A comparative study of clinical and radiological findings in operated patients of chronic rhinosinusitis

 Corresponding author: Kruti Arhantbhai Chaudhari. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. A comparative study of clinical and radiological findings in operated patients of chronic rhinosinusitis Kruti Arhantbhai Chaudhari *, Nipa Aroonkumar Dalal, Saloni Parag Shah, Kishankumar Jaswantlal Soni, Ishita Bhavin Bhatt, Shailee Rajbahadur Johari and Mit Sanjay bhai Darediya Department of Otorhinolaryngology, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 092-095 Publication history: Received on 05 April 2025; revised on 18 June 2025; accepted on 20 June 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.23.2.0509 Abstract Background: Chronic rhinosinusitis (CRS) is a common inflammatory disorder affecting 11% of the population, leading to significant morbidity and economic burden. It presents with nasal obstruction, discharge, facial pain, and anosmia, with or without nasal polyps. Anatomical variations also contribute to disease severity. This study evaluates the correlation between clinical and radiological findings in CRS patients undergoing surgery. Methods: A prospective study of 50 CRS patients undergoing surgery was conducted from May 2022 to June 2024. All patients underwent nasal endoscopy and non-contrast CT scans. Findings were analyzed based on Kennedy CT staging and intraoperative observations. Results: The male-to-female ratio was 1.27:1, with 50% of patients in their 3rd and 4th decades. Nasal blockage (82%) was the most common symptom. Nasal endoscopy detected polyps in 68% and deviated nasal septum in 64%. Computed tomography of paranasal siuses (CT PNS) showed sinus involvement in 90%, with maxillary (94%) and ethmoid (90%) sinuses most commonly affected. Kennedy CT staging correlated best with intraoperative findings in stages II and IV. Conclusion: CRS is a prevalent condition, primarily presenting with nasal blockage. Nasal endoscopy is a valuable diagnostic tool, while CT scan remains the gold standard for disease assessment and surgical planning. However, CT findings may overestimate disease extent, highlighting the need for intraoperative confirmation. Keywords: CRS; Nasal Blockage; CT PNS; ENT 1. Introduction Chronic rhinosinusitis (CRS) is a heterogeneous group of disorders characterized by persistent inflammation of the nose and paranasal sinuses for a duration of at least 12 weeks. It presents with two or more of the following symptoms: nasal blockage, nasal discharge, facial pain (pressure or fullness), and a decreased sense of smell.[1] CRS represents a significant global disease burden, impacting at least 11% of the population.[2] Certain anatomical variations in nose contribute to obstruction of the osteomeatal complex, impairing drainage and ventilation, which increases the risk of sinus mucosal disease. Based on endoscopic findings, CRS is broadly classified into three subtypes: chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP), and fungal rhinosinusitis.[3] Among these, patients with nasal polyps tend to have a greater disease burden, increased severity, and poorer treatment outcomes compared World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 092-095 93 to those without polyps.[4] Recent advancements in endoscopic techniques and imaging modalities have considerably enhanced the understanding of CRS pathogenesis. 2. Materials and Methods This study involves 50 patients who presented to the ENT Department of a tertiary care hospital between May 2022 and June 2024 with clinical features indicative of chronic rhinosinusitis (CRS) which were then confirmed via radiological investigation and who subsequently underwent surgical intervention. 2.1. Inclusion criteria All the patients with chronic rhinosinusitis > 12 weeks duration of having 2 major or 1 major and 2 minor criteria (as described by Lanza Kennedy classification) who got operated and gave informed consent. 2.2. Exclusion criteria • Acute sinusitis, Neoplastic, acute condition, invasive fungal sinusitis • Patient treated with facial trauma • complicated sinusitis • only medical management-patient refuses for surgery • lost on follow up o Nasal endoscopy was conducted in all patients to assess the presence of edematous mucosa, polyps, mucopus, or other gross pathology. o A non-contrast computed tomography (CT) scan of the paranasal sinuses was performed to assess disease extent and anatomical variations. o Intraoperative findings were documented as per the Kennedy CT staging system. 