Diagnosis of chronic rhinosinusitis: can nasal endoscopy be the new gold standard in developing countries?

Sushant Tyagi; Mohit Srivastava; Vandana Singh

doi:10.18203/issn.2454-5929.ijohns20160066

Diagnosis of chronic rhinosinusitis: can nasal endoscopy be the new gold standard in developing countries?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20160066 ◽

2016 ◽

Vol 2 (1) ◽

pp. 30

Author(s):

Sushant Tyagi ◽

Mohit Srivastava ◽

Vandana Singh

Keyword(s):

Developing Countries ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Middle Turbinate ◽

Anatomical Variations ◽

Diagnostic Value ◽

Uncinate Process ◽

Nasal Endoscopy ◽

Deviated Nasal Septum ◽

Diagnostic Modality

Background: Objective of the study was to study the role of diagnostic value of nasal endoscopy in diseases involving nasal cavity and paranasal sinuses particularly chronic rhinosinusitis in developing countries.Methods: A total of 200 Patients with clinical evidence of sinonasal diseases were evaluated. All patients were subjected to thorough ENT examination with special emphasis on anterior and posterior rhinoscopy. Nasal Endoscopy was done using Hopkins rod endoscopes ( 0º, 30º, 45º, 70º and 90º) - diameter 2.7 mm/ 4 mm, length 18 cm after administering a spray puff of Xylocaine with adrenaline (10 drops of adrenaline to 2 ml of Xylocaine). Computed tomography of paranasal sinuses was done in 100 patients whose symptoms, examination and clinical picture were sufficient to warrant the procedure. Results: The most common anatomical variations detected on nasal endoscopy were deviated nasal septum (83.5%) followed by paradoxical middle turbinate (42.5), and concha bullosa (26.5%). Accessory middle turbinate was seen in 7 out of 200 cases (3.5%). The most common pathological abnormality detected on nasal endoscopy was mucopus in middle meatus (69%) and next were hypertrophied (45 and 35% inferior and middle turbinate respectively) and congested turbinates (44.5%), followed by polypoidal changes (28%) and oedematous/congested uncinate process (27.5%).Conclusion: Diagnostic nasal endoscopy can prove to be a better diagnostic modality compared to CT scan when conditions like middle meatal secretions, condition of mucosa, polyps are looked for. It can detect early polypoidal and other pathological changes missed on CT which can aid in early diagnosis and medical management of sinonasal diseases thereby preventing patient from unnecessary surgical exposure. Also being easily available and cost effective, patients can be spared from unnecessary cost and radiation exposure by performing diagnostic nasal endoscopy prior to CT.

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Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195697 ◽

2019 ◽

Vol 6 (1) ◽

pp. 101

Author(s):

Falguni J. Parmar ◽

Avani D. Patel

Keyword(s):

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Care Center ◽

Tertiary Care ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Advantages And Disadvantages

Background: Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).Methods: A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included. Results: Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.Conclusions: Prolonged duration of rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.

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Prospective evaluation of chronic rhinosinusitis with reference to anatomical variation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200145 ◽

2020 ◽

Vol 6 (2) ◽

pp. 326

Author(s):

Sindhura . ◽

Mamatha Devi Kandipilli ◽

Ali Shaik ◽

Venkata Ramana

Keyword(s):

Chronic Rhinosinusitis ◽

Anatomical Variation ◽

Medical Science ◽

Middle Turbinate ◽

Anatomical Variations ◽

Final Diagnosis ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Deviated Nasal Septum ◽

A Prospective Study

Background: Rhinosinusitis is one of the commonest sinonasal condition with chronic Rhinosinusitis affecting 10% of population worldwide. Although the diagnosis of chronic rhinosinusitis is clinical, the final diagnosis should be confirmed by objective measures like radiography and nasal endoscopy. Though anatomical variations in sinonasal region are rare, they have significant impact in the causation of sinonasal diseases and pose difficulties during surgery.Methods: This was a prospective study conducted on 60 patients who attended to the Department of ENT and HNS, Konaseema Institute of Medical Science, Amalapuram between December 2017 to July 2019. By considering AAO-HNS criteria patients were selected and subjected to high resolution computerized tomography para nasal sinuses and diagnostic nasal endoscopy. Results: As per study, 60% patients are having deviated nasal septum, followed by aggar nasi in 58.3%, concha bullosa in 26.8%, Haller cells in 11.7%, paradoxical middle turbinate in 11.7%, uncinate pneumatisation in 5%, and onodi cells in 5% of cases.Conclusions: Anatomical variations in sinonasal cavity predispose to chronic rhinosinusitis and hence require correction. Also, detecting these variations preoperatively by computed tomography of paranasal sinus helps in avoiding complications during functional endoscopic sinus surgery.

