The burden associated with ocular symptoms in allergic rhinitis.

BACKGROUND: Ocular symptoms remain widely neglected while they concern the majority of subjects with allergic rhinitis (AR) and impair their daily activities. We describe the characteristics of ocular symptoms in subjects suffering from AR in the French INSTANT study and their impact on daily activities. METHODS: This cross-sectional observational survey was carried out in November 2006 using face-to-face interviews. RESULTS: 31.7% of the population-based sample (n = 4,019) suffered from AR and 52.0% of AR subjects (n = 663) described ocular symptoms. Men had significantly less ocular symptoms than women (odds ratio 0.71, 95% CI 0.57-0.89). 57.5% of subjects suffered from ocular symptoms for >5 years, 30.2% for >6 months in the past 12 months, and 92.2% during the pollen season. The troublesome ocular symptoms were itching eyes (51.1%), watery eyes (38.6%), red eyes (6.6%) and swollen eyelids (3.6%). The trigger factors were pollens (51.3%), household dust and mites (34.8%), pets (12.2%) and air pollution (3.8%). Ocular symptoms had a negative impact on daily activities (blurred sight 47.8%, reduction in daily activities 38.8%, reduction in efficacy at work 25.8%, sleep disturbances 16.3%, and sick leave 12.9%). They were diagnosed in 38.9% of subjects and followed up in 34.8%. Treatment for ocular symptoms was prescribed to 35.4% of subjects and to 61.9% of subjects with a regular follow-up care. CONCLUSIONS: This survey confirms the impact of ocular symptoms on AR patients' lives and suggests that they are still neglected and undertreated.

Presentation and treatment of acute maxillary sinusitis in general practice: a French observational study.

This survey-based study was conducted to determine the characteristics that influence the diagnosis and treatment patterns of acute maxillary sinusitis among general practitioners in France. Questionnaires were sent to 467 physicians and requested to be completed for the next 4 adult (≥ 15 years) patients diagnosed with acute maxillary sinusitis. A total of 397 physicians responded with eligible data on 1585 patients (57.5% female; mean age, 42.3 years). The most common presenting signs and symptoms were moderate-to-severe nasal obstruction (80.4%), pain on sinus palpitation (76.8%), facial pain (74.5%), rhinorrhea (70.4%), and headache (63.6%). Local treatments were prescribed in 93.2% of cases, including nasal lavage (52.1%), vasoconstrictors (42.2%), and intranasal corticosteroids (38.7%). Almost all patients (99%) were prescribed oral treatment including antibiotics (86.5%), analgesics (56.3%), antipyretics (53.7%), and expectorants/mucolytics (45.6%). Symptoms were indicated as having a moderate to very significant effect on quality of life areas including activities of daily living (71.6% of patients), leisure (63.1%), and professional/school activities (59.2%). The diagnosis and management patterns of acute maxillary sinusitis among general practitioners in France are generally consistent with the 2007 European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) guidelines.

Altered quality of life in Rendu-Osler-Weber disease related to recurrent epistaxis.

OBJECTIVES: Development and validation of an epistaxis-specific quality-of-life questionnaire (EQQoL) to evaluate the impact on quality of life of epistaxis, during hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Prospective clinical study using QoL instruments administered twice in HHT patients. PATIENTS AND METHODS: In total, 109 patients who had epistaxis and a clinical diagnosis of HHT according to Curacao criteria were included. Invoice of the questionnaire in 2004 and 2006 included SF-36, Jenkins` sleep scale and the new epistaxis-specific13-item EQQoL. RESULTS: EQQoL uptake rate was 98%, mean score 58/100 +- 27, and Cronbach alpha 0.96. EQQoL was sensitive to change with a strong correlation with the course of epistaxis. Factorial analysis showed that EQQoL was clearly distinct from SF-36 and Jenkins sleep scales. In stepwise multivariate ordinal logistic regression, frequency and duration of epistaxis were both associated with lower EQQoL. Conversely, visceral involvement and comorbidity had independent impact on SF-36 scores, but not on EQQoL. CONCLUSIONS: This new epistaxis-specific EQQoL questionnaire provides complementary information on the impact of HHT on patients quality of life relative to the SF-36 generic questionnaire. After international validation, the EQQoL might prove a useful tool for treatment evaluation.

