To the Editor,

I read with interest the recent case report by Alimohammadi et al. describing a patient with a giant frontoethmoidal osteoma and associated sleep apnea attacks (J Guil Uni Med Sci. 2024; 32(4):350-359). While the surgical management and outcome are commendable, I would like to offer an alternative interpretation of the clinical presentation.

In the case description, the authors note the presence of multiple nasal polyps on rhinoscopic examination. Nasal polyposis is a well-known contributor to upper airway obstruction and can significantly exacerbate or even cause obstructive sleep apnea. Despite this, the role of the polyps in the patient's sleep apnea symptoms was not fully explored in the discussion.

Given the concurrent finding of nasal polyposis and the absence of prior sleep studies or other standardized assessments (e.g., polysomnography), it remains unclear whether the sleep apnea was primarily due to the osteoma, the nasal polyps, or a combination of both. It is plausible that surgical intervention—particularly the endoscopic management of the sinonasal tract—alleviated the nasal obstruction caused by polyps, which may have been the critical factor in improving the patient's apnea symptoms.

I respectfully suggest that future reports on similar cases consider the potential role of nasal polyposis and emphasize the need for comprehensive preoperative assessment of sleep-disordered breathing, including objective sleep studies. This would help accurately attribute symptom causality and optimize individualized treatment plans.

Sincerely,