2.2.1. Kennedy CT staging system [6] • STAGE 0 Normal • STAGE 1 Anatomic abnormalities, all unilateral sinus disease, Bilateral disease limited to ethmoidal sinuses • STAGE 2 Bilateral ethmoidal disease with involvement of one dependent sinus • STAGE 3 Bilateral ethmoidal disease with involvement of two or more dependent sinuses on each side • STAGE 4 Diffuse sinonasal polyposis 2.3. Postoperative Follow-Up Schedule Patients were followed up at 1 week, 2 weeks, 6 weeks, and 3 months. Nasal endoscopy was performed during each visit and findings were noted. 3. Results In this study data was collected from 50 patients admitted in ENT department of our hospital from May 2022 and June 2024. Our observations are the male-to-female ratio was 1.27:1, with 50% of patients in their 3rd and 4th decades. Table 1 Symptom wise distribution Presenting complaints Number of patients (n=50) Nasal blockage 48(98%) Nasal discharge 30(60%) Headache 23(46%) Sneezing 11(22%) Facial pain 4(8%) Anosmia 1(2%) Fever/Malaise 1(2%) World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 092-095 94 Present study shows most common presenting symptom as nasal blockage followed by nasal discharge followed by headache followed by sneezing, facial pain, ansomia, fever/malaise. Table 2 Correlation between nasal endoscopy and CT PNS findings Present study (n=50) Findings Nasal endoscopy CT PNS Polyposis 34(68%) 45(90%) u/l polyposis 12(24%) 18(40%) b/l polyposis 22(44%) 27(60%) Deviated nasal septum 32(64%) 29(58%) Hypertrophy of Inferior turbinate 11 (22%) 14(28%) Concha bullosa 2 (4%) 5(10%) Paradoxical middle turbinate 2(4%) 4(8%) Bulla ethmoidalis - 3(6%) Narrowed infundibulum - 1(2%) Agger nasi cell - 3(6%) In this study, polyposis was the most common finding, followed by a deviated nasal septum. CT scan better detects polyposis, inferior turbinate hypertrophy, concha bullosa, paradoxical middle turbinate, bulla ethmoidalis, narrowed infundibulum, and agger nasi cell. Concha bullosa was suspected in 2 cases on endoscopy but confirmed on CT. CT is crucial for identifying CRS factors and anatomical variations, aiding in surgical planning. Table 3 Comparison between CT scan and intraoperative findings KENNEDY CT Staging No. Of Cases Intraoperative finding Present study Rathor a bhattacharjee et al. n=50 Similar to CT Scan findings Not Similar to CT Scan findings n=34 Similar to CT Scan findings Not Similar to CT Scan findings Stage (i) 20 14(70%) 6(30%) 18 12(66.7%) 6(33.3%) Stage (ii) 4 3(75%) 1(25%) 5 3(60.0%) 2(40.0%) Stage (iii) 2 1(50%) 1(50%) 6 5(83.3%) 1(16.7%) Stage (iv) 22 18(81.81%) 4(18.18%) 5 4(80.0%) 1(20.0%) Analysis of Kennedy CT staging with intraoperative findings shows the highest similarity in stages IV and II, followed by I and III. In stage I, 6 of 20 cases appeared diseased on CT but were disease-free intraoperatively. In stage II, 1 of 4 cases showed discrepancies in sinus involvement. In stage III, 1 of 2 cases had mucosal thickening on CT but intraoperatively. only right frontal sinus showed disease. In stage IV, 4 cases showed all sinus involvement on CT, but intraoperatively it was not found. CT PNS is highly sensitive, detecting minimal mucosal thickening to extensive polyposis, sometimes exaggerating sinus involvement. In this study and Rathor & Bhattacharjee’s study, 12 operated cases showed discrepancies between CT findings and intraoperative observations, with CT often indicating mucosal thickening in disease-free sinuses. 4. Discussion A prospective study of 50 CRS patients (May 2022–June 2024) found male-to-female ratio of 1.27:1, with 50% in their 3rd and 4th decades. Nasal blockage (82%) was the most common symptom, followed by nasal discharge (60%), headache (46%), sneezing (22%), and anosmia (2%). World Journal of Biology Pharmacy and Health Sciences, 2025, 23(02), 092-095 95 CT scans showed a deviated septum in 58%, turbinate hypertrophy in 28%, nasal cavity involvement in 90%ma. Kennedy CT staging correlated best with intraoperative findings in Stage IV and II cases. This study emphasizes the importance of clinical, endoscopic, and radiological assessments in CRS diagnosis and surgical planning. 5. Conclusion CRS is a common rhinological condition, mainly affecting those in their 30s and 40s, with nasal polyposis being prevalent. Key symptoms include nasal blockage, discharge, headache, sneezing, facial pain, and anosmia. Nasal endoscopy is most simple and effective tool which provides very good information about the disease and diagnosis. CT of the paranasal sinuses is the gold standard investigation. Compliance with ethical standards Disclosure of conflict of interest No conflict-of-interest to be disclosed. Statement of informed consent Informed consent was obtained from all individual participants included in the study. References [1] Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2_suppl): S1-S39. 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