CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients

Abstract

CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection. (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases.Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven.Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis.The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.

Computerised Tomographic Evaluation of Structural Variations in Sinonasal Region and its Clinical Correlation

“…(Table 5 In our study, uncinate pneumatization was seen in 12 (11.3%) cases of which 10 (9.43%) were bilateral and only 02 (1.89%) were on the right side. These findings correlated to Lloyd GAS et al, (1991) who reported 16 % cases of uncinate pnuematization [25].…”

Concha bullosa: types and relationship with chronic sinusitis

“…3,4 Lloyd et al have stated that when CB occupies the space between the septum and the lateral nasal wall, there may be total impediment of the middle meatus orifice. 14,15 In our study we found that there was no significant relation between presence of concha bullosa and occurrence of sinusitis even on segregating the data for comparing type of concha bullosa with occurrence of sinusitis no significant relation was found. One of the drawbacks of the present study was that the concha bullosa dimensions were not taken into account.…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…In practice, interviews concerning the causal relation, frequency, latent period and atopic disposition often provide suggestions but sometimes give unreliable evidence to base the diagnosis of occupational nasal allergy. Therefore, nasal provocation tests (144,(1314)(1315)(1316)(1317) are necessary to confirm the causality between the disease and any work exposure (1390 Computerized tomography has become the principal radiological investigation for major sinonasal disorders but is of limited use in the diagnosis of allergic rhinitis (1392)(1393)(1394)(1395)(1396). Computerized tomography scans can be carried out after receiving specialist advice:…”