Use of Miconazole Cream As Adjunctive Therapy to Treat Isolated Sinus Mucormycosis: A Case Report and Literature Review.

Black fungus, also known as mucormycosis, is one of the most serious infections affecting immunocompromised individuals. Invasive fungal sinusitis due to mucormycosis is quite rare globally. Hence, this article presents a case report of invasive fungal sinusitis in a 53-year-old diabetic female who presented to the emergency department with a severe case of diabetic ketoacidosis secondary to acute sinusitis, which was confirmed by histopathology to be mucormycosis. An extensive surgical debridement and liposomal amphotericin B were the mainstay of treatment. The treatment of mucormycosis consists of treating the underlying disease, antifungal therapy, and surgical debridement. Also, previous studies have discussed the use of medical therapy alone, surgical therapy alone, and combination therapy. It was found that the combination of medical and surgical therapy was the most effective method in treating this condition. However, the high mortality rate of this disease indicates the need for a possible adjuvant therapy which could increase the survival rate. Therefore, recent studies have proposed new adjuvant modalities, such as hyperbaric oxygen therapy and local treatment with amphotericin B. In this study, we propose a new adjuvant therapy using local miconazole cream which showed a good prognosis with the combination of oral amphotericin B and surgical debridement. This highlights the necessity for extensive future clinical trials to validate its effectiveness in treating isolated sinus mucormycosis.

A Case Report of Frontal Sinus Abscess Complicated by Epidural Abscess with a Literature Review.

Inflammation of the frontal sinus is a relatively common clinical condition among paranasal sinusitis and is curable through anti-infection treatments, with a rare progression to frontal sinus abscess. An even rarer complication is the development of intracranial epidural empyema secondary to frontal sinus abscess. In this report, we describe a case of a 14-year-old male with a frontal sinus abscess that led to intracranial infection and was complicated by an epidural abscess misdiagnosed as an epidural hematoma. The primary symptoms were headache, dizziness, and fever. Following combined antibiotic therapy and surgical intervention, including maxillary and frontal sinus window drainage, the patient was cured. A follow-up period of three months showed no recurrence, indicating a favorable outcome.

Therapeutic Effects of Vitamins and Nutritional Supplements on Sinusitis: A Narrative Review.

Sinusitis, one of the most prevalent and undertreated disorders, is a term used to describe inflammation of the paranasal sinuses caused by either infectious or non-infectious sources. Bacterial, viral, or fungal infections can all cause sinusitis. Sinusitis is classified into 3 types: acute, subacute, and chronic. Acute sinusitis lasts for less than 1 month, subacute sinusitis lasts from 1 to 3 months, and chronic sinusitis persists for over 3 months. This condition affects a significant portion of the population, imposing a substantial burden on the healthcare system. Antibiotics are the gold standard of bacterial sinusitis treatment. However, due to the rise of antimicrobial resistance, especially in immune-compromised patients, it is necessary to investigate potential adjunctive therapies. Based on the literature, vitamins (eg, vitamin D) have antioxidant, anti-inflammatory, and immune-modulatory properties and may effectively treat sinusitis and reduce mucous membrane inflammation. Besides vitamins, many other supplements like quercetin, sinupret, and echinacea have immunomodulatory effects and have shown promising results in sinusitis treatment. In this review, we look at the therapeutic role, safety, and efficacy of vitamins and nutritional supplements in sinusitis treatment.

The Efficacy of Omalizumab in Patients with Chronic Rhinosinusitis with Nasal Polyps and Comorbid Severe Allergic Asthma.

