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

Abstract

Background Patients presenting with unilateral sinus symptoms or nasal polyps raise concerns about sinister pathology. Yet despite the relatively common occurrence of this presentation, and its potential severity, an organized diagnostic approach to unilateral sinus disease (USD) has never been defined. The purpose of this work was to propose a diagnostic algorithm for managing patients with USD based on prior experience. Methods We performed a retrospective review of the medical records of all patients with USD who underwent surgical intervention and had pathological specimens during a 15-year period at an urban academic center. Nasal endoscopy and computed tomography (CT) scan findings, demographic characteristics, presenting symptoms, medical histories, and previous treatments were analyzed. Results A total of 191 patients met the inclusion criteria, 153 of whom were initially diagnosed at our center. Among the latter group, 51 (33%) presented with a nasal mass or polyp observed by endoscopy. Inverted papilloma was present in 16% of those cases, and malignant tumors comprised 14%. In contrast, of patients without an obvious nasal polyp (n = 102), 2% had inverted papilloma and 3% had malignancies. Overall, chronic rhinosinusitis was the most common diagnosis both in patients with polyps (67%) and those without nasal polyps (69%). Conclusion Although USD is most likely to represent chronic inflammation, there exists a fair likelihood of finding malignant pathology, particularly in cases where patients have a unilateral polyp. Based on this review, we propose a strategy for the management of new presentations of USD.

Unilateral versus bilateral sinonasal disease: Considerations in differential diagnosis and workup

“…Out of our 110 patients with unilateral disease, 22% had bone displacement with thinning, 25% had extra‐sinus extension, and 38% had radiographic evidence of a mass. The presence of these radiographic findings should alert the surgeon to the possibility of a neoplasm, particularly in patients with unilateral disease . In contrast, benign disease is often associated with mucosal thickening, polyposis, and boney remodeling…”

“…The differential diagnosis for such complaints includes inflammatory processes such as chronic rhinitis or rhinosinusitis and neoplastic processes including both benign and malignant tumors . Making an accurate diagnosis requires a combination of careful history taking, physical examination, nasal endoscopy, and imaging studies …”

“…1 Making an accurate diagnosis requires a combination of careful history taking, physical examination, nasal endoscopy, and imaging studies. 2,3 Sinus computed tomography (CT) is a key component in the workup of sinonasal complaints-noted for its anatomic precision and ability to provide a roadmap for functional endoscopic sinus surgery. 4,5 Some data suggest that CT has the ability to lead to an accurate diagnosis in 75% of chronic sinusitis cases.…”

Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis

“…4 While multiple etiologies exist for unilateral sinonasal disease, CRS remains the most common diagnosis for patients with unilateral disease requiring surgical intervention. 4,5 …”

Editorial

“…Proper evaluation of unilateral sinus disease is examined in depth by Paz Silva et al, 7 who review their 15-year experience with 191 patients. Overall CRS is the most common cause in 68%, with fungal disease identified in 17% and inverted papilloma and malignancy in 7% each.…”