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BackTable / ENT / Article
Chronic Frontal Sinusitis: Clinical Presentations & Management Strategies
Megan Saltsgaver • Updated Sep 12, 2024 • 55 hits
Chronic frontal sinusitis is a prolonged inflammation of the mucosa in the paranasal sinuses, lasting for three or more months. It can be diagnosed clinically through subjective symptoms or confirmed with objective findings on imaging, such as CT or MRI. Before considering surgical intervention, patients typically need to show a lack of response to conservative management over a period of time. Otolaryngologist Dr. Jens Andersson shares his insights on the evaluation and management of chronic frontal sinusitis based on his practice in Sweden.
This article features excerpts from the BackTable ENT Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.
The BackTable ENT Brief
• Chronic frontal sinusitis is an inflammatory condition of the paranasal sinuses mucosa that persists for 12 weeks or more. Patients often present with headaches between their eyes, nasal congestion or blockage, facial pressure, and drainage.
• Risk factors for chronic frontal sinusitis include facial trauma, nasal polyps, and frequent exposure to barotrauma, such as flying or diving.
• Treatment of chronic frontal sinusitis is often aimed at controlling inflammation. Nasal saline and steroid rinses are often first line. Antibiotic use is not a mainstay of uncomplicated chronic frontal sinusitis treatment, but if needed, macrolides may be used.
• Endoscopic sinus surgery is considered when conservative measures fail after 3-4 weeks. ENT surgeons have many different approaches to sinus surgery depending on the severity of the disease.
Table of Contents
(1) Clinical Presentations of Chronic Frontal Sinusitis
(2) Initial Management of Chronic Frontal Sinusitis
(3) Antibiotic Management of Chronic Frontal Sinusitis
(4) Surgical Approaches to Chronic Frontal Sinusitis
Clinical Presentations of Chronic Frontal Sinusitis
Chronic frontal sinusitis is a condition characterized by sinusitis symptoms persisting for three months or longer. Patients typically present with headaches, nasal congestion, stuffiness, and occasionally, low-grade fevers. A frontal sinus headache is usually felt between the eyes and down through the nose. The pain is often not confined to the frontal sinuses and may involve the ethmoid and maxillary sinuses as well. Dr. Andersson described a unique case of a patient who presented with a swollen right eye, which was later found to be related to chronic frontal sinusitis on a CT scan.
Risk factors for chronic frontal sinusitis include trauma, such as fractures to the frontal sinus or other head injuries, nasal polyps, and barotrauma. Barotrauma, an injury caused by changes in air pressure, commonly affects the ears and sinuses. Individuals who frequently fly, such as flight attendants, or those who dive, are more prone to chronic frontal sinusitis. Another often-overlooked risk factor is dental infections, particularly in immunocompromised patients or those with poor oral hygiene.
[Dr. Gopi Shah]
In terms of, now getting into our clinical topic, we're going to talk about chronic frontal sinusitis. How did these patients present to you? What symptoms do they usually have?
[Dr. Jens Andersson]
I knew this question was going to come and still I have a hard time answering it because they can actually come in any number of ways. They can obviously have had problems for a long time with headaches and stuffiness and nasal congestion and sometimes low-grade fever. Actually, this week I had a man who came I think originally from Bangladesh but he'd been in the healthcare system. He'd been seeing his GP for a while and then they referred him to the ophthalmology clinic and always it's easy when you are the last one seeing the patients. Sometimes I say that the most useful tool we have is the retrospectoscope. When we see something and we can tell, "Oh, okay, you should have seen this coming," and they didn't. He presented with a swollen right eye, and then when we did the CT scan, he had a severe frontal sinusitis with bony wall destruction to his right eye. Then also almost surprised that it wasn't a Potts puffy tumor because he had a destruction in his frontal table of the sinus and also actually a bit in the back and towards the intracranial space. He had been going with this for a long time. Actually, I think it was dental from the beginning because one of the biggest mucous seals in the maxillary sinus that I've seen. His teeth were not that good.
[Dr. Gopi Shah]
Wow. You're right. Sometimes the presentations can be a little indolent and it can take a long time in the frontal sinus because of where it's located the patients can present. You're right, they don't always look as sick as they should.
[Dr. Jens Andersson]
No, no. I always see them when they've been to other doctors so I can only read about how it started because I always see them later when they're ill. When they're worse. Yes.
