Sinus Computed Tomography Scans Research Articles

Regional differences of chronic rhinosinusitis endotypes based on tissue inflammatory and remodeling biomarkers

Objective: To analyze the characteristics of patients with chronic rhinosinusitis (CRS) in the South China region based on pathological tissue biomarkers for regional comparison. Methods: The study population consisted of CRS in-patients in the First Affiliated Hospital of Sun Yat-sen University from October 2019 to June 2022. Among all the 181 cases, 123 of them were male and 58 were female, with an average age of 40. Retrospectively collected clinical data included demographic information, preoperative symptom scores, preoperative endoscopic images, preoperative paranasal sinus computed tomography scanning images, and inflammatory serological features. In addition, 52 variables of pathological tissue biomarkers including cytokines, chemokines and remodeling factors were collected for analysis. Cluster analysis was performed on the integrated data of training set through centroid-based clustering algorithm, and the inflammatory characteristics, post-operation control status, and airway diseases comorbidity of each endotype were analyzed. R project (version 4.2.2) was used in statistical analysis. Results: Cluster analysis divided 181 patients with CRS into 4 endotypes. Cluster 1 (n=101, 55.80%) showed a locally low inflammatory status. Cluster 2 (n=23, 12.71%) showed a mixed type of inflammation with predominantly neutrophilic inflammation and tissue remodeling. Cluster 3 (n=11, 6.08%) was characterized by type Ⅱ inflammation without tissue remodeling. Cluster 4 (n=46, 25.41%) was mainly characterized by type Ⅱ inflammation with tissue remodeling, showing higher comorbidity rate of asthma and allergic rhinitis. This cluster presented more severe symptoms, significant olfactory dysfunction, extensive overall inflammation based on objective examination results, a notable increase in total eosinophil count and proportion in peripheral blood, and the highest uncontrolled rate observed one year post-surgery. In comparison to other regions, the endotype classification of CRS in Southern China was characterized by a predominant pattern of locally low inflammatory status, a moderate level of type Ⅱ inflammation with tissue remodeling, and a lesser presence of neutrophilic inflammation. Conclusion: CRS distribution in Southern China is mainly characterized by low inflammatory endotype and type Ⅱ inflammation with tissue remodeling. The latter shows more severe clinical manifestations and higher uncontrol rate after surgery.

Location of infraorbital and accessory infraorbital foramina in Iranian population: a retrospective radiological study with crucial clinical implications.

The location of infraorbital foramen (IOF) and the prevalence of accessory IOF vary among different populations. It may lead to infraorbital nerve (ION) blockage during surgery. This study aimed to assess the IOF location and AIOF frequency in Iranian people. In this retrospective cross-sectional study, 500 paranasal sinus computed tomography scans of adults were examined using the INFINITT PACS system. The distance from IOF to infraorbital margin (IOM), mid-pupillary line (MPL), midsagittal line (MSL), canine eminence (CE), and skin thickness (ST) was 8.97 ± 1.79, 5.73 ± 1.84, 24.86 ± 2.23, 20.39 ± 3.47, and 10.90 ± 2.59mm, respectively. The vertical and transverse diameters of the foramen were 3.03 ± 0.65 and 3.71 ± 0.76mm, respectively. In addition, the shape of 63.5% of the foramina was oval. The prevalence of AIOF was 9%, and its most common location was superomedial to IOF. We believe that in this study, landmarks like IOM, MPL, MSL, CE and ST could help the clinicians localize IOF and improve the ION anesthesia success rate. Furthermore, the occurrence of AIOF should be considered by physicians to reduce the chance of injuries to the infraorbital neurovascular complex.

