Recurrent and prolonged frontal sinusitis

The purpose of the study was to find the factors that predict the prolongation or recurrence of frontal sinusitis, to analyse the results of endoscopic surgery and trephination and also to analyse the value of the clinical estimation made by the treating specialist. The study was partly prospective, partly retrospective, and it was carried out in 1995-97. The follow-up continued until the end of 1998. The sample consisted of 456 patients (264 men and 192 women) treated for acute frontal sinusitis in Turku University Central Hospital. The collected information consisted of patient history, treatment, outcome and possible re-operations. To be able to evaluate conservative treatment in relation to operative treatment in patients with prolonged disease, a matched conservatively treated patient was selected for each endoscopically operated patient. Of the 456 patients, 359 healed normally, 85 developed prolonged disease, while recurrences were found in 50 patients. Endoscopic surgery was performed in 35 patients. The mean time interval between the endoscopic sinus operation (FESS) and healing was 8.2 weeks. Trephination was performed in 52 patients and FESS in 35 patients. In the statistical analysis, the factors having significance in predicting the outcome of the disease were, in the bivariate analysis, atopy and type of primary operation, chronic rhinitis, polyps, type of previous operations and of re-operations. Neither trephination nor FESS proved markedly better than the other one. Our conclusion was that the prognosis of frontal sinusitis is difficult to predict with any single factor, but is affected by many of them.