[Dr. Gopi Shah]
You're right. They might have in addition to the nasal congestion and then drainage, they might have that low-grade fever, headache, sometimes the eye presentation where acute maxillary sinusitis isn't going to always have as many, maybe, but sometimes it can be hard to tease out.
[Dr. Jens Andersson]
Yes. Often, they have the frontal headache right between the eyes and a bit down towards the nasion.
[Dr. Gopi Shah]
Do you have a group of patients where it's isolated frontal sinusitis or do you find that in your practice they'll still have associated max ethmoid as well?
[Dr. Jens Andersson]
The feeling I have is that it's more often other sinuses involved as well. I would say if someone has an isolated frontal sinus problem, obviously, they can have, but maybe more if they had a trauma before, sometimes it's-- what do you call it in English? Barotrauma in Swedish. Sorry. That can absolutely present as an isolated frontal sinus problem but more often than not, I would say that more sinuses are involved in my experience.
[Dr. Gopi Shah]
Yes that brings up the next question I'm going to ask you is, some of the risk factors for chronic frontal sinusitis in terms of risk factors, trauma, or history of a frontal sinus fracture or head trauma potentially, what other kinds of risk factors? You mentioned barotrauma, is that usually somebody that dives, scuba dives or flight even?
[Dr. Jens Andersson]
Yes, sometimes divers come and complain about this, but sometimes also just ordinary people who fly a lot. We had flight attendants, which is obviously very stressful because they can't really work because it hurts like crazy. I actually know what it feels like. I used to have those problems. I was scuba diving when I was younger and I had those. I often pressurized my frontal sinuses with blood and it's not a pleasant feeling. Other risk factors are polyps, for instance. As this patient I just described, other types of infections like dental infections or if you're immunocompromised. There are a lot of things that actually can predispose for having frontal sinusitis. You're forgetting one.
[Dr. Gopi Shah]
Yes, we can stick with that as our case example for this podcast. The dental infection is definitely-- I feel like I don't look at the teeth enough or pay attention to that, but you're right. It leads to deep neck infections, sinus infection.
[Dr. Jens Andersson]
More before, I think it was overlooked. Nowadays, I look at the radiography pictures myself, and I always look at the teeth. If I'm uncertain, I actually call the radiologists and discuss with them because we have some very good radiologists and those I know they look at the teeth. If they have answered, I really don't need to call them because I know they've looked at it. If it's someone I don't recognize or sometimes you can outsource the radiology departments, when someone else looks at the picture and then sometimes I have to call my friends at my own radiology department and ask them.
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Initial Management of Chronic Frontal Sinusitis
Controlling inflammation of the paranasal sinuses and their linings is often more important than antimicrobial management in chronic frontal sinusitis. Conservative management includes intranasal steroids, systemic steroids, and saline irrigation consistently before surgical management is considered. If patients are not consistently doing these, then they are heavily encouraged to. Antibiotic rinses can be considered if patients have other health concerns.
When a patient presents with chronic frontal sinusitis symptoms but lacks previous imaging, the decision for imaging relies heavily on the presentation and history. Imaging for confirmation of chronic frontal sinusitis can be considered if patients pain is atypical or cannot be controlled with conservative management.
Additionally, obtaining a culture, whether the patient has pus or not, can be helpful in determining next steps in management. An immunology assessment can help to determine if the patient has an underlying immune disorder, particularly in the setting of multiple other infections.
[Dr. Gopi Shah]
In terms of the patients that come to you in clinic, for the ones that say don't have imaging, at that visit, do you get imaging? Do you send them home with antibiotics? Do you culture the pus? What are your next steps?
[Dr. Jens Andersson]
I also knew this question was going to come and it's highly dependent on how they present themselves. It's hard to give a generic answer to that. If there's something and they had it for a long time, they haven't had any imaging, which is actually rare when I see them because normally they pass a few institutions on the way and there are some pictures, radiography taken. Obviously, I think about doing it, but I do take cultures. If there's pus, I always culture. Sometimes I do it when there's not because I want to see if there's something else wrong. If they have a history of other infections, I try to do an immunology assessment. I don't know if you do the MBL, Mannose-Binding Lectin, also Swedish. It's a molecule. You can have a deficiency of this MBL and that can predispose you. If you ask the infectionists, they say that it doesn't really matter if you don't have an IgG deficiency as well.
