Chronic rhinosinusitis: the correlation between symptom severity score and findings on plain radiographs of the paranasal sinuses


  • Omoregie J. Idugboe Department of Otorhinolaryngology, Federal Medical Center Yenagoa, Bayelsa State, Nigeria
  • Bright Otoghile Department of Otorhinolaryngology, Federal Medical Center Yenagoa, Bayelsa State, Nigeria
  • Ibrahim O. Musa Department of Otorhinolaryngology, General Hospital Ilorin, Kwara State, Nigeria
  • Adeleke A. Adeosun Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria



Chronic rhinosinusitis, Paranasal sinuses, Radiographs, Symptom severity score


Background: Chronic rhinosinusitis (CRS) is a common clinical problem with often refractory symptoms. Though computed tomography scan of the paranasal sinuses (PNS) is the radiological gold standard for confirming the diagnosis of CRS, it is not readily available and affordable in developing countries. Hence plain radiographs are heavily relied upon to confirm the diagnosis of CRS. The reliability and adequacy of plain sinus radiographs in combination with disease specific questionnaires in the management of CRS is still debatable. The objectives of the study were to determine the correlation between symptom severity score and findings on plain radiograph of the PNS in adult patients with CRS.

Methods: This was an eight month prospective cross sectional study (April-November, 2014) of Fifty- two consecutive newly diagnosed adult patients with CRS.  

Results: Age of patients ranged from 19–91 years. Male to female ratio was 1:1.26. There was significant positive correlation between high and moderate symptom severity score (severe and moderate disease) with findings on plain radiograph of the PNS (p=0.032 and 0.048 respectively).

Conclusions: The overall symptom severity score of CRS correlates with findings on the plain radiographs of patients with CRS especially in severe and moderate disease. 


Fokkens WJ, Lund VJ, Mullol J. European position paper on Rhinosinusitis and Nasal polyps. Rhinology. 2007;20:1-136.

Ray NF, Baraniuk JN, Thamer M, Rinehart CS, Gergen PJ, Kaliner M. Healthcare expenditures for sinusitis in 1996: Contributions of Asthma, Rhinitis, and other airway disorders. J Allergy Clin Immunol. 1999;103:408-14.

Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Langngol Suppl. 2004;193:3-5.

Fokkens W, Lund V, Mullol J. European position paper on Rhinosinusitis and Nasal polyps Group. EP3OS 2007: A summary for Otolaryngologists. Rhinology. 2007;45:97-101.

American Academy of pediatrics- Subcommittee on management of sinusitis and committee on Quality Management. Clinical Practice guideline: Management of sinusitis. Pediatrics. 2001;108:798-808.

Slavin RG, Spector SL, Bernstein IL. The diagnosis and management of sinusitis: a practical parameter update. J Allergy Clin Immunol. 2005;116:13-47.

Report of the Rhinosinusitis Task force committee Meeting. Alexandria, Virginia, August 17, 1996. Otolargngol Head Neck surg. 1997;117:1-68.

Benninger MS, Ferguson BJ, Hadley JA. Adult Chronic Rhinosinusitis: definition, diagnosis, epidemiology, and patho-physiology. Otolaryngol Head Neck Surg. 2003;129:1-32.

Mendelsohn M, Noyek A. The role of conventional sinus radiographs in paranasal sinus disease. Arch Otolaryngol Head Neck Surg. 2004;130:329-34.

Evans KL. Diagnosis and management of sinusitis. BMJ. 1994;309:1415-22.

Aalᴓkken TM, Hagtvedt T, Dalen I. Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis. Dentomaxillofac Radiol. 2003;32:60-2.

Ezeanolue BC, Aneke EC, Nwagbo DFE. Correlation of plain radiological diagnostic features with antral lavage results in chronic maxillary simusitis. West Afr J med. 2000;19:16-8.

Lanza DC, Kennedy DW. Adult Rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997;117:1-S7.

Hopkins C, Gillet S, Slack R, Lund VJ, Browne JP. Psychometric validity of 22-item sinonasal outcome test. Clin Otolaryngol. 2009;34:447-54.

Sahlstrand-Johnson P, Ohlsson B, von Buchwald C, Jannert M, Ahlner-Elmqvist M. A multicenter study on quality and absenteeism in patients with CRS reffered for endoscopic surgery. Rhinology. 2011;49:420-8.

Piccirillo JF, Merrit MG, Richards ML. Psychrometric and clinimetric validity of the 20 - item sino-Nasal outcome Test (SNOT-20). Otolaryngol Head Neck surg. 2002;126:41-7.

Haung JL, Lin TY, Wang KF. Sinusitis and bronchial asthma in children. Acta Paed Sin. 1995;36:20-3.

Friedman R, Ackerman M, Wald E, Casselbrant M, Friday G, Fireman P. Asthma and bacterial sinusitis in children. J Allergy Clin Immunol. 1984;74:185-9.

Rachelefsky GS, Katz RM, Siegel SC. Chronic sinus disease with associated reactive airway disease in children. Paediatrics. 1984; 73: 526-9.

Shapiro GG, Furukawa CT, Pierson WE, Gilbertson E, Bierman CW. Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol. 1986;77:59–64.

Al-Azzawi AA, Al-Umeri KK. Comparison of clinical symptoms, plain radiographs, coronal CT and Antral Lavage in patients with chronic maxillary sinusitis. Medical J Babylon. 2011;8:1.

Ologe FE, Olatunji AA. Radiographic pattern of chronic sinusitis in Ilorin, Nigeria. Niger Postgrad Med J. 2003;10:205-7.

Da Lilly-Tariah OB, Aniemeka JA. Pattern of clinical features of simple chronic rhinosinusitis in Port Harcourt. Niger J Clin Pract. 2006;9:142-6.

Sogebi OA, Oyewole EA, Bajomo AA. Radiologic features of chronic rhinosinusitis in Sagamu. Nigerian Med Practitioner. 2008;54:28-31.

Kolo ES, Ezeanolue BC. Chronic rhinosinusitis in kano: A correlational study of the symptomatology and plain radiographic findings. Nigerian J Otorhinolaryngol. 2010;7:19.

Bhattacharyya NA. Comparison of symptom scores and radiographic staging systems in chronic rhinosinusitis. Am J Rhinol. 2005;19:175-9.

Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay grading system for chronic rhinosinusitis: how is it used and what does it predict. Otolaryngol Head Neck Surg. 2007:137:555-61.

Kenny TJ, Duncavage J, Bracikowski J, Yildirim A, Murray JJ, Tanner SB. Prospective analysis of sinus symptoms and correlation with paranasal computed tomography scan. Otolaryngol Head Neck Surg. 2001;125:40-3.

Da Lilly-Tariah OB, Aniemeka J. Plain radiological profile of paranasal sinuses in chronic nasal diseases in University of Port Harcourt Teaching Hospital. Niger J Med. 2006;15:305-8.






Original Research Articles