Cell-mediated immunity plays an important role in host defence against fungal pathogens, regulated by differentiation of lymphocytes towards T-helper 1 or 2 cells. This study reports intracellular cytokine variation in terms of invasive fungal sinusitis type and outcome.

The mononuclear leukocytes of 15 patients with invasive fungal sinusitis (mucormycosis in 8, aspergillus in 7) were stained with antibodies against intracellular cytokines, after fungal antigen stimulation and culture, and immunophenotyped. Patients were followed up for six months, with clinical course categorised as improvement, worsening or death.

The mean percentages of mononuclear cells producing interleukins 4, 5, 10 and 12, and interferon-γ, in the mucormycosis group were 0.575, 0.284, 8.661, 4.460 and 1.134, respectively, while percentages in the aspergillosis group were 0.233, 0.492, 4.196, 4.466 and 1.533. Cells producing interleukin 4 and 10 were higher in the mucormycosis group, while those producing interleukin-12 and interferon-γ were lower. Cells producing interleukins 4 and 12 were higher in patients with a poor outcome (p-values of 0.0662 and 0.0373, respectively), while those producing interferon-γ were lower (p = 0.0864).

Adaptive cell-mediated immunity is expressed differently in two categories of invasive fungal sinusitis, and the cytokine expression pattern is related to prognosis.

This study aimed to assess the outcomes of a prelacrimal recess approach assisted middle meatal antrostomy in the management of hard to reach maxillary sinus pathologies.

Twenty-five patients with maxillary sinus pathology underwent prelacrimal recess approach assisted middle meatal antrostomy (with a prelacrimal recess width of more than 3 mm). Patients were prospectively evaluated using both the Arabic version of the Sino-Nasal Outcome Test-22 and nasal endoscopy at least 6 months post-operatively.

Our study included 25 maxillary sinuses (13 with antrochoanal polyps, 10 with maxillary fungal ball and 2 with a migrated part of a tooth). At a mean follow-up period of 10.9 months, all patients showed significant improvement in total mean Sino-Nasal Outcome Test-22 score. There was recurrence of one case with antrochoanal polyp and two cases with asymptomatic synechia. Injury to the nasolacrimal duct was not reported.

A prelacrimal recess approach assisted middle meatal antrostomy is a reliable and safe technique to manage pathologies in hard to reach regions within the maxillary sinus.

Treatment of inflammatory and neoplastic disease in the maxillary sinus, pterygopalatine and infratemporal fossae requires appropriate surgical exposure. As modern rhinology evolves, so do the techniques available. This paper reviews extended endoscopic approaches to the maxillary sinus and the evidence supporting each technique.

A literature search of the Ovid Medline and PubMed databases was performed using appropriate key words relating to endoscopic approaches to the maxillary sinus.

Mega-antrostomy and medial maxillectomy have a role in the surgical treatment of refractory inflammatory disease and sinonasal neoplasms. The pre-lacrimal fossa approach provides excellent access but can be limited because of anatomical variations. Both the transseptal and endoscopic Denker's approaches were reviewed; these appear to be associated with morbidity, without any significant increase in exposure over the afore-described approaches.

A range of extended endoscopic approaches to the maxillary sinus exist, each with its own anatomical limitations and potential complications.

Concha bullosa may be associated with paranasal sinus infections and nasal obstruction. Middle concha mucosa membranes have olfactory neurofibrils. This study investigated the impact of routinely used concha bullosa surgery techniques – crushing and lateral laminectomy – on nasal and olfactory functions.

Forty-three adult patients who had undergone surgery for a symptomatic concha bullosa completed the odour test, nasal obstruction visual analogue scale, 22-item Sino-Nasal Outcome Test, and peak nasal inspiratory flow test, pre-operatively and three months post-operatively. The pre- and post-operative results within and between the two treatment groups were compared.

Intragroup comparison of mean pre- versus post-treatment changes revealed statistically significant findings for the nasal obstruction visual analogue scale, Sino-Nasal Outcome Test, peak nasal inspiratory flow and olfaction tests (all p < 0.05). However, there were no statistically significant changes when comparing the scores between the groups (intergroup comparison).

Lateral laminectomy and crushing in concha bullosa surgery have no negative effects on olfactory function. Concha bullosa surgery provides positive outcomes regarding nasal complaints in symptomatic patients.

Computed tomography is the standard pre-operative imaging modality for sinonasal papilloma. The complementary use of magnetic resonance imaging as an additional investigation is debated. This study aimed to establish whether magnetic resonance imaging can accurately detect tumour extent and is a useful adjunct to computed tomography.

A retrospective review was conducted on 19 patients with sinonasal papilloma. The interpretation of computed tomography and magnetic resonance imaging scans, by three clinicians, was conducted by comparing prediction of tumour extent. The perceived necessity of magnetic resonance imaging was compared between clinicians.

