Epithelial shedding of the inferior turbinate in perennial allergic and nonallergic rhinitis - A riddle to solve

Objective: To examine the epithelial integrity of the inferior turbinate in patients with perennial allergic rhinitis ( PAR) and perennial nonallergic ( vasomotor) rhinitis ( PNAR). Design: Nonrandomized, controlled morphometric study. Setting: University- affiliated hospital. Patients: Fifty- eight inferior turbinate samples were processed for histological study. Nineteen were from patients with PAR, and 20 were from patients with PNAR. Samples from 19 healthy individuals who underwent rhinoplasty for cosmetic reasons served as control specimens. Main Outcome Measures: The length of the basement membrane ( BM) covered with intact epithelium, covered with a single layer of basal cells, and devoid of epithelium was measured. Results: Intact respiratory epithelium and areas of partial and complete epithelial denudation were encountered in control specimens and in samples from patients with PAR and PNAR. A significant difference was found between the 3 groups ( P=. 001). The proportion of the BM covered with undamaged epithelium was significantly greater in control specimens and in samples from patients with PNAR than in samples from patients with PAR; the difference between the former 2 groups was nonsignificant. Most of the epithelial damage in patients with PAR occurred between columnar and basal cells rather than between basal cells and the BM ( P=. 02). Conclusions: Epithelial shedding of the inferior turbinate is a genuine feature of PAR and is not an artifact of tissue sampling. The finding of greater epithelial exfoliation between basal cells and the more superficial columnar cells than between basal cells and the BM probably reflects different attachment qualities of these cells.