The impact of sinus computed tomography on treatment decisions for chronic sinusitis

OBJECTIVES: To determine the impact of sinus computed tomography (CT) on treatment decisions by otolaryngologists and to explore the factors leading to choice of surgical treatment for patients suspected of having chronic sinusitis. DESIGN: Prospective cohort study. SETTING: A tertiary academic medical center. PATIENTS: Questionnaires were administered to 3 otolaryngologists in a tertiary academic institution regarding diagnosis and treatment decisions in 27 patients suspected of having chronic sinusitis, before and after they reviewed sinus CT scans. MAIN OUTCOME MEASURES: The dichotomous decisions regarding surgical or nonsurgical treatment and the agreement of treatment decisions among surgeons were evaluated. The factors strongly influencing surgeons' treatment decisions regarding patients selected for surgery were also determined. RESULTS: The dichotomous treatment decisions were changed in one third of patients (9 of 27) after the sinus CT scans were reviewed. The agreement of treatment decisions among the 3 surgeons was markedly improved after they reviewed sinus CT scans. The factors favorably influencing surgical treatment were obstruction of the ostiomeatal complex on CT and concordance of CT abnormality with a patient's symptoms. Lund-Mackay stage, symptoms, and corticosteroid or antibiotic use were not significant predictors. CONCLUSIONS: Despite the common belief that treatment decisions for chronic sinusitis should be solely based on clinical grounds, with sinus CT providing only anatomic detail before surgery, our study indicates that the decision to perform surgery was altered by CT in a substantial portion of the patients. In our preliminary study, CT increased the tendency to elect surgical treatment by all 3 surgeons.     

Risk assessment in coronal computed tomography scans of the paranasal sinuses

Computed tomography (CT) is a prerequisite to planning and performing FESS procedures. No standards exist for assessing the risk to the anatomical structures in the proximity of the nose and sinuses associated with surgery. The aim is to assess the agreement of surgeons in identifying key areas related to the anterior skull base and the orbit on coronal CT scans. A cross-sectional study involving five otolaryngologists from three centres related the scans. Two scoring systems were used to rate each film; the Lund-MacKay system and a risk assessment system. The latter system was compiled and agreed upon by the authors. κ analysis was used for measurement of inter-observer agreement. A consecutive series of patients undergoing CT scanning in advance of paranasal sinus surgery formed the study population. Patients who had previous surgery, anterior skull base trauma or were suspected of malignant disease were excluded. Twenty-nine scans were reviewed. There was moderate agreement using the Lund-MacKay system (median value 0.5) values. The risk assessment system showed moderate agreement in two of 11 parameters (pneumatized ethmoid roof 0.58 and uncinate process variations 0.43), poor agreement on the other parameters assessed (range ?0.06–0.21). The difficulties encountered in judging vulnerability or anatomical structures on coronal CT of sinuses may relate to a lack of clear definitions of structures, subtle degree of variation or technical aspects of scanning.     

Nasal septal mucosal contact points: associated symptoms and sinus CT scan scoring

An association between nasal septal mucosal contact points and facial pain has often been quoted, but may be coincidental. CT scans of 100 consecutive rhinology patients were examined for contact points, and the sinuses were scored according to the Lund-Mackay system. The patients' nasal symptoms were recorded using validated questions. Contact of the nasal septum with the lateral nasal structures was identified in 55 patients. The presence of contact was significantly (P < 0.01) associated with nasal blockage and reduction of smell, but there was no association with facial pain. The median Lund-Mackay score for scans with contact was significantly greater than the score for scans without contact. Whereas the results of the study support the hypothesis that nasal contact may impede ventilation and drainage of the paranasal sinuses, the study finds no evidence to support the concept that contact points cause facial pain or headaches.     

