Endoscopic stenting of nasofrontal communication in frontal sinus disease.

The volume of literature on frontal sinus surgery suggests that the success of surgery to cure frontal sinus pathology is inversely proportional to the total number of techniques described. In an attempt to develop an effective means of treating acute and chronic frontal sinusitis, including iatrogenic naso frontal communication obstruction, an endoscopic stenting procedure has evolved. This method might be contemplated, in selected patients, as the preferred surgery or a useful low morbidity alternative, to more invasive traditional frontal sinus surgery. A high degree of technical difficulty is associated with endoscopic frontal sinus procedures, and they are definitely not recommended for the novice or occasional sinus surgeon. Several years of follow up are required to evaluate the validity of any frontal sinus procedure. More observation of these subjects' clinical progress is necessary before endoscopic stenting of the nasofrontal communication passes the test of time.

Bacterial patterns found in surgery patients with chronic sinusitis.

Aseptic samples of sinus mucosa or aspirates from maxillary sinuses were taken from 197 patients who underwent sinus surgery and were cultured for aerobic bacteria. Anaerobic cultures were also obtained from 143 of these patients. A total of 236 bacterial isolates from 174 patients were analyzed. No anaerobic organisms were isolated. The most commonly isolated organisms were Staphylococcus species (coagulase-negative), Staphylococcus aureus, gram-negative bacilli, and Streptococcus species. Penicillin G, erythromycin, tetracycline hydrochloride and, to a lesser degree, first-generation cephalosporins were found to be inferior to ciprofloxin, trimethoprim/sulfamethoxazole, and cefuroxime axetil when the susceptibilities of all the bacterial isolates to oral antibiotics used commonly in the empiric therapy of chronic sinusitis were compared.

Ethmoid sinus disease and nasal septal deformities as etiologies of chronic cephalgia: results of surgical management.

Results of a retrospective chart review of 80 patients, in conjunction with recently completed questionnaires, document the effects of sinus and nasal surgeries on chronic headache symptoms believed to originate within the ethmoid sinuses or nose. Seventy (88%) of the patients in this study experienced a dramatic improvement of their headache symptoms after undergoing surgical treatment. The authors conclude that this type of cephalgia is more common than expected, that its cause goes largely undiagnosed by the majority of physicians, and that an effective method of treatment is available to improve the quality of life of these patients.

Current concepts in management of sinus disease.

All the paranasal sinuses originate embryologically from the lateral nasal wall or ethmoid air cells. This common development also determines the ability of the paranasal sinuses to function normally. Disease affecting the common drainage area of the sinus ostia, the ostiomeatal complex, also affects the function of the closely associated paranasal sinuses. Therapy directed toward any sinus without efforts to identify and correct the pathologic process of the ostiomeatal complex often leads to less-than-satisfactory results. Determination of the etiology of chronic paranasal sinus disease depends on the clinical history, endoscopic rhinoscopy, and computerized imaging. Therapy is directed toward relief of the sinus ostial obstruction and restoration of the normal mucociliary clearance. After medical therapy has failed to reverse the pathophysiology of acute or chronic paranasal sinus disease, surgical intervention may be considered.