Epithelial Shedding of the Inferior Turbinate in Perennial Allergic and Nonallergic Rhinitis

Abstract

Setting: University-affiliated hospital.Patients: Fifty-eight inferior turbinate samples were processed for histological study. Nineteen were from patients with PAR, and 20 were from patients with PNAR. Samples from 19 healthy individuals who underwent rhinoplasty for cosmetic reasons served as control specimens. Main Outcome Measures:The length of the basement membrane (BM) covered with intact epithelium, covered with a single layer of basal cells, and devoid of epithelium was measured.Results: Intact respiratory epithelium and areas of partial and complete epithelial denudation were encountered in control specimens and in samples from patients with PAR and PNAR. A significant difference was found between the 3 groups (P=.001). The proportion of the BM covered with undamaged epithelium was significantly greater in control specimens and in samples from patients with PNAR than in samples from patients with PAR; the difference between the former 2 groups was nonsignificant. Most of the epithelial damage in patients with PAR occurred between columnar and basal cells rather than between basal cells and the BM (P=.02).Conclusions: Epithelial shedding of the inferior turbinate is a genuine feature of PAR and is not an artifact of tissue sampling. The finding of greater epithelial exfoliation between basal cells and the more superficial columnar cells than between basal cells and the BM probably reflects different attachment qualities of these cells.

Radiological anatomy analysis of uncinate process, concha bullosa, and deviated septum in chronic rhinosinusitis

“…11 Alternatively, a compensatory inferior turbinate hypertrophy opposite the side of septal deviation may play a role with deviated septum towards contralateral maxillary sinusitis due to narrowing of the nasal valve, resulting in an increase in the airflow turbulence, and later causing epithelial shedding. 9,11,12 Harar et al 13 postulated that a deviated septum caused an increase in the airflow around ostiomeatal complex (OMC) causing disturbance of mucociliary clearance, while the concha bullosa narrowed the semilunar hiatus, obstructing the infundibular drainage thereby resulting in ipsilateral maxillary sinusitis. In a group of 76 subjects with sinusitis and headache predominant symptoms, Hatipoglu et al 14 found a concurrent deviated septum and concha bullosa in 44% of the cases.…”

Different types of tissue composition in inflammatory or reparative upper airway disorders

“…The first innovative observation is that tissue changes can affect nearly all types of chronic inflammatory diseases in upper airways, although with different degree of severity and many similarities with ECM changes in asthma have been observed (13,14) . In vasomotoric and allergic rhinitis, changes in tissue composition appears to be more limited (15)(16)(17) . Epithelial shedding can accompany clinical response to cold, dry air or to urban pollution (18) .…”

Evolution of patients with nonallergic rhinitis supports conversion to allergic rhinitis

“…3,6 In contrast with these results, Bachert et al 2 reported in a questionnaire survey in Belgium that patients with AR had more persistent and severe symptoms than patients with NAR. The great heterogeneity of patients with idiopathic rhinitis might explain the different clinical 2,3,6 and histologic [17][18][19][20] results. Further studies including different subsets of idiopathic rhinitis might help elucidate this question.…”