Background
Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS.
Methods
Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional, computerized volumetric analysis, as well as via a semi-quantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system.
Results
The overall cohort (n=199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Rs= −0.461; p<0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs= −0.573; p<0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs= −0.141; p=0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs= −0.377; p<0.001) subgroup but stronger in the CRSsNP (Rs= −0.225; p=0.018) group when compared to olfactory cleft correlations. Greater intra-class correlations (ICC) were found between quantitative volumetric measures of olfactory cleft opacification (ICC=0.844; p<0.001) as compared with semi-quantitative Likert grading (ICC=0.627; p<0.001).
Conclusions
Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps.
BACKGROUND
Abnormal olfaction is common with chronic rhinosinusitis (CRS) and associates with various measures of sinonasal inflammation. The Brief Smell Identification Test (BSIT) has demonstrated improvements in abnormal olfactory detection following endoscopic sinus surgery (ESS), but olfaction remains understudied using this instrument. Discerning longitudinal, postoperative durability in olfaction is critical for patient counseling.
METHODS
Adult participants with medically recalcitrant CRS were prospectively enrolled into a multi-institutional cohort study and observed for 18-months following ESS. Olfaction was operationalized using BSIT scores collected at baseline, 6-months, 12-months, and 18-months postoperatively and compared using repeated measures ANOVA.
RESULTS
122 participants met inclusion criteria and were recruited between March, 2011 and February, 2014. Improvement in mean BSIT scores at 6-month follow-up were reported for all participants (p=0.014) with greatest improvement in subjects with nasal polyposis (p=0.001). No differences in mean BSIT scores were found between 6-month and 18-months overall, however subjects with comorbid asthma (F(2)=5.29; p=0.010) and nasal polyposis (F(2)=3.99; p=0.033) reported significant mean worsening. Prevalence of abnormal olfaction decreased from 28% preoperatively to 17% at 6-months (p=0.015), for all subjects, without significant change 12-months (19%; p=0.791) or 18-months (21%; p=0.581) postoperatively.
CONCLUSIONS
Postoperative improvement in olfaction was reported 6-months after ESS using BSIT scores, with greatest improvements in patients undergoing polypectomy. Overall improvement persisted between 6-month and 18-month following ESS for most patient subgroups, however, dysosmia worsened after initial improvement in patients with asthma and nasal polyps, highlighting the need for further identification of prognostic factors associated with abnormal olfaction in CRS.
AFRS and CRSwNP have increased numbers of DCs displaying costimulatory molecules, DC chemoattractants, and their corresponding receptors in the sinus mucosa compared to controls. These differences represent a possible mechanism for increased numbers of DCs with a T helper 2 (Th2)-skewed profile seen in CRSwNP and AFRS.
Background
The immunopathogenesis of chronic rhinosinusitis (CRS) is largely unknown, but it is thought that different inflammatory profiles are responsible for the different CRS subtypes. 25-hydroxyvitamin-D (25-VD3) has been shown to alter inflammatory mediators in other disease processes and 25VD3 deficiency is associated with CRS with nasal polyps (CRSwNP), but it is unknown if 25VD3 levels impacts local inflammation in CRS. This study investigated the correlation between plasma 25-VD3 and sinonasal mucus MCP-1, RANTES and bFGF levels in patients with CRS.
Methods
Study subjects undergoing endoscopic sinus surgery (ESS) for CRS were prospectively enrolled from January 2012-August 2014. Control subjects included patients undergoing ESS for non-inflammatory pathology. Blood and sinonasal mucus were collected at the time of ESS. Plasma 25-VD3 was measured by ELISA and mucus levels of MCP-1, RANTES, and bFGF by cytometric bead array (CBA).
Results
A total of 57 patients were enrolled and categorized as CRS without nasal polyps (CRSsNP) (n=31), CRSwNP (n=14) and controls (n=12). No significant correlation was found between MCP-1 and 25-VD3. There was a significant negative correlation between 25-VD3 and RANTES (r= −0.612; p=0.026) and bFGF (r= −0.578; p=0.039) in CRSwNP patients; however, there was no significant correlation in CRSsNP patients.
Conclusion
This data suggests that 25-VD3 may play a role in regulation of RANTES and bFGF expression in CRSwNP. This may occur through regulation of nasal polyp fibroblasts or other immune cells. Further investigation is warranted to better elucidate the role of RANTES, bFGF and 25-VD3 in CRSwNP.
ROS are differentially expressed in various subtypes of CRS. SHS exposure increases ROS in sinus tissue of control patients, but the clinical significance of this is unclear.
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