真菌性鼻窦炎主观评价与客观检查的相关性研究

目的：通过对真菌性鼻-鼻窦炎（FRS）患者主观评价和客观检查方法的研究,了解FRS对患者生活质量的影响,分析FRS患者主观评价之间,客观检查方法之间以及主观评估与客观检查方法之间的相关性。方法：收集18例FRS患者的鼻腔鼻窦结局测量20条（SNOT-20）及视觉模拟量表（VAS）、Lund-Kennedy鼻内镜评分以及Lund-Mackay CT评分数据,并对这些数据进行相关性分析。结果：在SNOT-20中得分最高的前6项为：头面部疼痛及压迫感;流脓涕;需要擤鼻涕;打喷嚏;疲倦;沮丧、焦躁、易怒。SNOT-20总分与其他主客观评分之间无相关性（P〉0.05）,SNOT-20鼻部症状评分与Lund-Mackay CT评分呈正相关（r=0.536,P〈0.05）,SNOT-20睡眠症状评分与VAS评分呈正相关（r=0.605,P〈0.01）。VAS评分与Lund-Mackay CT评分正相关性（r=0.615 0,P〈0.01）,Lund-Mackay CT评分和Lund-Kennedy鼻内镜检查评分呈正相关（r=0.500 4,P〈0.05）,Lund-Kennedy鼻内镜检查与主观调查量表之间在统计学上无相关性（P〉0.05）。结论：FRS患者的客观评价方法之间有着较好的相关性,Lund-Mackay CT评分与SNOT-20鼻部症状评分以及VAS评分之间有相关性,SNOT-20睡眠症状评分与VAS评分呈正相关。     

慢性鼻窦炎骨炎患者病情程度的危险因素

目的 探讨慢性鼻窦炎骨炎患者病情程度的危险因素及预防对策.方法 对2011年4月～2014年4月期间本院收治的120例慢性鼻窦炎患者的手术治疗及临床资料进行回顾性分析,对影响患者病情程度的危险因素进行Logistic回归分析.结果 本组慢性鼻窦炎病例中,有65例（54.17％）合并骨炎,与未合并骨炎患者比较,其慢性鼻窦炎病程、合并哮喘比例、伴发鼻息肉比例、手术次数、Lund Kennedy评分、Lund Mackay评分、GOSS评分等指标差异有统计学意义（P＜0.05）,尤其慢性鼻窦炎病程、Lund Kennedy评分、LundMackay评分及手术次数等,均是影响慢性鼻窦炎骨炎患者全球骨炎评分（GOSS）的独立危险因素（P＜0.05）.结论 慢性鼻窦炎患者骨炎的发生与手术次数、慢性鼻窦炎病程、Lund-Kennedy评分、Lund-Mackay评分等因素密切相关,应规范鼻窦手术操作,预防骨炎的发生。     

导航辅助鼻内镜下复发性鼻窦炎全组鼻窦开放策略

鼻内镜手术是鼻科手术的里程碑，而计算机辅助导航鼻内镜手术则是鼻科又一个里程碑。笔者所在科室自2005年采用美敦力光学导航行导航辅助鼻内镜手术近2000例。本文重点讨论导航辅助鼻内镜下复发性鼻窦炎全组鼻窦开放策略。首先是术前需要拍摄鼻窦导航CT，行导航般阅片，对鼻窦按改良Lund-Mackay方法评分，对额隐窝各种气房进行识别，分析额窦引流通道，按High CLOSE方法对鼻窦及周围重要解剖标志进行严密阅片，然后按术前导航般阅片制定手术策略，术中在导航引导下按术前影像分析，按着解剖标志逐一开放全组鼻窦。导航辅助鼻内镜手术是在有扎实的解剖学基础，有导航般阅片能力基础上使用的。计算机辅助导航系统的应用可以让医师更好的对复发性鼻窦炎行全组鼻窦开放术。     

鼻腔结构重塑在慢性鼻-鼻窦炎治疗前后的主客观评估及相关性研究

目的探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者行鼻腔结构重塑前后的主客观评估及相关性研究。方法对70例CRS患者鼻内镜下行下鼻甲射频消融外移术、中鼻甲成形术及窦口鼻道复合体功能性切除术,同期行鼻中隔黏膜下矫正术。术前对所有患者作主观症状视觉模拟量表(visual analog scale,VAS)调查、客观检查及评分、Lund-Kennedy内镜评分和Lund-Mackay CT评分。术后随访1年,分别行以上3种评分,并作相关性分析。结果术前VAS评分总分与CT评分呈显著正相关(r=0.39,P<0.01),内镜评分与CT评分呈正相关(r=2.11,P<0.05),但嗅觉障碍的VAS评分与内镜、CT评分无相关性,差异无统计学意义。术前VAS与术后VAS评分差异具有统计学意义(t=39.51,P<0.01),术后VAS与术后内镜评分差异具有统计学意义(r=0.59,P<0.01),术前与术后Lund-Kennedy内镜评分比较差异具有统计学意义(t=39.30,P<0.01)。结论术前VAS评分、CT评分、内镜评分呈正相关,术后随访1年,手术后主观症状VAS总分与术前差异具有统计学意义,与术后Lund-Kennedy内镜评分呈正相关。术前及术后的鼻塞、头晕、面部疼痛、鼻漏症状与客观评估有相关性。手术需多方面评价,有利于个体化的手术。     

