Sinus Computed Tomography Images Research Articles

The accuracy of deep learning models for diagnosing maxillary fungal ball rhinosinusitis.

To assess the accuracy of deep learning models for the diagnosis of maxillary fungal ball rhinosinusitis (MFB) and to compare the accuracy, sensitivity, specificity, precision, and F1-score with a rhinologist. Data from 1539 adult chronic rhinosinusitis (CRS) patients who underwent paranasal sinus computed tomography (CT) were collected. The overall dataset consisted of 254 MFB cases and 1285 non-MFB cases. The CT images were constructed and labeled to form the deep learning models. Seventy percent of the images were used for training the deep-learning models, and 30% were used for testing. Whole image analysis and instance segmentation analysis were performed using three different architectures: MobileNetv3, ResNet50, and ResNet101 for whole image analysis, and YOLOv5X-SEG, YOLOv8X-SEG, and YOLOv9-C-SEG for instance segmentation analysis. The ROC curve was assessed. Accuracy, sensitivity (recall), specificity, precision, and F1-score were compared between the models and a rhinologist. Kappa agreement was evaluated. Whole image analysis showed lower precision, recall, and F1-score compared to instance segmentation. The models exhibited an area under the ROC curve of 0.86 for whole image analysis and 0.88 for instance segmentation. In the testing dataset for whole images, the MobileNet V3 model showed 81.00% accuracy, 47.40% sensitivity, 87.90% specificity, 66.80% precision, and a 67.20% F1 score. Instance segmentation yielded the best evaluation with YOLOv8X-SEG showing 94.10% accuracy, 85.90% sensitivity, 95.80% specificity, 88.90% precision, and an 89.80% F1-score. The rhinologist achieved 93.5% accuracy, 84.6% sensitivity, 95.3% specificity, 78.6% precision, and an 81.5% F1-score. Utilizing paranasal sinus CT imaging with enhanced localization and constructive instance segmentation in deep learning models can be the practical promising deep learning system in assisting physicians for diagnosing maxillary fungal ball.

Assessment of cerebral venous sinus: Anatomical and functional diagnostic performance of three-dimensional reconstruction models based on venous sinus MRI and CT images

Venous sinus stenosis is commonly observed in patients presenting with pulsatile tinnitus (PT). While magnetic resonance imaging (MRI) and computed tomography (CT) are commonly used for assessing venous sinus geometries, the preferred modality remains unclear. In this study, we reconstructed the three-dimensional (3D) geometries of the venous sinus using MRI and CT imaging data from 20 PT patients. We conducted comparisons of the anatomical features of the venous sinus through case-wise analysis and anatomic geometrical parameter-wise analysis. Our findings indicate that by taking the geometries from CT as a reference, MRI could provide a better illustration of venous structure, primarily due to a stronger flow signal concentrated in the vascular tree. We observed high agreements in anatomic parameters measured from 3D geometries reconstructed based on CT and MRI in 19 out of 20 cases. Notably, the cross-sectional area of the sinus and segment length displayed the highest consistency, with a mean difference of -5.01% and 6.5% between modalities, respectively. In addition, we noticed that 55% of cases exhibited consistency in analyzing the confluence of the sinus, while variants of connectivity and collateral branching were observed between CT and MRI. Importantly, CT-based geometric reconstruction provided better detail of inflow side branches in the straight sinus, whereas MRI preserved more side branches of outflow in the downstream sinus. It is important to note that CT-based evaluation may be affected by the bone structures surrounding the venous sinus, whereas MRI-based evaluation focuses on blood flow to the segments, potentially indicating both anatomical and functional abnormalities.

The Effects of Nasal Septal Deviation on Anterior Skull Base Parameters.

Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objectıve The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level ( p < 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications.