Chronic rhinosinusitis whit nasal polyps (CRSwNP) is the most common comorbid disease accompanying asthma. Omalizumab is a recombinant anti-immunoglobulin (Ig) E antibody, and studies suggest that omalizumab may also affect CRSwNP regardless of asthma. We aimed to assess the effect of omalizumab treatment on CRSwNP accompanying severe allergic asthma (SAA) patients. Clinical data including spirometry measurements, serum/nasal secretion biomarker levels were collected. NP scores and CRS scores (Lund-Mancay [LM] scores) were also recorded before omalizumab treatment, as well as at the 4th and 12th months of omalizumab treatment. Twenty-one patients with both CRSwNP and SAA who underwent omalizumab therapy were assessed. There was a significant difference among forced expiratory volume (FEV1), ACT scores, NP scores, LM scores, serum IgE, and blood eosinophil levels of the patients before omalizumab therapy at the 4th and 12th months of omalizumab treatment. A significant negative correlation was observed between ∆FEV1 and ∆NP scores (r=-0.485), between ∆ACT and ∆NP scores (r=-0.469), and ∆ACT and ∆LM scores (r=-0.436). When we grouped the patients who benefited from 1 year of omalizumab therapy and those who did not in terms of NP, there was no difference between the two groups related to local eosinophil and local IgE levels in the nasal polyp biopsy. Omalizumab treatment is effective for asthma and CRSwNP in patients with CRSwNP accompanied by SAA. Improvement in asthma is associated with improvement in CRSwNP. The efficacy of omalizumab on NP in patients with CRSwNP accompanied by SAA is independent of local IgE and eosinophil counts.

Orofacial Migraine-A Narrative Review.

The diagnosis of migraine is based on clear criteria outlined in the International Classification of Headache Disorders version 3 (ICHD-3). Notably, the criteria in ICHD-3 omit the location of the migraine. There are increasing reports of migraine in the facial region. Facial presentations of migraine are not easy to diagnose as they appear in the lower two-thirds of the face, often in the maxillary sinus region, around the ear, the upper/lower jaws, and the teeth. Additionally, a similar but distinct entity, neurovascular orofacial pain, has been established. The symptomatology of facial presentations of these headaches often resembles sinusitis and dental pathology. We will review these presentations, their diagnosis, and possible pathophysiology.

Persistent Fever in Bilateral Septic Cavernous Sinus Thrombosis: A Case Report.

Septic cavernous sinus thrombosis (SCST) is a rare and life-threatening condition characterized by thrombus formation within the cavernous sinus, typically resulting from the spread of infection from facial, paranasal sinus, or dental origins. We report the case of a middle-aged man with a history of methicillin-resistant Staphylococcus aureus (MRSA) skin infections who presented with severe neck pain, fever, and bilateral eye swelling. The patient was bacteremic with MRSA and found on imaging to have thickening of extraocular muscles and air-fluid levels present within the sphenoid sinuses. Despite aggressive antibiotic and anticoagulant therapy, the patient's condition deteriorated. Imaging showed extensive intracranial thromboses involving the cavernous sinuses. Given the lack of clinical improvement and persistent bacteremia, otolaryngological surgical intervention was undertaken. Post-surgery, the patient showed marked improvement, underscoring the critical role of source control in managing SCST. This case highlights the importance of considering surgical options in the treatment of SCST to prevent severe complications and improve patient outcomes.

Biologics in Chronic Rhinosinusitis: Current and Emerging.

Chronic rhinosinusitis (CRS) is categorized phenotypically into CRS with and without nasal polyps (CRSwNP, CRSsNP). Endotyping categorizes the disease based on immune cell activity and inflammatory mechanisms into Type 1, Type 2, and Type 3. The Type 2 endotype is the most researched and associated with asthma, atopic disease, and severe CRSwNP. For patients with poorly controlled CRSwNP, there are 3 approved biologic treatments: omalizumab, dupilumab, and mepolizumab. Many other biologics are being tested in Type 2, non-Type 2, and mixed endotypes in CRSwNP and CRSsNP. These studies will play a significant role in shaping the future of CRS management.

Radiographic anatomy of the nasal conchal bullae and conchal sinuses in mature horses.

