All chronic rhinosinusitis endotype clusters demonstrate improvement in patient‐reported and clinical outcome measures after endoscopic sinus surgery

Abstract

BackgroundIt is unclear if chronic rhinosinusitis (CRS) endotypes show differential response to endoscopic sinus surgery (ESS). We explored mucus inflammatory cytokine expression in a cohort with CRS and associations with both patient‐reported and clinically measured postoperative outcome measures.MethodsPatients with CRS were prospectively recruited between 2016‐2021 into a multi‐center observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient reported outcome measures included the Sino‐Nasal Outcome Test (SNOT‐22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included Threshold, Discrimination, and Identification (TDI) scores using Sniffin’ Stick testing and Lund‐Kennedy endoscopic scores (LKES).ResultsA total of 115 patients were clustered into type 2 inflammatory, non‐type 2 inflammatory, non‐inflammatory, and 2 indeterminate clusters based upon individual protein levels. Overall, the type 2 inflammatory cluster was found to report the highest mean improvement in both SNOT‐22 (‐28.3 [SD±16.2]) and TDI (6.5 [SD±7.9]) scores 6 months after ESS. However, all endotype clusters demonstrated improvement in all outcome measures after ESS on average, without statistically significant between‐group differences in SNOT‐22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures.ConclusionsAll CRS endotype clusters respond favorably to surgery and show improvement in patient reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes.This article is protected by copyright. All rights reserved