Evaluation of computed tomography (CT) findings in patients with symptomatic deviated nasal septum and their correlation with intraoperative findings

AimTo evaluate the computed tomography (CT) findings in patients having a symptomatic deviated nasal septum (DNS) and their comparison with intraoperative findings.MethodsCross-sectional, observational study done in the department of ENT and HNS at a tertiary care center, over a period of 16 months. Patients presenting with nasal obstruction as the chief complaint and findings of deviated nasal septum on anterior rhinoscopy without clinical features of chronic rhinosinusitis (CRS) were included in the present study. All patients underwent CT scans of paranasal sinuses (PNS) as per the govt. scheme for approval of surgery. Surgery was planned as per the indication based on history, clinical examination, and non-contrast CT scan PNS findings. The average duration from CT scan to surgery was 4.5 weeks.ResultsAll 200 (100%) patients had DNS with inferior turbinate hypertrophy in 103 (52.5%), concha bullosa in 22 (11.0%), pneumatized superior turbinate in 6 (3.0%), and PMT (paradoxical middle turbinate) in 22 (11.0%). On comparing CT scan findings with intraoperative findings, it was found that maxillary sinus involvement had been seen in 28 (14.0%) patients on CT scan and only 8 (4.0%) patients intraoperatively. Similarly, CT scan involvement compared to and intraoperative involvement of anterior ethmoidal sinus was seen in 20 (10.0%) compared to 6 (3.0%) patients intraoperatively, posterior ethmoid in 12 (6.0%) compared to 3 (1.5%) frontal sinus in 4 (2.0%) compared to 1 (0.5%), sphenoid in 11 (5.5%) compared to 2 (1.0%), and osteomeatal complex (OMC) in 27 (13.5%) compared to 6 (3.0%) patients intraoperatively. Involvement of PMT, enlarged inferior, and concha bullosa was similar on CT scan and intraoperatively.ConclusionFrom this study, we concluded that a preoperative CT scan is a poor tool in predicting sinus disease in patients without clinical features of sinus disease and has a limited role in patients with symptomatic DNS. Insurance companies and government agencies should review their policies of ordering CT scans for approving septal surgeries.

Pre-Operative Computed Tomography Scan Assessment of Variations in Olfactory Fossa Depth among Adults

Context: The paranasal sinus Computed Tomography (CT) scan is important in the evaluation of patients with sino-nasal pathologies and serves as a tool for navigation during endoscopic sinus surgery (ESS). The risk of skull base injury during ESS is assessed using the depth of the olfactory fossa, which has been shown to have racial variations. We aimed to use Keros classification to study the variations in the depth of the olfactory fossa at a specialized tertiary ENT hospital in Kaduna, Northwest Nigeria. Setting and Design: It was a retrospective cross-sectional study conducted at the radiology department of the National Ear Centre, Kaduna. Materials and Methods: All CT scans of the paranasal sinuses from January 2021 – January 2022 were retrieved and reviewed. Coronal CT scans of patients, 18 years and above, were included. Those who had skull-based surgery and those with tumors of the paranasal sinuses were excluded. Statistical Analysis Used: Data were entered in Statistical Product and Service Solutions (SPSS) version 25. Results: A total of one hundred and six (106) CT scans were studied which resulted in 212 depths of olfactory fossa measurements. The age range of participants was 18–81 years with a mean age of 41.1 ± 14.18 years. The male-to-female ratio was 1:1.08. Keros type II was found to be the most prevalent (68.4%) generally, as well as across gender and laterality distribution, with statistically significant difference between males and females, and no significant difference between the right and left sides. Conclusion: Type II Keros classification was the most common across gender and laterality distributions, with statistically significant differences between males and females. Cognizance of individual variations in preoperative assessments and surgical planning is imperative in ensuring safe and satisfactory surgical outcomes. We recommend further studies with a larger sample size and from different regions of the country.

Eosinophilia, asthma, NERD and the use of oral corticosteroids predict uncontrolled chronic rhinosinusitis with nasal polyps after surgery.

Severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenging condition to treat. The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020) has the following criteria when considering biological therapy for severe uncontrolled CRSwNP: eosinophilia, need for oral corticosteroids (OCS), symptom score, loss of sense of smell and co-morbid asthma. This study aimed at finding associations of baseline factors with uncontrolled CRSwNP after endoscopic sinus surgery (ESS). Electronic health record data of CRSwNP patients (N = 137) undergoing ESS in 2002-17 were used. Endpoints of uncontrolled CRSwNP were revision ESS, purchased OCS and antibiotic courses during follow up. Baseline factors were chosen based on EPOS2020 and the data available: nasal polyp (NP) eosinophilia, peripheral blood eosinophilia, co-existing asthma and/or non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD), need for OCS during the previous year, previous ESS, endoscopic NP score, and Lund-Mackay score of sinus computed tomography scans. During the follow-up of 10.1 ± 3.1 (mean ± standard deviation) years, 35 (25.5%) individuals underwent revision ESS. The best predictive model was obtained by a sum of baseline (1) blood eosinophilia ≥ 250 cells/≥l and/or NP eosinophilia ≥ 30% (Eos), (2) asthma/NERD, and (3) ≥ 1 OCS/year. It was significantly associated with revision ESS, purchased doctor-prescribed OCS and antibiotic courses during follow-up. We identified similar predictive variables for uncontrolled CRSwNP that are used in the EPOS2020 indications of biological therapy, thus suggesting that these estimates are usable in clinical practice.

Imaging anatomy of the vidian canal and its clinical significance.

Vidian neurectomy (VN) is an effective surgical treatment for severe allergic rhinitis (AR). However, little research has been conducted on the imaging anatomy of the vidian canal (VC). This study aimed to analyze the computed tomography (CT) imaging of the VC and its surrounding structures and investigate the morphometric characteristics and clinical significance of VN. We analyzed 118 paranasal sinus CT scans (55 male and 63 female patients), with axial, coronal, and sagittal slices being used in the study. Among the 118 patients in this study, the average length of the VC in male and female patients was 14.00±3.35 and 12.51±3.42 mm, respectively; the transverse diameter of the posterior segment of the VC in females was larger than that in males; and the length of the VC and the distance between VC and foramen rotundum (FR) in males were longer than those in females. The angle between the VC and the sagittal plane and the angle between the sphenopalatine foramen (SPF) and the VC in females were larger than those in males, and the distance between the attachment to the end of the middle turbinate (MT) and the VC was greater. Type 2 VC occupied a dominant position. The VC was mostly at the same line as the medial wall of the maxillary sinus (MS) and was located on the medial side of the medial pterygoid plate (MPTG). The highest point of the VC was mostly superior to that of the palatovaginal canal (PVC). Most of the VC was inferior to the internal carotid artery (ICA), and no cases were observed in which the VC was above the ICA. Some of the measurements of the VC and its surrounding structures were correlated. The position and morphometric information of the VC could be reflected in a CT scan, which may contribute to the evaluation of VN preoperatively and postoperatively.

Correlation of Upper Lateral Cartilage Collapse and Nasal Septal Deviation

Background and Objectives: This study aimed to elucidate the relationship between nasal septal deviation (NSD) and upper lateral cartilage (ULC) collapse.Methods: We conducted a retrospective review of 142 paranasal sinus computed tomography scans from patients who had undergone septoplasty due to confirmed NSD. The ULC angle was measured on both the narrow and wide sides of the nasal cavities, and these measurements were compared to evaluate the extent of ULC collapse in relation to the degree of NSD and patient age. The correlation between the degree of NSD and the degree of ULC collapse was also analyzed.Results: The mean ULC angle was found to be 13.4°±2.7° on the narrow side and 14.3°±2.7° on the wide side, with a statistically significant difference between the two (p<0.001). When comparing caudal and non-caudal NSD patients, there was no significant difference in the degree of ULC on either side (p=0.166). When comparing the ULC angle between two age groups (≥50 vs. <50 years), the difference in ULC angles was significantly greater in the group of patients aged under 50 years (0.3°±3.8° vs. 1.1°±2.2°, p=0.014). There was a significant positive correlation between the degree of ULC collapse and the degree of septal deviation (r=0.214, p=0.01).Conclusion: NSD was associated with ULC collapse on the narrow side and a narrow internal nasal valve area. This result indicates that clinicians should check for concomitant ULC collapse in patients with NSD.