The dorsal and ventral nasal conchal bullae and conchal sinuses are part of the complex equine paranasal sinus system and are commonly affected by secondary sinusitis. However, the radiographic anatomy of the conchal sinuses is poorly reported in the literature. The present study aimed to describe the radiographic anatomical characteristics of the nasal conchal bullae and conchal sinuses in mature horses. Six equine cadaveric heads without sinus or dental disorders were studied. A maxillary sinusotomy was performed to identify the dorsal and ventral nasal conchal bullae and conchal sinuses, allowing the application of radiopaque contrast medium in these structures. Afterward, the same projections were repeated. Laterolateral views allowed an adequate visualization of nasal conchal bullae and conchal sinuses; however, they overlapped the same contralateral structure. In the latero30°dorsal- lateroventral oblique view, the same structures were easily recognizable, but in an oblique view, the structures were projected dorsally in relation to the contralateral one. The dorsoventral view allowed partial visualization of the dorsal conchal bullae and dorsal sinuses, but it was not possible to identify the ventral conchal sinus and ventral conchal bullae. The offset dorsoventral view helped in the identification of the dorsal conchal bullae and dorsal conchal sinus, also achieving visualization of the medial region of the ventral conchal sinus and ventral conchal bullae. The use of contrast medium, added to the anatomical dissection, allowed a better radiographic identification of the sinuses and conchal bullae. The combination of different radiographic views is recommended for the evaluation of these structures.

Mucosal infection with Tsukamurella species following nasal septum procedure: a rare case report.

Introduction and importance: Tsukamurella species are rare, aerobic, gram-positive bacteria known to cause infections, primarily in immunocompromised individuals. This case report presents a rare instance of a mucosal infection caused by Tsukamurella species following a nasal septum procedure in an immunocompetent patient. Case presentation: A 51-year-old man with a history of multiple hereditary exostosis, allergic rhinitis, and recent nasal fracture repair presented with persistent fevers and low back pain. Postoperatively, he developed sinus pain and small oral lesions, initially treated with antibiotics for presumed sinusitis. Despite treatment, his fever persisted, leading to an emergency department visit. Laboratory tests indicated sepsis, but a CT scan of the sinuses showed no sinusitis. Despite broad-spectrum antibiotics, the patient's fever continued. On admission day 9, nasal endoscopy and culture identified Tsukamurella species. The patient was treated with augmentin, fluconazole, and levofloxacin, leading to the resolution of symptoms and discharge with ongoing treatment. Clinical discussion: Tsukamurella species are uncommon pathogens that are often associated with bacteremia in immunocompromised individuals. This case highlights the diagnostic challenges and the importance of considering unusual pathogens in postprocedural infections, even in immunocompetent patients. Accurate identification and appropriate management are critical in improving outcomes for patients with Tsukamurella infections. Conclusion: This case underscores the need for vigilance in diagnosing rare infections like Tsukamurella, even in immunocompetent individuals. The successful resolution with combination therapy highlights the importance of appropriate antibiotic selection in managing such infections.

Relationships Between Radiomorphometric Parameters of the Maxillary Sinus and Development of Sinusitis: A Cone Beam Computed Tomography Study.

The presence of maxillary sinusitis can complicate dental procedures. This study aimed to explore the relationship between maxillary sinus radiomorphometric factors, observed in cone-beam computed tomography (CBCT) images, and inflammatory sinus diseases. In this cross-sectional study, CBCT images from patients referred to a private radiology center between January 2018-January 2020 were analyzed. Sinuses were categorized as healthy or pathologic. Sinus pathologies were further classified into subgroups; mucosal thickening, retention cyst, partial opacification, complete opacification and air-fluid level. Radiomorphometric parameters, including ostium height, drainage length, ostium opening size, and drainage angle, were measured in the coronal plane. A p value less than 0.05 was considered statistically significant. A total of 433 maxillary sinuses from 258 patients were examined. Height of the ostium and drainage path length in the groups with various sinus pathologies was significantly higher than in healthy sinuses (p < 0.05 for each subgroup) except for air-fluid level (p = 0.334 and p = 0.520, respectively). Drainage path length was significantly longer in all patient groups. Maxillary ostium openings were significantly smaller in retention cyst and partial opacification subgroups, compared to healthy patients (p = 0.000 and p = 0.006, respectively) except for mucosal thickening or air-fluid levels conditions (p = 0.094 and p = 0.62). Drainage angle did not significantly differ. This study reveals that longer drainage length is associated with a higher risk of inflammatory sinus diseases, with increased severity. Smaller ostium openings are linked to retention cysts and partial opacification, while higher ostium locations increase the likelihood of sinus inflammation and disease severity.

Chronic Invasive Fungal Sinusitis Mimicking Malignancy Post-Radiotherapy: A Case Report.

