Zinc-depletion associates with tissue eosinophilia and collagen depletion in chronic rhinosinusitis

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0 ◽  
Author(s):  
M. Suzuki ◽  
M. Ramezanpour ◽  
C. Cooksley ◽  
T.J. Lee ◽  
B. Jeong ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Tissue Eosinophilia ◽  
Zinc Depletion

Distinct Patterns of Tissue Remodeling and Their Prognostic Role in Chronic Rhinosinusitis

ORL ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ho Yun Lee ◽  
Jung-Soo Pyo ◽  
Su Jin Kim
Keyword(s):  
Chronic Rhinosinusitis ◽  
Structural Changes ◽  
Squamous Metaplasia ◽  
Tissue Remodeling ◽  
Sinus Surgery ◽  
Prognostic Role ◽  
High Power Field ◽  
Tissue Eosinophilia ◽  
Allergy Test ◽  
Stromal Edema

<b><i>Introduction:</i></b> Tissue remodeling refers to structural changes that occur in damaged tissue and is associated with disease severity in asthma. However, the characteristics of tissue remodeling and its prognostic role in chronic rhinosinusitis (CRS) remain unclear. In this report, we evaluated the clinical implications of tissue remodeling in CRS. <b><i>Methods:</i></b> We performed a retrospective cohort study of adult patients who underwent endoscopic sinus surgery for bilateral CRS. The histopathology of sinus mucosa was determined by evaluating the inflammatory cell count and tissue remodeling markers (squamous metaplasia, subepithelial gland proliferation, basement membrane [BM] thickening, stromal edema, and fibrosis). Eosinophilic CRS (ECRS) was defined as an eosinophil count &#x3e;15/high-power field in the biopsied tissue. Patient characteristics, allergy test grade, preoperative Lund-Mackay score (LMS), and pre- and postoperative Lund-Kennedy scores (LKSs) were analyzed. <b><i>Results:</i></b> Of the identified patients, 59.1% were classified as ECRS and the remaining 40.9% as non-ECRS. Regarding tissue remodeling markers, stromal edema was seen in 90.9%, BM thickening in 63.6%, and stromal fibrosis in 34.1% of patients. In cases with stromal edema and BM thickening, greater tissue eosinophilia was observed, while stromal fibrosis decreased tissue eosinophilia (<i>p</i> &#x3c; 0.05). Prognostically, subepithelial gland proliferation alone was an independent risk factor for poor postoperative endoscopic findings (odds ratio: 8.250, 95% confidence interval: 1.128–60.319, <i>p</i> = 0.038). <b><i>Conclusions:</i></b> Tissue eosinophilia was commonly associated with BM thickening and stromal edema. Subepithelial gland proliferation predicted a poor surgical prognosis in CRS. These findings imply that tissue remodeling provides additional information not only on the CRS endotype but also on the postsurgical prognosis.

scholarly journals Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

2020 ◽  
pp. 014556132096035
Author(s):  
Gian Luca Fadda ◽  
Andrea Galizia ◽  
Giuseppe Galizia ◽  
Paolo Castelnuovo ◽  
Maurizio Bignami ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Predictive Biomarker ◽  
Blood Eosinophil ◽  
High Power Field ◽  
Diverse Range ◽  
Blood Eosinophilia ◽  
Tissue Eosinophilia ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Clinical Records

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively.

How Does Age Impact Presentation and Outcomes in Chronic Rhinosinusitis?

2020 ◽  
Vol 129 (9) ◽  
pp. 872-877
Author(s):  
Thomas Holmes ◽  
Chadi Makary ◽  
Aykut A. Unsal ◽  
Paul Biddinger ◽  
Camilo Reyes-Gelves ◽  
...  
Keyword(s):  
Young Adults ◽  
Elderly Patients ◽  
Chronic Rhinosinusitis ◽  
Statistical Difference ◽  
Prognostic Indicators ◽  
Level Of Evidence ◽  
Tissue Eosinophilia ◽  
Short And Long Term ◽  
Snot 22

