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Background: Cystic fibrosis (CF) is a complex systemic disease involving numerous organ systems. With improved treatment options and increasing life expectancy of persons with CF (PwCF), extrapulmonary manifestations are coming increasingly into the focus. From birth, almost all PwCF have radiologically detectable pathologies in the upper airways attributable to CF-associated chronic rhinosinusitis (CF-CRS)., Objective: The aim of this work is to provide an up-to-date overview of CF-CRS from the otorhinolaryngology perspective and to provide the reader with background knowledge and current developments., Pathophysiology: The cystic fibrosis transmembrane conductance regulator (CFTR) gene defect leads to increased viscosity of sinonasal secretions and reduced mucociliary clearance, causing chronic infection and inflammation in the upper airway segment and, consequently, to CF-CRS., Clinical Picture and Diagnostics: The clinical picture of CF-CRS comprises a wide spectrum from asymptomatic to symptomatic courses. CF-CRS is diagnosed clinically and radiologically., Therapy: Sinonasal saline irrigation is recommended as a conservative treatment measure. Topical corticosteroids are also commonly used. Surgical therapy is reserved for highly symptomatic treatment-refractory patients without a sufficient response to conservative treatment including CFTR modulator (CFTRm) therapies. Depending on the CFTR mutation, CFTRm therapies are the treatment of choice. They not only improve the pulmonary and gastrointestinal manifestations in PwCF, but also have positive effects on CF-CRS., Conclusion: The ENT specialist is part of the interdisciplinary team caring for PwCF. Depending on symptom burden and treatment responsiveness, CF-CRS should be treated conservatively and/or surgically. Modern CFTRm have a positive effect on the clinical course of CF-CRS., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The SNOT-22 is a validated and widely used outcomes tool in chronic rhinosinusitis (CRS). We hypothesized that SNOT-22 scores and response patterns could be used as a diagnostic tool to differentiate between patients with CRS and those who present with CRS-like symptoms but prove not to have CRS., Methodology/principal: SNOT-22 measurements were collected from 311 patients who presented with a chief complaint of sinusitis to a tertiary rhinology practice. Following a full diagnostic evaluation, patients were diagnosed with CRS or determined to have non-CRS diagnoses. A response pattern "heatmap" of the SNOT-22 scores for each group was compared. An optimal cutoff point for total SNOT-22 score in predicting CRS was sought using a receiver operating characteristic (ROC) curve., Results: A total of 109 patients were diagnosed with CRS and 202 patients were assigned to non-CRS. The non-CRS SNOT-22 total score histogram had lower overall scores compared to the CRS group, although there was substantial overlap. The CRS SNOT-22 heatmaps had a distinctive pattern compared to the non-CRS group. As individual measures, 3 of the 4 cardinal symptoms of CRS (nasal congestion, loss of smell, and rhinorrhea) were found to be significantly different between the 2 groups ( P  < .002). However, the ROC analysis showed the total SNOT-22 score to be a poor instrument to differentiate CRS from non-CRS patients., Conclusions: Our results cause us to reject our hypothesis and conclude that, while an effective outcomes tool, the SNOT-22 (using total score and response pattern) is a poor differentiator between CRS and non-CRS patients.

Purpose: To assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists., Methods: We assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations., Results: 166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines., Conclusions: Overall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often.