In my experience, I've had some patients with severe runny noses with pus and all kinds of weird bacteria. The only thing I can find is the MBL deficiency that we can't do anything about, but it's-
[Dr. Gopi Shah]
It's at least information.
[Dr. Jens Andersson]
Yes. I've had a few of those actually, but how important it is, I can't really tell you. Also, the question was, when do I do imaging? If they have had longstanding problems, pain, and I can't resolve it because sometimes they haven't rinsed enough and they haven't used the cortisone spray. I start by telling them that you have to do this. You have to do the rinses. You have to do the cortisone spray. Otherwise, I won't see you basically, or I won't go the next step.
[Dr. Gopi Shah]
In terms of longstanding, I usually think of the 12 weeks, the three months of symptoms.
[Dr. Jens Andersson]
Yes. That's the definition of chronic sinusitis. It depends on how troubled they are, how much pain they are in or how little they can breathe through the noses. You always have to weigh in all the symptoms.
[Dr. Gopi Shah]
Yes. The patients that you've cultured, do you start them on empiric antibiotics in that clinic visit, or do you wait for the culture to come back?
[Dr. Jens Andersson]
Also depends on your symptoms because if you have low-grade symptoms and you've had them for a long time, then I absolutely wait for the culture to come back. If the culture is what we call blank, if it doesn't show anything. Also I've had this discussion with our microbiology department because sometimes we ask, "Is there anything growing here?" They answer, "Nothing that is clinically relevant." Sometimes I want to decide what is clinically relevant because-
[Dr. Gopi Shah]
You're looking at the nose and the patient.
[Dr. Jens Andersson]
Yes. One of these girls who had this MBL deficiency, and I've had to culture her for several, I don't know how many times. One time I asked them, just answer everything that grows and I'll be the judge of what's clinically relevant. They still said it was blank. Then one of my colleagues asked a direct question, is it Klebisella ozaenae? It was. I just had wished they told me that before.
[Dr. Gopi Shah]
In terms of the sinus rinses, have any ever used antibiotics in the rinses, like Bactroban or Mupirocin?
[Dr. Jens Andersson]
It's not the tradition in Sweden. I'm not opposed to it at all, but I don't have any experience with it. I do sometimes use budesonide in the rinses, but I've never done the antibiotics. Are you familiar with that?
[Dr. Gopi Shah]
I've used it for my cystic fibrosis patients, depending on what their cultures are. Sometimes the pharmacies can do tobramycin irrigations prep for them, occasionally maybe in my PCD, my Primary Ciliary Dyskinesia kids, but not routinely. I've done Mupirocin or Bactroban rinses, meaning I'll have the family, because my practice is it's all children, so a little bit of Mupirocin or Bactroban ointment in the rinse bottle. If they're growing staph or if there's a lot of inflammation. Sometimes I'll have them do that just for a week, something like that, but nothing nebulized or anything, and not anything routinely. Other than those three categories, I have not. Budesonide rinses, yes, most of the time insurance will be okay, but every once in a while, I've had to do the phone call and discuss, and sometimes they approve it, sometimes they don't.
Antibiotic Management of Chronic Frontal Sinusitis
The decision to start empiric antibiotics depends on the severity and duration of the patient’s symptoms. If cultures were obtained, waiting for results before prescribing antibiotics in cases of mild, long standing symptoms is reasonable. However, if the patient is having trouble breathing through their nose, consider starting antibiotic treatment sooner. Dr. Andersson likes to have patients try saline rinses and sprays for about a week before starting an antibiotic.
If a patient is started on antibiotics in chronic frontal sinusitis, a macrolide can be used. Depending on symptoms and severity, length of treatment can range from a week to more long term usage, such as three to six months.
[Dr. Gopi Shah]
Let's say you did antibiotics for the patient in the clinic. How many days do you usually give?
[Dr. Jens Andersson]
Depends also, 7 to 10 days, depending. Sometimes if they're getting partial resolution of their symptoms, I can prolong it. Then there are the other cases where we do the long-term antibiotic treatments. Sometimes there are three, but more often there are six months with macrolide, you call that in English as well?
[Dr. Gopi Shah]
Yes.
[Dr. Jens Andersson]
Normally, first I try, with the rinses and spray and then about 7 to 10 days treatment or sometimes 14, but not much more than that.
