Unilateral versus bilateral sinonasal disease: Considerations in differential diagnosis and workup

Abstract

Objective Imaging findings play an important role in the workup and diagnosis of sinonasal disease. Unilateral versus bilateral involvement is a key finding that can differentiate between various diagnoses. Our objective is to characterize presenting symptoms, imaging findings, and most common diagnoses associated with unilateral versus bilateral sinonasal disease. Methods Patients who underwent surgical intervention for sinonasal disease at Emory University between May 2015 and December 2016 were included in the study. Information including demographic variables, comorbidities, presenting symptoms, imaging findings, and pathologic diagnosis was collected for each patient. Unilateral versus bilateral disease was determined by preoperative computer tomography and magnetic resonance imaging, and correlated to surgical and pathologic findings. Data was analyzed using quantitative methodologies and descriptive statistics. Results The study cohort consisted of 250 patients presenting for primary sinonasal surgery, including 110 patients with unilateral disease and 140 patients with bilateral disease. The most common diagnosis for patients with bilateral disease was chronic rhinosinusitis with nasal polyps (46%) followed by chronic rhinosinusitis without polyps (26%). For patients with unilateral disease the most common diagnoses were chronic rhinosinusitis without nasal polyps (21%), malignancy (19%), benign neoplasm (15%), and allergic fungal sinusitis (10%). There was a statistically significant association between unilateral sinonasal disease and the final diagnosis of benign neoplasm (OR = 7.8, P < .01) and malignancy (OR = 8, P < .01). Conclusion Patients with unilateral sinus disease on initial imaging are less likely chronic rhinosinusitis compared to patients with bilateral disease. This should be taken into consideration in the workup and management of patients with unilateral sinus disease. Level of Evidence 3 Laryngoscope, 130:E116–E121, 2020

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…To rule out the primary headache and similar disorders, such as myofascial pain and temporomandibular joint pain, an accurate history and physical exam are needed. Chronic dental infection, foreign body, and both benign and malignant sinonasal neoplasia must be included in the differential diagnosis of unilateral CRS 539 . S 1 Most of these conditions can be eliminated by a thorough physical exam including nasal endoscopy along with appropriate imaging (CT or MRI).…”

Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach—Long-Term Outcome and Literature Review

“…The likelihood of a final diagnosis of a benign or malignant tumor is increased approximately eight-fold in unilateral versus bilateral sinonasal disease [1,4]. IP is found in up to 17% of patients with unilateral sinus disease [2].…”

“…There are several differential diagnoses of unilateral sinus disease with or without polypoid masses in the nasal cavity and middle meatus, e.g. asymmetric manifestation of bilateral chronic rhinosinusitis, odontogenic sinusitis, (antro)choanal polyp, otherwise undefined isolated nasal polyps and benign or malignant tumors [1,2,3,4]. Tumors can mimic inflammatory lesions due to superficial edema hiding the typical endoscopic appearance of such tumors.…”

Computed Tomography Findings Can Help Identify Different Chronic Rhinosinusitis With Nasal Polyp Phenotypes

“…Preoperative computed tomography (CT) findings may aid in this evaluation, with previous work focusing on common diagnoses for unilateral compared to bilateral disease processes. 4 , 5 For example, AFRS patients often demonstrate unilateral disease, heterogeneous opacification, and expansion of the sinuses. 6 Recently, our group and others have identified that patients with CCAD demonstrate septal and centrally located mucosal thickening on CT scan.…”