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Sinusitis, Nasal polyps, Paranasal sinuses
Background and aim: Chronic rhinosinusitis (CRS) is a chronic and recurrent disease that negatively affects patients’ quality of life. CRS has two main phenotypes: CRS with nasal polyps (CRSwNP) and CRS without polyps (CRSsNP). Minimal research has been conducted to study the variability in patients’ characteristics. Therefore, we conducted this study to examine these differences.
Methods: A retrospective cohort study included patients with both CRSwNP and CRSsNP. Outcomes included symptom severity, radiographic severity, and number of sinus surgeries. Symptom severity was assessed using the Sino-nasal Outcome Test and the Lund-Mackay CT score was used to determine radiographic severity. Further subgroup analysis was done based on the presence or absence of comorbid asthma.
Results: A total of 110 and 106 patients were included in the CRSwNP and CRSsNP groups, respectively. The mean age in the CRSwNP and CRSsNP groups was 50.2 and 48.7, and the proportion of female patients was 40.9% and 58.5%, respectively. No significant difference in symptom severity was noted between CRSwNP and CRSsNP group (68.1±18.6 vs. 73.2±21.27; P=0.097), while the Lund-Mackay score was significantly lower in the CRSsNP group (7.4±2.3 vs. 11.9±3.6; P=0.016). Also, the number of surgeries was significantly lower in the CRSsNP group as compared to the CRSwNP group (P=0.023). Subgroup analysis revealed statistically significant differences between those with and without asthma in patients with CRSwNP in terms of Lund-Mackay scores and number of surgeries (P=0.038 and 0.043), respectively. However, no significant differences were noted in the CRSsNP group (P>0.05).
Conclusions: There is a clear variability in the characteristics of patients with CRSsNP and CRSwNP. A similar difference was noted in the CRSwNP group when patients were stratified based on the presence of absence of asthma. This warrants further investigation of potential correlation with the prognosis and optimum treatment strategies of this patient population
2. Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe—an underestimated disease. A GA(2)LEN study. Allergy 2011; 66:1216-23
3. Workman AD, Kohanski MA, Cohen NA. Biomarkers in chronic rhinosinusitis with nasal polyps. Immunol Allergy Clin North Am 2018; 38: 679-92
4. Bachert C, Zhang N, Hellings PW, Bousquet J. Endotype-driven care pathways in patients with chronic rhinosinusitis. J Allergy Clin Immunol 2018; 141: 1543-51
5. Marseglia GL, Caimmi S, Marseglia A, Poddighe D, Leone M, Caimmi D, Ciprandi G, Castellazzi AM. Rhinosinusitis and asthma. Int J Immunopathol Pharmacol 2010; 23(Suppl. 1): 29-31.
6. Laidlaw TM, Mullol J, Woessner KM, Amin N, Mannent LP. Chronic Rhinosinusitis with Nasal Polyps and Asthma. J Allergy Clin Immunol Pract 2021; 9(3): 1133-41.
7. Gallo S, Russo F, Mozzanica F, et al. Prognostic value of the Sinonasal Outcome Test 22 (SNOT-22) in chronic rhinosinusitis. Acta Otorhinolaryngol Ital 2020; 40(2): 113-21.
8. Brooks SG, Trope M, Blasetti M, et al. Preoperative Lund-Mackay computed tomography score is associated with preoperative symptom severity and predicts quality-of-life outcome trajectories after sinus surgery. Int Forum Allergy Rhinol 2018; 8(6): 668-75.
9. Gendy S. An Audit of the Predictive Value of SNOT-22 Tests in Evaluating Nasal Surgeries Emerson's Green/ Devizes NHS Treatment Centres. Am J Otolaryngol Head Neck Surg 2019; 2(5): 1050.
10. Tosun F, Arslan HH, Karslioglu Y, Deveci MS, Durmaz A. Relationship between postoperative recurrence rate and eosinophil density of nasal polyps. Ann Otol Rhinol Laryngol 2010; 119(7): 455-9.
