Paranasal Sinus CT Research Articles

The Effects of Intervening With Synonasal Changes on Headaches in Migraine Patients Using Endonasal Surgery.

Some anatomical changes might trigger headaches in people who have migraine, and that surgical applications eliminating the structural problems in treatment-resistant migraine patients are effective in pain treatment. A total of 36 patients, who did not respond to different treatment options without aura migraine and chronic migraine that were showing synonasal and anatomical changes in synonasal nasal endoscopy and/or paranasal sinus CT screening, responding insufficiently and/or approximately one year period also did not respond to different treatment options, were included in this study between June 2016 and September 2019. The relation between migraine episodes and synonasal symptoms was found to be statistically significant. A significant difference was detected between nasal congestion and obstruction, postnasal discharge, and runny nose in patients with attacks compared to patients without attacks. The difference between mean pain severity values was statistically significant when compared to preoperative values (3.0(3.0∼4.0)) and post-operative values (1.0(0∼1.0)). When the pain severity after the operation (1.0(1.0∼2.75)) was compared with the severity of pain before the operation (5.0 (3.0∼5.0)), it was determined that there was a significant decrease in pain severity in patients diagnosed with chronic migraine, the difference between the mean pain severity values was statistically significant, and the prevalence of pain decreased at a significant level after the operation. The results of the present study indicate that the elimination of synonasal structural changes, which were hypothesized to trigger pain in migraine patients, could have a pain-reducing effect on the frequency and severity of the pain.

Sinonasal alterations in computed tomography scans in adult cystic fibrosis patients

Adult CF patients often have upper airway involvement, and many develop chronic rhinosinusitis (CRS). There is a disagreement on which paranasal sinus CT features of CRS in CF patients should be considered essential. It is important to define the main criteria for evaluation of the paranasal sinus CT scans and signs of CRS associated with CF to improve CRS diagnosis in CF patients. The aim of the study was to assess the main of paranasal sinus disorders in adult CF patients and increase the effectiveness of CRS diagnosis by CT. Methods. CT features of CRS were assessed in 97 adult CF patients (range: 18 - 44 years, median: 25.8 ± 5.4) with no history of surgical treatment of CRS from different regions of the Russian Federation. The paranasal sinus CT scans performed in 2015 - 2019 were evaluated. Specific features of the paranasal sinus and middle nasal meatus structure and bony variants were found, and the prevalence of sinusitis with different paranasal sinus involvement was assessed. Results. The analysis of CT scans of 97 adult CF patients showed that the main CT features of CRS are maxillary sinus hypoplasia, opacified maxillary and sphenoid sinuses, as well as the ostiomeatal complex changes: enlargement of ethmoid infundibulum, polypous hypertrophy of uncinate process, and medial bulging of the lateral nasal wall. Conclusion. The characteristic CT features of paranasal sinuses in adult CF patients include agenesis of the frontal, maxillary, and sphenoid sinuses, opacification of the maxillary and ethmoid sinuses, and changes in the middle nasal meatus structures. Correct assessment of the listed paranasal sinus CT features will help to diagnose CRS and CF in adult patients.

EFFICIENCY OF COMPUTED BRAIN TOMOGRAPHY AND MINIMAL PARA-NASAL SINUS SCANNING IN PATIENTS WITH HEADACHE

Background: Headache is the most common human condition and affects a wide range of populations with a number of etiologies. The majority of headaches are accounted for by main headache disorders that involve migraine, cluster and tension-type headaches, whereas secondary headaches are much less common than those with underlying disease (e.g. tumour).
 Aims & objectives: To assess the Utility of computed tomography of brain and limited para-nasal sinuses scanning in patients with headache.
 Methodology: This prospective research included 400 cases of primary headache symptoms undergoing computed brain tomography and minimal para-nasal sinus CT scans. For the diagnostic yield from imaging, findings were tabulated and analysed.
 Results: Isolated headache, accompanied by headache with vomiting, was the most common symptom of referral to CT brain. In 44 subjects, 26 due to intracranial pathology and 18 due to para-nasal sinus disease, a severe abnormality was found. Of the 44 positive cases, 12 were lesions occupying room, 4 vaccine infarctions, 2 subarachnoid haemorrhages, 8 cortical vein thrombosis, and 18 had sinusitis.
 Conclusion: Computed tomography is a useful screening tool in the assessment of headache patients.
 Keywords: Headache, Computed Tomography, Migraine, Para Nasal Sinus.

