Dry versus wet temporalis fascia graft in type-I tympanoplasty: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the efficacy of dry versus wet temporalis fascia graft among patients undergoing type-I tympanoplasty. METHODS: Web of Science, Scopus, PubMed, and CENTRAL databases were screened from inception until July 2022. The Cochrane risk of bias tool was used to assess the quality of included RCTs. The outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) in a random-effects model. RESULTS: Eight RCTs with 989 patients (dry group = 514 and wet group = 475) were included. The overall quality was 'low', 'some concerns', and 'high' risk of bias in five, two, and one RCT(s), respectively. There were no significant differences between both groups regarding the surgical success rate (n = 8 RCTs, RR 0.99, 95% CI [0.95, 1.03], p = 0.6), audiological success rate (n = 5 RCTs, RR = 0.93, 95% CI [0.73, 1.13], p = 0.48), mean difference in pure tone average (n = 2 RCTs, MD = 2.73 Hz, 95% CI [- 2.31, 7.77], p = 0.29), and mean difference in graft placement time (n = 3 RCTs, MD = - 2.18 min, 95% CI [- 5.11, 0.76], p = 0.15). However, the mean difference in operative time was significantly lower in favor of the wet compared with the dry temporalis fascia group (n = 2 RCTs, MD = 2.95 min, 95% CI [- 1.80, 4.11], p < 0.001). The surgical success rate was not significantly different between both groups according to the tympanic membrane perforation size and site. CONCLUSIONS: The type of temporalis fascia graft (dry or wet) did not influence the clinical outcomes of type-I tympanoplasty.

The effect of intranasal irrigation with epinephrine solution on intraoperative visualization and bleeding during FESS.

PURPOSE: Bleeding during Functional endoscopic sinus surgery (FESS) can have adverse effect on surgical outcomes. This study evaluates if there is any benefit of adding epinephrine to the saline nasal irrigation in patients undergoing elective FESS for chronic rhinosinusitis. METHODS: A prospective, randomized, double-blinded study was performed. Fifty ASA I or II patients undergoing FESS were randomized to have irrigation either with normal saline or (1:100,000) epinephrine in normal saline during surgery. Outcomes measure included the Boezaart grading scale to assess the intraoperative surgical field, surgeon's satisfaction with field visualization and bleeding which was evaluated in a 10 cm visual analog scale, estimated blood loss as well as hemodynamic parameters changes. RESULTS: There was no statistically significant difference in the studied variables between both groups. However in patients with higher than 12 Lund-Mackay score the volume of blood loss was significantly less in the epinephrine group. All surgical procedures were completed and there were no operative complications or any reported perioperative cardiovascular events. CONCLUSIONS: Intraoperative irrigation with saline-epinephrine solution at a concentration of (1:100,000) is safe and does not change heart rate or blood pressure but is unlikely to improve the setting of intraoperative surgical field except for decreasing the volume of blood loss in patients with high Lund-Mackay score.

The Bacteriology of Middle Meatus and Ethmoid Sinuses in Chronic Rhinosinusitis: Epidemiological Analysis and Surgical Impact.

OBJECTIVES: The aim of this study was to explore the difference between sinus bacteriology in chronic rhinosinusitis patients with and without nasal polyposis. We also analyzed the possible differences in culture results from swabs taken from the middle meatus versus the ethmoid sinus. METHODS: Retrospective chart review of adult chronic rhinosinusitis patient data from the year 2006 to 2020. Nasal swabs were taken under endoscopic guidance either intraoperatively from either the ethmoid sinus or middle meatus, or in the outpatient clinic from the middle meatus. The results were categorized based on the most common microorganisms affecting the nose and sinuses. RESULTS: We found that, the presence of nasal polyps seemed to have no effect on sinus bacteriology as whole. There was also no significant difference between the bacteriology of chronic rhinosinusitis patients who did not need surgery and those who did. Finally, we found that middle meatal cultures, taken endoscopically, give similar bacteriology results to that of ethmoid sinus cultures (taken intraoperatively). CONCLUSION: Middle meatal culture results accurately represent true sinus flora, and therefore can be used to aid in appropriate culture guided antibiotic therapy for patients visiting the outpatient clinic.

Bifid Antrochoanal Polyp: First Case Report in the English Literature.