Deep learning in computed tomography to predict endotype in chronic rhinosinusitis with nasal polyps

BackgroundAs treatment strategies differ according to endotype, rhinologists must accurately determine the endotype in patients affected by chronic rhinosinusitis with nasal polyps (CRSwNP) for the appropriate management. In this study, we aim to construct a novel deep learning model using paranasal sinus computed tomography (CT) to predict the endotype in patients with CRSwNP.MethodsWe included patients diagnosed with CRSwNP between January 1, 2020, and April 31, 2023. The endotype of patients with CRSwNP in this study was classified as eosinophilic or non-eosinophilic. Sinus CT images (29,993 images) were retrospectively collected, including the axial, coronal, and sagittal planes, and randomly divided into training, validation, and testing sets. A residual network-18 was used to construct the deep learning model based on these images. Loss functions, accuracy functions, confusion matrices, and receiver operating characteristic curves were used to assess the predictive performance of the model. Gradient-weighted class activation mapping was performed to visualize and interpret the operating principles of the model.ResultsAmong 251 included patients, 86 and 165 had eosinophilic or non-eosinophilic CRSwNP, respectively. The median (interquartile range) patient age was 49 years (37–58 years), and 153 (61.0%) were male. The deep learning model showed good discriminative performance in the training and validation sets, with areas under the curves of 0.993 and 0.966, respectively. To confirm the model generalizability, the receiver operating characteristic curve in the testing set showed good discriminative performance, with an area under the curve of 0.963. The Kappa scores of the confusion matrices in the training, validation, and testing sets were 0.985, 0.928, and 0.922, respectively. Finally, the constructed deep learning model was used to predict the endotype of all patients, resulting in an area under the curve of 0.962.ConclusionsThe deep learning model developed in this study may provide a novel noninvasive method for rhinologists to evaluate endotypes in patients with CRSwNP and help develop precise treatment strategies.

Imaging of the Ethmomaxillary Sinus, its Prevalence, and Evaluation of its Relationship with Chronic Rhinosinusitis

Objective: The presence of an ethmomaxillary sinus (EMS) may increase the susceptibility to inflammatory paranasal sinus diseases such as chronic rhinosinusitis (CRS) and cause difficulties in surgical interventions to the paranasal sinuses. Therefore, this study aimed to examine the EMS in patients with and without CRS. Methods: The study included 150 patients (300 sides) diagnosed with CRS by the ear–nose–throat clinic and 151 individuals (302 sides) without CRS. Paranasal sinus computed tomography images were reviewed retrospectively. The presence of an EMS (bilateral or not) and its relationship with age and sex were examined. The severity of CRS was determined with the Lund–Mackay scoring system, and its relationship with EMS was evaluated. Results: The EMS was detected in 7 patients (7/301, 2.32%) and 9 sides (9/602, 1.49%) of 301 patients (602 sides) included. The incidence in the CRS group was 2.6%. Three cases were unilateral, and one was bilateral. The incidence in the control group was 1.98%, two cases were unilateral, and one was bilateral. According to the Lund–Mackay scoring system, the mean CRS severity was 8.62 (±5.47). Its severity was 5.25 (±3.94) in the EMS group and 8.71 (±5.48) in the non-EMS group. Conclusion: No statistically significant difference was found between the groups with and without CRS in terms of the presence of EMS (p = 0.723). No evidence reveals that EMS increased the severity of CRS.

Assessment of the prelacrimal recess in different maxillary sinus pneumatizations in relation to endoscopic prelacrimal recess approaches: a computed tomography study.

To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations. Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups. The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001). This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.

Relationship Between Nasal Septal Deviation Angles and Turbinates: A Computed Tomography Study.

