[Endonasal endoscopic ethmoidectomy in acute therapy refractory sinusitis]

Acute sinusitis usually requires conservative treatment with antibiotics and decongestion nose drops. However, a certain number of cases do not respond to that treatment. Because functional endoscopic endonasal sinus surgery (FESS) has been proven to be a valuable tool in treatment of all kind of chronic sinus diseases, it was adopted for acute complicated sinusitis.

Between 1990 and 1993, ethmoidectomy was performed in 43 patients with acute inflammatory sinus disease in whom conservative treatment had failed (frontal sinusitis n = 11, max. sinusitis n = 10, isolated ethmoiditis n = 5, orbital complications of sinusitis n = 10, sphenoidsinusitis n = 2, acute pyomucocele n = 5). Coronal CT scan revealed mucosal pathology of the ethmoid region in 41 cases. None of the patients had intranasal polyposis. Complete ethmoidectomy was performed under general anesthesia using an endoscope and the transnasal route.

All patients had relief of their symptoms within the first two postoperative days. One patient with a mucocele and two patients with orbital complications following osteoplastic procedures required revision surgery for removal of screws and plates from previous surgery. None of the patients developed recurrent symptoms of acute complicated sinusitis within the mean postoperative observation period of nine months.

FESS should early be considered as a possible treatment of acute sinusitis and its complications if conservative treatment fails.