Unilateral Concha Bullosa Research Articles

THE INCIDENCE OF CONCHA BULLOSA: A RETROSPECTIVE RADIOLOGIC STUDY

Background: Middle nasal concha hypertrophy known as concha bullosa is caused by its pneumatization. Although it is the most common anatomical variation of the ostiomeatal complex, research on it in different populations is limited. It is uncertain whether concha bullosa prevalence varies across populations throughout the world.
 Objective: The purpose of study was to determine the prevalence of (superior, middle and inferior turbinate concha bullosa) in patients who visited an ENT clinic with various ENT symptoms.
 Methods: The duration of this retrospective descriptive study was six month. The study was carried out between the period from June 2022 to November 2022 at Department of ENT and Head & Neck Surgery. We examined the axial and coronal planes of patients' computed tomography (CT) scans of nose as well as paranasal sinuses who reported headaches or nasal obstruction symptoms in addition to symptoms of chronic sinusitis.
 Results: Concha bullosa was seen in 14% of the 100 scans examined. Six (42.8%) individuals had bilateral concha bullosa, whereas eight (57.1%) had unilateral concha bullosa. Out of the eight conchae, two (25%) were found on the right side while six (75%) on the left side.
 Conclusion: Study concluded that concha bullosa is the most common anatomic variation. During the preoperative evaluation, the radiologist must pay close attention to anatomical variants. It is critical for surgeons to be aware of this variation.

Do Nasal Anatomical Variations Affect the Maxillary Sinus? A CBCT Volumetric Analysis

Objective: This study aimed to determine the effect of the concha bullosa (CB) and the nasal septum deviation (NSD) on the volume of the maxillary sinuses using ITK-SNAP (http://www.itksnap.org/ download/snap/). Methods: A total of 70 CBCT scans were analyzed. Three groups were evaluated; control (absence of CB), unilateral CB, and bilateral CB. Moreover, scans were classified according to the NSD into control (no deviation), mild, moderate, and severe NSD deviation. The volume of each maxillary sinus was calculated using the ITKSNAP. Intra-observer reliability analysis was performed by paired-sample t-test. Analysis of variance ANOVA and t-test were used to compare the mean bilateral maxillary sinus volumes. Results: Intra-observer reliability for the maxillary sinus volume exhibited no significant difference for both sides (p > 0.05). The mean volume of the right and left maxillary sinuses were 12.98±4.90 cm3 and 13.18±4.99 cm3 , respectively. No significant difference between the volumes of both sides (p > 0.05) was found. The results showed no significant differences between the CB or NSD groups on both sides (p > 0.05). Conclusion: The two anatomical variations have no effect on the maxillary sinus volume. The open-source software ITK-SNAP is a valuable tool for volumetric analysis.

The Relationship between Isolated Unilateral Concha Bullosa and Mastoid Air Cell Volumes

Introduction: The purpose of this study was to investigate the relationship between the pneumatization of mastoid air cells (MACs) and isolated unilateral concha bullosa (CB) using computed tomography (CT) scans of the paranasal sinuses (PNS). Material and Methods: A retrospective review of PNS CT scans from 53 patients was performed. Cases with nasal septum angulation >5° were excluded from the study. CT evaluations were made with a 128-slice multislice CT scanner in two projections, axial and coronal. Slice thickness was taken as 1 mm for volumetric analysis. Volume measurements were calculated using the syngo.via software program by selecting the relevant anatomical region and using step-by-step addition and expansion processes. Volumes of the MACs (right and left) and isolated unilateral CB (right and left) were obtained and compared using statistical analysis. Results: The volume of MACs and isolated unilateral CB did not change with age; however, the volumes of male participants were larger than that of women. It was observed that the pneumatization of MACs on the side with isolated unilateral CB was significantly greater than for opposing MACs. Discussion and Conclusion: In our study, it was concluded that the isolated unilateral CB caused a significant increase in the MACs volume on the same side of CB.

A Comparative Study of CT Scan and Nasal Endoscopic Findings of Lateral Wall of Nose, in Headache of Rhinogenic Origin.