[Dr. Gopi Shah]
Are oral steroids part of your treatment plan ever?
[Dr. Jens Andersson]
Sometimes, yes. This patient that we referenced before, he got some oral steroids as well when he was admitted.
[Dr. Gopi Shah]
Did it help with his eye and his swelling?
[Dr. Jens Andersson]
Actually, what helped was when we drained the pus. I'd like to think that it helped because you don't get the swelling afterwards because it's always hard. That's the hardest part with frontal sinus surgery. The hardest part is to get it to stay open. Often it's not that difficult to open it up, but it's hard to get it to remain open. That's an ongoing discussion all the time. How do we do it the best?
Surgical Approaches to Chronic Frontal Sinusitis
Endoscopic sinus surgery (ESS) for chronic frontal sinusitis is typically considered for patients who do not respond to conservative management after a few weeks. ESS often involves the use of surgical navigation, which utilizes the patient's CT scan to help the surgeon accurately navigate the sinuses and surrounding anatomy during the procedure.
Dr. Jens Andersson prefers to perform the majority of the surgery with a 0-degree scope, then switch to a 45 or 70-degree scope to evaluate the surgical area and determine if additional sinus opening is needed. He emphasizes the importance of avoiding excessive mucosal damage to promote better recovery. To preserve the mucosa, Dr. Andersson recommends pushing tissue away from you when using surgical instruments, rather than pulling, to prevent tearing.To minimize scarring post-surgery, gauze strips with antibacterial ointment are often used and typically left in place for two days.
Various tools and techniques can be employed in frontal sinus surgery. Dr. Andersson favors the use of angled burrs over angled microdebriders when working on the frontal sinus. Balloon dilations are another option for cases of uncomplicated chronic frontal sinusitis, as they can effectively open the sinuses while causing less scarring. Polyps can make the use of balloons challenging. Mastery of a variety of tools and techniques enhances a surgeon's ability to achieve optimal outcomes.
[Dr. Gopi Shah]
Let's talk about some of the surgical approaches. For frontal work, do you always use navigation? Is that always part of your setup?
[Dr. Jens Andersson]
I actually use navigation as often as I can and always try to tell the residents to do it as well because, yes, it costs money. Also if you use it on the simpler cases, then when you get to the difficult cases, you already know what you're doing and you're not practicing two things at the same time because you already know how to work the navigation. For simple surgery, I don't do it and especially if I don't have anyone with me. Normally there should be a resident and then often I try to hook up the navigation system.
[Dr. Gopi Shah]
Yes. If I have a scan that's fine cut, which most of them are nowadays, thankfully, and I have access to a navigation system, I use it. I totally agree with your point of if how to work your machine and those reps are going to come in with as many setups as you can get in when it's 10:00 PM at night or something and you have a case that's got to go, then I'm not sitting here like, "Well, is the tech here that knows how to set it up? Can I get a rep here?" No, it's me.
[Dr. Jens Andersson]
Yes. You also have to know how to work the machine.
[Dr. Gopi Shah]
Yes, and that's the last thing I want to have to think about is being limited by that because that's somewhat a little bit out of my control.
[Dr. Jens Andersson]
You have to know how to get the pictures in. You have to know how to adjust the settings, the contrast, the lighting.
[Dr. Gopi Shah]
Yes. Navigate the instruments. Right? How many times have we had everything set up and we can't get the straight section to navigate? What are the little tips and tricks for that? Is it the cord? Maybe. There could be about three other things we have to do.
[Dr. Jens Andersson]
Yes. Sometimes you just need to move the screen further away because that's actually happened because it-
[Dr. Gopi Shah]
It was too close.
[Dr. Jens Andersson]
Yes.
[Dr. Gopi Shah]
Then, so tell me about your approach to the funnels. What scopes do you like? What instruments do you like? If you're teaching your residents, what are some of the pros that you tell them about frontal sinus work?
[Dr. Jens Andersson]
You have to ask them if I say something good, but I try to use the 0-degree scope as long as I can. More often than not, you can actually do almost the whole of the surgery with the 0-degree scope, but then you have to have vision. Normally I switch to a 45 or 70 degree actually scope when I try to see what I've done and also try to see if there's something more I need to take down, if there's another wall or some piece of mucosal debris that I need to remove. I tend to use the 0-degree scope mostly when I'm doing the surgery. Then I can switch and I can sometimes I do the final parts with an angle scope.
