and clinical models. Areas of particular interest include changes in cell morphology, microplastic permeation, cytotoxicity, and inflammatory effects. Although permeation and toxicity findings vary across studies, the literature collectively indicates hazards to cellular health and potential impacts on patient quality of life.

Sinusitis doi: 10.3390/sinusitis9020024

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

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.

Sinusitis doi: 10.3390/sinusitis9020023

Authors: Gabija Klyvyte Shyam Gokani Lavandan Jegatheeswaran Louis Luke Jeremy Jonathan Wong Carl Philpott

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.

Sinusitis doi: 10.3390/sinusitis9020022

Authors: Mert Burak Koci Onur Belen Gözde Orhan Kubat

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.

Sinusitis doi: 10.3390/sinusitis9020021

Authors: Farid Syamil Ramli Anna Fariza Jumaat Farah Dayana Zahedi

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.

Sinusitis doi: 10.3390/sinusitis9020020

Authors: Melanie Perrier Maty Looijen Gabriel Manso-Diaz

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.

Sinusitis doi: 10.3390/sinusitis9020019

Authors: Sean Bo Jie Loh Nevin Yi Meng Chua Lee Fang Ang Francesco Di Pierro Chew Lip Ng

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.

Sinusitis doi: 10.3390/sinusitis9020018

Authors: Zacharias Kalentakis Nikolaos Garifallos Georgia Baxevani Kyriaki Panagiotou Evangelos Spanos Ioannis Vlastos Alexandre Karkas

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.

Sinusitis doi: 10.3390/sinusitis9020017

Authors: Nathalia Silveira Finck Erick Gomes Perez

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.

Sinusitis doi: 10.3390/sinusitis9020016

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

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.

Sinusitis doi: 10.3390/sinusitis9020015

Authors: Chiara Rustichelli Alessandro Serrone Giovanni Cavallo Antonino Maniaci Gian Luca Fadda

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.

Sinusitis doi: 10.3390/sinusitis9020014

Authors: Jasmine Pei Ying Kho Sakinah Mohammad Chae-Seo Rhee

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 ORSAFC = 1.646 and ORSBFC = 4.483, respectively. Conclusion: The presence of SAFCs and SBFCs statistically increased the probability of developing FS.

Sinusitis doi: 10.3390/sinusitis9020013

Authors: Thitapon Uiyapat Aideen Ni Mhuineachain Andrew James Wood

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.

Sinusitis doi: 10.3390/sinusitis9020012

Authors: Mustapha Sellami Sofiane Amazigh Akbal Lycia Zaidi Abderrahmane Akacha

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%.

Sinusitis doi: 10.3390/sinusitis9010011

Authors: Domen Vozel

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.

Sinusitis doi: 10.3390/sinusitis9010010

Authors: Tessa K. Suttle Johan Grobbelaar Ursula Lesar Razaan Davis Leon Janse van Rensburg Shaun E. Adam

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.

Sinusitis doi: 10.3390/sinusitis9010009

Authors: 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 Thais Machado de Carvalho Coutinho

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.

Sinusitis doi: 10.3390/sinusitis9010008

Authors: Raymond J. So Hannan A. Qureshi Evelyn M. Leland Anirudh Saraswathula Murugappan Ramanathan Nyall R. London Nicholas R. Rowan

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.

Sinusitis doi: 10.3390/sinusitis9010007

Authors: William Crohan Phillip Sale Shyan Vijayasekaran

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.

Sinusitis doi: 10.3390/sinusitis9010006

Authors: Jeeho D. Kim Bastien A. Valencia-Sanchez Beau Hsia Saif A. Alshaka Gabriel Bitar Vijay A. Patel

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.

Sinusitis doi: 10.3390/sinusitis9010005

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

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.

Sinusitis doi: 10.3390/sinusitis9010004

Authors: Swathi Krishna Vivekanand Ashok Shahseena Abdulla Rosmy John Prathap Ramalingam

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.

Sinusitis doi: 10.3390/sinusitis9010003

Authors: Luca Galassi Federica Facchinetti

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.

Sinusitis doi: 10.3390/sinusitis9010002

Authors: Yihuai Qu Jeffrey C. Mecham Michael J. Marino

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.

Sinusitis doi: 10.3390/sinusitis9010001

Authors: Marcelo Rolla Karem Paula Pinto Luciana Moura Sassone Emmanuel João Nogueira Leal Silva

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.

Sinusitis doi: 10.3390/sinusitis8020009

Authors: Aurelio D’Ecclesia Stefano Patruno Christian Fiorentino Lazzaro Cassano

Silent sinus syndrome is a rare condition characterized by an almost always unilateral collapse of the maxillary sinus. The most characteristic symptom of this syndrome is enophthalmos. Naso-sinusal disorders are rarely associated with this condition. We are going to discuss a case that was associated with recurrent sinusitis. In this case report, we describe how we managed this rare syndrome so we can share our experience with those colleagues that may face this condition.

Sinusitis doi: 10.3390/sinusitis8020008

Authors: Natalia Fourla Nikolaos Drimalas Ioannis Michael Vlastos

Bardet–Biedl syndrome (BBS) is a genetic disease caused by mutations of the BBS genes that encode proteins involved in cilia functioning. It can present with major and/or minor clinical manifestations, such as rod–cone dystrophy, polydactyly, obesity, speech delay, anosmia, congenital heart disease and genital and renal abnormalities. Diagnosis of this rare disease is based on clinical criteria and can be confirmed with molecular genetic testing. Although BBS is a ciliopathy, nasal polyposis has never before been reported in patients with this condition. This article presents the case of a 12-year-old male patient admitted with symptoms of retinopathy, development delay, anosmia, bifid epiglottis and recurrent nasal polyposis. After several clinical, imaging and genetic examinations, the patient was diagnosed with BBS. His nasal symptoms were treated with functional endoscopic sinus surgery and long-term antibiotic therapy, whereas courses of topical antibiotics as well as topical and systemic corticosteroids had no effect. As a conclusion, it is a rare case that presents new clinical manifestations (nasal polyps) that can be related to BBS and possible effective treatments.

Sinusitis doi: 10.3390/sinusitis8020007

Authors: Owen Tsung Wen Ho Alex Chengyao Tham

We aim to provide an updated and comprehensive review of the current literature on the clinical profile and treatment options of CSBO caused by sinusitis. Three databases, Pubmed, Embase and Scopus, were searched from inception until 2 October 2022. Titles and abstracts were used for the first stage of study selection; subsequently, full texts were screened for final inclusion. Nine studies were included, with eight case reports and one case series. Patients ranged between 33 and 75 years old, with four females and four males total in the case reports. In the case series, there were 14 patients with a mean age of 62 years old. Patients with CSBO secondary to sinusitis often present with non-specific symptoms which may mimic other pathologies of the head and neck. A high index of suspicion for CSBO is important in the presence of an unremitting headache or cranial nerve palsy. Treatment options include culture-directed long-term antibiotics and surgery. The role of surgery in these patients, however, needs to be investigated more thoroughly. We believe that more large-cohort observational studies assessing the association between sinusitis and CSBO should be performed to further analyze and evaluate this topic.

Sinusitis doi: 10.3390/sinusitis8020006

Authors: Philippe Eloy Gabriela Cornelia Musat

Nasal polyposis is defined as a Th2-driven chronic inflammation of the nose and sinus with polyps visible in the nasal fossae. It is a prevalent disease with a significant impact on health-related quality of life (HRQL). Allergies, allergic rhinitis, asthma, and aspirin intolerance are frequently associated. The management is individual. The first line of treatment is long-term treatment with intranasal corticosteroids. Oral corticosteroids should be used with caution. When the medical treatment fails, the patient is eligible for sinus surgery, which usually consists of a complete sphenoethmoidectomy. In the case of symptomatic recurrence after both medical and surgical treatment, biologics are currently a very promising treatment effective on all respiratory tracts. Dupilumab is considered in the literature to be the molecule of choice. However, besides the international guidelines published by EPOS and Euforea, the molecule prescribed depends also on its availability in each country and the criteria edited by the health authorities to receive reimbursement. Traditional medical treatment remains necessary as a complement to biologics. At the moment, there is no consensus on when the medical treatment can be stopped.

Sinusitis doi: 10.3390/sinusitis8020005

Authors: Nitish Kumar Pedro Lanca Gomes Michael J. Marino Amar Miglani Devyani Lal

Although technical causes of endoscopic sinus surgery (ESS) failure have long been reported, we were curious about the quality of contemporary sinus surgery. The electronic health database of Mayo Clinic, Arizona was scrutinized to identify adult patients with diffuse chronic rhinosinusitis (CRS) who underwent revision ESS between January 2019 and September 2023 with a history of bilateral full-house ESS. Anatomical features on preoperative radiology and intraoperative endoscopy were cataloged: residual uncinate tissue, maxillary antrostomy with a non-incorporated natural os, residual ethmoidal septations (three septations > 3 mm), and inadequate sphenoid osteotomy (os size < 6 mm). Sixty-nine subjects were identified. A deviated nasal septum was present in 53.6%. Residual uncinate tissue was noted in 50.7% of patients associated with missed natural maxillary os in 39.13% of antrostomies. An inadequate os diameter was noted in 63.8% of sphenoidotomies. Significant residual septations were seen in posterior ethmoidal cells in 66.7% and anterior ethmoidal cells in 62.3% of patients. Residual frontoethmoidal cells were noted in 72.4% of patients. Although the extent of ESS must be individualized, a high prevalence of features reflecting suboptimal surgery that could limit the success of ESS was identified. These findings merit further consideration for focused training during residency and continuous professional development activities.