Objectives/Hypothesis: The presence of eosinophilia and nasal polyps are well-established prognostic indicators of chronic rhinosinusitis (CRS). The importance of demographic background, such as age, as independent variables has not been elucidated while taking these factors into account. Study Design: Respective review. Methods: CRS patients who underwent primary surgical treatment were subdivided based on age (young adults = age 18-39, adults = age 40-64, and elderly = age 65+). Groups were then subdivided based on tissue eosinophilia and nasal polyposis. Sinonasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy scores, and Lund-McKay (LM) CT scores were compared preoperatively, and postoperatively during a 5-year period. Results: A total of 431 CRS patients identified and then subsequently broken down into 63 young adults (YA), 209 adults (A), and 159 elderly (E). There was no statistical difference between tissue eosinophilia and presence of polyps between the groups. All three groups had similar short- and long-term SNOT-22 patterns postoperatively. At presentation, young adults had significantly higher SNOT-22 score (33.2 YA, 25.3 A, 23.5 E, P = .029) and significantly higher rhinologic scores (1.9 YA, 1.3 A, 1.3 E, P = .0012) than the adult and elderly patients. Objective disease severity using LK endoscopy scores were only significantly higher in young adults at 1-year time ( P = .0026). There was no statistical difference between the groups in regards to preoperative LM CT scores. Conclusions: Young adults are more likely to present with overall higher subjective SNOT-22 scores over adults and elderly patients, despite similar objective findings in the groups. Short- and long-term postoperative improvement holds across all age groups. Level of Evidence: 4

Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis

2016 ◽  
Vol 155 (1) ◽  
pp. 173-178 ◽  
Author(s):  
Sarah A. Gitomer ◽  
Cynthia R. Fountain ◽  
Todd T. Kingdom ◽  
Anne E. Getz ◽  
Stefan H. Sillau ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Severity ◽  
Severe Asthma ◽  
Case Series ◽  
Medication Usage ◽  
Mucosal Disease ◽  
Tissue Eosinophilia ◽  
Chronic Corticosteroid ◽  
Histopathologic Findings ◽  
Tissue Eosinophil

Objective (1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predicts disease severity in CRSwNP. Study Design Case series with chart review. Setting Academic hospital specializing in respiratory and allergic disease. Subjects Patients with CRSwNP treated from 2008 to 2010. Methods Clinical data were collected; sinus computed tomography (CT) scans were scored according to the Lund-Mackay system; and surgical specimens were evaluated for degree of tissue eosinophilia. Statistical analysis was performed to compare eosinophilia with indicators of disease severity. Results Seventy CRSwNP patients were included, with a mean Lund-Mackay score of 16.7; 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms, or Lund-Mackay scores, nor did it correlate with presence of asthma or aspirin-sensitivity (P = .09). Patients with mild asthma had significantly more tissue eosinophils versus patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. There was no correlation between tissue and serum eosinophil counts (P = .97), but there was a significant positive correlation between CT score and peripheral eosinophil level (P < .05). Conclusions Higher serum eosinophil levels may indicate more extensive mucosal disease as measured on CT scan. Neither serum nor tissue eosinophilia predicted disease severity in our retrospective analysis of CRSwNP patients, and serum eosinophil level did not serve as a marker of tissue eosinophilia.

Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis

2014 ◽  
Vol 151 (1_suppl) ◽  
pp. P114-P114
Author(s):  
Todd T. Kingdom ◽  
Sarah A. Gitomer ◽  
Stefan H. Sillau ◽  
Rohit K. Katial ◽  
Vijay R. Ramakrishnan
Keyword(s):  
Chronic Rhinosinusitis ◽  
Clinical Examination ◽  
Nasal Polyposis ◽  
Tissue Eosinophilia

Eosinophilia in the Ethmoid Mucosa and Its Relationship to the Severity of Inflammation in Chronic Rhinosinusitis

2002 ◽  
Vol 16 (3) ◽  
pp. 131-134 ◽  
Author(s):  
Eva Szucs ◽  
Saied Ravandi ◽  
Anita Goossens ◽  
Mieke Beel ◽  
Peter A.R. Clement
Keyword(s):  
Ct Scan ◽  
Chronic Rhinosinusitis ◽  
Staging System ◽  
Inflammatory Cells ◽  
Sinus Surgery ◽  
Mucosal Inflammation ◽  
Tissue Eosinophilia ◽  
Eosinophilic Infiltrate ◽  
Preoperative Ct ◽  
Sinus Mucosa

