CT of the paranasal sinuses and functional endoscopic surgery: A critical analysis of 100 symptomatic patients

X-ray Department, Royal National Throat Nose and Ear Hospital, London.
The Journal of Laryngology & Otology (Impact Factor: 0.67). 04/1991; 105(3):181-5. DOI: 10.1017/S0022215100115300
Source: PubMed


CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection, (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases. Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven. Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis. The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.

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    • "Computed tomography (CT) is being used to assess the volume of inflammatory load within the paranasal sinuses in chronic rhinosinusitis (CRS) and also as an aid in diagnosing and deciding the treatment of CRS [1] [2] [3]. CT is also a useful tool for objectively evaluating the degree of improvement in CRS before and after drug therapy or surgery [2]. "
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    ABSTRACT: Objective: The Lund-Mackay system (L-M system) is widely used for computed tomography (CT) evaluation of chronic rhinosinusitis (CRS). However, a major drawback of the L-M system is its insufficiency of gradation. To avoid this deficiency, a new staging system proposed by American societies and the Zinreich system were reported as modifications of the L-M system. The aim of this study was to investigate the efficiency of gradation and the accuracy of the visual quantification of these modified staging systems. Methods: Preoperative CT scanning was performed on 20 adult patients with CRS. A computer workstation was used to measure the volume of each sinus and the volume of inflammatory disease in each sinus. Then the soft tissue density rate (STDR) and objective scores, which were adapted to each system, were calculated. Visual evaluation of the CT images was performed using these systems. The visual score with each staging system and STDR value were evaluated for a correlation, and the rate of agreement was determined between the visual and objective scores obtained with each staging system. Results: The correlation between the visual scores and the STDR values was shown with all staging system including L-M system. The coefficients of correlation between the visual scores and the STDR values with these modified systems were higher than with the L-M system. While the agreement rates with these modified systems were significantly lower than with the L-M system, differences of 2 or greater between the subjective and objective scores were rare. Conclusion: We cannot conclude that one of these three staging systems is superior to the other. With this study, the simple grading system such L-M staging score was considered easy and accurate method to use the clinical level. The modified staging systems showed more efficient ability to gradate in evaluating rhinosinusitis inflammation compared with the L-M system and also showed acceptable accuracy.
    Auris, nasus, larynx 06/2013; 40(6). DOI:10.1016/j.anl.2013.04.010 · 1.14 Impact Factor
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    • "The incidence rate of this disorder has varied from 14 to 53% in different studies. The relationship between the presence of concha bullosa and sinusitis has not been clarified yet [6] . While some studies suggest that septal deviation(SeD) or the presence of concha bullosa may interfere with proper airflow, potentially predisposing to sinus diseases, other studies have produced contradictory findings [7,8]. "
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    ABSTRACT: Background Sinusitis is an inflammation of the paranasal sinuses that can be caused by anatomic variations of the nasal cavity and paranasal sinuses. In this study we aimed to find the relationship between sinusitis and septal deviation (SeD) and concha bullosa. Methods Two trained resident of ENT evaluated sinus CT scans of 463 cases presenting with nasal obstruction or chronic sinusitis symptoms from April 2011 to December 2011. CT scans were checked for the presence of conchae bullosa and the degree of septal deviation. The severity of sinusitis was evaluated according to the Lund Mackay criteria. The frequency of patients with different degrees of SeD and different grades of chronic sinusitis were studied. Results Of 463 cases, 47% had septal deviation. Concha bullosa was seen in 16.8% of the patients in the left side and 27.6% of them in the right side. There was no significant relationship between the presence of concha bullosa and the severity of sinusitis. Also the P value of analytical tests between the severity of sinusitis, osteomeatal involvement and the degree of septal deviation was not significant. Analysis of the relationship between the presence of SeD (either to right or left) and the severity of sinusitis in different sinuses revealed no significant P value. Conclusions By this study, the relationship between concha bullosa in osteomeatal complex and the severity of sinusitis was not cleared. No relationship was found between the severity of sinusitis, osteomeatal involvement and the degree of septal deviation. Also SeD (either to right or left) was not found to be associated with the severity of sinusitis in different sinuses.
    BMC Ear Nose and Throat Disorders 12/2012; 12(1):15. DOI:10.1186/1472-6815-12-15
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    • "Sinus imaging by screening CT scan provides information on any obstruction of the osteomeatal complex, and can also aid in identifying polyps, turbinate edema, or bony abnormalities such as concha bullosae[84]. However, given cost and radiation exposure, imaging is reserved for cases of lack of response to therapy, high index of clinical suspicion, or pre-operative assessment for use during endoscopic sinus surgery to delineate anatomy[89,90]. Additional specialized testing (e.g. acid reflux testing by pH probe, assessment of nasal volume by acoustic rhinometry) can be useful for evaluation of exacerbating factors, such as gastroesophageal reflux disease or decreased nasal patency in select settings[23,91,92]. "
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    ABSTRACT: The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 2030 1 . With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people and require attention to improve quality of life. Several mechanisms likely underlie the pathogenesis of rhinitis in these patients, including inflammatory conditions and the influence of aging on nasal physiology, with the potential for interaction between the two. Various treatments have been proposed to manage this condition; however, more work is needed to enhance our understanding of the pathophysiology of the various forms of geriatric rhinitis and to develop more effective therapies for this important patient population.
    Allergy Asthma and Clinical Immunology 05/2010; 6(1):10. DOI:10.1186/1710-1492-6-10 · 2.03 Impact Factor
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