Invasive fungal sinusitis is a life-threatening form of fungal rhinosinusitis. Due to the aggressive clinical presentation and radiological appearance, there is diagnostic difficulty in differentiating invasive fungal sinusitis from a malignant process. This is even more challenging in oncological patients who have undergone previous head and neck radiotherapy, due to possibility of a recurrence of primary malignancy and radiation-induced neoplasms. We report a rare case of invasive fungal sinusitis mimicking a malignancy in a post-radiotherapy patient. Our patient was a 68-year-old male, 25-years post-radiotherapy for nasopharyngeal carcinoma. He presented with a 3-month history of purulent sputum and right facial paraesthesia. Magnetic resonance imaging showed an irregular destructive enhancing mass of the greater wing of right sphenoid and pterygoid bone with extensive extension into nearby structures. In view of extensive local and bony invasion, and a history of radiotherapy, initial suspicions were that of primary malignancy, specifically radiation-induced sarcoma, and recurrence of nasopharyngeal carcinoma. He underwent transpterygoid biopsy of the lesion, and histopathology demonstrated Aspergillus species, with no malignancy identified. Our report highlights the diagnostic difficulties in the post-radiotherapy cancer patient presenting with symptoms suggestive of aggressive sino-nasal disease. Invasive fungal sinusitis closely mimics the clinical and radiological findings of several neoplastic processes. We discuss the clinical and radiological characteristics of pathologies that may mimic invasive fungal sinusitis. Histological examination remains the gold standard for diagnosis, and early fungal staining is crucial. Furthermore, one should not presume the initial histopathological diagnosis to be confirmatory of isolated fungal disease. Repeat radiological investigations for disease resolution and histopathologic re-evaluation if required should be performed, keeping in mind possibility of coexisting malignancy.

Predictive value of tooth and sinuses radiological characteristics in managing odontogenic sinusitis of endodontic origin.

BACKGROUND: One of the most common causes of bacterial odontogenic sinusitis (ODS) is endodontic disease with periapical lesions (PAL). Referrals between otolaryngologists and dental specialists are indispensable for proper diagnosis and treatment. If the disease does not resolve after medical and root-canal treatment (RCT), tooth extraction, endoscopic sinus surgery (ESS) or both are the ways of management.The aim was to clarify the predictive value of disease's radiological characteristics for the further surgical intervention. METHODOLOGY: 68 symptomatic patients evaluated by an otolaryngologist and dental specialist were included to this prospective observational cohort study. Patients who failed medical treatment of sinusitis (intranasal steroids, saline rinses and antibiotics) and RCT were treated either with ESS, tooth extraction or both at the same time. RESULTS: 87% of patients required surgical intervention. 12% improved after tooth extraction alone, 47% after ESS and 31% required both procedures. The degree of maxillary sinus' (MS) opacification was not correlated with the need of invasive procedures implementation, as opposed to ostiomeatal complex' patency (p<0.001). Cortical bone destruction towards the MS and multiple tooth roots involvement suggested ODS resolution only after combined surgical approach (p=0.041). CONCLUSIONS: Radiological characteristics of causative tooth and patency of ostiomeatal unit correlate with the evolution of ODS and need for either ESS and/or tooth extraction. Patients with multiple roots affected, shorter distance to the MS floor and PAL's with visible bone destruction may require tooth extraction and ESS to resolve ODS completely. CLINICAL IMPLICATIONS: Radiological data may help in earlier diagnosis and treatment of ODS with PALs for both otolaryngologists and dental specialists.

Genetic correlation between chronic sinusitis and autoimmune diseases.

