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Role of Concha Bullosa in Etiopathogenesis of Chronic

Rhinosinusitis: A Clinical Study
Sumit Prinja1, Jailal Davessar2, Gurbax Singh3, Latika Kansal4, Jasmine Kaur4

bullosa was reported by various studies.1 concha bullosa may

ABSTRACT block area of middle meatus by mucosal contact.2 It is a possible
Introduction: Chronic rhinosinusitis is diagnosed by surgeons factor in recurrent sinusitis due to negative influence on sinus
mainly based on clinical presentation. Pneumatisation of the ventilation.3 Aim of our study was to find the association of
middle turbinate is a common anatomical variant, usually referred concha bullosa and chronic rhinosinusitis and to study relation
to as a concha bullosa. There are studies in the literature suggesting of concha bullosa and maxillary,ethmoid,frontal sinusitis.
that concha bullosa may have a role in sinusitis etiology. Aim
of our study was to find the association of concha bullosa and MATERIAL AND METHODS
chronic rhinosinusitis. This prospective study was conducted at the Department of
Material and Methods: Our study included 50 patients who Otorhinolaryngology, G.G.S. Medical college, faridkot. Total
were diagnosed to have chronic rhinosinusitis clinically [>2major
50 patients were enrolled presenting to our OPD with chronic
symptoms or 1major symptom with >1 minor symptoms] after
rhinosinusitis from dec 2013 to dec 2016. Well informed written
detailed history taking. Non contrast (coronal and axial) CT
scans were obtained for all patients. Patients of study group who
consent was sought. A thorough clinical examination was done,
underwent functional endoscopic sinus surgery for correction of all patients were investigated for routine hematological and
anatomical variants were followed up for a minimum of 1 month serum investigations.
and their improvement was assessed. Nasal endoscopy and CT Scan (after a course of antibiotics and
Results: Our study showed higher incidence of concha bullosa decongestants) were performed in all cases.It is recommended
in the age group 21 to 30 years of age. There is a predominance that either a CT scan or endoscopic evaluation of nose
of concha bullosa in Chronic Rhinosinusitis patients. The “p” provides majority of objective data used to diagnose chronic
value of <.05 signifies that the relation between Concha Bullosa rhinosinusitis.4-8
and Chronic Rhniosinusitis is significant. Our study showed a
statistically significant association between presence of concha The inclusion criteria
bullosa and maxillary sinusitis with a p value of 0.00002. 1. Patients of age more than 10 years,
Conclusion: The relation between Concha Bullosa and Chronic 2. 12 weeks or more of signs and symptoms of chronic
Rhniosinusitis is significant. In our study 35 patients had concha rhinisinositis with 2 major factors or 1 major and >1minor
bullosa out of 50 patients of chronic rhinosinusitis. factors

Keywords: Concha Bullosa, Chronic Rhniosinusitis, Maxillary The exclusion criteria

Sinusitis 1. Patients with acute sinusitis
2. Patients with complications of sinusitis
The 1997 Task Force on Rhinosinusitis of the American Academy
INTRODUCTION of Otolaryngology–Head and Neck Surgery recommended
diagnosing rhinosinusitis based on major and minor criteria.
Rhinosinusitis refers to a group of diseases, mainly inflammatory
and infectious, which affect the mucosa of paranasal sinuses. Major factors
Factors involved include host and environmental such as Headache
allergens, air pollutants, viruses. Host factors include congenital Nasal obstruction
conditions, hyperactive airway disease, Anatomic abnormalities Nasal discharge
Post nasal drip
and Systemic diseases. Pneumatisation of the middle turbinate
Smell disturbances
is a common anatomical variant, usually referred to as a concha
bullosa. These variants could shift and compress the osteomeatal Minor factors
complex, obstructing the paranasal sinuses drainage pathway Fever
and causing chronic rhinosinusitis. There are studies in the Halitosis
literature suggesting that concha bullosa may have a role in
sinusitis etiology. Even a nondiseased concha bullosa may 1
Assistant Professor, 2Professor and Head, 3Associate Professor,
cause critical obstruction in the presence of otherwise normally Department of E.N.T, 4Post Graduate Student, G.G.S. Medical College
sized anterior ethmoid. We carried out a prospective study at our and Hospital, Faridkot, Punjab, India
Department to document the incidence of concha bullosa and its
correlation with pathogenesis of paranasal sinus inflammatory Corresponding author: Dr. Sumit Prinja, Department of E.N.T, G.G.S
disease. The concha bullosa is a classic example of the potential Medical College, Faridkot, India
of an anatomical variation to predispose to sinus disease. A How to cite this article: Sumit Prinja, Jailal Davessar, Gurbax Singh,
concha bullosa by itself does not represent a disease state per Latika Kansal, Jasmine Kaur. Role of concha bullosa in etiopathogenesis
se, but it predisposes the patient to develop rhinosinusitis more of chronic rhinosinusitis: a clinical study. International Journal of
readily and more frequently. A 14%-53.6% frequency of concha Contemporary Medical Research 2017;4(3):774-776.