Headache disorders are rated among the ten most disabling conditions worldwide. Contact points like septal spur, septal deviation, concha bullosa and bulla ethmoidalis can cause rhinogenic headache (RH). Diagnostic nasal endoscopy (DNE) is an essential part of evaluation of sinonasal disease and is the key to understanding anatomical variations. As compared to CT paranasal sinus (CT PNS), DNE is cheaper and has wider availability, being part of the basic training of present ENT curriculum. We conducted a prospective observational study from September 2018 to June 2020 on 202 patients who were diagnosed to have RH. The aim of this study was to the define the role of DNE as the primary examination for early and accurate diagnosis of rhinogenic headache as compared to CT PNS. RH patients were evaluated with DNE followed by CT PNS. Evaluation of the findings of anatomical variations of lateral wall of nose on DNE and CT PNS was done. In our study the most common anatomic variations in order of frequency in both DNE and CT PNS was deviated nasal septum, impacting spur and unilateral concha bullosa. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DNE for the various anatomical variations was statistically better than CT PNS findings. We conclude that DNE is a better than CT PNS as a diagnostic technique to detect various anatomical variations, thus initiating early management of RH.

Impact of a Concha Bullosa on Nasal Airflow Characteristics in the Setting of Nasal Septal Deviation: A Computational Fluid Dynamics Analysis.

A concha bullosa (CB) of the middle turbinate is frequently observed on the nondeviated side of patients with a nasal septal deviation (NSD). However, the impact of the CB on nasal airflow characteristics in patients with NSD has been incompletely defined. The purpose of this study was to evaluate the impact of a CB in patients with NSD on nasal airflow characteristics using a computational fluid dynamics (CFD) approach. Twenty patients with NSD and a unilateral CB of the middle turbinate on the nondeviated side (study group) were recruited. Another 20 patients with NSD without the formation of a CB (control group) were also enrolled. Using CFD, the maximal airflow velocity, nasal resistance, maximal wall shear stress, and minimal temperature in the bilateral nostrils of each group were assessed. Moreover, the volume of the nasal tract, surface area-to-volume ratio, and the total nasal resistance were compared between the study and control groups. In the study group, no significant differences of airflow dynamics between the bilateral nasal cavities were observed. In the control group, however, there were statistically significant differences for maximal airflow velocity, nasal resistance, maximal wall shear stress, and minimal airflow temperature between the bilateral nostrils. The surface area-to-volume ratio and total nasal resistance in the study group was significantly higher and the nasal volume was significantly decreased than that in the control group. CB of the middle turbinate on the nondeviated side of patients with NSD rendered airflow characteristics more evenly distributed between the bilateral nostrils as assessed by CFD. From an aerodynamics perspective, a CB may represent a compensatory action to normalize airflow dynamics. However, a CB may also result in constriction of the ipsilateral nasal cavity.

STUDY OF NORMAL ANATOMICAL VARIATIONS IN PARA-NASAL SINUSES USING COMPUTED TOMOGRAPHY SCAN: A CROSS SECTIONAL STUDY FROM CENTRAL INDIA

Background: The standard imaging in the assessment of the para-nasal sinuses is currently computed tomography scanning. This provides an applied anatomical view of the area as well as the common anatomical variants. The advancement and improvement of computed tomography scans has provided for a comprehensive evaluation of patients' para-nasal sinuses, allowing Functional Endoscopic Sinus Surgery surgeons to operate with a guide chart.
 Objectives: To study normal anatomical variations in para-nasal sinuses using Computed Tomography.
 Material and Methods: This research took place in a tertiary healthcare center's radiology department over the course of two years. Axial para-nasal sinuses cuts were taken using a multi-slice (128 slice scanner), followed by coronal and sagittal reconstruction.
 Results: The most common anatomic variation, according to the findings, was nasal septal deviation. The rarest variation in our sample was Haller cell and pneumatized septum. There was also a close connection between unilateral Concha bullosa and contra-lateral septal deviation, as evidenced by the research.
 Conclusion: A wide range of lesions can affect the para-nasal sinus area. Normal anatomical differences and congenital abnormalities in this area are significant because they can have pathological consequences or cause difficulty/complication during surgery.
 Keywords: Para-nasal sinuses, Computed Tomography, Functional Endoscopic Sinus Surgery.

Concha bullosa, nasal septal deviation, and their impacts on maxillary sinus volume among Emirati people: A cone-beam computed tomography study.

PurposeTo determine the prevalence of concha bullosa (CB) and nasal septal deviation (NSD) and their impact on maxillary sinus volume (MSV).Materials and MethodsCone-beam computed tomographic (CBCT) images of 106 Emirati people were used in this study. The direction and angle of septal deviation were calculated. The presence of CB, which could be unilateral, contralateral, or bilateral in relation to the direction of NSD, was also recorded. MSV was measured using reconstructed Digital Imaging and Communication in Medicine images on Dolphin 3D imaging software version 11.8 premium (Dolphin Imaging, Chatsworth, CA, USA). P values <0.05 were considered to indicate statistical significance.ResultsCB was detected in 37.7% of the sample; 20.7% of the sample showed single unilateral CB and 16.6% had single bilateral CB. NSD was seen in 74.5% of the sample. In the participants with CB, 45.5% showed mild deviation, 34.4% showed moderate deviation, and only 12.5% showed severe septal deviation. CB, but not NSD, was associated with significantly higher MSV on the affected side (P=0.001).ConclusionAlthough NSD was observed in more than two-thirds of the sample and CB was present in more than one-third of the sample, only CB had a significant impact on MSV.

