Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis

Abstract

Background: Causes of osteitis in chronic rhinosinusitis (CRS) other than previous surgery are poorly defined. Patients with eosinophilic CRS (ECRS) have more severe disease and poorer outcomes despite repeated surgery. Associations between osteitis and markers of ECRS are not well described. Methods:A cross-sectional study of CRS patients undergoing sinus surgery was conducted. Osteitis was scored radiologically using previously published measures. Associations between osteitis and histopathology, symptoms, endoscopy, CT mucosal score and seromarkers were analyzed.Results: Eighty-eight patients were assessed of whom forty-five had osteitis. Patients undergoing revision surgery recorded higher osteitis scores. Patients with mucosal eosinophilia had higher osteitis score than those without. Patients with osteitis had higher serum eosinophil. Similar relationships were also found in primary surgery. Osteitis was associated with endoscopic and radiologic, but not symptomatic disease severity. Conclusions:Osteitis is associated with tissue and serum eosinophilia in both patients with and without prior surgery. Patients with these features may benefit from post-operative corticosteroid therapy to prevent osteitis.

High tissue eosinophilia as a marker to predict recurrence for eosinophilic chronic rhinosinusitis: a systematic review and meta‐analysis

“…Recently, CRS has also been classified based on underlying inflammatory process into 2 groups: eosinophilic CRS (ECRS) and non‐eosinophilic CRS (NECRS) . Typical features associated with ECRS compared with NECRS are presented in Table . ECRS patients represent a unique subtype, as they appear to be more resistant to current medical and surgical interventions .…”

Osteitis is Associated with P-Glycoprotein Overexpression in Patients with Chronic Sinusitis without Nasal Polyps

“…Identification of patients with elevated P-gp may therefore be useful to guide treatments directed toward this novel therapeutic target. Radiographic osteitis scores 2,3 have been previously shown to correlate with eosinophilic inflammation and thus may be useful in stratifying patients with P-gp overexpression. P-gp is a 170-kDa glycoprotein encoded by the MDR1 (ABCB1) gene located on chromosome 7q21.12.…”

Crosstalk Between Mucosal Inflammation and Bone Metabolism in Chronic Rhinosinusitis

“…Increasingly many studies have suggested that immune cells are crucial for bone remodeling in CRS patients. Snidvongs et al [17] found that osteitis was associated with tissue and serum eosinophilia in both patients with and without prior surgery. Mehta et al [31] reported that blood eosinophil levels in patients were directly correlated with sinus mucosal thickening and associated with osteitis.…”

“…Lee et al [15] reported the presence of osteitis in 36%-53% of CRS pa-tients based on either the radiographic criterion of bony thickening or pathologic findings. Snidvongs et al [17] found evidence of osteitis in around 51% of CRS patients, with a higher prevalence in patients with prior sinus surgery (76%). Georgalas et al [18] reported that 33% of primary CRS patients showed signs of osteitis.…”