Sinusitis doi: 10.3390/sinusitis8020004

Authors: Ahda Farhah Mohd Kutubudin Aneeza W. Hamizan Kew Thean Yean Farah Dayana Zahedi Baharudin Abdullah Salina Husain

Background: A centrally limited radiological pattern, marked by mucosal thickening in the central sinonasal cavity with relatively unaffected surrounding sinuses, has been linked to allergy in chronic rhinosinusitis (CRS). However, a comparison between allergic and non-atopic CRS patients is lacking. The role of anatomical variations in the ostiomeatal complex also remains unclear. Methods: Adult CRS patients with allergic rhinitis, asthma, eczema, and positive allergy tests were recruited. CRS patients without atopic disease and negative allergy tests were controls. CT scans were evaluated for the centrally limited radiologic pattern. Anatomical variations in the ostiomeatal complex were also examined. Results: The study included 15 allergic CRS and 17 non-atopic CRS participants. Allergic CRS patients showed a higher prevalence of centrally limited sinus disease compared to non-atopic CRS patients (50% vs. 14.7%, p < 0.01). No anatomical variations were conclusively linked to allergy status or the centrally limited sinus disease. Conclusion: Centrally limited sinus disease on radiology is associated with underlying allergy in CRS but should not be the primary diagnostic tool. Anatomical variants did not clearly relate to allergy status or the radiologic pattern but this requires further studies.

Sinusitis doi: 10.3390/sinusitis8020003

Authors: Margaret B. Mitchell Alan D. Workman Richard Lu Neil Bhattacharyya

Background: Sinusitis, whether acute or chronic, is likely due at least in part to disruptions in the microbiota of the paranasal sinuses. Sinus cultures are often employed to guide medical treatment. Objective: To quantify the contemporary microbiology of the paranasal sinuses and better understand the utility of paranasal sinus cultures. Methods: We identified patients from 2018 to 2019 with sinus cultures taken by an otolaryngologist in the outpatient setting in our healthcare system with a concurrent diagnosis of acute or chronic rhinosinusitis. These cultures were analyzed based on their culture type and result. The most commonly isolated bacteria were further analyzed by species; Staphylococcus resistance patterns were analyzed as well. Results: A total of 2302 culture samples were collected: 2012 (87%) bacterial, 287 (13%) fungal, and 3 (0.1%) mycobacterial cultures. The results of more than half (1142, 57%) of these bacterial cultures were positive for a named genus, while those of 592 (29%) were positive for normal sinus flora and 16 (0.8%) for normal oral flora, and those of 183 (9%) showed no growth. The results of another 79 (4%) bacterial cultures were positive for unnamed bacteria, which were not further classified (e.g., Gram-negative rods). Of the positive bacterial cultures with named genera, the most common genera identified was Staphylococcus (383, 34%). Of these, the most common species of Staphylococcus was S. aureus (311, 81%), 42 of which (14%) showed methicillin resistance (MRSA). Of the fungal cultures, 265 (92%) resulted in no growth, and all three mycobacterial cultures showed no growth. Conclusions: In contrast to fungal cultures, the majority (57%) of sinus bacterial cultures showed positive results, with the identification of a named genus, highlighting the potential utility of this assay in guiding medical therapy.

Sinusitis doi: 10.3390/sinusitis8020002

Authors: David Longhino Arianna Aruanno Eleonora Nucera

In recent years, nasal cytology (NC) has become a valuable diagnostic tool in rhinology due to its easy practicability, non-invasiveness, and low cost [...]

Sinusitis doi: 10.3390/sinusitis8010001

Authors: Snezhina Lazova Kremena Naydenova Tsvetelina Velikova

Although the cough reflex is one of the essential protective mechanisms in the respiratory tract, it is considered a considerable health problem in adults and children when it becomes chronic and hypersensitive. However, the need for biomarkers for chronic cough in children and adults is critical. The problem with cough is also a severe symptom in hypersensitivity children. Respiratory infections are a considerable challenge for pediatricians, especially in allergic children. The term cough hypersensitivity syndrome, although introduced in adults, was questioned for children. Eosinophil cationic protein (ECP) is a promising marker for chronic cough but still needs to be validated and proved in clinical settings. In this review article, we aimed to discuss the possible role of ECP in connection to IgE for chronic cough in children.

Sinusitis doi: 10.3390/sinusitis7020004

Authors: Jessa E. Miller Jennifer L. Taylor-Cousar Daniel M. Beswick

Cystic fibrosis (CF) is an autosomal recessive disorder that results in deranged ion transport and affects multiple organ systems, including the upper and lower respiratory tracts. People with CF (PwCF) often develop chronic rhinosinusitis (CRS) with or without nasal polyposis. CRS can significantly decrease quality of life for PwCF and can lead to more frequent pulmonary exacerbations. The management of CRS in PwCF is different from that in individuals without CF. Novel therapies have emerged in the last several years that have drastically altered the progression of both pulmonary and sinonasal disease in people with CF. It is critical for providers who manage CF-related CRS to understand the unique characteristics and challenges that coincide with this disease process. This review article aims to provide readers with an overview of the pathophysiology of CF and to summarize best practice strategies for the management of CF-related CRS.

Sinusitis doi: 10.3390/sinusitis7020003

Authors: Camron Davies Franklin Wu Emily Y. Huang Masayoshi Takashima Nicholas R. Rowan Omar G. Ahmed

Central compartment atopic disease (CCAD) is a distinct phenotype within chronic rhinosinusitis with nasal polyps (CRSwNP) with a pathophysiology that bridges the gap between allergy and CRSwNP, an association that was previously ambiguous. Understanding this endotype and its link to allergic disease is crucial for improved CCAD management. Using a systematic search and an independent dual-reviewer evaluation and data extraction process, this scoping review examines the clinical features, management options, and treatment outcomes of CCAD. Central compartment (CC) polypoid changes of the MT predominantly correlate with allergic rhinitis, increased septal inflammation, oblique MT orientation, and decreased nasal cavity opacification and Lund–Mackay scores compared to other CRSwNP subtypes. CCAD patients also exhibit higher rates of asthma, allergen sensitization, and hyposmia or anosmia. Surgical outcomes, including revision rate and SNOT-22 improvement, are favorable in CCAD as well. In conclusion, CCAD primarily affects atopic individuals and is managed using endoscopic sinus surgery combined with treating the underlying allergy. Continued research is needed to further refine understanding and develop optimal treatment strategies of this emerging CRS subtype.

Sinusitis doi: 10.3390/sinusitis7010002

Authors: Terese Huiying Low Jun Jie Seah Somasundaram Subramaniam Vijayaraj Thirunavukarasu Chew Lip Ng

The authors describe an unusual case of chemical sinusitis and orbital cellulitis secondary to a sodium hypochlorite accident in a patient who had just undergone root canal treatment. The patient presented with acute, progressive symptoms of unilateral maxillary sinusitis, facial cellulitis and orbital cellulitis which began hours after root canal treatment on the ipsilateral side. He was admitted to hospital under the care of the Otorhinolaryngology team and reviewed regularly by the Ophthalmologists. He underwent Endoscopic Sinus Surgery during his hospital stay. The intraoperative findings revealed necrotic sinus mucosa and slough within the involved maxillary sinus, which were suggestive of chemical burn injury induced by the highly alkaline sodium hypochlorite solution used during root canal treatment. He was treated postoperatively with regular nasal toilet, culture-directed antibiotics and topical ocular pressure-lowering eyedrops. He displayed a slow recovery with eventually no orbital sequelae, but experienced persistent cheek numbness three months post-injury. Severe chemical sinusitis with orbital cellulitis secondary to sodium hypochlorite accident is a rare complication of root canal treatment, with potentially severe consequences. It can present with symptoms similar to complicated acute bacterial sinusitis. Otorhinolaryngologists and dental surgeons should maintain a high index of suspicion when managing a patient post-root canal treatment with symptoms of unilateral sinusitis, facial cellulitis, orbital cellulitis and even airway compromise. This would allow prompt intervention before sight or life-threatening complications set in.

Sinusitis doi: 10.3390/sinusitis7010001

Authors: Rory Chan Kirsten Stewart Rasads Misirovs Brian Lipworth

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) and severe eosinophilic asthma (SEA) are common comorbidities characterised by type 2 inflammation associated with increased expression of interleukin 5. Methods: Eight patients with SEA and severe CRSwNP attended the Scottish Centre for Respiratory Research as part of a clinical trial (EudraCT number 2019-003763-22). Following an initial 4-week run-in period (baseline) when patients took their usual inhaled and intranasal corticosteroid treatment for SEA and CRSwNP, they all received subcutaneous benralizumab 30 mg q4w for 12 weeks. Results: Following 12 weeks of benralizumab, no significant differences were detected in nasal global symptom visual analogue score (VAS), hyposmia VAS, total nasal symptom score, or peak nasal inspiratory flow. In contrast, Asthma Control Questionnaire significantly improved along with near-complete depletion of peripheral blood eosinophils by 99%, while eosinophil-derived neurotoxin fell by 72%. Conclusions: Greater improvements in patient-reported outcomes related to asthma were observed than with CRSwNP in response to benralizumab.

Sinusitis doi: 10.3390/sinusitis6020009

Authors: Snezhina Lazova Nikolay Yanev Nadia Kolarova-Yaneva Tsvetelina Velikova

(1) Background: A number of studies have demonstrated the connection between developing or exacerbating chronic respiratory diseases in adults and children. However, still, few studies focus on reducing exacerbations via immunomodulation. (2) Methods: In this pilot study, a total of 25 pediatric and adult patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)/persistent bacterial bronchitis (PBB) were included, administered over-the-counter (OTC) immunomodulators and followed up for 6 or 12 months. (3) Results: We observed a decrease in the frequency of exacerbations with slight improvements in functional respiratory indicators in adults on their second and third visits and a reduced number of exacerbations and improved spirometry indices in children with BA, although exacerbations requiring hospital admission remained at a similar rate. (4) Conclusions: We confirmed that the number of exacerbations of underlying chronic respiratory disease in adults and children could be reduced after the administration of OTC immunomodulators, probably by optimizing the immune resistance to common viral infections.

