Radiation-Induced Rhinitis: Cytological and Olfactory Changes

Abstract

Background Oral mucositis is a well-known adverse event of radiotherapy (RT) for head and neck cancer (HNC). Its nasal counterpart, the radiation-induced rhinitis, is poorly studied and considered in clinical practice. Objective The aim of this observational study was to evaluate acute cytological and olfactory alterations during RT and their correlation with RT doses. Methods Ten patients who underwent RT for HNC, excluding tumors of the nasal cavities, were evaluated with nasal scraping for cytological examination, Sniffin’ Sticks test for olfactory assessment, and Nasal Obstruction Symptom Evaluation scale. The examinations were performed before (T0), at mid-course (T1), and at the end (T2) of RT. They were repeated 1 and 3 months after RT (T3 and T4). Mean dose (Dmean) and near maximum dose (D2%) to nasal cavities and inferior turbinates were used for correlation analyses. Results Radiation-induced rhinitis was present in 70% of patients at T2, and it was still observed in 40% of cases after 3 months. Although olfactory function remained within the normal range at the evaluated times, a significant decrease in odor threshold and discrimination was observed during RT, which returned to baseline levels after RT. Nasal cytology showed a radiation-induced rhinitis with neutrophils and sometimes bacteria. Mucous and squamous cell metaplasia appeared in 10% of patients. Dmean and D2% to inferior turbinates were associated to neutrophilic rhinitis at T2, and D2% to inferior turbinates was correlated to mucous cell metaplasia at T2. Conclusions RT for HNC induces acute rhinitis that may persist after the completion of treatment and can affect patient’s quality of life. Nasal cytology can help to choose the best treatment on an individual basis.

Post-Irradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Proton Therapy

“…In the treatment of NPC, the radiation volume covers the nasopharynx, posterior nasal cavity, skull base, sphenoid sinus, posterior parts of the ethmoid and maxillary sinus, oropharynx, and upper neck [ 9 ]. Although the paranasal sinuses are usually not considered to be radiosensitive tissues according to the literature regarding tolerance doses for organs in the head and neck region [ 10 ], increasing evidence observed the irreversible damage to the epithelial lining by irradiation [ 11 , 12 , 13 , 14 , 15 , 16 ]. Nasal cytology analysis demonstrated a higher percentage of neutrophilic inflammation, squamous cell metaplasia, and mucous cell metaplasia in treated patients [ 13 , 14 ].…”

“…Although the paranasal sinuses are usually not considered to be radiosensitive tissues according to the literature regarding tolerance doses for organs in the head and neck region [ 10 ], increasing evidence observed the irreversible damage to the epithelial lining by irradiation [ 11 , 12 , 13 , 14 , 15 , 16 ]. Nasal cytology analysis demonstrated a higher percentage of neutrophilic inflammation, squamous cell metaplasia, and mucous cell metaplasia in treated patients [ 13 , 14 ]. Radiation therapy causes sinonasal epithelial cells to become degenerative and more prone to desquamation and ciliary dysfunction [ 16 ].…”

Dosimetric parameters predict radiation-induced choanal stenosis in patients with nasopharyngeal carcinoma

“…In literrature, there was merely one study directly reporting the correlation between radiation dose and nasal mucositis. Riva et al discovered that elevated Dmean and D2 were associated with a higher incidence of nasal mucositis [15]. But the severity was not discussed in that study.…”

Nasal Cytology in Radiofrequency Turbinate Volume Reduction

“…In our study, we used a noninvasive method to evaluate mucosal changes in patients who underwent RFTVR. Nasal cytology is a low-cost method, and it is already a currently used tool for the diagnosis of AR and NAR and other pathological alterations of nasal mucosa [11,[13][14][15][16]. To our knowledge, this is the first study evaluating cytological changes after RFTVR, taking into consideration different types of rhinitis and focusing on inflammatory infiltrate of the mucosa.…”