Correlation Between the Opacification Degree of Paranasal Sinuses on CT, Clinical Symptoms and Anatomical Variations of the Nose and Paranasal Sinuses in Patients with Chronic Rhinosinusitis
Abstract
Objectives: This study aimed to evaluate the correlation between the opacification degree of the paranasal sinuses on computed tomography (CT) with clinical symptoms, and anatomical variations of the nose and paranasal sinuses in patients with chronic rhinosinusitis (CRS).
Materials and Methods: This descriptive prospective study evaluated 100 patients (60 males and 40 females), who were diagnosed with CRS by ENT specialists according to the clinical findings, and were scheduled for a CT scan. The patients were requested to express the severity of their symptoms using a visual analog scale. The CT scans of the paranasal sinuses were assessed for the presence of anatomical variations and scored using the modified Lund-Mackay scoring system for the opacification degree of each sinus. The correlations between the anatomical variations and sinusitis, and also between the severity of symptoms/disease severity and CT scores were statistically analyzed. P<0.05 was considered statistically significant.
Results: The most common symptoms were purulent (discolored) nasal drainage and nasal obstruction. Septal deviation was the most common anatomical variation. The maxillary and anterior ethmoid sinuses were the most commonly involved areas. The Spearman’s correlation coefficient showed a significant correlation between the sinus involvement and some of the evaluated symptoms, as well as certain types of anatomical variations (P<0.05).
Conclusion: Some specific anatomical variations of the paranasal sinuses may predispose them to sinusitis. The CT scan score can predict the severity of many symptoms such as purulent (discolored) nasal drainage, nasal obstruction, hyposmia/anosmia, halitosis, cough, and fatigue, among the other symptoms of CRS.
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2. García‐Rodríguez JF, Corominas M, Fernández‐Viladrich P, Monfort JL, Dicenta M. Rhinosinusitis and atopy in patients infected with HIV. Laryngoscope. 1999 Jun;109(6):939-44.
3. Porter JP, Patel AA, Dewey CM, Stewart MG. Prevalence of sinonasal symptoms in patients with HIV infection. Am J Rhinol Allergy. 1999 May-Jun;13(3):203-8.
4. Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol. 2004 Oct;25(9):1613-18.
5. Fadda G, Rosso S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2012 Aug;32(4):244-51.
6. Azila A, Irfan M, Rohaizan Y, Shamim A. The prevalence of anatomical variations in osteomeatal unit in patients with chronic rhinosinusitis. Med J Malaysia. 2011Aug;66(3):191-4.
7. Madani SA, Hashemi SA, Modanluo M. The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery. J Pak Med Assoc. 2015 Jun;65(6):612-14.
8. Bijani B, Qasemi Barqi R, Najjari Alamooti J. Radiologic association between chronic sinusitis and anatomical variations of the nasal cavity. J Qazvin Univ Med Sci. 2018 Aug-Sep;22(3):13-22.
9. Kaya M, Çankal F, Gumusok M, Apaydin N, Tekdemir I. Role of anatomic variations of paranasal sinuses on the prevalence of sinusitis: Computed tomography findings of 350 patients. Niger J Clin Pract. 2017 Nov;20(11):1481-8.
10. Nitinavakarn B, Thanaviratananich S, Sangsilp N. Anatomical variations of the lateral nasal wall and paranasal sinuses: A CT study for endoscopic sinus surgery (ESS) in Thai patients. J Med Assoc Thai. 2005 Jun;88(6):763-8.
11. Shrikrishna B, Jyothi A, Sanjay G, Sandeep Samson G. Prevalence of Anatomic Variations in chronic rhinosinusitis. J Evol Med Dent Sci. 2013 Jun;2(11):1608-17.
12. Kaygusuz A, Haksever M, Akduman D, Aslan S, Sayar Z. Sinonasal anatomical variations: their relationship with chronic rhinosinusitis and effect on the severity of disease—a computerized tomography assisted anatomical and clinical study. Indian J Otolaryngol Head Neck Surg. 2014 Sep;66(3):260-6.
13. Ameri A, Eslambolchi A, Bakhshandeh H. Anatomic variants of paranasal sinuses and chronic sinusitis. Iran J Radiol. 2005 Jun;2(3,4): 121-4.
14. Campbell PD, Zinreich SJ, Aygun N. Imaging of the paranasal sinuses and in-office CT. Otolaryngol Clin North Am. 2009 Oct;42(5):753-64.
15. Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy. 2005 May;60(5):583-601.
16. Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg. 2007 Oct;137(4):555-61.
17. 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 Jul;125(1):40-3.
18. Pokharel M, Karki S, Shrestha B, Shrestha I, Amatya R. Correlations between symptoms, nasal endoscopy computed tomography and surgical findings in patients with chronic rhinosinusitis. Kathmandu Univ Med J (KUMJ). 2013 Jul-Sep;11(3):201-5.
19. Stewart MG, Sicard MW, Piccirillo JF, Diaz-Marchan PJ. Severity staging in chronic sinusitis: are CT scan findings related to patient symptoms? Am J Rhinol Allergy. 1999 May-Jun;13(3):161-8.
20. Hwang PH, Irwin SB, Griest SE, Caro JE, Nesbit GM. Radiologic correlates of symptom-based diagnostic criteria for chronic rhinosinusitis. Otolaryngol Clin North Am. 2003 Apr;128(4):489-96.
21. Bhattacharyya N, Fried MP. The accuracy of computed tomography in the diagnosis of chronic rhinosinusitis. Laryngoscope. 2003 Jan;113(1):125-9.
22. Lehman DA, Casiano RR, Polak M. Reliability of the University of Miami chronic rhinosinusitis staging system. Am J Rhinol Allergy. 2006 Jan;20(1):11-9.
23. Ogunleye A, Nwargu O, Lasisi A, Ijaduola G. Trends of sinusitis in Ibadan, Nigeria. West Afr J Med. 1999 Oct-Dec;18(4):298-302.
24. Amodu EJ, Fasunla AJ, Akano AO, Olusesi AD. Chronic rhinosinusitis: correlation of symptoms with computed tomography scan findings. Pan Afr Med J. 2014 May;18(1):40.
25. Khajavi M, Ahmady RN, Vaez AR. Nasal and paranasal sinuses anatomical variations in patients with and without chronic rhinosinusitis. J Otorhinolaryngol Facial Plast Surg. 2015 Feb; 1(1):13-20.
26. Arslan H, Aydınlıoğlu A, Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx. 1999 Jan;26(1):39-48.
27. Shpilberg KA, Daniel SC, Doshi AH, Lawson W, Som PM. CT of anatomic variants of the paranasal sinuses and nasal cavity: poor correlation with radiologically significant rhinosinusitis but importance in surgical planning. AJR Am J Roentgenol. 2015 Jun;204(6):1255-60.
28. Senturk M, Guler I, Azgin I, Sakarya EU, Ovet G, Alatas N, et al. The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning. Braz J Otorhinolaryngol. 2017 Jan-Feb;83(1):88-93.
29. Sarkar PS, Bhosale PR, Bharthi AR, Ananthasivan R. Computed Tomography Scan Correlation between Anatomic Variations of Paranasal Sinuses and Chronic Rhinosinusitis. Int J Sci Study. 2016 Jul;4(4):122-8.
30. Hirsch SD, Reiter ER, DiNardo LJ, Wan W, Schuman TA. Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis. Laryngoscope. 2017 Jan;127(5):1011-6.
31. Pruna X. Morpho-functional evaluation of osteomeatal complex in chronic sinusitis by coronal CT. Eur Radiol. 2003 Jun;13(6):1461-8.
32. Bhattacharyya N. Clinical and symptom
criteria for the accurate diagnosis of chronic rhinosinusitis. Laryngoscope. 2006 Jul;116(S110):1-22.
33. Abrass LJ, Chandra RK, Conley DB, Tan BK, Kern RC. Factors associated with computed tomography status in patients presenting with a history of chronic rhinosinusitis. Int Forum Allergy Rhinol. May-Jun 2011;1(3):178-82.
34. Gregurić T, Trkulja V, Baudoin T, Grgić MV, Šmigovec I, Kalogjera L. Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol. 2017 May;274(5):2165-73.
35. Basu S, Georgalas C, Kumar B, Desai S. Correlation between symptoms and radiological findings in patients with chronic rhinosinusitis: an evaluation study using the Sinonasal Assessment Questionnaire and Lund-Mackay grading system. Eur Arch Otorhinolaryngol. 2005 Sep;262(9):751-4.
36. Bhattacharyya N. Relationship between
mucosal inflammation, computed tomography, and symptomatology in chronic rhinosinusitis without polyposis. Ann Otol Rhinol Laryngol. 2008 Jul;117(7):517-22.
