Association of Benign Paroxysmal Positional Vertigo with Osteoporosis and Vitamin D Deficiency: A Case Controlled Study.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is a common type of vertigo caused by the peripheral vestibular system. The majority of cases are accepted as idiopathic. Calcium metabolism also plays a primary role in the synthesis/absorption of otoconia made of calcium carbonate and thus might be an etiological factor in the onset of BPPV. In this study, we aimed to investigate the role of osteoporosis and vitamin D in the etiology of BPPV by comparing BPPV patients with hospital-based controls. MATERIALS AND METHODS: This is a case-control study comparing the prevalence of osteoporosis and vitamin D deficiency in 78 BPPV patients and 78 hospital-based controls. The mean T-scores and serum vitamin D levels were compared. The risk factors of osteoporosis, physical activity, diabetes mellitus, body mass index, and blood pressure were all compared between the groups. To avoid selection bias, the groups were stratified as subgroups according to age, sex, and menopausal status. RESULTS: In this study, the rates of osteoporosis and vitamin D deficiency detected in BPPV patients were reasonably high. But there was no significant difference in mean T-scores and vitamin D levels, osteoporosis, and vitamin D deficiency prevalence between the BPPV group and controls. CONCLUSION: The prevalence of osteoporosis and vitamin D deficiency is reasonably high in the general population. Unlike the general tendencies in the literature, our study suggests that osteoporosis and vitamin D deficiency are not risk factors for BPPV; we conclude that the coexistence of BPPV with osteoporosis and vitamin D deficiency is coincidental.

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo.

OBJECTIVE: Although there has been a wide consensus on the mechanism of nystagmus and clinical presentation of benign paroxysmal positional vertigo (BPPV), the neuroepithelial pathophysiology of BPPV still remains unclear. In this study, we aimed to clarify the pathophysiology of BPPV by evaluating the cervical vestibular-evoked myogenic potential (cVEMP) findings of patients. MATERIALS AND METHODS: Thirty-six BPPV patients and 20 healthy volunteers were included. Bilateral cVEMP tests were performed on all participants. The participants were divided into the following three groups: those with a BPPV-affected ear, those with a BPPV-unaffected ear, and the healthy control group. RESULTS: There were no significant differences regarding the latencies of the first positive (p1) and negative (n1) peaks among the three groups. The mean normalized amplitude asymmetry ratio also did not differ between the BPPV and control groups. However, the normalized amplitudes of the BPPV patients (with both affected and unaffected ears) were significantly lower than those of the healthy control group. CONCLUSION: We detected that the cVEMP data of the affected and unaffected ears of the BPPV patients was similar and that their normalized amplitudes significantly differed from those of the healthy controls. Eventually, we concluded that even if the symptoms of BPPV were unilateral, the findings suggest that the bilateral involvement of the macular neuroepithelium is important in understanding the pathophysiology of BPPV. This finding supports the conclusion that the pathophysiological process starts with neuroepithelial membrane degeneration and continues with otoconia separation.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations / Efeitos do tempo de permanência de splints intranasais sobre a colonização bacteriana, complicações no pós-operatório e desconforto do paciente após septoplastia

Abstract Introduction: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. Objective: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. Methods: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. Results: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. Conclusions: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Resumo Introdução: A principal razão para a colocação de tampões nasais em septoplastias é a prevenção de hemorragia pós-operatória, enquanto o objetivo secundário é a estabilização interna após cirurgias que envolvam o esqueleto cartilaginoso do nariz. Os splints intranasais de silicone são tão eficazes como outros materiais para o controle de hemorragias do septo no pós-operatório. A possibilidade de manter os splints intranasais por longos períodos ajuda a estabilizar o septo na linha média. No entanto, não há nada na literatura sobre quanto tempo esses splints podem ser mantidos na cavidade nasal sem aumentar o risco de infecção, complicações no pós-operatório e causar desconforto ao paciente. Objetivos: O presente estudo teve como objetivo avaliar a associação entre o tempo de tamponamento com splints intranasais e colonização bacteriana, complicações no pós-operatório e desconforto do paciente. Método: Os pacientes submetidos a septoplastia foram divididos em três grupos, de acordo com o dia da remoção dos splints de silicone. Os splints foram removidos no 5°, 7° e 10° dias de pós-operatório, e a seguir, cultivados microbiologicamente. Complicações precoces e tardias foram avaliadas, incluindo infecções locais e sistêmicas, necrose do tecido, formação de granulomas, crostas na mucosa, sinéquias e perfuração do septo. O desconforto do paciente no pós-operatório foi avaliado com o uso de pontuação dos níveis de dor e de obstrução nasal. Resultados: Nenhuma diferença significante foi encontrada na taxa de colonização bacteriana entre os diferentes grupos. Diminuições da formação de crostas na mucosa e de sinéquias foram detectadas com tempos mais longos de uso de splints de silicone. A dor e a obstrução nasal também diminuíram no terceiro dia de pós-operatório. Conclusões: O uso de splints de silicone foi bem tolerado pelos pacientes, e seus efeitos negativos sobre o conforto do paciente no pós-operatório foram limitados. De fato, o tempo prolongado de uso teve um efeito redutor sobre as complicações tardias. O uso prolongado de splint nasal de silicone é um método confiável, eficaz e pouco desconfortável em pacientes com lesão excessiva da mucosa e naqueles cuja estabilização óssea e cartilaginosa do septo a longo prazo é essencial.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations.

