CT scan vs nasal endoscopy findings in the diagnosis of chronic rhinosinusitis: our experience

Background: Diagnostic nasal endoscopy and CT imaging are both widely used essential diagnostic tools for chronic rhinosinusitis (CRS). This study analyses their individual roles in the management of CRS as well as the degree of correlation between the two.Methods: A prospective observational comparative study was conducted in the Department of Otorhinolaryngology, Mahatma Gandhi Hospital, Jaipur from January, 2017 to June, 2018 on a sample size of 201 patients diagnosed with chronic rhinosinusitis, as per AAOHNS guidelines. DNE and CT PNS were done for all patients enrolled in the study, the findings of each were correlated and their individual sensitivity and specificity for each variable was calculated. Results: On Comparing CT findings with diagnostic nasal endoscopic findings, Polyps were seen in 91 patients’ CT scans as opposed to 124 on DNE. B/L Polyps on CT imaging vs bilateral ethmoidal polyps visualized during DNE revealed a highly significant “P” value; whereas for antrochoanal polyps or unilateral polyps there was no significant difference. Maxillary sinus involvement is the most commonly observed finding in CT scan of PNS in CRS while deviated nasal septum is the most common finding on a diagnostic nasal endoscopy, seen in 60.7%. For anatomical variants like concha bullosa and paradoxical middle turbinate, no significant difference was seen.Conclusions: CT scans and DNE are both key pre-operative diagnostic tools for patients of CRS and both are complementary to each other in detecting type and extent of pathology.

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ROLE OF SEPTOPLASTY AND FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN THE TREATMENT OF RHINOGENIC HEADACHE

UP STATE JOURNAL OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY ◽

10.36611/upjohns/volume9/issue1/2 ◽

2021 ◽

Vol VOLUME 9 (ISSUE 1) ◽

pp. 6-12

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

P Value ◽

Age Group ◽

Significant Difference ◽

Key Factor ◽

A Prospective Study

INTRODUCTION: Rhinogenic headaches are basically described as headache or facial pain caused by rhinological source. The presence of nasal symptoms & it’s temporal relationship with headache is the key factor that can guide the diagnosis and patient management. AIMS: This study aims to evaluate the efficacy of Septoplasty with Functional endoscopic sinus surgery (F.E.S.S) in the management of Rhinogenic headache. MATERIALS & METHODS: It was a Prospective study conducted in M.G.M Medical College & associated M.Y group of hospitals from March 2019 to March 2020. 64 patients of age group 18 years to 60 years having chronic rhinosinusitis with headache included in the study. After detailed history and thorough examination, nasal endoscopy and CT Paranasal sinus was done. Patients not responding to conservative management were selected for undergoing functional endoscopic sinus surgery. RESULTS: A total of 64 patients were included in the study,34 male & 30 female with the mean age group of 31.4 & 30.1 years respectively. Out of 64 patients,67% were completely free from headache,15% were significantly improved,7% had mild relief & 11% did not show any benefit in headache from surgery. Postoperatively, there was statistically significant difference was found patient’s symptomatology (i.e. p value =0.0165). CONCLUSION: To make the diagnosis both anatomical & infective factors needed to be considered. Correction of obvious anatomic abnormalities in carefully selected patients can significantly improve several important clinical outcomes from abolishing headache completely to decreasing its intensity and frequency of episodes. KEY-WORDS: Rhinogenic headaches, Septoplasty, Chronic rhinosinusitis, F.E.S.S, Nasal endoscopy

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Diagnosing chronic rhinosinusitis: a comparative study between diagnostic nasal endoscopy and computed tomographic scan paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213897 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1630

Author(s):

Dharmishtha H. Parmar ◽

Hiten R. Maniyar ◽

Hetna A. Patel

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Predictive Value ◽

Nasal Endoscopy ◽

P Value ◽

Computed Tomographic ◽

Heterogenous Group ◽

Operative Evaluation ◽

Accurate Procedure

Background: The term ‘rhinosinusitis’ refers to a heterogenous group of disorders characterized by inflammation of mucosa of the nose and paranasal sinuses. The National Institute of Allergy and Infectious Diseases (NIAID) have recently mentioned that 136 million people of India suffer from chronic rhino sinusitis.Methods: A total 50 patients with symptoms of rhinosinusitis were investigated with both diagnostic nasal endoscopy and CT scan paranasal sinuses and their findings were scored with particular scoring system and compared with each other. Results: Out of 50 patients, 90% patients were diagnosed on CT scan and 84% patients were diagnosed on nasal endoscopy. By considering CT scan as accurate procedure and correlating nasal endoscopy with CT scan, sensitivity was 88.88%, specificity was 60%, positive predictive value was 95.23%, negative predictive value was 37.5%, and p value was 0.004671, which was significant at p<0.05, indicates that CT paranasal sinuses is more accurate than diagnostic nasal endoscopy in diagnosing chronic rhinosinusitis.Conclusions: Both diagnostic nasal endoscopy and CT paranasal sinuses are important pre-operative evaluation tools in detecting pathology and both are complementary to each other. But CT paranasal sinuses are more convenient than endoscopy according to this study.

