Various causes for frontal sinus obstruction

Purpose: A variety of inflammatory and structural conditions can cause frontal sinusitis. The present study was conducted as pilot study to determine the primary cause of frontal sinusitis at the time of endoscopic sinus surgery. Materials and methods: Retrospective chart review was performed from 1997 to 2004 of patients who underwent endoscopic frontal sinus surgery at the University of Virginia. Demographic data, intraoperative frontal recess findings, and history of prior sinus procedures were collected. Results: There were 102 patients, and 176 endoscopic frontal sinus surgeries were performed with mean follow-up of 29 months. The major causes for frontal sinusitis were polyp (53%), frontal recess synechia (21%), agger nasi cell (12%), and narrow osteomeatal complex (5%). Frontal recess synechia was present only in patients who had prior surgery. Conclusions: Inflammatory polyps, followed by synechia, were the most common causes of chronic frontal sinusitis requiring frontal sinus surgery. Further investigation is warranted to identify the sources of frontal recess synechia and to develop preventative strategies of this iatrogenic problem. (C) 2009 Elsevier Inc. All rights reserved.