Chronic Rhinosinusitis: Risk Factors for the Recurrence of Chronic Rhinosinusitis Based on 5-Year Follow-Up after Endoscopic Sinus Surgery

Abstract

Background: Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases in the US, and little is understood about its pathogenesis. This study was conducted to characterize, retrospectively, the clinical, objective and immunological parameters that accompany recurrence of CRS during long-term follow-up after surgery. Methods: Fifty-six patients with CRS who had undergone endoscopic sinus surgery were followed up for 5 years after the surgery. The CRS parameters chosen were as follows: history of asthma and/or allergic rhinitis, peripheral eosinophilia of at least 520 cells/µl, peripheral eosinophil count, total IgE, presence of polyps, CT score, presence of fungi (positive fungal culture or stain), mucus or mucosal eosinophilia, mucosal eosinophil count, presence of acute infection after surgery, gender and age. Individual correlations and stepwise regression were performed. Results: Patients with a total peripheral eosinophil count of 520/µl or more and those with asthma were likely to experience recurrence of CRS within 5 years after surgery. Furthermore, patients with mucus or mucosal eosinophilia who were diagnosed as having eosinophilic CRS (ECRS) showed a high incidence of recurrence within 5 years. The parameter of mucus or mucosal eosinophilia (diagnosis of ECRS) had a positive predictive value of 85.7%. Conclusions: Surgeons should always examine the inflammatory infiltrate of nasal polyps or the paranasal mucosa, and patients with ECRS require anti-inflammatory medications, such as steroids, for a long time after surgery. Long-term follow-up is also essential.

Reduction of blood eosinophil counts in eosinophilic chronic rhinosinusitis after surgery

“…1 Mucosal eosinophilia (defined as more than 120 cells per high-power magnification field) is reported to most strongly correlate with chronic rhinosinusitis recurrence. 8 The association of eosinophilic chronic rhinosinusitis with asthma is widely accepted. 10 The present study also found a higher prevalence of asthma in eosinophilic chronic rhinosinusitis patients.…”

“…Furthermore, chronic rhinosinusitis with nasal polyps was subdivided into eosinophilic and non-eosinophilic chronic rhinosinusitis according to the degree of eosinophilic infiltration into sinus mucosal tissue ( Figure 1). 8 Before surgery, all patients underwent CT imaging and the peripheral eosinophil count, total serum immunoglobulin E (IgE) and respiratory function were measured. Computed tomography scans were evaluated by an otolaryngologist and a radiologist who were blinded to the disease subtype and staged according to the Lund-MacKay scoring system.…”

“…The disease was subclassified according to the degree of eosinophilic infiltration (average number of tissue eosinophils) into eosinophilic chronic rhinosinusitis (at least 120 cells per high-power magnification field) and non-eosinophilic chronic rhinosinusitis group (less than 120 cells per high-power magnification field). 8 The Blood eosinophil count and total serum IgE level were measured before FESS. Blood eosinophil counts and IgE levels before and after FESS were available for 13 eosinophilic chronic rhinosinusitis patients.…”

Human Eosinophil Innate Response to Alternaria Fungus through Protease-Activated Receptor-2

“…Eosinophils are multifunctional leukocytes implicated in the pathogenesis of various inflammatory processes, including allergic diseases, bronchial asthma, chronic rhinosinusitis (CRS), helminth and viral infections, tumor immunity, and tissue injury [1,2,3]. The mere presence of eosinophils, as in the normal intestinal mucosa [4], does not lead to pathology.…”

The Influence of Selected Preoperative Factors on the Course of Endoscopic Surgery in Patients with Chronic Rhinosinusitis

“…The analysis of the available reports indicates that mostly disease severity, comorbidities, medications used prior to surgery and a history of previous surgical treatment due to rhinosinusitis are the preoperative factors that influence surgery [10][11][12][13][14][15].…”