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Relationship of Computed Tomographic Findings to Allergy, Asthma, and Eosinophilia

Leslie J. Newman, MD; Thomas A. E. Platts-Mills, MD, PhD; C. Douglas Phillips, MD; Kevin C. Hazen, PhD; Charles W. Gross, MD

JAMA. 1994;271(5):363-367.

Abstract
Objective.
—To develop a technique for evaluating the severity of chronic sinus disease and to examine the correlation with allergy, asthma, and eosinophilia.

Design.
—A survey of 104 patients undergoing surgery for chronic sinusitis.

Setting.
—A university hospital ear, nose, and throat clinic.

Patients.
—A referral population of adult patients being scheduled for endoscopic sinus surgery was eligible; 104 completed questionnaires and agreed to participate.

Main Outcome Measures.
—Computed tomographic scans were reviewed and scored for extent of disease. Serum samples were assayed for total IgE and specific IgE antibodies to common inhalant allergens. Peripheral blood samples were analyzed for total eosinophil count. Surgical biopsy specimens were examined for eosinophilia and cultured for bacteria and fungi.

Results.
—Extensive disease was present in 39% of subjects and correlated well with asthma, specific IgE antibodies, and eosinophilia, but not with elevated total IgE. Among patients with peripheral eosinophilia, 87% had extensive disease. All cultures grew aerobic bacteria; anaerobes and fungi were uncommon.

Conclusions.
—We present a system for quantitation of disease extent using computed tomographic scans of patients with chronic sinusitis. The well-accepted associations of chronic sinusitis with asthma and allergy appear to be restricted to the group with extensive disease. The presence of peripheral eosinophilia in patients with sinusitis indicates a high likelihood of extensive disease.

(JAMA. 1994;271:363-367)

Author Affiliations
From the Departments of Medicine (Drs Newman and Platts-Mills), Radiology (Dr Phillips), Pathology (Dr Hazen), and Otolaryngology (Dr Gross), University of Virginia Health Sciences Center, Charlottesville.

Footnotes
Reprint requests to Division of Allergy and Clinical Immunology, University of Virginia, Box 225, Charlottesville, VA 22908 (Dr Platts-Mills).

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