Objectives/hypothesis: The European Position Paper on Rhinosinusitis and Nasal Polyps proposes an assessment of clinical control of chronic rhinosinusitis (CRS). However, there are limited data about the percentage of postoperative control, and no prediction models for uncontrolled CRS have been reported. The aim of the study was to develop prediction models for postoperative uncontrolled CRS., Study Design: Retrospective case series., Methods: Patients (n = 136) who had undergone endoscopic sinus surgery at least 1 year prior to the study were recruited to assess the clinical control. Risk factors were determined by logistic models and presented as odds ratio (OR) with a 95% confidence interval. Receiver operating characteristics curves were constructed to set the cutoff points and create predictive models., Results: Approximately 47.8% of patients had controlled, 22.1% partially controlled, and 30.1% uncontrolled CRS. Univariate regression models revealed the risk factors for uncontrolled CRS: tissue eosinophilia, blood eosinophilia, high computed tomography (CT) score, bilateral disease, asthma, and allergic rhinitis. Multiple regression models found tissue eosinophil ratio >0.206 (OR: 12.96, P = .001) or blood eosinophil ratio >0.025 (OR: 4.56, P = .003), Lund-Mackay (LM) score ≥ 15 (OR: 15.50, P < .001) and CT ethmoid (E) score ≥ maxillary (M) score (OR: 3.51, P = .037) were independent risk factors. We generated a pathological model (tissue eosinophil ratio and LM score) and a clinical model (blood eosinophil ratio, LM score and E ≥ M score) to categorize CRS into mild, moderate, and severe., Conclusions: This research provides simplified and efficient prediction models for uncontrolled CRS. It may help otolaryngologists to predict the prognosis before surgery in daily practice., Level of Evidence: 2b Laryngoscope, 128:2673-2680, 2018., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

The objective of the present study was to elucidate the peculiar features of acute viral and bacterial sinusitis in the children and to elaborate the algorithm for their treatment based on the results of the primary clinical and laboratory examination. As many as 224 children at the age varying from 1-17 years suffering from acute sinusitis were enrolled in the study. The following methods were employed for the purpose of the study; the analysis of the medical histories of the patients, general examination by an otorhinolaryngologist, diagnostic endoscopy of the nasal cavity and nasopharynx, radiological studies and computed tomography of the paranasal sinuses, echosinusoscopy, the comprehensive microbiological and virological investigation, and evaluation of the peripheral blood characteristics. The study allowed to elucidate the main clinical specific features of acute sinusitis of different etiology including the virological one. The scoring system for the estimation of the risk of development of acute bacterial sinusitis was proposed and the algorithm was developed for the treatment of the children suffering from acute sinusitis to be used in the practical work by general practitioners and otorhinolaryngologists.

Objective: Rhinologists are seeing an increasing number of immunosuppressed patients. Currently, no treatment paradigm exists for treating acute and chronic noninvasive rhinosinusitis (ARS, CRS) in this growing population. This study aims to identify patient and treatment factors that affect rhinosinusitis outcomes in this vulnerable population., Study Design: Prognostic retrospective cohort study., Methods: Immunocompromised patients treated by rhinologists for ARS or CRS 10/2007 to 10/2012 were identified by rhinosinusitis diagnostic codes, codes for transplant, cancer, HIV, diabetes, and codes indicating immunosuppression in the intensive care setting. Associations between patient factors and outcome were analyzed by logistic regression. Associations between treatment and outcome were analyzed by Firth logistic regression., Results: A total of 132 subjects were identified. Of those, 90.9% had CRS and 9.1% had ARS; 12.9% were transplant patients; 47% were diabetic; 37.9% were cancer patients; and 16.7% were in the intensive care unit. Patients with higher American Society of Anesthesiologists (ASA) scores had decreased disease resolution (odds ratio [OR] = 0.5, P = 0.021). Transplant patients (OR = 22.5, P = 0.001), diabetics patients (OR = 6.4, P = 0.017), cancer patients (OR = 5.4, P = 0.046), and patients with prior medical therapy for rhinosinusitis (OR = 5.84, P < 0.001) had increased disease resolution compared to immunosuppressed critical care patients. Patients treated with antibiotics alone had no statistically significant difference in disease resolution compared to those receiving no treatment. In contrast, treatment plans including surgery were associated with greater disease resolution., Conclusion: This data indicates that surgical treatment provides improved outcomes for patients presenting with acute exacerbations of rhinosinusitis related to their immunocompromised state. Given the limited study population, these findings may not apply to HIV-positive or ARS patients, and further study should be undertaken in these groups., Level of Evidence: 4., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: This update of a 2007 guideline from the American Academy of Otolaryngology--Head and Neck Surgery Foundation provides evidence-based recommendations to manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS)., Purpose: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia., Action Statements: The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms; (5) should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia; (6) should confirm the presence or absence of nasal polyps in a patient with CRS; and (7) should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS. The update group stated as options that clinicians may (1) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)