Numeric score and visual analog scale in assessing seasonal allergic rhinitis severity.

BACKGROUND: Allergic rhinitis (AR) is characterized by symptoms whose severity can be difficult to quantify due to the patient's subjective perception. The aim of this study was to compare two methods for assessing the severity of allergic rhinitis, a numerical score (SGS) and a visual analog scale (VAS), respectively. METHODS: A large study was carried out on more than 36,000 patients with a diagnosis of a non-complicated and non-treated seasonal allergic rhinitis (SAR) between May and August 2004 over all the metropolitan France. For each patient, a physician had to assess the severity of the AR calculating a score corresponding to the intensity of the symptoms as felt by the patient but also using an analog scale. RESULTS: SAR severity differed according to the used method: 18.94% of the patients were classed severe according to the SGS and 23.58% according to the VAS. Moreover, among the 35,126 people for which the two measures were available, 23.86% were classed severe according to one but not according to the other. These patients differ from those classed in the same manner by SGS and VAS in age, gender, type of doctor and geographical area. SGS and VAS correlated each other. Principal prescribed drugs for SAR were antihistamines and local steroids. CONCLUSION: Severity assessment varied according to the used method.

Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis.

BACKGROUND: Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 microg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 microg bd and FPANS 200 microg once a day (od) in maintenance and long-term treatment. METHODS: Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 microg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 microg bd during acute period and FPANS 200 microg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 microg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade. RESULTS: After acute period and maintenance periods, FPANS 200 microg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 microg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events. CONCLUSION: The study demonstrated the efficacy of FPANS 200 microg bd in acute treatment and FPANS 200 microg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.

[Diagnosis and management of ENT conditions responsible for acute community acquired bacterial meningitis]. / Recherche et prise en charge de la porte d'entrée ORL des méningites aiguës bactériennes communautaires.

Only few epidemiological studies evaluate the role of ENT infections in meningitis. A retrospective review of data shows that the frequency of ENT infections is estimated at 25% in adults and children. Meningitis may occur during otological and nasosinusal infections. Acute otitis media and mastoiditis are the most common ear infections responsible for meningitis. Chronic otitis (cholesteatoma) are rarely involved. In case of acute rhinosinusitis, frequently responsible frontal and ethmoidal locations are investigated by nasal endoscopy and CT scan. A CSF leak originating mostly from anterior skull base or middle ear, either posttraumatic or spontaneous, may also be associated with meningitis. The management of ENT infections begins with antibiotics. Drainage may be discussed when identification of the bacteria is needed or if the medical treatment seems inefficient. In case of a CSF leak, closure of the defect is performed according to its location and size after evaluation by imaging (CT scan, MRI).

Physician and patient survey of allergic rhinitis in France: perceptions on prevalence, severity of symptoms, care management and specific immunotherapy.

BACKGROUND: Specific immunotherapy (SIT) is the only aetiological treatment used in allergic rhinitis (AR). A telephone survey of patients and physicians in France was carried out to understand better the real and perceived advantages and inconveniences of this therapeutic approach. METHODS: A cohort of 453 individuals with AR was selected using the Score For Allergic Rhinitis questionnaire. The survey evaluated the level of understanding of allergic rhinitis and its management, including both pharmacotherapy and SIT. A parallel survey was conducted with 400 general practitioners, allergists and nonallergist specialists. RESULTS: Approximately 50% of patients had heard about SIT as a therapeutic option. Of these, 56% had a positive view of SIT and 14% a negative image. A majority of patients and physicians with a positive opinion associated SIT with improved well-being and quality of life, while those with a negative opinion considered it to be a long and inconvenient treatment, with uncertain results. Over 50% of patients who had been offered SIT had accepted it and approximately 60% of these were satisfied with it. The future availability of SIT as sublingual tablets was perceived positively by both patients and physicians. CONCLUSIONS: Many patients with AR are unaware of their pathology and few seek help from health professionals. When patients take medication, they are generally satisfied with their treatment, even if it is only symptomatic. Patients and physicians see the notion of definitive recovery as the main benefit of SIT, whereas the main disadvantage is the duration of treatment.

