0:01

I mentioned the findings of acute sinusitis previously

0:04

where we have air fluid levels

0:07

Or Bubbly secretions or increased density to the sinus

0:12

Air, As well as new findings on a current study

0:17

that were not present on a previous study.

0:19

And ultimately concluded that the best way

0:21

to make the diagnosis

0:22

of acute sinusitis really is a clinical evaluation and

0:26

or with endoscopy.

0:28

Chronic Sinusitis is something that is quite

0:32

Often Imaged as in our life as a neuroradiologist.

0:36

We see a lot of facial CT scans

0:38

or sinus cts for chronic sinusitis when the patient's being

0:42

evaluated for potential functional endoscopic sinus surgery.

0:46

What are the findings that define chronic sinusitis? Well,

0:49

It's usually muco

0:51

Periosteal thickening

0:52

or retention cysts within the sinus,

0:55

which may often be totally asymptomatic, polypoid,

0:59

mucosal thickening or

1:00

Polyps. We

1:01

May see chronic

1:03

Osteitis with thickening of the bone and the walls of the

1:06

Perinasal sciences or Even bone remodeling.

1:09

Now, I do wanna point out one thing,

1:11

and that is that there is a natural

1:15

Variation in the

1:17

Mucosal thickening from right to left in

1:20

Patients who are asymptomatic,

1:22

And that's just the normal variation.

1:24

This is what's known as the nasal cycle,

1:26

and again, my colleague and great friend

1:28

Jim Zrich, defined this very well early

1:30

In the 1980s.

1:32

I'm gonna do something for you

1:33

and that I'm gonna show you the nasal cycle for

1:36

Dave Uum. If

1:37

I obstruct my right nostril

1:40

and breathe through my left nostril

1:43

and then obstruct my left nostril

1:45

and breathe through my right nostril, you can probably hear

1:49

that the left side is more wide open than the right

1:53

side that is natural.

1:55

And in point of fact, what Jim showed was

1:58

that there is a cyclic change from right to left,

2:02

which varies in patients from 90 minutes to six hours,

2:05

where one side passively congests

2:09

and the other side decongest, and then they switch back

2:13

and forth in this right to left difference known

2:16

as the nasal cycle.

2:17

This occurs in your ethmoid sinuses

2:21

and in your nasal cavity.

2:22

And that is normal mucosal, passive congestion

2:25

and decongestion known as the nasal cycle.

2:28

So at the end of this presentation, I'm going to check

2:32

and see whether I flip from right to left,

2:34

because right now my left side's doing most of the work.

2:37

It's wide open as opposed to the right side,

2:41

which you can see is more congested,

2:43

potentially just the normal nasal cycle.

2:46

And that's why when you see one to two millimeters

2:49

of mucosal thickening in the maxillary science

2:52

or OID size, I don't make very much of it.

2:55

I think it might just be a manifestation of the normal nasal

2:58

Cycle.

3:00

When we talk about chronic sinusitis,

3:02

we wanna talk about the degree

3:04

to which there is mucosal thickening

3:06

or a ification of the paranasal sciences.

3:09

Which sinuses are involved? What's the type?

3:12

Is it just smooth? Is it polypoid?

3:15

And whether or not there's any complications

3:16

of chronic sinusitis, which include things like mucus seals

3:20

where you have an obstructive sinus

3:22

and backup of that sinus.

3:25

One of the staging classifications

3:28

that was originally described is what's known

3:30

as the lung mackay staging of sinus disease.

3:34

This is really pretty gross from the standpoint

3:39

of the degree of sinus inflammation.

3:42

It defines each of the sinuses that you just see here,

3:45

the frontal, the anterior ethmoid, the posterior ethmoid,

3:48

the sphenoid, the maxillary, and the complex in terms

3:50

of a three point system.

3:53

Zero is clear, one is partial classification,

3:56

and two is total classification.

3:59

I don't like this classification.

4:01

I use it in some research projects that I have.

4:04

But the problem is that if you just see seven millimeters

4:08

of mucosal thickening in the maxillary antrum,

4:12

that would be described as one partial O classification.

4:15

Whereas if you see three fourths

4:17

of the maxillary science opacified, it still is classified

4:21

as a one because it's not total and it's not clear.

4:25

So the one variation can be quite striking

4:28

between a little bit of mucosal thickening versus

4:31

nearly completely opacified.

4:34

So I don't think it's a great staging classification,

4:36

but it is what you can sometimes see in the literature

4:40

when I'm describing the sinus disease.

4:42

I will use the terms near complete opacification,

4:46

complete opacification or partial opacification

4:49

or minimal mucosal thickening or trivial mucosal thickening.

4:54

Sometimes when I think it's just part of the nasal cycle.

4:57

So those are the terms that I'm usually using.

4:59

Uh, trivial, minimal, moderate, near complete opacification,

5:04

total opacification of the paranasal sciences.

5:07

Understanding this is a

5:11

classification scheme that has not been validated or,

5:15

or used widely, uh, throughout the Cy Nasal community.