Optimization of paranasal sinus CT procedure: Ultra-low dose CT as a roadmap for pre-functional endoscopic sinus surgery.

To assess image quality and radiation dose associated with ultra-low dose CT protocol for patients with benign paranasal sinus diseases undergoing functional endoscopic surgery (FESS). We scanned the head portion of Alderson RANDO phantom on a second generation, dual-source, multidetector-row CT scanner (Siemens Definition Flash) using standard-dose and five low-dose protocols. Two radiologists assessed the image quality for each protocol to determine best ultra-low-dose protocols for imaging patients with benign paranasal sinus diseases undergoing FESS. The ultra-low-dose CT protocols were then used for scanning. Thereafter, 40 adult patients (age range 18-54years, M:F 23:17) were scanned with the four low dose scanning protocols (10 patients per protocol). On both transverse and coronal reformatted CT images, two radiologists assessed visibility of key anatomic landmarks for FESS on a 2-point scale (1=clear and complete visualization; 2=suboptimal visualization). Data were analyzed with descriptive statistics and Cohen's kappa coefficient for interobserver agreement. In phantom study, the lowest dose scan protocol (CTDIvol 2.1mGy, 70kV, 75 mAs) was unacceptable due to poor image quality. For patient studies, both radiologists gave acceptable image quality scores for ultra-low-dose scan protocol with axial scan mode, automatic tube potential selection and tube current modulation (CTDIvol 2.2mGy; DLP 22.9mGy.cm) with up to 60% lower dose compared to prior standard-dose CT (CTDIvol 5.3mGy; DLP 73.5mGy.cm). Ultra-low-dose CT protocol provides sufficient image quality for scanning patients undergoing functional endoscopic surgery for benign paranasal sinus diseases.

PNEUMOSINUS DILATANS: A CASE REPORT

Frontal sinuses that present with abnormally large size are often clinically described as a deformity of the forehead, caused by Pneumosinus dilatans (PD). We report a rare case of Pneumosinus dilatans frontalis which was accidentally discovered by a paranasal sinus CT scan requested following frontal headaches, and thus revealing diffuse osteoporosis. Pneumosinus dilatans is often an unexpected radiological finding; however, in most cases, it is diagnosed by recognition of a frontal deformity.

A new perspective on imaging of olfactory dysfunction: Does size matter?

PurposeThis study assesses the diagnostic utility of olfactory nerve and bulb morphologies in addition to volumetric analysis in classification of different olfactory dysfunction etiologies. Methods106 patients presenting with olfactory loss and 17 control subjects were included. Based on detailed anamnesis, smell test and ear-nose-throat examination; patients were categorized into four groups as post-viral, post-traumatic, idiopathic, and obstructive olfactory dysfunction. Olfactory region was imaged with paranasal sinus CT and MRI dedicated to olfactory nerve. Olfactory bulb volume and olfactory sulcus depths were calculated on MRI. The olfactory bulb was assessed for morphology, contour lobulations and T2-signal intensity; and olfactory nerve for uniformity and clumping. ResultsVolumetric analysis showed decreased olfactory bulb volume in idiopathic and obstructive group compared to control subjects. Olfactory sulci were shallower in post-viral, post-traumatic, idiopathic, and obstructive group compared to the control group.In post-viral group; olfactory bulbs had lobulated contour and focal T2-hyperintense regions in 67 % of cases, and olfactory nerves had a clumped and thickened appearance in 66 % of cases. In idiopathic group, olfactory bulbs were rectangular shaped with minimally deformed contours, and olfactory nerves were thin and hard to delineate. No specific olfactory bulb or nerve pattern was identified in obstructive and post-traumatic groups, however closed olfactory cleft and siderotic frontobasal changes were helpful clues in obstructive and post-traumatic groups, respectively. ConclusionIn addition to olfactory cleft patency, olfactory sulcus depth and olfactory bulb volume; bulb and nerve morphologies may provide diagnostic information on different etiologies of olfactory dysfunction.

