19 - Use of Computed Tomography of Paranasal Sinuses (CT-PNS) to Detect Anatomical Variants in Symptomatic Subjects of Sinusitis

Poster Board Number: 19
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Abstract Body : Introduction and Objective: One in seven adults suffer from sinusitis, the second most common infectious disease. Moreover, chronic sinusitis is the fifth most common reason for antibiotic prescription and can result in antibiotic resistance. As such, it is important to investigate possible factors leading to onset of infection and development of medical chronicity. Anatomical variants impact the mucociliary sinus drainage pathway and can cause sinusitis. Studies demonstrate the prevalence of sinonasal anatomical variants ranges from 10% to 95% in symptomatic subjects of sinusitis. The aim of this study is to investigate the frequency of sinonasal anatomic variants in symptomatic subjects of sinusitis on CT- PNS scan and their association with symptoms of sinusitis.
Materials and Methods: A prospective cross-sectional study including 80 patients was conducted after obtaining written informed consent at a public hospital in Karachi, Pakistan. The study involved males and females with ages ranging from 18 – 60 years. Patients’ CT-PNS scan were conducted to obtain a coronal and axial view. The study includes symptomatic subjects of sinusitis who also presented with headache, nasal-obstruction, facial-pain, and rhinorrhea. SPSS was used for statistical analysis. Chi-square test and Fischer exact tests were conducted and p-value of ≤ 0.05 was considered statistically significant.
Results: 53 male and 27 female patients were included in the study. The most common concurrent condition was headache (48.75%), followed by nasal-obstruction (26.25%), rhinorrhea (18.75%) and facial-pain (6.25%). Additionally, the most frequent anatomical variants were deviated nasal-septum (58.5%) followed by agger-nasi cells (56.3%), concha bullosa (CB) (46.3%), septal bony spur (40%), hypoplastic frontal-sinus (31.3%), asymmetry of both cavities of the sphenoid-sinus (18.8%), onodi-cells (12.5%), haller-cells (11.3%), uncinate-process deviation (2.5%) and pneumatization (3.8%), superior-CB (1.3%), paradoxical-middle-CB (1.3%), and maxillary septa (1.3%). Importantly, we found that nasal-obstruction and headache were associated with agger-nasi-cells on the right and left nostril (p = 0.014 and 0.026, respectively).
Conclusions: CT-PNS of sinonasal region shows anatomical variations were highly prevalent in symptomatic subjects of sinusitis, especially males. Significant associations were observed between nasal-obstruction and headache with agger-nasi-cells. The findings indicate anatomical variations can be an etiology for sinusitis and their complex and variable anatomy makes grants them high surgical importance. Moreover, CT-PNS scan is a technique that should be implemented to accurately identify the morphology of anatomical variants and the extent of the disease in and around the nasal cavity and paranasal sinuses.
Significance/Implications: The choice of treatment for patients with chronic sinusitis is Functional Endoscopic Sinus Surgery (FESS). However, surgeons often overlook the need to test for anatomical variants which may increase the risk for intraoperative or postoperative complications. The present study recommends the use of CT-PNS as a tool to detect anatomical variants and enhance surgical outcomes. Further studies will correlate CT-PNS findings with endoscopic examinations, mucosal contact points, and Lund Mackay scoring to assess morphological variations in patients that could be used to guide surgical procedures.