The purpose of this review is to explain the relationship between chronic rhinosinusitis (CRS) and lower respiratory tract inflammation, especially asthma and introduce the new advances in the treatment of CRS patient with asthma. We also introduce our treatment strategy for these patients, including surgery technique and perioperative management.

Objectives/hypothesis: Previous studies showed that chronic rhinosinusitis (CRS) accounts for billions of dollars in healthcare resource utilization. However, all such study estimates of the economic burden of CRS were based on subpopulations in Western societies. This study aimed to investigate differences in the utilization of healthcare services between subjects with CRS and comparison subjects using Taiwan's National Health Insurance database., Study Design: A cross-sectional study., Methods: In total, 5,849 CRS subjects and 17,547 selected comparison subjects were included in this study. We evaluated healthcare resource utilization in a 1-year period. Variables of healthcare resource utilization included the following: numbers of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. We also divided healthcare resource utilization into ear, nose, and throat (ENT) and non-ENT services., Results: On the utilization of ENT services, CRS subjects had significantly more outpatient visits (3.9 vs. 1.4, P < .001) and significantly higher outpatient costs (US$77.7 vs. US$19.4, P < .001) than comparison subjects. As for the use and costs of all healthcare services, CRS subjects had significantly more outpatient visits (27.9 vs. 18.3, P < .001) and significantly higher outpatient (US$953 vs. US$665, P < .001) and total (US$1319 vs. US$946, P < .001) costs than comparison subjects. Namely, on average, CRS subjects had 152% more outpatient visits and 139% higher total costs than comparison subjects., Conclusions: This study found that subjects with CRS had significantly higher use of all healthcare services and costs than aged-matched controls., Level of Evidence: 2c., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: The need for objective assessment of patient outcomes is becoming an essential component of clinical practice for both private and academic otolaryngologists. The purpose of this study is to describe the implementation of an online model for collection of clinical outcomes data in patients with chronic rhinosinusitis (CRS)., Methods: Patients completed the Sinonasal Outcome Test (SNOT-22), Chronic Sinusitis Survey (CSS), and EuroQol 5-dimension assessment (EQ-5D), before and after sinus surgery. One year after initial patient enrollment, an online tool was developed to facilitate collection of postoperative data. Response rates preimplementation and postimplementation of online data collection were compared., Results: A total of 520 sinus surgery patients provided outcomes data from the practices of 7 private practice (n = 308) and 4 academic otolaryngologists (n = 212). With implementation of the online collection instrument, the response rate at 3 months increased from 67% to 78.8% (p = 0.004). The overall follow-up rate at 3 months was higher in patients recruited from private as compared to academic practices (77.9% vs 69.8%, respectively, p = 0.04)., Conclusion: Quality of life data can be effectively collected from CRS patients in both the private and academic practice setting. The addition of an online data collection tool can significantly increase response rates, and allow a comprehensive capture of meaningful clinical outcomes. Such a model is not difficult to implement and has increasing relevance as payers begin to request outcome data from providers., (© 2014 ARS-AAOA, LLC.)

