Imaging tests identify role of allergies in chronic sinus disease

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 sinus disease, according to a report in the December issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

Chronic disease of the maxillary sinus (the sinus cavity located in the mid-face beneath the cheeks, on either side of the nose) is common and affects a wide population of adults and children, according to background information in the article. "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," the author writes. "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."

Zdenek Pelikan, M.D., Ph.D., of Allergy Research Foundation, Breda, the Netherlands, studied 71 patients with chronic maxillary sinus disease and 16 control individuals with allergic rhinitis but no history of sinus disease. The patients with sinus disease underwent a total of 135 nasal provocation tests, in which allergens were applied to the linings of their nasal cavities, and 71 control challenges in which only phosphate-buffered saline was applied. In the control patients, 16 positive nasal provocation tests were repeated. Before and repeatedly after these tests and challenges, images were taken of the maxillary sinuses using both radiography (X-rays) and ultrasonography. Changes to the skeleton, air fluid level, thickening of the mucus membrane in the sinus and other parameters were noted.

Of the 71 patients with sinusitis, 67 developed 104 positive nasal responses to the provocation tests. Of these, 89 were accompanied by significant changes to the maxillary sinus on radiographs and 83 were also associated with significant changes on ultrasonograms. No significant changes on radiographs or ultrasonograms were noted during the 71 saline control tests on patients with sinus disease, or during the 16 nasal provocation tests conducted on control patients without sinus disease.

"The possible involvement of allergy, and especially of nasal allergy, in some forms of sinus disease has already been reported in the literature," the author writes. "There are a number of anatomic and physiologic similarities between the nasal mucosa and mucosa of the maxillary sinuses." The maxillary sinuses open into the nasal canal through a valve known as the ostium. If mucus membranes in the nasal cavity are swollen, the ostium can become blocked, trapping fluids in the sinus.

"In conclusion, nasal allergy may be involved in chronic disease of the maxillary sinuses in some patients," the author concludes. "Nasal challenge with allergen combined with ultrasonography and, if necessary, also with one of the radiographic imaging methods may be a useful supplement for the diagnosis of this disorder in the clinical practice, especially in children. The confirmation of involvement of nasal allergy in patients with chronic disease of the maxillary sinuses would indicate an additional treatment of the nasal allergy."
-end-
(Arch Otolaryngol Head Neck Surg. 2009;135[12]:1246-1255. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

The JAMA Network Journals

Related Chronic Disease Articles from Brightsurf:

How to ensure patients manage their chronic kidney disease
A Singapore study finds patients with chronic kidney disease need tailored nutrition guidance, as well as better communication with doctors and family support, to empower them to manage their condition.

COVID-19 a double blow for chronic disease patients
The COVID-19 pandemic has escalated into a 'syndemic' for people with chronic illnesses, a new UNSW study analysing data from low and middle-income countries shows.

Children with chronic kidney disease have outsized health burden
Chronically ill children with kidney disease may spend more time in the hospital, incur larger health care costs and have a higher risk of death compared to pediatric patients hospitalized for other chronic conditions, a new study suggests.

Your neighborhood may raise your risk of chronic kidney disease
A neighborhood's overall socioeconomic status, including income and education-level, may influence its residents' risk of chronic kidney disease, according to a study recently published in SSM Population Health by researchers from Drexel University's Dornsife School of Public Health.

Antioxidant agent may prevent chronic kidney disease and Parkinson's disease
Researchers from Osaka University developed a novel dietary silicon-based antioxidant agent with renoprotective and neuroprotective effects.

Chronic disease prevention could ease opioid crisis
Preventing chronic disease could help curb the opioid epidemic, according to research from the University of Georgia.

New study provides insight into chronic kidney disease
Researchers have further analyzed a known signaling pathway they believe brings them one step closer to understanding the complex physiology of patients with chronic kidney disease (CKD), which might provide a path to new treatment options.

Predicting risk of chronic kidney disease
Data from about 5 million people (with and without diabetes) in 28 countries were used to develop equations to help identify people at increased five-year risk of chronic kidney disease, defined as reduced estimated glomerular filtration rate (eGFR).

Milk and dairy products can help prevent chronic disease
Ángel Gil, Professor of Biochemistry and Molecular Biology at the University of Granada, has recently coordinated a study reviewing worldwide scientific literature on the role of dairy products in health and in the prevention of chronic diseases (cardiovascular, metabolic syndrome, colon or bladder cancer, and type 2 diabetes).

Digital health must be reimbursed to cope with chronic disease
Sophia Antipolis, 28 March 2019: Health systems must reimburse digital health and integrate it into routine care to cope with chronic disease.

Read More: Chronic Disease News and Chronic Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.