Objectives: The aim of this study was to compare the efficacy of
conventional radiography (CR), computed tomography (CT) and nasal
endoscopy for the preoperative evaluation of chronic rhinosinusitis in
patients with persistent complaints despite appropriate medical therapy.
Patients and Methods: Forty-three patients (26 males, 17 females;
mean age 43 years; range 15 to 73 years) were prospectively evaluated.
All patients underwent detailed physical examination, CR and
coronal high resolution CT of paranasal sinuses. Thirty of them were
evaluated with detailed nasal rigid and/or flexible endoscopy as well.
The anatomic variations and mucosal changes in paranasal sinuses
were noted. The specificity and sensitivity of CR was calculated
using CT findings as a reference point. Surgery was performed on
two of the other three patients because of obstructive symptoms of
middle turbinate. Paradoxal middle turbinate surgery was performed
on one patient due to a headache of rhinogenic origin.
Results: In our study 40 (93%) of all patients showed mucosal
abnormalities on CT. Computed tomography scanning of the patients
revealed anatomic variations in 74.4% of the cases. Mucosal pathology
was most frequently observed in the anterior ethmoid region
(middle meatus). While we found mucosal anomalies in 47.4% of all
sinuses using CR, 42.2% of these cases were confirmed with CT.
Also, 19.5% of all sinuses evaluated as normal with CR presented
pathologic findings on CT. An overall correlation of 75.3% was
observed between CR and CT, while diagnostic nasal endoscopy
and CT findings were correlated at a rate of 87%.
Conclusion: (i) While no ipsilateral maxillary or frontal sinus disease
was detected when no abnormality in the anterior ethmoid region and
infundibulum was observed endoscopically in the presence of mucosal
abnormalities similar abnormalities were seen at the same side for maxillary
or frontal sinuses. (ii) Anatomic variations of nasal and paranasal
sinuses may be considered as etiologic and predisposing factors of
chronic rhinosinusitis. (iii) Conventional radiography should not be used
as a single diagnostic tool in pre-operative evaluation; however, due to
its high sensitivity, CR technique may be used alone in the diagnosis
and follow-up of maxillary sinus disease. (iv) Nasal endoscopy may
reduce unnecessary diagnostic CT scanning procedures.
FREE FULL TEXTAnahtar Kelimeler: Konvansiyonel radyografi; endoskopik sinüs cerrahisi;paranazal bilgisayarlı tomografi.