The imaging anatomy of ethmomaxillary sinus and its impact on chronic rhinosinusitis

The aim of this study was to investigate the pneumatization degree of ethmomaxillary sinus (EMS) and adjacent structures, and its impact on chronic rhinosinusitis (CRS). A retrospective analysis of paranasal sinus CT scans of 996 patients was conducted. The maximum vertical diameter of EMS in the coronal plane was measured, allowing EMS to be classified, and its impact on ipsilateral CRS were examined. The prevalence of EMS was 11.9%. The maximum vertical diameter of EMS in the coronal plane ranged from 3.68 to 28.76mm with a mean (± SD) of 11.32 ± 5.12mm. The prevalence rates of EMS in CRS sides and non-CRS sides were 12.5% and 9.3%, respectively, which was significantly different (χ2 = 4.495; p < 0.05). The difference in prevalence between the three types of EMS in ipsilateral CRS was statistically significant (χ2 = 6.733; p < 0.05). The difference in Lund-Mackay (LM) score of ipsilateral CRS between the three types showed no statistically significant difference (H = 4.033; p > 0.05). EMS is a common anatomical variation with marked individual differences in shape and pneumatization degree. A higher degree of EMS pneumatization may contribute to the occurrence of CRS; this should be investigated before surgery.

Lacrimal Drainage System Problems After Rhinoplasty.

To report case series of permanent nasolacrimal system problems following rhinoplasty METHODS: The documents of patients with epiphora and history of rhinoplastic surgery were reviewed. The data of patients with permanent epiphora (continued over 3months or started after 3months of post-rhinoplasty surgery) and lacrimal drainage system (LDS) problems were analyzed for demographics, the result of diagnostic probing and irrigation, findings of orbital and paranasal sinuses CT scan, abnormalities in nasal endoscopy, treatment, and follow-up data. Forty-three patients with epiphora and history of rhinoplasty were referred to our clinic. Ten of them had permanent epiphora and LDS problems. In these patients, the mean time between rhinoplasty and initial symptoms of LDS problems was 10.3 ± 15.1 (range, 0-45months) and the mean time between rhinoplasty and the LDS surgery was 22.2 ± 19.5months (range 4-60months).Diagnostic probing and irrigation test revealed canalicular stenosis in four (40%) patients, pus reflux in four (40%), clear reflux without passage in four (40%), and partial nasolacrimal duct obstruction (NLDO) in two (20%) of patients. DCR was performed in eight (80%) patients. Therapeutic probing and lacrimal intubation were performed in two (20%) patients. A permanent injury of the LDS is one of the important complications of the rhinoplastic surgery that should be managed based on theonset and duration of the symptoms and the location of the injury. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of optic nerve variations in relation to posterior paranasal sinuses among study population of Mandya District of Karnataka State

