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Pathohistologic Study on Mucosal Morphology of Chronic Maxillary Sinusitis

Petar Drviš
Hrvoje Čupić
Tomislav Baudoin
Livije Kalogjera
Mirko Ivkić
Dražen Shejbal

Sažetak

The aim of the study was to evaluate morphological changes of maxillary sinus mucosa and to compare them with the levels of tryptase, myeloperoxidase (MPO) and eosinophil cationic protein (ECP) in sinus lavage, and also with subjective outcomes in patients with chronic rhinosinusitis after endosinusal treatment. Thirty patients with the symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than 3 months and maxillary sinus mucosa thickening by >6 mm, considered as maxillary sinusitis. Patients with asthma, polyposis, recent infection, systemic steroid therapy or previous sinus surgery were excluded. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamicin per maxillary sinus daily for 5 days. Patients rated their nasal/ chronic rhinosinusitis disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage with 5 ccm of saline was obtained prior to the first endosinusal treatment. Tryptase, MPO and ECP were determined from lavage fluid. Biopsy specimens of maxillary sinus mucosa were obtained by biopsy forceps during sinusoscopy through the inferior meatus in local anesthesia. Fifteen (50%) patients showed improvement and symptom alleviation after the treatment (responders), and 15 (50%) were unchanged or worsened (IR <1) after the treatment (nonresponders). The pretreatment and post-treatment sinusitis symptom scores and improvement rate of sinusitis symptom scores showed no correlation with any of the histologic parameters. Significant improvement was noted for the overall sinusitis symptoms score (p<0.01) in the study group as a whole. There was a significant difference in the baseline levels of MPO and ECP in sinus lavage (p<0.01), and a difference in the number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa (p>0.05) between the responders and nonresponders. Responders had a higher level of MPO and ECP in sinus lavage and higher number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa than nonresponders. There was no statistical difference in tryptase and other histologic parameters (number of mononuclears, edema, fibrosis, seromucous glands and goblet cell density) between responders or nonresponders. Eosinophilia in maxillary sinus mucosa specimens showed close correlation with ECP level in sinus lavage and inverse correlation with fibrosis (p<0.05). Other inflammatory cells (mononuclears and neutrophils) in maxillary sinus mucosa specimens did not correlate with the level of any cytokine in sinus lavage or with other histologic parameters. Globlet cell density correlated with ECP level (p<0.05) and inversely with MPO level in sinus lavage (p<0.01). Fibrosis showed close correlation with tryptase (p<0.01) and MPO (p<0.05) levels in sinus lavage and inversely with edema (p<0.01). Study results indicated higher levels of MPO and ECP in sinus lavage and higher number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa to predict better response to endosinusal steroid/ antibiotic treatment.

Ključne riječi

Chronic rhinosinusitis; endosinusal treatment; cytokines; sinus mucosa; histology

Hrčak ID:

15164

URI

https://hrcak.srce.hr/15164

Datum izdavanja:

1.6.2004.

Posjeta: 1.458 *