DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20210160

Correlation of sinonasal anatomical variations with relevant sinus involvement in chronic rhinosinusitis: a prospective observational study

Priyanka Chauhan, Nalini Bhat, Pallavi Bhandarkar, Ankita Singh

Abstract


Background: The purpose of this study was to study the association of anatomical variations as risk factors in affecting specific sinuses in cases of chronic rhinosinusitis (CRS).

Methods: It is an observational study carried out from June 2018 to May 2019. 61 patients of CRS were included in this study. The diagnosis of CRS with or without nasal polyposis was made as per diagnostic guidelines of the task force on chronic rhinosinusitis. Each of them was assessed by nasal endoscopy and computed tomography (CT) imaging for diagnosis and evaluation of anatomical risk factors.

Results: A total of 61 patients of CRS were examined. Presence of various anatomical variants in relation to CRS were studied. We studied CT paranasal sinuses of the 61 patients, since each patient has 2 of each groups of sinuses, a total 122 group of sinuses are assessed in this study. On analyzing, we found, a significant association between deviated nasal septum (DNS) and maxillary sinusitis. Agger nasi cell and frontal and ethmoid (anterior and posterior) sinusitis, concha bullosa and maxillary sinusitis and over pneumatized ethmoid bulla and anterior and posterior ethmoid sinusitis. Other anatomical variants encountered, had no significant association with diseased sinuses (p value >0.01).

Conclusions: The study showed that, there is a strong relationship between the presence of diseased sinus and some anatomical variants. It is suggested that besides anatomical variations, other clinical parameters should also be taken into account for the etiology of sinusitis.


Keywords


Chronic rhinosinusitis, Anatomical variants, DNS, Concha bullosa, Agger nasi

Full Text:

PDF

References


Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, et al. Chronic rhinosinusitis in Europe an underestimated disease. A GA (2) LEN study. Allergy. 2011;66(9):1216-23.

Shi JB, Fu QL, Zhang H, Cheng L, Wang YJ, Zhu DD, et al. Epidemiology of chronic rhinosinusitis: results from a crosssectional survey in seven Chinese cities. Allergy. 2015;70:533-9.

Benninger MS. Rhinosinusitis, in editor. Scott-Brown’s Otolaryngology, Head and neck surgery. 7th Edition, vol. 2. Hodder Arnold. 2008.

Bhattacharyya N. Symptom and disease severity differences between nasal septal deviation and chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2005;133(2):173-7.

Wani AA, Kanotra S, Lateef M, Ahmad R, Qazi SM, Ahmad S. CT scan evaluation of the anatomical variations of the ostiomeatal complex. Indian J Otolaryngol Head Neck Surg. 2009:61:163-8.

Sheetal D, Devan PP, Manjunath P, Martin P, Kumar KS, Sreekantha F, et al. CT PNS- Do We Really Require before FESS? J Clin Diagnostic Res. 2011;5(2):179-81.

Tiwari R, Goyal R. Study of Anatomical Variations on CT in Chronic Sinusitis. Indian J Otolaryngol Head Neck Surg. 2015;67(1):18-20.

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;66(3):260-6.

Gupta AK, Gupta B, Gupta N, Tripathi N. Computerized Tomography of Paranasal Sinuses: A Roadmap to Endoscopic Surgery. Clin Rhinol Int J. 2012;5(1):1-10.

Singh C, Dhawan R, Kawatra R, Khanduri S, Hussain P. Incidence of sinonasal anatomical variants based on CT scan inIndian population. Odisha J Otolrhinollaryngol. 2013;7(2):3136.

Fadda GL, Rosso S, Aversa S, Petrelli A, Ondolo C. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2012;32:244-51.

Senniappan S, Raja K, Tomy AL, Kumar CS, Panicker AM, Radhakrishnan S. Study of anatomical variations of ostiomeatal complex in chronic rhinosinusitis patients. Int J Otorhinolaryngol Head Neck Surg. 2018;4(5):1281-6.

Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1-12.

Tan BK, Kern RC, Schleimer RP, Schwartz BS. Chronic Rhinosinusitis: The Unrecognized Epidemic. Am J Respir Crit Care Med. 2013;188(11):1275-7.

Kim H J, Jung Cho M, Lee J W, Tae Kin Y, Kahnq H, Sung Kim H, Hahm KH. The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children. Acta Otolaryngol. 2006;126(10):1067-72.

Maru YK, Gupta V. Anatomic variations of the bone in sinonasal C.T. Indian J Otolaryngol Head Neck Surg. 2001;53(2):123-8.

Zinreich SJ. Rhinosinusitis: radiologic diagnosis. Otolaryngol Head Neck Surg. 1997;117:27-34.

Bolger WE, Parsons DS, Butzin CA. Paranasal sinus bony anatomic variation and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1):56-64.

Lloyd GA. Computed tomography of the paranasal sinuses: study of control of series in relation to endoscopic sinus surgery. J Laryngol Otol. 1990;104(6):477-81.

Sivasli E, Sirikci A, Bayazyt Y A, Bayram M, Erbagci H, et al. Anatomic variations of the paranasal sinus area in pediatric patients with chronic sinusitis. Surg Radiol Anat. 2003;24(6):400-5.

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

Maru YK, Gupta V. Anatomic variations of the bone in sinonasal C.T. Indian J Otolaryngol Head Neck Surg. 2001;53(2):123-8.

Mendiratta V, Baisakhiya N, Singh D, Datta G, Mittal A, Mendiratta P. Sinonasal Anatomical Variants: CT and Endoscopy Study and Its Correlation with Extent of Disease. Indian J Otolaryngol Head Neck Surg. 2016;68(3):352-8.

Lerdlum S, Vachiranubhap B. Prevalence of anatomic variation demonstrated on screening sinus computed tomography and clinical correlation. J Med Assoc Thai. 2005;88.

Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviations and paranasal sinus disease. Am J Neuroradiol. 2004;25:1613-8.

Holbrook EH, Brown CL, Lyden ER, Leopold DA. Lack of significant correlation between rhinosinusitis symptoms and specific regions of sinus computer tomography scans. Am J Rhinol. 2005;19(4):382-7.

Nouraei SA, Elisay AR, Dimarco A, Abdi R, Majidi H. Variations in paranasal sinuses anatomy: implication for the pathophysiology of Chronic Rhinosinusitis and safety of endoscopic sinus surgery. J Otolaryngol Head Neck Surg. 2009;38:32-7.

Earwaker J. Anatomic variants in sinonasal CT. Radiographics. 1993;13(1):381-415.