A comparative study and correlation between preoperative computed tomogram and endoscopic sinus surgery in chronic rhinosinusitis


  • Mithra Sara John Department of ENT, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
  • N. Gopinathan Pillai Department of ENT, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India




Rhinosinusitis, Nasal obstruction, CT scan, POSE


Background: Chronic rhinosinusitis (CRS) with its classical symptoms of nasal obstruction, nasal discharge, and headache is relatively a common disease in otorhinolaryngology practice. The objectives of the present study was to correlate the operative findings in such patients with the CT findings, using the Perioperative sinus endoscopy (POSE) scoring system and to correlate the maximum scores obtained in the POSE scoring system and Lund-Mackay scoring system.

Methods: A prospective study was conducted from January 2014 to March 2015 in 50 patients suffering from chronic rhinosinusitis who underwent endoscopic sinus surgery in the age group of 36-60 years of age.  

Results: Agger nasi cells were the most common wandering ethmoid cell detected (90%) followed by various types of frontal cells (54%), Haller cells (26%) and least commonly Onodi cells (12%). Almost perfect agreement was obtained for rest of the criteria which included middle turbinate status, ethmoid cavity mucosal edema and ethmoid cavity polypoid change. Lund-Mackay scoring system was used to score findings in the CT scan and POSE scoring system used to score peroperative findings in the study and this study reveals excellent correlation (Pearson correlation value of 0.879).

Conclusions: Novel POSE scoring is a new entity which has the potential to be a valid system to score preoperative and perioperative findings. In the current study POSE scoring shows excellent correlation with Lund Mackay scoring which is an established scoring system used in the evaluation CT scan.


Maru YK, Gupta Y. Concha bullosa: frequency and appearances on sinonasal CT. Indian J Otolaryngol Head Neck Surg. 1999;52(1):40-4.

Sood VP. Computed tomographic study of paranasal sinuses. Asian J Ear Nose Throat. 2011.

Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variation and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56-64.

Asruddin, Yadav SPS, Rohtas KY, Singh J. Low does CT in chronic sinusitis. J Otolaryngol Head and Neck Surg. 2000; 52(1):17-22.

Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinol. 1993;31(4):183-4.

Wright ED, Agrawal S. Impact of perioperative systemic steroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis: evaluation with the novel perioperative sinus endoscopy (POSE) scoring system. Laryngoscope. 2007;117:1-28.

Talaiepour AR, Sazgar AA, Bagheri A. Anatomic Variations of the Paranasal Sinuses on CT scanl images. Frontiers in Dentistry. 2005;2(4):142-6.

Asif AW, Sohit K. CT scan evaluation of the anatomical variations of the ostiomeatal complex. Indian J Otalaryngol Head Neck Surg. 2009;61:163-8.

Azila A, Med M, Irfan M. The prevalence of anatomical variations in osteomeatal unit in patients with chronic rhinosinusitis. Med J Malaysia. 2011;66(3):191-4.

Nitinavakarn B, Thanaviratananich S, Sangsilp N. Anatomical variations of the lateral nasal wall and paranasal sinuses: a CT study for endoscopic sinus surgery in Thai surgery. J Med Asoc Thai. 2005;88(6):763-8.

Daniel GB, Samuel SB. Allergic and non-allergic sinusitis for the primary care physician. Pathophysiol Evaluat Treatment.

Rashmi PR, Anil S. Correlation between pre-operative CT scan findings and operative findings during endoscopic sinus surgery in chronic sinusitis patients. Int J Advan Res Technol. 2015;4(2):149-62.






Original Research Articles