Background The aim of this study was to analyze histopathologically mucosal inflammation in patients with chronic rhinosinusitis. In addition, we assessed tissue eosinophilia in relation to the severity of inflammation and to the computer tomographic (CT) findings. Methods Forty-eight pathological sinus mucosa specimens obtained during functional endoscopic sinus surgery were stained by hematoxylin and eosin. Total inflammatory cells and eosinophils were quantified. The preoperative CT scans were scored by the staging system of Lund-MacKay. Results The grade of the eosinophilic infiltration in the diseased sinus mucosa correlated significantly with the severity of the mucosal inflammation. Allergy or asthma had no effect on the proportion of the eosinophilic infiltrate. The CT scan scores assessed by the Lund-MacKay system correlated significantly with the severity of the inflammatory cellular infiltrate. The correlation between the CT scan scores and the eosinophilic infiltrate of the mucosa was close to significant. Conclusion Eosinophilic mucosal inflammation represents the most severe inflammatory changes of the mucosa. Twenty to forty percent of the patients with chronic rhinosinusitis had no eosinophilic inflammation of the mucosa. The CT-staging system of Lund-Mackay correlated with the extent of mucosal inflammation.

scholarly journals Cellular phenotyping of chronic rhinosinusitis with nasal polyps

2016 ◽  
Vol 54 (2) ◽  
pp. 150-159
Author(s):  
Hongfei Lou ◽  
Yifan Meng ◽  
Yingshi Piao ◽  
Nan Zhang ◽  
Claus Bachert ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Plasma Cells ◽  
Inflammatory Cells ◽  
Recurrence Rates ◽  
Tissue Eosinophilia ◽  
Inflammatory Pattern ◽  
Polyp Recurrence ◽  
Cellular Phenotypes

Background: Defining the phenotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) with prognosis may lead to delivery of personalized treatment. This study aimed to identify cellular phenotypes of CRSwNP using cluster analysis and define an algorithm for different clusters associated with polyp recurrence. Methods: Overall, 366 patients with CRSwNP were enrolled in this retrospective analysis. Eighteen variables, including clinical characteristics and tissue/peripheral inflammatory cells assessments, were selected for factor analysis. Unsupervised cluster analysis was performed after variables reduction and standardization and differences in polyp recurrence during follow-up for a minimum of 24 months were analysed among clusters. Discriminant analysis was further used to develop a clinically useful algorithm for predicting clustering. Results: Five phenotypic clusters were identified. Clusters 1 and 2 were plasma cell-dominant and lymphocyte-dominant phenotypes, respectively. Cluster 3 revealed a mixed inflammatory pattern. Cluster 4 was characterized by infiltration of predominantly neutrophils. Cluster 5 was characterized by a marked tissue eosinophilia and highest recurrence rate of 98.5%. The clinical algorithm predicted clustering with 93.7% accuracy. Conclusions: Chinese CRSwNP patients may be classified into five phenotypes with different polyp recurrence rates, based on the presence of predominantly plasma cells, lymphocytes, neutrophils, eosinophils or mixed inflammatory cells in polyps.

scholarly journals Correlation between Peripheral Blood Eosinophilia and the Histopathological Changes in Nasal Mucosal in Chronic Rhinosinusitis

2021 ◽  
pp. 440-448
Author(s):  
Jahnavi Narayanan ◽  
K. Nithin Diwagar ◽  
Ganthimathy Sekhar
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyp ◽  
Peripheral Blood ◽  
Eosinophil Count ◽  
P Value ◽  
Blood Eosinophilia ◽  
Tissue Eosinophilia ◽  
Group 2 ◽  
Peripheral Blood Eosinophilia ◽  
Group 1

