Background and objective Anatomical variations of the paranasal sinuses influence sinus drainage and airflow, contributing to chronic rhinosinusitis. This study aimed to assess the prevalence of these variations and their association with sinus infections by using CT findings. Methods A retrospective CT-based analysis of 75 patients (aged 25-70 years) was conducted. Anatomical variations, including nasal septal deviation (NSD), concha bullosa, agger nasi cells, Haller cells, and Onodi cells, were recorded. The association between these variations and affected sinuses was analyzed using the chi-squared test and Fisher's exact test
a p-value <
0.05 was considered statistically significant. Results NSD was the most common anatomical variation, observed in 50 patients (66.6%), followed by hypertrophic ethmoidal bulla in 35 (46.6%), and concha bullosa in 30 (40%). Among the affected sinuses, maxillary sinusitis was the most frequently observed, affecting 60 patients (80%), followed by frontal in 45 (60%), ethmoidal in 30 (40%), and sphenoid sinusitis in eight (10.6%). Significant associations were found between NSD, concha bullosa, and maxillary sinusitis
agger nasi cells with frontal/ethmoid sinusitis
Haller cells with maxillary sinusitis
and Onodi cells with sphenoid sinusitis (p<
0.05). Conclusions Paranasal anatomical variations significantly correlate with sinusitis, emphasizing the importance of preoperative CT evaluation in guiding medical and surgical management. Recognizing these variations enhances diagnostic accuracy and improves surgical outcomes in functional endoscopic sinus surgery (FESS).