Chronic rhinosinusitis: is the nose really involved?

To determine whether chronic rhinitis usually accompanies chronic sinusitis, and critically examine the concept of chronic rhinosinusitis, paired specimens of nasal septal mucosa and ethmoid sinus mucosa were obtained in a prospective cohort of 42 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. The histopathological degree of inflammation for each specimen was scored using a five-point rating scale. Cell counts for eosinophils and inflammatory cells per high-power field (HPF) were determined. Mean patient age was 40.5 years and mean Lund score was 9.3. The inflammation grade of the septal mucosa was within one point of the ethmoid mucosa in 36 (85.7%) cases, and correlated exactly in 24 patients (57.1%). A statistically significant correlation was found between septal and ethmoid mucosa inflammation grades (p = 0.048). No significant difference in mean non-eosinophilic inflammatory cell count per HPF was noted betmeen ethmoid mucosa and septal mucosa (48.2 versus 54.3 cells/HPF, p = 0.061, power = 0.873). Ethmoid mucosa had a significantly higher mean eosinophil count than septal mucosa (6.6 versus 1.9 cells/HPF, p < 0.001). For combined inflammatoty cell counts, no significant difference in cell counts was noted (54. 7 cells/HPF ethmoid versus 56.1 septal, p = 0.670, power = 0.847). Histopathologic evidence of rhinitis is associated with chronic sinusitis. This supports the concept of rhinosinusitis rather than sinusitis alone. Eosinophils are found in significantly higher numbers in sinus mucosa than in nasal mucosa, suggesting a site-specific role in rhinosinusitis.