This study aims to determine relationship of optic nerves to posterior paranasal sinuses, its types, incidence and prevalence among study population of Mandya district, Karnataka. This observational study comprised 124 patients who were recommended for FESS and were referred to radiology department for CT scan between July 2019 to December 2019 at MIMS, Mandya. The age and sex of the patients along with the symptoms and its duration was recorded. All the patients underwent a comprehensive medical history and head and neck physical examination. A high resolution, 1.25 mm thick CT scan was taken for the study. Relationship of optic nerves to posterior paranasal sinuses was categorized according to Delano classification. Descriptive statistics like mean and percentages were used for analysis using SPSS v.22. The findings showed the prevalence of Onodi cells in 22.6% of the patients. Onodi cells were observed in 8.9% on the right side and 5.6% on left side of the patients respectively. In 8.1% of the patients, bilateral Onodi cells were present. ACP pneumatization was present in 25.1% of the patients bilaterally. ACP pneumatisation was found on the right side and left side in 10.5% and 6.5% respectively. 124 patients underwent CT of paranasal sinuses during study period and course of 248 optic nerves were examined in relation to posterior paranasal sinuses. Type 1, Type 2, Type 3, and Type 4 optic nerves was present in 83.33%, 8.87%. 12.1%, and 21.78% respectively. Bilateral Type 1 optic nerves was present in 58.88% patients, both Type 2 and Type 3 optic nerves were seen bilaterally in 3.23% of patients and bilateral Type 4 optic nerve was seen in 10 (8.06%) cases. Optic nerve Type 1 (83.88%) was the most frequent nerve type, followed by Type 4 (21.78%). In conclusion, the anatomical variations of paranasal sinuses are very important to be identified preoperatively since sphenoid sinus and optic nerve relation is known for its variation. Before endoscopic sinus surgery, one needs to know this anatomy using CT of paranasal sinuses using Delano classification of optic nerve.

The Trend of Changes in Paranasal CT Scan in Patients with Hematologic Malignancy Under Chemotherapy

ObjectivesThe aim of this study was to evaluate the clinical significance of early screening of computerized tomography scan of paranasal sinuses (PNS CT) in hematologic malignancies before chemotherapy and evaluation of changes after chemotherapy and during neutropenia.MethodsAll 40 new cases of hematologic malignancies with febrile neutropenia in a teaching referral hospital between 2018 and 2019 were enrolled in this study. All of these patients underwent paranasal sinus (PNS) CT scan before chemotherapy, along with other preliminary investigations. Symptoms and signs indicating the infectious process were meticulously followed and monitored before and during chemotherapy as well as the occurrence of febrile neutropenia. All patients were clinically and radiologically evaluated regarding the presumptive diagnosis of invasive fungal sinusitis during prolonged febrile neutropenia (more than 4 days). PNS CTs before and after chemotherapy of all patients were compared by two radiologists and were evaluated based on histopathologic findings of nasal and or paranasal biopsies.ResultsAround 50% of patients with PNS CT scan abnormality suspected inflammatory process including microbial and fungal sinusitis during prolonged febrile neutropenia (more than 4 days) were confirmed that have had similar involvement before starting chemotherapy and these abnormalities have been stable with no significant changes after chemotherapy. The histopathologic examination of sinuses also showed no evidence of invasive fungal infection by endoscopic biopsy. Therefore, the abnormal findings including mucosal thickening in PNS CT during prolonged febrile neutropenia were not consistent with the confirmed invasive fungal infection. The rate of mortality was 2.5% without association with invasive fungal sinusitis.ConclusionsA considerable number of patients with underlying hematologic malignancies have paranasal sinus involvement such as mucosal thickening that may be misdiagnosed as invasive fungal sinusitis during the hazardous phase of prolonging febrile neutropenia. Thus, performing PNS CT scan before initiation of chemotherapy even though in asymptomatic patients could be helpful to decrease the number of suspected and probable cases of fungal sinusitis based on abnormal findings in PNS CT scan followed by the number of cases undergoing sinus endoscopic surgery.

Objective assessment of nasal function changes after revision endoscopic sinus surgery in patients with recurrent sinusitis

