Temporal bone pneumatization and its relationship to paranasal sinus development in cystic fibrosis.

BACKGROUND: There is significant debate on the influence of inflammatory mucosal disease on paranasal sinus pneumatization (PSP) and temporal bone pneumatization (TBP) in cystic fibrosis patients (CF). It is often assumed that mucosal disease of the paranasal sinuses will negatively influence development and pneumotization of the paranasal sinuses and temporal bone system. METHODS: A case-control study of TBP and PSP in CF, chronic rhinosinusitis (CRS) and healthy control patients from a tertiary rhinology clinic. TBP and PSP were assessed by computed tomography (CT) using a previously validated scale. Genotype data for patients with CF was determined. RESULTS: In total, 186 temporal bones and paranasal sinuses from 93 adult patients were assessed through evaluation of CT scans. Tha patients had a mean age of 43.4 +/- 14.9 yrs. The interobserver correlation for TB scoring was 0.86. TBP did not differ between CF, CRS and controls (chi(2) = 6.93, p = 0.38). PSP was less in the CF group (chi(2) = 34.2, p < 0.001) than the CRS and control groups. CRS and controls did not differ in PSP. 51.6% of CF patients were homozygous for DeltaF508 and 16.1% were heterozygous. The DeltaF508 status correlated with poorer SP (chi(2) = 34.2, p < 0.001), but greater TBP (chi(2) = 14.9, p = 0.002) CONCLUSIONS: PSP is impaired in CF and DeltaF508 homozygosity is related to poor PSP. TBP is well preserved in the CF population and DeltaF508 homozygosity correlates with greater TBP, with the underlying mechanisms being unclear. Genotype might play a role in skull base pneumatization.

Local IgE production in nonatopic nasal polyposis.

INTRODUCTION: Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents an eosinophilic T-helper 2 inflammatory response. Local production of IgE within nasal polyps (NPs) has been demonstrated, suggesting a role for local IgE in the pathogenesis of NP in atopic CRS patients. We hypothesized that local IgE specific to inhalant allergens may also play a role in the genesis of NP in nonatopic CRS patients. METHODS: Sinus and inferior turbinate tissue was obtained from nonatopic CRSwNP patients (n = 7), chronic rhinosinusitis without nasal polyps (CRSsNP) patients (n = 15), and healthy controls (n = 9) at the time of surgery. ImmunoCAP analysis (Phadia AB, Portage, MI) for 14 common inhalant antigens was performed on tissue homogenates to determine the antigen-specific response. RESULTS: Total IgE levels did not differ in sinus or turbinate tissue between CRSwNP, CRSsNP, or control patients. CRSwNP sinus tissue had higher levels of specific IgE for cockroach and plantain (p = .03) than other groups and elevated Alternaria IgE levels when compared with CRSsNP sinus tissue (p < .05). No significant differences were found for any of the other antigen-specific IgE levels. Fifty-seven percent of CRSwNP polyps demonstrated a polyclonal IgE response, whereas the other 43% had no demonstrable antigen-specific IgE. In contrast, only 17% of CRSsNP patients demonstrated a polyclonal response within sinus tissue, whereas 67% had no detectable antigen-specific IgE. There was no significant difference in levels of IgE in inferior turbinate tissue between the groups (p > .05). CONCLUSIONS: Localized mucosal IgE specific to common inhalant allergens appears to play a role in a subset of CRSwNP patients without evidence of systemic atopy.

Local production of antigen-specific IgE in different anatomic subsites of allergic fungal rhinosinusitis patients.

OBJECTIVE: Local production of antigen-specific IgE in allergic fungal rhinosinusitis (AFRS) is likely integral to the expression of allergy. This study examines if there are anatomic variations in local IgE expression or if variations among fungal and nonfungal IgE exist. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Specimens from 11 AFRS, 8 chronic rhinosinusitis without nasal polyps (CRSsNP), and 9 control patients underwent immunohistochemical localization for IgE and evaluation for antigen-specific IgE by ImmunoCAP testing. RESULTS: Inferior turbinate (IT) epithelium had greater IgE staining in AFRS than control (P=0.013) and CRSsNP (P=0.002). A significant difference was also found at the IT subepithelial level for AFRS compared with controls (P=0.001) and CRSsNP (P<0.001). Within AFRS, IgE staining was increased in the subepithelium compared to epithelium (P=0.003). ImmunoCAP analysis on IT tissue from AFRS and controls demonstrated increased antigen-specific IgE for 5 of 14 antigens (P<0.05) and total IgE (P<0.001). There were no significant anatomic differences between IT and sinus IgE staining. CONCLUSION: More fungal and nonfungal IgE is expressed in IT and sinus tissues of AFRS patients, as compared with control and CRSsNP patients.

Localized immunoglobulin E expression in allergic rhinitis and nasal polyposis.

PURPOSE OF REVIEW: This article reviews recent literature on local tissue identification of immunoglobulin E (IgE) in various sinonasal inflammatory conditions. Discussions of local IgE expression in allergic and nonallergic rhinitis, atopic and nonatopic sinonasal polyposis, and allergic fungal rhinosinusitis are included. RECENT FINDINGS: Increased levels of IgE and positive reactivity on nasal allergen provocation tests have been demonstrated in nasal lavage fluid of patients with negative systemic allergy testing. In addition, elevated levels of Alternaria alternata-specific IgE have been identified in nasal polyp patients; this is hypothesized as a contributory factor in the development of nasal polyposis. Further evidence supports the role of local IgE to Staphylococcus aureus superantigens in atopic and nonatopic nasal polyposis. Finally, local IgE specific for a range of antigens has been identified in sinus and inferior turbinate tissue in patients with allergic fungal rhinosinusitis. SUMMARY: Increased levels of IgE have been identified in sinonasal tissues in allergic and nonallergic rhinitis, atopic and nonatopic sinonasal polyposis, and allergic fungal rhinosinusitis. The ability to identify local tissue IgE in inflammatory sinonasal disease states may have significant diagnostic and therapeutic implications.

Antigen-specific IgE in sinus mucosa of allergic fungal rhinosinusitis patients.

BACKGROUND: Local tissue production of antigen-specific immunoglobulin E (IgE) has been shown in patients with allergic rhinitis and in patients with chronic rhinosinusitis (CRS) with nasal polyps. In allergic fungal rhinosinusitis (AFRS), specific IgE has been established in nasal lavage fluid and eosinophilic mucin. In this study, local production of antigen-specific IgE within sinus mucosa of AFRS patients was evaluated. METHODS: Sinus mucosa homogenates from 11 AFRS patients, 8 patients with CRS without nasal polyps (CRSsNP), and 9 nonrhinosinusitis control patients were assessed for IgE localization by immunohistochemistry. AFRS and control tissue homogenates were also evaluated for antigen-specific IgE to 14 common antigens by ImmunoCAP testing (Phadia AB, Portage, MI). RESULTS: There was a significant increase in IgE staining in AFRS sinus epithelium and subepithelium compared with controls and with patients with CRSsNP (p

The delta F508 mutation in cystic fibrosis and impact on sinus development.

BACKGROUND: Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. METHODS: This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients > or =18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. RESULTS: Forty-five patients were identified with an average age of 32 years (range, 18-48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). CONCLUSION: CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.