Suspected Chronic Rhinosinusitis

Pathway

Images

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1a		Chronic Sinusitis Image 1a, b and c (Computed Tomography): There is mucosal thickening of the right maxillary sinus with no bony obstruction or soft tissue changes. Associated with this is mucosal thickening of the right ostiomeatal complex. The left maxillary antrum and ostiomeatal complex are unremarkable.
1b
1c

Teaching Points

Teaching Points

• Chronic rhinosinusitis is a clinical diagnosis and is defined as rhinosinusitis lasting >12 weeks that includes two or more of the following signs and symptoms:
  • Mucopurulent drainage (anterior, posterior, or both)
  • Nasal obstruction (congestion)
  • Facial pain-pressure-fullness, or
  • Decreased sense of smell
  AND clinical diagnosis of chronic rhinosinusitis should be confirmed with objective evidence of sinonasal inflammation, either with anterior rhinoscopy, nasal endoscopy or radiographically
• Plain radiography has limited value for imaging the paranasal sinuses and routine use is not indicated
• CT without IV contrast is the imaging modality of choice
• Significant unilateral disease is suspicious for neoplasm or inverted papilloma and warrants further evaluation

References

References

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

1. Kirsch CFE, Bykowski J, Aulino JM, Berger KL, Choudhri AF, Conley DB, et al. ACR appropriateness criteria((R)) sinonasal disease. J Am Coll Radiol. 2017;14(11s):S550-s9. (Guidelines). View the reference
2. Setzen G, Ferguson BJ, Han JK, Rhee JS, Cornelius RS, Froum SJ, et al. Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease. Otolaryngol Head Neck Surg. 2012;147(5):808-16. (Guidelines). View the reference
3. 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. (Guideline). View the reference
4. Kandukuri R, Phatak S. Evaluation of sinonasal diseases by computed tomography. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(11):TC09-TC12. (Level II-III evidence). View the reference
5. Holbrook EH, Brown CL, Lyden ER, Leopold DA. Lack of significant correlation between rhinosinusitis symptoms and specific regions of sinus computer tomography scans. Am J Rhinol. 2005;19(4):382-7. (Level II evidence). View the reference
6. Falco JJ, Thomas AJ, Quin X, Ashby S, Mace JC, Deconde AS, et al. Lack of correlation between patient reported location and severity of facial pain and radiographic burden of disease in chronic rhinosinusitis. International forum of allergy & rhinology. 2016;6(11):1173-81. (Level II-III evidence). View the reference <
7. Yeo NK, Park WJ, Ryu IS, Lim HW, Song YJ. Is facial or head pain related to the location of lesions on computed tomography in chronic rhinosinusitis?. Ann Otol Rhinol Laryngol. 2017;126(8):589-96. (Level II-III evidence). View the reference
8. Greguric T, Trkulja V, Baudoin T, Grgic MV, Smigovec I, Kalogjera L. Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol. 2017;274(5):2165-73. (Level II evidence). View the reference
9. Stewart MG, Sicard MW, Piccirillo JF, Diaz-Marchan PJ. Severity staging in chronic sinusitis: are CT scan findings related to patient symptoms? Am J Rhinol. 1999;13(3):161-7. (Level II-III evidence). View the reference
10. Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology. 1993;31(4):183-4. (Level II-III evidence). View the reference
11. Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg. 2007;137(4):555-61. (Level II evidence). View the reference
12. Aribandi M, McCoy VA, Bazan C. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 2007;27(5):1283-96. (Review article). View the reference
13. Joshi VM, Sansi R. Imaging in sinonasal inflammatory disease. Neuroimaging Clin N Am. 2015;25(4):549-68. (Review article). View the reference

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