Objective:To investigate the objective evaluation system of nasal function changes in patients with recurrent sinusitis after revision endoscopic sinus surgery. Method:Sixty patients with recurrent sinusitis underwent revision endoscopic sinus surgery. The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score were performed before surgery, 3, 6 and 12 months after surgery. The saccharin test was used to evaluate the nasal mucosa ciliary moving function（nasal mucosal ciliary motor velocity） before surgery, 6 and 12 months after surgery. The correlation of objective evaluation indexes before and after surgery was analyzed. Result:The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score of patients 3, 6, 12 months after surgery were lower than those before surgery（P<0.05）; The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score of patients 6 and 12 months after surgery were lower than those 3 months after surgery（P<0.05）; The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score of patients 12 months after surgery were lower than those 6 months after surgery（P<0.05）. The nasal mucosal ciliary motor velocity of patients 6 and 12 months after surgery was lower than that before surgery（P<0.05）; The nasal mucosal ciliary motor velocity of patients 12 months after surgery was lower than that 6 months after surgery（P<0.05）. The Lund-Kennedy endoscopic sinus score was positively correlated with Lund-Mackay paranasal sinus CT score in patients before surgery, 3, 6 and 12 months after surgery（P<0.05）; The Lund-Kennedy endoscopic sinus score was negatively correlated with nasal mucosal ciliary motor velocity in patients before surgery, 6 and 12 months after surgery（P<0.05）; The Lund-Mackay paranasal sinus CT score was negatively correlated with nasal mucosal ciliary motor velocity in patients before surgery, 6 and 12 months after surgery（P<0.05）. Conclusion:There is good correlation among the Lund-Kennedy endoscopic sinus score, the Lund-Mackay paranasal sinus CT score and the nasal mucosal ciliary motor velocity in patients with recurrent sinusitis before and after revision endoscopic sinus surgery. This study establishes an objective evaluation system for evaluating the changes in nasal function with these three indexes as the main body.

Prevalence of Chronic Rhinosinusitis in ENT Departement RSUP Dr. Mohammad Hoesin Palembang Period 2016-2018

Chronic rhinosinusitis (CRS) is an inflammation involving the nose and paranasal sinuses where the patient has two or more major symptoms or one major symptom with two minor symptoms for ≥12 weeks. The prevalence of CRS throughout the world population is around 10-12%. The prevalence of CRS in Indonesia is uncertain. A research has been conducted on the prevalence of CRS in RSUP Dr. Mohammad Hoesin Palembang in 2015, therefore this study aims to find out more about the prevalence of CRS in the ENT Department of Dr. Mohammad Hoesin Palembang General Hospital in the period 2016-2018 and its distribution based on age, sex, major symptoms, minor symptoms, and the number of sinuses involved. This research was an observational descriptive survey with cross-sectional design. This study used medical records of CRS patients undergoing surgery in the Rhinology Division of the ENT Department RSUP Dr. Mohammad Hoesin Palembang period 2016-2018. Sampling was done by consecutive sampling method. The amount of samples in this research is 99 cases. The result of this research is presented in table and narration form. The prevalence of CRS was 33.55%. CRS is most commonly found by the age group 46-53 years (21.2%), male sex (65.7%) with a ratio between men and women 1.9: 1. The most common major symptom was nasal congestion (100%) and the most common minor symptom was headache (62.6%). The most number of sinuses involved based on the paranasal sinus CT scan results was multiple sinusitis (52.5%).

Prevalence of Chronic Rhinosinusitis in ENT Departement RSUP Dr. Mohammad Hoesin Palembang

Introduction: Prevalence of Chronic Rhinosinusitis in ENT Department RSUP Dr. Mohammad Hoesin Palembang Period 2016-2018. Chronic rhinosinusitis (CRS) is an inflammation involving the nose and paranasal sinuses where the patient has two or more major symptoms or one major symptom with two minor symptoms for ≥12 weeks. The prevalence of CRS throughout the world population is around 10-12%. The prevalence of CRS in Indonesia is uncertain. A research has been conducted on the prevalence of CRS in RSUP Dr. Mohammad Hoesin Palembang in 2015, therefore this study aims to find out more about the prevalence of CRS in the ENT Department of Dr. Mohammad Hoesin Palembang General Hospital in the period 2016-2018 and its distribution based on age, sex, major symptoms, minor symptoms, and the number of sinuses involved.&#x0D; Methods: This research was an observational descriptive survey with cross-sectional design. This study used medical records of CRS patients undergoing surgery in the Rhinology Division of the ENT Department RSUP Dr. Mohammad Hoesin Palembang period 2016-2018. Sampling was done by consecutive sampling method. The amount of samples in this research is 99 cases. The result of this research is presented in table and narration form. The prevalence of CRS was 33.55%. CRS is most commonly found by the age group 46-53 years (21.2%), male sex (65.7%) with a ratio between men and women 1.9: 1. The most common major symptom was nasal congestion (100%) and the most common minor symptom was headache (62.6%). The most number of sinuses involved based on the paranasal sinus CT scan results was multiple sinusitis (52.5%).

