Chronic sinusitis: symptoms versus CT scan findings Michael G. Stewart and Romaine F. Johnson Purpose of review The association between symptoms of chronic rhinosinusitis and findings on a sinus CT scan remains controversial. Although the 1997 Task Force on Rhinosinusitis definition of chronic rhinosinusitis includes only symptoms and signs, many clinicians use CT scans for diagnosis and assessment of disease severity. Recent findings Two prospective studies evaluated associations between symptoms and CT scan findings. One study compared the diagnosis of chronic sinusitis with findings using a validated CT staging system; the CT findings were poorly predictive of the presence or absence of chronic sinusitis. The other study used a nonvalidated assessment of symptoms and several measurements from CT scans and identified a few significant associations. Summary There are few recent studies explicitly addressing symptom severity and CT scan findings in chronic sinusitis. Most studies conclude that there is little correlation between CT findings and symptoms but that both are important in the evaluation of sinusitis. Keywords chronic sinusitis, CT scan, symptoms, diagnosis Curr Opin Otolaryngol Head Neck Surg 12:27–29. © 2004 Lippincott Williams & Wilkins. Introduction The association between chronic sinusitis and CT scan findings continues to be controversial. The 1997 Task Force on Rhinosinusitis definition of chronic rhinosinus- itis includes only symptoms and signs [1]. Therefore, chronic sinusitis is defined by the presence of a charac- teristic group of symptoms, with no radiologic imaging as part of the diagnosis. Nevertheless, many clinicians cur- rently use the sinus CT scan for two important clinical purposes: (1) as a diagnostic test confirming the presence of chronic sinusitis and (2) as an indicator of disease severity. Furthermore, the CT scan is critical in defining the sinus anatomy, identifying anatomic abnormalities, and as a “road map” to assist at surgery. In addition, prior studies have found the CT scan stage to be an indepen- dent predictor of outcome after sinus surgery, when out- come is assessed primarily using nasal endoscopy. Therefore, the CT scan is an important tool in the ar- mamentarium of the physician treating chronic sinusitis. However, if chronic sinusitis is defined by symptoms, then the association between CT scan findings and symptoms should be well understood. In theory, if there were a strong association between symptoms and CT findings, then symptom severity could serve as a proxy for CT scan findings and vice versa. In contrast, however, several previous reports have indicated no association between symptom severity and CT scan severity, and other reports have found, at best, a very weak association. In this report, we summarize the recent literature on symptoms and CT scan findings in patients with chronic sinusitis. We reviewed articles reported in MEDLINE that were published between August 1, 2003, and July 1, 2003. Our search strategy incorporated multiple MeSH and free-text terms, including sinusitis, ethmoidal sinus- itis, maxillary sinusitis, chronic sinusitis, x-ray CT, radi- ography, x-ray, and so on. We reviewed only articles pub- lished in English. We identified more than 140 articles of potential interest, but review of the abstracts of those articles demonstrated that only 16 potentially addressed the topic of interest. Each of those articles was reviewed in more detail, and only six of them addressed symptoms and CT scan findings in chronic sinusitis. These six ar- ticles are reviewed below. Chronic sinusitis and the CT scan Hwang et al. [2••] conducted a prospective clinical study comparing the presence of symptoms of chronic sinusitis with the presence of sinus CT scan findings. A consecu- tive series of patients seen in evaluation for chronic si- The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas, USA Correspondence to Michael G. Stewart, MD, MPH, The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, 6550 Fannin, Suite 1727, Houston, TX 77030, USA E-mail: mgstew@bcm.tmc.edu Current Opinion in Otolaryngology & Head and Neck Surgery 2004, 12:27–29 © 2004 Lippincott Williams & Wilkins 1068-9508 27