gms | German Medical Science

Background: Because of recurrent postoperative cicatrisation of the ostiomeatal complex and mucosal remodelling a therapy of chronic rhinosinusitis without nasal polyposis remains a therapeutical problem. To investigate the ultrastructural changes the present study was initiated.

Materials and Methods: In case of revision sinus surgery of 21 patients at the Department of Otorhinolaryngology, Head and Neck Surgery of Martin-Luther-University Halle-Wittenberg/Germany we took samples of nasal mucosa and examined them by electron microscopy. All subjects suffered from recurrent chronic rhinosinusitis without nasal polyps. The primarily applied conservative therapy failed.

Results: The chronically damaged epithelium is characterized by a loss of cilia and an increased formation of microvilli. In the lamina propria an augmented implementation of collagen fibres can be found besides to an enlarged number of fibrocytes, fibroblasts and myofibroblasts. Investigating the capillary vessels there are not only duplications of the basal lamina but also activated endothelial cells and pericytes lying upon each other. Sometimes metaplastic changes were seen in glands.

Conclusion: The ultrastructural architecture of mucosa among patients with chronic rhinosinusitis without nasal polyposis is characterized by a distinctive fibrosis caused by proliferation of fibroblasts, myofibroblasts and fibrocytes. There is a remarkable implementation of collagens and changes of the vascular walls.

Finished mucosa-remodelling seems not being influenceable by medicamentous methods. Therefore a therapy by corticoids starting at an early stage of disease may be decisive for a successful conservative management.