Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects

BACKGROUND: Viral cold is thought to be the major contributing factor in the pathogenesis of sinusitis, as it causes ostiomeatal obstruction. The aim was to evaluate whether paranasal sinus functioning during viral colds is similar in subjects with and without allergic rhinitis. METHODS: Forty-eight volunteers were examined during an early (2-4 days) natural cold and again 3 weeks later. The examinations included computed tomography (CT) scans, nasal mucosal biopsies, and viral and bacterial specimens. Subjects with positive skin prick tests and persistent or intermittent rhinitis were considered to have allergic immunoglobulin E (IgE)-mediated rhinitis. In addition, specific IgE antibodies to staphylococcal enterotoxin B (SEB) were measured. RESULTS: Nine subjects (19%) had allergic rhinitis. The allergic subjects were significantly more often IgE sensitized to SEB than the nonallergic subjects (33%vs 3%, P = 0.02). Viral etiology of the cold was identified in 32 (67%) subjects. The subjects with allergic rhinitis had significantly higher CT scores compared with nonallergic subjects during the colds (median (range) scores 16 (6-22) vs 6 (0-17), P = 0.004). In both groups, the median scores declined markedly during convalescence, but the difference remained significant (P = 0.009). Among the allergic subjects, those who were IgE sensitized to SEB tended to have the highest CT scores [median (range) 16 (16-22)]. Total serum IgE and the nasal subepithelial eosinophil counts correlated with the CT scores during the cold (rs = 0.38, P = 0.008 and rs = 0.46, P = 0.001, respectively). CONCLUSIONS: Subjects with allergic IgE-mediated rhinitis had more severe paranasal sinus changes in CT scans than nonallergic subjects during viral colds. These changes indicate impaired sinus functioning and may increase the risk of bacterial sinusitis.     

In vitro diagnosis of chronic nasal inflammation

BACKGROUND: Differential diagnosis of chronic nasal inflammation is insufficient when based solely on clinical examination and radiography of paranasal sinuses. Patients complain about more or less similar symptoms. Activation of mast cells and eosinophils is pivotal in nasal inflammation. OBJECTIVE: To compare tryptase and eosinophilic cationic protein (ECP) in nasal secretions in different forms of chronic nasal inflammation and to establish norm values. METHODS: The study included 1710 patients presenting with nasal complaints. Nasal secretions were gained by the cotton wool method and analysed for tryptase, as a marker of mast cell activation, and for ECP, as a marker of tissue eosinophilia and activation. Patients were grouped according to their diagnosis: chronic, non-allergic rhinosinusitis (sinusitis, n=194), non-allergic nasal polyposis (polyposis, n=138), non-allergic rhinitis with eosinophilia syndrome (NARES, n=198), isolated perennial allergic rhinitis (AR) (n=126), isolated seasonal AR (n=132), and patients allergic to both, seasonal and perennial allergens (n=193). Seven hundred and twenty-nine patients with nasal complaints due to a deviated septum and without any nasal inflammation served as controls. RESULTS: Nasal tryptase was highly significantly (P<0.001) elevated in polyposis, NARES, and in AR. ECP was highly significantly (P<0.001) elevated in all groups of patients suffering from chronic nasal inflammation. Based on our data and method we established norm values (95% confidence interval of mean value) for nasal tryptase in healthy adults, ranging from 12.0 to 18.7 ng/mL and for ECP ranging from 84.4 to 102.6 ng/mL. CONCLUSION: Mast cells and eosinophils are involved in non-allergic and allergic forms of chronic nasal inflammation. We established an in vitro assay for tryptase and ECP in nasal secretions and defined norm values based on our data and method. In vitro measurement of biological markers in nasal secretions provides important information for differential diagnosis and therapeutic strategies of chronic nasal inflammation.     

Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization

BACKGROUND: Allergic rhinitis is associated with Th2-dependent inflammation. Nasal obstruction is the most typical symptom in children with mite allergy. OBJECTIVES: The aim of this study was to evaluate the possible relationships among nasal symptoms, allergic inflammation, including inflammatory cells and cytokine pattern, and nasal airflow in children with persistent allergic rhinitis because of mite sensitization. METHODS: Twenty children (13 males and seven females, mean age 13.4 +/- 1.6 years) with persistent rhinitis because of mite allergy were evaluated. All of them had moderate-severe grade of nasal obstruction. Total symptom score (TSS), rhinomanometry, nasal lavage, and nasal scraping were obtained in all subjects. Inflammatory cells were counted by conventional staining; interleukin (IL)-5, and IL-8 were measured by immunoassay on fluids recovered from nasal lavage. RESULTS: Eosinophils were significantly associated with TSS (R = 74.4%, P = 0.0002), with IL-5 (R = 90.6%, P < 0.0001) and with nasal flow (R = -69%, P = 0.0007), but not with IL-8 (R = 0.1%, P = 0.995). Eosinophil levels were shown to independently predict nasal flow (P < 0.001), with flow decreasing linearly for increasing eosinophils, together with a significant effect of neutrophils (P = 0.016, linear increase in flow) and a borderline effect of IL-8 (P = 0.063, linear increase in flow). CONCLUSIONS: This study demonstrates the close association between IL-5 concentration and eosinophil infiltration. In addition, there is clear evidence concerning the relationship between eosinophil infiltration and nasal airflow. Thus, nasal eosinophils can be regarded as the most important predictor of upper airway function. These findings constitute first evidence of the relationship between nasal airflow impairment and Th2-related eosinophilic inflammation in children with persistent allergic rhinitis because of mite sensitization.     

Sinus CT scans and mediator release in nasal secretions after nasal challenge with cypress pollens

BACKGROUND: Involvement of paranasal sinuses has been suggested in allergic rhinitis but not clearly demonstrated. AIMS: To investigate the relationship between intermittent allergic rhinitis and computerized tomography (CT). METHODS: Twenty patients with intermittent rhinitis and sensitized to cypress pollens underwent unilateral nasal provocation tests (NPTs) using increasing concentrations of cypress pollens out of the pollen season. Sinus CT-scans were carried out just before a NPT and 24 h later. Nasal lavage was carried out just before a NPT, 30 min after a positive challenge and again 24 h later. Leucotriene C4/D4, intracellular adhesion molecule-1 and eosinophil cationic protein were measured in nasal secretions. RESULTS: Thirteen patients (65%) showed an alteration in their CT-scans after allergen challenge. Ten of them showed sinus changes controlateral to their allergenic provocation. Radiological changes mainly affected the osteomeatal complex and the ethmoid sinuses. Pre-existing abnormalities (13 of 20 cases) mainly concerned the maxillary sinuses. There was no correlation between CT-scan abnormalities and levels of mediators released in nasal secretions. CONCLUSIONS: We have shown that nasal allergen challenge can produce radiological changes in the paranasal sinuses. This mainly concerned the ethmoid sinuses.     

Correlation of nasal inflammation and nasal airflow with forced expiratory volume in 1 second in patients with perennial allergic rhinitis and asthma.

BACKGROUND: Allergic rhinitis and asthma are frequently associated and are characterized by TH2-dependent inflammation. Nasal and bronchial obstruction largely depend on allergic inflammation. OBJECTIVE: To evaluate the relationships among nasal eosinophil counts, interleukin 4 (IL-4) and interferon-gamma (IFN-gamma) levels, nasal airflow, and forced expiratory volume in 1 second (FEV1) in patients with perennial allergic rhinitis and asthma. METHODS: Eight men and 7 women (mean +/- SD age, 24.8 +/- 4.7 years) with perennial allergic rhinitis and asthma were evaluated. All 15 patients had a moderate-to-severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, and spirometry were evaluated in all patients. Eosinophils were counted using conventional staining; IL-4 and IFN-gamma levels were measured by immunoassay in fluids recovered from nasal lavage. RESULTS: Significant positive relationships were demonstrated between eosinophil infiltration and IL-4 levels, nasal airflow and IFN-gamma levels, FEV1 and IFN-gamma levels, and nasal airflow and FEV1 (P < .001 for all). Significant negative relationships were demonstrated between eosinophil infiltration and IFN-gamma levels, IL-4 and IFN-gamma levels, eosinophil infiltration and nasal airflow, IL-4 values and nasal airflow, nasal eosinophil counts and FEV1, and IL-4 values and FEV1 (P < .001 for all). CONCLUSIONS: There is a close association between TH2 cytokines and eosinophil infiltration in the nose. There is also clear evidence concerning the relationships among eosinophil infiltration, IL-4 and IFN-gamma levels, and nasal airflow. Nasal eosinophil, IL-4, and IFN-gamma levels correlate with FEV1. Finally, nasal airflow is related to FEV1. These findings constitute the first evidence of a relationship between TH2-related nasal inflammation and nasal and bronchial airflow in patients with perennial allergic rhinitis and asthma.     

