Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes

Wang, Feng; Yang, Yang; Wu, Qihan; Chen, Haihong

doi:10.1016/j.amjoto.2019.03.014

Cited by 10 publications

(10 citation statements)

References 26 publications

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“…8 Though both the present study and prior study participants originated from the same geographic areas, the two populations represent independent groups identified during different enrollment periods Prior studies demonstrated that tissue eosinophilia correlates with worse LMS and LKS in CRS patients. 18,[25][26][27] Our study did demonstrate a similar relationship, as well as weak correlation between neutrophil density and both worse LKS and LMS. However, after controlling for NP, the only remaining significant correlation was eCRSsNP demonstrating worse LMS than those with CRSsNP, which is consistent with some prior studies.…”

Section: Discussionsupporting

confidence: 77%

“…Prior studies demonstrated that tissue eosinophilia correlates with worse LMS and LKS in CRS patients. 18,25–27 Our study did demonstrate a similar relationship, as well as weak correlation between neutrophil density and both worse LKS and LMS. However, after controlling for NP, the only remaining significant correlation was eCRSsNP demonstrating worse LMS than those with CRSsNP, which is consistent with some prior studies.…”

Section: Discussionsupporting

confidence: 75%

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Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

Farrell

Mace

Sauer

et al. 2021

Am J Rhinol�Allergy

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Background Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS). Objectives This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function. Methods Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores. Results 77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP. Conclusion Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 75%

Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

Farrell

Mace

Sauer

et al. 2021

Am J Rhinol�Allergy

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“…However, the SNOT-22 test (high scores indicating worse symptoms), which was widely used for measurement of sinonasal symptomatology, did not display significant differences between ECRSwNP and NECRSwNP patients (Table 2). Previous studies demonstrated that ECRSwNP had significantly worse SNOT-22 scores than NECRSwNP (Thompson et al, 2016;Wang et al, 2019). The reason we did not observe the differences of SNOT-22 scores between the two groups is because only surgical CRSwNP patients with severe symptoms were included in the study.…”

Section: Discussionmentioning

confidence: 68%

Sinus Microbiota in Patients With Eosinophilic and Non-Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Feng

Miao

Liu

et al. 2021

Front. Cell. Infect. Microbiol.

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Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2-skewed inflammation and increased colonization by Staphylococcus aureus. CRSwNP can be distinguished as eosinophilic (ECRSwNP) and non-eosinophilic (NECRSwNP) by the infiltration of eosinophils. The local microbiota plays an important role in the persistent inflammation of CRSwNP. To evaluate the bacterial community composition on the distinct types of CRSwNP patients, we collected nasal swabs from 16 ECRSwNP patients, 18 NECRSwNP patients, and 39 healthy control subjects. The microbiome structure for all the samples were analyzed by high-throughput 16S rRNA gene sequencing. Concentration of S. aureus was determined using TaqMan quantitative polymerase chain reaction (qPCR) targeting the nuclease (nuc) gene. The result showed significant differences in the sinus microbiome among healthy control subjects and CRSwNP patients. Microbiota community diversity was significantly lower in NECRSwNP samples compared to that of healthy control subjects. Interestingly, the abundance of several pathogenic bacteria was diverse between ECRSwNP and NECRSwNP patients. Although Staphylococcus prevailed in all groups, the abundance of Staphylococcus was significantly higher in the healthy control group than the ECRSwNP group. More importantly, the abundance of S. aureus was much higher in NECRSwNP patients. This study highlights that microbiota composition may contribute to the different clinical types of CRSwNP, inspiring new therapeutic strategies to resolve this chronic inflammation process.

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“…Recent descriptions of mucosal structural changes in the sinuses may imply irreversible mucosal disease which is hypothesized to have implications for recalcitrant disease. Although 2 studies have shown that basement membrane thickness adversely affected symptom improvement after ESS [6, 21], the relationship between remodeling and disease recurrence is still unclear. In Do’s study [9], although NPs with remodeling had greater steroid requirements postoperatively, the need for further revision surgery was equal to NPs without remodeling.…”

Section: Discussionmentioning

confidence: 99%

Alteration of Histopathology in Recurrent Nasal Polyps

Wang¹,

Yang²,

Chen³

2021

ORL

Self Cite

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Objective: The objective of this study was to analyze the histopathologic changes in recurrent nasal polyps (NPs) in terms of tissue inflammatory cells infiltration and mucosal remodeling. Methods: Thirty-five patients with primary NPs requiring a revision surgery during follow-up and a matched control group of 35 primary NP patients without recurrence were retrospectively enrolled. Histopathologic examination was performed of tissue inflammatory cells, subepithelial edema, epithelial cell hyperplasia, basement membrane thickness, and fibrosis. Results: The mean eosinophil and neutrophil counts, proportions of eosinophil and neutrophil, as well as total inflammatory cell count were significantly higher in the recurrent group than those in the controls. Higher subepithelial edema was seen in the recurrent group. Within the recurrent group, the mean tissue eosinophil count and relative eosinophilia reduced from the first operation to revision surgery, whereas neutrophil count and proportion, and total inflammatory cell counts remained unchanged. Subepithelial edema and epithelial cell hyperplasia were significantly reduced after the first surgical procedure. Conclusion: NP recurrence is associated with higher inflammatory grade (especially in eosinophilia and neutrophilia). Surgical and corticoid treatments may have an impact on mucosal histopathologic changes but need further certification.

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Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes

Cited by 10 publications

References 26 publications

Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

Sinus Microbiota in Patients With Eosinophilic and Non-Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Alteration of Histopathology in Recurrent Nasal Polyps

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