Impact of Mucosal Eosinophilia and Nasal Polyposis on Quality‐of‐Life Outcomes after Sinus Surgery

Abstract

Objective-Assess whether the presence of mucosal eosinophilia correlates with surgical outcomes in patients with chronic rhinosinusitis. Study Design-Prospective cohort Setting-Tertiary medical centerSubjects and Methods-Adult patients with chronic rhinosinusitis were prospectively enrolled and demographic data and medical comorbidities recorded. Preoperative quality-of-life (QOL) was measured by the Chronic Sinusitis Survey (CSS), Rhinosinusitis Disability Index (RSDI), and Short Form-36 General Health Survey (SF-36). Sinus mucosal specimens were collected at the time of surgery and the degree of eosinophilia quantified. Postoperative QOL was measured and differences in QOL improvement were compared between those with and without eosinophilia.Results-A total of 102 patients had both histopathologic and QOL outcome data available for review. Follow-up averaged 16.5 months. Patients with eosinophilia showed significantly less improvement in the RSDI total (17.9 vs 25.0; p=0.044), RSDI functional (5.7 vs 8.8; p=0.018), CSS medication (3.6 vs 17.3; p=0.013), SF-36 general health (0.6 vs 9.6; p=0.008), SF-36 physical role (16.1 vs 34.7; p=0.036), and SF-36 vitality (11.9 vs 21.2; p=0.034) scales than those without eosinophilia. The greatest improvement in QOL was seen in patients without eosinophilia or polyps and the least improvement seen in those with eosinophilia but without polyps. Conclusion-The presence of mucosal eosinophilia at the time of surgery consistently predicted less improvement in both disease-specific and general QOL compared to those without eosinophilia. The impact of eosinophilia on outcomes was greatest for patients without nasal polyposis, a group which demonstrated the least improvement in QOL measures.

Impact of Allergy and Eosinophils on the Morbidity of Chronic Rhinosinusitis with Nasal Polyps in Northwest China

“…A remarkable association between high peripheral EOS levels and the morbidity of CRSwNP was identified. In several previous studies, eosinophilic inflammation of the nasal mucosa has been shown to play a role in nasal polyp pathogenesis and it has a negative impact on the prognosis and is associated with worse treatment outcomes [15, 19, 25-27]. Also eosinophilic inflammation has been reported to be related to disease severity.…”

“…Peripheral eosinophil (EOS) absolute counts > 0.52 × 10 9 /L (or tissue EOS > 10/HPF) are considered elevated and peripheral EOS absolute counts ≤0.52 × 10 9 /L (or tissue EOS ≤10/HPF) are normal [19]. …”

Eosinophilia and Quality of Life in Patients Receiving a Bioabsorbable Steroid-Eluting Implant during Endoscopic Sinus Surgery

“…CRSwNP patients that have recurrence of nasal polyps after surgery are more likely to have pronounced eosinophilic infiltration of the nasal mucosa [15,16]. Eosinophilic CRS is a subtype of CRS that predicts less post-operative improvement in patient-reported QOL and disease-specific measures [17,18]. Peripheral blood eosinophilia and tissue eosinophilia are associated with more severe CRSwNP, higher recurrence rates of nasal polyps after surgery [14,15], and higher revision surgery rates [19].…”

Histopathological inflammation and symptom outcomes after endoscopic sinus surgery

“…In an excellent follow-up study, Soler et al 13 also examined the influence of tissue eosinophilia on postoperative health-related quality of life outcomes after ESS. They found some substantial correlations between increasing tissue eosinophilia at the time of ESS and worsening quality of life outcomes in several domains.…”