The addition of magnetic resonance imaging improved accuracy of pre-operative interpretation; specifically, this finding was significant in cases with frontal sinus involvement. Surgeons were more likely than a radiologist to request magnetic resonance imaging, particularly when computed tomography indicated frontal sinus disease.

Pre-operative combined magnetic resonance imaging and computed tomography helped predict disease in the frontal sinus better than computed tomography alone. A close working relationship between the ENT and radiology departments is important for accurate tumour localisation.

Re-stenosis and a consequent need for revision surgery are the most common problems in the follow-up period following endoscopic modification of the Lothrop procedure.

This paper reports a new technique for reconstructing and resurfacing of the posterior frontal recess bone for prevention of re-stenosis.

A 46-year-old man presented with a frontal sinus osteoma, and treatment featured an endoscopic modification of the Lothrop procedure. A vascularised, posteriorly based, septal mucosal flap was used in reconstruction. There have been no reported issues over 24 months of follow up.

The use of a nasoseptal flap seems feasible to reduce scarring and recurrence of (common) frontal recess stenosis after a Draf III operation.

This study aimed to compare the view into the maxillary sinus using the posterior translacrimal approach compared with grade 3 antrostomy.

Grade 3 antrostomy followed by a posterior translacrimal approach was performed on four cadavers. The maximum intramaxillary view was documented endoscopically guided by electromagnetic navigation. Representative screenshots were evaluated in a blinded manner by three independent sinus surgeons. In addition, a prospective investigation of specific complications in the post-operative course of consecutive patients was performed.

In the cadaver study, the posterior translacrimal approach provided a significantly better view into the maxillary sinus compared with grade 3 antrostomy. In the clinical study, only 1 out of 20 patients reported on a minor problem with lacrimal drainage at 6 months.

The posterior translacrimal approach to visualising the maxillary sinus should be considered a strong alternative to more radical techniques.

This study aimed to radiologically evaluate the influence of inflammatory changes in frontal recess cells on frontal sinusitis.

A total of 93 patients (186 sides) who underwent primary sinonasal surgery at Hyogo College of Medicine were enrolled in 2015 and 2016. Opacification of agger nasi, fronto-ethmoidal, ethmoid bulla, suprabullar and frontal bulla cells was determined by pre-operative computed tomography and its influence on frontal sinusitis was investigated.

In all, 42 per cent of 186 sides were affected by frontal sinusitis. Agger nasi, ethmoid bulla, fronto-ethmoidal, suprabullar and frontal bulla cells were identified in 99 per cent, 100 per cent, 38 per cent, 69 per cent, and 16 per cent of sides, respectively. The presence of frontal recess cells and frontal ostium size did not significantly influence frontal sinusitis development. However, opacification of agger nasi, type 1 fronto-ethmoidal and suprabullar cells significantly influenced frontal sinusitis development.

Frontal sinusitis is caused by inflammatory changes in frontal recess cells.

Despite advances in endoscopic sinus surgery, frontal sinus obliteration is still indicated in some cases. Current options for obliteration include autologous and synthetic materials. The use of ß-tricalcium phosphate as a resorbable bone graft substitute is a good alternative for frontal sinus obliteration. This study aimed to report our experience with this material.

A retrospective chart review of patients who underwent frontal sinus obliteration at our clinic between 2008 and 2013 was performed. Demographic data, indications, previous surgery, and immediate and late complications were examined. Information on persisting symptoms and patient outcomes was collected using a telephone questionnaire in February 2016.

None of the patients underwent further surgery for frontal sinus disease. All of them reported a good cosmetic result and symptom improvement.

ß-tricalcium phosphate is a good, safe and cost-effective material for frontal sinus obliteration.

This study assessed the utility of current sialendoscopes in the paranasal sinuses in a cadaveric model and evaluated novel uses for sialendoscopes.

Currently available sialendoscopes were used for visualisation and performing interventions in the paranasal sinuses. Ten cadaver heads were studied before and after dissection. Outcomes included ostia identification, sinus cannulation, success of mucosal biopsy collection and image clarity.

Marchal and Erlangen sialendoscopes were found to be effective for both visualising and cannulating the sphenoid sinuses before and after dissection. Both types demonstrated poor maxillary ostia visualisation without dissection, but did allow treatment after antrostomy. Larger diameter sialendoscopes were associated with the lowest image distortion during maxillary ostia assessment. Mucosal biopsy collection within the sphenoid sinus, but not in the maxillary sinus, was possible before dissection.

Sialendoscopes can be used for visualisation and performing interventions in the sinonasal cavity, but their utility is mainly limited to the sphenoid sinus. They may be considered a minimally invasive method for drug delivery and/or biopsy collection in the post-operative setting for all sinuses. Design improvements are suggested.

Periorbital infections represent a spectrum of sepsis that carries potentially significant morbidity and mortality. Early recognition, systematic assessment and aggressive treatment of the condition are essential.

