Rhinosinusitis and Allergies in Elderly Patients.

The sinonasal tract plays important roles in respiration, olfaction, and defense against external pathogens. Like many organ systems, the nose and sinuses undergo several changes with advancing age that can play a role in the development of disease. This article discusses the physiology of the aging sinonasal tract and reviews the common diseases affecting older patients, such as rhinitis and rhinosinusitis.

Powered endoscopic dacryocystorhinostomy with selective stenting.

OBJECTIVES/HYPOTHESIS: To compare surgical outcomes of primary powered endoscopic dacryocystorhinostomy (DCR) with selective or routine silicone stenting in anatomic and functional nasolacrimal duct obstruction (NLDO). STUDY DESIGN: Prospective nonrandomized cohort study with historical control group. METHODS: Thirty-one consecutive primary powered endoscopic DCR procedures with selective stenting were performed for anatomic or functional NLDO. No stenting was used unless a tight Rosenmuller valve was appreciated when probing nasolacrimal system during surgery. Nasolacrimal system irrigation, dacryocystography, and lacrimal scintigraphy were used for preoperative assessment. Success was defined as absence of symptoms and patent nasolacrimal system. Comparisons were made with a historical cohort of 31 consecutive primary powered endoscopic DCR procedures with routine stenting. RESULTS: The overall success rate was 79% (49/62), with 96.3% (26/27) success for anatomic and 65.7% (23/35) for functional NLDO. Success rates for anatomic NLDO were 100% (8/8) with selective stenting and 94.7% (18/19) with routine stenting (P > .05). Success rates for functional NLDO were 60.9% (14/23) with selective stenting and 75% (9/12) with routine stenting (P > .05). In the selective stenting group, 2/8 of the anatomic obstructions and 8/23 of the functional obstructions required stents. CONCLUSIONS: Our study suggests that there is no difference in surgical outcomes of primary powered endoscopic DCR with selective or routine stenting in both anatomic and functional NLDO. We advocate a selective stenting approach for primary endoscopic DCR, whereby stents are only inserted when a tight common canaliculus opening is found during surgery.