Published July 30, 2025 | Version v1

Study of Anatomical Variations on High Resolution Computed Tomography [HRCT] Para Nasal Sinuses in Chronic Rhinosinusitis

  • 1. International Journal of Medical Science and Innovative Research (IJMSIR)

Description

Abstract

Introduction

Chronic rhinosinusitis (CRS) is a common and debilitating condition affecting millions of individuals globally, having a significant burden on healthcare systems and public health resources. The prevalence of CRS has been estimated up to 10% to 12% of the population, establishing it one of the most common chronic diseases worldwide. CRS is defined as inflammation of the nasal and paranasal sinuses for 12 weeks or longer, even after appropriate medical therapy. Its impact extends beyond the upper respiratory tract, as it is associated with many systemic effects such as fatigue, sleep disturbances, impaired productivity along with reduced quality of life. Patients with CRS often report prolonged physical discomfort due to symptoms such as nasal congestion, purulent nasal discharge, facial pain or facial pressure, and reduced or complete loss of smell.1 Chronic rhinosinusitis is often classified into two primary subtypes: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). These subtypes differ in their clinical presentation, underlying pathophysiology, and response to treatment.1

The etiology of CRS is multifactorial with host, environmental, and microbial factors are major contributors. With host component, anatomical variations in the paranasal sinuses is major contributor in the pathogenesis of CRS. This can disrupt the sinus ventilation and drainage pathways resulting in an environment favouring to mucus stasis and bacterial colonization leading to persistent inflammation. Therefore, understanding the role of anatomical variations is essential, both for diagnosing CRS and tailoring the effective treatment strategies, including surgical intervention.2

High-resolution computed tomography (HRCT) is the gold standard for evaluating sinonasal anatomy and pathology. It enables precise identification of anatomical variations, supports CRS diagnosis, and is critical for preoperative planning in functional endoscopic sinus surgery (FESS).

This study aims to assess the role of anatomical variations in the pathogenesis of CRS and highlight the diagnostic value of HRCT in evaluating these changes.

