Computed Tomographie Study of Paranasal Sinuses and Nasal Lavage in Atopic Children without Sinusitis Symptoms

Abstract

Paranasal sinus disease is frequently associated with allergic rhinitis and asthma, but the role of allergic inflammation in the sinus mucosa remains controversial. The objectives of this investigation were to evaluate the extent of sinus disease and to examine its correlation with peripheral eosinophilia and inflammatory cells in nasal lavage samples. Forty-eight atopic children, as defined by a positive skin prick test to house dust mites, with allergic rhinitis (33 asthmatics) were studied; 13 nonatopic children served as a control group. Neither patients nor controls had sinusitis symptoms, which are characterized by the presence of sore throat, postnasal drip, thick green nasal discharge, and congestion, with associated nighttime and daytime cough. Coronal computed tomographic (CT) scans were obtained and interpreted by a radiologist blinded to the clinical condition. CT scans were graded following a published standard protocol. A sinus CT score of 12 or higher indicated extensive disease. Quantitative cytology of nasal lavage samples was performed and expressed as number of cells per milliliter. Nine of 48 patients (19%) had extensive disease, 7 were asthmatics, and 2 had only rhinitis; 39 of 48 atopics, and 13 controls had a CT score under 12. Atopic patients had significant eosinophilia in nasal lavage samples and peripheral blood. Total cell counts in nasal lavage samples were higher in atopic patients than in the control group. Total and differential cell counts in nasal lavage samples were similar in atopic patients regardless of CT score. There was a correlation between CT score, peripheral eosinophil, and nasal lavage eosinophil counts in atopic patients. Extensive sinus disease is frequent in atopic patients without sinusitis symptoms. Total and differential cell counts in nasal lavage samples did not distinguish atopic patients with more extensive disease on CT scan. The extension of disease on CT scan correlated with peripheral blood and nasal lavage eosinophil counts, however, suggesting that these cells may be involved in sinus mucosa inflammatory changes.