engleski

Patohistologic study on mucosal morphology of chronic maxillary sinusitis

The aim of our study was to evaluate the morphological changes of the maxillary sinus mucosa and compare them with level of tryptase, myeloperoxidase (MPO) and eosinophil cationic protein (ECP) in sinus lavage and also to compare with subjective outcomes in patients with chronic rhinosinusitis after endosinusal treatment. 30 patients with symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than three 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 gentamycine per maxillary sinus daily for 5 days. Patients rated 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 taken prior to the first endosinusal treatment. Tryptase, MPO and ECP were determined from lavage fluid. Biopsy specimens of maxillary sinus mucosa were taken with a biopsy forceps during sinusoscopy through the inferior meatus in local anaesthesia. 15 (50%) patients showed improvement and symptom alleviation after the treatment (responders), 15 (50%) were unchanged or worsened (IR<1) after the treatment (nonresponders). Pretreatment and posttreatment sinusitis simptom scores and improvement rate of sinusitis symptom scores was not found to be correlated to any of histologic parameters. Significant improvement was noted for overall sinusitis symptoms score (p<0.01) in the study group as a whole. Difference in baseline level for MPO and ECP in sinus lavage between responders or nonresponders was significant (p<0.01), as well as for the number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa (p>0.05). Responders had 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 for tryptase and for other examined histologic parameters (number of mononuclears, oedema, fibrosis, seromucous glands and goblet cell density) between responders or nonresponders. Eosinophilia in maxillary sinus mucosa specimens was closely correlated with the ECP level in sinus lavage and inversely correlated with fibrosis (p<0.05). Other inflammatory cells (mononuclears and neutrophils) in maxillary sinus mucosa specimens did not correlate to the level of any cytokine in sinus lavage or to other histologic parameters. Globlet cell density was correlated with the ECP level (p<0.05) and inversively correlated with MPO level in sinus lavage (p<0.01). Fibrosis was closely correlated to tryptase (p<0.01) and MPO (p<0.05) level in sinus lavage and inversely correlated with edema (p<0.01). Results indicate higher level 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.

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

nije evidentirano