Correlation between clinical Features and imaging findings in pediatric patients with Rhinosinusitis: A tertiary care hospital based study

Background: Rhinosinusitis (RS) is a common disease in children that is sometimes overlooked. . Pediatric sinusitis is a potential common end point of many predisposing conditions rather than a distinct clinical identity. It is a problem of mucosal defense rather than an anatomic obstruction in large majority of cases5.The current study is undertaken to study the correlation between clinical features and imaging findings in pediatric patients with Rhinosinusitis. Aims and objectives: To identify clinical signs and symptoms in patients of pediatric sinusitis.Radiological evaluation of recurrent and chronic sinusitis in pediatric age group and to find the relationship between clinical signs and symptoms with imaging finding in chronic and recurrent sinusitis. Materiel and methods: The study was conducted for a period of 20 months, between Feb 2013 and sep 2014 in the department of Pediatrics, G.B Pant Hospital GMC Srinagar. Patients included were in age group of 3-15 years with symptoms of chronic paranasal sinus disease. After a detailed history and thorough clinical examination they were subjected to radiological imaging, X-Ray paranasal sinuses, adenoid X-Ray and CT scan nose and paranasal sinuses (axial and coronal sections). Results: Most common complaint in this study was nasal obstruction 38 (93%), followed by nasal discharge 34 (83%), and PND 17 (41%) while as other symptoms like sleep disorder was seen in 14 (34%), recurrent sore throat in 10 (24%) of patients, headache in 8 (19%), cough in 9 (22%) of patients. History of allergy was present in 15 (36%) of patients. Nasal Septum was deviated in 41% of patients. Turbinates were hypertrophied in 70% of patient. 11 (27%) had middle meatal discharge. Only 7 (17%) patients had Otitis Media. It was found that 14 (34%) of antra were radiologically clear, 27 (66%) had disease on plain X-rays. Sensitivity of X-ray is 66%.The most common sinus involved on X-ray was maxillary sinus 25 (61%) of cases. Out of 41 patients of CRS 6 (15%) had normal CT findings while as disease was confirmed in 35 (85%) of patients. Sensitivity of CT is 85%. Maxillary sinus followed by ethmoid sinus were more commonly involved. Hence, there is a significant correlation of clinical sinusitis with CT Nose and PNS. Conclusion: Nasal obstruction is most common symptom followed by nasal discharge.Recurrent sore throat, fetid breath, PND, and sleep disorder are other presenting symptoms.Non-obstructive DNS is an incidental finding in 41% of patients, Turbinates were hypertrophied in 70% of patients, 11 (27%) had middle meatal discharge. Sensitivity of X-ray is 66%.X-ray for adenoids showed adenoid hypertrophy in 18 (44%) and normal in 23 (56%) of patients.Out of 41 patients of CRS, 6 (15%) had normal CT findings while as in 35 (85%) patients had sinus pathology on CT. Sensitivity of CT is 85%.There is a significant correlation of clinical sinusitis with CT Nose and PNS. It has not significant correlation with X-ray findings.6 (15%) of patients had LM scoring 0 – 5 with no disease on CT while adopting cut off 5 to represent true disease.