Investigation of maxillary sinus volume relationships with nasal septal deviation, concha bullosa, and impacted or missing teeth using cone-beam computed tomography.

The aim of this retrospective study was to investigate the correlations of maxillary sinus volume with nasal septal deviation, concha bullosa, impacted teeth, and missing teeth in the maxillary posterior region on maxillary sinus volume using cone-beam computed tomography (CBCT) images. The study cohort comprised 252 CBCT images of 252 patients retrospectively selected from the records in our CBCT archive. All CBCT images were exported to 3D modeling software for calculation of maxillary sinus volumes. Nasal septal deviation cases were grouped as mild, moderate, and severe. Concha bullosa was classified as lamellar, bulbous, and extensive. Maxillary sinus volume differences were evaluated by comparing the bilateral sinus volumes in patients with nasal septal deviation, unilateral concha bullosa, and unilateral impacted or missing maxillary posterior teeth. The findings revealed that males had a significantly higher mean sinus volume than females (p < 0.01) and that sinus volume tended to decrease with age (p < 0.05). In moderate and severe nasal septal deviation cases, the maxillary sinus volume was significantly smaller on the same side as the deviation than on the contralateral side (p < 0.05). There were no significant correlations between maxillary sinus volume and concha bullosa, unilateral impacted teeth, or unilateral missing teeth (p > 0.05). The present findings suggest that maxillary sinus volume is smaller on the same side as the deviation in moderate and severe septal deviation cases and that the maxillary sinus volume tends to decrease with increasing age.

Role of Concha Bullosa in Chronic Rhinosinusitis.

cross sectional study. 60. all patients of chronic rhinosinusitis. patients with previous sinus surgeries, malignancy and acute cases of chronic rhinosinusitis.

The Effect of Unilateral Concha Bullosa on Olfactory Bulb Volume: an Assessment by Magnetic Resonance Imaging.

In this study, the authors compared the right and left olfactory bulb volumes by magnetic resonance image findings of patients with unilateral concha bullosa (CB). The cranial magnetic resonance imaging studies of 24 patients having unilateral CB were reviewed. There were 10 males and 14 females ranging in age from 29 to 51 years (mean age, 29 ± 15.2 years). The volumes of both olfactory bulbs (contralateral and ipsilateral to the concha bullosa side) were calculated by using the computer program. The average values for olfactory bulb volumes were 46.57 ± 8.03 mm in the CB side of the nasal cavity and 54.80 ± 10.031 mm in the normal side of the nasal cavity. We found a statistically significant difference in olfactory bulb volume between the contralateral and ipsilateral to the concha bullosa side of the patients (t = -3.08 and P < 0.01 for CB side, t = -3.47 and P < 0.01 for left normal side). Our results may point out a possible relationship between CB and ipsilateral decreased olfactory bulb volume, yet the exact mechanism still remains unclear. Decreased nasal air flow on the CB side may be attributed to the pathophysiologic mechanism of this finding. Also, the significant reduction in olfactory bulb volumes ipsilateral to CB compared with the contralateral olfactory bulb volumes seems to support our hypothesis.

Anatomical variations in patients with chronic sinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;C&lt;/span&gt;&lt;span lang="EN-IN"&gt;hronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process.&lt;strong&gt; &lt;/strong&gt;Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.&lt;/span&gt;&lt;/p&gt;

Study of Asssociation of Concha Bullosa with Rhinosinusitis

Introduction&#x0D; There are several studies with contradictory findings about the role of concha bullosa with predisposition to rhinosinusitis. This study was conducted to assess the relationship of osteomeatal unit blockage with concha bullosa.&#x0D; Materials and method&#x0D; A cross-sectional observational study by radiological assessment of prevalence of chronic rhinosinusitis and blockage of ipsilateral osteomeatal unit was done on 100 cases of concha bullosa detected on computed tomography to determine the prevalence of chronic rhinosinusitis in subjects with concha bullosa and to examine the latter’s relationship to osteomeatal unit blockage, which is a precursor for rhinosinusitis.&#x0D; Result&#x0D; One hundred cases of concha bullosa were studied in a total of 87 CT scan films depicting concha bullosa. Some CT scans showed unilateral concha bullosa while few scans showed bilateral concha bullosa. Ipsilateral rhinosinusitis was found in only 31% of the sides in scans of subjects with concha bullosa. Of the total 100 concha bullosae studied, extensive type was the commonest followed by bulbous and lamellar variety.&#x0D; Discussion&#x0D; Although rhinosinusitis was more predominant in the extensive type of concha bullosa compared to other types, it was statistically not significant and there was no statistically significant association between any type of concha bullosa with ipsilateral rhinosinusitis either in right side or left side.&#x0D; Conclusion&#x0D; This study has found no statistically significant association between any type of concha bullosa with rhinosinusitis. A bigger study with larger sample size is required to better assess the strength of association between concha bullosa and rhinosinusitis.

