Diagnostic algorithm for unilateral sinus disease: a 15-year retrospective review

Area of Science:

• Otolaryngology
• Rhinology
• Pathology

Background:

• Unilateral sinus disease (USD) presentation warrants investigation for sinister pathology.
• Despite its prevalence and severity, a defined diagnostic approach for USD is lacking.
• This study aims to establish a diagnostic algorithm for USD management.

Purpose of the Study:

• To propose a diagnostic algorithm for managing patients with unilateral sinus disease (USD).
• To provide a structured approach for clinicians encountering unilateral sinus symptoms or nasal polyps.

Main Methods:

• Retrospective review of 191 patients with USD undergoing surgery over 15 years.
• Analysis of nasal endoscopy, CT scans, demographics, symptoms, history, and treatments.
• Evaluation of pathological specimens for diagnosis.

Main Results:

• Among 153 initially diagnosed patients, 33% presented with nasal polyps.
• Inverted papilloma (16%) and malignancies (14%) were found in patients with polyps.
• Chronic rhinosinusitis was the most common diagnosis (67% with polyps, 69% without).

Conclusions:

• While USD is often inflammatory, malignant pathology is a significant concern, particularly with unilateral polyps.
• A proposed management strategy for new USD presentations is based on this review.
• Early and accurate diagnosis is crucial for effective USD management.