An update on chronic sinusitis

The management of chronic sinus disease has been revolutionized by the application of computed tomographic (CT) imaging and rigid endoscopes in diagnostic evaluation and surgical treatment. These diagnostic advances have led to a better understanding of sinus pathophysiology and the development of more rational surgical treatment. Obstruction of mucociliary drainage in the anterior ethmoid sinus-middle meatus region (ostiomeatal complex) is now understood to be the cause of chronic symptomatic sinus disease. Involvement of the maxillary or frontal sinus is usually secondary to disease in the ostiomeatal complex. Three cases are presented to illustrate the use of CT scanning and nasal endoscopy in the evaluation of chronic sinusitis. Precise identification and correction of ostiomeatal complex obstruction with endoscopic surgical techniques has proven efficacious and is associated with minimal patient morbidity. Endoscopic sinus surgery is emerging as the treatment of choice for medically unresponsive chronic sinus disease.