Objectives/hypothesis: To evaluate the cost-effectiveness of preapproval requirements for computed tomography (CT) of the sinuses in the evaluation and management of chronic rhinosinusitis (CRS)., Study Design: Retrospective analysis of prospectively collected data., Methods: Over a 6-month period, all sinus CT scans ordered by an otolaryngology practice and requiring preapproval by a third-party payor were tabulated. Characteristics of the preapproval process that were recorded and analyzed included time spent by office administrative staff, need for peer-to-peer review, and time spent by the ordering physician., Results: All 111 sinus CT scans ordered during the 6-month time period required preapproval based on insurer requirements-38 performed by computer, 71 by telephone, and two required both-costing an average of 8.1 minutes per scan by administrative staff (range, 2.0-20.0 minutes). Thirteen preapprovals required peer-to-peer telephone interaction by the ordering physician, utilizing an average of 7.7 minutes (range, 5-12 minutes). In no case was the insurance company peer an otolaryngologist. Ultimately, no sinus CT scan request was rejected by a third-party payor., Conclusions: Preapprovals for sinus CTs ordered by otolaryngologists are unlikely to save costs for third-party payors, as sinus CT for the evaluation of CRS is well established and therefore unlikely to be rejected. Preapproval in this context comes at the expense of practice administrative and physicians' time. Based on our results, preapproval for sinus CT scans ordered by an otolaryngologist for evaluation of CRS appears to be an unnecessary and costly requirement., Level of Evidence: N/A., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Chronic rhinosinusitis (CRS) is a disease of remarkable medical and economic importance. Therefore, assessment of the objective as well as the subjective outcomes of different therapeutic strategies in CRS patients is of growing interest. Validated quality-of-life (QOL) instruments are one important means of assessing the subjective outcomes of patients. The Short Form 36 Health Survey (SF-36) is the most frequently used generic instrument in medicine and is typically used in prospective studies. A German version of this questionnaire has been validated, providing normative data as well as data for comparison with other diseases. The Glasgow Benefit Inventory, which was designed for retrospective studies, is another frequently used QOL instrument. Several disease-specific measuring instruments for use in CRS patients have been developed during the last 15 years. In this review, we evaluate 11 disease-specific QOL instruments. Only four of these instruments cover the four main symptoms of CRS and are validated instruments as well. The most frequently used instruments [Sino-Nasal Outcome Test 20 (SNOT-20) and the Chronic Sinusitis Survey] do not query all of the main symptoms of CRS, whereas the only validated German instrument (SNOT-20 GAV) meets this requirement. For the latter instrument, a grading scale is available that allows interpretation of the results for a single patient.

Background: There are 50,000 practitioners of complementary and alternative medicine (CAM) within the United Kingdom. The current U.K. prevalence of CAM use is reported to be 25% and is rising. The national expenditure on CAM is an estimated pound1.6 billion. The aim of this study was to explore the pattern of CAM use in patients attending a rhinology outpatient clinic in Aberdeen., Methods: Questionnaires were provided to 100 patients over a 2-month period. The questionnaire consisted of demographic sections and whether they had ever used CAM from a list of 49 herbal and nonherbal alternative therapies. Subjects were also asked why they used CAM, where they learned of CAM, whether they found it efficacious, and whether their general practitioner was aware they were using it., Results: One hundred subjects completed questionnaires. Patients attending the clinic were suffering from the most common rhinological complaints including rhinosinusitis and nasal polyps. Sixty-five percent of patients had ever used CAM. Women were statistically significantly more likely to use CAM than men (p = 0.012). Patients who were employed were more likely to use CAM, but there was no significant difference in CAM usage depending on marital status, social class, and age. Only 6% of patients felt CAM use was definitely ineffective. Only 43% of users of CAM had informed their doctor about its use., Conclusion: CAM usage is growing in popularity. All health care professionals should be aware of this and of the potential for adverse drug reactions occurring. The dangers of noncompliance with conventional medications should be emphasized to CAM users.