Nasal polyposis: is there an inheritance pattern? A single family study.

BACKGROUND: Nasal Polyposis (NP) is defined as a chronic inflammatory disease of sinonasal mucosa leading to diffuse formation of benign polyps. Although family histories are frequently suggested in medical literature, no specific study focused on this point has been reported. The purpose of this study is to determine whether a hereditary factor could be implied for NP in a family where several members were affected. We included 99 members of this family. METHODS: All patients were assessed for conditions known to be associated with the development or presence of NP. Concerning NP, patients were screened with a validated questionnaire and selected patients had a medical examination by an Ear, Nose and Throat practitioner. RESULTS: Thirteen patients had a personal history of NP without asthma, aspirin intolerance, Churg Strauss syndrome, cystic fibrosis, Young's syndrome, bare lymphocyte syndrome, or primary ciliary dyskinesia. Within this family, 19.7% of those older than 17 years were affected by NP, as compared with the national French prevalence of 2.1%. CONCLUSIONS: Regarding the pedigree, we discuss different modes of inheritance. The presence of consanguineous unions in this family suggests the possibility of a common ancestor and thus a recessive autosomal mode of inheritance.

[Role of imaging in the pre-treatment assessment and post-treatment follow-up of sinonasal malignancies]. / Place de l'imagerie dans le bilan préthérapeutique et la surveillance post-thérapeutique des tumeurs malignes du massif facial.

Malignant sinonasal tumors are the most frequent facial malignancies in adults. Assessment of these tumors requires a multidisciplinary approach and imaging plays a major role to define the precise tumor location, volume and extension and to plan post-treatment follow-up. MRI provides superior differentiation between tumor and surrounding tissues and depiction of intracranial or perineural extension. CT is a useful complement to demonstrate bone erosion or extension into the skull base.

[Patient preference survey on the lack of taste and odor of Nasonex nasal spray. Which impact on compliance to treatment?]. / Enquête de préférence patients sur l'absence de saveur et d'odeur du Nasonex en pulvérisation nasale. Quel impact sur l'observance du traitement ?

In order to assess the acceptability of a new scent-free formulation of mometasone furoate (Nasonex) among allergic rhinitis patients, who already have been treated by the scented formulation of Nasonex, a phone survey was performed with a sample of 216 patients recruited by Nasonex GP's prescribers and pharmacists. The aim of this survey is to assess the diagnosis modalities, the allergic rhinitis characteristics and associated symptoms in one hand and in the other hand, the main reasons which led them to prefer a new scent-free formulation, in comparison with the only commercialized scented mometasone furoate (Nasonex) at the time when this survey was conducted. The impact of unscented Nasonex on patient's compliance to treatment was also assessed. This survey confirms that the GP is the key actor who usually establish the allergy diagnosis and the interrogatory is the principle method used. The prick test was more often and significantly used in 35% of the perennial rhinitis instead of 19% in seasonal allergic rhinitis (p < or = 0.05). When the diagnosis of allergy was established by an allergologist, 89% of them used a prick test. In this survey, asthma was associated in 24% of the patients, particularly in who suffering from perennial allergic rhinitis. 85% of patients rate their smell as globally good. 75% of the treated patients were interested by the new unscented formulation of Nasonex, regardless of the type of their rhinitis, seasonal or perennial. About 60% of patients stated that the lack of odor will led them to be more compliant to their treatment.

[Peak Nasal Inspiratory Flow: learning curve for the measurement method and reproducibility]. / Peak Nasal Inspiratory Flow: apprentissage de la méthode de mesure et reproductibilité.