Objective: The association between autoimmune diseases and chronic rhinosinusitis in observational studies remains unclear. This study aimed to explore the genetic correlation between chronic rhinosinusitis and autoimmune diseases. Methods: We employed Mendelian randomization (MR) analysis and linkage disequilibrium score regression (LDSC) to investigate causal relationships and genetic correlations between autoimmune phenotypes and chronic rhinosinusitis. Additionally, transcriptome-wide association (TWAS) analysis was conducted to identify the shared genes between the two conditions to demonstrate their relationship. The CRS GWAS (genome-wide association study) data and other autoimmune diseases were retrieved from ieuOpenGWAS (https://gwas.mrcieu.ac.uk/), the FinnGen alliance (https://r8.finngen.fi/), the UK Biobank (https://www.ukbiobank.ac.uk/), and the EBI database (https://www.ebi.ac.uk/). Results: Utilizing a bivariate two-sample Mendelian randomization approach, our findings suggest a significant association of chronic rhinosinusitis with various autoimmune diseases, including allergic rhinitis (p = 9.55E-10, Odds Ratio [OR] = 2,711.019, 95% confidence interval [CI] = 261.83391-28,069.8), asthma (p = 1.81E-23, OR = 33.99643, 95%CI = 17.52439-65.95137), rheumatoid arthritis (p = 9.55E-10, OR = 1.115526, 95%CI = 1.0799484-1.1522758), hypothyroidism (p = 2.08828E-2, OR = 4.849254, 95%CI = 1.7154455-13.707962), and type 1 diabetes (p = 2.08828E-2, OR = 01.04849, 95%CI = 1.0162932-1.0817062). LDSC analysis revealed a genetic correlation between the positive autoimmune phenotypes mentioned above and chronic rhinosinusitis: AR (rg = 0.344724754, p = 3.94E-8), asthma (rg = 0.43703672, p = 1.86E-10), rheumatoid arthritis (rg = 0.27834931, p = 3.5376E-2), and hypothyroidism (rg = -0.213201473, p = 3.83093E-4). Utilizing the Transcriptome-Wide Association Studies (TWAS) approach, we identified several genes commonly associated with both chronic rhinosinusitis and autoimmune diseases. Genes such as TSLP/WDR36 (Chromosome 5, top SNP: rs1837253), ORMDL3 (Chromosome 13, top SNP: rs11557467), and IL1RL1/IL18R1 (Chromosome 2, top SNP: rs12905) exhibited a higher degree of consistency in their shared involvement across atopic dermatitis (AT), allergic rhinitis (AR), and chronic rhinosinusitis (CRS). Conclusion: Current evidence suggests a genetic correlation between chronic rhinosinusitis and autoimmune diseases like allergic rhinitis, asthma, rheumatoid arthritis, hypothyroidism, and type 1 diabetes. Further research is required to elucidate the mechanisms underlying these associations.

Extent of Endoscopic Sinus Surgery for Odontogenic Sinusitis of Endodontic Origin with Ethmoid and Frontal Sinus Involvement.

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund-Mackay, Lund-Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis.

Clinical Significance of Isolated Sphenoid Sinusitis Identified in Pediatric Patients Presenting with Headache.

Background and Objectives: Brain imaging studies in pediatric patients with headaches often reveal inflammation of the sphenoid sinus. When we encounter patients presenting with headaches without respiratory symptoms, determining the causal relationship between isolated sphenoid sinusitis observed in brain imaging studies and headache is challenging. This study aims to evaluate the clinical characteristics of pediatric patients with headaches and isolated sphenoid sinusitis identified by brain imaging studies and to determine the effects of antibiotics on headache relief. Materials and Methods: Among patients aged <18 years with headaches, those in whom isolated sphenoid sinusitis was observed on brain imaging were included. Their medical records were retrospectively reviewed to evaluate their clinical characteristics and outcomes. Based on antibiotic and analgesic effects, the included patients were categorized into acute bacterial sinusitis (BS) and non-BS groups, and clinical data were compared between the two groups. Results: Brain imaging studies were performed for 1751 patients, and 205 (11.7%) and 41 (2.3%) patients demonstrated sinusitis and isolated sphenoid sinusitis, respectively. For the 41 patients with isolated sphenoid sinusitis, migraine with or without aura (58.5%) was the most frequent type of headache. Throbbing pain (34.1%) occurred most frequently, and the temporal area (51.2%) was the most common location of headache. Nausea/vomiting (56.1%) was the most common accompanying symptom, followed by ocular symptoms (34.1%). Only one (2.4%) patient complained of neurologic symptoms. Headache improved in 26 (63.4%) patients, with improvement without antibiotic therapy in 19 (46.3%) patients. The acute BS and non-BS groups demonstrated comparable characteristics, except for a higher frequency of ocular symptoms in the acute BS group than in the non-BS group (p = 0.044). Conclusions: Isolated sphenoid sinusitis was rarely identified in pediatric patients with headache examined using brain imaging studies. Considering the clinical characteristics and antibiotic effects, early intensive antibiotic therapy cannot be prioritized.

