Chronic rhinosinusitis (CRS) is a condition characterized by inflammation of mucosa of nose and sinuses, resulting in symptoms like nasal congestion, facial pain, and loss of smell (1). Causative factors of CRS is complex and multifactorial, involving a combination of genetic, environmental, and anatomical factors (3,6).

Anatomical variations of the nose and paranasal sinuses specially osteomeatal complex (OMC) have been implicated in development of CRS. OMC is a critical area in nasal cavity where the frontal, anterior ethmoid, and maxillary sinuses drain (4). Anatomical variations of the OMC, such as septal deviation, concha bullosa, large agger nasi cell, and various attachment of uncinate process can obstruct the normal drainage of the sinuses, leading to inflammation and infection (2,7).

Aim:

This study aims to investigate the correlation between structural abnormalities of nose and paranasal sinuses leading to CRS in a sample of 80 participants. The study examined association between various anatomical variations of the OMC and different types of sinusitis, and explored the potential implications of these findings for the diagnosis and treatment of CRS.

Study Design:

This study was a cross-sectional observational study that aimed to investigate the correlation between anatomical variations of nose and paranasal sinuses with chronic rhinosinusitis (CRS).

Study Population:

Study consisted of 80 participants who were diagnosed with CRS. Participants were recruited from otorhinolaryngology department of a tertiary care hospital over a period of one year.

The inclusion criteria were:

• Age: 11-50 years
• CRS based on clinical symptoms and radiological findings
• Presence of anatomical variations of nose and paranasal sinuses

The exclusion criteria were:

• Presence of nasal polyps or other nasal tumors
• History of nasal surgery or trauma
• Presence of other respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD), Allergic fungal rhinosinusitis, cystic fibrosis, primary ciliary dyskinesia, young syndrome, EGPA, AERD etc

Data Collection:

• Demographic data: Age, sex, and medical history were recorded for each participant.
• Clinical evaluation: A thorough clinical evaluation was performed to assess the symptoms of CRS, such as nasal congestion, facial pain, and loss of smell.
• Radiological evaluation: Computed tomography (CT) scans of the paranasal sinuses were performed to assess the anatomical variations of nose and PNS and presence of sinusitis.
• Anatomical variations of the OMC during nasal endoscopy and various nasal surgeries.

Data Analysis:

Descriptive statistics: Frequency and percentage were used to describe the demographic data and the presence of anatomical variations of nose and PNS.

Study consisted of 80 participants, with 35 males (43.8%) and 45 females (56.3%). The age distribution showed that: 25% of participants were between 11-20 years old, 33.8% were between 21-30 years old, 27.5% were between 31-40 years old, 13.8% were between 41-50 years old. Overall, the study had a slightly higher representation of females and a relatively even distribution across the different age groups.

Table 1: Demographic characteristics of study participants

Study revealed that maxillary sinusitis was the most common type, affecting 50% of participants. Bilateral sinusitis was more prevalent than unilateral sinusitis, with 63.8% of cases affecting both sides, followed by the right side (40%) and left side (35%). The distribution of sinusitis cases was as follows: maxillary (40 cases), frontal (26 cases), ethmoid (33 cases), and sphenoid (12 cases). Notably, some participants had multiple types of sinusitis, resulting in a total of 111 sinusitis cases among 80 participants.

Table 2: Distribution of study participants by sinusitis status

Study population exhibited various anatomical variations of nose and PNS. Most common variation was a septal deviation affecting 37.5% of population, followed by concha bullosa (31.3%), various attachments of uncinate process (27.5%), large agger nasi cell (25%), Haller cell (18.8%), and paradoxical middle turbinate (12.5%).

Table 3: Distribution of anatomical variations of nose and PNS

This study shows the association between various anatomical variations and sinusitis in different sinuses. Septal deviation was most common variation, associated with 45% of maxillary, 46.2% of frontal, 45.5% of ethmoidal, and 41.7% of sphenoidal sinusitis. Other variations, such as concha bullosa, large agger nasi cell, haller cell, Paradoxical Middle turbinate, and Various attachments of uncinate process also showed significant associations with sinusitis in different sinuses. These findings suggest that anatomical variations play a significant role in the development of sinusitis in different sinuses.