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Incidence of sinonasal anatomical variations associated with chronic sinusitis by CT scan in Karaikal, South India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172291 ◽

2017 ◽

Vol 3 (3) ◽

pp. 576 ◽

Cited By ~ 1

Author(s):

Kranti Gouripur ◽

Udaya Kumar M. ◽

Anand B. Janagond ◽

S. Elangovan ◽

V. Srinivasa

Keyword(s):

Ct Scan ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Deviated Nasal Septum

Background: Variations in sinonasal anatomy of adults are common and vary among different populations. Their role in development of pathological conditions such as sinusitis, epistaxis, etc is debated. Having clear picture of sinonasal anatomy of a person is essential in avoidance of complications during surgery. This study was done to analyze sinonasal anatomy in adults from Karaikal region having chronic sinusitis by nasal endoscopy and CT scan imaging.Methods: A total of 50 patients undergoing endoscopic sinus surgery were studied by preoperative nasal endoscopy, CT scanning and endoscopy at the time of definitive surgery and variations recorded and analyzed. Results: The incidence of the sinonasal anatomical variations in CT scan study were – discharge in the frontal sinus (100%), agger nasi cells (96%), deviated nasal septum (70%), anterior ethmoidal cells (86%), posterior ethmoidal cells (58%), sinus lateralis (52%), frontal cells (50%), discharge in sphenoid sinus (50%), pneumatised superior turbinate (46%), INSA (34%), prominent bulla ethmoidalis (30%), supra orbital cells (26%), pneumatised septum(16%), medialised uncinate process (16%), paradoxical middle turbinate (16%), Haller cells (14%), supreme turbinate (14%), pneumatised inferior turbinate (12%), frontal recess obliteration (12%), absent pneumatisation of frontal sinus (12%), pneumatised middle turbinate (10%), Onodi cells (6%), pneumatised uncinate process (2%), maxillary sinus septation (2%).Conclusions: The high incidence of variations emphasises the need for proper preoperative assessment for safe and effective endoscopic sinus surgery.

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A CT and DNE study of osteomeatal complex variations and their correlation in chronic rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173032 ◽

2017 ◽

Vol 3 (3) ◽

pp. 606 ◽

Cited By ~ 1

Author(s):

Parul Sachdeva ◽

Kuldeep S. Sachdeva ◽

Baldev Singh ◽

Manjit Singh ◽

Manpreet Kaur ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Middle Turbinate ◽

Process Variations ◽

Anatomical Variations ◽

Uncinate Process ◽

Deviated Nasal Septum ◽

Chi Square ◽

Persistent Symptoms ◽

Osteomeatal Complex ◽

Chi Square Test

Background: CRS is a global burden reducing the productivity at work. This study was done to evaluate the occurrence of anatomical variations of osteomeatal complex (OMC) and to assess its relation in causation of chronic rhinosinusitis in the study population. Methods: A 100 patients diagnosed with CRS in the outdoor of Dept. Of ENT between November 2012 – November 2015 were subjected to CT Imaging and DNE and the frequency of anatomical variations and involvement of paranasal sinuses were evaluated. The correlation between them was established using chi-square test. Results: Agger nasi cells were the most common variant seen in 73 (73%) patients with 12% being unilateral and 61% bilateral. Other variants seen were: deviated nasal septum in 68%, uncinate process variations in 58%, concha bullosa in 30%, enlarged bulla ethmoidalis in 25%, paradoxical middle turbinate in 18%, haller’s cells in 6% and accessory maxillary ostia in 2%. We could establish a correlation between a few of these variants and the affected sinuses. Conclusions: The importance of CT and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.

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Study of anatomical variations of ostiomeatal complex in chronic rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183696 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1281

Author(s):

Shivakumar Senniappan ◽

Komathi Raja ◽

Ammu Lizbeth Tomy ◽

Chinnu Sudha Kumar ◽

Anjali Mahendra Panicker ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Maxillary Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Deviated Nasal Septum ◽