INTRODUCTION: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. OBJECTIVE: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. METHODS: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. RESULTS: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. CONCLUSIONS: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Diagnostic value of vestibular-evoked myogenic potentials in Ménière's disease and vestibular migraine.

Overlaps can be seen between vestibular migraine (VM) Ménière's Disease (MD) and diagnosis is difficult if hearing is normal. We aimed to investigate the sacculo-collic pathway in VM patients, MD patients, and healthy controls to define the diagnostic role of cervical VEMP (cVEMP). VEMP testing in response to 500 Hz and 1000 Hz air-conducted tone burst (TB) stimulation was studied prospectively in 22 subjects with definite VM (according to Bárány nomenclature), 30 subjects with unilateral definite MD, and 18 volunteers matched healthy controls. In VM subjects, response rate, p13 and n23 latencies were similar to healthy controls, but peak-to-peak amplitudes were bilaterally reduced at 500 Hz TBs (p= 0.005). cVEMP differentiated MD patients from VM and healthy controls with asymmetrically reduced amplitudes on affected ears with low response rates at 500 Hz TBs, and alteration of frequency dependent responses at 500 and 1000 Hz TBs. These findings suggest that cVEMP can be used as a diagnostic test to differentiate MD from VM. On the other hand, VEMP responses are symmetrically reduced on both sides in VM patients, suggesting that otolith organs might be affected by migraine-induced ischemia.

Bilateral Nasolabial Cyst as a Rare Case Report.

The etiology, clinical features, and treatment of an extremely rare case of a bilateral nasolabial cyst have been evaluated in this report. A 60-year-old female presented to our clinic with a pain-free swelling above the upper lip for a year and obstruction of the left nasal cavity for two months. On undergoing a physical ENT examination, she showed bulging of both nasal fossae and effacement of the bilateral nasolabial groove with a fluctuating smooth mass. A paranasal sinus CT scan showed a smooth, ovoid mass of 20×13 mm at the right side and 26×22 mm at the left side occupying the floor of the nasal fossa and restricted to the soft parts of the premaxillary region, without any bony destruction. The patient underwent surgical excision under general anesthesia via sublabial approach. Histopathology confirmed the diagnosis of bilateral nasolabial cyst. The patient was asymptomatic during 18-month of postoperative follow-up. Bilateral nasolabial cysts should be considered in the differential diagnosis of cystic masses of the nasal vestibule and deformities of the premaxillary region. Although endonasal endoscopic cyst marsupialization is a relatively new treatment, surgical resection with the sublabial approach is the treatment of choice.

Propranolol and venlafaxine for vestibular migraine prophylaxis: A randomized controlled trial.

