Remodeling changes of the upper airway with chronic rhinosinusitis
Background Although remodeling changes of the lower airway are well described, similar changes in the upper airway are less well known. Remodeling changes of the upper airway in chronic rhinosinusitis (CRS) relevant to different phenotypes and endotypes and their clinical characteristics are investi...
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Published in | International forum of allergy & rhinology Vol. 5; no. 7; pp. 565 - 572 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Blackwell Publishing Ltd
01.07.2015
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Although remodeling changes of the lower airway are well described, similar changes in the upper airway are less well known. Remodeling changes of the upper airway in chronic rhinosinusitis (CRS) relevant to different phenotypes and endotypes and their clinical characteristics are investigated.
Methods
A cross‐sectional study of adult patients with CRS was performed. Mucosal samples were taken during endoscopic sinus surgery (ESS). Histopathological analysis included eosinophil count, eosinophil activation (eosinophilic mucin), and remodeling changes. Mucosal damage was defined as ulceration, edema, and hypertrophic changes. Patient‐reported outcomes (PROMs) were assessed using a Nasal Symptom Score (NSS) and Sino‐Nasal Outcome Test (SNOT‐22). Patients were subgrouped by presence of polyps (CRSwNP/CRSsNP) or tissue eosinophilia (>10/high power field). Subgroup analysis was performed when both eosinophilic chronic rhinosinusitis (eCRS) and eosinophil activation (eCRSwEA) were coexistent. Analysis between subgroups, pathology, and PROMs was also performed.
Results
A total of 259 patients (age 48.5 ± 15.6 years, 45% female) were recruited; 53% CRSwNP, 51% eCRS. Remodeling changes were present in 85%, higher in both CRSwNP (90%, p = 0.006) and eCRS (91%, p = 0.004). Mucosal damage changes were common in eCRS (ulceration 18%, p = 0.003; edema 98%, p < 0.001; hypertrophic changes 25%, p = 0.007). NSS was worse in CRSwNP compared to CRSsNP (2.84 ± 1.1 vs 2.29 ± 1.1, p < 0.001) and eCRSwEA (2.95 ± 0.16 vs 2.51 ± 0.11, p = 0.04). “Loss of sense of smell or taste” was worse in patients with evidence of mucosal damage (p = 0.006).
Conclusion
Remodeling features are present in CRS. Tissue eosinophilia and evidence of eosinophil activation is closely associated with remodeling features of CRS, associated mucosal damage and clinical symptoms. |
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Bibliography: | istex:30616AF2936D09FC5EB801E9328C68BD8CF3E5CD ArticleID:ALR21546 ark:/67375/WNG-JPXVHS4D-3 Potential conflict of interest: R.J.H. has served on an advisory board for Schering Plough and Glaxo‐Smith‐Kline and on the speakers’ bureau for Merek Sharp Dolme and Arthrocare, was a previous consultant with Medtronic and Olympus, and has received grant support from NeilMed. R.S. is a consultant for Medtronic. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2042-6976 2042-6984 |
DOI: | 10.1002/alr.21546 |