Background This study aimed to evaluate inferior turbinate hypertrophy caused by nasal septum deviation, nasal septal deviation (SD) angles, and age differences with the help of paranasal computed tomography (CT) and to investigate the relationship between these parameters. Methodology The paranasal sinus CT images of 100 patients (50 males and 50 females) were retrieved from the hospital's picture archiving and communication system. In this retrospective study, patients were examined in two groups. There were 50 patients aged >35 years in group 1 and 50 patients aged <35 years in group 2. The SD side was determined using a coronal image and was mentioned as the ipsilateral side. The contralateral side of the SD side was mentioned as the contralateral side. Additionally, the SD curve angle (SDCA), superior SD angle (SSDA), and diameters and mucosal thicknesses of the inferior turbinates were measured. Concomitant ipsilateral sinusitis and ipsilateral concha bullosa (in the middle concha) were also noted as present or absent. Results In our study, the SDCA values of the ≥35-year age group were significantly higher than those of the <35-year age group (p < 0.05). Furthermore, the SSDA values of the ≥35-year age group were significantly lower than those ofthe <35-year age group (p < 0.05). In each of the age groups, ipsilateral inferior turbinate mucosal thickness and ipsilateral inferior turbinate diameter values were significantly higher than those of the contralateral sides (p < 0.05). Ipsilateral concha bullosa was present in 30.0% of the <35-year age group and 18.0% of the ≥35-year age group.Ipsilateral sinusitis was present in 34.0% of the <35-year age group and 52.0% of the ≥35-year age group. Conclusions SD and inferior turbinate hypertrophies should be evaluated together and measured with paranasal CT to provide more efficient nasal aeration. Studies with larger patient series are needed to elucidate the etiology.

HOW DEEP DO YOU GO? CLINICAL PREDICTION OF NASOPHARYNGEAL DEPTH BASED ON FACIAL MEASUREMENTS.

Nasopharyngeal depth (ND) prediction is clinically relevant in performing medical procedures, and in enhancing technique accuracy and patient safety. Nonetheless, clinical predictive variables and normative data in adults remain limited. This study aimed to determine normative data on ND and its correlation to external facial measurements. A multicenter cross-sectional study obtained data from adults presenting to otolaryngology clinics at five sites in Canada, Italy, and Spain. Investigators compared endoscopically measured depth from the nasal sill (soft tissue between the nasal ala and columella) to nasopharynx along the nasal floor to the "curved distance from the alar-facial groove along the face to the tragus" and "distance from the tragus to a plane perpendicular to the philtrum." When sinus CT images were available, the distance from the nasopharynx to the nasal sill was also collected. 371 patients participated in the study (41% women; 51 years old, SD 18). Average ND was 9.4 cm (SD 0.86) and 10.1 cm (SD 0.9) for women and men, respectively (p<0.001; 95% CI 0.46 to 0.86). Perpendicular distance was strongly correlated to ND (r=0.775; p<0.001), with an average underestimation of 0.1 cm (SD 0.65; 95% CI 0.06 to 0.2). The equation: ND(cm) = perpendicular distance*0.773 + 2.344, generated from 271 randomly selected participants, and validated on 100 participants, resulted in a 0.03 cm prediction error (SD 0.61; 95% CI -0.08 to 0.16). Nasopharyngeal depth can be approximated by the distance from the tragus to a plane perpendicular to the philtrum. This article is protected by copyright. All rights reserved.

Assessment of low-dose paranasal sinus CT imaging using a new deep learning image reconstruction technique in children compared to adaptive statistical iterative reconstruction V (ASiR-V)