OBJECTIVES: A prospective study on the learning curve and reproducibility of PNIF measurement with 18 different operators. MATERIAL AND METHODS: Five hundred twenty-eight patients in two groups were prospectively enrolled in this study from September 2003 to April 2004. The learning curve of the technique was monitored after five patients had been measured. Reproducibility was evaluated with all patients after two consecutive measurements. RESULTS: The technique was acquired by all operators after the fifth patient. The mean PNIF measurements in controls and patients were 86.02+/-36.96 l/min and 89.59+/-41.97 l/min, respectively. Reproducibility (PNIF2-PNIF1=5.51+/-24.93 l/min) was obtained for all operators, whatever the number of measurements taken. CONCLUSIONS: The study confirms the good reproducibility and the easy training in PNIF measurement.

[Current management of acute pediatric rhinosinusitis in France]. / Etat actuel de la prise en charge des infections rhinosinusiennes aiguës de l'enfant en France.

A multidisciplinary panel of specialists and general practitioners provided definitions for the different forms of acute pediatric rhinosinusitis, with a description of the main symptoms and signs. They emphasized the role of concomitant systemic diseases, such as allergy and immunological disorders. Incidence, description, and management of complications are presented. They also provided the indications for radiological examination and microbiological investigations. The adequate medical management, particularly the place and the type of antibiotics, is analyzed and discussed, and guidelines for practical situations are suggested.

[Efficacy and safety of mometasone furoate nasal spray in the treatment of sinusitis or acute rhinosinusitis]. / Efficacité et tolérance du furoate de mometasone spray nasal dans le traitement de la sinusite ou de la rhinosinusite aiguë.

Sinusitis or acute rhinosinusitis, is defined as an acute viral or bacterial infection characterised by inflammation of the mucosa of the nose and paranasal sinuses. Although antibiotics are routinely prescribed for the treatment of acute sinusitis, most cases are caused by viral infections and will resolve without antibiotic therapy. Given concerns about global antibacterial resistance, evidence-based clinical practice guidelines recommend a conservative approach to antibiotic treatment, with mild or moderately severe acute sinusitis managed symptomatically. Intranasal corticosteroids act on the nasal mucosa to relieve inflammation and its associated symptoms, and may be a useful symptomatic treatment option. Two randomised, placebo-controlled trials have demonstrated that the corticosteroid mometasone furoate, administered as a nasal spray (MFNS), is effective as an adjunct to antibiotics in acute sinusitis. The design of these studies show a therapeutic approach known in Europe, but this attitude is still different from the current French guidelines. Furthermore, the efficacy and safety of MFNS monotherapy has been compared with antibiotic therapy in a randomised, double-blind, placebo-controlled trial in adults with acute uncomplicated sinusitis and probably viral. In this study, twice-daily (BID) MFNS 200 microg produced statistically greater improvements in overall symptoms and most individual symptoms compared with amoxicillin or placebo, even though Amoxicillin is not the one recommended by the French guidelines for this indication. These findings suggest that MFNS may play an important role in the management of acute sinusitis, either as monotherapy or as adjunctive treatment to antibiotics. These results lead also to think over its interest in the treatment of uncomplicated common forms of sinusitis, where antibiotics are still widely prescribed in daily practice.

[Prospective evaluation of the method of measurement of the peak nasal inspiratory flow (PNIF) in allergic rhinitis. Observational study "Pratic in ORL"]. / Evaluation prospective de la méthode de mesure du flux inspiratoire nasal par le PNIF dans la rhinite allergique. Résultats de l'observatoire "Pratic en ORL".

