A computed tomography and endoscopy assisted study of the anatomical variations of lateral wall of nose in patients of chronic rhinosinusitis- our experience at a tertiary care centre

Background: Chronic rhinosinusitis (CRS) is a common and persistent illness that ENT surgeons encounter in their day to day practice. The lateral wall of the nose contains the ostiomeatal unit which is the key area targeted in the management of CRS. The lateral wall of nose shows several variations which can alter the course of the disease. It is of utmost importance for the ENT surgeon to be aware of these variations as they decide the overall line of management. The objectives of the study was to study the anatomical variations of the lateral wall of nose using computed tomography (CT) scans and nasal endoscopy in patients of chronic rhinosinusitis.Methods: A one year study from April 2015 to March 2016 involving 50 patients attending the ENT outpatient department clinically diagnosed as CRS using the criteria of task force on rhinosinusitis were included in the present study. Patients underwent a CT scan and DNE and the anatomical variations of the lateral wall of nose were studied. Results: Concha bullosa was the most common anatomic variation noted in 20 (40%) of the total 50 patients. The other anatomic variations noted were uncinate process variations in 15(30%) patients, agger nasi cells in 3 (6%) patients, hypoplastic middle turbinate in 1 (2%) patient, paradoxical middle turbinate in 2(4%) patients, bulla ethmoidalis in 4 (8%) patients and Haller cells in 1 (2%) patient. Conclusions: The lateral wall of nose is made up of several structures showing variations which can lead to the development CRS and affect the overall management. They should be evaluated pre-operatively in order to avoid intraoperative complications. CT scan and DNE both complement each other and effectively evaluate the anatomical variations of the lateral wall of nose.

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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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The role of concha bullosa in chronic rhinosinusitis: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202787 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1326

Author(s):

Afshan Fathima ◽

Ramappa Arabhanvi ◽

Karthik Shamanna ◽

Lyra Joy

Keyword(s):

Chronic Rhinosinusitis ◽

Maxillary Sinusitis ◽

Tertiary Care ◽

Lateral Wall ◽

Anatomical Variations ◽

P Value ◽

Care Hospital ◽

Concha Bullosa ◽

Chi Square ◽

Chronic Maxillary Sinusitis

Background: Chronic rhinosinusitis (CRS) is a common and persistent illness that otorhinolaryngologists encounter commonly. It is an important cause of morbidity and accounts for major loss of income. Anatomical variations of the lateral wall of the nose have been reported which can predispose to CRS. The aim of the present study was to determine the percentage of concha bullosa in patients with CRS and to ascertain its relationship with chronic rhinosinusitis.Methods: 100 patients attending the ENT outpatient department, Bangalore Medical College and Research Institute between December 2018 and 2019 were included in the study. Patients clinically diagnosed as CRS underwent diagnostic nasal endoscopy (DNE) and computed tomography (CT) scan of nose and paranasal sinuses, following which the relationship between concha bullosa and CRS was determined. The results were tabulated in excel sheet. Chi square test was applied for qualitative data. Results: Of the 100 patients of CRS, 40 were males and 60 females. Of the 40 male patients, 16 showed presence of concha bullosa and of the 60 female patients, 28 showed concha bullosa. Headache (92%) was the most common presenting symptom in our study. A statistically significant correlation was noted between the presence of concha bullosa and chronic maxillary sinusitis (p value <0.05).Conclusions: Concha bullosa is one of the most common anatomical variations of the lateral wall of the nose. The presence of concha bullosa plays a significant role in the development of chronic rhinosinusitis particularly in chronic maxillary sinusitis.

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Triple-Divided Concha Bullosa: A New Anatomic Variation

Case Reports in Otolaryngology ◽

10.1155/2013/342615 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Turhan San ◽

Barış Erdoğan ◽

Bülent Taşel

Keyword(s):

Computed Tomography ◽

Paranasal Sinus ◽

Imaging Techniques ◽

Anatomic Variation ◽

Middle Turbinate ◽

Anatomical Variations ◽

Concha Bullosa ◽

Paranasal Sinus Computed Tomography

In recent years, with the widespread use of imaging techniques such as paranasal sinus computed tomography (CT), many variations of nasal turbinates have been described. One of these variations known as concha bullosa (CB) is pneumatization of nasal turbinates. CB is the most frequently encountered anatomical variations of the middle turbinate. The term of septated concha bullosa has been described recently and it is an uncommon pneumatization anomaly of the middle turbinate. There has not been any study that correlates the number of septations and the presence of sinonasal pathologies. We hereby present a case of triple septated concha bullosa that has not been reported so far.