PurposeTo compare the effects of deep learning image reconstruction (DLIR) and adaptive statistical iterative reconstruction V (ASiR-V) on image quality in low-dose computed tomography (CT) of paranasal sinuses in children.MethodsLow-dose CT scans of the paranasal sinuses in 25 pediatric patients were retrospectively evaluated. The raw data were reconstructed with three levels of DLIR (high, H; medium, M; and low, L), filtered back projection (FBP), and ASiR-V (30% and 50%). Image noise was measured in both soft tissue and bone windows, and the signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the images were calculated. Subjective image quality at the ethmoid sinus and nasal cavity levels of the six groups of reconstructed images was assessed by two doctors using a five-point Likert scale in a double-blind manner.ResultsThe patients’ mean dose-length product and effective dose were 36.65 ± 2.44 mGy·cm and 0.17 ± 0.03 mSv, respectively. (1) Objective evaluation: 1. Soft tissue window: The difference among groups in each parameter was significant (P < 0.05). Pairwise comparisons showed that the H group’ s parameters were significantly better (P < 0.05) than those of the 50% post-ASiR-V group. 2. Bone window: No significant between-group differences were found in the noise of the petrous portion of the temporal bone or its SNR or in the noise of the pterygoid processes of the sphenoids or their SNRs (P > 0.05). Significant differences were observed in the background noise and CNR (P < 0.05). As the DLIR intensity increased, image noise decreased and the CNR improved. The H group exhibited the best image quality. (2) Subjective evaluation: Scores for images of the ethmoid sinuses were not significantly different among groups (P > 0.05). Scores for images of the nasal cavity were significantly different among groups (P < 0.05) and were ranked in descending order as follows: H, M, L, 50% post-ASiR-V, 30% post-ASiR-V, and FBP.ConclusionDLIR was superior to FBP and post-ASiR-V in low-dose CT scans of pediatric paranasal sinuses. At high intensity (H), DLIR provided the best reconstruction effects.

Forensic Identification from Three-Dimensional Sphenoid Sinus Images Using the Iterative Closest Point Algorithm.

Forensic identification of human remains is crucial for legal, humanitarian, and civil reasons. Wide heterogeneity in sphenoid sinus morphology can be used for personal identification. This study aimed to propose a new protocol for personal identification based on three-dimensional (3D) reconstruction of sphenoid sinus CT images using Iterative Closest Point (ICP) algorithm. Seven hundred thirty-two patients which consisted of 348 females and 384 males were retrospectively included. The study sample includes 732 previous images as a source point set and 743 later ones as a scene target set. The sphenoid sinus computed tomography (CT) images were processed on a workstation (Dolphin imaging) to obtain 3D images and stored as a file format of Stereo lithography (.STL). Then, a Python library vtkplotter was used to transform the STL format to PLY format, which was adapted to Point Cloud Library (PCL). The ICP algorithm was used for point clouds matching. The metric Rank-N recognition rate was used for evaluation. The scene target set of 743 individuals was compared with the source point set of 732 individual models and achieved Rank-1 accuracy of 96.24%, Rank-2 accuracy of 99.73%, and Rank-3 accuracy of 100%. Our results indicated that the 3D point cloud registration of sphenoid sinuses was useful for assessing personal identification in forensic contexts.

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital. MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system. ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020). ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.

Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: a retrospective study

BackgroundMultiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants.MethodsClinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra‑low‑dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years.ResultsThe septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.00), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases.ConclusionsThe endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.

ORTA ANADOLU'DA KRONİK RİNOSİNÜZİTİN BİREYSEL ÖZELLİKLER VE ÇEVRESEL FAKTÖRLERLE İLİŞKİSİ

OBJECTIVE: The aims of this study were to investigate the prevalence and distribution of sinonasal diseases in patients that underwent paranasal sinus computed tomography (CT) due to chronic rhinosinusitis (CRS) with or without nasal polyps, and to explore the association between CRS and sinonasal variations and the effect of environmental factors.MATERIAL AND METHODS: The paranasal sinus CT images and files of 1000 patients that referred to a tertiary health center in Ankara were retrospectively evaluated. The CT findings, smoking status, presence of allergies, place of residence (urban/rural), and history of functional endoscopic sinus surgery were noted.RESULTS: CRS was seen in 68% of the patients, and most common in maxillary sinuses (53%). Nasal polyps with CRS were noted in 11% of the cases. CRS was also more common among smokers (p&amp;lt;0.001). In CRS accompanied by nasal polyps, no difference was found between urban and rural residence. However, most cases of CRS with nasal polyps lived in urban areas (81.4%, p=0.006). There was no difference between allergy and CRS with and without nasal polyps or between sinonasal variations and CRS development.CONCLUSIONS: In the region investigated, the prevalence of CRS with nasal polyps was higher in the urban area (higher air pollution); however, the prevalence of CRS without nasal polyps did not change according to the place of residence. CRS was generally more common among smokers, but there was no significant difference in patients with CRS accompanied by nasal polyps. CRS was not more common in people with allergies.

