Peripheral eosinophilia in the diagnosis of chronic rhinosinusitis

A novel risk score for disease control prediction of Chronic rhinosinusitis

Objectives

To assess the impact of risk factors on the disease control among chronic rhinosinusitis (CRS) patients, following 1 year of functional endoscopic sinus surgery (FESS), and combining the risk factors to formulate a convenient, visualised prediction model.

Design

A retrospective and nonconcurrent cohort study.

Setting and Participants

A total of 325 patients with CRS from June 2018 to July 2020 at the First Affiliated Hospital of Sun Yat‐sen University, the Third Affliated Hospital of Sun Yat‐sen University, the Seventh Affiliated Hospital of Sun Yat‐sen University.

Main Outcomes Measures

Outcomes were time to event measures: the disease control of CRS after surgery 1 year. The presence of nasal polyps, smoking habits, allergic rhinitis (AR), the ratio of tissue eosinophil (TER) and peripheral blood eosinophil count (PBEC) and asthma was assessed. The logistic regression models were used to conduct multivariate and univariate analyses. Asthma, TER, AR, PBEC were also included in the nomogram. The calibration curve and area under curve (AUC) were used to evaluate the forecast performance of the model.

Results

In univariate analyses, most of the covariates had significant associations with the endpoints, except for age, gender and smoking. The nomogram showed the highest accuracy with an AUC of 0.760 (95% CI, 0.688–0.830) in the training cohort.

Conclusions

In this cohort study that included the asthma, AR, TER, PBEC, which had significantly affected the disease control of CRS after surgery. The model provided relatively accurate prediction in the disease control of CRS after FESS and served as a visualised reference for daily diagnosis and treatment.

Fungus and chronic rhinosinusitis: from bench to clinical understanding

Although fungus-related sinusitis has been described for at least 2 centuries, a more detailed pathologic description of the problem as it relates to eosinophilic disease was not detailed until 1983, when "allergic fungal sinusitis" was described histopathologically. Until then, most fungal sinus disease was perceived to occur in immunosuppressed diabetic patients with invasive fungus. It is now acknowledged that depending upon the immune status of the host, fungus-related sinus disease can take several forms. Interest in this subject matter was intensified in 1999, when it was suggested that fungi might be an important cause of most cases of chronic rhinosinusitis. This hypothesis remains controversial, and there is mounting evidence to support the multifactorial nature of chronic rhinosinusitis, which may include fungus. In fact, etiologic factors for all forms of fungus-related sinus disease are still poorly understood. The prevalence of the disease and the dominant fungal pathogen appear to vary in different geographic regions and probably are related to individual host conditions. Immunoglobulin E-mediated allergic reactions to mold appear to be associated with disease in some patients, but not in all. Although antifungal therapy is known to be lifesaving for invasive disease, its role in extramucosal disease is less well defined. Preliminary trials suggest that some systemic and topical antifungal agents are of clinical benefit in extramucosal disease. Since sinus fungi are rarely invasive in immunocompetent individuals, it is not clear whether the effects of the antifungal treatments are a result of the antifungal action itself, or due to additional properties these drugs possess. This review summarizes the available data and presents some of our clinical and experimental findings as to the role of fungus in chronic rhinosinusitis.

Surgical rhinology: recent advances and future directions

The discipline of rhinology is poised on the cusp of explosive growth in its cumulative body of knowledge. Advances in surgical technique, applied technology, and basic science over the past 2 decades have yielded significant benefits to both practitioner and patient. The future holds great promise for continued technical innovation, acquisition of new knowledge,and advances in the science of rhinology.

Symposium: masters in otolaryngology--update in rhinology

The past few years have witnessed several noteworthy advances in the field of rhinology in general and in the treatment of chronic sinusitis in particular. Many of these advances can be classified into three major trends: technology, techniques, and tissue eosinophilia.

Chronic rhinosinusitis: is the nose really involved?

To determine whether chronic rhinitis usually accompanies chronic sinusitis, and critically examine the concept of chronic rhinosinusitis, paired specimens of nasal septal mucosa and ethmoid sinus mucosa were obtained in a prospective cohort of 42 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. The histopathological degree of inflammation for each specimen was scored using a five-point rating scale. Cell counts for eosinophils and inflammatory cells per high-power field (HPF) were determined. Mean patient age was 40.5 years and mean Lund score was 9.3. The inflammation grade of the septal mucosa was within one point of the ethmoid mucosa in 36 (85.7%) cases, and correlated exactly in 24 patients (57.1%). A statistically significant correlation was found between septal and ethmoid mucosa inflammation grades (p = 0.048). No significant difference in mean non-eosinophilic inflammatory cell count per HPF was noted betmeen ethmoid mucosa and septal mucosa (48.2 versus 54.3 cells/HPF, p = 0.061, power = 0.873). Ethmoid mucosa had a significantly higher mean eosinophil count than septal mucosa (6.6 versus 1.9 cells/HPF, p < 0.001). For combined inflammatoty cell counts, no significant difference in cell counts was noted (54. 7 cells/HPF ethmoid versus 56.1 septal, p = 0.670, power = 0.847). Histopathologic evidence of rhinitis is associated with chronic sinusitis. This supports the concept of rhinosinusitis rather than sinusitis alone. Eosinophils are found in significantly higher numbers in sinus mucosa than in nasal mucosa, suggesting a site-specific role in rhinosinusitis.