Comparative evaluation of preoperative CT Scan and intraoperative endoscopic sinus surgery findings in patients with chronic rhinosinusitis

ABSTRACT

Chronic rhinosinusitis [CRS] is a common condition in medical practice. The diagnosis generally relies on clinical judgment, but computed tomography [CT] together with sinonasal endoscopy, provide the majority of the objective data. This study was carried out to determine the agreement between preoperative CT findings and intraoperative endoscopic sinus surgery [ESS] findings in patients with CRS. Statistical analysis of collected data from paranasal sinus CTs of 51 patients aged between 15 and 77 who subsequently underwent ESS for CRS at two training hospitals during a 2-year period, was performed. The agreement between CT and ESS findings was assessed by Kappa statistics, Chi-square and t test were also used for data analysis. The most common co-morbidity found among the patients with chronic sinusitis was allergy in 18 [35%] patients. Hypertrophy of the inferior turbinate was the most obvious finding in CT [71%] and during endoscopic evaluation [69%]. No significant correlation was found between clinical symptoms and gender or the length of disease. In 8 unusual patients [one with choanal atresia, one with bone wax in nasal cavity, and 6 with small polyposis], CT could not show the problem. There are good to excellent agreements between the two diagnostic procedures, except for the choanal atresia, which showed no agreement [K = 0]. The results of nasal fossa findings obtained by nasal endoscopy are more conclusive in the elucidation of diagnosis than those obtained by paranasal sinus CTs. In spite of a good agreement between CT and ESS findings in most patients, it seems in some unusual cases, CT may miss many patients