Related Experiment Video
Updated: Jun 18, 2026
10:52
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
The two holes syndrome.
Ranko Mladina1, Katarina Vuković, Gorazd Poje
1Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Zagreb, Croatia. prof_mladina@yahoo.com
American Journal of Rhinology & Allergy
|December 5, 2009
Summary
Fontanel defects in the lateral nasal wall are more common in chronic rhinosinusitis (CRS) patients than healthy individuals. These "Two Holes Syndrome" defects may contribute to chronic sinusitis symptoms.
Area of Science:
- Otolaryngology
- Rhinosinusology
- Anatomy
Background:
- Accessory or secondary ostia in the lateral nasal wall fontanel region are linked to chronic maxillary sinusitis.
- Mucus recirculation between the natural ostium and fontanel defect defines the "Two Holes Syndrome."
Purpose of the Study:
- To determine the incidence of fontanel defects in patients with chronic rhinosinusitis (CRS).
- To compare the incidence of fontanel defects in CRS patients versus healthy subjects.
Main Methods:
- Nasal fiberendoscopy was used to examine 8,879 outpatients with CRS.
- A control group of 1,442 healthy volunteers with no history of CRS was also examined.
Main Results:
- Posterior fontanel defects occurred in 19.3% of CRS patients, often bilaterally (68.03%).
- Anterior fontanel defects were found in 0.61% of CRS patients.
- Posterior fontanel defects were rare in healthy subjects (0.48%) and never bilateral.
Conclusions:
- Posterior fontanel defects are significantly more prevalent in CRS patients.
- These defects are associated with chronic maxillary sinus infection and mucus recirculation, not accessory ostia.
- The "Two Holes Syndrome" may contribute to symptoms like postnasal drip, headache, and cough.
Related Concept Videos
01:43Sex Linked Disorders
Like autosomes, sex chromosomes contain a variety of genes necessary for normal body function. When a mutation in one of these genes results in biological deficits, the disorder is considered sex-linked.
01:25Hiatal Hernia
A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or heavy...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
01:23Genital Herpes
Genital herpes is a sexually transmitted infection primarily caused by herpes simplex virus type 2 (HSV-2), though herpes simplex virus type 1 (HSV-1) is increasingly implicated in genital infections, particularly among younger populations. Transmission occurs mainly through sexual contact, with asymptomatic viral shedding serving as a major route of spread. This characteristic makes HSV-2 difficult to control at a population level, as individuals may unknowingly transmit the virus even in the...