Maxillary sinus hypoplasia with a patent ostiomeatal complex: A therapeutic dilemma.

Maxillary sinus hypoplasia (MSH) is a radiologically detectable abnormality of the maxillary sinus that can be associated with sinusitis. Symptomatic MSH patients with a patent ostiomeatal complex (MSHPO) constitute a particular therapeutic challenge. Ostiomeatal unit CT scans of 1293 patients with various sinonasal symptoms such as purulent discharge, postnasal drip, facial pain or headache were reviewed to determine the incidence, clinical symptoms and outcomes of MSHPO following medical treatment. Seventy-five cases (5.8%) were found to have MSHPO. Excluding patients with nasal septal deviation and positive allergy test, 37 of those 75 patients (2.86% of the original cohort) had MSHPO as the only definable sinonasal abnormality. Radiographs showed all patients had antral mucosal thickening. Postnasal drip (43.2%) was the most common symptom, followed by nasal obstruction (40.5%), purulent rhinorrhea (32.4%), hyposmia or anosmia (32.4%), cough (21.6%) and headache (18.9%). Medical treatment consisted of clarithromycin and ebastine for all patients. Medical treatment resulted in complete symptom resolution in only 24.3% of patients. Primary MSHPO was present in approximately 3% of patients with sinonasal symptoms. The response rate to medical treatment was poor. MSHPO should be considered a differential diagnosis in patients presenting with non-specific sinonasal complaints.