Predicting Positive CT Findings in Non-Polypoid Para-Nasal Sinus Disease
Objective: Chronic rhinosinusitis affects significant portion of the population and is one of the most common reasons for Otolaryngology visits. In recent years, Computed Tomography (CT) has become the main modality of investigation in sinus disease. However, significant paucity in evidence exists in correlating symptoms and laboratory findings with positive CT findings. Given the associated radiation exposure and significant cost on the healthcare system, clinical guidelines in determining the appropriateness of CT investigation are needed.
Study Design: Eighty-three consecutive patients referred to a single rhinologist for evaluation for chronic rhinosinusitis without nasal polyposis were retrospectively reviewed.
Setting: The study involved two McGill University associated hospitals in a 13 month period.
Subjects and Methods: Patients were evaluated for presence of six subjective symptoms and two objective signs. Complete blood count and CT sinuses were then ordered. CT sinuses were subsequently graded using the Lund-McKay scoring system. Results: No single symptom, sign or combinations were predictive of positive CT finding. No laboratory markers were able to predict a positive scan. Interestingly inflammatory markers were lower in positive scan group compared to the negative scan population.
Conclusion: Clinical diagnosis of chronic rhinosinusitis in nonpolypoid patients presents a challenge. CT imaging is a fundamental component in diagnosing those patients, yet clinical experience is important in preventing unnecessary radiation exposure.