engleski

Two hole syndrome (THS) is present in more than half of the postnasal drip patients

Background: The etiology of the postnasal drip has been a subject of long lasting scientific and expert discussions, particularly during the last decade. It is well known that there are at least three most important possible reasons for the onset of this clinical entity: gastro-esophageal reflux disease (GERD), laryngeal-pharyngeal reflux (LRP), chronic rhino sinusitis (CRS) and allergy. Defects in the fontanel region of the lateral nasal wall have been described in the literature as accessory or secondary ostia. Opposite to this, the authors consider them a sign of chronic maxillary sinus inflammation, i.e. the equivalent of the defects at the tympanic membrane in cases of chronic otitis media. If this was true, these defects should be found much more frequently in CRS patients than in healthy ones. Objective: The aim of this study was to compare the incidence of fontanel defects in patients with postnasal drip and in healthy subjects. Methods: 723 out-patients suffering from postnasal secretion as a leading symptom were examined during the last ten years by means of nasal fiberendoscopy. The control group consisted of 312 healthy volunteers with no history of postnasal drip. Results: defect in the posterior fontanel was found in 243 out of 723 postnasal drip patients (33.7%). The recirculating mucus ring was identified in 57 out of 243 patients carrying a fontanel defect (23.4%). No defects in the posterior neither anterior fontanel were found in healthy volunteers at all. Conclusion: posterior fontanel defects were found in postnasal drip patients but not at all in healthy subjects. These defects have been clinically related to chronic inflammation of the maxillary sinus and should not be called accessory ostia". We named this entity the Two Holes Syndrome (THS).

chronic rhinosinusitis ; postnasal drip

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