Usefulness of computed tomography in predicting ethmoidal arterial bleeding in refractory epistaxis.

Epistaxis that is refractory to conservative management can be treated with endoscopic sphenopalatine artery ligation (ESPAL). Although rare, ethmoidal artery (EA) bleeding can be a cause of rebleeding after successful ESPAL. EA bleeding is diagnosed by angiography and can also be identified during surgical exploration. However, since the angiographic embolization of the EA is contraindicated, surgical hemostasis is mandatory. This study investigated whether paranasal sinus (PNS) CT could provide information for predicting EA bleeding without angiography in patients with refractory epistaxis requiring ESPAL. Forty-seven patients, who were surgically treated [with ESPAL or EA ligation (EAL)] for refractory epistaxis from March 2010 to June 2019, were retrospectively analyzed. A positive PNS CT finding for EA bleeding was defined as the presence of soft tissue densities having continuity with the EA pathway, accompanied by a partially deficient surrounding bony canal. These findings as well as soft tissue densities in each paranasal sinus were compared between the ESPAL and EAL groups. All patients in the EAL group had positive CT findings of EA bleeding, compared to only 12.2% in the ESPAL group (P < 0.001). The rate of soft tissue densities within the frontal and sphenoid sinuses were noted in 26.8% and 17.1% of patients in the ESPAL group, compared to 83.3% and 83.3% of patients in the EAL group (P = 0.013 and P = 0.003, respectively). PNS CT might be useful for predicting EA bleeding in patients with refractory epistaxis requiring surgical hemostasis.

Experimental study on the effect of adaptive statistical iterative reconstruction algorithms on image quality and radiation dose in paranasal sinus CT

Objective To explore the effect of pre- and post-adaptive statistical iterative reconstruction-Veo (ASiR-V) on image quality and radiation dose in paranasal sinus CT, and to find the best combinations. Methods One head specimen was scanned with the routine spiral CT scanning parameters [noise index (NI)=8] and different levels of pre-ASiR-V (0—100%, with an interval of 10%). The images were reconstructed with different post-ASiR-V (0—100%, with an interval of 10%) for the bone algorithm and standard algorithm. All of 242 thin-layer images of paranasal sinuses were obtained. The region of interest (ROI) was selected to measure the CT value to calculate the contrast to noise ratio (CNR) and figure of merit (FOM). The volume CT dose index (CTDIvol) and Smart mA were recorded. The linear regression was conducted to analyze the relationship between CTDIvol, SmartmA, CNR and FOM. And with the same pose-ASiR-V level, the CNR of images which reconstructed by bone and soft algorithms were compared with pair-wise t test. The image quality was subjectively evaluated by three independent experienced radiologists using a 4-point scale (4 was the best). Results As the pre-ASiR-V levels (0—100%) increased, Smart mA and CTDIvol were reduced with a linear negative correlation (r=-0.981, -0.976, both P<0.001). The Smart mA decreased by 72.05% and CTDIvol by 71.22%. Keeping the same pre-ASiR-V level,the CNR increased with the increase of post-ASiR-V level (for the bone algorithm images:R2=0.976, 0.992, 0.982, 0.982, 0.975, 0.975, 0.979, 0.996, 0.952, 0.978, 0.965;for the standard algorithm images: R2=0.944, 0.990, 0.988, 0.993, 0.996, 0.987, 0.984, 0.996, 0.996, 0.990, 0.965).Under the same level of post-ASiR-V, the CNR and FOM fluctuated with the pre-ASiR-V level (for the bone algorithm images:R2=0.335, 0.341, 0.344, 0.364, 0.385, 0.405, 0.418, 0.429, 0.455, 0.474, 0.516; for the standard algorithm images: R2=0.223, 0.278, 0.327, 0.285, 0.309, 0.329, 0.325, 0.346, 0.360, 0.390, 0.380). All subjective image quality could meet the diagnostic requirements (the score≥3). Conclusion At NI=8, for the bone algorithm, the best combination is 80% pre-ASiR-V and 100% post-ASiR-V; for the standard algorithm, the best iteration combination is 100% and 100%. The appropriate choice of pre- and post-ASiR-V levels in paranasal sinus CT scan can effectively reduce the radiation dose under the premise of maintaining the image quality that meets the diagnostic needs. Key words: Paranasal sinuses; Tomography, X-ray computed; Radiation dosage; Image processing, computer-assisted; Image quality