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References

  • 1. Benninger MS. Rhinosinusitis. In: Gleeson M. Scott-Brown's Otolaryngology, Head and NeckSurgery. 7th ed. Vol. 2. London: Hodder Arnold; 2008. p. 1439-1447. 2. Tan BK, Kern RC, Schleimer RP, Schwartz BS. Chronic rhinosinusitis: the unrecognized epidemic. Am J Respir Crit Care Med. 2013 Dec 1; 188 (11):1275-7 3. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997 Sep; 117(3 Pt 2):S1–7. 4. Tiwari R, Goyal R. Role of concha bullosa in chronic rhinosinusitis. Indian J Otolaryngol Head Neck Surg. Indian J Otolaryngol Head Neck Surg (Jan–Mar 2019) 71(1):128–131; 5. Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M Jr. Environmental air pollution and chronic rhinosinusitis: a systematic review. Laryngoscope Investing Otolaryngol. 2022 Mar 11; 7(2):349-60. 6. Reh DD, Higgins TS, Smith TL. Impact of tobacco smoke on chronic rhinosinusitis: a review of the literature. Int Forum Allergy Rhinol. 2012 Sep-Oct;2(5):362-9. 7. Talugula S, Chiu R, Nyenhuis SM, Eldeirawi K, Lee VS. Sex-based differences in severity of chronic rhinosinusitis as reported by SNOT-22 scores. Am J Otolaryngol. 2024;45(6):104465. 8. Behnke J, Dundervill C, Al-Asadi Z, Shahid M, Ramadan HH, Makary CA. Gender differences in adults with chronic rhinosinusitis: a scoping review. Otolaryngol Head Neck Surg. 2024 Jun;170(6):1659-67. 9. Lee WT, Kuhn FA, Citardi MJ. 3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis. Otolaryngol Head Neck Surg. 2004 Sep;131(3):164-73. 10. DelGaudio JM, Hudgins PA, Venkatraman G, Bening field A. Multiplanar computed tomographic analysis of frontal recess cells: effect on frontal isthmus size and frontal sinusitis. Arch Otolaryngol Head Neck Surg. 2005;131(3):230-5. 11. Johari HH, Mohamad I, Sachlin IS, Aziz ME, Mey TY, Ramli RR. A computed tomographic analysis of frontal recess cells in association with the development of frontal sinusitis. Auris NasusLarynx. 2018 Dec;45(6):1183-90. 12. Eweiss AZ, Khalil HS. The prevalence of frontal cells and their relation to frontal sinusitis: a radiological study of the frontal recess area. ISRN Otolaryngol. 2013 Jul 24;2013: 687582. 13. Tan HK, Ong YK. Sphenoid sinus: an anatomic and endoscopic study in Asian cadavers. Clin Anat. 2007 Oct;20(7):745-50. 14. Hamid O, El Fiky L, Hassan O, Kotb A, El Fiky S. Anatomic variations of the sphenoid sinus andtheir impact on trans-sphenoid pituitary surgery. Skull Base. 2008 Jan;18(1):9-15. 15. Pérez-Piñas I, Sabaté J, Carmona A, Catalina-Herrera CJ, Jiménez-Castellanos J. Anatomical variations in the human paranasal sinus region studied by CT. J Anat. 2000 Aug;197(Pt 2):221–7. 16. Devaraja K, Doreswamy SM, Pujary K, Ramaswamy B, Pillai S. Anatomical variations of the nose and paranasal sinuses: a computed tomographic study. Indian J Otolaryngol Head Neck Surg.2019 Nov;71 (Suppl 3):2231-40. 17. Asruddin, Yadav SP, Yadav RK, Singh J. Low dose CT in chronic sinusitis. Indian J Otolaryngol Head Neck Surg. 1999 Dec;52(1):17–22. 18. Karki S, Pokharel M, Suwal S, Poudel R. Prevalence of anatomical variations of the sinonasal region and their relationship with chronic rhinosinusitis. Kathmandu Univ Med J (KUMJ). 2016Oct-Dec;14(56):342-6. 19. Mamatha H, Shamasundar NM, Bharathi MB, Prasanna. Variations of ostiomeatal complex and its applied anatomy: A CT scan study. Indian J Sci Technol. 2010, Volume: 3, Issue: 8, Pages:904-9073:904–907 20. Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A radiological study of anatomical variations of uncinate process. Clin Rhinol An Int J. 2016;9(2):59-61 21. Fathima A, Arabhanvi R, Shamanna K, Joy L. The role of concha bullosa in chronic rhinosinusitis: our experience at a tertiary care hospital. Int J Otorhinolaryngol Head Neck Surg2020;6:1326-30. 22. Chakraborty P, Jain RK. Radiologic Variations of Nose and Paranasal Sinuses: A Ct Based Study.J Med Sci Clin Res. 2016; JMSCR Vol|| 04|| Issue|| 05||Page 10536-10541||May 23. Chaitanya DK, Suseelamma D, Singh V. Anatomical variations of paranasal air sinuses – A CT scan study. journal of the anatomical society of india 64 (2015) 87 – 90 24. Senturk M, Guler I, Azgin I, Sakarya EU, Ovet G, Alatas N et al. The role of Onodi cells insphenoiditis: results of multiplanar reconstruction of computed tomography scanning. Braz J Otorhinolaryngol. 2017;83(1):88-93. 25. Almushayti ZA, Almutairi AN, Almushayti MA, Alzeadi HS, Alfadhel EA, Al Samani AN. Evaluation of the Keros classification of olfactory fossa by CT scan in Qassim region. Cureus. 2022 Feb 19;14 (2):e22378. 26. Yousuf M, Jamil A, Hashmi Q, Hameed K, Sami M, Shaikh Tet al. Anatomical variation of the olfactory fossa according to Keros and Yenigun classifications in Karachi, Pakistan. Cureus.2024 Nov 9;16 (11): e73314. 27. Burulday V, Muluk NB, Akgül MH, Kaya A, O􀇆 ğden M. Presence and types of anterior clinoid process pneumatization, evaluated by Multidetector Computerized Tomography. Clin Invest Med. 2016 Jun16;39(3):E105-10. 28. Elsawaf ME. Impact of anterior clinoid process pneumatization on adjacent anatomical structures. Acad Anat Int. 2018;4(1):07-10