Sinusitis doi: 10.3390/sinusitis6020008

Authors: Agrani Ratnayake Kumar Andrew James Wood

Tranexamic acid (TXA) is an inexpensive and widely used medication indicated for the reduction of bleeding. There are data showing the efficacy of intravenous (IV) and topical TXA in endoscopic sinus surgery (ESS) but the safety of this practice is not well studied. The objective of this study was to assess the safety of using both IV and topical TXA in ESS. A scoping review was performed to investigate the effect of TXA on respiratory epithelia. A retrospective single-surgeon study was used to assess 177 comprehensive ESS cases from January 2017–December 2019 for the safety of combined IV and topical TXA. The scoping review demonstrated that respiratory epithelia could withstand a wide range of TXA concentrations without detrimental morphological effects. Topical TXA may have positive effects on wound healing and inflammation. The retrospective study showed no thromboembolic complications attributable to TXA in the 28 days after ESS. Only two patients (1.3%) who received TXA re-presented with post-operative bleeding. The use of IV and topical TXA is safe with regards to its effect on respiratory epithelium and thromboembolic disease. Topical TXA may have more positive effects than merely the reduction of bleeding following ESS.

Sinusitis doi: 10.3390/sinusitis6020007

Authors: Ricardo G. Figueiredo Caio Laudano Jaqueline Muniz José de Bessa

Despite significant advances in pharmacological treatment over the last few decades, COPD remains a heavy burden on the health systems around the world, affecting approximately 210 million people, with elevated morbimortality and socioeconomic impact. Barriers to healthcare access were even more evident during the coronavirus disease 19 (COVID-19) pandemic and increased patients’ vulnerability to physical deconditioning, depression, and social isolation. Home-based respiratory care in patients with COPD provides a valuable contribution to effective disease management, with potential advantages for monitoring, treatment adherence, and cost reduction. Technological innovation allows clinical markers of interest, such as respiratory frequency, pulmonary function, and oxygen saturation, to be tracked remotely from the patients’ homes, providing a better understanding of their real needs. Home-based telerehabilitation can also be a viable alternative to hospital-based programs. Here, we highlight the full extent of health benefits of HRC in COPD, particularly for patients with a higher risk of exacerbations, multiple comorbidities, and limited access to health services.

Sinusitis doi: 10.3390/sinusitis6020006

Authors: Fernando M. Calatayud-Sáez Blanca Calatayud Ana Calatayud

Introduction: Acute Otitis Media (AOM) is the most commonly-occurring bacterial complication in childhood. After making certain corrections to the patients’ dietary habits, which we found to be excessively high in animal-based and industrially-processed foods, we observed a significant reduction in recurrent colds and their bacterial complications. We promote an original way of treating these diseases, since until now the conventional treatment is based on pharmacological and surgical treatment. From our point of view, the mucosa that covers the entire ENT area is in a pro-inflammatory and hyper-reactive state, as a consequence of the alterations produced by an inadequate diet. For us there is no difference in the nutritional treatment of the different mucous membranes that cover the ENT area. The purpose of the study was to assess the effects of the Traditional Mediterranean Diet (TMD) on patients diagnosed with Recurring Acute Otitis Media (RAOM). Methods: prospective pre-postest comparison study with 48 girls and 42 boys aged 1–5 years, each of whom had been and included on the 1-year programme “Learning to eat the Mediterranean Way”, designed to encourage the adoption of the TMD. We studied clinical and therapeutic variables and various anthropometric parameters. Results: all the symptomatic indicators studied (number and intensity of episodes of otitis and emergency admissions) showed a positive and statistically significant evolution in RAOM. By the end of the study, none of the patients met the criteria for classification as RAOM, and 60% percent of patients did not present any further episodes of AOM. In line with the above, the use of anti-microbial drugs and symptomatic treatments reduced considerably; the use of antibiotics dropped from 4.30 occasions/patient/year, to 0.66 (p < 0.001), and the used of symptomatic treatments dropped from 7.63 to 2.75 (p < 0.001). The level of family satisfaction was very high. Conclusions: the adoption of the Traditional Mediterranean Diet has been demonstrated to significantly reduce occurrence of acute otitis media and may contribute to the treatment of patients diagnosed with recurrent acute otitis media.

Sinusitis doi: 10.3390/sinusitis6020005

Authors: Ricardo G. Figueiredo Lucas F. Araujo José de Bessa Junior

Chronic obstructive pulmonary disease (COPD) is a global public health burden that stands out as a leading cause of mortality around the world, especially in less developed countries. COPD treatment should be centered on the individual necessities of each patient, integrating pharmacological therapy, immunization, nutritional support, pulmonary rehabilitation and control of comorbidities. Combining a long-acting antimuscarinic (LAMA) with a long-acting beta2-agonist (LABA) bronchodilator has proven to be more effective than monotherapy with LABA or LAMA, in terms of the functional improvement of forced expiratory volume (FEV1), symptoms and life quality and may be helpful in patients with progressive dyspnea. The eosinophil blood count is a simple biomarker that could guide personalized treatment strategies by identifying patients with greater clinical benefits of inhaled corticosteroid (ICS) treatment. However, one critical concern is the increased risk of pneumonia in individuals treated with ICS.

Sinusitis doi: 10.3390/sinusitis6020004

Authors: Fernando M. Calatayud-Sáez

‘Understand your honours that it is not so much that the traditional diet rooted in our homes has a miraculous character, as that the diet that modernity imposes on us is unhealthy and inadequate for the human intestines [...]

Sinusitis doi: 10.3390/sinusitis6010003

Authors: Sy Duong-Quy

The concept of united airway disease interaction, which comprises chronic rhinosinusitis and other lower airway disorders such as asthma, has been recognized for over a decade [...]

Sinusitis doi: 10.3390/sinusitis6010002

Authors: Abigail Weaver Andrew Wood

It is established that non-white people experience worse health outcomes than white people within the same population. Equity addresses differences between patient subgroups, allowing needs-based distribution of resources. The use of quality-of-life (QoL) tools to assist clinical decision making such as the SNOT-22 for chronic rhinosinusitis promotes equality, not equity, as quality-of-life (QoL) tools provide the same criteria of symptom scoring across diverse populations. We considered the effects of ethnicity and race on SNOT-22 scores and whether these scores should be adjusted to improve equity. PubMed and MEDLINE provided papers for a scoping review. A combination of the following search terms was used: patient-reported outcome measures (PROM) (OR) quality of life; (AND) race (OR) ethnicity (OR) disparities; (AND) otolaryngology (OR) SNOT-22 (OR) sinusitis. The first study identified no evidence of ethnic variability in SNOT-22 scores. However, the study did not represent the local population, including 86% white people. Other studies identified baseline SNOT-22 disparities with respect to population demographics, gender, and age. Ethnic differences appear to exist in acute sinusitis symptomatology. In other fields both within and outside of otorhinolaryngology, ethnic differences exist with regard to QoL tools. This scoping review identified a paucity of data in rhinology. However, evidence implies some form of correction to QoL scores could help promote equity for non-white patients.

Sinusitis doi: 10.3390/sinusitis6010001

Authors: Snezhina Lazova Marta Baleva Stamatios Priftis Emilia Naseva Tsvetelina Velikova

Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma exacerbation. Objective: The study aims to perform a comparative analysis of different laboratory methods for a serological assessment of an atopic status in asthma and respiratory allergies in children. Material and methods: A total of 86 children were included, all of whom were diagnosed with bronchial asthma, aged from 5 to 17 years and screened for total IgE level using enzyme-linked immunosorbent assay (ELISA). In 48 randomly selected children, we performed a semi-quantitative serological in vitro assessment of the specific IgE antibodies against food and aeroallergen, using two different laboratory methods—Euroimmun Immunoblot and ImmunoCAP (Phadiatop/fx5). Results: In 70% of the children with a history of allergies, and 65.3% without clinically manifested allergies, multiscreen test ImmunoCAP Phadiatop/fx5 showed positivity and confirmed atopy. Our results showed a significant moderate to strong correlation between multiscreen ImmunoCAP Phadiatop/fx5, and Euroimmun specific IgE titers against aero-allergens—cats, mites, tree mix and food allergens—soy, wheat (р = 0.006), rice, р = 0.090), apple р = 0.007) and peanut. A sensitivity of 63% and specificity of 73.5% was observed for EUROIMMUN Pediatric (food allergens, IgE titer > 1) compared with the gold standard ImmunoCap/fx5. The mean value of total IgE is significantly higher in children with asthma and concomitant with allergic rhinitis compared to those without allergic rhinitis (mean 202.52 U/mL, IQR 102.50 (24.20–363.95) vs. 316.68, IQR 261.00 (109.20–552.50), p = 0.005). Conclusion: Establishing the spectrum of the most common respiratory and food allergens is an essential factor for maintaining asthma control, both through a strategy to avoid allergen exposure and by developing a recommendation plan. The immunoblotting technique is easily applicable in daily clinical and laboratory practice. It is also a cost-effective and reliable alternative to the “gold standard” ImmunoCAP Phadiatop/fx5 in diagnosing atopy in children.

Sinusitis doi: 10.3390/sinusitis5020014

Authors: Fabio Bernardello Teresa Lombardi Claudio Stacchi

Sinus membrane perforation is the most frequent intraoperative complication occurring during maxillary sinus floor elevation. Although numerous techniques for perforation management are present, grafting material dissemination may still occur, representing a potential trigger factor leading to acute or chronic sinusitis. This case report describes two cases of xenogeneic bone substitute in gel form accidentally dispersed into the sinus cavity during maxillary sinus floor elevation with a transcrestal approach. In both cases, immediately postoperative radiographic imaging showed an important amount of gel graft dislodged into the sinus cavity as a consequence of hidden perforations that remained undetected during surgery. Patients were monitored for 6 months after surgery and reported no signs or symptoms related to possible sinus disease. Control radiographs showed no sinus membrane hypertrophy and/or presence of residual disseminated gel, confirming complete clearance of the accidentally dispersed graft through the ostiomeatal complex. In order to minimize postoperative complications, bone substitutes in gel form could represent an interesting alternative to granular grafts for their easier clearance from the maxillary sinus cavity in case of accidental dissemination during sinus augmentation procedures.

