Correlation between the cytology of the nasal middle meatus and BAL in chronic rhinosinusitis

The relation between chronic rhinosinusitis (CRS) and the associated lower airways involvement is not clear yet. In this context, the aim of this prospective study was to evaluate the correlation between middle meatal lavage (MML) and bronchoalveolar lavage (BAL) cytology in adult CRS patients. Based on clinical history and pulmonary function changes, CRS patients were divided into three subgroups: asthma, small airway disease (SAD) and normal lower airway (NLA) subgroups. Preoperatively, 50 MMLs and 25 BALs were performed in 25 CRS patients scheduled for FESS. At 1000X power microscopic magnifications, 48 MML and 24 BAL cytospin slides were examined for total and differential cell counts (DCC). This study showed that eosinophils were the dominant inflammatory cells in MMLs of the asthma subgroup and were significantly correlated to FEVI (p=0.042) and Tiffineau index (p=0.037). On the other hand, neutrophils were the dominant inflammatory cells in MMLs of the SAD subgroup and significantly correlated to FEF75% and Tiffinau index (p=0.013 and p=0.012 respectively). There was no significant correlation between MML and BAL cell differential counts in CRS patients (p > 0.05). The data showed that the lower airways involvement in CRS patients could be related to the dominant type of inflammatory cells in the upper airways.