Relationship between sinusitis and adenoid size in pediatric age group

OBJECTIVES: We sought to examine the relationship between adenoid volume and the stage of rhinosinusitis, as well as the relationship between age and adenoid size. METHODS: Forty-two children complaining of nasal discharge, whose paranasal sinus computed tomographic scans had been obtained, were involved in the study. The patients with adenoid enlargement underwent adenoidectomy. The volumes of adenoid vegetation were measured in square centimeters, and paranasal sinus computed tomographic scans were classified according to the Lund-Mackay staging system. RESULTS: No statistically significant difference existed between patients whose Lund-Mackay scores were 0 and those with scores greater than 0. There seems to be no correlation between the Lund-Mackay score and the degree of adenoid vegetation. CONCLUSIONS: Adenoid vegetation may cause nasal discharge that is not necessarily due to sinusitis. We could not find any supportive data for the statement "The greater the adenoid tissue, the more extensive the sinusitis."     

主观感觉评估与解剖结构及鼻功能测量在慢性鼻窦炎中的相关性研究

目的 探讨主观感觉测量与解剖结构及鼻功能测量在慢性鼻窦炎疾病中的相关性。方法 选择2019年9月-2020年10月在山西医科大学附属汾阳医院耳鼻咽喉科就诊的慢性鼻窦炎患者43例。分别应用视觉模拟量表评估患者鼻塞主观症状;Lund-Mackay评分和Lund-Kennedy评分系统评估鼻窦CT及鼻内镜检查结果;鼻声反射、鼻阻力测量评估鼻腔通气情况,采用SPSS 19.0软件对其相关性进行统计学分析。结果 Spearman相关性显示,慢性鼻窦炎患者鼻塞视觉模拟评分量表（VAS）评分与最小横截面积2（MCA2）、最小横截面积距离前鼻孔的距离2（MD2）、距鼻孔2~5 cm鼻腔容积（Vol2~5）呈负相关（P<0.05）,与鼻腔有效阻力、Lund-Mackay评分、Lund-Kennedy评分呈正相关（P<0.05）;Lund-Mackay评分、Lund-Kennedy评分与鼻声反射、鼻阻力呈相关性（P<0.05）。结论 主观感觉测量、解剖结构测量及鼻功能测量相联合能综合评估慢性鼻窦炎患者鼻塞病情的严重程度,有利于治疗方案的选择。     

Learning curve of septomeatoplasty

Objective

To determine the time for us to train a well-trained surgeon to perform septomeatoplasty.

Material and methods

From July 1, 2003 to June 30, 2007, we included 75 patients with nasal septal deviation and chronic hypertrophic rhinitis received septomeatoplasty into this study. All the procedures were performed by four surgeons trained in the same tertiary referral center. We stratified the patients into groups according to the surgeon level at the time of the operations performed. We analyzed the operation time, surgical complications and hospital stay length of these patients.

Results

We stratified the patients according to surgeon years, from year two to year five. The surgical or operation time of the 3rd, the 4th and the 5th year surgeons was statistically shorter than that of the 2nd year surgeons. The operation time of the 4th and 5th year surgeons was statistically shorter than that of the 3rd year surgeons and the operation time of the 5th was also statistically shorter than that of the 4th year surgeons. The hospital stay length of the 4th and the 5th year surgeons was significantly shorter than that of the 3rd year surgeons. No significant difference was noted between that of the 4th and the 5th surgeons. There was no difference on surgical complication among all year group.

Conclusion

Surgeon's years of experience could make the difference on the speed of operation and may also shorten hospital stay length. We conclude that it takes at least five years for us to train a well-trained surgeon for septomeatoplasty.     