Does Nasal Septal Deviation and Concha Bullosa Have Effect on Maxillary Sinus Volume and Maxillary Sinusitis?: A Retrospective Study.

PurposeThis study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis.Materials and MethodsThis study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4.ResultsIntersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both: p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201).ConclusionAlthough nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.

Role of CT Nose Paranasal Sinuses and Nasal Endoscopy for Decision Making in a Case of Deviated Nasal Septum

Introduction&#x0D; Deviated nasal septum (DNS) can be asymptomatic in an individual or may cause nasal obstruction. The condition is generally diagnosed clinically and based on clinical diagnosis it is managed Surgically by large without much heed to diagnostic procedure. Thus, often underlying other causes of Obstruction is missed. Thus, it becomes essential to evaluate every patient presenting with history of Nasal obstruction and clinically Deviated septum, with aid of Nasal Endoscopy and CT scan Nose Paranasal Sinuses (PNS) to rule out/diagnose other coexisting conditions.&#x0D; Methods and Methodology&#x0D; 100 patients who presented with nasal obstruction and clinically diagnosed to have Deviated Nasal Septum were then subjected to Nasal Endoscopy and CT scan Nose and PNS and findings were noted for analysis.&#x0D; Results and Analysis&#x0D; Of these 100 patients, 48 patients were found to have coexisting pathological conditions/anatomical variants. Various anatomical and pathological Conditions were found to coexist together. Inferior turbinate hypertrophy in 34% is the most common pathological condition found to be associated with DNS followed by of sinusitis in 25% patients apart from polyp, concha bullosa and paradoxical middle turbinate.&#x0D; Discussion&#x0D; Studies done so far shows there is a definite link of deviated nasal septum to various anatomical and pathological conditions of the nose. CT Scan Nose PNS and Nasal Endoscopy plays a vital role in diagnosing such anomalies.&#x0D; Conclusion&#x0D; Most of the patients, presenting with nasal obstruction and having Deviated Nasal Septum, undergo management without proper analysis and returns with recurrence of symptoms which could be analyzed properly if Nasal endoscopy and CT scan is employed during diagnosis of the condition, reducing risk of treatment failure.

Effect of anatomical changes of frontal recess and frontal sinus on airflow after nasalisation by image reconstruction and numerical simulation

