Nasal nitric oxide concentration in paranasal sinus inflammatory diseases

Abstract

In normal upper airways, nitric oxide is generated by the paranasal sinus epithelium and then diffuses into the nasal cavities. This study examined whether or not nasal NO concentration is affected by paranasal sinus inflammatory diseases.The influence of obstruction (nasal polyposis) and/or inflammation (allergy or chronic sinusitis) of the paranasal sinuses on nasal NO concentration was evaluated in nasal allergic (n=7 patients) or nonallergic (n=20) polyposis, nonallergic chronic sinusitis (n=10) and Kartagener's syndrome (n=6) and compared with control subjects (n=42). A score of alteration of the paranasal sinus (number of altered and occluded sinuses) was determined by a computed tomography scan.The nasal NO concentration in nasal nonallergic polyposis (15020 parts per billion (ppb)) was significantly decreased compared with both controls (2236 ppb, p=0.01) and polyposis with allergy (27228 ppb, p<0.0001). In each group, the nasal NO concentration was inversely correlated with the extent of tomodensitometric alteration of the paranasal sinuses. In Kartagener's syndrome, the nasal NO concentration (142 ppb) was drastically decreased compared with all other groups, despite the presence of open paranasal sinuses.Thus, the nasal NO concentration in patients with nasal polyposis appeared to be dependent on both the allergic status and the degree of obstruction of the paranasal sinuses. Eur Respir J 1999; 13: 307±312. The discovery that mammalian cells generate nitric oxide, a free radical gas previously considered merely as an atmospheric pollutant, is providing important information about many biological processes. NO is generated from arginine by a family of enzymes, the NO synthases (NOS), and acts as an autocrine and paracrine messenger [1,2]. NO also plays a major role in nonspecific host defence as a result of its antiviral and antibacterial properties. Type II NOS, initially characterized in the rodent macrophage, has been shown to be expressed only after induction by pro-inflammatory cytokines or bacterial lipopolysaccharide [1]. This isoform can be expressed by most cells involved in inflammation and is also called inducible NOS [3].Recently, LUNDBERG and coworkers [4±6] have clearly shown that most of the NO in the exhaled air of healthy subjects originates from the upper respiratory tract, with only a minor contribution from the lower airways. A type II NOS, mainly expressed in the epithelium of the paranasal sinuses, would account for most of this NO production [6]. Thus, NO could play a critical role in the physiology and pathology of the upper respiratory tract because, in addition to its role in immunity and host defence [3], NO stimulates ciliary motility [7]. Interestingly, LUNDBERG et al. [8] showed that patients with Kartagener's syndrome (referred to as an immobile cilia syndrome and characterized by situs inversus, sinusitis and bronchiectasis) had very low nasal NO concentrations. The present authors [9] and others [10] have recently shown that the nasal NO concentration in patie...

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

“…We found an inverse correlation between nNO levels and CT scores in our study, and the nNO levels were the lowest in patients with severe sinus pathology as evidenced by complete sinus opacification on CT scans. This inverse correlation which is in accordance with studies by Ragab et al [27] and Arnal et al [31] suggests that the nNO levels may be of some value for evaluation of sinus pathology and to screen patients for sinus ostium patency as well as possible defects in mucociliary clearance.…”

“…Lindberg et al [25] made no distinction between chronic rhino-sinusitis with or without polyps and had nNO significantly lower compared to healthy controls. Whereas in a study by Arnal et al [31] nNO was not significantly lowered in the chronic sinusitis group, though in the nonallergic polyposis group it was significantly lowered and in both groups there was an inverse correlation of nNO levels with the extent of CT scan alterations. Arnal et al also reported that in the group with Kartagener's syndrome, the nNO concentration (13.1 ppb) was dramatically decreased compared with all other groups.…”

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

“…A great deal of NO is produced in the sinuses [5], but the contribution of sinus NO to that found in the nasal cavity is somewhat unclear. Some authors have claimed that sinus NO is the major source of nasal NO [5,20,21], while others believe the contribution from the sinuses is of minor importance [22]. In the present study, silent nasal NO output was between 5-50% lower immediately after repeated humming.…”

Measurement of Nasal Nitric Oxide Is Useful for the Diagnosis of Sinusitis-Induced Prolonged Cough

“…An important role of ostial patency in nNO concentration was suggested in a study by Bommarito et al (2008), who reported that levels of nNO in chronic rhinosinusitis with polyps were significantly lower than those in chronic rhinosinusitis without polyps. In nasal polyposis, the nNO concentration was inversely correlated with the number of occluded sinuses (Arnal et al 1999). Thus, measurement of nNO may be useful in the investigation of prolonged cough etiologies and could be a useful method for identifying sinusitis-induced cough.…”

“…These findings are consistent with previous reports on nNO levels in sinusitis. In acute or chronic sinusitis, levels of nNO have been reported to be reduced, compared with healthy controls (Baraldi et al 1997;Lindberg et al 1997;Deja et al 2003); however, other studies have not confirmed this (Arnal et al 1999;Lundberg et al 2003;Wodehouse et al 2003). Treatment of sinusitis with antibiotics restored decreased nNO levels in children (Baraldi et al 1997) and adults (Degano et al 2005).…”