<p>This study aims to investigate the concomitant presence of the paradoxical middle turbinate and paranasal sinus pathologies, sinonasal variations, and nasal septal deviation in the tomography. The paranasal sinus computed tomography images of a total of 602 patients were analyzed retrospectively. Seventy-eight patients with unilateral or bilateral paradoxical middle turbinate constituted the study group, and 80 patients with normal middle turbinate constituted the control group. Both groups were compared with respect to the presence of sinus pathology (sinusitis, mucosal thickening, retention cyst), paranasal sinus variations (Haller cell, Agger nasi cell), and nasal septal deviation. The relationship between the localization of the paradoxical middle turbinate and the direction of nasal septal deviation was investigated. The prevalence of paradoxical middle turbinate was 12.9%. The most common sinus pathology accompanying paradoxical middle turbinate was in the maxillary sinus (43.6%). There was no significant difference between the groups in terms of the prevalence of sinus pathologies. The prevalence of sphenoid sinus pathology was significantly less in the paradoxical middle turbinate group than in the control group (<i>p</i> = 0.006). The prevalence of nasal septal deviation was significantly higher than the control group (<i>p</i> = 0.023). No significant relation was found between the localization of the paradoxical middle turbinate and the direction of the nasal septal deviation (<i>p</i> = 0.202). The prevalence of sphenoid sinus pathology was significantly less, and the nasal septal deviation was significantly higher in the patients with paradoxical middle turbinate.</p>