Concha Bullosa and Other Sinonasal Variants; Clinical and CT Correlation

Backgroud/ In recent years endoscopic sinus surgery has been established as a successful treatment of chronic sinusitis and more attention has been given to CT evaluation of the paranasal sinuses. Concha bullosa is defined as aeration of the middle turbinate. It is one of the most important anatomic variants that may cause inflammatory sinus disease by narrowing of the middle meatus. The incidence of concha bullosa has been reported from 4-80% in different studies. The goal of this study is to determine the incidence of concha bullosa and a few other significant sinonasal anatomic variants in symptomatic patients and to correlate with the presence of inflammatory sinus disease as detected on CT. Coronal CT scans of the sinuses were evaluated in 174 consecutive symptomatic patients. The symptoms included postnasal discharge and tenderness over the facial sinuses during the past two weeks prior to examination. The mean age of patients was 30.6 years (from 7 to 66 years); and there were 95 (54.6%) males and 79 (45.4%) females. Concha bullosa was present in 113 (64.9%) patients. It was bilateral in 45 (39.8%) and unilateral in 68 (60.2%) patients. In cases with unilateral concha bullosa, the left to right ratio was 1.7 to 1. Inflammatory disease of the sinuses was identified in 81 (71.7%) patients with concha bullosa and 35 (57.7%) patients without concha bullosa. The incidence of inflammatory disease of the sinuses was higher when there was coexistence of concha bullosa and deviation of the nasal septum. The most common symptom was headache (71.8%), and the least common was fever (27.9%). Tenderness over the frontal and maxillary sinuses, postnasal drip and fever were more common in patients with concha bullosa. Concha bullosa is associated with higher incidence of inflammatory sinus disease. With simultaneous concha bullosa and nasal septal deviation, the incidence of inflammatory disease increases.