title: Osteomeatal complex obstruction is not associated with adjacent sinus disease in chronic rhinosinusitis with polyps.
abstract: BACKGROUND
  It is universally accepted that osteomeatal complex (OMC) disease is linked to the subsequent development of chronic rhinosinusitis without nasal polyps (CRSsNPs) via postobstructive mechanisms. The role of OMC obstruction in the pathogenesis of CRSwNPs  is less clear. This study was designed to identify if there is an association between OMC obstruction and inflammation of the adjacent sinuses, when patients are stratified by polyp status. This is a follow-up and expanded series of a previous pilot study from our group.
  
  
  METHODS
  CT scans of 144 patients with CRSsNPs and 123 patients with CRS with nasal polyps (CRSwNPs) were evaluated for each sinus and OMC. Patients had no previous surgeries for NPs. CT scans were obtained after a trial of maximal medical therapy.
  
  
  RESULTS
  Increasing OMC involvement  was associated with increasing Lund-Mackay score for both CRSsNPs and CRSwNPs. In CRSsNP patients, OMC status significantly correlated with adjacent sinus status (p << 0.0001). Meanwhile in CRSwNPs, OMC status does not correlate with adjacent sinus status (p = 0.328).
  
  
  CONCLUSIONS
  OMC obstruction in the setting of CRSwNP may be a barometer of the overall disease process, but in this scenario, paranasal sinus inflammation can not be classified as a postobstructive phenomenon. These findings question the role of minimally invasive procedures in the management of CRSwNPs.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. randy.leung@utoronto.ca
authors.forename: Randy M
authors.initials: RM
authors.lastname: Leung
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
authors.forename: David B
authors.initials: DB
authors.lastname: Conley
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Tan
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chandra
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D009298:Nasal Polyps / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology*; D010865:Pilot Projects; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D012852:Sinusitis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed