Radiology and endoscopic findings of silent maxillary sinus atelectasis and enophthalmos.

OBJECTIVES: The objective of this study is to discuss the presentation and surgical management of patients presenting with silent maxillary sinus atelectasis with enophthalmos (SMSAE). STUDY DESIGN AND METHODS: We performed an analysis of prospectively collected data on patients with maxillary sinus opacification and associated enophthalmos from 1999 to 2003. Patients were evaluated based on physical examination, nasal endoscopy, and computed tomographic findings. RESULTS: Sixty-four patients were identified with unilateral maxillary sinus opacification. Of these, 7had radiographic evidence of maxillary sinus volume reduction. Of these 7 patients, 5 had maxillary sinus atelectasis with enophthalmos, the components constituting SMSAE. The mean age of the patients was 42 years (range, 22-65). None of the patients had any history of nasal trauma or developmental defects before presentation. All 5 patients with SMSAE had uncinate retraction on nasal endoscopy. Uncinate retraction was not seen in the 2 patients without enophthalmos (chi(2) = 7, P= .008). All 7 patients with maxillary opacification were treated with endoscopic sinus surgery, with resolution of their maxillary sinus obstruction at 2 years' follow-up. Only 1 of 5 patients with SMSAE requested orbital floor reconstruction after sinus surgery performed by the oculoplastic service with resolution of enophthalmos. CONCLUSION: All patients with SMSAE had evidence of uncinate process retraction on nasal endoscopy, whereas patients without enophthalmos did not, and the difference was statistically significant. Surgical treatment is the mainstay of therapy for this condition, with resolution of maxillary opacification at 2 years' follow-up.

Rhinosinusitis Task Force symptoms versus the Sinonasal Outcomes Test in patients evaluated for chronic rhinosinusitis.

BACKGROUND: The aim of this study was to compare Rhinosinusitis Task Force (RSTF) symptom scores with Sinonasal Outcome Test 20 (SNOT-20) in patients with chronic rhinosinusitis (CRS) and controls. METHODS: An analysis was performed of prospectively collected data in patients with CRS (n=201) and controls (n=100). The severity of individual RSTF major and minor symptom scores graded on a visual analog scale and total symptom scores were compared between the two groups. Correlation of the RSTF symptoms with the SNOT-20 was performed using data collected from the CRS group at baseline and at 1 year postoperatively. RESULTS: CRS patients had higher RSTF symptom scores compared with control patients when asked to rate the severity of nasal obstruction, facial pain/pressure, facial congestion, alteration of smell, nasal discharge, postnasal drip, headache, halitosis, fatigue, cough, and ear pain (p < 0.005). No statistically significant difference was seen for the symptoms of dental pain and fever. Total RSTF scores were 54.5 +/- 1.9 in CRS patients versus 23.4 +/- 3.0 in controls. Total SNOT-20 scores were 28.7 +/- 0.8 in CRS patients versus 15.2 +/- 0.6 in controls. In CRS patients, total RSTF scores correlated with total SNOT-20 scores at baseline (r = 0.36; p < 0.0001) and 1-year postoperatively (r = 0.37; p < 0.0001). CONCLUSION: Total RSTF symptom scores are significantly different in patients with chronic rhinosinusitis compared with those without this disease. The total RSTF symptom scores also correlate with a validated outcome measures instrument.

Important clinical symptoms in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis.

OBJECTIVE: To evaluate the prevalence and severity of individual Rhinosinusitis Task Force (RSTF) symptoms in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS). METHODS: Retrospective analysis of prospectively collected data in 201 patients treated with FESS. The prevalence and severity of individual RSTF major and minor symptom scores graded on a visual analogue scale (VAS) were compared. Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed. RESULTS: One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78%. The average age was 49.4 (range 18-80) with a male-to-female ratio of 1.1:1. The preoperative leading mean symptom scores were postnasal drip (5.8 +/- 0.3), nasal obstruction (5.7 +/- 0.3), and facial congestion (5.1 +/- 0.3). These symptoms were also the most prevalent with 82%, 84%, and 79% of patients reporting these symptoms, respectively. Postoperative symptom improvements were significant (P < .0001) across all RSTF domains except fever. The highest percentage improvement was seen with facial congestion (93%), nasal obstruction (92%), and postnasal drip (85%). Multivariate analysis revealed significant (P < .0001) high correlation between improvements of facial pain/pressure with facial congestion (R = 0.72), facial congestion with nasal obstruction (R = 0.65), and facial pain/pressure with headache (R = 0.72). CONCLUSION: The top three RSTF symptoms were postnasal drip, nasal obstruction, and facial congestion in terms of prevalence and severity. Symptom scores improved after FESS. Of these symptoms, the degree of improvement of facial pain/pressure, facial congestion, nasal obstruction, and headache are highly correlated.

Advances in imaging of the paranasal sinuses.

Imaging technology has played a significant role in the diagnosis and management of sinonasal disorders. Plain sinus films are almost exclusively replaced by CT in the work-up for inflammatory sinus disease. MRI provides complementary information to CT in cases of sinonasal and skull-base neoplasms. The evolution of endoscopic surgical techniques for the paranasal sinuses and skull base is made possible by the parallel advancement of imaging technologies. Recent advances that are currently in clinical use have included multidetector row CT scanners and computer image-guidance systems for surgery. Three-dimensional CT angiography, image-guided CT-MR fusion, and intraoperative image-guidance are new techniques that are currently being evaluated. As imaging technology continues to advance, so does the capability to treat diseases beyond the sinuses and skull base with minimally invasive, endoscopic approaches.