Antrochoanal polyp is a benign unilateral sinonasal lesion that arises from maxillary sinus and reaches the choana. It is composed of 2 components: the solid nasal division and the antral part which is almost always cystic and single. Proper identification and removal of polyp attachment to the maxillary sinus wall are essential steps to prevent recurrence. We report the first case of a bifid antrochoanal polyp in a 55-year old male patient. The polyp had an attachment to the posteroinferior wall of the maxillary sinus and then divided inside the sinus into 2 branches that exited the sinus through 2 different accessory ostia but only the posterior part reached the choana. The polyp was successfully removed via an endoscopic surgical approach.

Bulla Down Endoscopic Sphenoidotomy.

Surgical approach to the sphenoid sinus is still one of the most challenging steps in sinus surgery. The author describes a novel, simple, and safe technique to access sphenoid sinus to manage isolated sphenoid pathologies or approach skull base by removing the bulla ethmoidalis and temporarily lateralizing the middle turbinate during endoscopic sinus surgery. The current approach provides an effective method to access the sphenoid sinus without increasing morbidity and avoids unnecessary possible complications associated with turbinates' resection.

Food Sensitization in Medically Resistant Chronic Rhinosinusitis with or without Nasal Polyposis.

BACKGROUND: Nasal polyposis is a common nasal mass with unknown etiology. It has been assumed that allergy predisposes to polyp formation. Our objective was to compare the prevalence of food sensitization in medically resistant chronic rhinosinusitis patients with or without nasal polyposis. METHODS: One hundred and fifty-five patients who fulfilled the inclusion and exclusion criteria were incorporated into this study. The results of their total serum IgE and food-specific IgE levels were examined. RESULTS: The average age was 33 years (± 13) with 96 males and 59 females. The percentage of patients in each group that had a positive result for at least one tested allergen was 84% (88 patients in the sinusitis without polyposis group and 42 patients in nasal polyposis group). Patients without nasal polyposis reacted to an average of 4.6 foodstuffs, whereas patients with nasal polyposis reacted to 4.1. Egg white, sheefish and cherry were the most common type of sensitized food. There were no significant differences in the prevalence, type, number of positive food allergens and class level between the two groups. CONCLUSIONS: Food sensitization is common in medically resistant chronic rhinosinusitis. Since food sensitization prevalence, type and severity do not significantly differ between the two groups studied, food atopy is unlikely to be a major factor in nasal polyposis pathogenesis.

Concha Bullosa and Ethmoid Structures Pneumatization: The Effect of Altitude and Other Variables.

The effect of altitude on the paranasal sinus pneumatization is not well understood. This study aims to evaluate the effect of altitude on the surface area and type of the concha bullosa (CB) as well as the number of aerated ethmoid structures, and to study the correlation between CB, age, gender, and Lund-Mackay score (LMS).Sixty-five randomly collected paranasal sinus computed tomography scans of adult patients with sinonasal symptoms who had CB were reviewed for the type and surface area of CB, ethmoid structures pnumatization including crista galli, nasal septum, superior turbinate, and uncinate process, as well as the LMS. The mean age of patients was 35 ±â€Š9.64 years, with 29 females (41.7%) and 36 males (58.3%). The average LMS, altitude, and number of aerated ethmoid structures were 6 ±â€Š4, 580 ±â€Š325 m, and 4 ±â€Š1.4, respectively.The average CB surface area in females was 163 mm compared to 109 mm in men; this difference was statistically significant. Furthermore, females had significantly higher prevalence of bulbous and extensive CB. There was no significant correlation between altitude and the presence of ethmoid structures pneumatization.We concluded that altitude is not an important factor in ethmoid structures aeration. Our results indicate that female patients have larger CB and number of pneumatized ethmoid structures than males. We found a significant correlation between the surface area of CB and the number of aerated ethmoid structures, which indicates possible common etiology.

Extensive Chondrosarcoma of the Nasal Septum: Endoscopic Resection and Long-Term Follow-Up.

Chondrosarcoma of the nasal septum is extremely rare slow growing malignant tumor of nonepithelial origin. Preoperative differentiation between low-grade chondrosarcoma and benign cartilaginous tumors such as chondroma may be difficult. Surgical excision is the treatment of choice. Radiotherapy is reserved for residual or recurrent patients. Recent advance in endoscopic sinus surgery has allowed successful, noninvasive excision of many sinonasal tumors with low morbidity.The authors herein report, what we believe, the most extensive case of posterior nasal septal chondrosarcoma with the longest follow-up period that was completely excised endoscopically with no evidence of local or systemic recurrence after 5 years. The authors also discuss its relevant clinical presentation, diagnosis, and management.

