A comparison of imaging techniques in patients with chronic sinusitis (X-ray, MRI, A-mode ultrasound)

Paranasal sinus pathoses on cone beam computed tomography

Purpose:

The aim of this study was to investigate paranasal sinus pathoses detected on cone-beam computed tomography (CBCT) in an adult population.

Patients and Methods:

Three observers retrospectively inspected 353 consecutive CBCT scans obtained in a dentomaxillofacial radiology department for paranasal sinus pathoses. Descriptive statistics and chi-square tests were used to determine the prevalence of categorical parameters.

Results:

The age of the patients ranged from 18 to 85 years (mean 41.27±16.76). There were 172 (48.7%) females and 181 (51.3%) males. There was a significant difference between the genders (p=0.02), with males (53.5%) having more sinus pathoses than females (46.5%). When the left and right sinuses were considered together, pathoses were most commonly seen in the maxillary sinuses (57.1%), followed by the ethmoid (53.7 %), frontal (22.6%), and sphenoid sinuses (15.8%). Mucosal thickening was the most frequently observed abnormality (51.7%), followed by hypoplasia (17.5%) and sinusitis (17.3%).

Conclusion:

CBCT is a preferable imaging method for evaluation of paranasal sinuses. Dentomaxillofacial radiologists should examine the whole volume of CBCT images to ensure they do not overlook paranasal sinus pathoses.

Imaging evaluation of sinusitis: diagnostic performance and impact on health outcome

Sinusitis is a highly prevalent disease, with a significant impact on the health care economy. Sinus CT is the primary imaging modality for evaluation of acute and chronic sinusitis. The roles of CT for patients with sinusitis are to assist clinical diagnosis, to evaluate the extent of disease, and to provide detailed anatomy necessary for treatment planning. Although sinus CT has been criticized for lack of specificity and correlation with patients' clinical symptoms, sinus CT may provide pivotal objective information that affects treatment decisions for acute and chronic sinusitis. This article provides a clinical overview and reviews the role of imaging studies in diagnosis and treatment of sinusitis.

The value of Waters' projection for assessing maxillary sinus inflammatory disease

OBJECTIVE

The significance of the Waters' projection for judging maxillary mucosal disease is, at the least, questionable. The aim of this study was to evaluate the diagnostic use of Waters' projection of the maxillary sinus with particular regard to sinus mucosal swelling as a consistent sign of maxillary sinusitis.

STUDY DESIGN

Forty consecutive adult patients were referred to an ear, nose, and throat surgeon for pain in the region of the paranasal sinus, recurrent mucopurulent rhinorrhea, and nasal congestion or obstruction for at least 3 months without any response to conservative treatment. Both conventional radiographs (Waters' projection) and coronal and axial computed tomography (CT) scanning of the maxillary sinuses were recorded. The conventional radiographs and CT scans, all made within an hour, were blinded and assessed in random order by 2 independent well-trained observers with standard radiodiagnostic criteria for sinus mucosal swelling. Intraobserver and interobserver agreements were quantified by calculating Cohen's kappa. The diagnostic significance of the Waters' projection was assessed with the CT scan images as criterion standard by calculating sensitivity and specificity, positive predictive value, likelihood ratio, and diagnostic odds ratio.

RESULTS

Cohen's kappa for the intraobserver agreement of Waters' examination was 0.96, and the intraobserver agreement for CT scanning was 0.92. The interobserver agreement for Waters' projection and CT scanning was 0.76 and 0.92, respectively. With CT scanning as criterion standard, the sensitivity and specificity of Waters' projections to detect maxillary sinus mucosal swelling were 83.3% and 69.2%, respectively. The positive predictive (diagnostic) value of Waters' projections was 83.3%, the positive likelihood ratio 2.7, and the diagnostic odds ratio 11.25.

CONCLUSIONS

From this study it can be concluded that Waters' projections do not necessarily rule out the presence of maxillary sinus mucosal swelling. Additional examinations may be indicated, especially in patients with compromised sinus clearance.

Perennial allergic rhinitis and chronic sinusitis: correlation with rhinologic risk factors

BACKGROUND

The reported association of allergy and sinusitis varies greatly between study, and the exact role of allergy in predisposing to sinusitis is not clear. We attempted to determine whether patients with perennial allergic rhinitis are at greater risk of developing sinusitis with respect to a control group, and to determine whether there is a correlation between rhinomanometry, endoscopy, and nasal swab, and computed tomography (CT) findings.

METHODS

Forty adult patients with perennial allergic rhinitis underwent CT scans of the paranasal sinuses, and the results were then compared to CTs of the paranasal sinuses of 30 control subjects. All allergic patients underwent nasal endoscopy, nasal swab, and active anterior rhinomanometry, and the results were studied in relation to the CT findings.

RESULTS

We found sinusitis in 67.5% of the allergic patients and in 33.4% of the controls, with a statistically significant difference between the two groups (P = 0.017). Twenty-three patients had a positive nasal swab; 22 showed increased nasal resistance on rhinomanometry, and 36 had positive endoscopy, but the association of CT findings with endoscopy, rhinomanometry, or nasal swab was not statistically significant (P = 0.583, P = 1.00, P = 0.506, respectively).

CONCLUSIONS

Allergic rhinitis is often associated with sinusitis, but the underlying mechanism has yet to be determined. Evidently, factors other than classical pathogen growth and mechanical factors, such as the association of the various factors and immunologic mechanisms, may contribute to the pathogenesis of chronic sinusitis in allergic patients.

Evaluation of the patient with sore throat, earache, and sinusitis: an evidence based approach

Sore throat, earache, and sinusitis are common presenting complaints in the emergency department, and all fall within the top ten in the United States. These complaints usually have a benign course but rarely can be a symptom of a serious disease process. This article provides an evidence-based review of the literature regarding the diagnosis of pharyngitis, otitis media, and sinusitis.