Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses
Keywords:CT scan paranasal sinus, Endoscopic sinus surgery, Paranasal sinuses, Septal deviation, Paradoxical middle turbinate, Concha bullosa
Background: Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).
Methods: A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included.
Results: Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.
Conclusions: Prolonged duration of rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.
Lanza DC. Diagnosis of chronic rhinosinusitis. Ann OtolRhinol Laryngol. 2014;193:10-4.
Shahizon AM, Suraya A, Rozmnan Z, Aini AA, Gendeh BS. Correlation of computed tomography and nasal endoscopic findings in chronic rhinosinusitis. Med J Malaysia. 2008;63(3):211-5.
Bradoo R. Endoscopic anatomy. In: Anatomic principles of Endoscopic sinus surgery: A step by step approach. 1st ed. New Delhi: Jaypee Bros; 2005: 59-70.
Meltzer EO, Hamilos DL, Hadley JA, American Academy of Allergy, Asthma and Immunology, The American Academy of Otolaryngic Allergy, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;131(6S):S1-62.
Van Alyea OE. Sphenoid sinus: anatomic study, with consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otolaryngol. 1941;34(2):225-53.
Mafee MF, Chow JM, Meyers R. Functional endoscopic sinus surgery: anatomy, CT screening, indications, and complications. Am J Roentgenol. 1993;160(4):735-44.
Kasapoglu F, Onart S, Basut O. Preoperative evaluation of Chronic rhinosinus it is patients by conventional radiographies, computed tomography and nasal endoscopy. Kulak Burun Bogazlhtis Derg. 2009;19(4):184-1.
Jareoncharsri P, Thitadilok V, Bunnag C, Ungkanont K, Voraprayoon S, Tansuriyawong P. Nasal endoscopic findings in patients with perennial allergic rhinitis. Asian Pac J Allergy Immunol. 1999;17(4):261-7.
Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relatioship to nasal septal deviations and paranasal sinus disease. Am J Neuroradiol. 2004;25:1613–8.
Krzeski A, Tomaszewska E, Jakubczyk I, Galewicz-Zielińska A. Anatomic variations of the lateral nasal wall in the computed tomography scans of patients with chronic rhinosinusitis. Am J Rhinol. 2001;15:371–5.