改良鼻窦CT嗅区评分对慢性鼻-鼻窦炎鼻息肉嗅觉评估及预后判断的价值

目的　探讨改良鼻窦CT嗅区评分对慢性鼻-鼻窦炎鼻息肉患者术前嗅觉功能评估及术后嗅觉功能判断的价值。方法　前瞻性分析慢性鼻-鼻窦炎鼻息肉患者54例,排除合并哮喘、变应性鼻炎和伴有可能影响嗅觉功能的系统性因素。所有患者均接受功能性鼻内镜手术和规范的药物治疗,并行术后随访。根据鼻窦CT冠状位嗅裂区堵塞程度评为0、1、2分,分别对嗅裂前区（anterior olfactory cleft score,AOCS）（中鼻甲对应嗅裂区）和嗅裂后区（posterior olfactory cleft score,POCS）（上鼻甲对应嗅裂区）进行评分。术前所有患者均进行T&T嗅觉检测、嗅觉VAS评分和改良鼻窦CT嗅区评分和鼻窦CT Lund-Mackay评分,术后行T&T嗅觉检测、嗅觉VAS评分。分别将患者术前及术后6个月嗅觉阈值、嗅觉VAS评分与改良鼻窦CT嗅区评分和Lund-Mackay评分进行线性回归分析。结果　本研究纳入慢性鼻-鼻窦炎鼻息肉患者54例,其中男性36例,女性18例,平均年龄47.9岁（24～67岁）,其中30例患者随访达到6个月。线性回归分析结果显示,患者T&T嗅觉阈值与嗅觉VAS评分有显著相关性（Pearson相关系数r =0.70,P <0.01）。手 术前改良鼻窦CT嗅区评分AOCS和POCS均与嗅觉阈值评分、嗅觉VAS评分显著正相关（P <0.001）,Lund-Mackay评分与嗅觉阈值也有弱相关性（R 2=0.262,P =0.005）。手术前鼻窦CT嗅区评分AOCS、POCS与术后6个月的嗅觉阈值亦有相关性（R 2=0.211、0.181,P =0.014、0.024）,且术前AOCS与术后6个月嗅觉阈值正相关性更强。术前Lund-Mackay评分与术后6个月嗅觉阈值无相关性（R 2=0.073,P =0.165）。结论　改良鼻窦CT嗅区评分可作为慢性鼻-鼻窦炎鼻息肉患者术前嗅觉功能和功能性鼻内镜手术后嗅觉功能预后的客观评价指标。中鼻甲对应的嗅裂区的病变程度对嗅觉功能评价作用更重要。     

New bone formation in unilateral rhinosinusitis

BACKGROUND: Computed tomography (CT) frequently shows abnormal bone thickening in patients with chronic rhinosinusitis. The sinus bone may be not in a static state, and remodeling occurs in response to chronic inflammation. METHODS: Ostiomeatal unit CT scans were reviewed in 29 patients with unilateral rhinosinusitis (URS) undergoing endoscopic sinus surgery. We defined new bone formation (NBF) as a remarkable bone thickening or hyperostosis of the intrinsic sinus walls in comparison with the normal side. Bony CT scores of sinus walls were expressed by the Hounsfield unit (HU) and soft tissue CT scores were measured by the Lund-Mackay system. RESULTS: Almost all of the NBF was located at the maxillary and anterior ethmoid sinuses (83.7%), and it was significantly increased in patients with higher Lund-Mackay scores (p = 0.043). The HU values were significantly different between NBF and non-NBF contralateral sides (p < 0.05). CONCLUSION: The HU may be helpful to diagnose and quantify the bone remodeling in URS.     

变应性因素对慢性鼻-鼻窦炎影响的研究

目的:探讨变应性因素与慢性鼻-鼻窦炎(CRS)疾病严重程度之间的相关性以及其对CRS的病情发展和转归的影响.方法:101例CRS患者进行变应性因素血清相关指标检测:血清总IgE浓度、血清特异性变应原IgE半定量检测、血清嗜酸粒细胞阳离子蛋白(ECP)浓度及病史询问、Lund-Mackay CT系统评分.结果:CRS组血清总IgE浓度及血清ECP浓度均高于正常对照组(P＜0.01);CRS组血清总IgE浓度增高发生率及血清ECP浓度增高发生率随着临床分型的加重而显著增加,并且在有既往相关手术史的患者中较无相关手术史患者中亦有显著增高(P＜0.05);血清总IgE浓度及血清ECP浓度增高患者的平均Lund-Mackay CT评分较浓度正常患者CT评分有显著性增高.CRS组血清特异性变应原IgE半定量检测阳性率为67.32%,强阳性率27.72%;各分型之间特异性变应原强阳性率差异有统计学意义(P＜0.05);有既往相关手术史的患者变应原强阳性率较无手术史患者的强阳性率显著性增高(P＜0.05);变应原强阳性患者CT评分较阴性患者CT评分有显著性增高(P＜0.05).结论:变应性因素对CRS的病变程度有一定负面作用,是影响疾病严重度及手术预后的不良因素.     

