Use of mucosal eosinophil count as a guide in the management of chronic rhinosinusitis

Abstract

Background: Chronic rhinosinusitis (CRS) is a local inflammatory process driven by eosinophils. Mucosal eosinophil count (MEC) has previously been demonstrated to be a reliable indicator of disease severity. We aim to evaluate use of MEC in guiding medical management of CRS a er functional endoscopic sinus surgery (FESS). Methods:We retrospectively reviewed patients with CRS who underwent FESS from 2004 to 2017. Tissue MEC per high-power field (HPF) was determined by pathologic examination. MECs were compared by polyp status, postoperative medication requirements, and revision surgery. Patients received normal saline (NS) nasal irrigations with additional treatment as needed for disease control: 1-drug therapy (1-DT) intranasal steroid spray (ISS), 2-drug therapy (2-DT) ISS plus budesonide nasal irrigations (BNI) or leukotriene receptor antagonist (LRA), or 3-drug therapy (3-DT) ISS plus BNI and LRA. Correlations between MEC and 22-item Sino-Nasal Outcome Test (SNOT-22), preoperative computed tomography (CT), and nasal endoscopy scores were evaluated. Results:A total of 156 patients were included. Fi y-seven were managed with 1-DT, 35 with 2-DT, and 62 with 3-DT. Across all patients, mean postoperative 6-month and 1-year SNOT-22 (18.1 ± 17.0, 18.1 ± 20.2, respectively) and nasal endoscopy (3.6 ± 3.8, 3.6 ± 4.1, respectively) scores were significantly lower than preoperative scores (37.4 ± 22.8, 6.5 ± 4, respectively). With increasing MEC, odds of requiring 2-DT (odds ratio [OR] = 1.1, p = 0.0002), 3-DT (OR = 1.12, p < 0.0001), and revision surgery (OR = 1.11, p < 0.0001) were significantly increased. Preoperative endoscopy (ρ = 0.44, p < 0.0001) and CT scores (ρ = 0.51, p < 0.0001) and postoperative 6-month (ρ = 0.55, p < 0.0001) and 1-year (ρ = 0.4, p < 0.0001) endoscopy scores demonstrated good correlation with MEC. Conclusion: MEC correlates with objective clinical disease severity and may guide aggressiveness of management for the individual patient. C 2020 ARS-AAOA, LLC. How to Cite this Article: Sharbel D, Li M, Unsal AA, et al. Use of mucosal eosinophil count as a guide in the management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2020;10:474-480.C hronic rhinosinusitis (CRS) is an inflammatory condition involving the lining of sinonasal cavities.

The interplay of inflammation and remodeling in the pathogenesis of chronic rhinosinusitis: current understanding and future directions

“…According to the prior reports, eosinophils have been implicated in a variety of biological functions ( 109 ), including mediating inflammation or inducing immunity. Moreover, studies have found that eosinophilia is positively correlated with the severity of CRS, thus indicating that more the number of eosinophils, greater is the severity of the disease ( 110 ). This is in addition to the pro-inflammatory role of eosinophils in releasing IL-4, IL-5, and IL-13 cytokines.…”

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

“…2,3 Some have even proposed that eosinophilia could serve as a guide for patient management. [4][5][6][7] Previous studies have evaluated associations of tissue eosinophil density with disease severity, olfactory function, and patient-reported quality-of-life (QoL). [8][9][10] Evaluations of neutrophilia have demonstrated some variations in disease severity, but the association between mucosal neutrophilia and clinical features of CRS has not been thoroughly explored.…”

Inflammatory features and predictors for postsurgical outcomes in patients with nasal polyps stratified by local and systemic eosinophilia

“…Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory sinonasal disease, which involves various molecular and cellular pathways 1 . Although CRSwNP is a heterogeneous disorder characterized by distinct combinations of T‐cell and granulocyte responses, the eosinophilic feature is recognized as a pivotal trait of the disease and eosinophils are useful biomarkers in clinical practice for monitoring disease severity and control in CRSwNP patients 2–4 . Both mucosal and blood eosinophilia are associated with disease severity and postsurgical recurrence in CRSwNP patients 5–13 …”