Correlation of Clinical, Computed Tomographic, and Intraoperative Findings in Chronic Rhinosinusitis

Background: Chronic rhinosinusitis (CRS) is a common inflammatory condition of the nasal cavity and paranasal sinuses persisting for more than 12 weeks and causing significant morbidity worldwide. Accurate diagnosis and precise delineation of disease extent are essential for effective management. With the advent of Functional Endoscopic Sinus Surgery (FESS), diagnostic nasal endoscopy and computed tomography (CT) of paranasal sinuses have become integral to preoperative evaluation. However, discrepancies between radiological findings and intraoperative observations still exist, particularly regarding anatomical variations and sinus involvement. Establishing a correlation between clinical, radiological, and operative findings is therefore crucial to optimize surgical planning and outcomes. Material and Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology at a tertiary care teaching hospital in Western India between May 2023 and August 2024. A total of 42 patients diagnosed with chronic rhinosinusitis and planned for endoscopic sinus surgery were included. All patients underwent detailed clinical evaluation, diagnostic nasal endoscopy, and CT scan of paranasal sinuses prior to surgery. CT findings were compared with intraoperative observations to assess diagnostic accuracy. Sensitivity, specificity, accuracy, and Cohen’s kappa coefficient were calculated to evaluate agreement between CT and operative findings. Results: Among the 42 patients, males predominated (54.76%), with the most affected age group being 31–40 years. Nasal obstruction was the most common symptom (92.85%). Maxillary sinus was the most frequently involved sinus on CT, followed by ethmoid sinuses. CT scan demonstrated high sensitivity for detecting sinus disease and osteomeatal complex obstruction, with substantial agreement for osteomeatal complex blockage and deviated nasal septum. However, lower sensitivity and agreement were observed for certain anatomical variations such as concha bullosa and Onodi cells. Conclusion: CT scan of paranasal sinuses is a highly sensitive tool for evaluating CRS and guiding surgical management. When combined with clinical assessment and nasal endoscopy, it provides optimal preoperative planning and improves intraoperative safety