Image-Guided Sinus Surgery in Sinonasal Pathologies With Skull Base/Orbital Erosion.

OBJECTIVE: The aim of the study was to review the use and outcomes of image-guided sinus surgery (IGSS) in sinonasal pathologies with skull base/orbital erosion without intracranial or intraorbital extension. METHOD: A retrospective charts and medical records review was performed for 474 consecutive sinonasal surgeries performed by a single surgeon at tertiary, academic center from August 2010 to December 2013. RESULT: Fourteen subjects (mean age 27 years; 8 men and 6 women) were identified. Mucocele and tumor were the most common pathological indication for IGSS use in this case series. Orbital wall erosion was detected in 57%, skull base in 29%, and both sites in 14%. The average blood loss was 80  mL, the average operative time was 190 minutes, and the average hospital stay was 3 days. There was no major intra- or postoperative complications. Two patients required revision endoscopic sinus surgery. The mean follow-up was 14 months (range 8-36 months). CONCLUSION: Image-guided sinus surgery alone is safe and effective procedure for a variety of sinonasal pathologies with orbital and skull base erosion.

Extra middle turbinate lamellas: a suggested new classification.

PURPOSE: Proper knowledge of sinonasal configurations and anatomical structural variations is essential to perform safe endoscopic sinus surgery. Although common middle turbinate variations have been well described in literature, rare variations have not. The aims of this study are to revise the nomenclature of extra middle turbinate lamellas variations and suggest an easy classification system of these lamellas. METHOD: A retrospective charts and medical records review was performed for consecutive cases that were diagnosed with extra lamella middle turbinate based on endoscopic and stander three-dimensional reconstruction computer tomography scan at a tertiary academic center. After extensive literature review, these lamellas were classified into four types depending on the presence or absence of uncinate process and their morphological configuration. RESULT: Twenty-two subjects (mean age 35 years; 8 men and 14 women) were identified who had thirty extra middle turbinate lamellas. Nasal obstruction and discharge were the most common presenting symptoms. Accessory middle turbinate was the most common extra lamella been observed and bifid inferior turbinate was the least common. Ten patients (45 %) had an accompanied middle turbinate anatomical variations, 9 (41 %) had nasal septum deviation, 11 (50 %) had associated maxillary or ethmoid sinusitis and 5 (23 %) had hypoplastic maxillary sinus. CONCLUSION: Extra middle turbinate lamella is a rare type of middle turbinate anatomical variation that can be diagnosed by careful endoscopic examination and a precise computer tomography scan review. These lamellas may have a significant association with mucosa pathologies and are commonly seen with other common middle turbinate variations. Correct description and the use of common terminology can help to further evaluate the incidence of lamellas, their pathophysiological role, and to avoid any intraoperative landmark confusion.

Modified osteoplastic flap approach for frontal sinus disease.

OBJECTIVES: We review the use and outcomes of osteoplastic flap surgery in the current era of almost entirely endoscopic management of frontal sinus disease. METHODS: A retrospective review was performed of 312 consecutive sinus surgeries performed for frontal sinus disease at the University of Iowa Hospitals and Clinics from July 2002 to July 2008. RESULTS: Seventeen subjects (10 men and 7 women; mean age, 56 years) were identified. The indications for osteoplastic flap surgery were laterally located mucoceles in 8 patients, tumors in 7 patients, and osteomyelitis in 2 patients. Ten patients had skull base erosion, and 5 underwent cranialization for large posterior frontal bone defects. The average blood loss was 175 mL, and the average hospital stay was 3 days. There were no major intraoperative or perioperative complications. Two patients with mucoceles required revision surgery for disease recurrence. The mean follow-up was 25 months (range, 6 to 66 months). CONCLUSIONS: Osteoplastic flap surgery is an uncommon procedure in the modern endoscopic era of sinus surgery. In our series it was most commonly indicated for laterally located disease. Osteoplastic flap surgery is relatively safe and effective for a wide range of recalcitrant and complicated frontal sinus disorders.

Bilateral antrochoanal polyps: possible pathogenesis.