Table 4: Association of different categories of sinusitis with anatomical variations of nose and PNS

Table 5: Association of various attachment of uncinate process and different types of sinusitis

This study aimed to investigate the correlation between chronic rhinosinusitis (CRS) and anatomical variations of nose and PNS. The results showed a significant association between various anatomical variations and CRS.

Demographic Characteristics

Demographic characteristics of study participants show a slightly higher representation of females (56.3%) compared to males (43.8%). This finding is consistent with previous studies that have reported a higher prevalence of chronic rhinosinusitis (CRS) in females^8,9. Age distribution of the study participants shows a relatively even distribution across different age groups, with majority of participants (33.8%) between 21-30 years old. This finding is consistent with previous studies that have reported a peak prevalence of CRS in young adults^10,11.

Comparison of demographic characteristics with other studies:

Sinusitis Distribution

Study found that maxillary sinusitis was most common type, affecting 50% of participants, followed by ethmoidal sinusitis (41.3%), frontal sinusitis (32.5%), and sphenoidal sinusitis (15%).

Comparison of sinusitis distribution with other studies:

Study also found that bilateral sinusitis was more prevalent than unilateral sinusitis, with 63.8% of cases affecting both sides. This finding is consistent with previous studies that have reported a high prevalence of bilateral sinusitis in patients with chronic rhinosinusitis ^10,11. Findings are consistent with previous studies that have reported multiple sinuses involvement in patients with chronic rhinosinusitis¹².

Anatomical Variations

Study found that septal deviation was most common anatomical variation of nose and PNS, affecting 37.5% of the population. This finding is consistent with previous studies that have reported septal deviation as a common anatomical variation¹³. Study also found that concha bullosa was second most common anatomical variation, affecting 31.3% of population. This finding is consistent with previous studies that have reported concha bullosa as a common anatomical variation¹⁴.

Comparison of anatomical variations of nose and PNS with other studies:

Anatomical variations and different sinusitis association

This study found that septal deviation was the most common anatomical variation associated with sinusitis in different sinuses. This finding is consistent with previous studies that have reported a significant association between septal deviation and sinusitis¹³. For example, a study by Kaygusuz et al.¹⁵ found that septal deviation was significantly associated with maxillary and frontal sinusitis.

Study also found that concha bullosa was associated with sinusitis in different sinuses. This finding is consistent with previous studies that have reported a significant association between concha bullosa and sinusitis^14,17. For example, a study by Bolger et al.¹⁴ found that concha bullosa was a common anatomical variation in patients with chronic rhinosinusitis.

Study's findings on association between anatomical variations and sinusitis in different sinuses are consistent with previous studies that have reported a significant role of anatomical variations in the development of sinusitis^15,16. For example, a study by Alkire et al.¹⁶ found that sinonasal anatomical variants were significantly associated with recurrent acute rhinosinusitis.

Various Uncinate process attachment

This study found that the most common attachment of the uncinate process was to the lamina papyracea, accounting for 6 cases in maxillary sinusitis, 4 cases in frontal sinusitis, and 5 cases in ethmoidal sinusitis. This finding is consistent with previous studies that have reported lamina papyracea as a common site of attachment for uncinate process^14,17. Study also found that distribution of various attachments of the uncinate process differed among different types of sinusitis. For example, in sphenoidal sinusitis, all types of attachments were relatively evenly distributed, with 1 case each. This finding suggests that the anatomical characteristics of the uncinate process may vary among different sinusitis types.

Comparison of various attachments of uncinate process with other studies:

In conclusion, present study demonstrated a significant association between anatomical variations of nose and PNS with CRS. Findings suggest that identifying and addressing these variations may be important for preventing and treating CRS. Study also highlights importance of considering anatomical variations of nose and PNS in diagnosis and treatment of CRS.

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