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Prevalence of sinonasal anatomical variations and their effect on chronic rhinosinusitis in Al-Ramadi teaching hospital, Ramadi city, Iraq

Muthanna Medical Journal ◽

10.52113/1/2410-4590/2021-35-39 ◽

2021 ◽

Vol 8 (1) ◽

pp. 35-39

Author(s):

Raid M. Al-Ani, ◽

Ghassan M. Khalaf

Keyword(s):

Chronic Rhinosinusitis ◽

Teaching Hospital ◽

Anatomical Variations ◽

Cross Sectional Study ◽

Ct Scans ◽

P Value ◽

Deviated Nasal Septum ◽

Cross Sectional ◽

Radiological Features ◽

Significant Difference

Anatomical variations (AVs) of the nose and paranasal sinuses (NPS) are quite common findings on CT scans. However, their effect on chronic rhinosinusitis (CRS) is still controversial. The objectives of this study is to estimate the prevalence of AVs of the NPS on CT scans and to assess the association between multiple versus single variant and CRS. A cross-sectional study was conducted in the Al-Ramadi Teaching Hospital during the period from January 1, 2018, to March 31, 2019. We reviewed the CT scans of the patients with suggestive symptoms and signs of CRS. Out of 203 CT scans, there were 153 (75.4%) scans associated with AVs of the NPS (group A). Seventy-eight with and 75 without radiological features of sinusitis. While group B (n=50 24.6%) were not detected any variants, 24 with and 26 without features of sinusitis. There was no statistically significant difference between the two groups (p-value>0.05). There were 11 AVs detected. The septal deviation of 63% was the commonest one. Most of the AVs of the NPS were multiple (2 or more) 99 (64.7%). Forty-nine (49.5%) of them were associated with features of sinusitis. There was a statistically significant difference (p-value <0.05) between those with multiple and those with single AVS concerning the radiological features of sinusitis. In conclusion; AVs of the sinonasal region were common findings on CT scans. A deviated nasal septum is the commonest AVs. Most of our patients contain more than 2 AVs, and they were more vulnerable to sinusitis.

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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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A CT Scan Study Showing Prevalence of Haller Cells in Patients with Sinonasal Complaints

Academia Anatomica International ◽

10.21276/aanat.2020.6.2.20 ◽

2020 ◽

Vol 6 (2) ◽

pp. 92-95

Author(s):

Raag Reeti ◽

Md Jawed Akhtar ◽

Avanish Kumar ◽

Rishi Mani Srivastava

Keyword(s):

Ct Scan ◽

Endoscopic Sinus Surgery ◽

Anatomical Variations ◽

Sinus Surgery ◽

Ct Scans ◽

Categorical Variables ◽

P Value ◽

Exact Test ◽

Significant Difference ◽

Males And Females

Background: Anterior ethmoid cells that extend into the maxillary sinus roof are known as Haller cells. They are commonly seen on the floor of the orbit. They may cause sinusitis symptoms by blocking the infundibulum, may get infected and also sometimes complicate the Functional Endoscopic Sinus Surgery (FESS). The present study was undertaken to determine the prevalence of Haller cells on CT scans in patients having sino-nasal complaints. Subjects and Methods : This was a descriptive observational study carried out on 150 patients who presented with various sino-nasal complaints and underwent a CT Scan in the Department of Radiodiagnosis, Bangur Institute of Neurosciences, Kolkata. Their CT scans were studied retrospectively for the presence of Haller cells. Radiological variations data were summarized by routine descriptive statistics namely counts and percentages for categorical variables. Fisher’s Exact Tests and were applied to calculate the ‘p’ value to find out any statistically significant difference between males and females. Results: Haller cells were found in 12% (18 cases) in the present study, 5.33% in males and 6.67% in females. ‘p’ value in this case was 0.616 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like Haller cells are quite common and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the Haller cells in Eastern India which will definitely help the FESS surgery and its outcomes.