Full Body Screening Computed Tomography Prior to Allogeneic Hematopoietic Stem Cell Transplantation: A Single Institution Experience from an Academic Center

Background: The extent of pretransplant workup for allogeneic hematopoietic stem cell transplant (HSCT) differs considerably among transplant centers. Current practice at the University of Wisconsin is for all recipients to undergo screening CT (computed tomography) of the sinuses, chest, abdomen, and pelvis prior to HSCT which can reveal several incidental radiographic findings. Here, we examined the impact of this procedure on discovery of clinically meaningful incidental findings, on time to transplant, on detecting post-COVID-19 infection related complications and on overall clinical outcomes post-HSCT in the current era of novel treatments for malignant hematologic disorders. Methods: After IRB approval, all consecutive patients > age 18 years at the University of Wisconsin who underwent full body screening CT prior to HSCT, from January 2019 to August 2022 were studied. Imaging abnormalities were defined as any finding reported by the radiologist apart from isolated mucosal thickening on sinus CT scans. Post-transplant pulmonary complications were defined as abnormal chest CT scans within 6 months post-transplant. Patient and disease characteristics were tabulated, and descriptive statistics are reported. Progression free survival (PFS) is defined as the time from transplant to first identification of relapsed disease. Results: Table 1 shows clinical characteristics of the study cohort. Median follow up is 22.55 months (95% CI 12.04-34.78). A total of 205 patients underwent 577 screening CT scans prior to HSCT, of which 82% (n=169) had at least one abnormal finding and 52% (n=107) had an incidental finding. Of the patients with incidental findings, 53% (n=57) received no additional workup or intervention while 47% (n=50) underwent further workup, yet only 18% (n=19) had a change in management as depicted in figure 2. Therapeutic interventions included treatment with antifungals (n=11), antibiotics (n=5), thoracentesis (n=1), thoracotomy (n=1) and anticoagulation (n=1). Although 50% of all chest CT scans identified an abnormality, only 5% revealed an incidental finding that influenced management including pulmonary nodules (n=7), bronchiolitis (n=1) and pulmonary emboli (n=1), compared to just 3% for both sinus and abdominal CT scans including sinusitis (n=4), periapical abscesses (n=3) and abdominopelvic masses of the bladder (n=1), iliac fossa (n=1), pancreas (n=1) and ovary (n=1). Post-HSCT complications were identified in 23% (n=21) vs 16% (n=15) in those with abnormal and normal pre-HSCT chest CT, respectively. In the subset of patients who underwent therapeutic interventions resulting from abnormal screening chest CT, 28% (n=5) still experienced post-transplant complications. Finally, the incidence of post-transplant pulmonary complications was similar, 27% (n=4), in patients with and without documented COVID infection prior to transplant. Median time to HSCT after scan completion was similar in patients with normal vs abnormal imaging without additional workup at 23 days (range 11-47), compared to 24 days (range 8-62), respectively. In contrast, median time to HSCT was longer at 30 days (range 11-173) and 48 days (range 13-208) for those who received additional work up and a therapeutic intervention, respectively (p=0.0001). One year post HSCT non-relapse mortality was 9% and 12 % among patients with normal screening CT, and those with at least one abnormal finding, respectively. 2-year PFS was similar in patients with abnormal vs normal screening chest CT scans at 60% vs 58% respectively (p=0.98). Conclusions: We observed high rates of incidental findings leading to additional work up in over 40% of patients, though less than half of them led to changes in management. As expected, we noted a substantial risk of delay to HSCT in most recipients needing intervention. Chest CT scans had the highest prevalence of clinically significant incidental findings and meaningful impact on management, whereas routine sinus and abdomen-pelvic CT showed lower clinical benefit. No additional advantage of CT chest was found in asymptomatic patients who had a COVID-19 infection pre-HSCT. Our findings provide basis to re-evaluate current practice of pre HSCT screening, and identify at-risk patients who would benefit from screening. Additional analyses are needed to minimize risks of unnecessary interventions, delays and burden on patients and healthcare utilization.

Role of Electrodiagnostic Modalities in Detection of Nasal Septal Deviation.

