Abstract
<title>Abstract</title> <p>Background Chronic rhinosinusitis (CRS) is a persistent inflammatory disease that may extend beyond the mucosa and induce osteitis of the paranasal sinus walls. Radiologic assessment of sinonasal osteitis commonly relies on the Global Osteitis Scoring Scale (GOSS), which evaluates bone thickening but does not capture alterations in bone density. Computed tomography–derived Hounsfield Units (HU) provide a quantitative measure of bone mineralization and may offer complementary information regarding bone remodeling in CRS. Objective To evaluate the correlation between GOSS and HU values on sinonasal high-resolution computed tomography (HRCT) in assessing chronic sinonasal osteitis severity. Methods A retrospective cross-sectional study was conducted involving 32 adult CRS patients who underwent sinonasal HRCT. Each paranasal sinus was evaluated independently using the GOSS system, and mean HU values were measured at standardized sinus wall locations. Correlation analysis between GOSS scores and HU values was performed using Spearman’s rank correlation test (α = 0.05). Results A total of 156 osteitis-positive sinuses were identified, most frequently in the right anterior ethmoid sinus. The highest mean HU values were observed in sinuses without wall thickening (GOSS score 0). Correlation analysis demonstrated a statistically significant but very weak association between GOSS scores and HU values (r = 0.167; p = 0.038), suggesting that bone thickness and bone density represent distinct imaging characteristics of osteitic remodeling. However, no significant correlation was observed when each sinus was analyzed separately (p > 0.05), with some sinuses showing higher GOSS scores associated with lower HU values. Conclusion Assessment of chronic sinonasal osteitis should consider both structural and densitometric CT parameters, as thickness-based scoring alone may not adequately reflect the complexity of inflammatory bone remodeling. This combined approach may improve the radiologic characterization of CRS-related osteitis and support more accurate disease assessment.</p>