Prospective Longitudinal Study ◽

Anatomical Variant ◽

Persistent Symptoms ◽

Ostiomeatal Complex ◽

Prospective Longitudinal

Background: Anatomical variations like nasal septal deviations, concha bullosa, paradoxical middle turbinate, pneumatized or medially bent uncinate etc. can encroach upon the ostiomeatal unit and narrow ostiomeatal channels. The aim of the study was to study the anatomical variations of ostiomeatal complex commonly associated with paranasal sinus disease among patients with chronic sinusitis using computed tomography.Methods: A prospective longitudinal study was conducted in the ENT department of our hospital for a period of one year. All the adult patients with complaints suggestive of chronic rhinosinusitis for a period of more than 12 weeks, patients with acute exacerbation of chronic rhinosinusitis and with persistent chronic rhinosinusitis requiring surgical intervention are included in our study. Based on our inclusion and exclusion criteria a total of 138 patients were involved in the study. Results: In our study we saw the association between various sinusitis and the anatomic variations of the ostiomeatal complex and we found that concho bullosa found to have a strong significant association with maxillary sinusitis (43.6%) and anterior ethmoid sinusitis (42.1%). Most of the patients with posterior ethmoid sinusitis (53.8%) had a statistical significant association in developing deviated nasal septum type of anatomical variant and majority of the patients with sphenoidal sinusitis had a onodi cell type of anatomical variant and their association was found to be statistical significant (p<0.05).Conclusions: The importance of CT scan and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.

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A radiological study of anatomical variations in ostiomeatal complex in patients with chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172102 ◽

2017 ◽

Vol 3 (3) ◽

pp. 528

Author(s):

Rajneesh . ◽

Rahul S.

Keyword(s):

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Intraoperative Complications ◽

Preoperative Evaluation ◽

Middle Turbinate ◽

Uncinate Process ◽

Leonardo Da Vinci ◽

Type I ◽

Anatomical Variants ◽

Increased Risk

Background: In ancient times the paranasal sinuses, without any anatomical differentiation, were thought to be a system of hollow spaces through which mucus produced by the brain was drained. Leonardo da Vinci in Milano in 1489 was the first to prepare and draw anatomical specimens of the paranasal sinuses; the drawings, however, only became accessible to scientific evaluation as late as 1901.Methods: All adult patients (more than 20 years of age) attending the Outpatient department at ENT, diagnosed to have chronic rhinosinusitis, willing to undergoing Computed Tomographic evaluation were included in this study. Sample of 50 was selected using purposive sampling technique. All CT scans were obtained with GE Brightspeed scanner (16 slice MDCT scanner). Coronal sections were performed with the patients in prone position, with extended neck and the plane perpendicular to the infraorbitomeatal line.Results: Agger nasi was the most common variation seen in 72% cases followed by dwviated nasal septum in 66% patients. Other variations found were lateral attachment of uncinate process in 54%, uncinate attachment to skull base in 33%, concha bullosa in 32%, overpneumatized bulla ethmoidalis in 21%, medial attachment of unicinate process to middle turbinate in 13%, paradoxical bent middle turbinate in 11%, haller cell seen in 6%. 56% had type I frontoethmoidal cells, 29% had type II, and 15% had type III frontoethmoidal air cells.Conclusions: The presence of anatomical variants does not indicate a predisposition to sinus pathology but these variations may predispose patients to increased risk of intraoperative complications. The surgeon must pay close attention to anatomical variants in the preoperative evaluation avoid possible complications and improve success of management strategies.

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Anatomical variations in patients with chronic sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180702 ◽

2018 ◽

Vol 4 (2) ◽

pp. 428 ◽

Cited By ~ 1

Author(s):

Pragadeeswaran Kumarasekaran ◽

Rajprakash Dharmapuri Yadhava krishnan ◽

Gurumani Sriraman

Keyword(s):

Nasal Septum ◽

Chronic Sinusitis ◽

Anatomical Variation ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Anatomical Variant

Background: Chronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. Methods: Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. Results: In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. Conclusions: In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process. Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.

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CT Evaluation of Anatomical Variations in Osteomeatal Complex in Patients with Deviated Nasal Septum

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v21i2.27646 ◽

2016 ◽

Vol 21 (2) ◽

pp. 90-93

Author(s):

Mirza Aneesa ◽

Sajad Majid Qazi ◽

Aijazul Haq

Keyword(s):

Paranasal Sinuses ◽

Nasal Septum ◽

Complex Disease ◽

Anatomical Variation ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Anatomical Variations ◽

Lateral Nasal Wall ◽

Deviated Nasal Septum ◽

Osteomeatal Complex

Background:The presence of septal deviation has been positively associated with sinus disease, especially osteomeatal complex disease and anterior and posterior ethmoid disease.Computerized tomographic imaging (CT) of the paranasal sinuses has become a widely accepted tool for assessing the paranasal sinuses (PNS) and providing a detailed anatomy of the lateral nasal wall.Objective:The objective of the study was to identify the anatomical variations of lateral nasal wall and paranasal sinuses in patients with Deviated nasal septum.Methods:Computerized tomographic (CT) examination was carried out using the bone algorithm in the coronal plane in 40 patients who met the inclusion criteriain the Postgraduate Department of Otorhinolaryngology and Head and Neck Surgery, SMHS Hospital an associated Hospital of Government Medical College, Srinagar from March 2011 to May 2012.Results:In our study, CT Nose and PNS revealed Deviated nasal septum in 40 (100%) patients, Hypertrophied Inferior turbinate in 11 (27.50%) patients, Concha bullosa in 5 (12.50%) patients, Paradoxical Middle turbinate in 8 (20%) patients, Everted Hypertrophied Uncinate in 2 (5%) patients, Aggernasi cells in 4 (10%) patients, Haller cells in 3 (7.50%) patients and Onodi cells in 2 (5%) patients.Conclusion:The most common anatomical variation associated with deviated nasal septum was Hypertrophied Inferior turbinate and the least encountered variation was Everted Hypertrophied Uncinate and Onodi cells. The CT scan provides supplementary clinical data to the history and endoscopic examination and assists in directing surgical treatment to the affected areas.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 90-93

