TY - JOUR
T1 - Eosinophilic Mucin
T2 - A Predictor for Disease Severity in Chronic Rhinosinusitis
AU - Unsal, Aykut A
AU - Reyes, Camilo
AU - Biddinger, Paul
AU - Kountakis, Stilianos E.
PY - 2020
Y1 - 2020
N2 - Objective: The presence of tissue eosinophilia is a determinate of disease severity in patients with chronic rhinosinusitis (CRS). The impact of eosinophilic mucin (EM) as an independent variable has not yet been elucidated. Study Design: Retrospective review. Setting: Tertiary academic clinic. Subjects Methods: CRS patients who failed medical therapy were classified by tissue eosinophilia, presence of polyps and EM. Tissue eosinophilia count per high power field (HPF) as well as the presence of EM were determined by pathologic examination of sinus tissue removed during surgery. Sinonasal Outcomes Test (SNOT-22), Lund-Mackay (LM), and Lund-Kennedy (LK) scores were compared between all groups preoperatively and postoperatively up to two and a half years (30 months). Results: 192 patients with CRS were included in the study. 87 were diagnosed with eosinophilic CRS with polyps, 58 with eosinophilic CRS without polyps, 14 with noneosinophilic CRS with polyps, and 33 with noneosinophilic CRS without polyps. Only patients with eosinophilia had EM on pathology. Of eosinophilic CRS, 50% of patients with polyps and 12% of cases without polyps demonstrated EM, respectively. EM presence portended more severe disease in patients with eosinophilia on subjective and objective scores preoperatively (P < 0.005). Postoperatively, EM patients experienced a greater improvement of symptoms, but continued to have worse endoscopy scores until 1.5 years. A tissue eosinophil count of 30 or greater per HPF was identified as a potential marker for the development of EM. Conclusions: The presence of eosinophilic mucin predicts overall worse disease severity in patients with eosinophilic CRS.
AB - Objective: The presence of tissue eosinophilia is a determinate of disease severity in patients with chronic rhinosinusitis (CRS). The impact of eosinophilic mucin (EM) as an independent variable has not yet been elucidated. Study Design: Retrospective review. Setting: Tertiary academic clinic. Subjects Methods: CRS patients who failed medical therapy were classified by tissue eosinophilia, presence of polyps and EM. Tissue eosinophilia count per high power field (HPF) as well as the presence of EM were determined by pathologic examination of sinus tissue removed during surgery. Sinonasal Outcomes Test (SNOT-22), Lund-Mackay (LM), and Lund-Kennedy (LK) scores were compared between all groups preoperatively and postoperatively up to two and a half years (30 months). Results: 192 patients with CRS were included in the study. 87 were diagnosed with eosinophilic CRS with polyps, 58 with eosinophilic CRS without polyps, 14 with noneosinophilic CRS with polyps, and 33 with noneosinophilic CRS without polyps. Only patients with eosinophilia had EM on pathology. Of eosinophilic CRS, 50% of patients with polyps and 12% of cases without polyps demonstrated EM, respectively. EM presence portended more severe disease in patients with eosinophilia on subjective and objective scores preoperatively (P < 0.005). Postoperatively, EM patients experienced a greater improvement of symptoms, but continued to have worse endoscopy scores until 1.5 years. A tissue eosinophil count of 30 or greater per HPF was identified as a potential marker for the development of EM. Conclusions: The presence of eosinophilic mucin predicts overall worse disease severity in patients with eosinophilic CRS.
KW - chronic rhinosinusitis
KW - disease severity
KW - eosinophilic mucin
KW - eosinophils per high power field
KW - Lund Kennedy
KW - Lund MacKay
KW - nasal polyps
KW - outcomes
KW - sinonasal outcome test
KW - tissue eosinophilia
UR - http://www.scopus.com/inward/record.url?scp=85088317535&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85088317535&partnerID=8YFLogxK
U2 - 10.1177/1945892420943828
DO - 10.1177/1945892420943828
M3 - Article
AN - SCOPUS:85088317535
JO - American Journal of Rhinology and Allergy
JF - American Journal of Rhinology and Allergy
SN - 1945-8924
ER -