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Concha Bullosa in Paradoxical Middle Turbinate: A New Variation

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1288 ◽

2016 ◽

Vol 9 (3) ◽

pp. 141-142 ◽

Cited By ~ 1

Author(s):

Mohammad W El-Anwar ◽

Ahmed I Ali

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Laboratory Tests ◽

Anatomic Variation ◽

Middle Turbinate ◽

Anatomic Variations ◽

Concha Bullosa ◽

Normal Limits ◽

Osteomeatal Complex ◽

The Right

ABSTRACT Introduction Concha bullosa is the most common anatomic variation of osteomeatal complex region that is generally seen in the middle turbinate (MT). Materials and methods A 25-year-old male presented with headache and nasal obstruction. Computed tomography (CT) scan documented right paradoxical MT. The right MT also showed aerated concha bullosa with narrow right osteomeatal area. Routine preoperative laboratory tests were within normal limits. Results This case of concha bullosa in paradoxically bent MT was reported, described, and could be safely managed endoscopically. Patient was symptom free up to date without any complication, recurrence, or other pathology. Conclusion Computed tomography may easily identify such uncommon anatomic variations of the osteomeatal region. This directs the surgeon attention to these variations as a cause of headache and osteomeatal area obstruction. How to cite this article El-Anwar MW, Ali AI. Concha Bullosa in Paradoxical Middle Turbinate: A New Variation. Clin Rhinol An Int J 2016;9(3):141-142.

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Correlation of anatomical variations in chronic sinusitis with diagnostic nasal endoscopy and CT scan of paranasal sinuses: an observational study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20184723 ◽

2018 ◽

Vol 5 (1) ◽

pp. 41

Author(s):

G. Ramesh Babu ◽

G. Ravi Kumar ◽

V. Krishna Chaitanya

Keyword(s):

Ct Scan ◽

Paranasal Sinuses ◽

Middle Turbinate ◽

Lateral Wall ◽

Anatomical Variations ◽

Normal Function ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Common Finding ◽

Nose And Paranasal Sinuses

Background: Drainage and ventilation of paranasal sinuses are important for normal function which depends on effective mucociliary clearance. In present study we tried to emphasize variations in lateral wall of nose and clinical features leading to nose and paranasal sinus disease using diagnostic nasal endoscopy and variations in CT scan of paranasal sinuses. The objectives of the study are to observe various anatomical variations in nose and paranasal sinuses and their clinical presentation using diagnostic nasal endoscopy and CT scan of paranasal sinuses and to compare various anatomical variations in nose and paranasal sinuses.Methods: Present study included 54 patients presenting in Department of ENT, Head and Neck Surgery, during February 2015 to February 2017. Results: Diagnostic nasal endoscopy findings reveal that most common finding was polypoidal changes in nasal mucosa in 36 (66.67%) of patients, followed by mucopurulent discharge in 26 (48.14%), postnasal discharge in 20(37.03%) and 4 (7.40%) patients showed prominent agger nasi cell. CT scan of paranasal sinuses revealed multiple sinus involvement in 41 (75.92%) of patients with partial involvement of sinuses. Complete sinus opacification with pan sinusitis was observed in 9 (16.67%), blockade at osteomeatal complex was observed in 46 (85.18%), paradoxical middle turbinate was observed in 5 (9.25%), Concha bullosa was observed in 12 (22.23%) of patients.Conclusions: Each variation have an anatomic and surgical significance, hence each and every case should be individually studied in detail before undergoing functional endoscopic sinus surgery to maximize patient benefit and to prevent unnecessary complications. Diagnostic nasal endoscopic examination is clinical guide to evaluate disease.

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CT Scan Evaluation of Prevalence of Paradoxical Middle Turbinate In Adult Population of Bihar

Academia Anatomica International ◽

10.21276/aanat.2020.6.1.1 ◽

2020 ◽

Vol 6 (1) ◽

pp. 01-04

Author(s):

Raag Reeti ◽

Md Jawed Akhtar ◽

Avanish Kumar ◽

Binod Kumar ◽

Rajiv Ranjan Sinha

Keyword(s):

Convex Surface ◽

Adult Population ◽

Middle Turbinate ◽

Lateral Wall ◽

Anatomical Variations ◽

Sinus Surgery ◽

P Value ◽

Test Results ◽

Common Cause ◽

Exact Test

Introduction: Middle turbinate overlying the middle meatus is the most important anatomic area in the lateral wall of the nose. It is a thinsheet of bone which curves in different planes very similar to a dried leaf. Paradoxical Middle Turbinate (PMT) is the abnormal curvatureof middle turbinate, where the convex surface faces laterally instead of its usual medial curvature and may block the drainage pathway ofmiddle meatus. The present study aimed at observing the prevalence of the paradoxical middle turbinate in the adult population of Bihar. Subjects and Methods: This was a retrospective study being conducted on 150 patients who presented to the Department of Radiodiagnosis. Their CT scans were analysed for the presence of paradoxical middle turbinate. The results were analysed as percentage and ‘p’ value was calculated using Fischer’s Exact Test. Results: Prevalence of Paradoxical Middle Turbinate was observed in 28 cases i.e. 18.6% cases; 16 in males and 12 in females. ‘p’ value was 0.677 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like paradoxical middle turbinate are quite common cause of diseases involving paranasal sinuses and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the paradoxical middle turbinate which will definitely help the FESS surgery and its outcomes.

