Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study

Silva, Yeda da; Munhoz, Luciana; Parga Filho, José Rodrigues; Damasceno, Andreza Gomes; Rosa, Cesar Felipe França da; Zukovski, Eduardo Bilaqui; Teng, Erik Zhu; Arita, Emiko Saito; Castro, Cláudio Campi de

doi:10.1055/s-0043-1773761

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International Archives of Otorhinolaryngology

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Original Research • Int Arch Otorhinolaryngol 28 (2) • 2024 • https://doi.org/10.1055/s-0043-1773761 copy

Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system.

Objectives

The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations.

Methods

The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program.

Results

Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex.

Conclusions

Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.

Keywords
multidetector computed tomography; diagnostic imaging; maxillary sinus; aerospace medicine; aviation

Variable	Side	Evaluation	Group		p-value ^ According to Mann-Whitney test. Significant if p < 0.05. (pilots x control)
Variable	Side	Evaluation	Pilots (n = 15)	Control (n = 41)
Maxillary sinus mucous thickening	Right	Initial	0 (0–8)	0 (0–15)	0.050
		Final	6 (0–12)	2.1 (0–21)
		p ^* * according to Wilcoxon test; (initial x final)	0.018	0.295
	Left	initial	0 (0–13)	0 (0–11)	<0.001
		final	10 (0–26)	0.5 (0–11)
		p ^* * according to Wilcoxon test; (initial x final)	0.003	0.191
Frontal sinus mucous thickening	Right	initial	0 (0–0)	0 (0–7.6)	0.215
		final	0 (0–0)	0 (0–7.8)
		p ^* * according to Wilcoxon test; (initial x final)	-	0.176
	Left	initial	0 (0–0)	0 (0–12)	0.616
		final	0 (0–4)	0 (0–12)
		p ^* * according to Wilcoxon test; (initial x final)	0.317	0.128
Sphenoid sinus mucous thickening	Right	initial	0 (0–4.7)	0 (0–7.7)	0.205
		final	0 (0–7.1)	0 (0–5.7)
		p ^* * according to Wilcoxon test; (initial x final)	0.109	0.889
	Left	initial	0 (0–0)	0 (0–12)	0.400
		final	0 (0–0)	0 (0–12)
		p ^* * according to Wilcoxon test; (initial x final)	-	0.138
Mucous thickening of ethmoidal cells	Anterior	initial	0 (0–7)	0 (0–6.2)	0.139
		final	0 (0–7)	0 (0–7.2)
		p ^* * according to Wilcoxon test; (initial x final)	0.042	0.460
	Posterior	initial	0 (0–0)	0 (0–8)	0.657
		final	0 (0–2.6)	0 (0–7.5)
		p ^* * according to Wilcoxon test; (initial x final)	0.180	0.583
		initial	0 (0–7.9)	0 (0–27)
Polyp/pseudocyst maxillary sinus mucous retention	Right	final	0 (0–14.9)	0 (0–21)	0.359
		p ^* * according to Wilcoxon test; (initial x final)	0.285	0.700
		initial	0 (0–21.5)	0 (0–18)
	Left	final	0 (0–18)	0 (0–23)	0.814
		p ^* * according to Wilcoxon test; (initial x final)	0.715	0.116
		initial	0 (0–0)	0 (0–7)
Polyp/pseudocyst frontal sinus mucous retention	Left	final	0 (0–0)	0 (0–7)	0.545
		p ^* * according to Wilcoxon test; (initial x final)	-	0.317
		initial	0 (0–0)	0 (0–6.3)
Polyp/pseudocyst sphenoid sinus mucous retention	Right	final	0 (0–0)	0 (0–6.7)	0.898
Polyp/pseudocyst sphenoid sinus mucous retention	Right	p ^* * according to Wilcoxon test; (initial x final)	-	-	0.898

Variables			Right ostiomeatal complex obstruction		p-value ^* * according to Fisher's exact test. significant if p < 0.05.
Variables			No	Yes
Final Septal Deviation	Right Side	No	25	4	0.50
	Right Side	Yes	21	6	0.50
	Left Side	No	25	3	0.46
	Left Side	Yes	21	5	0.46
Paradoxical curvature of the middle turbinate	Right Side	No	38	8	1.00
	Right Side	Yes	8	2	1.00
	Left Side	No	47	8	1.00
	Left Side	Yes	1	0	1.00
Bullous medium turbinate	Right Side	No	35	6	0.43
	Right Side	Yes	11	4	0.43
	Left Side	No	41	4	0.04
	Left Side	Yes	7	4	0.04
Haller cell	Right Side	No	45	8	0.08
	Right Side	Yes	1	2	0.08
	Left Side	No	47	7	0.27
	Left Side	Yes	1	1	0.27
Prominent ethmoidal bulla	Right Side	No	40	8	0.62
	Right Side	Yes	6	2	0.62
	Left Side	No	43	5	0.08
	Left Side	Yes	5	3	0.08
Changes to the uncinated process	Right Side	No	39	10	0.33
	Right Side	Yes	7	0	0.33
	Left Side	No	44	7	0.55
	Left Side	Yes	4	1	0.55
Agger nasi cell	Right Side	No	25	6	1.00
	Right Side	Yes	21	4	1.00
	Left Side	No	33	5	0.70
	Left Side	Yes	15	3	0.70

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[1] Address for correspondence Luciana Munhoz, PhD, Department of Stomatology, School of Dentistry, University of São Paulo, 2227 Lineu Prestes Avenue, Zip Code: 05508-000, São Paulo, SP, Brazil, Pinhais Medicine School, Pinhais, 1065 Camilo de Lellis Avenue, Zip Code: 83323-000, Paraná, PR, Brazil (e-mail: dra.lucimunhoz@gmail.com).