Effect of paranasal anatomical variants on outcomes in patients with limited and diffuse chronic rhinosinusitis.
OBJECTIVE
The role of anatomical variants of the paranasal sinuses in the aetiology of chronic rhinosinusitis (CRS) is not well understood. Furthermore, the effect of anatomical variants on long-term outcomes has not been described. This study aims to assess the effects of anatomical variants of the middle meatus on patients with limited and diffuse CRS.


METHODS
A database analysis was conducted for patients with limited sinusitis (undergoing anterior FESS) and patients with diffuse sinusitis (undergoing complete FESS) between 2009 and 2013. Intergroup comparisons were made for symptom scores, CT scans, revision surgery, re-referrals following discharge and number of clinic follow-ups.


RESULTS
A total of 86 patients were included in the study: 40 anterior FESS, 25 CRSwNP and 21 CRSsNP. Following surgery, anterior FESS symptom scores reduced by 4.6±0.8 on average, while the CRSwNP and CRSsNP group reduced by 5.7±1.1 and 5.9±1.3 respectively. Patients undergoing anterior FESS required fewer clinic follow-ups than CRSwNP (Δ 2.7±0.9, P<0.001) and CRSsNP (Δ 3.3±0.6, P<0.001). Patients with fewer anatomical variants (0-2) required more follow-up (5.2±0.6) than those with higher numbers of variants (3+) (3.8±0.3, P=0.05). No significant differences were seen between groups for revision surgery, repeat CT and re-referral rates.


CONCLUSIONS
Limited surgery for local disease demonstrated comparable symptom improvement to patients with extensive disease receiving extensive surgery. Patients with greater numbers of anatomical variants are associated with localised sinus disease who typically require less postoperative care after receiving limited surgery.
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Johnny
J
Wu
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Ravi
R
Jain
Department of Surgery, The University of Auckland, Auckland, New Zealand. Electronic address: richard.douglas@auckland.ac.nz.
Richard
R
Douglas
D063405:Anatomic Variation; D002908:Chronic Disease; D016208:Databases, Factual; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures; D010256:Paranasal Sinuses / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D011182:Postoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
Abnormalities; Intranasal surgery; Paranasal sinuses; Sinusitis; Tomography