Objective: To describe the influence of post-operative anatomical structure changes on nasal airflow characteristics by 3D reconstruction and numerical simulation in real cases after nasalisation with Draf Ⅲ so as to explore the correlation between the changes of anatomical structure and subjective symptoms as well as airflow characteristics. Methods: Ten patients underwent nasalization with Draf Ⅲ in Department of Rhinology in Beijing Tongren Hospital from 2006 to 2018 were selected retrospectively. Postoperative follow-up of all patients was more than 1 year. All patients had no abnormalities in their paranasal sinus CT scans and Lund-Kennedy scores were 0 except scar. VAS scores including nasal obstruction, stimulation in frontal sinus, and headache were collected at the same period. The control model was a normal person. Numerical simulation was used for calculating airflow characteristics in deep inspiratory period of both models. Independent sample Mann-Whitney U test and Spearman correlation test were used by software SPSS 22.0. Results: The airflow pressure in frontal sinus ostium was (7.21±1.39)×10(4) Pa (Mean±SD), which was lower than that in normal subjects (8.99×10(4) Pa) under deep inspiratory simulation. But, the velocities in frontal sinus ostium and frontal sinus were (40.10±2.46) m/s and (28.19±1.73) m/s respectively, which were higher than those in normal one (2.70 m/s, 0.73 m/s). The airflow patterns of the two models were basically similar. There was no significant difference in the opening size and volume of frontal sinus between different groups after grouped by three symptoms respectively. No correlation could be found between the opening size and volume of the frontal sinus with the appearance and severity of three subjective symptoms. Conclusions: The airflow pattern and distribution after nasalisation with Draf Ⅲ are like those of normal person. There is no correlation between the changes of anatomy in frontal recess and frontal sinus and nasal airflow characteristics as well as subjective symptoms.

Anatomical Workspace Study of Endonasal Endoscopic Transsphenoidal Approach.

PurposeTo determine the workspace through an anatomical dimensional study of the skull base to further facilitate the design of the robot for endonasal endoscopic transsphenoidal (EET) surgery.MethodsThere were 120 cases having a paranasal sinus CT scan in the database. The internal volumes of the nasal cavities (NC), the volumes of the sphenoid sinuses (SS), and the distance between the anterior nasal spine and base of the sellar (d-ANS-BS) were measured.ResultsThe Pearson correlation coefficient (PCC) between the relevant distances and the volumes of the right NC was 0.32; between the relevant distances and the volumes of the left NC was 0.43; and between the relevant distances and volumes of NC was 0.41; with a statistically significant difference (p < 0.001). All PCCs had a statistically significant meaningful difference (p < 0.05).ConclusionThe volume of NCs were significantly correlated with distances (p < 0.05). The safest and shortest distance to guide the robotic arm length in the EET approach could be represented by d-ANS-BS. This result was also used as primary information for further robotic design.

Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study.

The surgical approach for hypophysectomy has undergone sweeping revolution in the past three decades. With the advent of endoscopes, better instrumentation, better illumination and viewing cameras, endoscopic endo-nasal trans-sphenoidal approach to sella has now largely become the norm. The aim of this study is to present our experience, analysing the surgical outcomes of this approach in patients with pituitary adenoma, pertaining to entirety of tumor removal, alleviation of symptoms and rate of complications. This prospective studywas conducted at our tertiary health care centre from June 2012 to June 2015. A total of 14 patients, meeting the inclusion criteria, underwent endoscopic trans-sphenoidal hypophysectomy for pituitary adenoma. Age of presentation ranged from 19 to 73years (mean 43.6years). 9 patients were female and 5 were male. The most common presenting symptom was headache, followed by visual disturbances. Amongst those with hormonal imbalance, most common were prolactinomas and growth hormone secreting adenomas. Preoperative MRI brain showed macroadenomas in all 14 patients. 7 (50%) patients had suprasellar extension, while 5 (36%) patients had intracavernous extension too. CT paranasal sinuses provided the roadmap for surgery by identifying anatomical variations. Alleviation of headache occurred in all cases. Normalization of altered hormonal profile was seen in all cases. 83.3% of our patients with visual field defects on perimetry showed improvement post-surgery. Recidivism was directly related to the size and extent of adenoma. Transient diabetes insipidus was seen in 4 (28%) cases. Persistent diabetes insipidus occurred in 1 (7%) patient. CSF leak was seen in 2 (14%) patients, 1 (7%) patient developed postoperative meningitis. Most common nasal complication was excessive crusting. There was no incidence of any vascular complications, focal neurological deficit or hypopituitarism in our study. The pure endoscopic approach is a safe, efficacious, and minimally invasive technique for the removal of pituitary adenomas. The results have been encouraging in our prospective study. However, the importance of learning curve in endoscopic skull base surgery and use of a multi-disciplinary collaboration cannot be overemphasized.