OBJECTIVES: To establish the ENT specialists's interest for the nasal obstruction measurement by the Peak Nasal Inspiratory Flow (PNIF) for the primary care medical management of patients with allergic rhinitis. MATERIAL AND METHODS: A nation wide mail survey was conducted on the whole set of 2,800 French ENT specialists. Physicians had to use the PNIF in 4-consecutive patients with allergic rhinitis and assess through a questionnaire their interest for this tool. RESULTS: About 8% of all ENTs (n = 228) responded. 65.3% of them had used the PNIF with their 4 patients, 29.7% used it in only 1 to 3 of their patients, and 5% did not use it at all. The PNIF was mainly used in moderate to severe rhinitis (94%) in contrast with mild rhinitis (32%) and in persistent rhinitis (94.2%) compared to intermittent rhinitis (54.8%). The primary motivation to use the PNIF on a systematic basis was to quantitatively assess nasal obstruction and to obtain an objective measurement of nasal obstruction. Conversely, the reasons for not using the PNIF were the needless of an objective measurement of nasal obstruction, the drawback of the PNIF in the patient physician relationship and lack of patient's acceptance of the device. Most physicians considered training for a correct usage of the PNIF was easy. Finally, about 2 thirds of the sample gave a positive rating on the usefulness of the PNIF for their patients. CONCLUSION: This study demonstrates the interest of the practitioners to dispose of a simple and reliable tool for the follow up of nasal obstruction in allergic rhinitis.

[Prospective study of 43 severe complications of acute rhinosinusitis]. / Etude prospective sur 43 complications sévères de rhinosinusites aiguës.

STUDY AIM: Incidence and distribution of severe infectious complications of bacterial rhinosinusitis are mostly unknown in adults. Our objective was to describe these complications, the patients clinical background, the relevant bacteria, their therapeutic management and their evolution. MATERIAL AND METHODS: From November 2001 to March 2003, this prospective and descriptive study recruited patients older than 13 years, immuno-competent and hospitalized in 6 French academic hospitals with severe acute complications of presumed-bacterial community acquired rhinosinusitis. RESULTS: Fourty three patients (40 +/- 18 years) were included. Fourty four per cent had an ENT history: Infectious rhinosinusitis (23%) and/or chronic rhinosinusitis (14%) and/or sinonasal surgery (19%). The initial sinusitis was either pansinusitis (24 cases) or an isolated sinusitis in 17 cases (missing data 2). The complication was either initial (15), or followed an infectious acute rhinosinusitis in 27 cases (1 missing data). In 39 cases, complications were isolated: Meningo-encephalic (16), orbital (15) and sub-cutaneous abscess (8). Seventy per cent of the swabs were positive, particularly with Haemophilus Influenzae and Streptococcus Pneumoniae in meningitis, Staphylococcus et Streptococcus species in orbital complications, and Staphylococcus species in sub-cutaneous locations. The initial management of the complication, combining systematic antibiotic therapy with surgery (31 patients), resulted in cure for 31 patients. The subsequent management of the 12 initial failures cured 10 more patients (of which 9 after surgery). CONCLUSION: This prospective study has shown the real risk of severe complications during any acute sinusitis and the need for early treatment often involving a surgery.

[Dragged disc syndrome in a patient presenting neurofibromatosis type II: a case study]. / Syndrome d'attraction papillaire chez une patiente présentant une neurofibromatose de type II.

We report a case of dragged disc syndrome associated with neurofibromatosis type II (NF2). A 5-year-old girl with amblyopia (right eye, 20/200; left eye, 20/40) presented with dragged disk syndrome and a posterior subcapsular cataract in the left eye associated with an epiretinal membrane in the right eye. Five years later, she developed exophthalmos in the right eye associated with a cervical mass. MRI revealed schwannoma developing in the left optic nerve sheath associated with a cervicothoracic schwannoma. The child was diagnosed with NF2. Association of posterior subcapsular cataract with macular epiretinal membranes is highly suggestive of NF2, although the dragged disk syndrome has not been previously reported in NF2 to our knowledge. It may also be an ocular feature of this disease.

[Community-acquired acute maxillary sinusitis or rhinosinusitis in adults in France: current management]. / Etat actuel de la prise en charge de la sinusite ou rhinosinusite maxillaire aiguë communautaire de l'adulte en France.