Risk factors for recurrent sinus surgery in cystic fibrosis: review of a decade of experience

BACKGROUND: Patients with cystic fibrosis (CF) who undergo endoscopic sinus surgery often require multiple revision procedures. Our objective was to identify risk factors for revision sinus surgery in patients with CF, to better identify this subset of patients who might be better suited for alternative interventions at their initial procedure. METHODS: Patients with CF who presented to our academic tertiary care sinus clinic between 1994 and 2003 were reviewed. Data were collected from CT scans using the Lund-Mackay scale. Data are collected on demographics, comorbidities, CF genotype, number and type of sinus surgeries, and pulmonary function tests. RESULTS: Eighty-one patients met inclusion criteria. Fifty patients were <18 years old at presentation. Forty-one patients were A508 homozygotes, 32 patients were A508 heterozygotes, and 5 patients were non-A508 heterozygotes. Respiratory comorbidities were asthma alone (28%) and aspirin triad (5%). Eighteen (22%) patients either smoked or lived with smokers. The mean Lund-Mackay score before the initial surgery was 16. Twenty patients were treated with medication only; 35 patients underwent 1 surgery; 14 patients underwent 2 surgeries; 8 patients underwent 3 surgeries; 2 patients underwent 4 surgeries; and 2 patients underwent 5 surgeries. Patients with higher Lund-Mackay scores at their initial CT were more likely to undergo repeat surgeries (p < 0.05). CONCLUSION: CF patients with high Lund-Mackay scores at their initial surgery are more likely to undergo several revision surgeries. These patients should be considered for more alternative initial management of their sinuses.     

A new score for tomographic opacificacation of paranasal sinuses in children

Many score methods have been created to measure paranasal sinus abnormalities seen under CT scan. Currently, the Lund-Mackay staging system is widely accepted. However, its results may be affected by the development in children.AimTo assess the precision and accuracy of a new tomography score, called “opacification-development ratio”. It translates the percentage of sinus area that is opaque.Materials and MethodsA cross-sectional study was prospectively conducted in patients ranging from 0-18 years of age who underwent CT scan assessment of rhinosinusitis. Two independent radiologists examined each scan twice, using both the Lund system and the ratio herein proposed.ResultsThe opacification-development ratio reached substantial intra and inter-examiner agreement, similar to the Lund system (Kappa > 0.60). Considering the Lund system as the gold standard, the most accurate cut-off point was approximately 15 (sensitivity and specificity approach 90%). There was a strong linear correlation between the two methods (r > 90).Conclusionsopacification-development ratio is precise and correlates with the Lund system. A cut-off point set at 15 could be used to call a test positive.     

鼻内镜术后中药鼻腔雾化吸入辅佐治疗慢性鼻-鼻窦炎的主客观评估

目的 评价慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者在鼻内镜术(endoscopic sinus surgery, ESS)后用中药进行鼻腔超声雾化吸入辅佐治疗的疗效。方法 63例CRS患者随机分为治疗组(33例)和对照组(30例),ESS术后第3天行鼻腔超声雾化吸入。治疗组雾化用药为鼻窦炎口服液,每天早晚各1次,每次8mL,连续5d,后改为每周1次,连续3个月。对照组使用生理盐水鼻腔雾化吸入,方法相同。雾化前(术后第2天)、雾化5d和3个月后分别采用视觉模拟量表、Lund Kennedy评分系统、Lund Mackay评分法进行相关评估。结果 通过对主观症状、鼻内镜及鼻窦CT扫描进行检查评估,治疗组与对照组在雾化前后及组间比较差异均有统计学意义。结论 CRS患者ESS术后中药雾化吸入能明显提高手术疗效。     