The relationship between nasal septal deviation and anatomical variations of the paranasal sinus

Objectives: The aim of this study was to determine the relationship between septum deviation and anatomic variations of the paranasal sinus. Methods: A total of 157 (79 males, 78 females) patients between the ages of 17 and 77 years (mean age: 33.7 ± 14.9 years) were included in the study. Using paranasal sinus computed tomography imaging, anatomical variations including nasal septal deviation, Agger nasi cells, Haller cells, Onodi Cells, sphenoid sinus pneumatisation, paradoxical middle turbinates, middle turbinate pneumatisation, maxillary sinus septa,vertical septa in the sphenoid sinus, optic nerve dehiscenceand cribriform plate lamina lateralis height were evaluated. Results: Agger nasi cells were present in 47.1% of cases, Haller cells were seen in 5% of cases and Onodi cells were observed in 23.6% of cases. In 70.1% of cases, one vertical septa in the sphenoid sinus was observed. Maxillary sinus septa was observed in 16.5% of cases. There was a significant negative correlation between the female gender and increased sphenoid sinus pneumatisation (p = 0.035). There was a positive correlation between maxillary sinus septa and the presence of Onodi cells (pright =0.045, pleft = 0.017). There was also a negative correlation between maxillary sinus septa and sphenoid sinus pneumatisation (pright = 0.001, pleft = 0.005). Conclusions: In our study, we found that maxillary sinus septa, Agger nasi, Haller cells, cribriform plate lamina lateralis height, sphenoid sinus septation and Onodi cells were interrelated. We recommend that surgeons evaluate patients with these variations to prevent complications.

Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study.

Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented. Objective: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin. We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab. Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab. Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a "one airway disease".

Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification.

Unilateral sinus disease (USD) carries a broader differential diagnosis than bilateral sinus disease, including various inflammatory and neoplastic conditions. Odontogenic sinusitis (ODS) is a common cause of unilateral maxillary sinusitis, but few studies have examined its incidence among all USD etiologies. The main purposes of this prospective study were to determine the incidences of ODS and other etiologies causing USD with complete maxillary sinus opacification on computed tomography (CT), and to compare CT features of ODS and non-odontogenic USD patients. In addition, clinical features of the ODS cohort are described. A prospective case series of 134 patients with USD with complete maxillary sinus opacification on CT was conducted from August 2015 to November 2018. Based on nasal endoscopy, sinus CT, and dental examination and imaging, patients were categorized as having unilateral ODS or non-odontogenic USD. Patients with non-odontogenic USD were categorized as inflammatory or neoplastic. Demographic and clinical data were reported for ODS patients. Of the 134 patients, 45% had ODS, 36% had non-odontogenic inflammatory conditions, 17% had inverted papilloma, and 2% had malignancies. Of the 60 ODS cases, 86.7% were associated with middle meatal purulence on nasal endoscopy. On CT, 88.3% had extramaxillary sinus disease extension, and 65.5% of CT reports made no mention of dental pathology. ODS caused nearly 50% of all USD cases with maxillary sinus opacification on CT, and was the most common individual etiology. ODS was frequently associated with anterior ethmoid and frontal sinus disease on CT, and middle meatal purulence on nasal endoscopy.

Olfactory Fossa and New Angle Measurements: Lateral Lamella-Cribriform Plate Angle.