774
International Journal of Contemporary Medical Research
Volume 4 | Issue 3 | March 2017 | ICV (2015): 77.83 | ISSN (Online): 2393-915X; (Print): 2454-7379
Prinja, et al. Concha Bullosa in Etiopathogenesis of Chronic Rhinosinusitis

Fatigue and 57.7% patients without concha bullosa.

Dental pain H. Halis Unlu et al13 in his study found that 38.1% had mucosal
Cough changes in maxillary sinus.
Our study included 50 patients who were diagnosed to have No significant association was noted between frontal sinusitis
chronic rhinosinusitis clinically [>2major symptoms or and concha bullosa (table-3). Our study showed a statistically
1major symptom with >1 minor symptoms] after detailed non significant association between presence of concha bullosa
history taking. Non contrast (coronal and axial) CT scans were and ethmoid sinusitis (table-4).
obtained for all patients. Patients of study group who underwent
CONCLUSION
functional endoscopic sinus surgery for correction of anatomical
variants were followed up for a minimum of 1 month and their Pneumatisation of the middle turbinate is a common anatomical
improvement was assessed. variant, usually referred to as a concha bullosa. We have
made an attempt to study the relationship of concha bullosa
STATISTICAL ANALYSIS with chronic rhinosinusitis. Our study showed a statistically
The collected data were evaluated, analysed and the statistical significant association between presence of concha bullosa and
tests used were mean and chi-square test at a 5% level of chronic rhinosinusitis.
significance. The “p” value was calculated which denotes the Our study showed a statistically significant association between
probability that the difference between two samples occurred presence of concha bullosa and maxillary sinusitis, statistically
by chance. The “p‟ value less than 0.05 is considered to
be statistically significant. This indicate that the difference Age group in Patients with Patients Total
occurred by chance has a probability of 5% or in other words, years CRS and with CRS
the examiner can be 95% sure that the difference is not by Concha and Without
chance. Concha
11-20 4 2 6
RESULTS
21-30 14 6 20
Out of 50 patients 22 were male and out of 22 male patients of 31-40 12 6 18
CRS 12 (54.6%) had concha bullosa. remaining 28 were female 41-50 3 1 4
and 15 (53.5%) female patients with CRS had concha. 51-60 2 0 2
There is a predominance of concha bullosa in Chronic >60 0 0 0
Rhinosinusitis patients. The “p” value of <.05 signifies that the Total 35 15 50
relation between Concha Bullosa and Chronic Rhniosinusitis is Table-1: Age Distribution of study population
significant.
Significant association was present between maxillary sinusitis Maxillary Maxillary Total
and Concha bullosa. sinusitis sinusitis
DISCUSSION present absent
Concha Present 33 2 35
Chronic rhinosinusitis is diagnosed by surgeons mainly based Concha Absent 6 9 15
on clinical presentation. CT scan is considered as the gold Total 39 11 50
standard investigation for evaluation of these patients. Chi-square = 18.032, p value: 0.00002, Significant
In our study the incidence of concha bullosa among female Table-2: Association between Concha bullosa and maxillary sinus-
patients was higher. A similar pattern was reported in several itis (on the same side as concha) in the study group
other studies.3,4
Our study showed higher incidence of concha bullosa in the age Frontal Frontal Total
group 21 to 30 years of age (table-1). Total 14 (40%) of 35 cases sinusitis sinusitis
were in this age (table-1). The mean age of patients with concha present absent
bullosa was 33 years. In a study done by Hatice Gul Hatipoglu, Concha Present 20 15 35
Mehmet Ali cetin Enis Yuksel9 the mean age of patients was 30 Concha Absent 8 7 15
years. Total 28 22 50
There is a predominance of concha bullosa in Chronic Chi-square =.06, p value: 0.8, nonsignificant
Rhinosinusitis patients in our study. Table-3: Association between Concha bullosa and frontal sinusitis
Stammberger10 et al state that pneumatization process apparently sinusitis in the study population
begins in middle age in some patients when there may be a
renewed spurt of growth activity. Ethmoid Ethmoid Total
Our study showed a statistically significant association between sinusitis sinusitis
presence of concha bullosa and maxillary sinusitis with a p present absent
value of <.05 (table-2). Concha Present 11 24 35
Maru11 et al showed an association between sinusitis and concha Concha Absent 7 8 12
bullosa in his studies especially with pnuematization involving Total 18 32 50
anterior end of middle turbinate. Chi-square = 1.05, p value: 0.303, non significant
Mohammad-Reda et al12 in his study showed inflammatory Table-4: Association between Concha bullosa and ethmoid
disease of the sinuses in 71.7% patients with concha bullosa sinusitis.

International Journal of Contemporary Medical Research 775

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV (2015): 77.83 | Volume 4 | Issue 3 | March 2017
Prinja, et al. Concha Bullosa in Etiopathogenesis of Chronic Rhinosinusitis

non significant association between presence of concha bullosa

and ethmoid sinusitis and no significant association was noted
between presence of concha bullosa with frontal sinusitis.
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Source of Support: Nil; Conflict of Interest: None

Submitted: 01-03-2017; Accepted: 06-04-2017; Published: 15-04-2017

776
International Journal of Contemporary Medical Research
Volume 4 | Issue 3 | March 2017 | ICV (2015): 77.83 | ISSN (Online): 2393-915X; (Print): 2454-7379