Creation and validation of a radiological checklist for functional endoscopic sinonasal surgery. A YO-IFOS initiative

BackgroundFunctional endoscopic sinus surgery might lead to dangerous complications. Studying and analysing preoperative CT scans provides surgeons with a precise knowledge of their patient's anatomy, thus reducing the risk of potential complications. Checklists highlighting key anatomical areas have been published and proven useful. However, none of these are widely accepted or systematically used in daily practice.ObjectiveIn this paper, the rhinology group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS) aim to create and validate a new checklist designed to be fast and user friendly for daily practice.MethodsTwo CT sinonasal scans were selected as test cases. Forty otolaryngologists were selected from five tertiary referral hospitals. It was a cross-sectional study; each participant was their own control. All participants completed a questionnaire after the analysis of both CT scans to prevent learning bias. The evaluation included ten items critical in endoscopic sinus surgery according to previous publications.ResultsThere were 80 evaluations. There was a significant increase in the number of correctly identified critical structures with the use of the checklist (p = .009). There was a statistically significant difference in low- experience evaluators, while it was not statistically significant for experienced surgeons. The most unanswered structures were suprabullar recess, dangerous v2 nerve, anterior ethmoid artery, dangerous vidian nerve and Onodi cell. The most wrongly identified structures were Keros type, septal deviation and cribiform middle turbinate.ConclusionThe YO-IFOS radiological checklist has proven a useful tool for correctly studying sinonasal anatomical variations. There is a clear learning component in the use of the checklist although it does not in any way exempt specialists from thorough study of sinonasal anatomy. Given the risk-benefit ratio, we strongly suggest the routine use of the checklist to systematically assess CT-scans prior to endoscopic sinonasal surgery.     

Olfactory dysfunction in nasal polyposis: correlation with computed tomography findings

AIMS: This study evaluates if a computed tomography (CT) scan is useful to assess the olfactory loss in sinonasal disease, and if a preoperative CT scan has a predictive value for the long-term outcome regarding olfaction. METHODS: Thirty-one patients with nasal polyposis were included. Olfactory function was assessed with the 'Sniffin' Sticks' test and subjective perception recorded with a visual analogue scale. CT scans were assessed with the Lund-Mackay system and the Damm nasal segmentation. Patients were retested after endoscopic sinus surgery in a follow-up appointment at least 1 year later. RESULTS: Disease in the upper meatus and the posterior portion of the middle meatus strongly affects olfactory function. Lund-Mackay scores were significantly correlated with preoperative olfactory test results. Preoperative subjective ratings had a significant correlation only with present disease in the anterior upper meatus. Postoperative results were significantly decreased. Their relative percentage change was correlated only with the preoperative presence of disease in the anterior upper meatus. No correlation was found between the Lund-Mackay score and the postoperative olfactory results. CONCLUSIONS: Olfactory dysfunction in nasal polyposis is strongly related to specific obstructed nasal areas. A CT scan has no predictive value for the long-term surgical outcome regarding olfaction.     

Correlation of allergy and severity of sinus disease

Allergy is an important consideration in the evaluation of patients with rhinosinusitis. Several studies have addressed staging systems for rhinosinusitis based on the extent of disease present on computed tomography (CT) scanning. The severity and extent of sinus disease present on CT imaging helps guide decisions regarding medical and surgical treatment options. This study evaluates the severity of sinus disease in allergic and nonallergic patients. A total of 42 patients at our institution underwent both modified RAST and coronal sinus CT scan in the evaluation of their rhinosinusitis symptoms. A single, blinded staff neuroradiologist staged all 42 CT scans using the Lund-Mackay staging system. None of the patients had undergone sinus surgery. Age, sex, co-morbidities, asthma, smoking, RAST score, total IgE, and CT staging score were analyzed. Allergic patients were found to have a higher CT scan score (mean score = 12) when compared to nonallergic patients (mean score = 6), indicating more extensive sinus disease (p = 0.03). We conclude that allergy is a significant factor in the development of rhinosinusitis, and allergic patients are more likely to demonstrate advanced disease on CT scan when compared to nonallergic patients.     

Computed tomographic assessment of chronic rhinosinusitis with asthma

BACKGROUND: The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. METHODS: Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0-2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. RESULTS: The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). CONCLUSION: Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.