The Condemned Sinus: Natural Disease or Surgical Sequela?

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.