Neuropathology in rhinosinusitis.
Pathophysiologic differences in neural responses to hypertonic saline (HTS) were investigated in subjects with acute sinusitis (n = 25), subjects with chronic fatigue syndrome (CFS) with nonallergic rhinitis (n = 14), subjects with active allergic rhinitis (AR; n = 17), and normal (n = 20) subjects. Increasing strengths of HTS were sprayed into their nostrils at 5-minute intervals. Sensations of nasal pain, blockage, and drip increased with concentration and were significantly elevated above normal. These parallels suggested activation of similar subsets of afferent neurons. Urea and lysozyme secretion were dose dependent in all groups, suggesting that serous cell exocytosis was one source of urea after neural stimulation. Only AR and normal groups had mucin dose responses and correlations between symptoms and lysozyme secretion (R(2) = 0.12-0.23). The lysozyme dose responses may represent axon responses in these groups. The neurogenic stimulus did not alter albumin (vascular) exudation in any group. Albumin and mucin concentrations were correlated in sinusitis, suggesting that nonneurogenic factors predominated in sinusitis mucous hypersecretion. CFS had neural hypersensitivity (pain) but reduced serous cell secretion. HTS nasal provocations identified significant, unique patterns of neural and mucosal dysregulation in each rhinosinusitis syndrome.
Division of Rheumatology, Immunology and Allergy, Georgetown University, 3800 Reservoir Road, N.W., Washington, DC 20007-2197, USA. baraniuj@georgetown.edu
James N
JN
Baraniuk
Kristina Naranch
KN
Petrie
Uyenphuong
U
Le
Chih-Feng
CF
Tai
Yong-Jin
YJ
Park
Atsushi
A
Yuta
Mushtaq
M
Ali
Christopher J
CJ
Vandenbussche
Benjamin
B
Nelson
D000208:Acute Disease; D000281:Administration, Intranasal; D000328:Adult; D000418:Albumins / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000032:analysis; D009093:Mucus / Q000378:metabolism; D009113:Muramidase / Q000032:analysis; D017817:Nasal Lavage Fluid / Q000737:chemistry; D009297:Nasal Mucosa / Q000294:innervation* / Q000378:metabolism; D009299:Nasal Provocation Tests; D009475:Neurons, Afferent / Q000187:drug effects / Q000502:physiology; D010146:Pain; D012220:Rhinitis / Q000503:physiopathology*; D012462:Saline Solution, Hypertonic / Q000494:pharmacology; D012852:Sinusitis / Q000503:physiopathology*; D014508:Urea / Q000032:analysis
D000418:Albumins; D009077:Mucins; D012462:Saline Solution, Hypertonic; D014508:Urea; D009113:Muramidase