[Dr. Gopi Shah]
Yes. I don't like switching back and forth a lot either. I like to do as much surgery as I can with the zero and then I graduate up depending on why I'm there and what I'm doing. I find a good shoulder roll. If I know I'm going to be in the front rolls, I find a good shoulder roll really helps me get the view as well. Then, in terms of instruments, they have nice angled sections these days, which is great. The Hosemann and the Kerrison, do you use that or are they called anything different? The Hosemann which is like a-
[Dr. Jens Andersson]
Yes, the Hosemann we use. We call it the baby Hosemann. Maybe it's not the correct term because sometimes I've discovered that what we call our instruments is not really what they're called in the catalog. We have one of those. It looks almost like a mushroom punch, with a point at the end. Yes. We also have actually angled mushrooms as well. We have what we call the giraffe forceps. I use the curettes. I really like that because you can feel what you're doing. You can feel in your fingers with actually how much pressure you're applying. Also because you're using it back to front, so it feels safe to use it. I try not to, if I can, it's obvious to you, but maybe not some of the listeners, but I try not to tear the mucosa all the way around in a circular fashion, because I'm always, I don't really like when it scars over.
[Dr. Gopi Shah]
What tips do you have for mucosal sparing, especially in the recess? Do you have any tips or tricks or things that you found work well or, hey, be careful of this?
[Dr. Jens Andersson]
Be careful not to try tear stuff. Try to bite and try to have instruments that are actually sharp. Sometimes you use the sickle knife sometimes for, not for the frontal recess, but you have what we call a sickle knife. Yes. I once got the sickle knife and I said, "This is not working. It's very slow." Yes, it says it's sickle knife slow here and I was like, "No, that doesn't exist." Someone must have said that this is a slow knife and they just put it back. They marked it up for sharpening and then they just put it back and wrote "Sickle knife slow." Yes, no, you have to have sharp instruments and try not to tear. Also if you cut mucosa and you get it stuck in your forceps, don't try to pull it towards you. Try to push it away. In that way it might go off easier and not tear away the whole part of mucosa closest to you.
[Dr. Gopi Shah]
Do you ever use angled microdebriders?
[Dr. Jens Andersson]
Yes, I do.
[Dr. Gopi Shah]
It can cut well, but I have to make sure I can see. Sometimes just being able to see where the blade is can be really hard because there's not any room. It's helpful, but-
[Dr. Jens Andersson]
I don't often use, so I have to correct myself there. When I almost always use the 12 angle, so it's not really angled, the 12 degree angle. When I do the frontal sinus, I almost never use an angled debrider. It's not wrong to do it, but I normally don't do it. I use angled burrs when I have to get the frontal beak down. That's about it. I think about how much power tools I want to put up there.
[Dr. Gopi Shah]
Yes. I think I use more for that anterior ethmoid tools because I find that that's probably one of the hardest parts of the surgery, in sinus surgery, posterior ethmoids are probably the easiest, and then, max and sphenoid, I feel like can be tied. That anterior ethmoid is something that I feel I didn't really appreciate the difficulty until I was out in practice. I don't think I appreciated that as a trainee.
[Dr. Jens Andersson]
That you don't get high enough up?
[Dr. Gopi Shah]
Yes, high enough, and then it's like, "Okay, this is why I'm working in a hole." In terms of any tricks for when you drill, and actually, before we get to that question, I wanted to ask you, how do you decide how much frontal sinus work to do? Is it ever enough just to do a good uncinectomy and then maxillary antrostomy, or how do you know how far to go?
[Dr. Jens Andersson]
It's also a very good question. It also depends on how it has presented itself. What I think the underlying problem is, sometimes it can be enough. If I think the problem is actually coming from down below, that is the maxillary sinus problem or, ethmoids, but if not, then I don't think it's enough, obviously. Sometimes it's enough and you can just get more space there for the drainage pathways to work as intended, or hopefully as intended. Then sometimes I just try to put a suction up and see, is there passage, and I try to not affect the mucosa too much because I'm afraid of scarring. I'm not afraid, afraid, but I don't like it and I don't want to give them problems that they didn't have before because sometimes if it scars enough, then you have to do much larger frontal sinus surgery. You have to do a draft three or something. If I can avoid it, I'll try.
