P. S. R. Rajeswari, Badireddi Sudha, S. Surya Prakasa Rao
BACKGROUND Rhinosinusitis is an infection of nose and paranasal sinuses (PNS) which is influenced by host and environmental factors and is the commonest problem encountered in ENT Clinics. Anatomical variations will affect the incidence of chronic rhinosinusitis which should be addressed in the management. Aims and Objectives 1. To study the incidence of chronic rhinosinusitis in different sex, age and socio-economic status. 2. To study anatomical variations in direct nasal endoscopy and CT scan in chronic rhinosinusitis. MATERIALS AND METHODS This study was carried out in the Department of ENT and Head & Neck Surgery of Govt. ENT. Hospital, Andhra Medical College, Visakhapatnam from 1-07-2015 to 30-06-2016. Out of the 72000 out patients, 10800 were with Chronic Rhinosinusitis and 102 cases were included in present study. After thorough clinical examination, direct nasal endoscopy, blood and urine routine examination, X-ray and CT PNS in coronal, sagittal and axial cuts, patients were distributed according to sex, age variation, socioeconomic status and symptoms. The anatomical variations both in direct nasal endoscopy and in CT PNS were recorded as aetiological factors. RESULTS Out of the 10800 CRS patients, 102 were included in this study. Male to female ratio was 1:0.47. The age group 21-30 yrs. (38.24%) is affected most commonly followed by 31-40 yrs. (28.45%). The low socio-economic group was affected most commonly (55%). Allergy was found in 62.8%. The most common symptom was postnasal discharge (72.94%) followed by nasal obstruction (65.17%) On endoscopic evaluation, deviated nasal septum was the most common finding (76%) followed by concha bullosa (33%). On CT evaluation, the most common variation was deviated nasal septum (78%), followed by concha bullosa (34%), agger nasi cell (33%), enlarged ethmoidal bulla (32%), uncinate process abnormalities (28%), paradoxical middle turbinate (22%), multiseptated sphenoid (14%), septal cell (12%), Onodi cell (8%) and Haller cell (4%). The least common variation was hypoplastic maxillary sinus (2%). CONCLUSION The results of this retrospective study show that some anatomical variations of the nose i.e., septum and lateral wall can play an important role in the pathogenesis of chronic rhino sinusitis, and thus may increase the risk of mucosal sinus disease. In this study, males and the age group 21-30 yrs. were most commonly suffered. CRS incidence was highest in low socioeconomic status due to poor nutrition, housing and unhygienic conditions. Allergy is a commonest predisposing and associated factor. Postnasal discharge due to excessive secretion and natural instinct of spontaneously sniffing back the secretions aided by backward movement of cilia of the nose was the commonest symptom. On direct nasal endoscopy and CT evaluation, the most common variation was deviated nasal septum followed by concha bullosa.
