Journal of Otology & RhinologyISSN: 2324-8785

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Research Article, J Otol Rhinol Vol: 3 Issue: 5

Lymphocytic Response and Inducible Nitric Oxide Synthase in WTC-Exposed Chronic Rhinosinusitis

Charles C. L. Tong1, Nancy Jiang1, David Cannan1, Maoxin Wu2, Andrew G. Sikora1,3, and Kenneth W. Altman1*
1The Mount Sinai School of Medicine Departments of Otolaryngology-Head and Neck Surgery, New York, USA
2The Mount Sinai School of Medicine Departments of Pathology, New York, USA
3The Mount Sinai School of Medicine Departments of Clinical Immunology, New York, USA
Corresponding author : Kenneth W. Altman
Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
Tel: 212 241-5944; Fax: 212 369-5701
Received: May 29, 2014 Accepted: August 22, 2014 Published: August 25, 2014
Citation: Tong CCL, Jiang N, Cannan D, Wu M, Sikora AG, et al. (2014) Lymphocytic Response and Inducible Nitric Oxide Synthase in WTC-Exposed Chronic Rhinosinusitis. J Otol Rhinol 3:5. doi:10.4172/2324-8785.1000186


Lymphocytic Response and Inducible Nitric Oxide Synthase in WTC-Exposed Chronic Rhinosinusitis

Background: A significant number of people exposed to the World Trade Center (WTC) site following the terrorist attacks suffer from sinonasal symptoms. We hypothesize that patients who were acutely exposed but developed chronic symptoms may have a unique lymphocytic profile to sinonasal inflammation.

Population: Retrospective review of pathology specimens from WTC-exposed subjects that underwent endoscopic sinus surgery at the Mount Sinai Medical Monitoring and Treatment Programs.

Methods: Following approval from the WTC Population Protection Committee and the Mount Sinai Human Subjects Committee, pathology specimen blocks were obtained from 26 WTC-exposed and 26 non-WTC-exposed (control) subjects who underwent sinus surgery. Hematoxilyn & Eosin (H&E) stains were obtained, along with immunohistochemistry (IHC) for inducible nitric oxide synthase (iNOS), CD3, CD4, CD8 and CD20 lymphocytes. Slides were graded by 3 blinded trained raters on a scale of 0 to 3.

Results: H&E staining was consistent among all specimens for acute and chronic inflammation. A Mann-Whitney U test was conducted, and the average rank of lymphocyte subpopulations (Controls vs. WTC-exposed) were: CD3 27.23 vs. 23.63 (z = -0.97, p = 0.33), CD4 27.54 vs. 23.29 (z = -1.27, p = 0.20), CD8 25.37 vs. 25.65 (z = -0.07, p = 0.94), CD20 27.15 vs. 23.71 (z = -0.98, p = 0.33), and iNOS 25.20 vs. 24.80 (z = 0.07, p = 0.94). There was no statistically significant difference in grading between the raters (linear-by-linear association, p = 0.18).

Discussion: WTC-exposed patients with chronic rhinosinusitis (CRS) have demonstrable disease. Immune response by identification of lymphocytic subpopulation and inflammatory contributions from reactive oxygen species appear comparable to the standard patient with CRS.

Clinical Significance: Chronic rhinosinusitis is present in the WTC-exposed population. Although anecdotal experience suggests a unique pattern of disease, the lymphocyte response in this population confirms the need for standardized care.

Keywords: WTC; Chronic rhinosinusitis; Lymphocytic response; Inducible nitric oxide

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