Chronic rhinosinusitis is a prevalent condition characterized by inflammation of the nasal and paranasal sinus cavities, significantly impacting quality of life and healthcare utilization. Computed tomography imaging is vital in assessing anatomical variations that may contribute to chronic rhinosinusitis pathogenesis. This study aimed to identify anatomical variations in the nasal cavities and paranasal sinuses using CT imaging and explore their relationship with sinus mucosal abnormalities. 154 chronic rhinosinusitis patients were recruited. The study revealed a high prevalence of anatomical variations, with deviated nasal septum being the most common (71.4%), followed by Agger nasi cell (66.2%), spur formation (51.3%), ICA into the sphenoid sinus (44.8%) and Concha bullosa (34.4%). Most anatomical variations are commonly found on both sides. Significant correlations were found between some variations and sinusitis involvement on the same side. However, no significant correlations were observed between angles of septal deviation and CRS incidence. These findings underscore the importance of recognizing anatomical variations in CRS management to mitigate risks and improve treatment outcomes. Further research, including a comparison group of patients without CRS, would provide a comprehensive understanding of the anatomical variations observed in the study.