11. Akdis C. A., Ballas Z. K. Precision medicine and precision health: building blocks to foster a revolutionary health care model. J Allergy Clin Immunol 2016; 137(5): 1359-61
12. Tomassen P, Vandeplas G, Van Zele T, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol 2016; 137(5): 1449-56.
13. Zhang N, Van Zele T, Perez-Novo C, et al. Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol 2008; 122(5): 961-8.
14. Bachert C, Akdis CA. Phenotypes and Emerging Endotypes of Chronic Rhinosinusitis. J Allergy Clin Immunol Pract 2016; 4(4): 621‐8.
15. Morales DR, Guthrie B, Lipworth BJ, Jackson C, Donnan PT, Santiago VH. NSAID-exacerbated respiratory disease: a meta-analysis evaluating prevalence, mean provocative dose of aspirin and increased asthma morbidity. Allergy 2015; 70(7): 828-35.
16. Hoyt AE, Borish L, Gurrola J, Payne S. Allergic Fungal Rhinosinusitis. J Allergy Clin Immunol Pract 2016; 4(4): 599-604.
17. Alanin MC, Aanaes K, Høiby N, et al. Sinus surgery postpones chronic Gram-negative lung infection: cohort study of 106 patients with cystic fibrosis. Rhinology 2016; 54(3): 206-13.
18. Del Gaudio JM, Loftus PA, Hamizan AW, Harvey RJ, Wise SK. Central compartment atopic disease. Am J Rhinol Allergy 2017; 31(4): 228‐34.
19. Stevens WW, Peters AT, Suh L, et al. A retrospective, cross-sectional study reveals that women with CRSwNP have more severe disease than men. Immun Inflamm Dis 2015; 3(1): 14–22.
20. Promsopa C, Kansara S, Citardi MJ, Fakhri S, Porter P, Luong A. Prevalence of confirmed asthma varies in chronic rhinosinusitis subtypes. Int Forum Allergy Rhinol 2016; 6(4): 373–7.
21. Ek A, Middelveld RJ, Bertilsson H, et al. Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey. Allergy 2013; 68(10): 1314–21.
22. Lin DC, Chandra RK, Tan BK, et al. Association between severity of asthma and degree of chronic rhinosinusitis. Am J Rhinol Allergy 2011; 25(4): 205–8.
23. Kirtsreesakul V. Role of allergy in the therapeutic response of nasal polyps. Asian Pac J Allergy Immunol 2002; 20(3):141-6.
24. Soler ZM, Sauer D, Mace J, Smith TL. Impact of mucosal eosinophilia and nasal polyposis on quality-of-life outcomes after sinus surgery. Otolaryngol Head Neck Surg 2010; 142(1): 64-71.
25. Lou H, Meng Y, Piao Y, Wang C, Zhang L, Bachert C. Predictive significance of tissue eosinophilia for nasal polyp recurrence in the Chinese population. Am J Rhinol Allergy 2015; 29(5): 350-6.
26. Sreeparvathi A, Kalyanikuttyamma LK, Kumar M, Sreekumar N, Veerasigamani N. Significance of Blood Eosinophil Count in Patients with Chronic Rhinosinusitis with Nasal Polyposis. J Clin Diagn Res 2017; 11(2): MC08-MC11.
27. Di Lorenzo G, Drago A, Esposito Pellitteri M, et al. Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis. Int Arch Allergy Immunol 2001; 125(2): 164-75.
28. Stryjewska-Makuch G, Janik M, Kolebacz B, Ścierski W, Lisowska G. Allergies, asthma or hypersensitivity to NSAIDs - are they an equally important risk factor for the development of a specific CRS phenotype?. Otolaryngol Pol 2019; 74(2): 8-16.
29. Oettgen HC, Geha RS. IgE in asthma and atopy: cellular and molecular connections. J Clin Invest 1999; 104(7): 829-35.
30. Ottaviano G, Savietto E, Scarpa B, et al. Influence of number of drugs on olfaction in the elderly. Rhinology 2018; 56: 351-7.
31. Peters AT, Spector S, Hsu J, et al. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol 2014; 113(4): 347-85.