Can postoperative steroid requirements for controlling mucosal inflammation provide insight into predicting which patients require more aggressive medical therapy to prevent disease relapse after sinus surgery for chronic rhinosinusitis (CRS)?
Bottom line: Tissue eosinophil aggregates appear to be the largest driving factor for increased prednisone requirements after sinus surgery to control mucosal disease than the mere presence of eosinophils. This finding may identify patients at high risk for sinus surgery failure and guide more proactive postoperative management.
Explore this issue:April 2019
Background: CRS without nasal polyps (CRSsNP) is often associated with increased fibrosis, goblet cell hyperplasia, and neutrophilia, while CRS with nasal polyps (CRSwNP) demonstrates predominantly edematous stroma with albumin deposition, pseudocyst formation, and eosinophilia. To date, limited research has investigated the postoperative steroid requirements of specific CRS endotypes beyond these binary models.
Study design: Retrospective chart review of 101 patients (42 CRSwNP, 59 CRSsNP) who underwent functional endoscopic sinus surgery (FESS) for refractory CRS.
Setting: Department of Otorhinolaryngology–Head and Neck Surgery; Rush Sinus Program, Rush Medical College, Chicago.
Synopsis: There was no difference in gender distribution or age between groups, but disease duration was longer in the CRSwNP group. The entire patient cohort showed overall improvement in SNOT-22 scores, from an initial mean score of 42.7 ± 2.42 to mean scores of 16.3 ± 1.72, 18.8 ± 2.15, and 19.1 ± 2.33 at one, three, and six months, respectively. CRS patients with eosinophilia (eos > 5/HPF) required greater cumulative postoperative prednisone to control mucosal inflammation at one-, three-, and six-month postoperative intervals compared to patients without eosinophilia. Patients with tissue eosinophil aggregates required the highest cumulative steroids at one-, three-, and six-month postoperative intervals. When removing patients with eosinophil aggregates from the eosinophilia group, no difference persisted between patients with eosinophilia and those without eosinophilia at all time intervals. All patients had a postoperative reduction in modified Lund-Kennedy scores, but patients with eosinophil aggregates consistently had higher scores at all time points compared to patients without eosinophil aggregates. Limitations included the retrospective nature of the study and difficulty capturing patients with late recurrence of disease.
Citation: Tajudeen B, Ganti A, Kuhar HN, et al. The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement. Laryngoscope. 2019;129:794–799.