[Dr. Gopi Shah]
Do you use stents, or how do you keep it from scarring? Do you put anything up there? Are you using propels? Are you using silicone?
[Dr. Jens Andersson]
I only have my thumbs and I cross them very hard. No, actually, the propel stents, we don't have access to them yet. They're coming, but we don't have them. For this patient that we refer to a number of times now, I wish I had them, but I didn't. I went the old school way and I put up a one centimeter gauze strip with antibacterial ointment. You can use this ointment just-- sometimes I've just actually took a syringe and put it on a 70 degree angle suction catheter and deposited the ointment up there. It's a combination of oxytetracycline and hydrocortisone. Normally I put them on the strips of gauze and I put them up. For this patient, it seems to have worked. I removed them. It's also an ongoing discussion, how long should you keep them? I held my finger up in the air and decided two days. I removed it and I had him at the outpatient clinic and looked at him and it looked fine. It was open. His eye was better and better. I'm seeing him again next week and, hopefully, it's-
[Dr. Gopi Shah]
It stays. I was going to ask how soon after surgery, if the frontal recess is going to scar, how far out have you seen that happen? Early on we're like, "Okay, if it's not here at a week, it's probably okay." I find that the longer you are in practice or the more patients in follow-up, you're like, "Oh, dang, it's been two months. It looked good three weeks ago." Then it's like, well, do I do anything? Do we do steroids? Is it soft? Is it just swelling? Do we just need to get back on rinses? Then we're kicking the can, especially in a patient that's not symptomatic.
[Dr. Jens Andersson]
Yes. It's a very hard thing to answer as well. Yes. I've seen one and I did everything I could and he had a large opening. There's an expression in Sweden, "I could throw my hat in it." When I saw him a week later, everything was swollen and he had gotten some swollen mucosa. It was almost like, "You know polyps there," and he wasn't a polyp patient, it was a mucocele. I've seen a range from one week to several months.
[Dr. Gopi Shah]
Yes. That's why they're chronic, I guess, right?
[Dr. Jens Andersson]
Yes.
[Dr. Gopi Shah]
In terms of other techniques or procedures, do you ever use balloons in the frontal sinus in your practice? Is that ever part of your practice?
[Dr. Jens Andersson]
I used to use more balloons than I do now. Now I basically don't. It's also because we're a small country and the best balloons we had went out of market and I couldn't find a substitute. I looked for a while. I was some courses and in contact with a few companies and I couldn't really find anything I liked because if you're doing balloons, I don't know what your opinion is, but I like to have the guidewire. If I need to put a hard tip of an object up the frontonasal recess anyway, then I might as well do surgery. That's my opinion.
[Dr. Gopi Shah]
Yes. I don't have as much experience either. My practice is pediatrics. I did a lot of pediatric chronic sinus stuff and I just didn't-- one of my partners, actually, she had a lot more experience. For me, it was like you said, if the light tip or the guidewire, all that stuff, if I'm not doing it all the time, I just didn't want to end up in the eyes. I don't want to end up in the wrong place. I just didn't use them as much. I used a handful of times that I can think of.
[Dr. Jens Andersson]
I just don't find them all that useful in the setting that we have in Sweden. I think you do more in office stuff, but in my setting, I don't see any use for them in sphenoids, which is a fairly easy sinus to reach. I don't see a reason for it to do it in the maxillary sinus, but in, frontal sinus in barotrauma patients, I would say that this is something I would use if I had a good balloon because you don't scar as much, and it's an easy identifiable problem that you can probably solve quite easily with a balloon. If it's other stuff like polyps or other underlying conditions, I can't really see the use. In my view, it's better to open up.
[Dr. Gopi Shah]
Yes. When we were at ESPO, there was a lot more talk about balloons for acute complications of sinusitis, like POTS and intracranial. There were some talks on that. Even, again, it's access, and having all that stuff.
[Dr. Jens Andersson]
I would still, and I do open up what I consider to be the proper way. People can feel free to disagree, but it's my point of view.
Podcast Contributors
Dr. Jens Andersson
Dr. Jens Andersson is a practicing ENT at Skåne University Hospital in Sweden.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Cite This Podcast
BackTable, LLC (Producer). (2023, November 14). Ep. 142 – Evaluation and Management of Chronic Frontal Sinusitis in Sweden [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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