Eosinophil count in nasal mucosa is more suitable than the number of ICAM-1-positive nasal epithelial cells to evaluate the severity of house dust mite-sensitive allergic rhinitis: a clinical correlation study

BACKGROUND: House dust mite (HDM)-sensitive allergic rhinitis is a perennial rhinitis with persistent nasal inflammation. Currently, there are no reliable parameters to monitor the severity of perennial allergic rhinitis. The purpose of this study was to evaluate correlations between clinical and laboratory parameters in patients with HDM-sensitive allergic rhinitis. METHODS: We measured nasal symptoms, did the Dermatophagoides pteronyssinus (Der P) skin prick test (SPT), evaluated the Der P allergen nasal challenge threshold, and laboratory parameters [(1) inflammatory cell count from nasal mucosal scraping specimens: eosinophils and neutrophils and (2) immunocytochemistry: ICAM-1 expression on nasal epithelial cells] in 20 cases of HDM-sensitive allergic rhinitis and performed correlation tests between all parameters. RESULTS: The wheal diameter induced by Der P SPT was significantly correlated with the Der P allergen nasal challenge threshold (p = 0.001). The number of eosinophils from nasal mucosal scrapping specimens was correlated with the ICAM-1 expression on nasal epithelial cells (p = 0.039), the number of neutrophils from nasal mucosal scrapping specimens (p = 0.001), and nasal stuffiness (p = 0.037) but did not correlate with total nasal symptom scores. CONCLUSION: Clinical symptoms of HDM-sensitive allergic rhinitis showed a poor correlation with inflammatory parameters. The eosinophil count in nasal mucosa is correlated with ICAM-1 expression and more suitable than ICAM-1 levels to evaluate the severity of HDM-sensitive allergic rhinitis. This study also supports the role of the SPT in the diagnosis of nasal allergy to HDM.     

Tryptase in nasal fluid is a useful marker of allergic rhinitis

Tryptase is a mast cell-specific marker of degranulation. To investigate the possible diagnostic value of tryptase in allergic rhinitis, we measured the levels in both serum and native nasal fluid with a sandwich RIA-assay (Pharmacia). Twenty-three allergic patients and five patients with chronic ethmoidal sinusitis were included. Eighteen of the 23 allergic patients were tested within the pollen season or had perennial rhinitis; the remainder were tested at least 1 month out of the pollen season. None of the patients had detectable serum tryptase (>0.1 ng/ml). Also patients with chronic ethmoidal sinusitis showed no tryptase in nasal fluid. One of seven allergic patients tested out of season had slightly increased nasal tryptase of 1.8 ng/ml. In patients with active nasal allergy, the tryptase in nasal fluid ranged from 6.4 ng/ml to 640 ng/ml with a mean of 101 ng/ml and SD 173. These results show a clear distinction between active and non-active nasal allergy and other non-mast-cell-related nasal disease. Further, nasal tryptase release by natural allergen exposure is even higher than that observed in allergen challenge tests.     

