Published: 2017-04-26

Radiological significance of isolated ethmoid sinus infections in asymptomatic patients of recurrent acute rhinosinusitis

Niranjan Sahu, Satya Sundar G. Mohapatra, Siba N. Rath, Rabindra N. Padhy


Background: Recurrent acute rhinosinusitis (RARS) being a low form chronic rhinosinusitis (CRS), is relatively under diagnosed many times because of lack of awareness regarding pattern of the disease presentation. Aim of the study is to evaluate the radiological significance of isolated ethmoid sinusitis in patients of RARS during the asymptomatic interval in between acute episodes of rhinosinusitis.

Methods: Total 124 patients with history suggestive of RARS who had undergone computed tomography study of brain during April 2015 to October 2016 for indications other than sinonasal diseases, were evaluated for isolated ethmoid sinusitis in the department of Radiology. Patients having any inflammatory or expansile sinonasal masses were excluded.

Results: Of total 124 patients of RARS aged from 18 to 70 years (mean age of 38.6 years), the study population included only seventy-two (58%) patients having isolated ethmoid sinus infections, were classified in to mild unilateral group I (46%) cases with grade I or II sinus infections and relatively severe bilateral group II (54%) cases having grade III or IV infections. Infective process involving two to three ethmoid cells each on either side is the most common variety encountered in 39% cases. Prevalence of infective process was fairly equal among all age groups. Statistical correlation between the severity of RARS in patients having group II variety of isolated ethmoid sinus infections was found highly significant.

Conclusions: Isolated ethmoid sinus infections are commonly encountered CT findings in adult RARS patients while they are asymptomatic from acute episodes of rhinosinusitis.


Asymptomatic, Isolated ethmoid sinus infections, Recurrent acute rhinosinusitis

Full Text:



Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. Clinical Practice Guideline (Update): Adult Sinusitis Executive Summary. Otolaryngology– Head and Neck Surgery. 2015;152(4):598-609.

Bhattacharyya N, Lee KH. Chronic recurrent rhinosinusitis: disease severity and clinical characterization. Laryngoscope. 2005;115:306-10.

Eichel B. Ethmoiditis: pathophysiology and medical management. Otolaryngol Clin North Am. 1985;18:43-53.

Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis 4 and nasal polyps 2012. Rhinology Suppl. 2012;23:1-298.

Stammberger H. Endoscopic endonasal surgery-concepts in treatment of recurring rhinosinusitis. I. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg. 1986;94(2):143-6.

Bhattacharyya N, Grebner, J, Martinson N G. Recurrent Acute Rhinosinusitis: Epidemiology and Health Care Cost Burden. Otolaryngology – Head and Neck Surgery. 2012;146(2):307-12.

Diament MJ, Senac MO, Gilsanz U, Baker S, Gillespie T, Larsson S. Prevalence of incidental paranasal sinus opacification in pediatric patients: a CT study. J Comput Assist Tomogr. 1987;11:426-31.

Kaszuba SM, Stewart MG. Medical management and diagnosis of chronic rhinosinusitis: a survey of treatment patterns by United States otolaryngologists. Am J Rhinol. 2006;20(2):186-90.

Bhattacharyya N, Fried MP. The accuracy of computed tomography in the diagnosis of chronic rhinosinusitis. Laryngoscope. 2003;113(1):125-9.

Buljcik-Cupic MM, Savovic SN. Endonasal endoscopy and computerized tomography in diagnosis of the middle nasal meatus pathology. Med Pregl. 2007;60(7-8):327-32.

Arango P, Kountakis SE. Significance of computed tomography pathology in chronic rhinosinusitis. Laryngoscope. 2001;10:1779-82.

Rosenfeld RM, Andes D, Bhattacharyya N. Clinical Practice Guideline: Adult Sinusitis Executive Summary. Otolaryngol Head Neck Surg. 2007;137:1-31.