Significance of osteomeatal complex obstruction.

Abstract

Classic teaching suggests that disease in the osteomeatal complex (OMC) plays a pivotal role in the establishment of chronic rhinosinusitis (CRS). We sought to test this hypothesis. Retrospective review of 106 consecutive patients enrolled prospectively into an allergy/sinus centre database, meeting Task Force criteria for CRS. Inflammatory disease was scored radiologically via a modification of Lund-Mackay methodology, omitting the OMC itself (maximum score 10 per side). Patients were stratified into three groups: no osteomeatal complex (NOMC) obstruction (n = 38; 35.8%), unilateral osteomeatal complex (UOMC) obstruction (n = 24; 22.6%), and bilateral osteomeatal complex (BOMC) obstruction (n = 44; 41.5%). The mean adjusted total disease score was 3.6, 6.3, and 12.3 for each, respectively (p < .0001). BOMC obstruction patients were significantly more likely to have asthma than those with UOMC or NOMC obstruction (52%, 17%, 16%, respectively; p < .0001). Nasal polyposis was more frequently observed in the setting of BOMC obstruction (59%) compared with either UOMC (38%) or NOMC (13%) obstruction (p < .0001). The series was also stratified by sides with osteomeatal complex (wOMC) obstruction (wOMC, n = 112) and those without osteomeatal complex (sOMC) obstruction (sOMC, n = 100). The mean ipsilateral score was calculated for the sinus cavities on each side, and this was significantly greater in the wOMC obstruction group (5.7 vs 2.0, p < .0001). The frequency of ipsilateral maxillary sinus disease was also significantly greater in the wOMC obstruction sides (p < .0001). More than 35% of patients meeting the Task Force definition of CRS did not manifest OMC obstruction radiologically. When present, OMC obstruction did correlate with the presence of asthma and polyps. OMC obstruction was also associated with increased disease burden overall and ipsilaterally.