Molecular and Cellular Staging for the Severity of Chronic Rhinosinusitis

Abstract

We suggest the following severity classification system for CRS: 1) eosinophilic chronic hyperplastic rhinosinusitis (ECHRS): patients with polyps and sinus tissue eosinophilia; 2) noneosinophilic chronic hyperplastic rhinosinusitis (NECHRS): patients with polyps but without sinus tissue eosinophilia; 3) eosinophilic chronic rhinosinusitis (ECRS): patients without polyps but with sinus tissue eosinophilia; 4) noneosinophilic chronic rhinosinusitis (NECRS): patients without polyps and without sinus tissue eosinophilia.

Total IgE Levels and Peripheral Eosinophilia

“…4 This phenotype of CRS is associated with the accumulation of acti-vated eosinophils in sinonasal tissue, the development of nasal polyposis, and asthma. The release of a variety of proinflammatory mediators from the activated eosinophils is believed to contribute to mucosal inflammation, edema, and tissue injury.…”

“…New efforts are focused on defining the cellular and molecular characteristics of CRS. 4 Recent investigations have focused on the eosinophil as the characteristic and predominant cell in CRS. Histopathologic studies of the sinus mucosa of most adult patients with CRS demonstrate eosinophilic tissue infiltration, as well as elevated levels of interleukin 5, granulocyte and macrophage colony stimulating factor, and interleukin 3, all of which support eosinophilic inflammation.…”

“…Kountakis et al 4 recently presented the molecular and cellular parameters associated with CRS in a cohort of patients undergoing endoscopic sinus surgery. They demonstrated a significant correlation between peripheral eosinophilia and the presence of asthma, nasal polyps, and severity of disease based on CT stage.…”

Rhinosinusitis - Its Impact on Quality of Life

“…Studies by Kountakis and Baudoin failed to demonstrate a correlation between the eosinophil count and the severity of CRS symptoms (Kountakis et al, 2004;Baudoin et al, 2006).…”

Nasal Symptom Questionnaire: Our Proposed Scoring System and Prognostic Factors in Chronic Rhinosinusitis

“…Clinical features of CRS with NP with eosinophil-dominant inflammation as “eosinophilic CRS (ECRS)” were first reported in Japan in 2001 [20]. Clinically, ECRS is associated more closely with CRS with NP, clinical complaints of nasal obstruction, and olfactory loss, and more frequently linked to comorbidities such as asthma and aspirin hypersensitivity [21-24]. For the treatment of CRS, there is currently an accepted treatment paradigm first with appropriate medical therapy such as macrolide therapy and then with surgery if patients are refractory to medical therapy [2, 25, 26].…”