OBJECTIVES/HYPOTHESIS: We compared the effectiveness of venlafaxine and propranolol for the prophylaxis of vestibular migraine (VM). STUDY DESIGN: Prospective, randomized, controlled clinical trial. METHODS: Sixty-four subjects with definite VM were enrolled. The subjects were randomly assigned to receive propranolol (group P, n = 33) or venlafaxine (group V, n = 31) for VM prophylaxis. Dizziness Handicap Inventory (DHI) scores, the Vertigo Severity Score (VSS), and the number of vertiginous attacks were recorded before and 4 months after treatment. The Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores were also recorded to monitor the resolution of psychiatric symptoms. RESULTS: At 4 months after treatment, the DHI total score decreased from 55.8 ± 2.7 to 31.3 ± 3.7 and from 50.9 ± 2.5 to 19.9 ± 2.9 (P < .001), the mean number of total vertiginous attacks decreased from 12.6 ± 1.8 to 1.9 ± 0.7 and from 12.2 ± 1.8 to 2.6 ± 1.1 (P < .001), and VSS decreased from 7.3 ± 0.3 to 2.1 ± 0.4 and from 7.9 ± 0.3 to 1.8 ± 0.5 (P < .001) in groups P and V, respectively. However, the treatment effects were similar in both groups (P > .05). BAI scores significantly decreased in both groups, whereas BDI scores decreased only in group V. CONCLUSIONS: This study provided evidence that venlafaxine and propranolol show equal effectiveness as prophylactic drugs for ameliorating vertiginous symptoms in VM patients. However, venlafaxine may be superior to propranolol in ameliorating depressive symptoms.

Otopathology of Vasculitis in Granulomatosis With Polyangitis.

OBJECTIVE: To describe the temporal bone histopathology of vasculitis in granulomatosis with polyangitis. BACKGROUND: Granulomatosis with polyangitis is an autoimmune disease that presents as granulomatosis and vasculitis. Otologic findings, including otitis media, hearing loss, vertigo, and facial paralysis are common in this condition. MATERIAL AND METHODS: The temporal bones of four subjects with manifestations of vasculitis attributed to granulomatosis with polyangitis were studied under light microscopy. RESULTS: The four subjects had manifestations of vasculitis including hemorrhage within the cochlea and vestibule, and inflammation and occlusion of vessels in the lateral cochlear wall and the vasa nervorum of the facial nerve. CONCLUSIONS: We infer that sensorineural hearing loss, vestibulopathy, and facial nerve paresis in granulomatosis with polyangitis can be the results of vasculitis.

The effects of different radiofrequency energy magnitudes on mucociliary clearance in cases of turbinate hypertrophy.

BACKGROUND: Radiofrequency ablation (RFA) application is a commonly used technique for the treatment of inferior turbinate hypertrophies. As the number of RFA applications has increased, some problems have been reported regarding the patient discomfort. The most frequent problems among these are the extended turbinate crusting and nasal obstruction. METHODS: Patients who received RFA were divided into two groups based on the applied energy value during the employment of the technique. Each group was including 30 patients. The patients in the first group received 8 watts and those in the second received 12 watts of energy. Saccharin transport times (STT) were measured four times. First a baseline measurement was performed followed by measurements on the 15th, 30th, and 45th days after the initial procedure. Nasal obstruction was twice assessed by peak nasal inspiratory flow (PNIF) measurements, which were taken both before the procedure and on the 45th day after the procedure. Turbinate surface crustings that were observed for more than 15 days were considered as an extended turbinate crusting. RESULTS: The STT and PNIF measurements taken before the procedure were not significantly different between the two groups. Postprocedure STT measurements were significantly higher than the preprocedure measurements taken in both groups, and were stable within the physiological range. The STT increase in Group II was significantly greater than in Group I. Postprocedure PNIF values in both groups were significantly higher than the preprocedure values. Group II had showed a significantly higher rate of crusting. CONCLUSION: Higher magnitudes of energy elongate the healing process of the turbinate tissue and they affect more extensively the mucociliary clearance. Elongation of the healing process of the turbinate tissue may increase the rate of postprocedural complications such as turbinate surface crusting.

Diagnostic value of frequency-associated vestibular-evoked myogenic potential responses in Ménière's disease.

Thirty subjects with unilateral Ménière's disease (MD) and 18 age-matched controls underwent cervical (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) testing using bilateral air-conducted stimulation (ACS) with stimulus frequencies of 500 and 1,000 Hz. The aim of this study is to determine the diagnostic value of frequency-associated responses in MD using oVEMP and cVEMP following 500- and 1,000-Hz ACS. In healthy controls and unaffected ears, responses to 500 Hz were found better than 1,000-Hz ACS in both oVEMP and cVEMP, while ears with MD responded to 1,000-Hz ACS better than to 500-Hz ACS in oVEMP. In cVEMP tests, affected ears responded to 500-Hz and 1,000-Hz ACS equally. Amplitude ratios of 1,000/500 Hz in both oVEMP and cVEMP were successful in differing affected ears from unaffected ears and healthy controls. This study showed frequency alteration of oVEMP and cVEMP can be used as a diagnostic test battery in MD.