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Evaluation of the Prevalence of Concha Bullosa in Cone-Beam Computed Tomography Images

Avicenna Journal of Dental Research ◽

10.34172/ajdr.2020.19 ◽

2020 ◽

Vol 12 (3) ◽

pp. 93-96

Author(s):

Nasim Shams ◽

Bahareh Shams ◽

Zahra Sajadi

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Middle Turbinate ◽

Cone Beam ◽

P Value ◽

Concha Bullosa ◽

Computed Tomography Images ◽

Significant Difference ◽

And Gender ◽

Sinus Ostium

Background: The ostiomeatal complex (OMC) is not a separate anatomical structure although it is a functional unit of structures, including the middle meatus, uncinate process, infundibulum, maxillary sinus ostium, ethmoidal bulla, anterior ethmoid sinus ostium, and frontal recess. Concha bullosa is the pneumatization of the concha, which is one of the most common anatomical variations in the middle turbinate. Methods: This study was conducted using the cone-beam computed tomography (CBCT) images of 172 patients in the archives of the Department of Oral and Maxillofacial Radiology, Dentistry School, Ahvaz Jundishapur. Patient information including age and gender, presence or absence of concha bullosa, the involved side (left or right), and its type (i.e., extensive, lamellar, and bulbous) were collected in the information form. Finally, the chi-square test (with SPSS, version 22) was used to analyze the data, and P value less than 0.05 was considered statistically significant. Results: Patients with and without concha bullosa were 39.1 and 41.7 years, respectively, but it was no significant difference in terms of age (P = 0.321). Out of 52 patients with concha bullosa, 19 (36.5%) cases were males and 33 (63.5%) of them were females. The prevalence of concha bullosa was higher for the bilateral side (20 patients, 38.5%, P = 0.000). The prevalence of bulbulsand lamellar-shape was nearly the same (32.7% and 30.8%, respectively). Eventually, the extensive shape with 36.5% was more frequent for the shape of concha bullosa (P = 0.000). Conclusions: The prevalence of concha bullosa was high. There was no significant difference in terms of age (P = 0.321) and gender (P = 0.058) of patients with concha bullosa. The extensive type and the bilateral appearance of concha bullosa were more significant (P = 0.000).

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EVALUATION OF DIAGNOSTICNASAL ENDOSCOPY AND CTSCAN IN VARIOUS SINONASAL DISEASES

International Journal of Advanced Research ◽

10.21474/ijar01/13662 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1144-1149

Author(s):

Ranjan Kumar ◽

◽

Rajeev Chandra ◽

Om Prakash ◽

◽

...

Keyword(s):

Ct Scan ◽

Surgical Intervention ◽

Maxillary Sinusitis ◽

Anatomical Variation ◽

Cost Effective ◽

Anatomical Variations ◽

Nasal Endoscopy ◽

Common Finding ◽

Polyp Detection ◽

Intervention Patient

Objective:To evaluate role of Diagnostic Nasal Endoscopy and CT scan in various Sinonasaldiseases with regards to diagnosis and surgical intervention. Patient and methods:This prospective study was carried out in Department of ENT, A.N.M.M.C.H., Gaya on 200 patients with clinical evidence of sinonasal disease who had presented between March 2016 to February 2019. All patients were evaluated with DNE using 0 degree 4mm endoscope and CT scan with 3 mm coronal cuts. Result: Female patients(56%) were more as compared to male(44%) with majority between 21 - 40 yrs. Most common finding on Diagnostic Nasal Endoscopy(DNE) was mucopurulent discharge in middle meatuswhile on CT Scan was maxillary sinusitis(60%). Sinonasal polyp detection was better with DNE.CT has better detection rate of anatomical variation of osteomeatal complex. Conclusion : DNE has become initial tool for diagnosis as it is cost effective and office based procedure. In patients where surgical intervention is required, CT scan has advantage as it provides detailed understanding of anatomical variations. So bothDNE and CT scan should be used in collaborative fashion. Source Of Support:Patients of A.N.M.C.H., Gaya. Conflict Of Interest:None.

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Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1713461 ◽

2020 ◽

Vol 17 (02) ◽

pp. 110-120

Author(s):

Ramesh Chandra Vemula ◽

B. C.M. Prasad ◽

Venkat Koyalmantham ◽

Kunal Kumar

Keyword(s):

Ct Scan ◽

Recurrence Rate ◽

Subdural Hematoma ◽

Surgical Intervention ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

P Value ◽

First Choice ◽

Significant Difference ◽

Preoperative Ct

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

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Thoax CT Scan as Invasive Fungal Infection (IFI) Screening In Neutropenic Patients, a Prospective-Retrospective Experience of It Impact on Therapeutic Intervention.

