Computed Tomographic Evaluation of Normal Anatomical Variants of the Paranasal Sinuses in Symptomatic and Asymptomatic Patients

Background: Anatomical variations of the nasal cavity and paranasal sinuses are frequently identified on computed tomography and may influence sinus drainage and the development of sinonasal disease. Their clinical significance, however, remains controversial. The objective is to compare the prevalence and distribution of anatomical variations of the paranasal sinuses between symptomatic and asymptomatic patients and evaluate their association with paranasal sinus and osteomeatal complex involvement. Material and Methods: A prospective comparative cross-sectional study was conducted over 18 months and included 196 participants undergoing computed tomography of the head, comprising 98 symptomatic and 98 asymptomatic patients. Consecutive eligible participants were enrolled. Computed tomography images were obtained using a standardized protocol and independently evaluated by a blinded radiologist for anatomical variations and sinus involvement. Demographic characteristics, clinical symptoms, and radiological findings were recorded. Statistical analysis was performed using descriptive statistics, Student's independent t-test, Chi-square test, and Z-test, with statistical significance set at p < 0.05. Results: Symptomatic patients demonstrated a significantly greater burden of multiple anatomical variations than asymptomatic patients (p = 0.011). Nasal septal deviation, concha bullosa, agger nasi cells, Haller cells, and pneumatized uncinate process were significantly more prevalent among symptomatic patients, whereas paradoxical middle turbinate and Onodi cells showed no significant differences. Maxillary, ethmoid, frontal, sphenoid, and osteomeatal complex involvement were significantly more frequent in symptomatic patients. Concha bullosa was significantly associated with ethmoid sinus disease (p = 0.007), while nasal septal deviation was significantly associated with osteomeatal complex involvement (p = 0.003). Conclusion: Selected anatomical variations are significantly associated with symptomatic sinonasal disease and radiological sinus involvement. Careful evaluation of these variations on computed tomography may assist clinical assessment and preoperative planning for Functional Endoscopic Sinus Surgery, although radiological findings should always be interpreted alongside clinical and endoscopic evaluation. Keywords: Anatomical variations, Paranasal sinuses, Computed tomography, chronic rhinosinusitis, Osteomeatal complex.