Nasal Septal Deviation (NSD) is a common sign in otorhinolaryngology that can lead to facial asymmetry. In this case-control observational study, we assessed the role of EMG and NCS in the diagnosis of NSD and its effect on neuromuscular function. Participants were divided into two groups based on paranasal sinus computed tomography scan (PNS CT) results: NSD cases (n = 21) and controls without NSD (n = 13). EMG and NCS were performed on both groups to assess nasal alar muscles at the root of the zygomatic nerve. Our findings showed a significant correlation between NSD and EMG/NCS tests (P-value = 000) and a significant association between septal deviation and nasal alar lateralization (P-value = 000). EMG/NCS can be useful in assessing NSD by providing a better understanding of related neuromuscular structures and neuromuscular function of the nasal alar dilator muscles and aid in the diagnosis of NSD. Nasal Septal Deviation, EMG (electromyography), NCS (nerve conduction studies), Neuromuscular function, Facial asymmetry, Otorhinolaryngology, Paranasal sinus, Computed tomography, Nasal alar muscles, Zygomatic nerve, Nasal Obstruction, Nasal alar lateralization, Diagnosis.

Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis

Cystic fibrosis (CF) is a multiorgan genetic disease with progressive upper and lower airway involvement. The effects of CF transmembrane conductance regulator (CFTR) modifier therapies on CF-related upper airway disease, specifically chronic rhinosinusitis (CRS), are not characterized. To determine the outcome of elexacaftor-tezacaftor-ivacaftor (ETI) on CRS as measured by changes in sinus computed tomography (CT) metrics and on clinical parameters in individuals with CF. This prospective longitudinal cohort study was conducted at the CF center of a tertiary care hospital between October 1, 2019, and July 31, 2021. A total of 64 participants with CF were included in the analysis. Sinus CT was obtained within 1 month of initiation of ETI therapy (baseline), and within 1 month of 1 year of ETI therapy. Images were independently analyzed by pulmonology, radiology, and otolaryngology physicians, using the Lund-Mackay and Sheikh-Lind scoring systems. Percent predicted forced expiratory volume in 1 second (ppFEV1), body mass index (BMI), and microbiologic data collected at initiation of ETI therapy and 3-month intervals for 1 year were also measured. The study hypothesis was that ETI therapy will improve CRS as measured by changes in sinus CT at initiation and 1 year after ETI therapy and clinical parameters in individuals with CF. Among the 64 participants (39 [60.9%] female; median age, 18.5 [IQR, 16.0-28.5] years; 64 [100%] White), improvement in CRS was noted by improvements in sinus CT scans using both sinus CT scoring systems after 1 year of ETI therapy. The reduction in the median total score using the Lund-Mackay sinus CT scoring system (from 5.8 [IQR, 5.0-7.0] to 3.3 [IQR, 2.6-4.2]) and the Sheikh-Lind scoring system (from 3.8 [IQR, 3.0-5.0] to 2.2 [IQR, 2.0-2.5]) was noted. Increases in ppFEV1 and BMI were also observed by 3 months of ETI therapy with persistent improvement through 1 year of treatment. Similarly, after 1 year of ETI therapy, participants with CF had reductions in positivity for Pseudomonas aeruginosa and Staphylococcus aureus in oropharyngeal cultures. This cohort study found that use of ETI therapy was associated with improved CRS outcomes in participants with CF as quantified by improved sinus CT scans measured by 2 radiographic scoring systems and was also associated with improved clinical outcomes. Despite improvement in CT scan scores, most people with CF continue to have scores that indicate severe sinus disease.

Anatomical variations of the frontal sinus: A computed tomography-based study.

Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations. Methods: Retrospectively, 1220 frontal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex. Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral ( p<0.01) and the bilateral hypoplasia ( p<0.05) were significantly higher in females. On the other hand, the left unilateral ( p<0.01) and the bilateral hyperplasia ( p<0.05) were higher in males. Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.

Anatomical identification of supraseptal posterior ethmoid cells and its significance for endoscopic sinus surgery.

