Impact of mucosal eosinophilia and nasal polyposis on quality-of-life outcomes after sinus surgery

Abstract

Objective: Assess whether the presence of mucosal eosinophilia correlates with surgical outcomes in patients with chronic rhinosinusitis.

Study design: Prospective cohort.

Setting: Tertiary medical center.

Subjects and methods: Adult patients with chronic rhinosinusitis were prospectively enrolled, and demographic data and medical comorbidities were recorded. Preoperative quality of life (QOL) was measured by the Chronic Sinusitis Survey (CSS), Rhinosinusitis Disability Index (RSDI), and Short Form-36 General Health Survey (SF-36). Sinus mucosal specimens were collected at the time of surgery and the degree of eosinophilia quantified. Postoperative QOL was measured, and differences in QOL improvement were compared between those with and without eosinophilia.

Results: A total of 102 patients had both histopathological and QOL outcome data available for review. Follow-up averaged 16.5 months. Patients with eosinophilia showed significantly less improvement in the RSDI total (17.9 vs 25.0; P = 0.044), RSDI functional (5.7 vs 8.8; general health subscale; P = 0.018), CSS medication (3.6 vs 17.3; P = 0.013), SF-36 general health (0.6 vs 9.6; P = 0.008), SF-36 physical role (16.1 vs 34.7; P = 0.036), and SF-36 vitality (11.9 vs 21.2; P = 0.034) scales than those without eosinophilia. The greatest improvement in QOL was seen in patients without eosinophilia or polyps, with the least improvement seen in those with eosinophilia but without polyps.

Conclusion: The presence of mucosal eosinophilia at the time of surgery consistently predicted less improvement in both disease-specific and general QOL compared with patients without eosinophilia. The impact of eosinophilia on outcomes was greatest for patients without nasal polyposis, a group that demonstrated the least improvement in QOL measures.

Trial registration: ClinicalTrials.gov NCT00799097.

Figure 1

Frequency distribution and range of absolute eosinophil counts for study subjects (n=102).

Figure 2

Differences in postoperative disease-specific QOL improvement on the RSDI instrument between CRS subtypes. Total and subscale scores are reported. QOL = quality-of-life. RSDI = Rhinosinusitis Disability Index. 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. *indicates a statistically significant subtype difference ≤ 0.05.

Figure 3

Differences in postoperative disease-specific QOL improvement on the CSS instrument between CRS subtypes. Total and subscale scores are reported. QOL = quality-of-life. CSS = Chronic Sinusitis Survey. 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. *indicates a statistically significant subtype difference ≤ 0.05.

Figure 4

Differences in postoperative general QOL improvement on the SF-36 instrument between CRS subtypes. Separate subscale scores are reported. QOL = quality-of-life. SF-36 = Medical Outcomes Short Form-36. 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. GH = General health subscale. PF = Physical functioning subscale. PR = Physical role subscale. ER = Emotional role subscale. SF = Social functioning subscale. BP = Bodily pain subscale. VT = Vitality subscale. MH = Mental health subscale. *indicates a statistically significant subtype difference ≤ 0.05.