Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Am J Rhinol Allergy. 2011 Nov-Dec;25(6):401-3. doi: 10.2500/ajra.2011.25.3672.
It is universally accepted that osteomeatal complex (OMC) disease is linked to the subsequent development of chronic rhinosinusitis without nasal polyps (CRSsNPs) via postobstructive mechanisms. The role of OMC obstruction in the pathogenesis of CRSwNPs is less clear. This study was designed to identify if there is an association between OMC obstruction and inflammation of the adjacent sinuses, when patients are stratified by polyp status. This is a follow-up and expanded series of a previous pilot study from our group.
CT scans of 144 patients with CRSsNPs and 123 patients with CRS with nasal polyps (CRSwNPs) were evaluated for each sinus and OMC. Patients had no previous surgeries for NPs. CT scans were obtained after a trial of maximal medical therapy.
Increasing OMC involvement was associated with increasing Lund-Mackay score for both CRSsNPs and CRSwNPs. In CRSsNP patients, OMC status significantly correlated with adjacent sinus status (p << 0.0001). Meanwhile in CRSwNPs, OMC status does not correlate with adjacent sinus status (p = 0.328).
OMC obstruction in the setting of CRSwNP may be a barometer of the overall disease process, but in this scenario, paranasal sinus inflammation can not be classified as a postobstructive phenomenon. These findings question the role of minimally invasive procedures in the management of CRSwNPs.
普遍认为，通过阻塞后机制，骨气房复合体（OMC）疾病与随后发生的无鼻息肉慢性鼻-鼻窦炎（CRSsNPs）有关。OMC 阻塞在有鼻息肉的慢性鼻-鼻窦炎（CRSwNPs）发病机制中的作用尚不清楚。本研究旨在确定当患者按息肉状态分层时，OMC 阻塞与相邻鼻窦炎症之间是否存在关联。这是我们小组之前的一项试点研究的后续和扩展系列。
对 144 例 CRSsNPs 患者和 123 例 CRSwNPs 患者的 CT 扫描进行了评估，评估了每个鼻窦和 OMC。患者没有接受过 NP 的手术治疗。CT 扫描是在最大药物治疗试验后获得的。
OMC 受累程度的增加与 CRSsNPs 和 CRSwNPs 的 Lund-Mackay 评分的增加相关。在 CRSsNP 患者中，OMC 状态与相邻鼻窦状态显著相关（p<<0.0001）。而在 CRSwNPs 中，OMC 状态与相邻鼻窦状态无关（p=0.328）。
CRSwNP 中 OMC 阻塞可能是整个疾病过程的晴雨表，但在这种情况下，鼻窦炎症不能归类为阻塞后现象。这些发现质疑了微创程序在 CRSwNPs 管理中的作用。