The rs6967330 minor allele in CDHR3 is a significant risk factor for severe acute exacerbations in CRS.

BACKGROUND: Acute exacerbations of chronic rhinosinusitis (AECRS) are commonly triggered by rhinovirus (RV) infections with secondary bacterial infections. Risk factors for AECRS are not well understood. OBJECTIVE: To determine if carriers of the minor allele rs6967330 (AA/AG) in the Cadherin related family member 3 (CDHR3) gene have an increased risk for RV infections in AECRS in vivo and identify CDHR3 genotype-dependent host responses to RV infection in differentiated nasal airway liquid interface (ALI) cultures ex vivo. METHODS: We performed a prospective year-long study of adult subjects with chronic rhinosinusitis (CRS) by rs6967330 genotype (AA/AG, n=16; GG, n=38). We contacted subjects every 2 weeks, and if they reported AECRS clinical data were collected. ALI cultures of adults with CRS (AG/AA,n=19; GG,n=19) were challenged with RV-A and RV-C. We measured viral copy numbers at 4- and 48-hours post-infection and RNA transcriptomes and cytokines at 48 hours post infection. RESULTS: Subjects with the minor allele had significantly higher rates of RV and bacterial infections than those with the major allele. ALI minor allele cultures had higher viral copy numbers of RV-A and RV-C after 48 hours compared to the major allele. Differentially expressed genes (DEG) and pathways identified an upregulation of IL-10 and IL4/13 pathways and a significant downregulation of toll like receptor (TLR) pathways in the minor allele cultures after RV-A and RV-C infection. Unsupervised hierarchical analysis of all DEGs suggest that allergic rhinitis had an additive effect on this response. CONCLUSIONS: The rs6967330 minor allele is associated with increased RV-A and RV-C replication, downregulation of TLR-mediated responses and increased T2-type and cytokine and chemokine responses during RV infection.

Sinusitis Management in Odontogenic Sinusitis.

For odontogenic sinusitis (ODS), appropriately treating the infectious dental pathology and sinusitis leads to disease resolution in greater than 90% of cases. Importantly, managing the sinusitis of ODS is distinct from non-odontogenic rhinosinusitis. The main factors affecting ODS management decision-making include whether patients present with complicated ODS (extrasinus infectious spread), whether they have treatable dental pathology, and whether they have high dental versus sinusitis symptom burdens. This article will provide an evidence-based approach to the multidisciplinary management necessary to manage the purulent sinusitis characteristic of ODS.

Sinus Pathophysiology of Odontogenic Sinusitis.

Odontogenic sinusitis (ODS) is distinct pathophysiologically from nonodontogenic rhinosinusitis. ODS refers to bacterial sinusitis secondary to infectious dental pathology or procedures. Sinus mucosal inflammation in ODS is severe, mostly lymphocytic, and is driven by Th1 or Th17 inflammation. The sinus's respiratory mucosa maintains its structure and function, contrary to significant epithelial barrier dysfunction seen in some forms of chronic rhinosinusitis. The severe inflammation and infection of ODS help explain certain unique clinical features like foul-smelling drainage, frequent purulence, and papillary edema on nasal endoscopy. Appreciating the unique pathophysiology of ODS facilitates its recognition and selection of optimal interventions.

The Future of Odontogenic Sinusitis.

This article discusses the exciting future of odontogenic sinusitis (ODS) in the context of recent advancements in ODS understanding. It emphasizes the importance of integrating ODS into the broader framework of sinonasal diseases and highlights the need for multidisciplinary collaboration among otolaryngologists and dental specialists to optimize clinical outcomes, research, and education. Key challenges include refining dental and sinus pathophysiologic understandings, establishing widely accepted diagnostic criteria, and optimizing multidisciplinary treatment pathways. The article provides also some tips for how to develop interdisciplinary networks both to improve clinical care and research endeavors.