Sinusitis doi: 10.3390/sinusitis5020013

Authors: Sy Duong-Quy Thuy Nguyen-Thi-Dieu Khai Tran-Quang Tram Tang-Thi-Thao Toi Nguyen-Van Thu Vo-Pham-Minh Quan Vu-Tran-Thien Khue Bui-Diem Vinh Nguyen-Nhu Lam Hoang-Thi Timothy Craig

(1) Background: Exhaled nitric oxide (NO) has been considered as a biomarker of airway inflammation. The measurement of fractional exhaled NO (FENO) is a valuable test for assessing local inflammation in subjects with allergic rhinitis (AR). (2) Objective: To evaluate (a) the correlation between nasal FENO with anthropometric characteristics, symptoms of AR and nasal peak flows in children without and with AR; and (b) the cut-off of nasal FENO for diagnosis of AR in symptomatic children. (3) Methods: The study was a descriptive and cross-sectional study in subjects with and without AR < 18 years old. All clinical and functional characteristics of the study subjects were recorded for analysis. They were divided into healthy subjects for the control group and subjects with AR who met all inclusion criteria. (4) Results: 100 subjects (14 ± 3 years) were included, including 32 control subjects and 68 patients with AR. Nasal FENO in AR patients was significantly higher than in control subjects: 985 ± 232 ppb vs. 229 ± 65 ppb (p < 0.001). In control subjects, nasal FENO was not correlated with anthropometric characteristics and nasal inspiratory or expiratory peak flows (IPF or EPF) (p > 0.05). There was a correlation between nasal FENO and AR symptoms in AR patients and nasal IPF and EPF (p = 0.001 and 0.0001, respectively). The cut-off of nasal FENO for positive AR diagnosis with the highest specificity and sensitivity was ≥794 ppb (96.7% and 92.6%, respectively). (5) Conclusion: The use of nasal FENO as a biomarker of AR provides a useful tool and additional armamentarium in the management of allergic rhinitis.

Sinusitis doi: 10.3390/sinusitis5020012

Authors: Laura Araújo Vanessa Arata Ricardo G. Figueiredo

Altered smell is one of the most prevalent symptoms in acute COVID-19 infection. Although most patients recover normal neurosensory function in a few weeks, approximately one-tenth of patients report long-term smell dysfunction, including anosmia, hyposmia, parosmia and phantosmia, with a particularly notable impact on quality of life. In this complex scenario, inflammation and cellular damage may play a key role in the pathogenesis of olfactory dysfunctions and may affect olfactory signaling from the peripheral to the central nervous system. Appropriate management of smell disturbances in COVID-19 patients must focus on the underlying mechanisms and the assessment of neurosensorial pathways. This article aims to review the aspects of olfactory impairment, including its pathophysiology, epidemiology, and clinical management in post-acute COVID-19 syndrome (PACS).

Sinusitis doi: 10.3390/sinusitis5020011

Authors: Fernando M. Calatayud-Sáez Blanca Calatayud Ana Calatayud

Introduction: There are more and more studies that demonstrate the anti-inflammatory effects of the traditional Mediterranean diet (TMD). The aim of the study was to assess the effects of an intervention with the TMD in patients with recurrent acute and chronic rhinosinusitis. Material and Methods: We performed a pretest–posttest comparison study in 114 patients (56 girls and 58 boys) aged one to five years who had three or more acute rhinosinusitis episodes in the period of 1 year. They were included for a year in the nutritional program “Learning to eat from the Mediterranean”. The anthropometric, clinical, and therapeutic characteristics were studied. Results: All the studied indicators showed a positive and statistically significant evolution. Of the patients, 53.5% did not have any episode of acute rhinosinusitis, and 26.3% had only one, compared to the 3.37 they had on average in the previous year. The use of antibiotics decreased by 87.6%. The degree of satisfaction of the families was very high. The Mediterranean Diet Quality Index (KIDMED) that assesses the quality of the TMD rose from 7.7 to 11 points. Conclusions: The adoption of the TMD could have promising effects in the prevention and treatment of recurrent acute and chronic rhinosinusitis, limiting the pharmacological and surgical intervention in many of these patients.

Sinusitis doi: 10.3390/sinusitis5010010

Authors: Fernando M. Calatayud-Sáez Blanca Calatayud Ana Calatayud

Introduction: During the first years of life, the oro-pharyngeal lymphoid tissue gradually increases in size, causing in some children difficulty breathing and often leading to surgical removal of the tonsils and adenoids. The objective of the study is to assess the effects of the Mediterranean diet in children who had chronic upper airway obstruction. Material and methods: This was a prospective study pre-test/post-test comparison. Eighty-seven patients from two to eight years old were recruited. A food reeducation program based on the Mediterranean diet was applied for one year. Clinical, therapeutic, and anthropometric variables were studied. Results: The degree of nasal obstruction decreased in 95.1% of the patients. After the nutritional intervention, the number of colds with bacterial complications decreased by 80.26%; 60.9% had no bacterial complications during the year of the study. The use of antibiotics decreased by 81.94%. Symptomatic treatment decreased by 61.2%. Most patients did not require surgical intervention, and clinical evolution suggested that it would no longer be necessary. Conclusions: We can conclude by saying that the application of the traditional Mediterranean diet could be effective in the prevention and treatment of persistent nasal obstruction, limiting pharmacological and surgical intervention in many of these patients.

Sinusitis doi: 10.3390/sinusitis5010009

Authors: Ganesh Chandra Jagetia

Oroxylum indicum, Sonapatha is traditionally used to treat asthma, biliousness, bronchitis, diarrhea, dysentery, fevers, vomiting, inflammation, leukoderma, skin diseases, rheumatoid arthritis, wound injury, and deworm intestine. This review has been written by collecting the relevant information from published material on various ethnomedicinal and pharmacological aspects of Sonapatha by making an internet, PubMed, SciFinder, Science direct, and Google Scholar search. Various experimental studies have shown that Sonapatha scavenges different free radicals and possesses alkaloids, flavonoids, cardio glycosides, tannins, sterols, phenols, saponins, and other phytochemicals. Numerous active principles including oroxylin A, chrysin, scutellarin, baicalein, and many more have been isolated from the different parts of Sonapatha. Sonapatha acts against microbial infection, cancer, hepatic, gastrointestinal, cardiac, and diabetic disorders. It is useful in the treatment of obesity and wound healing in in vitro and in vivo preclinical models. Sonapatha elevates glutathione, glutathione-s-transferase, glutathione peroxidase, catalase, and superoxide dismutase levels and reduces aspartate transaminase alanine aminotransaminase, alkaline phosphatase, lactate dehydrogenase, and lipid peroxidation levels in various tissues. Sonapatha activates the expression of p53, pRb, Fas, FasL, IL-12, and caspases and inhibited nuclear factor kappa (NF-κB), cyclooxygenase (COX-2), tumor necrosis factor (TNFα), interleukin (IL6), P38 activated mitogen-activated protein kinases (MAPK), fatty acid synthetase (FAS), sterol regulatory element-binding proteins 1c (SREBP-1c), proliferator-activated receptor γ2 (PPARγ2), glucose transporter (GLUT4), leptin, and HPV18 oncoproteins E6 and E7 at the molecular level, which may be responsible for its medicinal properties. The phytoconstituents of Sonapatha including oroxylin A, chrysin, and baicalein inhibit the replication of SARS-CoV-2 (COVID-19) in in vitro and in vivo experimental models, indicating its potential to contain COVID-19 infection in humans. The experimental studies in various preclinical models validate the use of Sonapatha in ethnomedicine and Ayurveda.

Sinusitis doi: 10.3390/sinusitis5010008

Authors: Margaret Zhang Somasundram Subramaniam Chew Lip Ng

Access to the lateral recess has always been a difficult task, especially in cases where the entrance to the lateral recess is very narrow. Various strategies have been described to approach it. Our study proposes a unique method of clearing debris in patients with concretions within the lateral recess. The “scrubbing brush technique” is based on easily accessible tools and has the exceptional advantage of being user friendly and having minimal potential side effects.

Sinusitis doi: 10.3390/sinusitis5010007

Authors: Karthika Nathan Sudhir Kumar Majhi Rohit Bhardwaj Ankur Gupta Sabarirajan Ponnusamy Chirayata Basu Aditya Kaushal

Introduction: The objective components of chronic rhinosinusitis (CRS) diagnosis require confirmatory findings from either diagnostic nasal endoscopy (DNE) or a computed tomography (CT) scan. Chronic rhinosinusitis affects a significant population worldwide, imposing a huge toll on the human economy as well as on quality of life. Thus, it is particularly important to define a cost-effective and easily available diagnostic tool for it. Hence, we have conducted this study with the aim of assessing the effectiveness of DNE in comparison with CT for evaluating CRS. Material and Methods: Eighty participants fulfilling the diagnostic symptom criteria of CRS underwent CTs of their noses and paranasal sinuses (PNS) and DNE. Standard Lund–Mackay and Lund–Kennedy scores were awarded to all participants based on the CT and DNE. A comparative analysis was done. Results: DNE in comparison to CT had 92.31% sensitivity, 73.33% specificity, 93.75% positive predictive value, 68.75% negative predictive value, and 88.75% diagnostic accuracy. Conclusion: We suggest that nasal endoscopy be used as an early diagnostic tool in the clinical assessment of suspected CRS patients (based on the diagnostic symptom criteria). DNE helps to decrease the usage of CT, thereby decreasing cost and radiation exposure. Computed tomography may be added for patients having anatomical defects (affecting endoscopic visualization) or refractory disease, and where surgery has been planned.