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The utility of chest computed tomography (CT) and RT-PCR screening of asymptomatic patients for SARS-CoV-2 prior to semiurgent or urgent hospital procedures

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.331 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1375-1377 ◽

Cited By ~ 1

Author(s):

Aditya S. Shah ◽

Lara A. Walkoff ◽

Ronald S. Kuzo ◽

Matthew R. Callstrom ◽

Michael J. Brown ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Tertiary Care ◽

Case Series ◽

Chest Ct ◽

Study Cohort ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Tertiary Care Medical Center ◽

Asymptomatic Patients

AbstractObjective:Presently, evidence guiding clinicians on the optimal approach to safely screen patients for coronavirus disease 2019 (COVID-19) to a nonemergent hospital procedure is scarce. In this report, we describe our experience in screening for SARS-CoV-2 prior to semiurgent and urgent hospital procedures.Design:Retrospective case series.Setting:A single tertiary-care medical center.Participants:Our study cohort included patients ≥18 years of age who had semiurgent or urgent hospital procedures or surgeries.Methods:Overall, 625 patients were screened for SARS-CoV-2 using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest computed tomography (CT) between March 1, 2020, and April 30, 2020.Results:Of the 625 patients, 520 scans (83.2%) were interpreted as normal; 1 (0.16%) had typical features of COVID-19; 18 scans (2.88%) had indeterminate features of COVID-19; and 86 (13.76%) had atypical features of COVID-19. In total, 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with a CT scan that yielded an atypical finding. Of the 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab 1 week after their initial swab. Also, 1 patient with a chest CT categorized as typical had a follow-up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. After surgery, none of the patients developed signs or symptoms suspicious of COVID-19 that would indicate the need for a repeated RT-PCR or CT scan.Conclusion:In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low-prevalence population.

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Polyps originating from accessory middle turbinate and secondary middle turbinate

The Journal of Laryngology & Otology ◽

10.1017/s0022215112000941 ◽

2012 ◽

Vol 126 (7) ◽

pp. 729-732 ◽

Cited By ~ 3

Author(s):

H Jung ◽

S K Park ◽

J-R Kim

Keyword(s):

Computed Tomography ◽

Case Report ◽

World Literature ◽

Middle Turbinate ◽

Anatomical Variations ◽

Sinus Surgery ◽

Histopathological Analysis ◽

Middle Meatus ◽

The World ◽

Paranasal Sinus Computed Tomography

AbstractObjective:We report two extremely rare cases of polyps from unilateral accessory middle turbinates, one of which coexisted with a polyp from an inferomedially projecting, pneumatised, secondary middle turbinate.Methods:Case report and literature review concerning accessory middle turbinate and secondary middle turbinate.Results:Two patients presented with unilateral nasal obstruction. In both patients, nasal endoscopy revealed polypoid masses originating from the middle meatus. Paranasal sinus computed tomography and histopathological analysis confirmed the presence of polyps originating from an accessory middle turbinate and secondary middle turbinate, which were resected uneventfully via endoscopic sinus surgery.Conclusion:To our knowledge, this is the first report in the world literature of polyps originating from a unilateral accessory middle turbinate and secondary middle turbinate. Pre-operative recognition of these rare anatomical variations is of particular importance in avoiding intra-operative complication.

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Correlation between nasal endoscopy and computed tomography in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195609 ◽

2019 ◽

Vol 6 (1) ◽

pp. 181

Author(s):

Vinnakota Sriprakash ◽

Shalini Singh Sisodia

Keyword(s):

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Predictive Value ◽

Tertiary Care ◽

Nasal Endoscopy ◽

Nasal Discharge ◽

Common Symptom ◽

Care Hospital ◽

The Right

Background: Chronic rhinosinusitis is associated with morbidity and affects the quality of life of the affected persons and increases their treatment costs. Diagnosis is mainly by nasal endoscopy or by computed tomography which is considered to be the gold standard.Methods: Nasal endoscopy was done for all the patients under local anaesthesia. All the patients also underwent computed tomography and paranasal sinuses and the findings were scored according to Lund Mackay scoring system. Results: The most common age group was 31-40 years and nasal discharge was the most common symptom seen in 82% of the patients. The paranasal sinuses that were involved were predominantly maxillary sinus in a total of 88% of the patients. 22% of the patients have sinusitis in the anterior ethmoid of the left nose and 20% on the right nose. Bilateral was seen in 22% of the cases. The sensitivity of nasal endoscopy over computed tomography was 95.6% while the specificity was 80%. The positive predictive value was 97.7% and the negative predictive value was 66.7%. The accuracy of the test was 94%.Conclusions: Nasal endoscopy is found to be as good as the computed tomography for the diagnosis of chronic rhinosinusitis and can be used on a regular basis for its detection among the patients. It not only lacks radiation but is also economically viable.

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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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