37. Ryan WR, Ramachandra T, Hwang PH. Correlations between symptoms, nasal endoscopy, and in‐office computed tomography in post‐surgical chronic rhinosinusitis patients. Laryngoscope. 2011 Mar;121(3):674-8.
38. Skoulas IG, Helidonis E, Kountakis SE. Evaluation of sinusitis in the intensive care unit patient. Otolaryngol Head Neck Surg. 2003 Apr;128(4):503-9.
39. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991 Jan;101(1):56-64.
40. Lloyd GA, Lund VJ, Scadding GK. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients. J Laryngol Otol. 1991 Mar;105(3):181-5.
2. García‐Rodríguez JF, Corominas M, Fernández‐Viladrich P, Monfort JL, Dicenta M. Rhinosinusitis and atopy in patients infected with HIV. Laryngoscope. 1999 Jun;109(6):939-44.
3. Porter JP, Patel AA, Dewey CM, Stewart MG. Prevalence of sinonasal symptoms in patients with HIV infection. Am J Rhinol Allergy. 1999 May-Jun;13(3):203-8.
4. Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol. 2004 Oct;25(9):1613-18.
5. Fadda G, Rosso S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2012 Aug;32(4):244-51.
6. Azila A, Irfan M, Rohaizan Y, Shamim A. The prevalence of anatomical variations in osteomeatal unit in patients with chronic rhinosinusitis. Med J Malaysia. 2011Aug;66(3):191-4.
7. Madani SA, Hashemi SA, Modanluo M. The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery. J Pak Med Assoc. 2015 Jun;65(6):612-14.
8. Bijani B, Qasemi Barqi R, Najjari Alamooti J. Radiologic association between chronic sinusitis and anatomical variations of the nasal cavity. J Qazvin Univ Med Sci. 2018 Aug-Sep;22(3):13-22.
9. Kaya M, Çankal F, Gumusok M, Apaydin N, Tekdemir I. Role of anatomic variations of paranasal sinuses on the prevalence of sinusitis: Computed tomography findings of 350 patients. Niger J Clin Pract. 2017 Nov;20(11):1481-8.
10. Nitinavakarn B, Thanaviratananich S, Sangsilp N. Anatomical variations of the lateral nasal wall and paranasal sinuses: A CT study for endoscopic sinus surgery (ESS) in Thai patients. J Med Assoc Thai. 2005 Jun;88(6):763-8.
11. Shrikrishna B, Jyothi A, Sanjay G, Sandeep Samson G. Prevalence of Anatomic Variations in chronic rhinosinusitis. J Evol Med Dent Sci. 2013 Jun;2(11):1608-17.
12. Kaygusuz A, Haksever M, Akduman D, Aslan S, Sayar Z. Sinonasal anatomical variations: their relationship with chronic rhinosinusitis and effect on the severity of disease—a computerized tomography assisted anatomical and clinical study. Indian J Otolaryngol Head Neck Surg. 2014 Sep;66(3):260-6.
13. Ameri A, Eslambolchi A, Bakhshandeh H. Anatomic variants of paranasal sinuses and chronic sinusitis. Iran J Radiol. 2005 Jun;2(3,4): 121-4.
14. Campbell PD, Zinreich SJ, Aygun N. Imaging of the paranasal sinuses and in-office CT. Otolaryngol Clin North Am. 2009 Oct;42(5):753-64.
15. Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy. 2005 May;60(5):583-601.
16. Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg. 2007 Oct;137(4):555-61.
17. 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 Jul;125(1):40-3.
18. Pokharel M, Karki S, Shrestha B, Shrestha I, Amatya R. Correlations between symptoms, nasal endoscopy computed tomography and surgical findings in patients with chronic rhinosinusitis. Kathmandu Univ Med J (KUMJ). 2013 Jul-Sep;11(3):201-5.
19. Stewart MG, Sicard MW, Piccirillo JF, Diaz-Marchan PJ. Severity staging in chronic sinusitis: are CT scan findings related to patient symptoms? Am J Rhinol Allergy. 1999 May-Jun;13(3):161-8.
20. Hwang PH, Irwin SB, Griest SE, Caro JE, Nesbit GM. Radiologic correlates of symptom-based diagnostic criteria for chronic rhinosinusitis. Otolaryngol Clin North Am. 2003 Apr;128(4):489-96.
21. Bhattacharyya N, Fried MP. The accuracy of computed tomography in the diagnosis of chronic rhinosinusitis. Laryngoscope. 2003 Jan;113(1):125-9.
