الفهرس 
Radiological diagnosis of chronic rhinosinusitis.Only 14 pages are availabe for public view
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Abstract
In this prospective study 25 CRS adult patients were enrolled. All patients were scheduled for functional endoscopic sinus surgery (FESS) after failure of medical treatment. The study population included 18 males and 7 females with an age raging between 25-66 y and a mean of 34.1y. The diagnosis of chronic rhinosinusitis in these patients was done according to the definition of the consensus report of rhinosinusitis task force group (Lanza 1997). Eligibility criteria for the study included: complaints, symptoms and signs of rhinosinusitis lasting for at least 3 months with typical nasal endoscopic findings confirmed with soft tissue involvement of the paranasal sinuses on the CT scan. No patients with cystic fibrosis, primary ciliary dyskinesia, recognised immunodeficiency or other systemic diseases that can affect the upper and lower airways were included. Also no systemic medications were allowed one month before the study except for asthma medications in cases of asthma .Preoperative CRS assessment, examinations and CT assessments were performed using standard scoring systems. Also pulmonary assessments using pulmonary function tests and bronchial provocation tests were done. Intraoperative specimens collections under aseptic precautions were performed before FESS. Nasal vestibular swabs, BAL, middle meatal lavages and swabs were obtained for bacteriological, mycological and cellular examination. FESS was performed with recording of the surgical scores and all the pathological specimens were subjected to H&E and GMS staining. In this study lower airways involvement was identified in 60% of adult chronic rhinosinusitis. Different kinds of lower airways involvement were present in chronic rhinosinusitis. Some are manifest such as asthma others are non-manifest such as SAD and bronchial hyperactivity .Different inflammatory cells in the nasal secretions of CRS patient with different manners of lower airways interactions were identified. In asthma eosinophils were the predominant cells in the upper airways .Its suggested interactions with the lower airways are through its mediators and toxic products. These mediators were suggested to produce inflammations in the lower airways through its passage directly to the lower airways or through the blood. On the other hand in CRS with SAD, the predominant cells in MML nasal mucus were neutrophils. Through its toxic products, it can affect cartilage devoid small airways bypassing directly through the respiratory passage or through its blood absorption. Both eosinophils in asthma and neutrophils of SAD correlated with lower airways obstructive pulmonary function changes. On the other hand their existed no significant correlation between the upper and lower airways cellular changes.In 92% of CRS no associated lower airways bacterial cultures could be identified. Aerobic gram positive bacteria were the most common cultured bacteria in CRS. Coagulase negative staph were the most common cultured bacteria in lower airways involvement subgroups. In SAD mixed infection of gram positive and anaerobic bacteria with associated neutrophilic inflammation were the main findings. Conversely in asthma the role of bacterial colonisation without neutrophilic inflammation were more apparent. Regarding fungal cultures, positive middle meatal cultures were obtained in 44% of all CRS cases. AFRS were retrieved in 16% of the cases and 75% of these cases had asthma. According to deChazo (1995) criteria of diagnosis of AFRS, 16% of our cases had AFRS. So for proper diagnosis of fungal relation to CRS especially in AFRS, the middle meatal fungal load together with identification the fungi (the genus and if possible the species) are important determinant. Nasal cavity lavages are not adequate procedure for sampling and diagnosis. Instead middle meatal samples can be considered with more advantages. Another manner of fungal rhinosinusitis was fungal balls with 8% incidence rate. The two cases of fungal balls had SAD with positive cultured fungal balls and negative middle meatal cultures. Functional endoscopic sinus surgery was performed in all the cases.The extention of the surgery was not proportional to the CT scan scores . Little differences in the operative score was observed between different lower airways involvement subgroups.