Why ENT Surgeons Must Review Sinus CT Scans — Not Just the Report

Australia has one of the most accessible and high-quality radiology ecosystems in the world. In NSW in particular, a competitive private imaging market has delivered rapid access, excellent technology, and broad geographic coverage. For patients, this is a clear strength.

For clinicians, however, it has introduced a growing problem:

fragmentation of imaging care and over-reliance on radiology reports

These two issues intersect in a way that directly affects how we diagnose and manage sinus disease.

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The Core Principle: Look at the Scan

In rhinology, one principle remains fundamental:

Always review the images—not just the report

Radiology reports almost never conclude that the sinuses are “normal.” Instead, they frequently describe:

• mucosal thickening
• partial opacification
• retention cysts
• “features of sinusitis”

For non-specialists—and for patients reading their own reports—this language implies disease. But in many cases, it does not reflect clinically meaningful pathology.

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What Does “Normal” Actually Look Like?

We addressed this directly in our systematic review of sinus imaging in asymptomatic populations.

Across 16,966 individuals with no sinus symptoms, the findings were clear (1):

• Mean Lund-Mackay score: 2.24
• ~15% had a score ≥4
• 13% had mucous retention cysts
• 17.7% had mucosal thickening ≥2 mm

The implication is straightforward:

Incidental sinus findings are common—and often normal

This is a critical point for both clinicians and patients. CT imaging is highly sensitive, but it does not distinguish between physiological variation and disease.

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The Clinical Disconnect

Radiologists are doing exactly what they should—describing structural findings.

But sinus disease is not defined by imaging alone.

It requires:

• symptoms (nasal obstruction, discharge, smell loss, etc.)
• objective findings (endoscopy ± imaging)
• clinical context

Without this, imaging findings risk being over-interpreted.

This leads to a familiar pattern:

• patients labelled with “sinusitis” based on imaging
• antibiotics prescribed unnecessarily
• referrals driven by reports rather than symptoms
• persistent confusion when treatment fails

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Why Reviewing the Images Matters

A written report cannot fully capture:

• distribution of disease (localised vs diffuse)
• anatomical variation
• surgical relevance
• correlation with symptoms

When you review the scan yourself, you can distinguish between:

• incidental change → common, non-contributory
• clinically relevant disease → requiring treatment

For example:

• mild maxillary mucosal thickening in an asymptomatic patient → likely normal
• diffuse ethmoid disease with anosmia → clinically significant

This level of interpretation cannot be outsourced.

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A New Problem: Fragmentation of Imaging Access

At the same time, accessing imaging has become more difficult.

Despite improved availability, we now face:

• multiple radiology providers
• separate portals for each group
• different usernames, passwords, and 2FA systems
• locked accounts from failed logins
• difficulty accessing prior imaging across providers

The result is paradoxical:

More imaging—but less usable continuity

For surgeons, this affects:

• comparison over time
• surgical planning
• confidence in decision-making

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A Practical Solution: A Central Access Resource

To address this, I have created this page as a practical tool for ENT surgeons and referrers.

Instead of searching for individual radiology portals each time, you can:

• select your state
• choose the radiology provider
• access the image portal directly

👉 Bookmark this page and use it as a central access point.

This is a simple step—but one that can significantly reduce friction in daily clinical practice. Message me if there is update or correction required.

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For Patients: Bring the Images

Patients should be encouraged to:

• bring their imaging (USB or digital access)
• use consistent providers where possible
• understand that reports may not reflect disease

A report is helpful—but it is not definitive.

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Listen to the Evidence

For a deeper discussion of incidental sinus findings and their clinical implications, you can listen to our podcast

OTO: Sinus Radiological Findings in General Asymptomatic Populations: A Systematic Review of Incidental Mucosal Changes

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