Sense of smell in allergic and nonallergic rhinitis

Hyposmia is a fairly common complaint in patients with long-continuing aliergic or nonallergic rhinitis. Other factors such as aging, smoking, or nasal surgery may affect olfaction, but these have been little studied in rhinitisrelated hyposmia. The purpose of this study was to measure and compare olfactory thresholds in 105 rhinitis patients and 104 healthy controls and to analyze possible relationships between the sense of smell and rhinitis, age, sex, smoking, prick-test results, nasal resistance, and history of nasal or paranasal surgery. The olfactory threshold was assessed with a commercially available kit of squeeze-bottle pairs. The most important variables associated with the sense of smell were determined with stepwise multiple regression analysis, and intergroup differences were assessed with analysis of variance. The reference interval of olfactory thresholds by age was estimated with regression analysis. Nasal resistance was measured by active anterior rhinomanometry. Age and rhinitis were the only variables with significant effect on the olfactory threshold in the whole series. Both the proportion of hyposmic persons and the degree of the impairment of the sense of smell were significantly higher in the rhinitis group than in the control group. The nonallergic patients' sense of smell was poorer than that of seasonal or perennial allergic rhinitis patients. A history of operations for nasal polyposis was associated with hyposmia, but operations for chronic maxillary sinusitis were not. Neither smoking habits nor sex were related to olfactory thresholds. In conclusion, hyposmia in rhinitis patients is partly attributable to age-related changes, but our results indicate that the disease itself impairs the sense of smell.     

Overview of comorbid associations of allergic rhinitis

Allergic rhinitis affects approximately 20% of the U.S. population. An association between allergic rhinitis and conditions including asthma, sinusitis, otitis media, nasal polyposis, respiratory infections, and even orthodontic malocclusions has been observed. Clinical research has identified shared pathogenic mechanisms, epidemiologic correlations, and findings from allergy testing to indicate that these conditions represent long-term physical consequences in allergic individuals. The positive response of patients afflicted with these conditions to antiallergic treatment further enhances the association between allergic rhinitis and other airway diseases. The use of nasal corticosteroids in patients with rhinitis and asthma reduces not only rhinitis symptoms but also asthma symptoms and airway reactivity to methacholine challenge. Similarly, antihistamines, with or without decongestants, result in improvement of objective measurements of pulmonary function. In the treatment of acute sinusitis, the combination of an intranasal corticosteroid and an antibiotic provides greater benefit than an antibiotic alone. Treatment strategies for allergic rhinitis should be directed at controlling the symptoms of allergic rhinitis and reducing the development of physical complications in susceptible persons. Three techniques for the treatment of allergic rhinitis are used, including avoidance of offending allergens, selection of appropriate pharmaceuticals, and allergy immunotherapy. Appropriate treatment may spare some patients of related airway diseases and may also reduce the overall cost of care. The broadened scope of allergic rhinitis and increased prevalence of IgE-mediated diseases have heightened awareness regarding the profound consequences of allergic rhinitis and the importance of effective treatment. (J Allergy Clin Immunol 1997;99:S773-80.)     

Effects of topical corticosteroid and combined mediator blockade on domiciliary and laboratory measurements of nasal function in seasonal allergic rhinitis.

BACKGROUND: Both domiciliary and laboratory measures of nasal function have been used to evaluate treatment response in allergic airways disease; however, these measures have not been compared. OBJECTIVE: To determine the relationship of domiciliary measures (daily symptoms, peak inspiratory nasal flow, and nasal oral index) and laboratory measures (rhinomanometry, acoustic rhinometry) in assessing treatment response with topical steroids and specific inflammatory mediator blockage. METHODS: Twenty-one patients with seasonal allergic rhinitis and asthma were enrolled into a single-blind, placebo-controlled, crossover study comparing 2 weeks of 1) 400 microg inhaled plus 200 microg intranasal budesonide once daily and 2) 10 mg montelukast plus 10 mg cetirizine once daily. Before each treatment, patients received 7 to 10 days of placebo period. Laboratory measurements were made of nasal resistance by posterior rhinomanometry, and nasal volume between 0 and 5 cm by acoustic rhinometry after both placebo and active treatment periods. Daily domiciliary recordings were made of allergic rhinitis nasal symptoms scores and peak nasal and oral inspiratory flow rate (enabling the calculation of a nasal/oral index) throughout the study. RESULTS: There were significant (P < 0.05) improvements for all allergic rhinitis symptoms with both therapies, after factoring for pollen count. Spearman's rank correlation for comparison among nasal symptoms and the objective responses were: nasal inspiratory flow rate (R = -0.50, P = 0.02); nasal/oral index (R = -0.55 P = 0.01); rhinomanometry (R = 0.24, P = 0.30); and acoustic rhinometry (R = -0.21, P = 0.36). CONCLUSIONS: Both treatments were effective in managing allergic rhinitis symptoms, and patients' symptoms were more closely associated with domiciliary measurements of nasal flow than laboratory measurements of nasal function.     

Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy?

BACKGROUND: The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that many patients may have a localized form of allergic rhinitis in the absence of other atopic symptoms and markers. This study compares detailed nasal challenge results obtained from patients with idiopathic rhinitis to those of atopic and normal controls. METHODS: Patients with idiopathic rhinitis (n = 23), perennial allergic rhinitis (n = 8) and normal controls (n = 8) underwent a normal saline challenge to exclude hyper-reactivity and then bilateral nasal allergen challenges. Nasal patency was assessed by anterior active rhinomanometry. RESULTS: All of the patients with atopic rhinitis demonstrated positive bilateral allergen challenges. All normal control subjects had bilateral negative challenges. Two patients in the idiopathic group tested positively to saline and were excluded from further study with 62% of the remainder testing positive to allergens. Of the idiopathic patients testing positive, 85% were sensitive to house dust mite. CONCLUSION: A significant proportion of patients with idiopathic rhinitis have positive nasal challenges, the vast majority to house dust mite allergen. These findings add to the weight of evidence that suggests 'localized allergy' may exist in the absence of systemic atopic markers.     

The effect of budesonide on the cytokine pattern in patients with perennial allergic rhinitis.

BACKGROUND: A T(H)2-polarized cytokine pattern has been demonstrated in allergic rhinitis. Budesonide represents an effective topical corticosteroid in the management of allergic rhinitis. OBJECTIVE: To evaluate cytokine pattern and symptoms in patients with perennial allergic rhinitis before and after treatment with intranasal budesonide. METHODS: All patients received budesonide aqueous nasal spray or placebo for 2 weeks. The study was double-blind, parallel group, placebo controlled, and randomized. Nasal lavage was performed in all patients before and after treatment. A panel of cytokines, including interleukin 4 (IL-4), IL-5, and IL-6, was measured by immunoassay on fluids recovered from nasal lavage. Total symptom score (including rhinorrhea, nasal itching, sneezing, and nasal obstruction) was evaluated before and after treatment. RESULTS: Twenty patients with perennial allergic rhinitis were evaluated (13 men and 7 women; mean age, 24.7 years). Budesonide aqueous nasal spray treatment showed a significant decrease of IL-4 (P = .007), IL-5 (P = .04), and IL-6 levels (P = .009). Budesonide aqueous nasal spray treatment also induced significant symptom relief (P = .006). Placebo treatment did not significantly affect the evaluated parameters. CONCLUSIONS: This study shows that budesonide aqueous nasal spray is effective in exerting immunomodulatory activity by reducing cytokine pattern and relieving symptoms. These findings are evidence of the effects of intranasal budesonide in treating perennial allergic rhinitis.     

Multiallergen nasal challenges in nonallergic rhinitis

BACKGROUND: It has been proposed that some patients with nonallergic rhinitis may have "localized allergy" of the nasal mucosa. Nasal challenges with aeroallergens can help determine whether a patient is clinically allergic via an IgE-mediated pathway. OBJECTIVE: To determine the prevalence of localized allergy in patients with negative skin prick test results via nasal challenges with an array of allergens. METHODS: Twenty individuals with perennial rhinitis and negative epicutaneous test results to common perennial aeroallergens underwent nasal challenges to glycerin, Alternaria, cockroach, timothy grass, cat hair, and Dermatophagoides pteronyssinus. Total symptom scores, peak nasal inspiratory flow rates, and nasal eosinophil counts were determined. RESULTS: Of 20 patients with nonallergic rhinitis, 4 were hyperresponsive to glycerin and were not subsequently challenged. Eleven patients had negative nasal challenges. Five patients developed positive challenges (total symptom score > or = 5) to 7 allergens. These 5 patients returned for nasal provocation testing to their offending allergens, and these repeated challenges were negative. Three control subjects with allergic rhinitis developed positive challenges after nasal allergen challenge. CoNCLUSIONS: Although some individuals with nonallergic rhinitis can have positive nasal allergen challenges, these results were not reproducible in the present patient population.     