Objectives: We sought to determine the impact of psychiatric comorbidity on symptom density and resource utilization in chronic rhinosinusitis (CRS)., Methods: A prospective cohort of patients who sought evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed to determine the interactions among psychiatric comorbidity, symptom reporting, and resource utilization in CRS., Results: We studied 143 patients (mean age, 43.4 years). Low, moderate, and high levels of anxiety were reported by 48.3%, 25.9%, and 25.9% of patients, respectively. Low, moderate, and high levels of depression were reported by 76.2%, 9.1%, and 14.7%. For the combined psychopathology group, 43.3%, 25.9%, and 30% had low, moderate, and high levels. Patients with high anxiety levels reported significant elevations of oropharyngeal symptoms (p = .013) and total symptoms (p = .030) in comparison with the low group. Patients with high depression levels reported higher oropharyngeal (p = .003), systemic (p = .001), and total symptom (p = .003) scores than did the low group. High combined psychopathology scores were associated with elevated facial, oropharyngeal, and systemic scores (p < .05). Regarding medical utilization, high anxiety levels or high combined psychopathology scores were associated with more frequent physician visits (p < .05). A high level of depression was associated with increased antibiotic use, missed workdays, and physician visits (p < .05)., Conclusions: High levels of anxiety and depression are common in patients who undergo evaluation for CRS. Psychiatric comorbidity is associated with increased symptoms in CRS and increased health-care utilization. Anxiety and depression should be identified in these patients to structure appropriate treatment.

Objective: To determine whether patients with chronic rhinosinusitis (CRS) exhibit more severe sinonasal symptom scores as compared with patients with nasal septal deviation (NSD) alone., Methods: Two patient cohorts were prospectively identified: patients undergoing surgery for NSD alone and those undergoing endoscopic sinus surgery for CRS without NSD. Patients in the NSD group were required to have normal paranasal sinus CT scans, whereas patients in the CRS group were required to have radiographic evidence of CRS. All patients completed the Rhinosinusitis Symptom Inventory (RSI). Statistical comparisons were conducted between cohorts with respect to RSI symptom domains and medical resource utilization., Results: A total of 42 patients were identified in the NSD group (mean age, 40.8 years) and 155 patients were identified in the CRS group (mean age, 44.9). Patients with CRS demonstrated higher severity scores for the nasal symptom domains (60.3 [CRS] versus 53.9 [NSD], P = 0.037). Oropharyngeal symptoms and total symptoms were also worse for the CRS group versus the NSD group (29.8 versus 23.1, P = 0.014 and 43.0 versus 37.0, P = 0.030). Facial and systemic symptom scores did not differ between groups. Patients with CRS demonstrated significantly higher utilization rates for topical nasal steroids (21.2 versus 12.2 weeks, P = 0.006) and oral antibiotics (7.9 weeks versus 2.1 weeks, P < 0.001), but not for oral antihistamines (P = 0.420)., Conclusions: Although patients with CRS manifest higher sinonasal symptom scores than patients with NSD alone, differentiating these 2 diagnoses on the basis of symptoms alone is difficult. These data suggest that as a disease process, CRS confers a significant disease burden with more significant negative symptom impact.

Measuring 'outcome' in rhinology has been challenging investigators for decades. With the introduction of patient-based, quality of life outcomes, investigators have developed rhinologic-specific outcomes tools for allergic rhinitis, nasal obstruction, and chronic rhinosinusitis. Outcomes research in rhinology, however, is a nascent field. This article focuses on outcomes research in the management of chronic rhinosinusitis, especially as it relates to endoscopic sinus surgery. Quality of life outcomes are addressed not only as outcomes but as measures of disease and how they relate to other commonly used measures of disease such as CT and endoscopy.

Acute infections of the upper respiratory tract are reviewed from an ENT point of view. Only the most frequent pathologies are taken into account. Clinical presentation and an update of current treatment are presented.

Chronic rhinosinusitis has been shown to have an adverse impact on the quality of life in those afflicted as determined by a number of standardized outcome tools. We have utilized a standardized, statistically validated, disease-specific tool, the Rhinosinusitis Disability Index (RSDI), to investigate the disability suffered by 292 consecutive patients with nine unique rhinologic diagnoses, including chronic rhinosinusitis. Physical, functional, and emotional domains were assessed. We have found that individuals with rhinologic disease in general have lower physical scores, followed by functional scores and emotional scores. Individuals with chronic rhinosinusitis and allergic rhinitis have the greatest level of disability, while those with aspirin triad are least affected.