Blood ◽

10.1182/blood.v116.21.4554.4554 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4554-4554

Author(s):

Sebastian Sevilla ◽

Gustavo Daniel Kusminsky ◽

Mario Atilio Damiano ◽

Miguel Rizzo ◽

Jose Trucco

Keyword(s):

Ct Scan ◽

Conflicts Of Interest ◽

Antimicrobial Treatment ◽

Antifungal Treatment ◽

Ct Scans ◽

Diagnostic Tools ◽

Persistent Fever ◽

Pulmonary Infiltrates ◽

Neutropenic Patients ◽

Thorax Ct

Abstract Abstract 4554 Introduction: Persistent fever in high risk neutropenic patients (HRNF) after day 5 of empiric treatment is a sign of high susceptibility for IFI with elevated morbidity and mortality. Diagnostic tools in this setting are inaccurate to determine the occurrence of IFI and most patients start with empiric antifungal agents. Drugs are usually associated with increasing costs and toxicity. It is challenging to establish the population of patients in whom in spite of persistent fever and neutropenia, avoidance of antifungal treatment is a reasonable strategy. Methods: We have prospectively allocated 229 HRNF patients in different empiric antimicrobial regimens over a 4.5 year period. In a retrospective revision, there were 33 patients with persistent fever on day 5 of empirical antimicrobial treatment and no evident new infection episode or clinical impairment. In 28 patients, a thorax CT scan was performed as part of the evaluation of persistent fever. The clinical outcome was evaluated regarding the presence or absence of pulmonary infiltrates in the CT scans. Initial empiric antifungal treatment, transfusions, days in hospital, days with neutropenia, antimicrobial treatment, and days with fever were evaluated. Results: Nineteen patients (68%) of 28 presented with pulmonary infiltrates. All of them received antifungal treatment. In 9 patients with normal CT scan antifungal treatment was deferred. The difference of the decision in not giving antifungals according CT scans was highly significant (p <0,0001). Transfusions of red blood cells and platelets were significantly less in the group of normal scans (p 0,0004 and 0,005 respectively). Antimicrobial treatment, days in hospital and days with fever were not significantly different in both groups. There was one death in the normal scan group due to relapse. Mortality was not significantly different in both groups. Conclusion: In HRNP, normal thorax CT scan changed the clinical decision in not starting antifungal treatment in spite of persistent fever. There was no difference in mortality with patients under antifungal treatment, allowing continuing with this strategy in more patients in the future. Disclosures: No relevant conflicts of interest to declare.

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A Study on the Efficacy of Saline Nasal Irrigation in Chronic Rhinosinusitis

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/463 ◽

2021 ◽

Vol 10 (30) ◽

pp. 2266-2270

Author(s):

Rachana Ramachandran ◽

Santhi Thankappan Pillai

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Post Treatment ◽

Oral Drug ◽

P Value ◽

Saline Irrigation ◽

Nasal Irrigation ◽

Significant Difference ◽

Chronic Rhino Sinusitis

BACKGROUND The objective of this study was to test as to whether daily saline nasal irrigation improved sinus symptoms in adult subjects with chronic rhino sinusitis, and also study the safety of saline irrigation, incidence of any complication and improvement in quality of life in these patients. METHODS This was a prospective observational study conducted between two groups of patients at Government TD Medical College, Alappuzha. Patients who satisfied the criteria for diagnosing chronic rhino sinusitis were included in the study. The first group was given saline nasal irrigation with oral drug therapy while the second group was put on oral drugs alone. Each subject was given a pretested, structured questionnaire. Along with socio-demographic information, the questionnaire also contained queries of quality of life measure, compliance of nasal irrigation and adverse effects following its use. RESULTS The pre-treatment scores and post treatment scores were analysed and the results were statistically significant with P values of < 0.001 in all. 77 % of the patients in the saline irrigation group were strictly using saline nasal irrigation which meant a satisfactory compliance and the improvement in post treatment scores was statistically highly significant with a P value of < 0.001. Also there was a statistically significant difference between the mean pre-test and post test scores of the two groups with P value of < 0.001 and t value of 51.942 using the paired t test. CONCLUSIONS Chronic rhinosinusitis has a major negative impact on the healthcare and economy of not only the patients but also of the society. Saline nasal irrigation is an effective yet easy method of therapy in alleviating the symptoms of chronic rhinosinusitis and improving the quality of life in these chronic sufferers. KEY WORDS Chronic Rhinosinusitis, Saline Nasal Irrigation, Quality of Life, Economic Burden

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