Chronic sinusitis in Malta--correlation between symptoms and CT scan

The diagnosis of chronic rhinosinusitis (CRS) is clinical as it is based on patient symptoms. Sinus CT has been used as an objective measure of CRS with varying degrees of success and correlation to patient symptoms.

This study aimed to investigate the relationship between patient symptoms, nasal endoscopic findings and CT in a small Mediterranean island community. A cohort of 305 consecutive patients with symptoms of CRS, that persisted despite maximal medical therapy, was evaluated by medical history, clinical examination and nasal endoscopy followed by sinus CT. Scans scoring 2 or higher on the Lund-Mckay scoring system were classified as positive for sinusitis while those scoring 0 or 1 were classified as negative for sinusitis.

The setting of this study was a busy otolaryngological practice on a small Mediterranean island using a computerised database.

In total, 172 patients (56%) had positive and 133 (44%) had negative CT scans. Males with CRS were significantly more likely to have a positive CT (chi squared test, p=0.0005). Postnasal drip/rhinorrhoea, nasal obstruction and hyposmia as primary symptoms were significantly more likely to be associated with a positive CT (chi squared test p=0.0001). Patients presenting with facial pain as the primary symptom were significantly more likely to have a negative CT (chi squared test, p=0.0001). Middle meatal pus or nasal polyps on nasal endoscopy were significantly more likely to be associated with a subsequently positive CT (chi squared test, p<0.0001). Mucosal oedema of the middle meatus was a non-specific finding. CT positive patients were more likely to be treated surgically while CT negative patients were more likely to be treated with medication (chi squared test, p=0.0001).

Patients were followed up for a mean of 2 years. Overall, there was a good or improved outcome in 81% of patients. Those with a positive CT did significantly well with surgical treatment.