Prevalencia, localización y severidad tomográfica de rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable

Common variable immunodeficiency (CVID) is one of the most common antibody deficiencies in adults. The prevalence of respiratory infections have been reported in 75% vs 2-16% in general population. Chronic rhinosinusitis is an inflammatory disease affecting paranasal sinuses and nose. To show the prevalence of chronic rhinosinusitis, affected sinus and severity by CT scan in adult patients with CVID. A descriptive, observational and cross sectional study was made including 21 patients with CVID. Paranasal sinus CT scan was performed to all patients and was assessed by Otolaryngologist. The chronic rhinosinusitis severity was assessed with Lund-Mackay score. Out of 21 patients, 15 were women (71.5%); average age was of 40 years (±13), 12 patients had chronic rhinosinusitis; according to Lund-Mackay score, 2 (17.8%) had the severe form, 3 (7.7%) had the moderate and 7 (54.5%) the mild one. The most affected sinus was bilateral maxilar sinus (n=7, 33%), ethmoid (n=6, 26%), unilateral maxilar sinus (n=4, 19%), frontal and sphenoid (n=3, 13%) each one. The following anatomical variations were found: deviated septum (n=6, 28.5%), maxillary septum (n=3, 14.2%), bilateral maxillary sinus hypoplasia (n=2, 10%), unilateral concha bullosa (n=2, 10%) and pneumatized Agger Nasi cell (n=1, 4.7%). 52% of patients with common variable immunodeficiency (CVID) presented chronic rhinosinusitis, 58% mild according to Lund-Mackay score; the main affected sinus was bilateral maxillary sinus (33%). Due to the prevalence of chronic rhinosinusitis in patients with common variable immunodeficiency, paranasal sinus CT scan should be performed in all patients to establish diagnosis and treatment.

A Study of Anatomical Variations of Osteomeatal Complex in Chronic Rhinosinusitis Patients-CT Findings.

Chronic rhino sinusitis (CRS) is the most common disease for which consultation of otorhinolaryngologist is sought. The approach to patients with chronic rhino sinusitis is endoscopic surgery which aims at removing the obstruction of the main drainage pathway. The osteomeatal complex based essentially on the concept that such obstruction perpetuates the sinus disease. This in turn requires the surgeons to have detailed knowledge of the anatomy of the lateral nasal wall, paranasal sinuses and surrounding vital structures and of the large number of anatomical variants in the region. To study anatomical variations of osteomeatal complex in chronic sinusitis patients. Descriptive cross-sectional study design in which 54 consecutive cases of chronic rhino sinusitis patients attending the ENT outpatient department, who had chronic sinusitis for more than three months duration not responding to the medical line of treatment and who were willing to undergo Functional Endoscopic Sinus Surgery satisfying the inclusion criteria were studied. The results were expressed in percentage and proportions. In our study it was observed that 53.7% of the chronic sinusitis cases had two or more anatomical variations and 33.3% of the cases had single anatomical variation. Deviated nasal septum was found to be the most common amongst the anatomical variations in chronic sinusitis cases in the present study which was followed by unilateral concha bullosa and paradoxically bent middle turbinate. Agger nasi cell and Haller cell were seen in one case each. Prevalence of multiple anatomical variations was more in our study in comparison to single anatomical variation. Deviated nasal septum was the most common anatomical variation encountered in our study followed by concha bullosa.

