Significance of computerized tomography and nasal cytology in the diagnosis of rhinosinusitis among asthmatic children

Abstract

Background: Chronic sinusitis, allergic rhinitis, and asthma are conditions that frequently coexist. Nasal sinus disease may contribute to poor control of asthma; this suggests that sinonasal involvement might be a risk factor for asthma severity and morbidity. Proposed mechanisms of this interaction include the presence of postnasal drip, nasobronchial reflex or systemic effect of mediators released from inflamed paranasal sinus tissue. Objective: In the present study, we sought to investigate the relationship of sinonasal inflammation as assessed by coronal sinus computerized tomography (CT) scanning, nasal cytology score, and asthma severity. Methods: Twenty-five children with asthma were recruited from the Pediatric Respiratory Clinic of Ain Shams University. Their ages ranged from 5-13 years with a mean age of 7.78 years. Twenty healthy children who were age- and sex-matched and who had normal sinus CT scans were selected as the control group. Patients were subjected to asthma severity assessment, nasal cytology, total serum IgE assay, and paranasal CT scanning and scoring. Results: Sinus CT scoring showed abnormalities in 88% of asthmatic children, and sinus CT scores correlated positively to asthma severity. Nasal cytology scores for eosinophils and neutrophils correlated positively with sinus CT scores. The most frequent symptoms associated with sinusitis were rhinorrhea (68%) and nasal obstruction (40%). The maxillary sinus was the most frequently affected one followed by the ethmoid sinus. Pathological features included mucosal thickening, osteomeatal complex occlusion, and polyp formation. Conclusion: Computed tomography scan is a useful diagnostic tool for assessment of sinus disease in asthmatic children. Rhinosinusitis is a common asthma comorbidity. Nasal eosinophil or neutrophil score >0.5 provides a better predictive value for rhinosinusitis compared to total serum IgE.

Keywords: computerized tomography, nasal sinus, asthma, sinusitis, allergic rhinitis, children

Egypt J Pediatr Allergy Immunol 2003; 1(2):94-101