Sinus CT Scan Findings in Patients with Chronic Cough Following Sulfur Mustard Inhalation: A Case-Control Study

Abstract

Sinusitis is one of the most common causes of chronic cough, which is the most common manifestation among patients exposed to sulfur mustard (SM). We conducted our study on exposed victims to SM with chronic cough for evaluation of probable sinus abnormality. In a case-control study, among referred patients for evaluation of persistent chronic cough, 39 patients with previous and 35 patients without previous history of exposure to SM underwent paranasal sinus computed tomography (CT) scans (Somatom CR CT scanner) in coronal planes. A well-designed standard pro forma was used for reporting sinus CT abnormalities. Data was analyzed with chi-square and Fisher exact test. Except one, all obtained CT scans findings showed some abnormalities. Mucosal abnormality was detected in 30 chemical-exposed cases (CEs) (76.9%), and 8 cases were categorized as severe types. In general, mucosal thickening in right (left) frontal, sphenoid, and maxillary sinus were observed in 12.8% (7.7), 5.1% (7.7), and 25.6% (30.8) of CEs, respectively; these proportions were 11.4% (11.4), 2.9% (2.9), and 45.6% (60) in non-chemical-exposed cases (NEs), respectively. Air fluid level in the right (left) frontal sinus was 10.3% (7.7) and in the right (left) maxillary sinus was 10.3% (15.4) in CEs; it was 2.9%(0) and 20%(20) in NEs for these locations, respectively. There were no statistically significant differences between findings of two groups (p > .05). Also, comparison of related data to osteomeatal complex obstruction, bulla ethmoidalis, haller cell, agger nasi, and pneumatized crista galli were not significant (p > .05). Thus; various types of sinus abnormalities were highly prevalent in both CEs and NEs with chronic chough and there was no specific pattern. Consequently, current approaches to chronic cough just based on conventional etiologies in this setting can lead to delay in diagnosis and mismanagement.