Sinusitis doi: 10.3390/sinusitis5010006

Authors: Yasutaka Yun Masao Yagi Tomofumi Sakagami Shunsuke Sawada Yuka Kojima Tomoe Nakatani Risaki Kawachi Kensuke Suzuki Hideyuki Murata Akira Kanda Mikiya Asako Hiroshi Iwai

Odontogenic maxillary sinusitis (OMS) is a disease in which inflammation from the teeth extend into the maxillary sinus, causing symptoms of unilateral sinusitis. OMS can recur, with some being resistant to antibiotics. In intractable cases, exodontia and endoscopic sinus surgery (ESS) are necessary treatments. Here we report our analysis on the indications for surgical intervention in cases diagnosed with and treated as OMS. We retrospectively examined 186 patients who were diagnosed with sinusitis on a computed tomography (CT) scan. For cases diagnosed with OMS, the site of the causative tooth and the presence or absence of oroantral fistula to the maxillary sinus was examined. In addition, we analyzed the therapeutic efficacy of the initial treatment of antibiotics, and what the indications were for ESS. Among the patients examined, OMS was diagnosed in 44 cases (23.6%). In 14 out of 20 cases that underwent a post-medical treatment CT scan, OMS found to be treatment-resistant. Of these 14 cases, 12 (88%) had oroantral fistulae to the maxillary sinus. In all cases where exodontia, fistula closure surgery, and endoscopic sinus surgery (ESS) were performed, the fistula disappeared and the shadow of inflammation in the paranasal sinus improved. In OMS with oroantral fistula, ESS, exodontia, and fistula closure should be recommended over medication such as macrolide therapy.

Sinusitis doi: 10.3390/sinusitis5010005

Authors: Kremena Naydenova Vasil Dimitrov Tsvetelina Velikova

Inflammation of the upper respiratory tract in patients with allergic rhinitis (AR) may contribute to lower respiratory airways’ inflammation. T-helper 17 (Th17) cells and related cytokines are also involved in the immunological mechanism of AR along with the classical Th2 cells. It is hypothesized that upon Th2 pressure, the inflammatory response in the lungs may lead to Th17-induced neutrophilic inflammation. However, the findings for interleukin-17 (IL-17) are bidirectional. Furthermore, the role of Th17 cells and their counterpart—T regulatory cells—remains unclear in AR patients. It was also shown that a regulator of inflammation might be the individual circulating specific non-coding microRNAs (miRNAs), which were distinctively expressed in AR and bronchial asthma (BA) patients. However, although several circulating miRNAs have been related to upper and lower respiratory tract diseases, their function and clinical value are far from being clarified. Still, they can serve as noninvasive biomarkers for diagnosing, characterizing, and providing therapeutic targets for anti-inflammatory treatment along with the confirmed contributors to the pathogenesis—Th17 cells and related cytokines. The narrow pathogenetic relationship between the nose and the bronchi, e.g., upper and lower respiratory tracts, confirms the concept of unified airway diseases. Thus, there is no doubt that AR and BA should be diagnosed, managed, and treated in an integrated manner.

Sinusitis doi: 10.3390/sinusitis5010004

Authors: Bassem Mettias Joshua D. Whittaker Yujay Ramakrishnan

Objective: investigate the impact of an intraoperative coding sticker (ICS) on the accuracy of coding in endoscopic sinonasal procedures. Methods: this was a two-cycle audit evaluating the accuracy (and financial impact) of intraoperative coding of sinonasal procedures at a single tertiary centre. An ICS was introduced following consultation with the coding department. The accuracy of coding was measured before (cycle 1) and after (cycle 2) the ICS was introduced to a pilot firm and compared to a control firm. The ICS was used in 35% of the pilot firm cases. Results: the accuracy of clinical coding for endoscopic sinus surgery was 60% in the first cycle. Switching to the ICS has improved the accuracy in that firm from 50% in first cycle to 70% in the second cycle (p = 0.936; Chi-squared test). The median reimbursement for endoscopic sinus surgery was equal in both cycles of £1493.00 per patient. However, inaccurate coding resulted in £109.92 excess tariff payment in first cycle and £130.96 deficiency in the second cycle. Users of ICS reported it to be easy to use for clinicians, staff and clinical coders, whilst minimizing human error. Conclusions: The integration of the ICS improves the coding in sinonasal procedures and offers low-fidelity option alternative to live coding on the computer. The accuracy was not statistically significant in the study possibly due to the low number of observations. This can allow a precise coding standard with reliable service remuneration.

Sinusitis doi: 10.3390/sinusitis5010003

Authors: Pranav Nair Kedar Prabhavalkar

Introduction: Asthma is a chronic inflammatory disorder of the airways often characterized by airway remodeling and influx of inflammatory cells into the airways. Saffron (C. sativus) has been reported to possess anti-inflammatory, anti-allergic and immunomodulatory properties. Salbutamol is known to relax airway smooth muscles. Objective: To investigate the combined anti-asthmatic effect of C. sativus extract (CSE) and salbutamol in an ovalbumin (OVA)-induced asthma in rats. Materials and methods: Airway hyperresponsiveness (AHR) was induced in male Sprague-Dawley rats by OVA challenge and treated with CSE (30 mg/kg and 60 mg/kg i.p.) and salbutamol (0.5 mg/kg p.o) for 28 days. After the induction period, various hematological, biochemical, molecular (ELISA) and histological analyses were performed. Results: OVA-induced alterations observed in hematological parameters (total and differential cell counts observed in Bronchoalveolar Lavage Fluid (BALF) were significantly attenuated (p < 0.01) by CSE (30 mg/kg and 60 mg/kg) and salbutamol (0.5 mg/kg). The treatment combination also significantly decreased (p < 0.01) the levels of total protein and albumin in serum, BALF and lung tissues. Treatment with CSE and salbutamol significantly attenuated (p < 0.01) increase in OVA induced Th2 cytokine levels (TNF-α, IL-1β, IL-4, IL-13). Histopathological analysis of lung tissue showed that combined effect of CSE and salbutamol treatment ameliorated OVA-induced inflammatory influx and ultrastructural aberrations. Conclusion: The results obtained from this study show that the combined effect of CSE and salbutamol exhibited anti-asthmatic properties via its anti-inflammatory effect and by alleviating Th2 mediated immune response. Thus, this treatment combination could be considered as a new therapeutic strategy for management of asthma.

Sinusitis doi: 10.3390/sinusitis5010002

Authors: Gyan Chandra Kashyap Deepanjali Vishwakarma Shri Kant Singh

India is greatly afflicted by sinusitis, which is a condition that involves inflaming sinuses (the air cavities in the nasal passage) in your nose, according to the National Institute of Allergy and Infectious Diseases (NIAID). The study’s objective was to evaluate the prevalence and risk factors of sinus and nasal allergies among tannery workers of Kanpur city. The study has used primary datasets obtained from a cross-sectional household study of tannery workers from the Jajmau area of Kanpur in northern India, which was conducted during January–June 2015 as part of a doctoral program. The study covered 286 tannery workers from the study area. Bivariate and logistic regression analysis was used to study the association between outcome variables (self-reported prevalence of sinus and nasal allergies) and predictor variables (socioeconomic and work-related characteristics). Results portray that a higher proportion of the tannery workers belong to economically and socially backward classes. Overall, 13.4 and 12.3% of sinus and nasal allergy prevalence have been reported by tannery workers, whereas tannery workers from the oldest age group were those who mainly suffered. A study found that the severity of nasal and sinus allergies increases with the increasing age and work duration in the tannery. Workers with low exposure to airborne dust were significantly more likely to develop sinus problems (OR = 4.16; p < 0.05) than those without exposure. Those tannery workers suffering from nasal allergy were more prone to develop sinus problems than those who were not suffering from nasal allergy. The risk factors responsible for these health hazards can be eliminated by improving the overall working conditions and ensuring necessary protective regulations for the tannery workers.

Sinusitis doi: 10.3390/sinusitis5010001

Authors: Rory Chan Chris RuiWen Kuo Brian Lipworth

Chronic rhinosinusitis (CRS) is one of the most common persistent disorders of the developed world, requiring input from various specialists including primary care physicians, otolaryngologists, respiratory physicians, and allergologists. B-cell lymphoproliferative disorders (BLPDs) are a heterogenous group of malignant conditions defined by an accumulation of mature B lymphocytes in the bone marrow, blood, and lymphoid tissues. We present a case report of an elderly man with rhinosinusitis-like symptoms and atypical features prompting further investigations that culminated in a diagnosis of BLPD.

Sinusitis doi: 10.3390/sinusitis4010003

Authors: Regimantas Simuntis Paulius Tušas Ričardas Kubilius Marijus Leketas Nora Šiupšinskienė Saulius Vaitkus

Background: The detailed relationship between apical periodontitis and maxillary sinus mucosal thickening is still unknown. The aim of this study was to evaluate the association between maxillary posterior teeth periapical odontogenic lesions and maxillary sinus mucosal (MSM) thickening by using volumetric 3D CT analysis. Methods: A total of 83 subjects with apical periodontitis around maxillary posterior teeth and maxillary sinus mucosal thickening were selected. 3D models of maxillary sinus mucosa and apical lesions were reconstructed from CT, and their volume, mean diameter were calculated. Results: Mean MSM thickening was 8.81 ± 12.59 mm with an average volume of 5092.58 ± 7435.38 mm3. Men had higher MSM thickening than women. Mean diameter of apical lesion was 5.94 ± 2.68 mm; average volume was 200.5 ± 197.29 mm3. Mean distance between MSM and apical lesion was 1.83 ± 2.07 mm. Mucosal volume was the highest in the S1 and D1 configuration and the lowest in R3. Reducing the distance between apical lesion and MSM by each millimetre, the volume of MSM increases by 759.99 mm3. Conclusions: Volumetric CT analysis is a circumstantial method to evaluate the association between maxillary posterior teeth apical periodontitis and MSM thickening. This relationship is not related to the size of the apical lesion but depends on their anatomical position and the distance from the maxillary sinus mucosa.

Sinusitis doi: 10.3390/sinusitis4010002

Authors: Russell Hopp

Pediatric chronic rhinosinusitis (CRS) remains an elusive diagnostic medical condition, largely based on imperfect diagnostic criteria, lack of controlled studies of therapy, lack of measure for resolution, and lack of information of pediatric sinus microbiome dysbiosis. The true prevalence of pediatric CRS is unknown, and symptoms often over-lap with other diagnoses. We review the unmet needs in pediatric CRS, to highlight potential research opportunities to improve understanding and therapy of the disease process.

Sinusitis doi: 10.3390/sinusitis4010001

Authors: Franck Vazquez

Since its inception in 2016 Sinusitis has published 25 articles on the topic of rhinitis, rhinosinusitis, nasal polyps, surgery in diseases of the upper airways, and new techniques and methods to investigate and treat upper airways disease [...]

