Chronic rhinusinusitis can be diagnosed on the basis of its classical symptoms such as nasal obstruction, facial pains, postnasal drip and hyposmia, supported by endoscopic findings such as oedema of middle meatus, mucopus and polyps. However, CT scan findings are an important adjunct, especially in the absence of polyps and in particular to differentiate from allergic rhinitis. Conventional CT scans require a second visit for the investigation and a third for consultation and decision on management. Cone beam CT scans (CBCT) which use a cone shaped X-ray beam and two-dimensional detectors can be performed the same day, thus allowing management decision in the patients’ first visit to the hospital. Of the 355 CBCT scans done, 306 were performed on the same day. Of these, 97 patients were discharged, 138 listed for surgery and the remaining 120 patients were advised biologic treatment. The authors support the use of CBCT on the basis of its lower cost, facilitation of one-stop rhinology clinic and allowing follow-up slots for new patients. Issues relating to this technique have been discussed. Of these, poorer image quality in CBCT is one factor but this did not result in any surgical problem in the 138 cases operated, and was considered sufficient for management. Supporting follow-up report by radiologists provided additional safety. The authors also carried out a survey by telephone and email to many other hospitals, resulting in 186 responses. A vast majority (86.5%) did not use CBCT. The barriers were lack of awareness, bureaucracy, image quality, time pressure on the clinician, medicolegal worries, extra time needed by the patient and availability of the scanner. CBCT seem to be a reliable alternative to conventional CT scans on their own merit.
Can ‘cone beam CT scan’ (CBCT) facilitate one-stop rhinology clinic?
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