Abstract

Topicality: Chronic rhinosinusitis (CRS) is a prolonged inflammatory condition that carries significant financial and societal consequences, as reflected in numerous articles and clinical guidelines. Despite the considerable array of potential treatments for CRS, etiotropic therapy remains elusive. Furthermore, there is no single pathogenesis explanation for the disease. The latest theories regarding the disease’s origin are presented in EPOS 2020, which also outlines potential risk factors, including allergies, bronchial asthma, and other lower respiratory tract conditions, non-steroidal anti-inflammatory drug intolerance, hypogammaglobulinemia, gastroesophageal reflux disease, anatomical peculiarities, infectious agents, mucociliary deficiency, smoking, obstructive sleep apnea syndrome, vitamin D, and metabolic syndrome. Among them, the least researched factor is anatomical, as there are still no definitive data characterizing the frequency of involvement of nasal sinuses in CRS, its types, the complexity of anatomical structures influencing susceptibility, and the relationship between intranasal structures and the likelihood or severity of CRS. A more detailed understanding of the anatomical characteristics of patients with CRS, their comparative characteristics between CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP), can be one of the critical factors influencing patient management.

Objective: To analyze computed tomography (CT) data of the nasal cavity and paranasal sinuses in patients with chronic rhinosinusitis with and without nasal polyps.

Results: According to the obtained data of the Lund-Mackay scores, the highest mean score was observed in Group 1 – 12.95 ± 6.84. In Group 2, the mean score was 3.17 ± 2.12, and in Group 3, the mean score was close to zero at 0.3 ± 0.74. The difference between groups was significant, P < 0.05. When determining the RLF/MCAS index, it was “> 1” in 137 individuals (87.8%) in Group 1, and in Group 2, it was present in 24 individuals (32.4%).

Based on the assessment of the APPS scale, it was found that Group 1 (CRSwNP) had a significantly higher mean score, while Group 2 (CRSsNP) had similar results to Group 3 (Control). Thus, Group 1 scored 13 ± 2.98 points, Group 2 – 10.41 ± 2.64, and Group 3 – 9.9 ± 2.35, P < 0.05. The data of the APPS scale assessment are demonstrated in Figure 2. When determining the correlation between the Lund-Mackay scale and the APPS scale, no statistically significant correlation was found, P > 0.05.

Conclusion: The study results revealed that in CRSwNP, the mean Lund-Mackay score was significantly higher compared to CRSsNP, which can be explained by the gradual diffuse spread of the disease. Assessing the impact of frontal sinus type on the severity of X-ray changes in frontal sinuses in CRSwNP revealed that the anatomical arrangement of frontal sinus structures does not affect the extent of mucosal polypoid changes according to CT data. There was also no relationship found between the structure of the lower wall of the maxillary sinus and the presence of any type of CRS. Anatomical deviations of the nasal septum were observed in 378 out of 384 cases. Therefore, the potential influence of this type of nasal architectural disorder on the development of chronic nasal diseases remains debatable. When evaluating the pneumatisation of the nasal cavity and paranasal sinuses using the APPS scale, it was found that in CRSwNP, pneumatisation was significantly higher than in CRSsNP. In turn, no statistically significant difference was found between CRSsNP and the control group (Group 3). Thus, increased pneumatisation may be associated with a higher risk of developing CRSwNP.

Keywords: anatomy, nasal cavity, CT, chronic rhinosinusitis, APPS scale, Lund-Mackay scale, nasal septum, pneumatisation.