Antrochoanal polyp is a rare, benign solitary mass that arises from maxillary sinus. It exits through sinus ostium, passes across the middle meatus, and reaches into the choana. In general, it represents up to 6% of all nasal polyps. Although it is usually unilateral, in extreme rare cases it could be bilateral.We herein report a case of an 11-year-old girl who presented with bilateral antrochoanal polyps and was managed successfully by endoscopic surgical approach. We also hypothesize a possible pathophysiologic explanation of this rare disease.

Food Elimination in the Management of Refractory Chronic Rhinosinusitis: A Pilot Study.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most commonly reported chronic diseases. Refractory CRS represents a subgroup of patients who continue to be symptomatic even after adequate medical and surgical therapy. These patients started to form a significant portion of patients with CRS. Food elimination as a therapeutic method to control symptoms of different chronic diseases, such as eosinophilic esophagitis, asthma, and atopic dermatitis, has been described in the literature with variable success rates. OBJECTIVES: To evaluate the effectiveness of food elimination therapy as adjuvant treatment in refractory patients having CRS with positive food sensitization. DESIGN: Prospective open-label study. SETTING: Tertiary academic center. METHODS: Consecutive adult patients with refractory nonobstructive CRS (patients who had persistent sinonasal symptoms despite endoscopic sinus surgery and patent sinuses ostia with adequate medical treatment) with positive food sensitization were included. Subjects were asked to eliminate the sensitized food from their diet. Clinical outcome was assessed using the Lund-Kennedy symptom and Lund-Kennedy endoscopic appearance scores. RESULTS: Twenty-two patients were initially enrolled in the study. Six patients were excluded; 4 were lost to follow-up, and 2 did not eliminate the causal food for the required period. The average age of the patients was 36 years old. There were 10 female and 6 male patients. Nasal discharge and facial pressure were the most common presenting symptoms. Shellfish, egg, and meat mix were the most common eliminated foods. There was a significant difference in the patients' Lund-Kennedy symptom and Lund-Kennedy endoscopic appearance scores at 6 and 12 weeks after food elimination therapy. CONCLUSIONS: Food elimination in refractory CRS is an effective adjuvant treatment and should be considered in the treatment algorithm of patients with persistent symptoms after successfully performed sinus surgery.

Wedge-shape Merocel Pack After Functional Endoscopic Sinus Surgery: Our Experience With 697 Patients.

BACKGROUND: Chronic rhinosinusitis (CRS) is a disease characterized by inflammation of the paranasal sinus mucosa for a duration of more than 12 weeks. It is one of the most frequently diagnosed chronic diseases that is encountered in everyday practice with an overall prevalence ranges from 7% to 27. OBJECTIVE: To evaluate our long-term experience using wedge-shape middle meatal Merocel packing after functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). METHODS: charts and electronic records of consecutive adult CRS patients who failed to respond to medical treatment and underwent endoscopic sinus surgery using wedge-shaped middle meatal Merocele packing were retrospectively reviewed. Demographic data, presence and absence of nasal polyps and/or asthma, postoperative bleeding, middle meatal adhesions and/or lateralization, and requirement of adhesiolysis were reviewed. RESULTS: 697 patients (1394 nasal sides) were included. The mean age was 34 years. CRS with nasal polyps was observed in 224 patients (32%) and 185 (27%) had associated asthma. Postoperative pain and discomfort while the pack in place were tolerable and no patient required pre-scheduled pack removal. All packs were removed in the clinic with tolerable discomfort. No major bleeding that required re-packing was seen, but mild oozing or minor bleeding was encountered in some cases which was controlled by small cotton packs soaked with diluted adrenaline. Thirty-four patients (4.9%) had middle meatal adhesions. Right side adhesions were seen in 13 patients (38.2%), left side adhesions in 12 patients (35.3%), and bilateral in 9 patients (26.4%). Significant severe lateralized middle turbinate was observed in 2 cases. No infectious complications related to the pack have happened. CONCLUSION: Wedge-shaped Merocel pack is an effective middle meatal pack after FESS. It is easy to shape, widely available, and economical. It can decrease early postoperative bleeding and also it provides support to the middle turbinate preventing lateralization and adhesions.

Role of dexamethasone in reducing pain after endoscopic sinus surgery in adults: a double-blind prospective randomized trial.

