Reduced Nitric Oxide in Sinus Epithelium of Patients with Radiologic Maxillary Sinusitis and Sepsis

Deja, Maria; Busch, Thilo; Bachmann, S.; Riskowski, Kerstin; Câmpean, Valentina; Wiedmann, Brigitte; Schwabe, Michael; Hell, Berthold; Pfeilschifter, Josef; Falke, K. J.; Lewandowski, K.

doi:10.1164/rccm.200207-640oc

Cited by 107 publications

(84 citation statements)

References 46 publications

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“…The nNO levels are considerably higher than lower airway levels [23,24]. In contrast to the lower airways, nNO levels in patients with upper airway inflammation are rather decreased than increased when compared with healthy controls [25][26][27]. Particularly low nNO levels have been observed in patients with immotile cilia syndrome.…”

Section: Discussionmentioning

confidence: 96%

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

Dabholkar

Saberwal

Velankar

et al. 2013

Indian J Otolaryngol Head Neck Surg

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Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.

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Section: Discussionmentioning

confidence: 96%

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

Dabholkar

Saberwal

Velankar

et al. 2013

Indian J Otolaryngol Head Neck Surg

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“…This humming peak is absent in patients with chronic sinusitis and those with cystic fibrosis [91,95]. There is evidence, in both these conditions, to suggest this is secondary to decreased expression of iNOS, leading to decreased nitric oxide biosynthesis [79,84,85,96].…”

Section: Hypothesis 3: Nitric Oxide Is Trapped In the Obstructed Paramentioning

confidence: 99%

“…Increasing nasal nitric oxide levels potentially reduces nasopharyngeal carriage of pathogens, thereby reducing the risk of lower respiratory tract infection. There is case in the literature of a healthy volunteer showing that nasal application of NOS inhibitors both reduces nasal NO and leads to sinus infection [96,103].…”

Section: The Value Of Augmentation Of Nitric Oxide Levels In Pcdmentioning

confidence: 99%

Nitric oxide in primary ciliary dyskinesia

et al. 2012

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Nitric oxide is continually synthesised in the respiratory epithelium and is upregulated in response to infection or inflammation. Primary ciliary dyskinesia (PCD) is characterised by recurrent sinopulmonary infections due to impaired mucociliary clearance. Despite chronic infections, nasal nitric oxide in such patients is markedly reduced and is used as a screening test for this condition. These low levels were first described .15 yrs ago but the underlying mechanisms have yet to be fully elucidated. We review epithelial nitric oxide synthesis, release and measurement in the upper airways with particular reference to PCD. The key hypotheses that have been proposed to explain the low nitric oxide levels in this condition are explored and the potential benefits of augmenting airway nitric oxide levels are considered. Further work in these patients clarifying both whether the respiratory epithelium is able to biosynthesise normal levels of nitric oxide and the role played by abnormalities in the anatomy of the paranasal sinuses is essential. While nitric oxide augmentation is unlikely to be beneficial in common PCD phenotypes, it has potential in the treatment of secondary dyskinesias and may also improve treatment of bacterial infections, particularly where biofilms are implicated.

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms for reduced nNO in sinusitis are not yet understood. A possible explanation is reduced production of NO from the maxillary sinuses in patients with sinusitis, resulting from reduced expression of inducible NO synthase in the sinus epithelium (Deja et al 2003). Another plausible explanation is impaired passage of sinus NO into the nasal cavity via narrowed sinus ostia, induced by mucosal congestion and increased mucus secretion.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Jeong

Kwak

et al. 2011

Tohoku J. Exp. Med.

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Upper airway cough syndrome (UACS), the most common cause of prolonged cough, is diagnosed based on clinical findings without specific diagnostic test. The concentration of nitric oxide in nasal cavity air (nNO) is influenced by allergic rhinitis and/or sinusitis, both of which are common causes of UACS. We measured nNO levels in patients with UACS and those with other causes. We also examined the usefulness of measuring nNO for differentiating patients with sinusitis from those without sinusitis. The study included 93 adult patients with prolonged cough lasting more than three weeks. Etiologies of cough were identified and nNO was measured at the initial investigation. UACS was diagnosed in 58 patients (62.4%), and sinusitis was identified in 11 (19.0%) of the 58 patients with UACS. Levels of nNO in UACS did not differ from non-UACS etiologies (316.2 ± 129.2 vs. 334.9 ± 88.2 ppb; p = 0.452), suggesting that the measurement of nNO could not discriminate UACS from other etiologies of prolonged cough. However, patients with sinusitis showed significantly decreased nNO levels (190.1 ± 114.8 ppb) compared with patients with UACS without sinusitis (345.7 ± 114.6 ppb; p < 0.001) and non-UACS patients (334.9 ± 88.2 ppb; p < 0.001). In a receiver operating characteristic curve analysis for the diagnosis of sinusitis in prolonged cough, the best sensitivity (73.2%) and specificity (81.8%) were obtained with a nNO cutoff value of 279.0 ppb. These findings imply that the measurement of nNO could be useful for diagnosis of prolonged cough associated with sinusitis.

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Reduced Nitric Oxide in Sinus Epithelium of Patients with Radiologic Maxillary Sinusitis and Sepsis

Cited by 107 publications

References 46 publications

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

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

Nitric oxide in primary ciliary dyskinesia

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

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