To investigate the anatomical imaging characteristics of supraseptal posterior ethmoid cells (SPEC). Paranasal sinus computed tomography scans of 153 inpatients from February 2019 to September 2021 were reviewed, and the anatomical characteristics of SPEC in the scans were collected. Supraseptal posterior ethmoid cells are posterior ethmoid (PE) cells extending medially and superiorly to the posterior superior of the nasal septum and into the sphenoid body but not close to the optic canal. The SPEC, Onodi cell, and sphenoidal sinus (SS) may appear in the posterior superior of the nasal septum, but the occurrence rate of the SPEC (5.88%; 9/153 cases) was significantly lower than that of the SS (22.88%) and Onodi cell (21.57%). The anterior SPEC is adjacent to the cribriform plate, the perpendicular plate of the ethmoid bone and the posterior ethmoidal artery (PEA). The posterior SPEC is adjacent to the SS and PE (6/9 cases), the SS and Onodi cell (2/9 cases) or the PE only (1/9 cases). The SPEC is a rare pneumatization that occurs in the posterior superior area of the nasal septum. Care should be taken to protect the skull base, cribriform plate and PEA when opening the SPEC during endoscopic sinus surgery.

An artificial intelligence algorithm for the classification of sphenoid sinus pneumatisation on sinus computed tomography scans.

Classifying sphenoid pneumatisation is an important but often overlooked task in reporting sinus CT scans. Artificial intelligence (AI) and one of its key methods, convolutional neural networks (CNNs), can create algorithms that can learn from data without being programmed with explicit rules and have shown utility in radiological image classification. To determine if a trained CNN can accurately classify sphenoid sinus pneumatisation on CT sinus imaging. Sagittal slices through the natural ostium of the sphenoid sinus were extracted from retrospectively collected bone-window CT scans of the paranasal sinuses for consecutive patients over 6 years. Two blinded Otolaryngology residents reviewed each image and classified the sphenoid sinus pneumatisation as either conchal, presellar or sellar. An AI algorithm was developed using the Microsoft Azure Custom Vision deep learning platform to classify the pattern of pneumatisation. Seven hundred eighty images from 400 patients were used to train the algorithm, which was then tested on a further 118 images from 62 patients. The algorithm achieved an accuracy of 93.2% (95% confidence interval [CI] 87.1-97.0), 87.3% (95% CI 79.9-92.7) and 85.6% (95% CI 78.0-91.4) in correctly identifying conchal, presellar and sellar sphenoid pneumatisation, respectively. The overall weighted accuracy of the CNN was 85.9%. The CNN described demonstrated a moderately accurate classification of sphenoid pneumatisation subtypes on CT scans. The use of CNN-based assistive tools may enable surgeons to achieve safer operative planning through routine automated reporting allowing greater resources to be directed towards the identification of pathology.

Protocol for capturing 3D facial meshes for rhinoseptoplasty planning

ObjectivesTo present and execute a protocol for the capture of 3D facial images using photogrammetry through the open access software Blender and its add-on OrtogOnBlender (OOB) and to evaluate the compatibility of the 3D meshes generated with Computed tomography (CT) of the sinuses. MethodsIndividuals >18 years old, candidates for Rhinoseptoplasty in a tertiary hospital, were submitted to a photographic session to perform the standardized protocol. In the session, divided into 3 phases, sequential photos were taken for processing the photogrammetry in the OOB and producing 3D meshes of the face. The photogrammetry reconstructions were compared with the reference mesh of the soft tissue surface of the Sinus CT scan to assess compatibility between them. Results21 patients were included, 67% female. 3 photogrammetry meshes and 1 CT reference mesh were generated, which demonstrated matching compatibility, as most of the mean distances between cloud points were <1.48 mm. Phase 3 of the session with the highest number of photos (54.36 ± 15.05) generated the most satisfactory mesh with the best resolution. ConclusionsThe proposed protocol is reproducible and feasible in clinical practice, generated satisfactory 3D meshes of the face, being a potential tool for surgical planning and comparison of results. For the implementation of photogrammetry for use in 3D anthropometry, it is necessary to validate this method. Level of evidence3.OCEBM Levels of Evidence Working Group.11OCEBM Table of Evidence Working Group = Jeremy Howick, Iain Chalmers (James Lind Library), Paul Glasziou, Trish Greenhalgh, Carl Heneghan, Alessandro Liberati, Ivan Moschetti, Bob Phillips, Hazel Thornton, Olive Goddard and Mary Hodgkinson. "The Oxford 2011 Levels of Evidence". Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653

