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Nasal brushing: a clinically useful procedure in pediatric patients with rhinosinusitis?
O Sacco1, V Tarantino, S Lantero
1Pulmonary Division, Giannina Gaslini Institute, Genoa, Italy.
Insights
Nasal brushing (NB) effectively diagnoses rhinosinusitis in children, especially nonallergic cases. This method provides insights into inflammation, unlike radiography, and avoids radiation exposure for pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Allergy and Immunology
- Diagnostic Microbiology
Background:
- Sinusitis frequently complicates allergic and non-allergic rhinitis, potentially leading to lower respiratory issues like asthma.
- Standard radiography offers limited insight into the infectious or allergic causes of sinusitis.
- Infectious rhinosinusitis is prevalent in children, even those with allergies.
Purpose of the Study:
- To evaluate nasal brushing (NB) for diagnosing maxillary sinusitis in children with recurrent respiratory symptoms.
- To determine if NB neutrophil/eosinophil percentages and cultures predict radiological sinusitis.
- To differentiate diagnostic findings between nonallergic and allergic pediatric patients.
Main Methods:
- Nasal brushing (NB) was performed on 117 children with recurrent respiratory symptoms.
- NB neutrophil/eosinophil percentages and culture results were analyzed.
- NB findings were compared with radiological evidence of maxillary sinusitis.
Main Results:
- NB neutrophil percentages significantly differed between children with and without maxillary sinusitis (median 2% vs. 18%, P < 0.001) in the nonallergic group.
- In nonallergic patients, NB showed 91% sensitivity and 84% predictive value for rhinosinusitis.
- Neutrophil or eosinophil percentages in NB did not significantly correlate with sinusitis presence in allergic patients.
Conclusions:
- Nasal brushing (NB) is a reliable tool for diagnosing rhinosinusitis, particularly in nonallergic pediatric patients.
- NB reflects the current inflammatory status of upper airways, aiding in identifying infections.
- NB offers an alternative to radiography, avoiding radiation and providing etiological information.
Abstract:
Sinusitis is a common complication of non-allergic and allergic rhinitis, and can trigger lower respiratory diseases, such as bronchitis and asthma. Standard radiography is unable to give any data about the underlying pathological mechanisms (infectious or allergic) involved and infectious rhinosinusitis is very common in pediatric age, even in allergic patients. We investigated the possibility of obtaining more useful diagnostic information, performing nasal brushing (NB) on 117 children with recurrent respiratory symptoms. The following hypothesis were evaluated: (1) whether NB neutrophil/eosinophil percentages and/or NB culture could predict the radiological evidence of maxillary sinusitis; and (2) whether differences between nonallergic and allergic patients could be detected. In the total patient group and in the nonallergic group, the comparison of NB neutrophil percentages in patients with and without maxillary sinusitis showed a statistically significant difference (median 2 and 18%, respectively; P < 0.001). In the nonallergic group, a NB neutrophil rate > or = 5% was chosen as a cut-off between positive and negative NB diagnosis of rhinosinusitis and NB data were compared with radiological investigations. The results obtained showed that NB was fairly sensitive (91%) and predictive (84%). In allergic patients, neither neutrophil nor eosinophil percentages significantly correlated with the presence of sinusitis. Microbiological studies showed that, even if the presence of bacteria in NB resulted associated with sinusitis, a negative culture was not predictive of the absence of the disease. We therefore suggest that NB describes the present inflammatory status of the upper airways, hence, it is more suitable to describe the inflammation related to ongoing upper respiratory tract infections rather than chronic inflammation due to allergic rhinitis, characterized by relapsing episodes of acute inflammation. In conclusion, we propose to consider NB a reliable tool in the diagnosis of rhinosinusitis, particularly in nonallergic pediatric patients. Compared to standard radiological techniques, NB makes it possible to avoid radiation exposure and gives information about the pathological mechanisms involved in the single patient.