Chronic rhinosinusitis: Allergy and sinus computed tomography relationships

The management of chronic or recurrent rhinosinusitis problems is multiface ted and should include consideration of contributory and potentially correc table medical and anatomic factors. To date, the relationship between aller gy and rhinosinusitis has not been clearly defined. The purpose of this stu dy is to improve understanding of the relative roles of perennial and seaso nal allergens in the cause of chronic rhinosinusitis. A retrospective revie w of 200 consecutive patients was carried out on patients who had chronic r hinosinusitis refractory to medical therapy and who subsequently underwent functional endoscopic sinus surgery. All of these patients had allergy test ing for common perennial and seasonal inhalant allergens before surgery. Ea ch patient had sinus CT imaging before undergoing the surgery. The CT scans of each patient were staged according to a validated, standardized grading system by investigators blinded to allergic profile. Allergy testing indic ated that 84% of all patients tested positive for allergies. Moreover, 60% of all patients had significant allergic sensitivity; 52% of all patients h ad multiple allergen sensitivities. Furthermore, there was a predominance o f perennial allergens, especially house dust mite over seasonal allergens. The vast majority of our patients undergoing functional endoscopic sinus su rgery had concomitant allergy. This study highlights the potential contribu tion of perennial allergies to the development of rhinosinusitis, Given thi s direction, future studies may reveal that in the care of patients with pe rennial allergic rhinitis, early intervention with identification of the of fending allergen(s), and subsequent treatment through avoidance, pharmacoth erapy, and/or immunotherapy may help in the prevention of recurrent and chr onic rhinosinusitis.