Evaluation of the Image Quality of Ultra-Low-Dose Paranasal Sinus Computed Tomography Scans

Objective: We aimed to investigate the image quality of paranasal sinus computed tomography (CT) scans obtained with the “Advanced intelligent Clear-IQ Engine” (AICE) software and ultra-low dose parameters in patients with prediagnosed rhinitis, sinusitis or nasal septum deviation. Methods: The first 50 patients (31 men and 19 women, aged 18-70 years) who agreed to participate in our prospectively planned study were included in the study. Imaging of the patients was performed with a 160-slice multidetector CT device Canon Aquilion Prime SP (Canon Medical Systems, Otawara, Japan). Tube voltage of 80 kV and tube current of 40 mA were chosen. The effective radiation dose (ED) was calculated based on the “dose-length product” (DLP) information of each patient. Evaluation of images was made on reformat images made with “AiCE Bone” filter in the axial and coronal planes. All images were double-blindly evaluated by 2 radiologists out of 5 points (5 = very good; 1 = not diagnostic). The visibility of 17 bilateral important anatomical landmarks examined on paranasal sinus CT was scored (0 = not visible; 2 = completely visible). In the evaluation of images, the agreement between radiologists was evaluated with Kappa statistics. Results: The median ED value of the CT protocol was 0.015±0.001 mSv [range 0.012-0.017 mSv]. The overall image quality of the images in our study was interpreted as 4 (good) or 3 (moderate) for all patients. Inter-research agreement was 92%. Most of the anatomical landmarks evaluated were completely visible. Six (bilateral of three) anatomical landmarks could be partially visible in some patients. Conclusion: Combining the ultra-low dose CT protocol and the AiCE reconstruction algorithm makes it possible to achieve very low ED values ​​in paranasal sinus CT scans and still obtain sufficient image quality in indications such as septum deviation and sinusitis.

Sinus inflammation and chronic rhinosinusitis are associated with a diagnosis of new onset asthma in the following year.

Chronic rhinosinusitis (CRS) and asthma commonly co-occur. No studies have leveraged large samples needed to formally address whether preexisting CRS is associated with new onset asthma over time. We evaluated whether prevalent CRS [identified in two ways: validated text algorithm applied to sinus computerized tomography (CT) scan or two diagnoses] was associated with new onset adult asthma in the following year. We used electronic health record data from Geisinger from 2008 to 2019. For each year we removed persons with any evidence of asthma through the end of the year, then identified those with new diagnosis of asthma in the following year. Complementary log-log regression was used to adjust for confounding variables (e.g., sociodemographic, contact with the health system, comorbidities), and hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. A total of 35,441 persons were diagnosed with new onset asthma and were compared to 890,956 persons who did not develop asthma. Persons with new onset asthma tended to be female (69.6%) and younger (mean [SD] age 45.9 [17.0] years). Both CRS definitions were associated (HR, 95% CI) with new onset asthma, with 2.21 (1.93, 2.54) and 1.48 (1.38, 1.59) for CRS based on sinus CT scan and two diagnoses, respectively. New onset asthma was uncommonly observed in persons with a history of sinus surgery. Prevalent CRS identified with two complementary approaches was associated with a diagnosis of new onset asthma in the following year. The findings may have clinical implications for the prevention of asthma.

Diagnosis of Fungal Sinusitis; Is Fungal Culture a Must?

