CORRELATION BETWEEN NASAL CAVITY ANATOMY AND PREDISPOSITION TO CHRONIC SINUSITIS: A RADIOLOGICAL STUDY

Abstract

Chronic sinusitis had been recognized as one of the most prevalent and persistent inflammatory diseases affecting the upper respiratory tract, significantly impairing patients’ quality of life. Anatomical variations within the nasal cavity and paranasal sinuses had been reported as key contributing factors to impaired sinus ventilation and mucociliary clearance, thereby predisposing individuals to recurrent or chronic sinus infections. Structural deviations such as nasal septal deviation, concha bullosa, paradoxical middle turbinate, and Haller cells had been considered crucial in altering airflow dynamics and drainage pathways. Radiological assessment, particularly through computed tomography (CT) imaging, had played an essential role in identifying these variations with high precision. Therefore, understanding the relationship between nasal anatomy and chronic sinusitis had been important for improving diagnostic accuracy and formulating preventive as well as surgical strategies.

Aim: The aim of this study had been to investigate the correlation between anatomical variations of the nasal cavity and the predisposition to chronic sinusitis using radiological (CT scan) evaluation among patients presenting with sinus-related complaints.

­­­­­Methods: This cross-sectional study had been conducted at Faisalabad Medical University, Faisalabad, from May 2024 to April 2025. The study population had comprised 110 participants aged between 18 and 60 years who had presented with clinical features suggestive of chronic sinusitis, such as nasal obstruction, facial pain, postnasal drip, or recurrent nasal discharge for more than 12 weeks. Patients with a history of prior nasal surgery, facial trauma, or sinonasal tumors had been excluded. High-resolution computed tomography (HRCT) scans of the paranasal sinuses had been performed for all participants. Radiological evaluation had been done in coronal, axial, and sagittal planes to identify anatomical variations such as nasal septal deviation, concha bullosa, Haller cells, agger nasi cells, and paradoxical middle turbinate. The severity of sinus disease had been scored using the Lund–Mackay system. Data had been analyzed statistically to determine correlations between anatomical variations and the presence or severity of chronic sinusitis using chi-square and Pearson correlation tests, with p < 0.05 considered

statistically significant.

Results: Out of 110 participants, 64 (58.2%) had been males and 46 (41.8%) females, with a mean age of 36.4 ± 9.8 years. Nasal septal deviation had been observed in 68 (61.8%) participants, concha bullosa in 44 (40.0%), paradoxical middle turbinate in 18 (16.4%), Haller cells in 22 (20.0%), and agger nasi cells in 30 (27.3%). Among these variations, nasal septal deviation and concha bullosa had shown a statistically significant association with chronic sinusitis (p = 0.001 and p = 0.003, respectively). The mean Lund–Mackay score had been significantly higher in patients with multiple anatomical variations compared to those with normal anatomy (9.8 ± 2.6 vs. 5.3 ± 1.9; p < 0.01). Additionally, a positive correlation (r = 0.62) had been found between the number of anatomical variations and sinus disease severity.

Conclusion: This study had demonstrated that specific anatomical variations of the nasal cavity, particularly nasal septal deviation and concha bullosa, had been significantly correlated with an increased predisposition to chronic sinusitis. Radiological evaluation using CT imaging had proved to be a valuable diagnostic tool in identifying these variations and predicting disease severity. Early recognition and appropriate management of anatomical abnormalities could potentially prevent chronicity and reduce the need for surgical intervention.