22. Lehman DA, Casiano RR, Polak M. Reliability of the University of Miami chronic rhinosinusitis staging system. Am J Rhinol Allergy. 2006 Jan;20(1):11-9.
23. Ogunleye A, Nwargu O, Lasisi A, Ijaduola G. Trends of sinusitis in Ibadan, Nigeria. West Afr J Med. 1999 Oct-Dec;18(4):298-302.
24. Amodu EJ, Fasunla AJ, Akano AO, Olusesi AD. Chronic rhinosinusitis: correlation of symptoms with computed tomography scan findings. Pan Afr Med J. 2014 May;18(1):40.
25. Khajavi M, Ahmady RN, Vaez AR. Nasal and paranasal sinuses anatomical variations in patients with and without chronic rhinosinusitis. J Otorhinolaryngol Facial Plast Surg. 2015 Feb; 1(1):13-20.
26. Arslan H, Aydınlıoğlu A, Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx. 1999 Jan;26(1):39-48.
27. Shpilberg KA, Daniel SC, Doshi AH, Lawson W, Som PM. CT of anatomic variants of the paranasal sinuses and nasal cavity: poor correlation with radiologically significant rhinosinusitis but importance in surgical planning. AJR Am J Roentgenol. 2015 Jun;204(6):1255-60.
28. Senturk M, Guler I, Azgin I, Sakarya EU, Ovet G, Alatas N, et al. The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning. Braz J Otorhinolaryngol. 2017 Jan-Feb;83(1):88-93.
29. Sarkar PS, Bhosale PR, Bharthi AR, Ananthasivan R. Computed Tomography Scan Correlation between Anatomic Variations of Paranasal Sinuses and Chronic Rhinosinusitis. Int J Sci Study. 2016 Jul;4(4):122-8.
30. Hirsch SD, Reiter ER, DiNardo LJ, Wan W, Schuman TA. Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis. Laryngoscope. 2017 Jan;127(5):1011-6.
31. Pruna X. Morpho-functional evaluation of osteomeatal complex in chronic sinusitis by coronal CT. Eur Radiol. 2003 Jun;13(6):1461-8.
32. Bhattacharyya N. Clinical and symptom
criteria for the accurate diagnosis of chronic rhinosinusitis. Laryngoscope. 2006 Jul;116(S110):1-22.
33. Abrass LJ, Chandra RK, Conley DB, Tan BK, Kern RC. Factors associated with computed tomography status in patients presenting with a history of chronic rhinosinusitis. Int Forum Allergy Rhinol. May-Jun 2011;1(3):178-82.
34. Gregurić T, Trkulja V, Baudoin T, Grgić MV, Šmigovec I, Kalogjera L. Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol. 2017 May;274(5):2165-73.
35. Basu S, Georgalas C, Kumar B, Desai S. Correlation between symptoms and radiological findings in patients with chronic rhinosinusitis: an evaluation study using the Sinonasal Assessment Questionnaire and Lund-Mackay grading system. Eur Arch Otorhinolaryngol. 2005 Sep;262(9):751-4.
36. Bhattacharyya N. Relationship between
mucosal inflammation, computed tomography, and symptomatology in chronic rhinosinusitis without polyposis. Ann Otol Rhinol Laryngol. 2008 Jul;117(7):517-22.
37. Ryan WR, Ramachandra T, Hwang PH. Correlations between symptoms, nasal endoscopy, and in‐office computed tomography in post‐surgical chronic rhinosinusitis patients. Laryngoscope. 2011 Mar;121(3):674-8.
38. Skoulas IG, Helidonis E, Kountakis SE. Evaluation of sinusitis in the intensive care unit patient. Otolaryngol Head Neck Surg. 2003 Apr;128(4):503-9.
39. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991 Jan;101(1):56-64.
40. Lloyd GA, Lund VJ, Scadding GK. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients. J Laryngol Otol. 1991 Mar;105(3):181-5.
| Issue | Vol 18 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v18i33.7337 | |
| Keywords | ||
| Tomography X-Ray Computed; Sinusitis; Signs and Symptoms; Anatomical Variation | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Niknami M, Emami E, Mozaffari A, Sharifian H, Safari S. Correlation Between the Opacification Degree of Paranasal Sinuses on CT, Clinical Symptoms and Anatomical Variations of the Nose and Paranasal Sinuses in Patients with Chronic Rhinosinusitis. Front Dent. 2021;18.