Background: Chronic rhinosinusitis is a common disease associated with significant morbidity. CT has been a poor predictor of the extent of symptoms among these patients. Allergic rhinitis is frequently associated with chronic rhinosinusitis. This study examines CT stage, allergic sensitivity, and sinus-related symptoms., Methods: Forty-eight patients with chronic rhinosinusitis underwent CT scanning and skin end-point titration (SET). They also completed the Rhinosinusitis Disability Index (RSDI), a measure of sinus-related disability., Results: No association was noted between CT stage and severity of sinus-related symptoms. There was a significant correlation between CT stage and SET mean end point and between SET mean end point and RSDI physical scale score, as well as between significance on the RSDI emotional scale score and overall score., Conclusion: The degree of allergic disease is a better indicator of symptom severity and impairment in quality of life among patients with chronic rhinosinusitis than CT stage. Careful evaluation and treatment of allergic disease is critical in the treatment of chronic rhinosinusitis.

Semiautomatic segmentation methods using High Resolution Computed Tomography (HRCT) or Magnetic Resonance Imaging give accurate and reproducible volumetric measurements in various intracranial diseases. In this prospective study, for the first time in literature, with the help of a new semiautomatic segmentation technique and coronal HRCT, we correlated the volumes and cross-sectional areas of the nasal cavity with those obtained by clinical acoustic rhinometry in 14 patients with chronic sinusitis. The measurements obtained by both techniques showed statistically significant correlations between volumes in the anterior and middle parts, but statistically poor correlations between the volumes in the posterior part of the nasal cavity. Coronal HRCT and our new microcomputer applicable semiautomatic segmentation software proved compatible with daily clinical practice. Based on the promising results of our study, we recommend the use of this technique in the validation studies of acoustic rhinometry and in complicated cases as a complementary examination in the evaluation of nasal cavity.

Revision functional endonasal sinus surgery (FESS) is recommended for patients whose symptoms of chronic or recurrent sinusitis persist despite primary FESS, long-term maximal medical therapy, and no sign of other abnormalities as demonstrated by computed tomography. After analyzing the charts of 673 patients who underwent primary FESS, we reviewed the 63 cases of revision surgery performed between 1986 and 1989. This retrospective analysis presents the management and outcome of 16 children (less than 16 years) and 47 adults who had revision FESS. The overall success rate of revision FESS was 78%, with no major complications, reflecting the improved management of sinus disease offered by this procedure.

The transnasal approach to the ethmoid and sphenoid sinuses is a well-established technique for treating nasal polyposis and chronic sinusitis. The literature supports the effectiveness and safety of this procedure when performed by experienced surgeons. Although various authors allude to catastrophic complications of intranasal ethmoidectomy, there are few case reports of complications involving significant morbidity or mortality. The potential for serious intracranial trauma is present during ethmoid surgery, especially during an intranasal approach due to limited exposure and difficulty in identifying surgical landmarks, but with renewed interest in this approach utilizing endoscopic instrumentation, the risks may be reduced.

Clinical examination of the nasal fossae and sinuses, and the picture formed by the Rhinologist allows him to classify the patient into one of the following three categories: Local inflammation, of which the solution is often surgical. Nasal sinus inflammations that have their origin in a disturbance, perhaps in the mucociliary system (mucoviscidosis) or perhaps in the immune system (allergy, repeated infections). Non-specific inflammation, eosinophils, associated or not with asthma (Nares, polyps, Fernand-Widal) and intolerances of drugs or chemicals. Some arguments plead in favour of allergic origin of inflammation. But the Rhinologist must give constant regard to the physico-pathological mechanisms of the nasal and sinus mucosae. The multiplicity of the mediators of inflammation. The mechanism of nasal vasomotricity. The role of the eosinophil in inflammation. Are such elements that are indispensible to his understanding.