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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　December 21, 2009 — 根據一項於12月號耳鼻喉頭頸部手術期刊發表的前瞻性臨床控制研究結果，暴露在過敏原的慢性鼻竇疾病患者，且之後X光或超音波影像顯示鼻過敏原可能與部分慢性頜竇疾病（CMSD）有關。
　　
　　荷蘭布雷達過敏研究基金會的Zdenek Pelikan醫師與其同事們表示，雖然慢性頜竇疾病牽涉到過敏感性機轉是已知的，特別是鼻過敏，但這個疾患的診斷方法與相關性不一。有關鼻黏膜過敏感化機轉與頜竇內潛在結果之間的資訊仍然相當欠缺。
　　
　　這項研究的目的在於以過敏原進行鼻誘發測試（NPTs）、放射線攝影與超音波評估鼻過敏原對CDMS的潛在角色。
　　
　　在一個學術轉介中心，71位罹患CDMS病患與16位控制組受試者做比較，這些受試者們有過敏性鼻炎病史，但沒有鼻竇疾病病史。以鼻腔測壓合併放射線造影與超音波，這71位病患總共接受135次NPT，而71位控制組受試者接受磷酸鹽緩衝食鹽水測試。
　　
　　在控制組，16位對NPTs測試呈陽性患者，再次接受放射線與超音波造影。主要試驗終點為鼻反應數目、型式，以及放射線與超音波造影相關變化，例如牽涉到骨骼的變化、出現空氣液體分層、以及黏液黏膜增厚。
　　
　　71位病患中的67位總共有104件不同種類的陽性鼻反應（P<0.001）。這些陽性反應伴隨著89件放射線攝影顯著改變（P=0.008），以及83件超音波發現顯著改變（P=0.007）。相對的，在71次對CDMS患者或控制組受試者的16次NPT（P值分別為0.15與0.12）進行的磷酸鹽緩衝實驗水控制組測試，X射線或是超音波並無顯著變化（P值分別為0.14與0.06）。放射線與超音波造影之間有顯著關聯（r=0.81；P<0.01）。
　　
　　研究者們寫到，鼻過敏可能與部分CDMS病患有關，使頜竇反應出現。
　　
　　透過一連串的超音波監測這個反應，如果需要的話，以傳統放射線攝影或是電腦斷層，配合過敏原誘發測試似乎是非常有用的診斷輔助工具，這使得我們可以針對鼻過敏提供額外的治療方法。
　　
　　Pelikan醫師表示已無相關資金上的往來。


Nasal Allergies Linked to Chronic Sinus Disease

By Laurie Barclay, MD
Medscape Medical News

December 21, 2009 — Exposing patients with chronic sinus disease to allergens and then obtaining repeated images by X-ray or ultrasound reveals that nasal allergies may be involved in some cases of chronic maxillary sinus disease (CMSD), according to the results of a prospective, clinical controlled study reported in the December issue of the Archives Otolaryngology-Head Neck Surgery.

"Although the involvement of hypersensitivity mechanisms, and especially of nasal allergy, in chronic disease of the maxillary sinuses has been recognized, the diagnostic procedures for this disorder and the relationship vary," write Zdenek Pelikan, MD, PhD, from the Allergy Research Foundation in Breda, the Netherlands, and colleagues. "There is a dearth of information regarding the direct causal involvement of hypersensitivity mechanisms of the nasal mucosa and potential consequences within the maxillary sinuses."

The study goal was to assess the potential role of nasal allergy in CDMS using nasal provocation tests (NPTs) with allergen, as well as radiography and ultrasonography.

At an academic referral center, 71 patients with CDMS were compared with 16 control subjects who had allergic rhinitis but no history of sinus disease. Using rhinomanometry combined with radiography and ultrasonography, the 71 patients underwent a total of 135 NPTs and 71 control challenges with phosphate-buffered saline.

In the control group, 16 positive NPTs were repeated in combination with radiography and ultrasonography. The primary endpoints were number, type, and timing of nasal responses and the accompanying changes on radiographs and ultrasonograms, such as changes involving bone, air fluid level, and mucus membrane thickening.

There were a total of 104 positive nasal responses of various types in 67 of the 71 patients (P < .001). There were significant changes on radiographs accompanying 89 of these positive nasal responses (P = .008), and 83 were associated with significant ultrasonography findings (P = .007). In contrast, there were no significant X-ray or ultrasound changes during the 71 phosphate-buffered saline control tests in the patients with CDMS (P = .14 and .06, respectively) or during the 16 NPTs in control subjects (P = .15 and .12, respectively). There was a significant correlation between radiographic and ultrasonographic findings (r = .81; P < .01).

"Nasal allergy may be involved in some patients with CDMS, resulting in appearance of a maxillary sinus response," the investigators write.

"Monitoring this response by means of serial ultrasonography and, if necessary, also by conventional radiography or computed tomography simultaneously with the nasal challenge with allergen seems to be a very useful diagnostic supplement allowing additional therapeutic measures focused on the nasal allergy."

Dr. Pelikan has disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2009;135:1246-1255.