Sinusitis in pilots of different aircraft types: Is allergic rhinitis a predisposing factor?

Background: Despite the high association of allergic rhinitis and acute sinusitis, their exact relationship remains unclear, especially in pilots. The purpose of this study was to analyze the possible relationship of a history of allergic rhinitis with the occurrence of acute sinusitis in Israeli air force pilots. A comparative case series was conducted. Methods: Events of acute sinusitis were compared between Israeli air force pilots with (n = 54) and without (n = 82) allergic rhinitis who presented for their annual physical examination. Results: Previous episodes of acute sinusitis were noted in 33% of the pilots with allergic rhinitis and 21 % of the control group (p = 0.09). A separate analysis of young pilots (< 26 years old) yielded corresponding rates of 57% versus 29% (p < 0.001). When the groups were divided by type of pilot, the results showed that 54% of the transport pilots, 34% of the fighter pilots, and 13% of the helicopter pilots with rhinitis also suffered from acute sinusitis, as opposed to 28, 15, and 15%, respectively, of the control group. Conclusion: Despite careful selection, allergic rhinitis is still a very common disease in pilots and may pose a risk of acute sinusitis. The lower prevalence of acute sinusitis in combat than in transport pilots with rhinitis may be explained by vasoconstriction due to psychological and physiological stress during flight missions.