Relationship between clinical measures and histopathologic findings in chronic rhinosinusitis

Abstract

Objective: Describe detailed histopathologic findings from a cohort of patients with chronic rhinosinusitis and evaluate whether histologic measures correlate with baseline clinical factors.

Study design: Cross-sectional study with planned data collection.

Setting: Tertiary medical center.

Subjects and methods: Adult patients with chronic rhinosinusitis were prospectively enrolled and demographic data and medical comorbidities recorded. Disease severity was measured by computed tomography (CT), endoscopy, Smell Identification Test (SIT), the Chronic Sinusitis Survey, Rhinosinusitis Disability Index, and SF-36 General Health Survey. Mucosal specimens were assessed for the presence of mucosal inflammation, including cellular (eosinophils, neutrophils, lymphocytes, mast cells, plasma cells, macrophages), epithelial (squamous metaplasia, basement membrane thickening, goblet cells), and stromal markers (subepithelial edema, fibrosis). Histopathologic findings were correlated to baseline clinical factors.

Results: A total of 147 subjects were enrolled with histologic samples available for review. Presence of inflammatory markers was diverse, with lymphocytes present in 100 percent of subjects, eosinophils in 49.7 percent, and neutrophils found in 0.7 percent. Total eosinophil counts correlated with the presence of nasal polyposis (r = -0.367; P < 0.001), asthma (r = 0.264; P = 0.001), and aspirin intolerance (r = 0.279; P = 0.001). Mucosal eosinophilia correlated with worse disease severity on CT (r = 0.414; P < 0.001), endoscopy (r = 0.376; P < 0.001), and SIT (r = -0.253; P = 0.002), with the highest correlations seen in subgroups without nasal polyps. Histopathologic findings did not significantly correlate with any quality-of-life measure.

Conclusion: Mucosal eosinophilia correlates with objective disease severity as defined by CT, endoscopy, and SIT scores. Although other histologic markers of inflammation are present, none show similar correlations. The presence of mucosal eosinophils does not correlate with quality-of-life scores.

Figure I

Comparison of mean olfactory (SIT) scores between CRS subtypes with and without nasal polyposis and measurable eosinophilia. ECRSwNP = Eosinophilic CRS with nasal polyposis. CRSwNP = Non-eosinophilic CRS with nasal polyposis. ECRSsNP = Eosinophilic CRS without nasal polyposis. CRSsNP = Non-eosinophilic CRS without nasal polyposis. Bars represent ± 1.0 standard deviation from the mean. * indicates a non-significant subtype difference p=0.649.

Figure II

Comparison of mean CT and endoscopy scores between CRS subtypes with and without nasal polyposis and measurable eosinophilia. ECRSwNP = Eosinophilic CRS with nasal polyposis. CRSwNP = Non-eosinophilic CRS with nasal polyposis. ECRSsNP = Eosinophilic CRS without nasal polyposis. CRSsNP = Non-eosinophilic CRS without nasal polyposis. Bars represent ± 1.0 standard deviation from the mean. * indicates a significant subtype difference p=0.037. ** indicates a significant subtype difference p=0.006.

Figure III

Frequency distribution and range of absolute eosinophil counts for subjects with chronic rhinosinusitis (n=147).