Prognostic factors in type I tympanoplasty.

OBJECTIVE: To identify the preoperative factors that influence the success rate of type I tympanoplasty. METHODS: A total of 247 type I tympanoplasty procedures were included in the present study. We determined the effects of the following preoperative variables on the anatomical and functional outcomes of type I tympanoplasty in order to identify prognostic preoperative factors: age (<16 years vs. >16 years), history of ear surgery, state of the contralateral ear (healthy vs. diseased), size of perforation, presence of septal pathology, presence of adenoid disease and history of smoking. Additionally, we stratified the surgical procedures according to the type of graft materials used and analyzed the effects of the above preoperative variables on the success rates of each type of procedure separately in order to eliminate the confounding effect of surgical technique. RESULTS: The study was conducted on 217 subjects (130 females, 87 males) who underwent a total of 247 surgical procedures. The graft take rate was significantly higher after tympanoplasty with perichondrium-cartilage island flap (PCIF) grafts than after tympanoplasty with temporalis fascia (TF) grafts (87.8% vs. 72.3%, p=0.008). Young age (p=0.013), presence of adenoid hypertrophy (p=0.001) and abnormality of the contralateral ear (p=0.027) were associated with lower success rates after tympanoplasty with TF grafts. The success rate of tympanoplasty with PCIF grafts was not affected by any of the preoperative variables we tested. Postoperative audiometry showed that the improvement in hearing ability did not differ between patients who received TF grafts and those who received PCIF grafts (p=0.325). CONCLUSION: Tympanoplasty with cartilage grafts was associated with better graft takes and comparable hearing outcomes than those associated with tympanoplasty with TF grafts. In patients with risk factors such as contralateral ear disease, a young age or adenoid disease, cartilage-perichondrium grafts are preferable to TF grafts.

Otopathology in congenital toxoplasmosis.

OBJECTIVE: To describe the temporal bone histopathology in children with congenital toxoplasmosis. BACKGROUND: Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii. If fetal infection occurs early in gestation, severe inflammation and necrosis can cause brain lesions, chorioretinitis, and hearing loss. Hearing loss in congenital toxoplasmosis may be preventable with early diagnosis and treatment. MATERIALS AND METHODS: The temporal bones of 9 subjects with congenital toxoplasmosis were removed at autopsy and studied under light microscopy. Cytocochleograms were constructed for hair cells, the stria vascularis, and cochlear neuronal cells. RESULTS: Three (33%) of 9 subjects were found to have parasites in the temporal bone. The organism was identified in the internal auditory canal, the spiral ligament, stria vascularis, and saccular macula. The cystic form of the parasite was not associated with the inflammatory response seen in the active tachyzoite form. CONCLUSION: We infer that the hearing loss of toxoplasmosis is likely the result of a postnatal inflammatory response to the tachyzoite form of T. gondii. Our findings have implications for the early identification and management of Toxoplasmosis.

Otopathology in idiopathic Dandy's syndrome.

BACKGROUND: Dandy's syndrome, or bilateral vestibular hypofunction and oscillopsia, may cause chronic disequilibrium aggravated by head movement or in the presence of reduced light. It may be secondary to ototoxicity, central nervous system tumors, Ménière's syndrome, infections, or trauma or may be idiopathic. OBJECTIVE: To describe the temporal bone histopathology in one individual with idiopathic Dandy's syndrome. MATERIALS AND METHODS: Temporal bones from 1 individual were removed at autopsy and studied using light and Nomarski microscopy. RESULTS: In this case, the otopathology demonstrated vestibular atelectasis of the membranous labyrinth of the superior, lateral, and posterior semicircular canals but not the utricle or saccule bilaterally. The findings also included mild hair cell loss in the cristae of all semicircular canals and of the utricular and saccular maculae and severely reduced neuronal count in Scarpa's ganglion bilaterally. There was also a scattered loss of inner and outer hair cells throughout the cochlea and moderate-to-severe loss of cochlear neurons bilaterally. CONCLUSION: We have reported the histopathologic findings in a case of idiopathic Dandy's syndrome. Both temporal bones showed vestibular atelectasis of all three semicircular canals, preservation of normal saccule and utricle, and severe reduction of the neuronal population in Scarpa's ganglion bilaterally. Both ears also showed substantial degeneration of the spiral ganglion of the cochleas. Severe Scarpa's ganglion degeneration was also noted in the only other case of idiopathic Dandy's Syndrome in the literature. However, that other case had no evidence of vestibular atelectasis and had normal hearing.

