Abstract
Study type
Prospective and observational study.
Methods
The study group was divided in two groups consisted of 50 normal subjects (100 meati) and 50 patients (100 meati) of chronic rhinosinusitis (CRS). All subjects underwent nasal endoscopy along with measurement of the pH of the middle meatus using a portable pH monitoring device. Statistical analysis was done to compare mean pH of normal middle meatus with the diseased one.
Results
The mean pH of normal 100 middle meati was measured to be 7.35(± 0.82). The mean pH of 100 middle meatii in CRS patients was higher 7.81(± 0.83) and was found to be statistically significant ( p = 0.00011).
Conclusion
Alkaline pH (7.81) was observed in the middle meatus of CRS patients.
1
Introduction
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases with a prevalence of as high as 15% of the population and believed to be increasing in both incidence and prevalence . According to AAO-HNS, persistent symptomatic inflammation of the nasal and sinus mucosa, fluids within these cavities, and/or underlying bone is defined as CRS . Diagnosis is made by the presence of nasal obstruction, discharge, purulence, post-nasal drip and associated facial pressure and pain for more than 12 weeks .
The inciting initial insult can be infection, allergy, anatomical causes or combination of these, leading to inflammation of the sinonasal mucosa, ostial obstruction and mucus stasis. Edema can appear in both acid and alkaline reactions leading to ciliostasis which is a known cause for development of CRS . Recently, beneficial effects of anti-reflux medication in CRS refractory to appropriate medical therapy have indicated gastro-esophageal reflux as a possible etiological factor for CRS .
It was observed that there was a drop in nasopharyngeal pH which was more frequent in number and longer in duration in patient group suffering from chronic rhinopharyngitis without any obvious underlying cause like allergy, infected adenoids, nasal deformities etc . DelGaudio further demonstrated that cases of refractory chronic rhinosinusitis have more reflux at nasopharynx and upper and distal esophagus as compared with control group.
Treatment of reflux leads to the improvement of symptoms of CRS refractory to medical management, which has been substantiated by many studies . However, the mechanism by which reflux may affect the nose and paranasal sinuses still remains unclear. It is doubtful that gastric contents reflux into the sinuses via natural ostia. It would be more likely that refluxate could reach the nasopharynx and the posterior nasal passage. The acidity may induce the nasal mucosal edema and inflammation and secondarily obstruct the ostia. Another possible mechanism may be reflux-induced autonomic nervous system hyperactivity, causing nasal edema and obstruction much like the patient with vasomotor rhinitis .
However, the literature establishing the relationship between the pH at middle meatus and CRS is scant. The present study aims to determine the normal range of pH of middle meatus and explore any change in cases of chronic rhinosinusits.
2
Methods
A prospective study was conducted in the tertiary care center, between August 2011 and April 2013. All patients of CRS, aged 15–60 years, admitted for FESS were included in the study. Diagnostic criteria were either two major or one major and two minor symptoms described by Rhinosinusitis Task Force, for at least 12 consecutive weeks . Cases with localized infection or acute/fungal/allergic rhinosinusitis, who had taken treatment elsewhere, were excluded. Fifty normal subjects, age and sex matched, who were under-going surgeries other then nasal/ear surgeries in the department were included as controls in the study.
A detailed history was asked and the patients with symptoms of gastro-esophageal reflux were excluded in the study. All patients underwent thorough otorhinolaryngological examination. Systemic examination was also done to rule out any systemic disorder. Subsequently, blood and urine samples were drawn for routine baseline investigation. The examination findings as well as investigation data were recorded on a Performa which was approved by the ethical committee of the institute.
Informed and written consent was taken from all subjects. Hopkins rigid 0°/30° nasal endoscope under general anesthesia was introduced in the nasal cavity without putting any drug/spray. Once the probe is in the middle meatus reading was taken when constant pH value is obtained with the device (GastrograpH mark IV, SME Medizintechnik, GmbH, Germany; Fig. 1 ). Similar procedure was adopted in CRS patients who were posted for FESS before putting local decongestants. The statistical analysis was done on SPPS software.
2
Methods
A prospective study was conducted in the tertiary care center, between August 2011 and April 2013. All patients of CRS, aged 15–60 years, admitted for FESS were included in the study. Diagnostic criteria were either two major or one major and two minor symptoms described by Rhinosinusitis Task Force, for at least 12 consecutive weeks . Cases with localized infection or acute/fungal/allergic rhinosinusitis, who had taken treatment elsewhere, were excluded. Fifty normal subjects, age and sex matched, who were under-going surgeries other then nasal/ear surgeries in the department were included as controls in the study.
A detailed history was asked and the patients with symptoms of gastro-esophageal reflux were excluded in the study. All patients underwent thorough otorhinolaryngological examination. Systemic examination was also done to rule out any systemic disorder. Subsequently, blood and urine samples were drawn for routine baseline investigation. The examination findings as well as investigation data were recorded on a Performa which was approved by the ethical committee of the institute.
Informed and written consent was taken from all subjects. Hopkins rigid 0°/30° nasal endoscope under general anesthesia was introduced in the nasal cavity without putting any drug/spray. Once the probe is in the middle meatus reading was taken when constant pH value is obtained with the device (GastrograpH mark IV, SME Medizintechnik, GmbH, Germany; Fig. 1 ). Similar procedure was adopted in CRS patients who were posted for FESS before putting local decongestants. The statistical analysis was done on SPPS software.