The authors investigated the olfactory fossa (OF) in patients with unilateral nasal septal deviation (NSD) and presented the lateral lamella-cribriform plate angle (LLCPA). Paranasal sinus computed tomography images of 300 adult subjects with unilateral NSD (111 males, 189 females) were evaluated retrospectively. Septal deviation angle (SDA), Keros Classification, OF depth and width, LLCPA; and orbital plate and cribriform plate (OPCP) distance were measured. The OF depth values (ipsilateral, contralateral) were found as Keros III >Keros II >Keros I (Padjusted <0.0175). The OF width values (ipsilateral) were detected as Keros I >Keros II and Keros I >Keros III (Padjusted <0.0175). In patients with higher SDA values, ipsilateral OF depth values decreased (P <0.05). The LLCPA and OPCP values were higher in Keros I and lower in Keros III (P <0.05). In patients with lower LLCPA and OPCP, endoscopic sinus surgery will be more dangerous for trauma to lateral lamella and intracranial penetration.

Relationship of the posterior septal angle to the anterior nasal spine in the Caucasian nasal septum.

This study aimed to determine the distance between the most anterior part of the anterior nasal spine and the posterior septal angle. Sinus computed tomography images from February to April 2016 were retrospectively analysed. Scans from adult Caucasians were included. Those with evidence of previous surgery, large slices or poor quality were excluded. The distance between the posterior septal angle and the most anterior part of the anterior nasal spine was measured digitally by two independent raters. Of 122 scans, 100 met the inclusion criteria (49 males and 51 females; mean age of 52.5 years). The mean distance measured was 5.13 mm (standard deviation = 1.24 mm, range = 1.85-8.00 mm). Measurements between male and female patients were not significantly different (t=0.450, p=0.654, 95 per cent confidence interval = -0.382 to 0.606). There is variability in the distance between the anterior nasal spine and the posterior septal angle. Surgeons should observe this relationship intra-operatively to avoid instability and unintended aesthetic changes.

Image quality and dose reduction in sinus computed tomography using iterative reconstruction: a cadaver study.

Concerns about radiation dose in computed tomography (CT) imaging have renewed interest in iterative reconstruction (IR), a technique which has the potential to produce images with less noise at lower radiation doses than traditional filtered back projection (FBP). This study aimed to assess whether application of IR could provide comparable quality sinus CT images to FBP at lower kilovolt (kV) and milliamp (mA) settings, and to establish optimal scan settings for sinus imaging. 30 sinus CT scans were performed on 5 cadaver heads at two kV setting and three mA settings. Each scan was reconstructed using FBP and 3 IR settings, yielding a total of 120 images series. Each image set was blinded and randomly reviewed by 3 rhinologists and 2 neuroradiologists. Using a 5-point Likert scale, 16 anatomical landmarks, were graded with respect to image quality. Data were assessed with respect to dose and IR settings using statistical analysis. Higher kV and mAs settings produced significantly higher quality images for structure identification across all 16 landmarks; however, the suitability for surgery did not increase in a linear fashion and plateaued by a total radiation dose of 0.1201 mSv. IR algorithm did not provide a benefit in the overall score of scans at a fixed kV and mAs. Identification of structures in sinus CT imaging significantly correlate with the kV and mA and overall dose of radiation; however, IR did not provide additional benefit in the image quality.

Low-Dose Noncontrast Examination of the Paranasal Sinuses Using Volumetric Computed Tomography.

The objective of this study was to evaluate image quality of low dose in noncontrast paranasal sinus computed tomography (CT) using single volumetric 320-row multidetector CT technique. The low-dose protocol including tube voltage of 135 kV and tube current of 5 mAs was chosen based on results of the present phantom study. Forty-six patients were assigned to control group with factory standard settings (120 kVp, 75 mAs), and 46 patients were assigned to study group and underwent noncontrast CT of paranasal sinus with low-dose protocol using single volumetric 320-row multidetector CT device. Objective and subjective image qualities were performed. Effective radiation dose calculated for control group scans was 0.45 (SD, 0.39) mSv. It was 0.038 (SD, 0.004) mSv for study group scans. The effective radiation dose of study group was statistically significant lower than control group (P < 0.001). Noncontrast paranasal sinus CT imaging can be performed at very low radiation exposure maintaining high image quality with 135 kVp and 5 mAs.