EVALUATION OF DIAGNOSTICNASAL ENDOSCOPY AND CTSCAN IN VARIOUS SINONASAL DISEASES

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Evaluation of nose and paranasal sinus disease, anatomical variations by computerized tomography

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174204 ◽

2017 ◽

Vol 3 (4) ◽

pp. 898

Author(s):

Prakash S. Handi ◽

Mallikarjun N. Patil

Keyword(s):

Ct Scan ◽

Paranasal Sinuses ◽

Anatomical Variation ◽

Anatomical Variations ◽

Sinus Surgery ◽

Type I ◽

Deviated Nasal Septum ◽

Radiologic Evaluation ◽

Road Map ◽

Preoperative Information

Background: The anatomy of paranasal sinuses is very complicated. Evaluation of the location, extent of sino nasal diseases and anatomical variations by preoperative radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology.Methods: Patients with sinonasal symptoms indicating requirement of CT scan evaluation and aged more than 10 years were included in the study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions. Results: Sinusitis (single or multiple sinus involvement), nasal polyposis, frontal mucocele and ethmoidal carcinoma with destruction of medial wall of maxilla were the pathologies observed in these CT scans with sinusitis [22 (43.1%)] being the most common pathology observed. Deviated nasal septum [21 (41.2%)] was the most common anatomical variation observed. All patients who had concha bullosa [5 (9.8%)] were observed to have sinusitis involving multiple bilateral PNS. Based on Keros’ classification, olfactory fossa depth type I was most commonly observed followed by type II and type III.Conclusions: CT scan is important in patients undergoing endoscopic sinus surgery for sinonasal diseases where it acts as a road map in identifying the presence, extent of disease and any anatomical variations. This pre-operative CT scan evaluation improves planning and helps in significantly reducing morbidity and possible complications during surgery.

Download Full-text

Nasal endoscopy in chronic maxillary sinusitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100108692 ◽

1989 ◽

Vol 103 (3) ◽

pp. 275-278 ◽

Cited By ~ 8

Author(s):

R. H. Kamel

Keyword(s):

Endoscopic Sinus Surgery ◽

Maxillary Sinusitis ◽

Anatomical Variations ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Middle Meatus ◽

Egyptian Patients ◽

Chronic Maxillary Sinusitis

AbstractThe role of the anterior ethmoids in the pathogenesis of chronic maxillary sinusitis is still a subject of controversy. Although the symptoms of maxillary sinusitis may be clinically dominant, many previous studies have showed that the origin of this disease was, in most cases, located within the anterior ethmoid region.This study included 100 Egyptian patients, suffering from chronic maxillary sinusitis (confirmed by maxillary sinoscopy), who were subjected to ‘systematic nasal endoscopy’. It was found that all cases of chronic maxillary sinusitis were associated with anatomical variations and/or pathological abnormalities of ‘the ostiomeatal area’. It is recommended, therefore, that during the diagnosis and treatment of chronic maxillary sinusitis, attention should be given to the region of the middle meatus and anterior ethmoid complex (or ‘ostiomeatal area’) for any anatomical variations and/or pathological abnormalities in order to avoid recurrence of maxillary sinusitis. This is the basis of the procedure of functional endoscopic sinus surgery.

Download Full-text

Correlation : Anatomical Variations of Nasal Cavity and Paranasal Sinuses and the Quality of Life Based on SNOTT-22 Score

Saintika Medika ◽

10.22219/sm.vol17.smumm1.13763 ◽

2021 ◽

Vol 17 (1) ◽

pp. 49-60

Author(s):

Rani Rahmawati

Keyword(s):

Quality Of Life ◽

Ct Scan ◽

Nasal Cavity ◽

Paranasal Sinuses ◽

Anatomical Variation ◽

Anatomical Variations ◽

Uncinate Process ◽

Paranasal Sinuses Ct ◽

Snot 22

This study aims to determine the correlation between the anatomical variations of nasal cavity and paranasal sinuses and the quality of life based on SNOT-22 score in the patients who underwent paranasal sinuses CT scan. The samples are 36 patients with age ≥ 18 years. The method is Chi Square test / Fisher's test and Spearman’s rho test. The results showed that anatomical variations of the nasal cavity and paranasal sinuses from most of the patients who underwent paranasal sinuses CT scan had septal deviation n = 29, p = 0.007 (p <0.05) and concha bullosa n = 15, p = 0.029 (p <0.05). There was a significant correlation between total anatomical variation and quality of life based on SNOT-22 score in the patients who underwent paranasal sinuses CT scan p = 0.025 (p <0.05). There was no correlation between the anatomical variations of frontal cells, agger nasi cells, ethmoid bulla, uncinate process and haller cells and the quality of life based on SNOT-22 score in the patients who underwent paranasal sinuses CT scan.