Clinical Aspect of Concha Bullosa of Middle Turbinate and Nasal Septal Deviation

Objectives: Concha bullosa (CB) with nasal septal deviation (NSD) can be the cause of postoperative functional failure if not corrected during surgery. Methods: All the paranasal computed tomography scans (CTs) taken in a tertiary hospital from May 2011 to October 2012 were analyzed. Cases with history of nasal surgery and nasal trauma were excluded due to the possibilities of nasal anatomical changes. Results: 520 CTs were included in this study, from 550 CTs analyzed. 331 males and 189 females were included, and the ages of patients ranged from 2 to 87. 444 patients (85.38%) had NSD. The age distributions of CB were as follows: in the age group of 0~15, 0%; 16~30,.70%; 31~45, 40%; 46~60, 33.14%; and over 60 years, 25%. In 444 patients with NSD, bilateral CBs were observed in 93, unilateral CBs in wide nasal cavity in 47, and narrow nasal cavity in 7. When 269 CBs were classified as true, lamella, or bullous type, the average measured pneumatization areas were statistically wider in true type (p=0.008). When comparing the maximum pneumatization areas of CB in coronal CT of patients with NSD, the CB area of wide side nasal cavity was statistically wider than that of narrow side nasal cavity ( P = 0.000). Conclusions: CBs are clinically thought to be formed in those over 15 years old. CBs are formed mainly in wider nasal cavity, and especially larger in true type, so they should be removedin surgery.

The Impact of Unilateral Concha Bullosa on Mucociliary Activity: An Assessment by Rhinoscintigraphy

In this study, we aimed to compare the differences of nasal mucociliary clearance rate (NMCR) by rhinoscintigraphic examination between the nasal cavities of patients with unilateral concha bullosa (CB). The study group consisted of 43 patients (18 men and 25 women), with unilateral CB ranging in age from 20 to 58 years (mean age, 33.5 ± 9.51 years). The nasal mucociliary clearance was described as the velocity (mm/min) of nasal mucociliary transport of the technetium 99m-macroaggragated albumin droplet. Rhinoscintigraphy was performed on each nasal cavity with 2-day intervals in the patients. The mucociliary clearance rates obtained in the unaffected side were accepted as control values. The average values for mucociliary clearance rate were 2.29 ± 0.42 mm/min in the CB side of the nasal cavity, and 3.19 ± 0.52 mm/min in the other side of the nasal cavity. Mucociliary transport took a longer time in the CB side of the nasal cavity than in the other side of the nasal cavity, which was found to be statistically significant (p < 0.001). Our study showed that unilateral CB might impair NMCR in the ipsilateral side of the nasal cavity. Thus surgical intervention to reduce the middle concha volume may result in a better mucociliary clearance with possibly a less chance of development of chronic sinus diseases and nasal pathologies. Obviously, it is of utmost importance that new studies be planned with larger patient series to better understand nasal mucociliary transport mechanism and CB relationships.

Endoscopic Turbinoplasty of Concha Bullosa: Long Term Results

The aim of this study is to assess the long-term results of our endoscopic turbinoplasty technique for concha bullosa. Thirty-six patients of chronic or recurrent sinusitis who had concha bullosa on CT scan along with mucosal disease in sinuses and underwent turbinoplasty with functional endoscopic sinus surgery were studied. They were followed regularly with endoscopic examination for 7years and were assessed for immediate or longterm complications of the procedure. Results of 36 patients revealed bilateral concha bullosa in 16 (44.4%) and unilateral concha bullosa in 20 (55.6%) patients. Out of 52 sides of turbinoplasties which were followed for average of 89months, only 3 sides (5.76%) had synechia between middle turbinate and septum. Only 1 (1.92%) side had adhesions between lateral wall and middle turbinate. There were no other immediate or longterm complications. We conclude from our study that endoscopic turbinoplasty is safe and effective procedure for concha bullosa. It preserves middle turbinate anatomically and physiologically and treats the concha with negligible complications.

Concha bullosa and septal deviation

The aim of this study was to investigate the incidence of concha bullosa (CB) in cases with septal deviation (SD), correlation between the angle of deviation and degree of pneumatization and compare these correlations with qualitative and quantitative methods. We retrospectively searched our radiology database for all paranasal sinus computed tomography (CT) findings for 672 patients. All scans were grouped according to the presence and side of SD and/or CB. SD angles and pneumatization degree of the CB were measured with appropriate method. These findings were also classified according to the initial defined qualitative method. Generally, CB and SD incidences were 31.52 and 47.77%, respectively. CB ratio in SD patients was 45.34% whereas ratio in non-SD patients was 18.95%. Mean deviation angle of the isolated SD group (15.24 +/- 5.03) was found higher than both deviation angle of the unilateral CB + SD group (13.16 +/- 4.19) and bilateral CB + SD group (11.15 +/- 3.73) (P = 0.002, P = 0.0001 respectively). In conclusion, CB may tend to develop bilaterally in normal, non-deviated nose. However, the increasing incidence of unilateral CB, especially contralateral ones, in septal deviated patients suggested that SD may prevent the development of ipsilateral CB.