Background: Chronic rhinosinusitis(CRS) has emerged as one of the major causes of significant morbidity in otorhinolaryngology, as it is often noted to be refractory to medical management and has a tendency to recur post-surgery. Limited research has shown that peripheral eosinophilia is related to the presence of nasal polyps, the extent of the mucosal disease, the severity of tissue eosinophilia, and the risk of recurrence. Aim: This study aimed to establish the significance of peripheral blood eosinophilia, both differential (EC) and absolute eosinophil counts (AEC) - in adult CRS, to correlate the tissue eosinophilia and peripheral blood eosinophilia, and compare the observations in the two types of CRS with nasal polyp and without nasal polyp. Material and Methods: A total of 50 adult patients with CRS who underwent FESS were included in the study and were divided based on the presence (Group 1) or absence (Group 2) of peripheral blood eosinophilia. Results: There were equal number of cases of chronic rhinosinusitis with nasal polyp (CRSwNP) and without polyp (CRSsNP); 25 each.  With regard to clinical features, Group 1 had a higher number of cases with nasal obstruction (p-value = 0.023), post-nasal drip (p-value = 0.035), and hyposmia (p-value = 0.021) when compared to Group 2. On histopathology, Group 1 had more areas of edema (p-value = 0.027), and mucous gland hyperplasia (p-value = 0.013) while Group 2 had prominent lymphoplasmacytic infiltrates (p-value = 0.035), neutrophilia (p-value = 0.047), and tissue infiltration of macrophages (p-value = 0.027).  Tissue eosinophilia was present in 32 out of the total cases; 20 (71.43%) in Group 1 and 12 (53.33%) in Group 2. The group with tissue eosinophilia had significantly higher eosinophil count (9.24 ± 4.26% vs 5.32 ± 2.9%; p-value < 0.01) as well as AEC (823.335 ± 434.357/µl vs 485.128 ± 285/µl. 907; p-value < 0.01). Conclusion: The study demonstrated that CRS cases with tissue eosinophilia exhibit an elevated peripheral eosinophil count when compared to non-eosinophilic CRS.

Histopathologic Influences of Tissue Eosinophilia Among Chronic Rhinosinusitis Patients

2019 ◽  
Vol 34 (3) ◽  
pp. 331-335 ◽  
Author(s):  
Ashwin Ganti ◽  
Hannah J. Brown ◽  
Hannah N. Kuhar ◽  
Paolo Gattuso ◽  
Ritu Ghai ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Chronic Rhinosinusitis ◽  
Revision Surgery ◽  
Squamous Metaplasia ◽  
Age At Diagnosis ◽  
Sinus Surgery ◽  
Tissue Eosinophilia ◽  
Basement Membrane Thickening ◽  
Increased Risk ◽  
History Of

Background A subset of chronic rhinosinusitis (CRS) patients demonstrates tissue eosinophilia on structured histopathology. Prior studies have suggested that these patients are at increased risk for recurrent disease. The goals of this study are to identify histopathologic features of CRS patients with tissue eosinophilia and compare the influence of tissue eosinophilia to the effects of age and revision surgery on histopathology. Methods A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery. Binomial logistic regression analysis was conducted to evaluate the association of age at diagnosis, tissue eosinophil count, and history of revision surgery with histopathology variables. Results A total of 281 CRS patients were included, of which 106 had tissue eosinophilia. Regression analysis demonstrated that tissue eosinophilia was associated with degree of inflammation (odds ratio [OR] 5.744; P <  .001), neutrophilic infiltrate (OR 1.882; P =  .020), basement membrane thickening (OR 3.561; P <  .001), squamous metaplasia (OR 3.315; P <  .001), fibrosis (OR 2.246; P =  .002), presence of Charcot–Leyden crystals (OR 20.700; P =  .004), and eosinophilic aggregates (OR 34.172; P <  .001). Age and history of revision surgery were not significant predictors of histopathology variables on multivariate analysis. Conclusion Tissue eosinophilia appears to be the predominant driving factor of histopathologic changes irrespective of previous sinus surgery or age at diagnosis. These findings may have important implications for postsurgical management and prognosis for patients with tissue eosinophilia presenting for revision surgery.

Sign in / Sign up

Export Citation Format

Share Document