Objective: To determine the diagnostic accuracy of computed tomography (CT) of paranasal sinuses (PNS) in detecting fungal sinusitis keeping fungal culture as the gold standard.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Jun 2019.&#x0D; Methodology: A total of 323 patients of either gender were included in the study (aged from 10-70 years). All the patients underwent plain CT scans of paranasal sinuses, and the CT scan findings were reported and recorded on pre-designed proforma. Results were then compared with the culture report of each patient respectively.&#x0D; Results: Among all the patients undergoing CT scans, paranasal sinuses 177 were True Positives, while 07 were False Positives. Out of a total of 139 CT scan-negative patients, 6 (False Negative) had fungal sinusitis on culture, whereas 133 (True Negative) had no fungal sinusitis on culture (p=0.001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CT scan Paranasal sinuses were 96.72%, 95.0%, 96.20%, 95.68% and 95.98%,respectively.&#x0D; Conclusion: CT scan of paranasal sinuses is a highly sensitive and accurate non-invasive investigation in detecting fungal sinusitis.

Endoscopic appearance of duplicated middle turbinate, case series and literature review.

Duplication of the middle turbinate is an extremely rare condition encountered in rhinology clinic. Knowledge and awareness of the nasal turbinates' variations are important to perform a safe endoscopic surgery and evaluate patients with inflammatory sinus diseases. Case series of two patients who visited rhinology clinic in academic university hospital. Case 1: presented with 6-month history of nasal blockage. Nasal endoscopy revealed bilateral duplication of the middle nasal turbinates. Computed tomography scans showed bilateral medially curved and anteriorly folded uncinate process, and right middle turbinate concha bullosa and its superior end of the middle turbinate was turned medially. Case 2: A 29-year-old gentleman presented with nasal obstruction mainly to the left side for several years. Nasal endoscopy showed bifid right middle turbinate and severe deviated nasal septum to the left. Upon imaging, a sinus computed tomography scan demonstrated a duplication of the right middle turbinates in the form of two middle nasal concha. Different rare anatomical variations can occur at different points during the embryological development. These rare variations include double middle turbinate, accessory middle turbinate, secondary middle turbinate, and bifid inferior turbinate. The appearance of double middle turbinate can be encountered in rhinology clinic only 2% of the time. Upon reviewing the literature, only few case reports were found regarding the double middle turbinate. A double middle turbinate has important clinical implications. Anatomical variation may lead to narrowing in the middle meatus which makes the patient vulnerable to sinusitis or maybe associated with secondary symptoms. We report rare cases of middle turbinate duplication. Awareness of the nasal turbinates' variations is important for detection and management of inflammatory sinus diseases. Further studies are needed to identify the association of other pathology.

Anatomical variations of frontal sinus pneumatization: A computed tomography-based study

Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations. Methods: Retrospectively, 1220 paranasal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex. Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral (p&lt;0.01) and the bilateral hypoplasia (p&lt;0.05) were significantly higher in females. On the other hand, the left unilateral (p&lt;0.01) and the bilateral hyperplasia (p&lt;0.05) were higher in males. Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.

Evaluation of Routine Ear, Nose, and Throat Screening in Heart Transplant Candidates: A Retrospective Cohort Study

Patients with end-stage heart failure refractory to medication can be treated with a heart transplant (HTx). These patients are subjected to a preoperative screening procedure according to International Society for Heart and Lung Transplantation guidelines. Additionally, in our hospital, a routine ear, nose, and throat (ENT) screening is performed, directed toward the identification of asymptomatic infections and head and neck neoplasms. There are no studies demonstrating that this screening has additional value in these patients. To investigate the yield of protocolled ENT screening in candidates for HTx, we retrospectively reviewed the medical records of patients who were subjected to the screening procedure between 2012 and 2020. The study population consisted of 251 patients of whom 177 (70.5%) were male with a median age of 52 years (IQR, 45-59 years). Ten patients (4.0%) were diagnosed with an infection (sinus) or a neoplasm, resulting in a number needed to screen of 25. In all cases, ENT consultation or sinus radiography did not influence the decision to list patients for HTx. Furthermore, no major ENT infections or occurrence of de novo head and neck malignant neoplasm were observed during follow-up after HTx. The clinically relevant yield of protocolled ENT screening in candidates for HTx is low. Based on these findings, we believe that only patients with abnormal findings on a routine sinus computed tomography scan and/or specific ENT complaints should be referred to an otorhinolaryngologist.