The Condemned Sinus: Natural Disease or Surgical Sequela?
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Updated: Feb 4, 2026
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Published on: April 28, 2023
Edward D McCoul1,2,3
1Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, LA.
Background:
Unilateral, mucopurulent drainage from an isolated paranasal sinus may be encountered in patients with a history of surgery for the treatment of chronic rhinosinusitis (CRS). Static mucus is visualized on nasal endoscopy within the sinus lumen but without significant disease in the adjacent sinuses. The reasons for this phenomenon are unknown although an iatrogenic cause is proposed.
Methods:
A case series was prospectively compiled from consecutive patients presenting for evaluation of CRS at a tertiary rhinology practice during a 16-month period. Computerized tomography and nasal endoscopy were performed, and endoscopically directed aerobic and anaerobic bacterial cultures were obtained. Osteitis scores were recorded for diseased and nondiseased sides.
Results:
Twenty-three of 113 patients (20.4%) had evidence of chronic unilateral drainage from either a maxillary (21) or sphenoid (2) sinus. Mean osteitis scores were higher for the diseased side (P < 0.01). A nonendoscopic transantral approach was reported in 57.1% of cases with chronic maxillary disease, with 52.2% occurring more than 10 years earlier. The most common bacterial isolate was Pseudomonas aeruginosa (6 cases, 26.1%), followed by methicillin-resistant Staphylococcus aureus (5 cases, 21.7%). Six cases (26.1%) were polymicrobial, and 6 (26.1%) were culture-negative. Tobacco use was reported in 8 (34.8%) cases, and chronic obstructive pulmonary disease was present in 6 (26.1%) cases.
Conclusion:
The condemned sinus is a distinct entity that may represent a sequela of previous non-mucosal-sparing surgery. An association with hyperostosis is observed. Mucopurulent drainage is characterized by polymicrobial infection comparable to that found in diffuse CRS.
Insights
Chronic unilateral sinus drainage, often linked to prior surgery for chronic rhinosinusitis (CRS), may result from a distinct entity called the condemned sinus. This condition is associated with infection and bone changes.
Area of Science:
- Otolaryngology
- Rhinology
- Infectious Disease
Background:
- Unilateral mucopurulent drainage from an isolated paranasal sinus can occur post-surgery for chronic rhinosinusitis (CRS).
- This phenomenon, characterized by static mucus in a single sinus lumen without adjacent disease, has an unknown etiology, with iatrogenic causes proposed.
Purpose of the Study:
- To investigate the characteristics and potential causes of isolated unilateral paranasal sinus drainage in patients with a history of CRS surgery.
Main Methods:
- A prospective case series of 113 CRS patients over 16 months.
- Utilized computerized tomography, nasal endoscopy, and bacterial cultures (aerobic/anaerobic).
- Assessed osteitis scores for diseased and non-diseased sinus sides.
Main Results:
- 20.4% of patients (23/113) presented with chronic unilateral drainage, primarily from the maxillary sinus.
- Higher osteitis scores were observed on the diseased side (P < 0.01).
- Previous non-endoscopic transantral surgery was reported in 57.1% of maxillary cases. Common isolates included Pseudomonas aeruginosa and MRSA; 26.1% were polymicrobial, and 26.1% culture-negative.
Conclusions:
- The 'condemned sinus' appears to be a distinct entity, potentially a sequela of non-mucosal-sparing surgery.
- An association with hyperostosis (bone thickening) is noted.
- The mucopurulent drainage involves polymicrobial infections, similar to diffuse CRS.
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