Sinusitis doi: 10.3390/sinusitis3020006

Authors: Alan D. Workman Neil N. Patel Ryan M. Carey Edward C. Kuan Noam A. Cohen

Bitter (T2R) and sweet (T1R) taste receptors are expressed in the upper airway, where they play key roles in antimicrobial innate immune defense. Bitter bacterial products are detected by taste receptors on ciliated cells and solitary chemosensory cells, resulting in downstream nitric oxide and antimicrobial peptide release, respectively. Genetic polymorphisms in taste receptors contribute to variations in T1R and T2R functionality, and phenotypic differences correlate with disease status and disease severity in chronic rhinosinusitis (CRS). Correspondingly, there are also subjective bitter and sweet taste differences between patients with CRS and individuals without CRS across a number of compounds. The ability to capture these differences with a simple and inexpensive taste test provides a potentially useful diagnostic tool, while bitter compounds themselves could potentially serve as therapeutic agents. The present review examines the physiology of airway taste receptors and the recent literature elucidating the role taste receptors play in rhinologic disease.

Sinusitis doi: 10.3390/sinusitis3020005

Authors: Remi Motegi Shin Ito Hirotomo Homma Noritsugu Ono Hiroko Okada Yoshinobu Kidokoro Akihito Shiozawa Katsuhisa Ikeda

The literature strongly recommends the use of oral corticosteroids in the management of patients with eosinophilic chronic rhinosinusitis (CRS) with nasal polyps. Although potential complications associated with the long-term use of oral corticosteroids for the treatment of CRS have been suggested, no studies have described these effects in detail. Forty-three patients with a mean age of 51 years with eosinophilic CRS were retrospectively evaluated after surgery. Short-course oral prednisolone (PSL, 0.5 mg/kg of body weight) was provided for one week when anosmia and eosinophilic mucin and/or nasal polyps were present. The postoperative follow-up period ranged from 12 to 108 months (average: 62 months). HbA1C showed normal ranges in all except one patient, who had a diabetic pattern of HbA1C of 6.5%. Five patients had serum cortisol levels below the cutoff value. However, re-examination of the serum cortisol and adrenocorticotropic hormone stimulation test showed normal ranges in all five patients who had initially shown abnormal values of serum cortisol. Thus, adrenal insufficiency in all the patients was negligible. Five (3 women and 2 men) out of the 15 patients (6 women and 9 men) who participated in bone mineral density measurement showed significant reductions, suggesting the presence of osteoporosis. Patients taking long-term and repeated short-course use of oral corticosteroids for refractory nasal polyps of eosinophilic CRS are likely to have a potentially increased risk for osteoporosis.

Sinusitis doi: 10.3390/sinusitis3020004

Authors: Ryan K. Sewell

Pediatric chronic rhinosinusitis is a common condition amongst pediatric patients. Despite its prevalence, debate continues regarding the best treatment strategies. The current paper examines the literature as it pertains to the surgical management of pediatric chronic rhinosinusitis. Adenoidectomy remains the mainstay in the initial surgical management. Both maxillary sinus irrigation and balloon dilation of the sinuses have been studied with disagreement as to the timing and patient selection for those procedures. Functional endoscopic sinus surgery is an accepted treatment modality, especially in initial surgical failures. Further studies will be needed to better delineate patient selection and timing of specific surgical techniques.

Sinusitis doi: 10.3390/sinusitis3020003

Authors: Amelia Licari Ilaria Brambilla Riccardo Castagnoli Alessia Marseglia Valeria Paganelli Thomas Foiadelli Gian Marseglia

Rhinosinusitis and asthma are two comorbid conditions that lead to pathological and clinical diseases affecting the respiratory tract. They are connected by significant anatomical, epidemiological, pathophysiological, and clinical evidence, and also share therapeutic principles. The aim of this review is to provide an updated overview of the existing link between rhinosinusitis and asthma focusing on the pediatric age.

Sinusitis doi: 10.3390/sinusitis3010002

Authors: Ayami Kajiwara-Morita Chandima Karunanayake James Dosman Joshua Lawson Shelley Kirychuk Donna Rennie Roland Dyck Niels Koehncke Ambikaipakan Senthilselvan Punam Pahwa Saskatchewan Rural Health Study Research Team

Although sinus problems have long been recognized as the most common respiratory symptoms associated with agricultural work, there is a scarcity of recent studies and/or reliable estimates as to the true prevalence or risk factors of sinus problems related to farming. The aim of this study was to determine the prevalence of sinus problems in farming and non-farming rural populations and further investigate the association of individual (for example life-style, occupational), contextual (e.g., environmental), and important covariates (e.g., age, sex) with sinus problems. A large-scale cross-sectional study was conducted in farm and non-farm residents of rural Saskatchewan, Canada. A logistic regression model based on a generalized estimating equations approach were fitted to investigate the risk factors of sinus problems. Sinus problems were reported by 2755 (34.0%) of the 8101 subjects. Farm residents were more likely to spend their first year of life on farm compared with non-farm residents, and indicated a significantly lower risk of sinus problems. Meanwhile, occupational exposure to solvent and mold were associated with an increased risk of sinus problems. Some health conditions such as allergy and stomach acidity/reflux, family history, and female sex were also related to a higher risk of sinus problems. Farm residents had a significantly lower risk of sinus problems than non-farm residents, likely due to the exposure to farm specific environments in their early life.

Sinusitis doi: 10.3390/sinusitis3010001

Authors: M. Asghar Pasha

Chronic rhinosinusitis (CRS) is a prevalent disease that causes persistent mucosal inflammation and is associated with bacterial infection, which is thought to play a role in the inflammatory process. Microbiome analysis provides insight to host–microbial interactions. Disturbances in the host and commensal bacteria interaction may lead to CRS. Culture-based methods are useful to isolate some microorganisms but are unable to grow a majority of the bacteria. A review of the literature shows that several recent studies attempted to overcome this issue by using molecular techniques, such as microbial RNA sequencing, to describe the CRS microbiome. All of these studies were performed in adults, with no comparative studies reported in the pediatric population. Similar studies, utilizing molecular techniques, are needed to better understand the mechanism of CRS in children. Because valuable data from these adult studies may help to bridge the gap in our knowledge of the microbiome in pediatric CRS, we present an overview of the methodology and results behind the current microbiomic approach to adult CRS to set the stage for its use in the study of CRS in children.

Sinusitis doi: 10.3390/sinusitis2040007

Authors: Russell Hopp

Pediatric chronic sinusitis is currently designated as pediatric chronic rhinosinusitis. In most pediatric cases, sinusitis is considered as infectious. In the adult literature, a wider repertoire of chronic rhinosinusitis conditions is recognized. In this review, the adult forms of chronic rhinosinusitis are used as a framework for identifying and defining the potential spectrum of pediatric chronic rhinosinusitis that exists beyond the most recognized condition, pediatric infectious chronic rhinosinusitis.

Sinusitis doi: 10.3390/sinusitis2030006

Authors: Russell Hopp

Pediatric chronic sinusitis has been re-termed, pediatric chronic rhinosinusitis, largely following the adult nomenclature. However, other large areas of medical management of the process have remained largely uninvestigated. This opinion piece discusses the gaps in our current knowledge of pediatric rhinosinusitis pathophysiology and limitations of current management protocols.

Sinusitis doi: 10.3390/sinusitis2030005

Authors: Michael Smith Philippe Berenger Peter Bonutti Alisa Ramakrishnan Justin Beyers Vivek Ramakrishnan

Chronic rhinosinusitis (CRS) is a common disease that affects over 200 million patients worldwide. CRS often presents with facial pain, which is considered an important criterion for the diagnosis of CRS. A single-arm clinical study was designed to test the effect of simultaneous high (1 MHz) and low frequencies (70–80 Hz) on facial pain in 14 CRS patients at the Sarah Bush Lincoln Health Center, Mattoon, IL, USA. We used two quality of life (QOL) instruments to test the effect of multimodal frequencies on patients suffering from CRS: the Brief Pain Inventory Short Form (BPI-SF), and the Sino-Nasal Outcome Test (SNOT-22). Mean BPI-SF severity scores improved by 0.80 points (Wilcoxon rank sum test p < 0.01) in all 14 patients. In patients with baseline facial pain (n = 9), the scores improved by an average of 1.5 (p < 0.01) points in the pain severity domain and by 1.4 points in the pain interference domain. Additionally, the mean improvement in SNOT-22 scores was 14.11 (p < 0.05), which is above the minimal clinically-important difference (MCID) of nine points. Our pilot study indicates that multimodal vibration frequencies applied over the facial sinuses reduce pain, possibly through the reduction of the inflammatory response and modulation of the pain receptors. This study suggests the possibility that combining different frequencies could have an enhanced effect on reducing CRS-related facial pain.

Sinusitis doi: 10.3390/sinusitis2020004

Authors: Basel Al Kadah Gudrun Helmus Quoc Dinh Bernhard Schick

Introduction: The impact of endoscopic sinus surgery on bronchial asthma has been studied by several groups. According to the latest studies, patients with chronic obstructive pulmonary disease (COPD) seem to have frequent symptoms of chronic rhinosinusitis. Our study compares the impact of endoscopic sinus surgery on both the upper and lower airways of patients with bronchial asthma as well as those with COPD. Methods: This study includes 43 patients (bronchial asthma, n = 32, COPD, n = 11) undergoing surgical treatment for chronic rhinosinusitis at the ENT-Department, University of Homburg (Homburg, Germany). To assess the effect of sinus surgery, the Sino-Nasal Outcome Test 20 German Adapted Version (SNOT-20 GAV) and St. George’s Respiratory Questionnaire (SGRQ) were used both pre- and postoperatively. Results: Both SNOT-20 (p < 0.001) and SGRQ (p = 0.021) scores improved significantly after sinus surgery. The postoperative improvement in bronchial asthma and COPD was similar in both groups, indicating no difference of the diseases in regards to postoperative symptom improvement. There was no difference indicated in SNOT-20 GAV or SGRQ when grouping patients by polyps, aspirin (ASS) intolerance, allergies, eosinophilia or previous surgery. Conclusions: The treatment of chronic rhinosinusitis by sinus surgery may help to improve the therapy outcome of patients with bronchial asthma as well as patients with COPD.

