Study of anatomical variations of ostiomeatal complex in chronic rhinosinusitis patients

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210160 ◽

2021 ◽

Vol 7 (2) ◽

pp. 296

Author(s):

Priyanka Chauhan ◽

Nalini Bhat ◽

Pallavi Bhandarkar ◽

Ankita Singh

Keyword(s):

Risk Factors ◽

Observational Study ◽

Chronic Rhinosinusitis ◽

Task Force ◽

Maxillary Sinusitis ◽

Strong Relationship ◽

Anatomical Variations ◽

P Value ◽

Deviated Nasal Septum ◽

Anatomical Variants

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.

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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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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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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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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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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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Anatomical variations of maxillary and ethmoid sinus in chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182703 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1008

Author(s):

Karthika Rajeev ◽

Ravishankara S. ◽

Chethana C. S. ◽

Supreetha B. Shenoy ◽

Jyoti .

Keyword(s):

Chronic Rhinosinusitis ◽

Maxillary Sinusitis ◽

Anatomical Variation ◽

Anatomical Variations ◽

Neck Surgery ◽

Ethmoid Sinus ◽

Septal Deviation ◽

Nasal Endoscopy ◽

Female Ratio ◽

Postnasal Drip

Background: The objectives of the study were to compare the anatomical variants of maxillary and ethmoid sinus in CT PNS and diagnostic nasal endoscopy, to determine the incidence of variations of maxillary and ethmoid sinus and to determine the association of anatomical variations with extent of the disease.Methods: Patients with chronic rhinosinusitis attending the outpatient department of otorhinolaryngology, head and neck surgery (ENT-HNS) of KVG Medical College for a period of 12 months from December 2016 to November 2017. 100 consecutive patients with history of CRS subjected for nasal endoscopy and CT-PNS. Results: The majority of patients were females. Male to female ratio was 1:1.46. Headache and postnasal drip were the main symptoms (76%). Concha bullosa (42.4%) was most common anatomical variation, which was detected in 59(42.4%) patients on CT PNS and DNE. There was statistically significant correlation between right septal deviation and right maxillary sinusitis (p<0.01), left septal deviation and left maxillary sinusitis (p=0.001) and left deviation and left ethmoid sinusitis (p=0.017). We also found correlation between left Haller cells and left ethmoid sinusitis (p=0.003).Conclusions: By using diagnostic nasal endoscopy and CT PNS, anatomic variations can be easily identified and aid as a guide map during functional endoscopic sinus surgeries.

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Long-term clinical, virological and immunological outcomes in patients hospitalized for COVID-19: antibody response predicts long COVID

10.1101/2021.03.08.21253124 ◽

2021 ◽

Author(s):

Javier García-Abellán ◽

Sergio Padilla ◽

Marta Fernández-González ◽

José A. García ◽

Vanesa Agulló ◽

...

Keyword(s):

Significant Proportion ◽

Severity Of Illness ◽

Antibody Responses ◽

Rt Pcr ◽

Prospective Longitudinal Study ◽

Viral Shedding ◽

Persistent Symptoms ◽

Clinical Events ◽

Prospective Longitudinal

ABSTRACTObjectiveLong-term data following SARS-CoV-2 infection are limited. We aimed to characterize the medium and long-term clinical, virological, and immunological outcomes after hospitalization for COVID-19, and to identify predictors of long-COVID.MethodsProspective, longitudinal study conducted in COVID-19 patients confirmed by RT-PCR. Serial blood and nasopharyngeal samples (NPS) were obtained for measuring SARS-CoV-2 RNA and S-IgG/N-IgG antibodies during hospital stay, and at 1, 2 and 6 months post-discharge. Genome sequencing was performed where appropriate. Patients filled out a COVID19-symptom-questionnaire (CSQ) at 2-month and 6-month visits, and those with highest scores were characterized.ResultsOf 146 patients (60% male, median age 64 years) followed-up, 20.6% required hospital readmission and 5.5% died. At 2-months and 6-months, 9.6% and 7.8% patients, respectively, reported moderate/severe persistent symptoms. SARS-CoV-2 RT-PCR was positive in NPS in 11.8% (median Ct=38) and 3% (median Ct=36) patients at 2-months and 6-months, respectively, but no reinfections were demonstrated.Antibody titers gradually waned, with seroreversion occurring at 6 months in 27 (27.6%) patients for N-IgG and in 6 (6%) for S-IgG. Adjusted 2-month predictors of the highest CSQ scores (OR [95%CI]) were lower peak S-IgG (0.80 [0.66-0.94]) and higher WHO-severity-score (2.57 [1.20-5.86]); 6-month predictors were lower peak S-IgG (0.89 [0.79-0.99]) and female sex (2.41 [1.20-4.82]); no association was found with prolonged viral shedding.ConclusionsLate clinical events and persistent symptoms in the medium and long term occurred in a significant proportion of patients hospitalized for COVID-19. Gender, severity of illness and weaker antibody responses, but not viral shedding, were associated with long-COVID.SummaryThis study characterizes the long-term clinical, virological, and immunological outcomes following COVID-19 hospitalization. We found a significant proportion of late clinical events and persistent symptoms. Gender, severity of illness and weaker antibody responses, but not viral shedding, predicted long-COVID.

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