Although it remains unclear if HRCT or LDCT play a role, clinical features may stratify patients for appropriate imaging evaluation in order to balance diagnostic yield and dose considerations. CT Maxillofacial CT of the sinuses and maxillofacial structures offers improved visualization of the sinonasal anatomy, allowing for localization, characterization, and grading of sinonasal pathology. UACS is largely a conglomerate terminology for cough related to inflammation or irritation of the upper airways, which includes postnasal drip, allergic and nonallergic CRS, as well as laryngeal reflux. UACS is considered one of the more common causes of chronic cough [1,53]. Based on a few case series of patients with chronic cough, UACS/rhinitis prevalence ranged from 6% to 65% [2,7,17]. Guidelines for the evaluation of chronic cough by the ACCP places sinus imaging under consideration after initial clinical examination and chest radiography [1]. The clinical evaluation of UACS is not sensitive and often not specific [53], and features may go unrecognized even by endoscopy [12,55,56], creating an integral role for noninvasive imaging. Symptoms alone were found to have a sensitivity between 37% and 73% in a retrospective analysis of 126 patients who underwent CT imaging for the evaluation of CRS [57]. Furthermore, up to 35% of patients who were diagnosed with CRS had normal endoscopic findings [57]. Abrass et al [55] reviewed 100 patients with clinical findings suspicious of CRS, all with negative endoscopic evaluations. The investigators reported between 20% and 49% of studied individuals had positive findings on point-of-care CT of the sinuses, and the utilization of imaging allowed for a decrease in unnecessary antibiotic prescription. In a small retrospective case control study evaluating patients with CRS, Conley et al [56] showed increased clinical accuracy and a lower rate of unnecessary antibiotic use when cone-beam CT was used to evaluate the sinuses at initial office visit. In a
Chronic Cough. Although it remains unclear if HRCT or LDCT play a role, clinical features may stratify patients for appropriate imaging evaluation in order to balance diagnostic yield and dose considerations. CT Maxillofacial CT of the sinuses and maxillofacial structures offers improved visualization of the sinonasal anatomy, allowing for localization, characterization, and grading of sinonasal pathology. UACS is largely a conglomerate terminology for cough related to inflammation or irritation of the upper airways, which includes postnasal drip, allergic and nonallergic CRS, as well as laryngeal reflux. UACS is considered one of the more common causes of chronic cough [1,53]. Based on a few case series of patients with chronic cough, UACS/rhinitis prevalence ranged from 6% to 65% [2,7,17]. Guidelines for the evaluation of chronic cough by the ACCP places sinus imaging under consideration after initial clinical examination and chest radiography [1]. The clinical evaluation of UACS is not sensitive and often not specific [53], and features may go unrecognized even by endoscopy [12,55,56], creating an integral role for noninvasive imaging. Symptoms alone were found to have a sensitivity between 37% and 73% in a retrospective analysis of 126 patients who underwent CT imaging for the evaluation of CRS [57]. Furthermore, up to 35% of patients who were diagnosed with CRS had normal endoscopic findings [57]. Abrass et al [55] reviewed 100 patients with clinical findings suspicious of CRS, all with negative endoscopic evaluations. The investigators reported between 20% and 49% of studied individuals had positive findings on point-of-care CT of the sinuses, and the utilization of imaging allowed for a decrease in unnecessary antibiotic prescription. In a small retrospective case control study evaluating patients with CRS, Conley et al [56] showed increased clinical accuracy and a lower rate of unnecessary antibiotic use when cone-beam CT was used to evaluate the sinuses at initial office visit. In a