Allergic Aspergillus sinusitis: a newly recognized form of sinusitis

The clinical and pathologic features of seven cases of a newly recognized form of chronic sinusitis are described. Most patients were young adults with a history of asthma, and all had chronic nasal polyps. Radiographically, there was opacification of multiple sinuses. Recurrent sinusitis was common, and several patients underwent numerous surgical drainage procedures. Histologically, a distinct mucinous material containing eosinophils, Charcot-Leyden crystals, and fungal hyphae was found in tissue resected from the sinuses. We believe that these findings constitute a distinct clinicopathologic entity that we term allergic Aspergillus sinusitis. This condition shares similar histopathologic features with allergic bronchopulmonary aspergillosis (ABPA) but affects the paranasal sinuses rather than the lung. Implications for therapy of this form of sinusitis and its possible relationship to allergic lung diseases are discussed.     

Increased immune reactivity to house dust mites in adults with chronic rhinosinusitis

Sixty-three adults with symptomatic chronic rhinosinusitis had computerized tomegraphic (CT) scans of the paranasal sinuses, which were used to quantify disease severity. These patients were divided into three closely age- and sex-matched groups: a CT scan-negative group (chronic rhinitis only), a mild sinusitis group and a severe sinusitis group. Serum dust mite-specific IgG levels were found to be significantly elevated in the sinusitis patients compared with a matched group of asymptomatic normal individuals. Levels were highest in the more severe sinusitis group, in which the mean titre was 559 U/ml and the incidence of litres greater than 400 U/ml was 48%, as compared with a mean titre of 139 U/ml and only a 10% incidence of litres greater than 400 U/ml in the normal subjects (P< 0.005 and <0.01). In contrast, although the frequency of immediate hypersensitivity to dust mite, as assessed by intradermal skin tests, tended to be higher in patients with sinusitis, it was not significantly different from normal individuals. The association between mite IgG and disease was most striking in the patient sub-group with negative mile skin tests. In this group, mite IgG levels were significantly higher than normal, even in those patients with only chronic rhinitis. These findings demonstrate that increased serum levels of IgG against dust mites are strongly associated with chronic rhinosinusitis, especially in the sub-group of patients who are not allergic to mites.     

Quality of life in patients with perennial allergic rhinitis: using the Japanese version of the SF-36 Health Status Questionnaire]

Perennial allergic rhinitis may impair daily activities. However it isn't known how it affects a patient's self-perceived health status. In present study, QOL was measured by MOS Short Form 36 Health Survey (SF-36) for assessment of useful information for individualization of care. 252 patients with perennial allergic rhinitis who visited 14 hospitals and clinics from June to August 1999 were questioned, and 249 patients were engaged in this study as subjects. Each patient's background was investigated, and the factors which influenced HRQOL score were identified. In addition, comparisons with healthy subjects and subjects with seasonal allergic rhinitis were performed. It was shown that age, gender, and the number of comorbid conditions were significant contributions to HRQOL score. It was considered that nasal obstruction had a strong influence on SF-36 score compared to other symptoms of nasal allergy. In general, QOL scores were significantly depressed in the patients with perennial and seasonal allergic rhinitis compared with healthy subjects. The difference of scores between perennial allergic rhinitis were not significant, although the patients with seasonal allergic rhinitis showed low scores compare with perennial allergic rhinitis.     

