Abstract : Anatomical variations (AVs) of the nose and paranasal sinuses (NPS) are quite common findings on CT scans. However, their effect on chronic rhinosinusitis (CRS) is still controversial. To estimate the prevalence of AVs of the NPS on CT scans and to assess the association between multiple versus single variant and CRS. A cross-sectional study was conducted in the Al-Ramadi Teaching Hospital during the period from 1st January 2018 to 31st March 2019. We reviewed the CT scans of the patients with suggestive symptoms and signs of CRS. Group A (n=153 75.4%) CT scans were associated with AVs of the NPS. Seventy- eight with and 75 without radiological features of sinusitis. While group B (n=50 24.6%) were not detected any variants, 24 with and 26 without features of sinusitis. There was no statistically significant difference between the 2 groups (p-value>0.05). There were 11 AVs detected, the septal deviation 63% was the commonest one. Most of the AVs of the NPS were multiple (2 or more) 99 (64.7%). A 49 (49.5%) of them associated with features of sinusitis. There was a statistically significant difference (pvalue <0.05) between those with multiple and those with single AVS concerning the radiological features of sinusitis. AVs of the sinonasal region are common findings on CT scans. A deviated nasal septum is the commonest AVs. Most of our patients contain more than 2 AVs and they were more vulnerable to sinusitis