OBJECTIVES: We sought to study postoperative pain after endoscopic sinus surgery and to evaluate the efficacy of dexamethasone sodium phosphate in reducing pain and rescue analgesic requirements. METHODS: In a prospective, double-blind, placebo-controlled clinical trial, 62 patients with chronic rhinosinusitis who were undergoing general anesthesia for endoscopic sinus surgery were randomized to receive either 8 mg (2 mL) of intravenous dexamethasone sodium phosphate or 2 mL of saline solution at the time of induction of anesthesia. After surgery, the patients were observed for 24 hours and were given 1 g of acetaminophen every 6 hours. Pain severity was reported immediately and 6 and 24 hours after surgery on a 10-cm visual analog scale. The need for rescue analgesia with tramadol hydrochloride was recorded and compared between the two groups. RESULTS: The two groups were matched by demographic data, clinical indications, and intraoperative details. The average postoperative pain severity scores at the 3 time intervals were 3.6, 2, and 1 in the dexamethasone group and 3.6, 2.5, and 1.6 in the saline solution group. These differences were not statistically significant. Ten patients in the dexamethasone group required rescue analgesia, compared to 12 in the saline solution group. The average patient required 0.53 doses of rescue analgesic in the dexamethasone group, versus 0.67 doses in the saline solution group. Again, these differences were not statistically significant. CONCLUSIONS: Dexamethasone injection at the time of induction of general anesthesia is not superior to placebo in controlling early postoperative pain in patients who undergo endoscopic sinus surgery.

Acute adult supraglottitis: current management and treatment.

Acute adult supraglottitis can be a serious, life-threatening disease because of its potential for sudden upper airway obstruction. Symptoms and signs of this disease may be nonspecific and may resemble those of upper respiratory tract infection. Unexplained sore throat with tenderness of the anterior neck over the hyoid bone warrant careful examination by flexible laryngoscopy to rule out laryngeal congestion and edema. Laboratory tests are usually not helpful in picking up the diagnosis. Following diagnosis, patients should be hospitalized, started on intravenous antibiotics and their airway closely monitored, as airway obstruction may develop.

Aeroallergen sensitization profile in medically resistant chronic rhinosinusitis.

OBJECTIVES: The aim of this study is to report the aeroallergen sensitization profile in medically resistant chronic rhinosinusitis with or without nasal polyps and its relationship to asthma. METHODS: Retrospective charts review of 402 chronic rhinosinusitis patients who failed to respond to medical treatment and scheduled for surgery at a tertiary academic center was performed. One hundred and fifty-five patients had chronic rhinosinusitis with nasal polyps and 247 patients had chronic rhinosinusitis without nasal polyps, furthermore; the two phenotypes were subdivided according to the presence or absence of asthma. Allergen-specific immunoglobulin E to 24 inhalant allergens was measured to all patients by the enzyme allergo-sorbent test. RESULTS: The average age was 35 years (SD ± 13) with 236 males and 166 females. Two hundred and fifty-three patients (63%) were tested positive for at least one allergen with no significant difference between patients with or without polyp (in chronic rhinosinusitis with nasal polyps, 103 patients (66%) were positive compared with 150 patients (61%) in chronic rhinosinusitis without nasal polyps). There were no significant differences in the prevalence, type, and number of positive allergens between the two phenotypes. The prevalence of asthma was found to be 19% in patients with chronic rhinosinusitis without nasal polyps versus 46% in those with chronic rhinosinusitis with nasal polyps (p = 0.001), and the prevalence of high eosinophils was 27%, and 47% in both phenotypes, respectively (p = 0.0001). CONCLUSIONS: The prevalence of inhalational allergy in medically resistant chronic rhinosinusitis is high, however, this profile does not differ based on the presence of polyp. Patients with chronic rhinosinusitis with nasal polyps had a higher prevalence of asthma and blood eosinophils as compared with chronic rhinosinusitis without nasal polyps. Our results showed a little role of inhalant allergens in nasal polyps or asthma comorbidity in refractory sinusitis patients.

Anesthesia During Functional Endoscopic Sinus Surgery for Kartagener's Syndrome: A Case Report and Literature Review.

