In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Jens Andersson, practicing ENT at Sweden’s Skåne University Hospital, tackle chronic frontal sinusitis.

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SHOW NOTES

First, Dr. Andersson talks about the Swedish healthcare systems, focusing on access to care and cost. The discussion then shifts to chronic frontal sinusitis. Symptoms associated with this disease include frontal headache, stuffiness, congestion, and low-grade fever. In cases of orbital involvement, patients may complain of proptosis or diplopia. Risk factors include frontal sinus fracture, barotrauma, an immunocompromised state, and dental infection. Most, but not all, patients have involvement of multiple sinuses.

Next, Dr. Andersson illuminates workup and treatment of chronic frontal sinusitis. His physical exam includes close inspection of the oral cavity, anterior rhinoscopy (performed with a microscope), and flexible fiberoptic laryngoscopy. When ordering imaging, he prefers cone-beam CT of the sinuses, though he orders MRI when bony invasion or extra-sinus disease are present.

Finally, the surgeons discuss operative management of chronic frontal sinusitis. Dr. Andersson talks listeners through his pre-operative planning, focusing on how he uses imaging. Moving to the OR, the surgeons share their techniques for operating on the frontal sinus. Dr. Andersson reviews strategies to avoid scarring, use of navigation systems, and post-operative management. Dr. Shah shares pearls from her pediatric sinus practice. The episode finishes with Dr. Andersson’s witty and high-yield advice for otolaryngologists.