Sinus infections, often viral, are a common reason for physician visits. The multiplicity of clinical presentations makes its diagnosis difficult. The problem is to recognize bacterial infection without additional testing, except in cases of treatment failures, complications or relapse. Patients with signs suggestive of rhinosinusitis fall into one of four basic clinical situations: common colds, 'doubtful' rhinosinusitis, apparent acute maxillary bacterial rhinosinusitis, and complications. Anterior rhinoscopy may help confirm diagnosis. Current bacterial epidemiology is based on the results of clinical studies, microbial ecology, and samples taken in cases of treatment failure. The two bacteria isolated most frequently are Streptococcus pneumoniae and Haemophilus influenzae, both of which pose resistance problems. Moraxella catarrhalis, Streptococcus pyogenes and Staphylococcus aureus are isolated less often. The dominant issue in management of acute rhinosinusitis is whether to use antibiotic or symptomatic treatment. For viral infections, antibiotic therapy is useless and highly inadvisable. For 'doubtful' infections, symptomatic treatment is likely to lead to recovery. The use of non-recommended antibiotics also increases the risk of selection of resistant bacteria. When bacterial rhinosinusitis is strongly suspected, recourse to antibiotic treatment is recommended in view of the benefits in this situation (AFSSAPS 2005). This treatment is probabilistic, should be decided at the end of the consultation, and follows the AFSSAPS guidelines.

Nosocomial sinusitis with isolation of anaerobic bacteria in ICU patients.

OBJECTIVE: To determine the frequency and the eventual clinical characteristics of nosocomial sinusitis with anaerobic bacteria isolation in patients in the intensive care unit (ICU). DESIGN: Retrospective study. SETTING: A 12-bed medical ICU in a teaching hospital. PATIENTS: 30 adult patients with documented nosocomial maxillary sinusitis. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Using appropriate microbiological techniques, 33 anaerobic bacterial strains were isolated in 18/30 patients (60 %) with nosocomial sinusitis. Anaerobic bacteria were associated with aerobic strains in 13 patients (72 %), whereas in 5 patients (28 %) only anaerobic strains were isolated in sinus puncture cultures. The most frequently isolated species were Prevotella sp. (n = 20, 60 %) and Fusobacterium nucleatum (n = 5, 15 %). The production of beta -lactamase was demonstrated in 13/27 gram-negative anaerobic bacteria. All patients in whom anaerobic bacteria were isolated from transnasal punctures had had a nasogastric tube. Patients in whom anaerobic bacteria were isolated more frequently had neurological disorders upon admission (p < 0.02). Ten patients (30 %) had nosocomial pneumonia, 8 of whom had at least one identical strain in both lung and sinus cultures, including 2 patients with anaerobic bacteria isolation. CONCLUSIONS: Using appropriate microbiological techniques, anaerobic bacteria were frequently isolated in nosocomial sinusitis. If necessary, the empirical choice of antimicrobial therapy in patients with nosocomial sinusitis should take into account these results.

Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses.

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow-up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow-up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses.

Diffuse nasal polyposis: postoperative long-term results after endoscopic sinus surgery and frontal irrigation.

Diffuse nasal polyposis remains a challenge despite recent improvements in endonasal surgery. The purpose of this study is to evaluate the results after a radical complete sphenoethmoidectomy with peroperative and postoperative frontal irrigation in cases of diffuse nasal polyposis. In this prospective study, we include 50 consecutive patients with diffuse nasal polyposis suffering from nasal obstruction, anosmia, and other symptoms of chronic sinusitis. All patients were refractory to medical therapy. In each patient an endoscopic complete sphenoethmoidectomy including total excision of all diseased ethmoid mucosa was performed. Preoperative and postoperative frontal irrigation was performed systematically. The patients were followed closely with serial endoscopic examination, and CT scanning was performed between 2 and 3 years after surgery. There were no complications. Thirty-nine of the 50 patients regained satisfactory olfaction. Partial nasal obstruction persisted in four of the 50 patients. Endoscopically, polyp recurrence was noted in 3% of posterior ethmoids, 23% of anterior ethmoids, and 50% of frontal recesses. We conclude that in cases of refractory and extensive nasal polyposis, a total sphenoethmoidectomy with perioperative frontal irrigation followed by long-term postoperative topical steroid therapy provides excellent improvement or cure with safety and reliability.