Sinusitis doi: 10.3390/sinusitis2010003

Authors: Jason Pou Charles Riley Kiranya Tipirneni Anna Bareiss Edward McCoul

Introduction: Bioabsorbable steroid-eluting implants are available as an adjunct for endoscopic sinus surgery (ESS) in the treatment of chronic rhinosinusitis (CRS). It is unclear which patients are most likely to benefit from this technology. We sought to determine if the severity of preoperative sinonasal inflammation influences the postoperative changes in patient-reported quality of life (QOL) and endoscopic appearance following ESS with implant placement; Methods: Consecutive adult patients undergoing ESS for CRS with ethmoidectomy and placement of a steroid-eluting implant over an 18-month period were prospectively included for study. Pre-operative sinus computed tomography (CT) opacification was evaluated using the Lund-Mackay score (LMS). Sinonasal Outcome Test (SNOT-22) scores and Lund-Kennedy endoscopic scores (LKES) for each patient were collected preoperatively and at three- and six-month intervals postoperatively. Serum eosinophilia (>6.0% on peripheral smear) and sinus tissue eosinophilia were recorded; Results: One hundred and thirty-six patients were included for analysis. Of these, 36.7% had polyposis, 15.4% had serum eosinophilia and 64.0% had tissue eosinophilia. The mean (standard deviation) SNOT-22 score was 45.5 (19.4) preoperatively, which improved postoperatively to 18.8 (14.1) at three months (p < 0.001) and 16.5 (14.0) at six months (p < 0.001). Similar results were found when stratified by the presence of polyposis, serum eosinophilia, tissue eosinophilia or high-grade CT findings (LMS > 6). Higher baseline LKES was observed for patients with eosinophilia or high-grade LMS, but these differences normalized at six months postoperatively; Conclusions: Patient-reported QOL and endoscopic appearance show improvement six months after placement of a steroid-eluting implant during ESS, irrespective of the presence of polyposis or eosinophilia.

Sinusitis doi: 10.3390/sinusitis2010002

Authors: Amanda Dilger Alexander Schneider John Cramer Stephanie Shintani Smith

Rhabdomyosarcoma (RMS) is an uncommon soft tissue malignancy that is typically found in the pediatric population. Here we describe a rare case of widely metastatic alveolar RMS of the right paranasal sinuses in an adult woman who presented with several months of unilateral sinus symptoms that was initially misdiagnosed as acute sinusitis. A middle-aged female presented with two months of right sinus pressure and unilateral epistaxis. She had previously been diagnosed with acute sinusitis and was treated with antibiotics without improvement. Nasal endoscopy demonstrated a fungating right nasal cavity mass. On computed tomography scan (CT), she was found to have metastatic disease in the mediastinum, lungs, bones, pancreas, and right ovary. Pathology of the nasal cavity mass was consistent with alveolar RMS. The patient initially responded well to chemotherapy, but subsequently developed brain and leptomeningeal metastases. This case of sinonasal rhabdomyosarcoma is unique in the extent of metastatic disease at the time of diagnosis and the initial misdiagnosis despite concerning unilateral symptoms and imaging. This thus highlights the importance of maintaining a high index of suspicion for malignancy in patients with unilateral sinus symptoms.

Sinusitis doi: 10.3390/sinusitis2010001

Authors: Jacob Brunner Charles Riley Edward McCoul

Background: Primary ciliary dyskinesia (PCD) may be an underlying factor in some cases of refractory chronic rhinosinusitis (CRS). However, clinical management of this condition is not well defined. This systematic review examines the available evidence for the diagnosis and management of CRS in adults with PCD. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pubmed, EMBASE, and Cochrane database were queried for studies pertinent to treatment of PCD in adults. Two investigators performed eligibility assessment for inclusion or exclusion in a standardized manner. Results: Of the 278 articles identified, six studies met the criteria for analysis. These studies had a predominately low level of evidence. Medical therapy included oral antibiotics and nasal saline rinses. Endoscopic sinus surgery (ESS) was described in three of six studies. Outcomes measures were limited and included non-validated questionnaires, subjective reporting of CRS symptoms, and decreased preciptins against pseudomonas following ESS. Recommendation for a standardized therapeutic strategy was not possible with the available literature. Conclusion: A paucity of evidence is available to guide the treatment of PCD in the adult population. Further prospective studies are needed to determine the optimal diagnostic and management strategy for this condition.

Sinusitis doi: 10.3390/sinusitis1010099

Authors: Angélica Bermúdez Amit Patel Edward McCoul

Mucocele is a rare complication of chronic rhinosinusitis that typically presents with delayed diagnosis and results in local erosion. We present the case of a symptomatic orbital mucocele arising from contralateral sinus disease that crossed the midline upon diversion by the effect of prior trauma. Effective treatment was provided by combined endoscopic surgery and external drainage.

Sinusitis doi: 10.3390/sinusitis1010092

Authors: Michael Marino Charles Riley Eric Wu Jacqueline Weinstein Edward McCoul

The relationship between paranasal sinus pneumatization and chronic rhinosinusitis (CRS) without cystic fibrosis is not well understood. Previous investigations have confirmed sinus hypoplasia in cystic fibrosis (CF) patients. This study compares paranasal sinus pneumatization of CRS patients to unaffected controls to determine if there is an analogous effect to that seen in CF. 591 sinus computed tomography (CT) scans, comprised of 303 adolescents (age 13–18) and 288 adults (age > 18), were analyzed for Lund-MacKay and Assessment of Pneumatization of the Paranasal Sinuses (APPS) scores. The APPS score is validated for measuring the extent of sinus pneumatization. A diagnosis of CRS and CRS phenotype was determined from the medical record. The mean APPS score for patients with a diagnosis of CRS was 10.61 (n = 111) compared to 9.62 (n = 448) for unaffected controls (p = 0.001). This was significant in adult (p = 0.021) and adolescent subgroups (p = 0.035). Sinus pneumatization did not differ according to CRS phenotype (p = 0.699). This suggests that there is not analogous anatomical sinus variation between CRS and CF, and that the mechanisms underlying sinus hypoplasia in CF may not be universal in patients with other types of sinus inflammation.

Sinusitis doi: 10.3390/sinusitis1010088

Authors: Francisco Muñoz-López

Here, we present a review of the development of paranasal sinuses and pathologies associated to them, allergic and/or infectious sinusitis, in children. A review of 200 medical records of children and adolescents affected with respiratory disease is carried out. 66 patients (33%) were diagnosed with sinusitis, six of which did not present any other respiratory processes. Of the remainder, association with rhinitis, asthma, or wheezy bronchitis, and one case with immune deficiency, was found. Other associated pathologies, such as cystic fibrosis, bronchiectasis, and other processes described as associated with sinusitis, were not detected in any case.

Sinusitis doi: 10.3390/sinusitis1010076

Authors: John Malaty

Chronic rhinosinusitis can be refractory and has detrimental effects not only on symptoms, but also on work absences, work productivity, annual productivity costs, and disease-specific quality of life measures. The pathophysiology of chronic rhinosinusitis continues to evolve. There is evidence that it is driven by various inflammatory pathways and host factors and is not merely an infectious problem, although pathogens, including bacterial biofilms, may certainly contribute to this inflammatory cascade and to treatment resistance. Given this, medical management should be tailored to the specific comorbidities and problems in an individual patient. In addition to treating acute exacerbations of chronic rhinosinusitis with amoxicillin-clavulanate, second or third generation cephalosporins, or fluoroquinolones, one must consider if nasal polyps are present, when symptoms and disease severity correlate to mucosal eosinophilia, and there is the best evidence for intranasal corticosteroids and saline irrigation. Asthma worsens severity of chronic rhinosinusitis and it is felt to be mediated by increased leukotrienes, when leukotriene antagonists may be utilized. Cystic fibrosis has a genetic defect and increased mucin, which are potential treatment targets with dornase alfa showing efficacy. Other comorbidities that may impact treatment include allergies, ciliary dyskinesia, immunodeficiency, and possibly allergic fungal rhinosinusitis.

Sinusitis doi: 10.3390/sinusitis1010065

Authors: Rogerio Pezato Cindy Claeys Gabriele Holtappels Claus Bachert Claudina Pérez-Novo

Background: Cysteinyl leukotrienes (CysLTs) play a crucial role in the pathogenesis of airway remodeling. The use of CysLTs receptor antagonists has been included in the management of asthma and rhinitis. However, despite the action of these compounds on leukotriene production has been well documented, their role in airway remodeling remains unclear. Objective: We aimed to investigate the capability of the leukotriene receptor antagonist Montelukast to inhibit MMPs release after CysLTs stimulation in nasal tissue fibroblasts. Methods: Fibroblasts were isolated from sinunasal tissue collected from five patients suffering of chronic rhinosinusitis without nasal polyposis. Cells were cultured and stimulated first with LTC4 and LTD4 (10−10, 10−8, 10−6 M) using as pre-stimulus 10 ng/mL of: IL-4, IL-13, or TGF-beta1 and in presence or absence of Montelukast (10−10, 10−8, 10−6 M). To evaluate the regulation of MMP-1 and TIMP-1 we used enzyme immunoassays and to evaluate CysLT1 receptor we used real time PCR. Results: LTD4 but not LTC4 induced production of mRNA for CysLT1 receptor in a dose dependent manner and with an additive effect when the cells where primed with TGF-β1. TNF-α, IL-4, and IL-13 did not influence the expression of the receptor. Levels of MMP-1 but not of TIMP-1 were statistically enhanced in cells primed with TGF-β1 and stimulated with LTD4. Montelukast significantly decreased Cys-LT1 receptor and MMP-1 concentrations in a dose-dependent way in cells stimulated with LTD4 and TGF-β1 separately and when they were applied together. Conclusion: The leukotriene pathway may play an important role in extra-cellular matrix formation in an inflamed environment, such as chronic sinusitis and, consequently, leukotriene receptor antagonists such as Montelukast may be of great benefit in management of this disease.