INTRODUCTION: Kartagener's syndrome (KS) is a ciliopathic, autosomal recessive disorder characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. The abnormal ciliary structure and function lead to variable clinical manifestations, including dextrocardia, pneumonia, bronchitis, chronic rhinosinusitis, otitis media, reduced fertility in women, and infertility in men. This article reports our experience on general anesthesia with endotracheal intubation during functional endoscopic sinus surgery (FESS) in a patient with KS. CASE PRESENTATION: A 44-year-old man was admitted to our hospital with chronic nasal obstruction, postnasal drip, chronic sinusitis, and chronic non-productive cough for FESS. The patient's heart was on the right side of his chest. A chest roentgenogram and a high-resolution chest and abdomen computed tomography (CT) scan identified dextrocardia, situs inversus, and chronic bronchitis and bronchiectasis involving both lung bases. CT sinuses showed mucosal thickening of bilateral maxillary and ethmoid and sphenoid sinuses. The patient was prescribed oral medications and nasal spray for crepitations and wheezes heard over bilateral lung fields. Intensive chest physiotherapy and supportive care prior to surgery were provided to prevent worsening of lung function. FESS with bilateral frontal polypectomy was performed. All hemodynamic parameters were stable. The emergence from anesthesia was smooth. After ~20 minutes in the post-anesthesia care unit, the patient was fully awake and pain-free. He was then transferred to the surgical intensive care unit and subsequently to the ward. The postoperative period was uneventful. The patient felt subjectively "very well" and was discharged from the hospital on the 2nd postoperative day. CONCLUSION: Anesthesiologists must be aware of cardiopulmonary inversion that could challenge the management of patients with KS. To avoid respiratory depression caused by long-acting systemic opioids, we suggest using short-acting opioids during general anesthesia and for postoperative pain relief.

Assessing effects of modification of middle meatal silastic splint after endoscopic sinus surgery for nasal polyps: A randomized controlled study.

PURPOSE: To investigate the efficacy of middle meatal silastic splint in preventing adhesions after bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP), and to assess nasal symptoms and endoscopic findings in splinted and non-splinted sides. METHODS: After completion of ESS, silicon silastic splints were randomly inserted in the middle meatus of one nasal side, while no stent in the other side (control). The surgeon was blinded to the side selection, and splint insertion until removal after 1 week. Patients were followed -up after 1 week, 1 and 6 months. Each side of the nasal cavity was assessed for adhesions, crusting, pus, pain, nasal obstruction, and nasal discharge by endoscopic examination and visual analogue scale. RESULTS: Forty-nine patients (98 nasal sides) were included. At the 1st week visit, there was no significant difference between the splinted and non-splinted sides for all investigated parameters.After 1- month, adhesions were seen in 10% of the splinted sides, while it was in 26% of the non-splinted sides (P = 0.037).At the 6 -month follow-up visit, the adhesions rate remained 10% in the splinted sides, however the rate increased to 32% in the non-splinted sides (P = 0.007). All other examined parameters remained statistically insignificant between both sides throughout the follow -up visits. CONCLUSIONS: Middle meatal silastic splint is significantly reducing middle meatal adhesions with low complication rate in CRSwNP patients undergoing ESS. Our results support its usage when the middle turbinate is unstable or traumatized during surgery.

The relationship between anatomical variations of the sino-nasal region and chronic sinusitis extension in children.

OBJECTIVE: To report the prevalence of paranasal sinus anatomic variations and their relationship with the extent of chronic sinusitis in pediatric population. METHOD: This is a prospective study of all the cases of persistent pediatric chronic sinusitis despite medical therapy that presented to the otolaryngology clinics of King Abdullah University Hospital in Irbed, Jordan, and had coronal computed tomography examination of the nose and paranasal sinuses as part of their diagnostic or preoperative work up, between the periods of April 2006 and August 2007. Sixty-five cases met inclusion criteria and were analyzed. Cases were further subdivided into three groups according to age. Group 1: with ages from 5 to 7 years; group 2: ages 8-12; and group 3: above 12 years. The scans were analyzed for the presence of anatomical variations, and disease extension. Correlation between anatomical variations and disease extension was the primary outcome measure. RESULTS: There were 30 boys and 35 girls with an average age of 11.4 (age ranges from 5 to 16). The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. Agger nasi cell was the most common anatomical variation, followed by concha bullosa of middle turbinate. The frequency of most of these variants differed widely between groups 1 and 2, groups 1 and 3, but not between groups 2 and 3. No significant correlation was found between these anatomical variants and the extent of chronic sinusitis. CONCLUSION: Anatomical variations in the nose and paranasal sinuses are common in children with chronic sinusitis. Although the prevalence of these variations changes during childhood development they are unlikely to predict the extent and severity of chronic rhinosinusitis in pediatric age group.