Relationship between patient-based descriptions of sinusitis and paranasal sinus computed tomographic findings

Abstract

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.