xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Orlandi et al.

FIGURE VII-1 Algorithm for the diagnosis of ARS

MT hypertrophy, 329 aerated uncinate process, 329,330 and asymmetry of the ethmoid roof. 330 Collectively, there is very weak evidence that these anatomical structures are a potential cause of ARS. In 2010, Orlandi published a systematic analysis of the association between septal deviation and RS. 332 Over 300 references were initially identified, and 13 articles com prised the basis of the analysis. The review found con flicting results and poorly powered studies. Overall, there appeared to be a small association between septal deviation and the presence of RS, with increasing degree of septal deflection correlating with increasing risk of RS. However, the studies comprising this systematic review did not ade quately differentiate ARS from RARS or CRS. Moreover, a search of the literature since that review, using the terms “septal deviation and acute rhinosinusitis/sinusitis” fails to identify any new studies on this topic. Thus, from the available published evidence, it is not possible to determine the pathophysiologic impact of septal deviation on ARS. No definitive guidance can be provided whether correct ing a septal deviation will result in reduced frequency of ARS episodes.

Since ICAR-RS-2016, several studies have evaluated the effect of anatomy on the specific diagnosis of ARS. A focused study on refractory ARS in 32 patients by Hir shoren et al. found a significant association with nasal septal deviation but no other anatomic variants, including agger nasi cell, infraorbital ethmoid cell, concha bullosa, or paradoxical MT. 331 On the contrary, Autio et al. evalu ated sinus disease progression through a single episode of ARS in 51 patients using cone-beam CT. 305 Patients diag nosed with ARS, including 16% with a history of recurrent maxillary sinusitis, underwent imaging at enrollment, 5 6 days after onset of symptoms, and around the 10 th day of symptoms. They evaluated the prevalence of multiple anatomic variants including, nasal septal deviation, and found no association of culture-proven bacterial ARS with any of these anatomical variations. A 2015 retrospective study that reviewed 192 CT images of patients referred for symptoms of active RS comparing those with minimal vs significant disease on CT imaging also did not find any difference in prevalence of anatomic variants. However, there was no distinction in the subtype of RS. 334 In sum mary, there is conflicting data that ARS is associated with