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November 1997

Relationship Between Patient-Based Descriptions of Sinusitis and Paranasal Sinus Computed Tomographic Findings

Author Affiliations

From the Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine (Mr Bhattacharyya and Dr Piccirillo), the Mallinckrodt Institute of Radiology, Washington University Medical Center (Dr Wippold), St Louis, Mo, and the Department of Radiology—Nuclear Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Wippold).

Arch Otolaryngol Head Neck Surg. 1997;123(11):1189-1192. doi:10.1001/archotol.1997.01900110039006

Objective:  To evaluate the relationship of paranasal sinus symptoms with coronal computed tomographic (CT) findings.

Design:  Prospective comparison of patient-based symptoms with imaging findings.

Setting:  Primary care and referral center office and hospital practices.

Patients:  Of 586 consecutive patients referred by otolaryngologists and primary care physicians for CT of the paranasal sinuses, 221 (151 women and 70 men; age range, 13-82 years; mean age, 44 years) participated by completing the Sino-Nasal Outcome Test-20 (SNOT-20) clinical questionnaire immediately before undergoing CT.

Main Outcome Measures:  Radiologists blinded to the patients' responses scored the degree of mucosal thickening at each of 12 sites on CT scans using a staged scale of severity (0-2 points). Bivariate analysis was performed to assess the relationship between patients' symptoms and CT findings.

Results:  The SNOT-20 scores ranged from 0 (normal) to 78 (mean, 34). The most commonly reported symptom was fatigue. The CT scores ranged from 0 (normal) to 24 (mean, 4.07). Seventy-five patients (34%) had normal findings on the CT scan. The maxillary sinus was the most commonly involved site (96 patients, or 43%). The SNOT-20 and CT scores failed to significantly correlate (r=0.11, P≤.09). When the subset of patients with "positive" or "very positive" CT scans were considered, no significant correlation was observed (r=0.12, P≤.16). For the 132 patients reporting facial pain, the mean CT score was lower than for patients without facial pain (3.78 vs 4.78, P=.21).

Conclusion:  Patient-based reports of paranasal sinus symptoms failed to correlate with findings on CT scans; therefore, CT should be reserved for delineating the anatomy and pattern of inflammatory paranasal disease prior to surgical intervention.Arch Otolaryngol Head Neck Surg. 1997;123:1189-1192