COMPARISON OF CT SCAN AND ELECTRON-MICROSCOPIC FINDINGS ON ENDOSCOPICALLY HARVESTED MIDDLE TURBINATES

CT scans of eight nonsmoking patients with chronic sinusitis and two c ontrols were graded for their disease severity (from 0 to IV) with the classification system proposed by May, Subsequently, endoscopically h arvested middle turbinate specimens from these patients (16 diseased t urbinates, 4 controls) were evaluated both by scanning and by transmis sion electron microscopy. As the severity of the disease increased as demonstrated by CT scan, electron microscopy of 5 x 3 x 0.05 mm mucosa l specimens demonstrated that the number of ciliated cells decreased w hereas the number of goblet and squamous cells increased, As the disea se progressed to stages III and IV scanning and transmission electron microscopy demonstrated areas of squamous metaplasia and areas complet ely denuded of epithelium. The increased goblet cell population, the l oss of cilia and ciliated cells, and the patches of denuded epithelium may account for the recurrent bacterial infections and chronic nasal drainage seen in patients with chronic sinusitis. The extensive mucosa l changes that occur in grade III and IV disease are similar to those occurring in cigarette smokers, and it takes years to recover after di scontinuation of smoking. Delayed recovery of the mucosal epithelium m ay account for both the recurrent infections and the slower response t o treatment on the part of patients with extensive grade ill and IV ch anges on the CT scan.