Histopathologic Influences of Comorbid Smoking Status in Chronic Rhinosinusitis

Abstract

Background Smoking status has been established as a known irritant of the upper and lower respiratory tracts, leading to inflammation throughout the respiratory system. Tobacco smoking is one comorbidity encountered among chronic rhinosinusitis (CRS) patients. The histopathologic features of CRS and comorbid smoking status have yet to be determined by structured histopathology and may have important implications on disease management. Methods Retrospective study of structured histopathology reports analyzing sinus tissue removed during functional endoscopic sinus surgery. Histopathology variables were compared among patients with CRS who were reported as never smokers, former smokers, or current smokers. Results A total of 285 CRS patients were included: 173 never smokers, 85 former smokers, and 27 current smokers. When compared with former smokers, current smokers demonstrated increased basement membrane thickening (88.9% vs 67.1%, P <.020). Compared with never smokers, former and current smokers collectively demonstrated increased hyperplastic changes (14.3% vs 6.9%, P < .035), increased squamous metaplasia (26.8% vs 17.3%, P < .040), and trends toward increased basement membrane thickening (72.3% vs 65.3%, P < .124) and increased fibrosis (47.3% vs 40.5%, P < .154). Conclusion Smoking status may influence histopathologic tissue-level changes in CRS disease. Interestingly, former and current smokers maintained few differences in histopathology. However, former and current smokers collectively demonstrated increased chronic inflammatory changes compared with never smokers. These findings suggest that the timing of smoking exposure has limited effect on the tissue level, rather exposure overall influences inflammatory change. These findings may have important implications on medical and surgical management of CRS disease and comorbid smoking status.

Distinct Histopathologic Features of Complicated Sinusitis

“…Of note, increased hyperplastic changes and squamous metaplasia has previously been found in former and current smokers with CRS relative to their never-smoker counterparts. 21 Because our data show that CS patients demonstrate a higher rate of past and current smokers relative to CRS control patients, we questioned whether the increased hyperplastic change in CS patients was a consequence of their smoking rather than their acute disease process. Therefore, we performed a binomial logistical regression.…”

Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting

“…42,43 Also, patients with HNC who are current smokers are more likely to report general and oral pain than former smokers or never-smokers 44 ; this is unsurprising, given that smoking is abrasive to the oral mucosa and is linked to general pain. 45,46 Further, race might contribute to the variations in pain prescription rates in smoking and nonsmoking patients. Several studies have established that differences in smoking behaviors are not independent of race and ethnicity 47 ; White patients have been shown to smoke for shorter periods of time and find more success in smoking cessation compared with other minority groups.…”

Olfactory dysfunction in passive vs active smoking

“…Tobacco use is associated with inflammation of the respiratory tract and structural changes in the epithelium, including reduced mucociliary activity, goblet cell hyperplasia, squamous metaplasia, and mucosal edema. 4 , 5 , 14 , 15 , 16 Histological examinations of smokers' olfactory epithelium revealed squamous metaplasia and altered morphology of olfactory receptor neurons. 17 In the study of Vent et al, smoke‐exposed animals, had a significantly higher rate of olfactory receptor neuron apoptosis when compared to controls.…”