Revista de Otologia e Rinologia

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

Charles C. L. Tong, Nancy Jiang, David Cannan, Maoxin Wu, Andrew G. Sikora1 and Kenneth W. Altman

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.