Sinusitis doi: 10.3390/sinusitis1010055

Authors: Suha Jabr Ayyad Jordi Roca-Ferrer César Picado

Background: Fibroblasts from nasal polyps (NP) of asthma patients have reduced expression of cyclooxygenase 2 (COX-2) and production of prostaglandin E2 (PGE2). We hypothesized that the reported alterations are due to alterations in the availability of arachidonic acid (AA). Objective: The objective was to determine the fatty acid composition of airway fibroblasts from healthy subjects and from asthma patients with and without aspirin intolerance. Methods: We analyzed the fatty acid composition of cultured fibroblasts from non-asthmatics (n = 6) and from aspirin-tolerant (n = 6) and aspirin-intolerant asthmatics (n = 6) by gas chromatography-flame ionization detector. Fibroblasts were stimulated with acetyl salicylic acid (ASA). Results: The omega-6 fatty acids dihomo-gamma-linolenic acid (C20:3) and AA (C20:4), and omega-3 fatty acids docosapentaenoic acid (DPA) (C22:5) and docosahexaenoic acid (DHA) (C22:6) were significantly higher in NP fibroblasts than in fibroblasts derived from nasal mucosa. The percentage composition of the fatty acids palmitic acid (C16:0) and palmitoleic acid (C16:1) was significantly higher in fibroblasts from patients with NP and aspirin intolerance than in fibroblasts derived from the nasal NP of aspirin-tolerant patients. ASA did not cause changes in either omega-3 or omega-6 fatty acids. Conclusions. Our data do not support the hypothesis that a reduced production of AA in NP fibroblasts can account for the reported low production of PGE2 in nasal polyps. Whether the increased proportion of omega-3 fatty acids can contribute to reduced PGE2 production in nasal polyps by competitively inhibiting COX-2 and reducing the amount of AA available to the COX-2 enzyme remains to be elucidated.

Sinusitis doi: 10.3390/sinusitis1010049

Authors: Jochen Mainz Christin Arnold Andrea Gerber Jürgen Rödel Nina Cramer Hans-Joachim Mentzel James Beck Burkhard Tümmler

Cystic fibrosis (CF) is the most frequent congenital lethal disease in Caucasians. Impaired mucociliary clearance causes chronic bacterial rhinosinusitis in up to 62% of patients, and almost all patients exhibit sinonasal pathology in CT scans. Pathogens like Pseudomonas aeruginosa (P.a.) chronically colonize about 70% of the CF adults’ lungs and are the major reason for pulmonary destruction and premature death. In our 34-year-old female CF patient, rhinosinusitis caused massive orbital hypertelorism despite three sinonasal operations. Her sputum samples had always been negative for P.a. Then, P.a. was primarily detected in her sputum and additionally in nasal lavage, which since then persisted in both, her upper and lower airways. The P.a. strains turned out to be genetically identical in both airway levels, indicating early colonization of the entire airway system with P.a. This first report on simultaneous primary P.a. detection in the sinonasal and pulmonary compartments highlights the need to include an assessment of upper airway colonization in the standards of CF care, particularly in patients without chronic P.a. colonization. Both airway levels need to be considered as one united system, and a strong cooperation between ENT and CF specialists should be established. Prospective longitudinal studies should assess the upper airways´ role in acquisition and persistence of pathogens and evaluate conservative and surgical therapeutic options.

Sinusitis doi: 10.3390/sinusitis1010044

Authors: Rosa Lipin Anita Deshpande Sarah Wise John DelGaudio Zara Patel

Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) are both highly prevalent chronic diseases in the United States. Association between culture positivity of CPAP machines and sinus samples has not been studied in patients with both disease states. Our objective was to compare the microbes present in the sinus cavities and CPAP reservoirs of patients with both CRS and OSA. Patients from an academic tertiary care Rhinology practice were identified with both CRS and OSA and enrolled prospectively. Inclusion criteria included age over 18 years; diagnosis of OSA by sleep study; regular CPAP use; and an active diagnosis of CRS. Exclusion criteria included treatment with antibiotics or cleaning of the CPAP reservoir in the month prior. Cultures were taken from participants’ sinus cavities and CPAP reservoirs and resulting microbial growth was compared. The most common organisms on CPAP culture were Enterobacter cloacae and Acinetobacter baumanii, whereas the most common on sinus culture were Staphyloccoccus aureus and Pseudomonas aeruginosa. Microbial growth from the sinus cavities and the CPAP reservoirs were not concordant in any of our patients. There is no association between bacterial colonization of the CPAP reservoir and the sinus cavities of those with CRS and OSA based on microbiologic cultures.

Sinusitis doi: 10.3390/sinusitis1010024

Authors: Adriana Izquierdo-Domínguez Arturo Cordero Castillo Isam Alobid Joaquim Mullol

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA) is a systemic small-to-medium-sized vasculitis associated with asthma and eosinophilia. Histologically EGPA presents tissue eosinophilia, necrotizing vasculitis, and granulomatous inflammation with eosinophil tissue infiltration. EGPA commonly involves the upper airway and lung parenchyma, peripheral neuropathy, cardiac disorders, and skin lesions. The anti-neutrophil cytoplasmic antibodies (ANCA) are positive in 40% of cases, especially in those patients with clinical signs of vasculitis. The pathogenesis of EGPA is multifactorial. The disease can be triggered by exposure to a variety of allergens and drugs, but a genetic background has also been described, particularly an association with HLA-DRB4. Th2 response is of special importance in the upregulation of different interleukins such as IL-4, IL-13, and IL-5. Th1 and Th17 responses are also of significance. Activated eosinophils have a prolonged survival and probably cause tissue damage by releasing eosinophil granule proteins, while their tissue recruitment can be regulated by chemokines such as eotaxin-3 and CCL17. Humoral immunity is also abnormally regulated, as demonstrated by excessive responses of IgG4 and IgE. EGPA has a good respond to glucocorticoids, although the combination of glucocorticoids and immunosuppressants (e.g., cyclophosphamide, azathioprine) is needed in most of cases. Newer treatment options include anti-IL-5 antibodies (mepolizumab), whose efficacy has been described in clinical trials, and anti-CD-20, a B cell-depleting agent (rituximab), reported in several case series.

Sinusitis doi: 10.3390/sinusitis1010013

Authors: Dennis Shusterman

Background: The paranasal sinuses serve as a reservoir of nitric oxide (NO), contributing to baseline nasal NO (nNO) levels. nNO has also been shown to increase transiently with humming, a response that may be blunted in severe rhinosinusitis. Blunting of the acoustically-induced nNO transient (“spike”) has been proposed as a screening test for osteomeatal complex (OMC) obstruction in sinusitis. Preparatory to conducting a clinical evaluation study, to eliminate variation in patient effort during this maneuver, we evaluated the use of external acoustic energy—in place of humming—to elicit nNO transients, documenting the effects of varying stimulus amplitude and gas sampling rates. Methods: Non-smoking, non-asthmatic subjects with no history of chronic sinusitis or nasal polyposis underwent nNO measurements in triplicate under: (1) control (quiet) conditions, and (2) with 128 Hz external acoustic energy. In Experiment 1, twelve subjects were exposed to two different intensities of external acoustic energy at 3 L/min sampling rate. In Experiment 2, a subset of nine subjects was sampled with and without acoustic stimulation at three different gas sampling rates (1, 2, and 3 L/min). Results: Experiment 1: Subjects, as a group, showed intensity-related increases in nNO with increasing acoustic amplitude (p < 0.01). Experiment 2: independently, both applied acoustic energy and lower nasal gas sampling rates increased measured nNO levels (p < 0.05 to p < 0.0001). Longitudinally, baseline (quiet) nNO obtained on a repeated basis in the two experiments (n = 9) was highly reproducible (R2 = 0.84; p < 0.001), and acoustically-stimulated nNO was moderately so (R2 = 0.50; p < 0.05). Conclusions: Application of external acoustic energy is a practical alternative to humming for mobilizing NO from the paranasal sinuses, and could be more objectively applied in any future validation studies involving clinical sinusitis and/or OMC obstruction.

Sinusitis doi: 10.3390/sinusitis1010003

Authors: Kevin Hsu Matthew Ericksen Peter Catalano

Introduction: The use of biomaterials to improve wound healing after endoscopic sinus surgery (ESS) is not new. Many types of resorbable and non-resorbable materials have been tried as a middle meatal (MM) dressing, spacer, or stent to prevent lateralization of the middle turbinate, formation of synechia, granulation tissue, adhesions and scarring. The FDA has recently approved Chitosan-based nasal dressing/spacers which have optimal wound healing characteristics, including hemostatic and bacteriostatic properties. Herein, we compare a new chitosan-based biomaterial to a popular fully synthetic resorbable dressing in patients undergoing ESS. Materials and Methods: A prospective randomized controlled study was performed comparing a new Chitosan-based bioresorbable nasal dressing (Posi-Sep X) against a previously studied and well known fully synthetic polyurethane-based control (Nasopore). Post-operative outcome metrics included the degree of crusting, amount of retained implant, patient comfort, wound healing, epistaxis, and post-operative infection at two weeks. Results: Thirty-five patients were enrolled and a total seventy implants were placed (n = 70) at the completion of ESS. The results show a statistically significant difference between the Chitosan-based product and the control with respect to wound healing, degree of crusting, and resorption profile. In addition, the Chitosan-based dressing had a markedly lower requirement for post-operative debridement, and a lower incidence of epistaxis and infection, which corresponds to superior patient comfort. Conclusion: Our study is consistent with the biomaterials literature regarding the potential advantages of Chitosan-based MM dressings after ESS regarding improved wound healing, biocompatibility, and patient comfort.

Sinusitis doi: 10.3390/sinusitis1010001

Authors: Hassan Ramadan

Sinusitis: a diagnosis that any patient you ask, will tell you that they have it. It is a very common condition, affecting 31 million patients annually in the United States [1]. Chronic rhinosinusitis (CRS) affects 12.5% of people [2]. [...]