Download Full-text

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.

Download Full-text

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.

Download Full-text

A comparative analysis of CT scan versus diagnostic nasal endoscopy in chronic rhino sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182401 ◽

2018 ◽

Vol 4 (4) ◽

pp. 930

Author(s):

Ahamed Nauphal Pullarat ◽

Shakeeber Kottayil ◽

Girish Raj ◽

Basheer N. K.

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Anatomical Variations ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Common Symptom ◽

Medical College ◽

Sinus Cavity ◽

Chronic Rhino Sinusitis ◽

Extent Of Disease

Background: With the advent of nasal endoscopy (DNE) and computed tomography (CT) in the evaluation of patients with chronic rhinosinusitis, it has popularized the functional endoscopic sinus surgery. The objective of this study is to find out effectiveness and limitations of CT and DNE in chronic rhinosinusitis.Methods: Patients attending the Otorhinolaryngology outpatient department of MES medical college with chronic rhinosinusitis (CRS), who satisfy the inclusion criteria, were included in the study. They were given a course of antibiotics and antihistamines for a period of 10 days prior to CT Nose & PNS followed by an interval of 5 days nasal endoscopy done and findings were compared. Results: In this study, 58% cases were males and 42% females, most common symptom was a headache (76%). In DNE 82% cases had septal deviation and 86% in CT scan. Most common sinus cavity involved in CT scan was maxillary sinus.Conclusions: CT scan has got a better advantage compared to DNE in detecting the anatomical variations as well as to know the condition of the sinus cavity and the extent of disease in sinuses. In conditions like middle meatal secretions, mucosal change, polyp DNE gave a better picture of the condition. Both DNE and CT scan are complementary to each other in CRS.

Download Full-text

Odontogenic Maxillary Sinusitis: Therapeutic Management of Cases with Oroantral Fistulae

Sinusitis ◽

10.3390/sinusitis5010006 ◽

2021 ◽

Vol 5 (1) ◽

pp. 53-58

Author(s):

Yasutaka Yun ◽

Masao Yagi ◽

Tomofumi Sakagami ◽

Shunsuke Sawada ◽

Yuka Kojima ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Surgical Intervention ◽

Maxillary Sinusitis ◽

Sinus Surgery ◽

Fistula Closure ◽

Treatment Resistant ◽

Oroantral Fistula

Odontogenic maxillary sinusitis (OMS) is a disease in which inflammation from the teeth extend into the maxillary sinus, causing symptoms of unilateral sinusitis. OMS can recur, with some being resistant to antibiotics. In intractable cases, exodontia and endoscopic sinus surgery (ESS) are necessary treatments. Here we report our analysis on the indications for surgical intervention in cases diagnosed with and treated as OMS. We retrospectively examined 186 patients who were diagnosed with sinusitis on a computed tomography (CT) scan. For cases diagnosed with OMS, the site of the causative tooth and the presence or absence of oroantral fistula to the maxillary sinus was examined. In addition, we analyzed the therapeutic efficacy of the initial treatment of antibiotics, and what the indications were for ESS. Among the patients examined, OMS was diagnosed in 44 cases (23.6%). In 14 out of 20 cases that underwent a post-medical treatment CT scan, OMS found to be treatment-resistant. Of these 14 cases, 12 (88%) had oroantral fistulae to the maxillary sinus. In all cases where exodontia, fistula closure surgery, and endoscopic sinus surgery (ESS) were performed, the fistula disappeared and the shadow of inflammation in the paranasal sinus improved. In OMS with oroantral fistula, ESS, exodontia, and fistula closure should be recommended over medication such as macrolide therapy.

Download Full-text

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191741 ◽

2019 ◽

Vol 5 (3) ◽

pp. 739

Author(s):

Shruti Baruah ◽

Pratibha Vyas ◽

Arpit Srivastava

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Middle Turbinate ◽

Ct Imaging ◽

Ct Scans ◽

Nasal Endoscopy ◽

Common Finding ◽

Diagnostic Tools ◽

P Value ◽

Significant Difference

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.

Download Full-text