Clinician assessment of paranasal sinus pneumatization is correlated with total sinus volume

Int Forum Allergy Rhinol. 2016 Oct;6(10):1088-1093. doi: 10.1002/alr.21779. Epub 2016 May 9.


Background: The Assessment of Pneumatization of the Paranasal Sinuses (APPS) score is a novel and validated instrument for comprehensively evaluating the pneumatization pattern of the sinuses. Previous studies on the relationship between sinus pneumatization and clinical parameters have been hindered by cumbersome volume analysis. The purpose of this study was to determine whether the APPS score correlates with total sinus volume.

Methods: Semiautomated 3-dimensional (3D) volume analysis of 20 consecutive sinus computed tomography (CT) scans was performed. Total paranasal sinus volume (TSV) for each scan was then calculated. Relative total paranasal sinus volume (RTSV) was calculated by dividing TSV by the volume of the right globe. An independent reviewer then scored each CT scan using the APPS instrument. The elapsed time to perform 3D analysis and APPS scoring was recorded for each CT scan.

Results: The APPS score was strongly correlated with TSV by Pearson's correlation coefficient (r = 0.893). The coefficient of determination (r2 ) was 0.797. The APPS score was also strongly correlated with RTSV (r = 0.851, r2 = 0.724). The mean elapsed time of 3D volume analysis for each CT scan was significantly greater than for APPS scoring (1187 vs. 37 seconds, p < 0.001).

Conclusion: The APPS score correlates strongly with both TSV and RTSV. Evaluation of paranasal sinus pneumatization by APPS score is also significantly faster than a semiautomated method for 3D volumes. The APPS instrument can be used to study large populations for relationships between clinical parameters and sinus volume.

Keywords: 3-dimensional; computed tomography; paranasal sinuses; pneumatization; sinus volume.

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Paranasal Sinuses / anatomy & histology*
  • Paranasal Sinuses / diagnostic imaging
  • Tomography, X-Ray Computed