Evaluation of the relationship of halitosis with anatomical variations and mucosal changes in the sinonasal region

Anatomical variations of the sinonasal cavities are quite common, and can result in narrowing or obstruction. Obstruction of the ostiomeatal channels disrupts normal sinus airflow and mucociliary clearance. Sinusitis is frequently caused by any disorder that can lead to obstruction of the ostiomeatal complex; such as infection, allergies, or transport disorders in mucociliary activity. Halitosis is defined as an unpleasant odor originating from the oral cavity that can cause social discomfort. The upper respiratory tract can be a significant contributor to halitosis. This study aims to evaluate the relationship between anatomical variations and sinonasal mucosal changes by reviewing the paranasal sinus computed tomography scans of 152 patients (66 women and 86 men, aged 18-76) who were admitted to the Uşak University Education and Research Hospital Ear, Nose and Throat Polyclinic between January and May 2024. The patients had no systemic diseases, maintained good oral hygiene, and underwent paranasal sinus computed tomography scanning. Halitosis was assessed prospectively using a questionnaire study and the organoleptic method. The most common anatomical variation observed was septum deviation (77.6%), while the least common anatomical variation was onodi cell (5.3%). Sinonasal mucosal changes were present in 44.1% of the cases, while 55.9% showed no such cases. The presence of concha bullosa was observed more frequently in individuals within the 18-45 age group (p=0.027). The rate of crista galli pneumatization was higher in males (p=0.021). In contrast, the rates of sinonasal mucosal changes were less common in females (p=0.003). No statistically significant relationship was found between anatomical variations of the sinonasal region, sinonasal mucosal changes, and halitosis (p>0.05). However, patients who reported having halitosis were more likely to perceive a higher occurrence of halitosis based on survey responses (p=0.023). A statistically significant correlation was also identified between halitosis and the frequency of tooth brushing (p=0.034). We believe that future studies could be conducted using a larger sample size and multiple centers to further evaluate the relationship of anatomical variations of the sinonasal region with sinonasal mucosal changes and halitosis.