Background: Recurrent acute rhinosinusitis (RARS) being a low form chronic rhinosinusitis (CRS), is relatively under diagnosed many times because of lack of awareness regarding pattern of the disease presentation. Aim of the study is to evaluate the radiological significance of isolated ethmoid sinusitis in patients of RARS during the asymptomatic interval in between acute episodes of rhinosinusitis.Methods: Total 124 patients with history suggestive of RARS who had undergone computed tomography study of brain during April 2015 to October 2016 for indications other than sinonasal diseases, were evaluated for isolated ethmoid sinusitis in the department of Radiology. Patients having any inflammatory or expansile sinonasal masses were excluded.Results: Of total 124 patients of RARS aged from 18 to 70 years (mean age of 38.6 years), the study population included only seventy-two (58%) patients having isolated ethmoid sinus infections, were classified in to mild unilateral group I (46%) cases with grade I or II sinus infections and relatively severe bilateral group II (54%) cases having grade III or IV infections. Infective process involving two to three ethmoid cells each on either side is the most common variety encountered in 39% cases. Prevalence of infective process was fairly equal among all age groups. Statistical correlation between the severity of RARS in patients having group II variety of isolated ethmoid sinus infections was found highly significant.Conclusions: Isolated ethmoid sinus infections are commonly encountered CT findings in adult RARS patients while they are asymptomatic from acute episodes of rhinosinusitis.

Background: Scrub typhus or rickettsia, a zoonotic infection occurs due to the transmission of Gram-negative bacteria, Orientia tsutsugamushi and/or Tsutsugamushi sp. by the larval stage of the trombiculid mite, Leptotrombidium deliense. Infections at endothelial cells and phagocytes manifest clinically as vasculitis with an acute onset of fever, rashes, headache, myalgia, multiple organ dysfunction, eschar, respiratory morbidity, meningioencephalitis and sepsis syndrome on skin, whose severity varying with patients. Herein obtained data is used for evaluating the dependability of two determinative tests.Methods: The prospective survey with 80 rickettsia patients was carried during the last 6 months of 2016. Patients with the occurrence of fever for more than two days and a clinical suspicion of rickettsia infection were promoted for Weil-Felix as well as, ELISA tests.Results: The prevalence of rickettsia in the population of 80 patients was 17.5, and the sensitivity (the portion of the people with the rickettsia infection who will have positive Weil-Felix test results) value was 0.7143 and specificity (the people without the disease who will have negative Weil-Felix test results) value was 0.9697. Probability of Weil Felix test positive was 0.15, and probability of ELISA test positive was 0.175.Conclusions: The dependability of each test independently or a posteriori probability was 0.857. Both tests are dependable for correctness of outcomes being 0.857 or 85.7%, in combination; a high specificity value of Weil Felix test is a valuable test.

Background: Recurrent acute rhinosinusitis (RARS), a low form chronic rhinosinusitis is frequently under evaluated. The significance of sinonasal anatomical variants of osteomeatal complex (OMC) and spheno-ethmoidal (SE) recess regions in patients of RARS is assessed.Methods: Retrospective analysis of coronal sinonasal computed tomography images of 120 RARS patients presented with sinonasal anatomical variants during November 2013 to October 2016 was carried out. Patients with acute and expansile sinonasal lesions are excluded.Results: Sinonasal anatomical variants in the regions of OMC and SE recess are responsible for obstruction of normal mucociliary drainage of corresponding paranasal sinuses in presence of inflammation predisposing to RARS. Anatomical variants of nasal septum were, deviated nasal septum (DNS) in 86 (72%) and septal spur in 58 (48%) patients. Anatomical variants in OMC region were, pneumatized middle turbinate (concha bullosa) in 50 (48%), paradoxical middle turbinate in 38 (28%), giant ethmoid bulla in 35 (32%), agger nasi cell in 29 (38%), Haller cell in 23 (15%), pneumatised uncinate process in 20 (18%), medialized uncinate process in 18 (22%) and septated maxillary sinus in 5 (4%) patients. Anatomical variants in SE recess were superior concha bullosa in 14 (12%) and septal bullosa in 11 (9%) patients.Conclusions: OMC pattern of recurrent rhinosinusitis is often prevalent in patients of RARS due to abundance of anatomical variants in the OMC region. DNS or ethmoid bulla when gets associated with concha bullosa increased the incidence of RARS. Present analysis would help surgeons to evaluate RARS patients for selective endoscopic sinus surgery.