A pilot study of symptom profiles from a polyp vs an eosinophilic‐based classification of chronic rhinosinusitis

Abstract

Introduction Chronic rhinosinusitis (CRS) is likely a biologically heterogeneous disease process. Current guidelines propose subclassification using polyp status while others propose using mucosal eosinophilia. We hypothesized that appropriate CRS subclassification would increase homogeneity of baseline symptoms, and identify characteristic symptoms of each subtype. Methods 57 CRS patients undergoing surgery prospectively completed a preoperative battery of 73 questions relating to symptoms including the SNOT-22 and PROMIS-29 general quality of life (QOL) measures. Eosinophilic cationic protein (ECP) levels were determined from ethmoid, uncinate, and polyp tissue homogenates using ELISA and normalized to total protein. Patients were classified as eosinophilic (eCRS) or non-eosinophilic (neCRS) using a 95-percentile threshold established from control tissue from 82 patients without CRS. Separate pairwise comparisons were performed on patient-reported symptoms using polyp and eosinophilic status. Results 28 of 57 patients had CRS with polyps (CRSwNP). 27 of 57 had eCRS (n=21 CRSwNP, n=6 CRSsNP). CRSwNP patients had increased need to blow nose, frequency of nasal congestion, more severe difficulty breathing through nose, more severe nasal discharge, but less cough (p<0.05). eCRS had more bothersome loss of taste/smell, ear pain, sneezing, severe difficulty breathing through nose, and severe nasal congestion compared to neCRS (p<0.05). Conclusion Subclassifying CRS with symptoms alone is difficult with neither polyp status nor eosinophilia giving a distinctive clinical symptom profile. However, certain symptoms may help otolaryngologists identify CRS subtypes, which may help guide future treatments. Further validation and evaluation of prognosis following treatment is required to evaluate appropriate means of subclassifying CRS.

Evidence for altered levels of IgD in the nasal airway mucosa of patients with chronic rhinosinusitis

“…9, 33 On electronic medical records review, clinical features including medication prescriptions were extracted. As shown in Table 1, patients in the high-IgD group more frequently had CRSsNP compared with the low-IgD cohort (75.0% versus 43.7%, respectively, P =.05).…”

Chronic Rhinosinusitis with Nasal Polyps

“…In a cohort of 126 CRS patients, Banjeri and colleagues found that nasal obstruction and hyposmia/anosmia were more significantly associated with CRSwNP while facial pain/pressure was more prevalent in CRSsNP patients 8 . Additional studies of CRS patients at separate tertiary care centers found CRSwNP patients were more likely to report rhinorrhea, severe nasal congestion and loss of smell/taste than patients with CRSsNP 9, 10 . However, in both studies, there was still a considerable overlap in symptoms reported by both CRSsNP and CRSwNP patients, thus emphasizing the need for additional criteria to diagnose CRSwNP.…”

“…It remains difficult to distinguish eosinophilic and non-eosinophilic nasal polyps by clinical symptoms alone. A recent study examining 57 CRS patients who underwent surgery at a tertiary care facility found that ear pain, sneezing, severe difficulty breathing through the nose, severe nasal congestion, and bothersome loss of taste/smell were significantly more likely to be reported in patients with eosinophilic compared to non-eosinophilic nasal polyps 10 . The duration of sinus symptoms is also critical to ascertain, as symptoms lasting greater than 12 weeks are consistent with chronic rhinosinusitis while those lasting less than 4 weeks are more concerning for an acute infectious process.…”

Heterogeneous inflammatory patterns in chronic rhinosinusitis without nasal polyps in Chicago, Illinois

“…8 Using these thresholds, 23%, 36% and 15% of CRSsNP ET showed type 1, 2 and 3 inflammation, based on the expression of IFN-γ, CLC and IL-17A, respectively (Fig. 1C).…”