Evaluation of Inferior Turbinate Stroma with Ultrasound Elastography in Allergic Rhinitis Patients

Abstract

Background: Diagnosis of allergic rhinitis is primarily based on history, physical examination and allergy testing. A technique that noninvasively evaluates the soft tissue changes in the nasal mucosa of allergic rhinitis patients has not been defined. Aims: To assess nasal mucosal changes and measure the submucosal fibrosis in allergic rhinitis patients with sonoelastography. Study Design: Case control study. Methods: Eighty-eight turbinates of 44 patients were included in the study. There were 23 prick test positive allergic rhinitis patients. The control group constituted 21 patients. The rhinitis quality of life questionnaire and the visual analogue scale were applied to the allergic rhinitis patients. A higher visual analogue scale score indicated more severe allergic rhinitis symptoms. Sonoelastographic measurements were made from the lateral nasal wall. The propagation speed of sound waves was recorded in m/s. The presence of asthma and the type of allergic rhinitis (seasonal or perennial) was noted. Results: Ten patients had seasonal allergic rhinitis and thirteen patients had perennial allergic rhinitis. Six patients (26.1%) had accompanying asthma along with allergic rhinitis. The median visual analogue scale score was 7 (3-9) in allergic rhinitis patients. The median symptom duration was 7 (1-24) months. The median quality of life questionnaire score was 3.39 (1.68-5.43) points. The median sonoelastography scores of allergic rhinitis patients and healthy subjects were 2.38 m/s (0.9-4.47) and 2.42 m/s (1.62-3.50), respectively. Sonoelastographic measurements of seasonal and perennial allergic rhinitis patients did not differ significantly (p>0.05). The presence of asthma did not have a significant impact on the elastography measurements (p>0.05). However, regression analysis revealed a significant inverse correlation (coefficients: B=0.005, standard error=0.097, beta 0=0.008) between the visual analogue scale and sonoelastography scores (p<0.05). Conclusion: Sonoelastography was not suitable as a diagnostic tool in allergic rhinitis. Reduced sonoelastography scores were measured in more symptomatic patients. Higher visual analogue scale scores could be an indicator of disease severity.

Keywords

• Sonoelastography, ultrasound elastography, allergic rhinitis, fibrosis, inferior turbinate

Kaynakça

1. 1. Li Y, Snedeker JG. Elastography: modality-specific approaches, clinical applications, and research horizons. Skeletal Radiol 2011;40:389-97.
2. 2. Meng W, Xing P, Chen Q, Wu C. Initial experience of acoustic radiation force impulse ultrasound imaging of cervical lymph nodes. Eur J Radiol 2013;82:1788-92.
3. 3. Fujiwara T, Tomokuni J, Iwanaga K, Ooba S, Haji T. Acoustic radiation force impulse imaging for reactive and malignant/metastatic cervical lymph nodes. Ultrasound Med Biol 2013;39:1178-83.
4. 4. Zhuo J, Ma Z, Fu WJ, Liu SP. Differentiation of benign from malignant thyroid nodules with acoustic radiation force impulse technique. Br J Radiol 2014;87:20130263.
5. 5. Kısmalı E, Göde S, Turhal G, Öztürk K, Raşit M. A new insight for evaluation of the inferior turbinate with ultrasound elastography. J Ultrasound Med 2015;34:777-82.
6. 6. Gode S, Turhal G, Kismali E, Ozturk K, Midilli R. A novel method for comparison of tissue fibrosis after inferior turbinate surgery: ultrasound elastography. Am J Rhinol Allergy 2015;29:33-6.
7. 7. Druce H. Allergic and nonallergic rhinitis. In: Middleton E, Jr, Ellis EE, Adkinson NF, Jr, et al, editors. Allergy: Principles and Practice, 5 ed. St Louis, Mosby: 1998:1005-6.
8. 8. Varjonen E, Kalimo K, Lammintausta K, Terhp P. Prevalence of atopic disorders among adolescents in Turku, Finland. Allergy 1992;47:243-8.

9. 9. Konstantinidis I, Constantinidis J. Endoscopic Management of Inferior Turbinate Hypertrophy. In: Rhinology and Facial Plastic Surgery. In: Stucker FJ, De Souza C, Kenyon GS, Lian TS, Draf W, Schick B, editors. Spring-Verlag Berlin Heidelberg: 2009:545-50.
10. 10. Chaiyasate S, Roongrotwattanasiri K, Fooanant S, Sumitsawan Y. Key nasal symptoms predicting a positive skin test in allergic rhinitis and patient characteristics according to ARIA classification. J Med Assoc Thai 2009;92:377-81.
11. 11. Lieberman P. The basics of histamine biology. Ann Allergy Asthma Immunol 2011;106(2 Suppl):S2-5.
12. 12. Lim MC, Taylor RM, Naclerio RM. The histology of allergic rhinitis and its comparison to cellular changes in nasal lavage. Am J Respir Crit Care Med 1995;151:136-44.
13. 13. Jacobson MR, Juliusson S, Löwhagen O, Balder B, Kay AB, Durham SR. Effect of topical corticosteroids on seasonal increases in epithelial eosinophils and mast cells in allergic rhinitis: a comparison of nasal brush and biopsy methods. Clin Exp Allergy 1999;29:1347-55.
14. 14. Raherison C, Montaudon M, Stoll D, Wallaert B, Darras J, Chanez P, et al. How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings. Allergy 2004;59:821-6.
15. 15. Demoly P, Bousquet J. The relation between asthma and allergic rhinitis. Lancet 2006;368:711-3.
16. 16. Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol 2002;109:419-25.
17. 17. Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, et al. Rhinitis and onset of asthma: a longitudinal population-based study. Lancet 2008;372:1049-57.
18. 18. Yuksel H, Yilmaz O, Alkan S, Bayrak Değirmenci P, Kirmaz C. Validity and reliability of Turkish version of rhinitis and mini-rhinitis quality of life questionnaires. Allergol Immunopathol (Madr) 2009;37:293-7.
19. 19. Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire. J Allergy Clin Immunol 1999;104(2 Pt 1):364-9.
20. 20. Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire. Clin Exp Allergy 2000;30:132-40.