Study of Anatomical Variations on High Resolution Computed Tomography [HRCT] Para Nasal Sinuses in Chronic Rhinosinusitis

Abstract Introduction Chronic rhinosinusitis (CRS) is a common and debilitating condition affecting millions of individuals globally, having a significant burden on healthcare systems and public health resources. The prevalence of CRS has been estimated up to 10% to 12% of the population, establishing it one of the most common chronic diseases worldwide. CRS is defined as inflammation of the nasal and paranasal sinuses for 12 weeks or longer, even after appropriate medical therapy. Its impact extends beyond the upper respiratory tract, as it is associated with many systemic effects such as fatigue, sleep disturbances, impaired productivity along with reduced quality of life. Patients with CRS often report prolonged physical discomfort due to symptoms such as nasal congestion, purulent nasal discharge, facial pain or facial pressure, and reduced or complete loss of smell.1 Chronic rhinosinusitis is often classified into two primary subtypes: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). These subtypes differ in their clinical presentation, underlying pathophysiology, and response to treatment.1 The etiology of CRS is multifactorial with host, environmental, and microbial factors are major contributors. With host component, anatomical variations in the paranasal sinuses is major contributor in the pathogenesis of CRS. This can disrupt the sinus ventilation and drainage pathways resulting in an environment favouring to mucus stasis and bacterial colonization leading to persistent inflammation. Therefore, understanding the role of anatomical variations is essential, both for diagnosing CRS and tailoring the effective treatment strategies, including surgical intervention.2 High-resolution computed tomography (HRCT) is the gold standard for evaluating sinonasal anatomy and pathology. It enables precise identification of anatomical variations, supports CRS diagnosis, and is critical for preoperative planning in functional endoscopic sinus surgery (FESS). This study aims to assess the role of anatomical variations in the pathogenesis of CRS and highlight the diagnostic value of HRCT in evaluating these changes.