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An assessment of sinonasal anatomic variants potentially associated with recurrent acute rhinosinusitis


  • Blake C. Alkire BS,

    1. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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    • Neil Bhattacharyya, MD is a consultant for Sinexus, Inc. and Entellus. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

  • Neil Bhattacharyya MD, FACS

    Corresponding author
    1. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
    2. Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
    • Division of Otolaryngology, 45 Francis St., Boston, MA 02115
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  • The level of evidence is 3B.



To examine sinonasal anatomic variants that may predispose toward recurrent acute rhinosinusitis (RARS).

Study Design:

Retrospective case-control.


Sinus computed tomography (CT) scans from a consecutive series of adult patients meeting strict diagnostic criteria for RARS were retrospectively reviewed. A control group was assembled from patients who underwent pituitary or temporal bone CT for a nonrhinosinusitis indication. CT scans were scored for the presence of Haller cells, concha bullosa, and impinging septal spurs. Maximal septal deviation (degrees), infundibular widths, and Lund staging were also assessed. The prevalence of these anatomic variants was statistically compared between the RARS and control groups.


Thirty-six patients met diagnostic criteria for RARS (mean age, 47.2 years; 2:1 female preponderance); 42 control patients were identified. The mean Lund score for patients with RARS was 2.25 versus 1.27 for the control group (P < .001). Although RARS patients were more likely to manifest concha bullosa (41.7% vs. 28.6%) or impinging septal spurs (27.8% vs. 19.0%), these differences were not statistically significant (P = .165 and P = .260, respectively). However, patients with RARS were significantly more likely to radiographically demonstrate Haller cells (39.9% vs. 11.9%, respectively, P = .006). Finally, patients with RARS had significantly smaller mean infundibular widths when compared with control patients (0.591 mm vs. 0.823 mm, respectively, P < .001).


The presence of Haller cells and smaller infundibular widths were statistically associated with RARS when compared to control patients. Our data suggest that anatomy could play a role in the pathogenesis of RARS. Further prospective study is warranted. Laryngoscope, 2010