Endoscopic Assessment of the Nasal Anatomical Variations among Adult Patients with Chronic Rhinosinusitis in Dar es Salaam, Tanzania

Abstract

Background: Chronic rhinosinusitis (CRS) tends to affect people of all ages. Diagnosis of CRS in resource-limited settings relies mainly on detailed clinical evaluation without nasal endoscopy and CT scans, which are mainly inevitable in the management of such patients. Data on endoscopic nasal anatomical variations among adult patients with CRS are scarce.
Methods: A prospective hospital-based study was conducted at a private hospital from January to December 2022 in Dar es Salaam. Cases were diagnosed to have CRS according to the Task Force criteria, while controls were individuals who attended outpatient clinics due to otological or laryngological complaints and had no symptoms of CRS. Cases and controls were matched in a 1:1 ratio. The rule of standard pass on each side was adhered to endoscopically. Data was analysed using the Statistical Package for Social Sciences version 23.
Results: A total of 120 patients with CRS and an equal number of controls were recruited. Patients and controls were equally aged between 18 and 70 years. Male patients predominated, 70 (58.3%), while female patients were 50 (41.7%), and the male-to-female ratio was 1.4:1. Among controls, males predominated, 68 (56.7%), while females were 52 (43.3%), and the male-to-female ratio was 1.3:1. Endoscopic nasal anatomical variations were found in 107 (89.2%) patients. Nasal septal deviation/nasal spur was the predominant anatomical variant in 51 (42.5%) patients, followed by concha bullosa in 27 (22.5%), a paradoxically curved middle turbinate in 22 (18.3%), and the least anatomical variant was a large bulla ethmoidalis, 7 (5.8%). Of the 120 controls, only 5 (4.2%) participants had endoscopic nasal anatomical variations, and 4 (3.3%) controls had septal deviation/spur, whereas 1 (0.8%) participant had a paradoxically curved middle turbinate. Regarding laterality of the observed endoscopic nasal anatomical variations, the majority of the variations had unilateral presentation, such as septal deviation (90.2% being unilateral), concha bullosa (81.5% being unilateral), and a paradoxically curved middle turbinate being unilateral in 77.3% of patients. Chronic rhinosinusitis was found to be significantly associated with septal deviation (P=.001), concha bullosa (P=.001) and a paradoxically curved middle turbinate (P=.001), while there was no significant association between CRS and large bulla ethmoidalis (P=.1).
Conclusion: Septal deviation/spur was the commonest nasal anatomical variant, 51(42.5%) and the least anatomical variant was a large bulla ethmoidalis 7(5.8%). Chronic rhinosinusitis was found to be significantly associated with septal deviation (P=.001), concha bullosa (P=.001) and a paradoxically curved middle turbinate (P=.001), and there was no significant association between CRS and large bulla ethmoidalis (P=.1).