title: Paranasal sinus exostoses: an unusual complication of topical drug delivery using cold nasal irrigations.
abstract: OBJECTIVE
  The use of topical drug delivery through nasal irrigations can minimize systemic side effects and deliver higher concentrations of drugs directly to diseased sinus mucosa. Complications related to this popular method of treatment are not well described. We present our experience with paranasal sinus exostosis (PSE), a new diagnostic entity that appears to be a complication of cold nasal irrigations.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Retrospective chart reviews were performed on patients within the Cleveland Clinic Foundation from 2005 to 2011. Six patients were identified with sinus exostoses. A literature review for "sinonasal exostoses" and "paranasal sinus exostoses" was performed using PubMed.
  
  
  RESULTS
  Six patients with PSE were identified at the Cleveland Clinic Foundation between 2005 and 2011. All patients had undergone sinus surgery, and none had documented evidence of PSE prior to surgery. There was no evidence of worsening PSE once the cold irrigations were stopped. No patients showed any resolution of PSE over time. None of our patients has progressed to have disease burden significant enough to require intervention.
  
  
  CONCLUSIONS
  PSE is a rare condition that mirrors a well-described otologic process; exostoses of the external auditory canal. PSE appears to be a complication of cold nasal irrigations. It does not resolve with the halting of cold irrigations, but does not appear to progress further after intervention. PSE only affects postoperative patients. With the evolving trend to treat postoperative sinus disease topically, the clinician should be aware of the dangers of cold irrigations, and patients should be counseled accordingly.
authors: Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: Timothy
authors: T
authors: Haffey
authors: Troy
authors: T
authors: Woodard
authors: Raj
authors: R
authors: Sindwani
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002908:Chronic Disease; D015331:Cohort Studies; D003080:Cold Temperature; D016208:Databases, Factual; D004724:Endoscopy / Q000379:methods; D005096:Exostoses / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000187:drug effects; D055556:Nasal Lavage / Q000009:adverse effects* / Q000379:methods; D059085:Nasal Sprays; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010254:Paranasal Sinus Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D035583:Rare Diseases; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D059085:Nasal Sprays