Allergic and nonallergic rhinitis: their characterization in a tropical environment

The differences between allergic and non-allergic rhinitis were evaluated in 127 individuals from tropical urban region of Venezuela. The study design had historic data obtained regarding exacerbation of initial symptoms on exposure to common precipitants, physical examination, nasal cytology, immunodiagnostic test, routine laboratory test (fresh stool test, white cell count and urine test) and sinus x-rays. Forty nine patients were diagnosed as having allergic rhinitis (AR), 10 as probably having AR, 13 had infectious rhinitis, 4 had mixed components, 1 as non-allergic non-eosinophilic rhinitis, and 50 had no evidence of immunological nasal respiratory allergy and were taken as controls. The associated findings with allergic rhinitis were: conjunctivitis 62%, sinusitis 23%, and bronchial asthma 24%. Our results support a significative prevalence of allergic rhinitis in this particular group, with similar symptom patterns to that of industrialized countries.     

鼻内镜手术治疗真菌性鼻窦炎35例

目的：探讨真菌性鼻窦炎的发病原因及鼻内镜手术治疗真菌性鼻窦炎的临床疗效。方法：采用鼻内镜手术治疗真菌性鼻窦炎35例,回顾性分析其临床表现、鼻内镜检查和鼻窦CT扫描的病变特征及手术疗效。结果：35例患者鼻内镜检查及鼻窦CT扫描显示,鼻腔均有不同程度解剖异常、窦腔内有不均匀不透光的钙化斑,全部病例术后病理学检查均发现真菌丝。术后随访6个月至2年,治愈31例（89．66％）,显效3例（8．57％）,无效1例（2．86％）。结论：鼻腔局部解剖结构异常及病变与真菌性鼻窦炎关系密切;鼻窦CT扫描结合鼻内镜检查是诊断真菌性鼻窦炎的重要方法;经鼻内镜充分开放病变鼻窦窦口,彻底清除病灶,保持窦口引流通畅,是治疗和预防复发的重要手段。     

Computed tomography findings in chronic rhinosinusitis patients with and without allergy

The purpose of this study was to compare the paranasal sinus mucosal thickenings, bony changes consistent with chronic sinusitis, and bony anatomic variations detected by computed tomography (CT) in chronic rhinosinusitis patients with and without allergy. Three hundred and thirty-nine patients with chronic rhinosinusitis were analyzed for their allergic status by performing skin prick test. Two hundred and thirteen patients (62.8%) had at least one positive skin prick test (allergic patients, male/female: 85/128, mean age: 29.1 +/- 1.2). One hundred and twenty-six patients (37.2%) were included in the non-allergic group (male/female: 53/73, mean age: 31 +/- 2.2). Maxillary mucosal thickening and frontal hypoplasy were significantly more common in allergic chronic rhinosinusitis patients. Moreover, pneumatized uncinate process is apparently more common in the allergic group than non-allergic group, and statistical analysis revealed marginal significance (p = 0.0535). In conclusion CT findings of allergic chronic rhinosinusitis patients are comparable to the CT findings of chronic rhinosinusitis patients without allergy. However, presence of maxillary mucosal thickening, frontal hypoplasia or pneumatized uncinate process in the CT scan of a patient with chronic rhinosinusitis could be of clinical significance, and might guide the otolaryngologist for the evaluation of the presence of allergy.     

鼻中隔偏曲与鼻窦炎关系的CT影像学研究

目的本文应用鼻窦冠状位CT对鼻中隔偏曲进行观察,并探讨其与鼻窦炎的关系。方法分析754例患者的CT片,从中分出正常组与鼻窦炎组。统计这两组中鼻中隔偏曲的发生率,并分析其与鼻窦炎的关系。再进一步统计分析高位偏曲和低位偏曲的发生率及其与鼻窦炎的关系。结果鼻中隔偏曲的发生率在两组间分布差异无显著性(x2=1.86,P0.05),但鼻窦炎组中鼻中隔高位偏曲的发生率明显高于正常组(x2=5.06,P0.05)。对于鼻中隔高位偏曲,无论是同侧还是对侧窦口鼻道复合体区域的解剖变异的发生率在两组间的分布均有显著性差异(P0.05)。结论鼻中隔高位偏曲可引起窦口鼻道复合体区的解剖异常,与鼻窦炎的发生相关。