A retrospective five-year case note review on the management of periorbital infections was performed at a tertiary centre. A literature review on the management of periorbital infections was also undertaken. A multidisciplinary guideline on the management of periorbital infections was developed based on the findings of the case and literature reviews.

The results of the retrospective case series correlate well with those of recent reports.

The new multidisciplinary guideline has been finalised and approved for practice and future auditing.

The association between eustachian tube dysfunction and middle-ear effusion is well established. Studies have also demonstrated pathological changes affecting the middle-ear mucosa associated with chronic sinonasal inflammation. No previous studies have evaluated symptoms related to sinonasal inflammatory disease in different ear diseases.

To assess the presence of sinonasal symptoms in ear diseases using the Dundee Rhinogram.

Data were collected prospectively in the period February–October 2011. Sinonasal symptoms were graded using the Dundee Rhinogram. Student's t-test analyses were performed to identify any statistically significant associations.

In total, 164 patients were assessed. There was a statistically significant association between sinonasal symptoms and mucosal middle-ear diseases (p < 0.005). The mean sinonasal symptoms score for mucosal middle-ear disease patients was 5.94 (range, 0–32).

Assessment of sinonasal symptoms is paramount in patients presenting with an ear symptom; inflammatory sinonasal disease treatment may become necessary in the management of middle-ear mucosal disease for better patient outcome.

To assess the outcome of children with chronic rhinosinusitis who were managed surgically, over a 10-year study period.

From January 1999 to December 2008 inclusive, 136 children diagnosed with chronic rhinosinusitis underwent surgery following unsuccessful medical treatment. The operations ranged from adenoidectomy to functional endoscopic sinus surgery.

The surgical procedures performed were: adenoidectomy (n = 69), antral washouts (n = 54), middle meatal antrostomy (n = 82), endoscopic ethmoidectomy (n = 66), nasal septal reconstruction (n = 10), and inferior turbinate outfracture (n = 23) or inferior turbinate reductions (n = 55). Follow-up duration ranged from 6 months to 9 years (average 3.2 years). Three patients required revision surgery: adenoidectomy in two patients and adenoidectomy with turbinate reductions in another.

This study demonstrates the benefits of focused surgical treatment for paediatric chronic rhinosinusitis. Surgical treatment can be an appropriate and effective option for children with chronic rhinosinusitis when medical management is unsuccessful.

The objective of this article was to report a case of isolated, acute, right-sided sphenoid sinusitis that progressed to contralateral cavernous sinus thrombosis in an 18-year-old male patient. We describe the atypical presentation of this case and discuss the relevant anatomy, pathogenesis, presentation, diagnostic evaluation and treatment.

A case report of sphenoid sinusitis leading to contralateral cavernous sinus thrombosis was reviewed and presented along with a comprehensive literature review of the relevant anatomy, pathophysiology, microbiology, diagnostic work-up and treatment options.

Cavernous sinus thrombosis is a rare clinical entity in the antibiotic era. However, limited sphenoid sinusitis may progress to cavernous sinus thrombosis in spite of maximal medical treatment, as highlighted in this case report. The mainstay of treatment includes early diagnosis allowing aggressive intravenous antibiotics and appropriate surgical management.

Nasal polyposis is characterised by opacification of the nasal cavities, paranasal sinuses and ostiomeatal complexes on computed tomography scanning. Sinonasal bony changes have been reported as disease sequelae.

To assess the prevalence of sinonasal bone expansion, erosion and thickening in patients with nasal polyposis, and to correlate disease severity with the prevalence of bony changes.

A retrospective radiological study was conducted comprising pre-operative computed tomography scans of 104 patients with nasal polyposis and scans of 44 age- and gender-matched individuals (control group) without sinonasal disease. Lund–Mackay scores and bony changes were quantified.

Ninety-three per cent of the study group scans showed sinonasal bony change, with no changes in the control group. Radiological severity of nasal polyposis correlated positively with the prevalence of bony changes (rs = 0.31; p < 0.01).

Sinonasal bony changes were common in the study group. This highlights the importance of pre- and intra-operative imaging, which can help to prevent intra-operative complications. As bony changes may mimic invasive disease, the importance of histological assessment of polyps is emphasised.

Functional endoscopic sinus surgery is a common adjunct to medical therapy in cases of chronic rhinosinusitis and nasal polyposis.

The objective of this study was to assess patients' quality of life up to two years after endoscopic sinus surgery.

Fifty consecutive patients attending a rhinology clinic filled in the Glasgow benefit inventory. The patients were divided into three groups according to the time period elapsed since surgery (i.e. six months, 12 months or up to two years).

The results showed that, generally, the Glasgow benefit inventory scores indicated a benefit from the procedure. Overall, surgery led to statistically significant improvements in both total and general scores (p < 0.05). Comparison of endoscopic sinus surgery with nasal polypectomy (plus endoscopic sinus surgery) indicated a greater benefit for polyp disease. No statistical difference was observed between the scores for females vs males or for various post-operative follow-up periods.