Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Abstract

Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.

Nasal nitric oxide as a marker of sinus mucosal health in patients with nasal polyposis

“…This suggests that patients with more severe sinus disease had lower nNO levels. This is consistent with 2 prior studies that also showed a negative correlation between nNO and disease severity on CT . In contrast, there was no correlation between the baseline nNO and SNOT‐22 score.…”

Monitoring of Chronic Sinusitis Using Nasal Nitric Oxide as a Marker of Sinus Health: A Systematic Review

“…The lack of NO may play a role in the pathogenesis of this disease, so this change in nNO amount can be easily measured and provides a valuable non-invasive marker for chronic rhinosinusitis. Overall, significantly lower levels of Nasal NO were reported in the patients with chronic rhinosinusitis (CRS) (irrespective of nasal polyps or allergic 18 indicated that, the lack of nNO is attributed to the pathogenesis of chronic rhinosinusitis. Furthermore, Bommarito, et al 19 and Liu, et al 13 stated that nNO levels were significantly lower in patients with CRSwNP than that in patients with CRSsNP and controls, these significant differences in the nNO levels have been used to distinguish between chronic rhinosinusitis patient with nasal polyps (NP) and chronic rhinosinusitis patient without nasal polyps (NP).…”

“…In addition to that the study of Jeong, et al 17 recorded significantly lower amounts of nNO in chronic rhinosinusitis (CRS) with polyps and allergic rhinitis than controls. Dabholkar, et al 18 reported that there was no difference in levels of NO between healthy control and common cold patients, whereas nNO levels was significantly lower in patients with chronic rhinosinusitis. Bommarito, et al 19 and Liu, et al 13 postulated that nNO levels could be used as marker to distinguish between chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP).…”

“…The search on the monitoring of chronic sinusitis using nasal Nitric oxide (nNO) as marker of sinus health resulted in 97 articles, of them 81 articles were irrelevant and six articles were reviews. The included studies in this review were 10 studies [14][15][16][17][18][19][20][22][23][24] . Overall sample size ranged between 12 to 187 patients.…”

Computed tomographic pulmonary changes in patients with chronic rhinosinusitis

“…[20][21][22][23] On the other hand, researchers have reached consensus on the role of nitric oxide (NO), given the direct links between low exhaled NO levels and clinical status deterioration and imaging findings. 24,25 Given that NO appears to be crucial for the optimal functioning of the mucociliary system, 26 we might interpret the observed lung abnormalities in patients with CRS as arising from dysfunctional ciliary status.…”