The role of the actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population.

OBJECTIVE: To determine the prevalence of tonsillar Actinomyces in subjects with recurrent tonsillitis and those with obstructive tonsillar hypertrophy, and to determine the association between the presence of Actinomyces and tonsillar volume, and crypt abscess. SUBJECTS AND METHODS: A prospective designed cross-sectional study consisted of 90 children subjects who underwent tonsillectomy or adenotonsillectomy for recurrent tonsillitis and obstructive tonsillar hypertrophy. The subjects of recurrent tonsillitis (Group A) and obstructive tonsillar hypertrophy (Group B) were compared to the presence of Actinomyces. The relationship between the presence of Actinomyces and the presence of crypt abscess, and tonsillar volume were also compared. RESULTS: Actinomyces was found to be significantly more prominent in obstructive tonsillar hypertrophy group (61.5%) compared to recurrent tonsillitis group (26.6%) (p<0.001). Additionally, the mean tonsillar volume was significantly higher in tonsils with Actinomyces than those without (p<0.001). The histopathological study revealed that there was no significant inflammatory response to the existence of Actinomyces. CONCLUSION: According to the presented study, Actinomyces was seen more prominent in subjects with obstructive tonsillar hypertrophy compared those with recurrent tonsillitis. Furthermore Actinomyces had a pathological influence on tonsil size. This study showed there was a significant relation between Actinomyces and enlargement of tonsillar tissue. However, how causes tonsillar hypertrophy is not understood yet in tonsillar disease.

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study.

The purpose of this study was to determine the effect of uncinectomy without sinusotomy and natural ostial dilatation on maxillary sinus ventilation in chronic rhinosinusitis. Twenty patients with chronic rhinosinusitis were included in this study. The patients were randomly divided into two groups. Group 1 consisted of patients with uncinectomy (n = 10), while group 2 was made up of patients treated with natural ostial dilatation (n = 10). The CO(2) tension and pressure levels of the maxillary sinus during inspiration and expiration phases were obtained and compared before and after the procedures within and between the groups. The mean CO(2) tension levels in both groups were significantly decreased after the procedures. The mean maxillary sinus pressure during inspiration was significantly decreased to a negative value after uncinectomy; however, no significant change was observed during expiration. There were no significant changes in maxillary sinus pressures after natural ostial dilatation procedure. Both uncinectomy and natural ostial dilatation seem to be equally effective in decreasing maxillary sinus pCO(2) levels. The effects of decreased maxillary sinus pressure during inspiration after uncinectomy on mucociliary clearance and development mechanisms of chronic rhinosinusitis seem to be worth investigating.

Middle turbinate osteoma extending into anterior cranial fossa.

Middle turbinate osteoma is very rare and only two times have been reported before. We reported a 31-year old male presenting middle turbinate osteoma that extending into the anterior cranial fossa, causing pneumocephalus. The osteoma was resected by combining endoscopic sinus surgery with bifrontal craniotomy and the patient was relieved of headaches.

Endoscopic balloon dilation sinuplasty including ethmoidal air cells in chronic rhinosinusitis.

OBJECTIVES: We present the results of our experience with balloon catheter sinusotomy (BCS) in patients who had chronic rhinosinusitis. METHODS: The medical records of 30 patients who were treated for chronic sinusitis with the BCS technique between April 2007 and February 2008 were reviewed retrospectively. Preoperative and postoperative assessments were performed by endoscopic endonasal examination and Lund-Mackay radiologic staging of paranasal sinus computed tomography scans. The symptom scoring was performed with the Sino-Nasal Outcome Test-20 (SNOT-20). The postoperative follow-up period was at least 12 months. RESULTS: We performed BCS in 151 sinuses, excluding 2 maxillary and 2 frontal sinuses. No major complication attributable to BCS was observed. After operation, suctioning and crust removal was not needed in the area operated on in BCS patients. Revision surgery was needed in 2 patients after 6 months. From before to after operation, the SNOT-20 values and Lund-Mackay scores decreased significantly. CONCLUSIONS: We conclude that BCS helps to dilate the sinus ostia properly and effectively in the management of chronic rhinosinusitis. It can also be performed in the ethmoidal air cell area.