Incidence and surgery of concha bullosa in chronic rhinosinusitis

Both diagnostic and therapeutical approaches of chronic non-allergic rhinosinusitis have been considerably modified by recently developed endoscopic and radiological means of investigation. Abnormalities of the ostiomeatal complex, such as hypertrophy and pneumatization of the middle turbinate (concha bullosa), seem to be associated with recurrent infections and inflammation of both turbinoseptal and adjacent sinuses mucosa. In 151 patients suffering from chronic non-allergic rhinosinusitis, the CT scan of the rhinosinusal area confirmed the presence of a middle concha bullosa and a mucoperiostal thickening of the adjacent sinusal cavities in 35% of the cases. The surgical treatment included the resection of the anterior third of the pneumatized middle turbinate with concomitant opening of the ethmoidal bulla. This procedure was performed under local anaesthesia and endoscopic control. A marked and long-lasting improvement of the symptoms was obtained in 80% of the patients (p < 0.001). Biochemical analysis of nasal mucosa biopsies in chronic non-allergic rhinosinusitis patients revealed a higher amount of neuropeptides of sensory nerve origin than in controls (p < 0.05). The influence of sensory neuropeptide mechanisms involved in the vicious circle of chronic non-allergic rhinosinusitis is discussed.