Immunological Aspects of Chronic Sinusitis

Abstract

Chronic sinusitis is one of the most prevalent nasal illnesses, especially in Japan. The pathogenesis of this disease has not yet been fully understood. Nasal and maxillary secretions may reflect pathological environments in the nose and paranasal sinuses. Therefore, analysis of immunoglobulins in these secretions may lead to better understanding of the pathogenesis and facilitate evaluation of the severity and effectiveness of the therapy of this disease. We measured concentrations of IgA, 11S IgA, IgG, IgM, total secretory component (SC) and albumin in the nasal and maxillary secretions from patients with chronic sinusitis. The immunoglobulin levels and the 11S IgA to IgA ratios of the subjects showed large variability. The immunoglobulin to albumin ratios indicated that a bulk of IgG in the secretion was derived from the serum. There were significant differences of the mean concentrations of IgA and IgM between nasal and maxillary secretions. The percentage of SC-positive (more than 0.5mg/dl) secretion was significantly higher in the nasal than the maxillary secretion. An immunofluorescent study of the surgically removed nasal and maxillary mucosa revealed that immunoglobulin-containing cells tended to be more numerous in the nasal than the maxillary mucosa. A tendency of IgA-containing cells to form aggregation in the superficial layer of the subepithelium and around the gland was characteristic of the maxillary mucosa, while in the nasal mucosa these cells tended to concentrate around the glands. These facts suggested that there was an immunological dissociation between the nasal and maxillary mucosae. In 31% of maxillary secretions, concentration of SC was less than 0.5mg/dl and this was found to be constant after repeated maxillary aspirations. The IgA to IgG concentration ratio which was less than 1.0 at the first aspiration exceeded 1.0 and the correlation between IgA and SC concentrations became significant after repeated maxillary aspirations. Although there was little direct evidence implicating immunological processes in the pathogenesis of chronic sinusitis, the circumstantial evidence found in this study suggested that there was an accumulation of immunoglobulins in the maxillary environment and the IgG antibody might mediate an adverse effect. © 1981, The Society of Practical Otolaryngology. All rights reserved.