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.