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A clinico-radiological study of anatomical variations of nose and para-nasal sinuses in chronic rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182709 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1040

Author(s):

Daya Shankar ◽

Sunil Kumar ◽

H.P. Singh ◽

Veerendra Verma ◽

Anupam Mishra

Keyword(s):

Ct Scan ◽

Nasal Septum ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Nasal Sinus ◽

Female Ratio

Background: There are a lot of anatomical variations in para-nasal sinuses that are responsible for various sinus pathologies. CT scan of paranasal sinuses prior to functional endoscopic sinus surgery has become extremely important to know the anatomy and its variations to avoid complications during surgery.Methods: This study was performed in 100 patients at King George’s Medical University, Lucknow UP, India to compare the anatomical variations between nasal endoscopy and CT scan findings. The outcome measures were deviated nasal septum, paradoxical middle turbinate, concha bullosa, medialized/lateralised uncinate process, pneumatized uncinate process, large ethmoid bulla, accessory ostium, Agger nasii cells, Haller’s cells and Onodi cells. Results: In this study the age of the patients were 30.00±9.56 yrs. with male to female ratio 1.9:1. Deviated nasal septum was the most common anatomical abnormality (70%) followed by large bulla ethmoidalis 17%. Occurrence of different types of special cells were studied which are better visualized on coronal CT scan images. Among these cells Agger nasi was the most common variety (15%) followed by Haller’s cells (11%) and Onodi cell (3%). Concha bullosa was present in 8%.Conclusions: The importance of CT and nasal endoscopy can be seen in patients with persistent symptoms to identify the anatomical variations that may responsible for the development of chronic sinus disease. In cases of sinusitis patients all the para-nasal sinus should be properly investigated to avoid complications.

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Role of CT Nose Paranasal Sinuses and Nasal Endoscopy for Decision Making in a Case of Deviated Nasal Septum

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i3.14 ◽

2019 ◽

Vol 27 (3) ◽

pp. 235-239

Author(s):

Sayan Hazra ◽

Ankit Choudhary ◽

Swapan Kumar Ghosh ◽

Subhradev Biswas ◽

Kaustuv Das Biswas

Keyword(s):

Ct Scan ◽

Nasal Obstruction ◽

Paranasal Sinuses ◽

Nasal Septum ◽

Pathological Condition ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Nasal Endoscopy ◽

Deviated Nasal Septum ◽

Pathological Conditions

Introduction Deviated nasal septum (DNS) can be asymptomatic in an individual or may cause nasal obstruction. The condition is generally diagnosed clinically and based on clinical diagnosis it is managed Surgically by large without much heed to diagnostic procedure. Thus, often underlying other causes of Obstruction is missed. Thus, it becomes essential to evaluate every patient presenting with history of Nasal obstruction and clinically Deviated septum, with aid of Nasal Endoscopy and CT scan Nose Paranasal Sinuses (PNS) to rule out/diagnose other coexisting conditions. Methods and Methodology 100 patients who presented with nasal obstruction and clinically diagnosed to have Deviated Nasal Septum were then subjected to Nasal Endoscopy and CT scan Nose and PNS and findings were noted for analysis. Results and Analysis Of these 100 patients, 48 patients were found to have coexisting pathological conditions/anatomical variants. Various anatomical and pathological Conditions were found to coexist together. Inferior turbinate hypertrophy in 34% is the most common pathological condition found to be associated with DNS followed by of sinusitis in 25% patients apart from polyp, concha bullosa and paradoxical middle turbinate. Discussion Studies done so far shows there is a definite link of deviated nasal septum to various anatomical and pathological conditions of the nose. CT Scan Nose PNS and Nasal Endoscopy plays a vital role in diagnosing such anomalies. Conclusion Most of the patients, presenting with nasal obstruction and having Deviated Nasal Septum, undergo management without proper analysis and returns with recurrence of symptoms which could be analyzed properly if Nasal endoscopy and CT scan is employed during diagnosis of the condition, reducing risk of treatment failure.

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