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

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.

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Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal Antrostomy Site Stenosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420929365 ◽

2020 ◽

Vol 129 (10) ◽

pp. 964-968

Author(s):

Hyo Jun Kim ◽

Ji Ho Choi ◽

Jae Yong Lee

Keyword(s):

Maxillary Sinusitis ◽

Rare Condition ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Contributing Factors ◽

Canine Fossa ◽

Middle Meatal Antrostomy ◽

Preoperative Ct ◽

Sinus Mucosa ◽

Mucosal Hypertrophy

Objective: This study was performed to evaluate the incidence, timing, and factors contributing to recurrent maxillary sinusitis due to middle meatal antrostomy (MMA) site stenosis after endoscopic sinus surgery (ESS). Methods: The medical records and endoscopic photographs of 288 patients with chronic rhinosinusitis who underwent ESS were evaluated. Patients visited the clinic with similar schedule after ESS; recurrent maxillary sinusitis due to MMA site stenosis was investigated, including in terms of the incidence and timing. The preoperative computed tomography (CT) scans, intraoperative findings, and possible factors contributing to MMA site stenosis were examined. Results: Recurrent maxillary sinusitis due to MMA site stenosis occurred in 10 patients. Most had unilateral sinusitis and stenosis was observed within 6 months postoperatively. All patients had severe inflammation, pus retention, and thick mucosal hypertrophy in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination. Conclusions: MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.

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

ORL ◽

10.1159/000515005 ◽

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

Introduction: 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. Methods: 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 >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. Results: 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 (p < 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, p = 0.038). Conclusions: 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.

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Endoscopic Visualization of the True Maxillary Ostium Following Uncinectomy

Ear Nose & Throat Journal ◽

10.1177/0145561319853260 ◽

2019 ◽

Vol 99 (6) ◽

pp. 384-387 ◽

Cited By ~ 1

Author(s):

Omar H. Ahmed ◽

Marissa P. Lafer ◽

Ilana Bandler ◽

Elcin Zan ◽

Binhuan Wang ◽

...

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Chronic Rhinosinusitis ◽

Study Design ◽

Endoscopic Sinus Surgery ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

Academic Hospital ◽

Preoperative Ct

Objectives: To examine the frequency in which angled endoscopes are necessary to visualize the true maxillary ostium (TMO) following uncinectomy and prior to maxillary antrostomy. Additionally, to identify preoperative computed tomography (CT) measures that predict need for an angled endoscope to visualize the TMO. Study Design: Retrospective study. Setting: Tertiary academic hospital. Patients and Methods: Patients who underwent endoscopic sinus surgery (ESS) between December of 2017 and August of 2018 were retrospectively identified. Cases were reviewed if they were primary ESS cases for chronic rhinosinusitis without polyposis and if they were at least 18 years of age. Results: Sixty-three maxillary antrostomies were reviewed (82.5% were from bilateral cases). Thirty-five cases (55.6%) required an angled endoscope in order to visualize the TMO. Of the preoperative CT measures examined, a smaller sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle was significantly associated with need for an angled endoscope intraoperatively to visualize the TMO (17.1° SD ± 3.2 vs 15.0° SD ± 2.9; P = .010). Conclusion: Angled endoscopes are likely required in the majority of maxillary antrostomies to visualize the TMO. This is important to recognize in order to prevent iatrogenic recirculation. The SK-CS-NL angle may help to identify cases preoperatively which require an angled endoscope to identify the TMO during surgery.

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Squamous Metaplasia and Chronic Rhinosinusitis: A Clinicopathological Study

American Journal of Rhinology ◽

10.2500/ajr.2008.22.3236 ◽

2008 ◽

Vol 22 (6) ◽

pp. 602-605 ◽

Cited By ~ 11

Author(s):

Robert G. Mynatt ◽

Jennifer Do ◽

Christine Janney ◽

Raj Sindwani

Keyword(s):

Chronic Rhinosinusitis ◽

Clinical Features ◽

Chronic Sinusitis ◽

Squamous Metaplasia ◽

Sinus Surgery ◽

Preoperative Ct ◽

Student’S T ◽

Pathology Reports ◽

Clinical Records ◽

Student’S T Test

Background The significance of squamous metaplasia (SM) in chronic rhinosinusitis (CRS) is unknown. The objectives of this study were to determine the prevalence of SM in histopathological specimens from patients with CRS and to correlate these histological findings with clinical features. Methods We reviewed the clinical records and pathological slides from 87 consecutive patients who underwent endoscopic sinus surgery for CRS. Demographic and clinical data, preoperative Chronic Sinusitis Survey (CSS) scores, and sinus CT stage were evaluated. Pathological slides were graded by a pathologist to characterize the degree of inflammation and SM, when present. CRS patients with and without SM were compared using student's t-test and χ2 test. Results Evaluation of the pathology slides revealed that 18.4% of specimens had SM present, whereas only 2.2% of pathology reports noted this. Histological grading of chronic inflammation showed significantly greater severity in specimens with SM (n = 16) when compared with the cohort without SM (n = 75; 100.0% versus 77.5%, respectively; p = 0.016). There was no difference in preoperative CT stage or the presence of hyperostosis on imaging, CSS scores, duration of CRS symptoms, or other clinical features between those with SM and those without SM (p > 0.05). Immunodeficiency was the only comorbidity more prevalent in the metaplastic group (12.5% versus 0%, respectively; p = 0.003). Conclusion SM is present in ∼18% of routine CRS specimens. It has a positive correlation with the severity of inflammation noted histologically in CRS but does not correlate with disease severity or chronicity, clinically.

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Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1255 ◽

2016 ◽

Vol 9 (1) ◽

pp. 13-17

Author(s):

Priyanko Chakraborty ◽

Rajiv K Jain ◽

Purnima Joshi ◽

Rakhi Kumari ◽

Sidharth Pradhan

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Chronic Rhinosinusitis ◽

Sinus Surgery ◽

Anatomic Variations ◽

Review Of Literature ◽

Computed Tomography Scan ◽

Diagnostic Endoscopy ◽

The Mean ◽

Tomography Scan

ABSTRACT Background Chronic rhinosinusitis (CRS) refers to a group of disorders characterized by inflammation of the mucosa of the paranasal sinuses. Nasal endoscopy and computed tomography (CT) scans are successfully used as diagnostic modalities of nose and paranasal sinus diseases. There have been many studies regarding the anatomic variations leading to pathogenesis of paranasal sinus diseases. Considerable progress has been made in the medical and surgical control of these conditions; however, a large number of questions relating to the diagnosis, evaluation, and treatment of the diseases remain unanswered. Materials and methods The study included 82 clinically diagnosed cases of CRS who underwent CT scan and were advised to undergo diagnostic endoscopy. The anatomical findings of the nose were compared to see correlation between nasal endoscopy and CT scan. Results The mean age (±standard error of the mean) of presentation was 34.11 (±1.42) years, while most patients were from the age group of 18 to 30 years. Males were predominating the study group with 62.2%, while 37.8% were females. The most common anatomic variation was deviated nasal septum with 92.68% CT reported patients. This was followed by inferior turbinate hypertrophy, septal spur, concha bullosa, and agger nasi cells. Conclusion Computed tomography scan is considered the gold standard for sinonasal imaging. Diagnostic endoscopy and CT scan are a must prior to any functional endoscopic sinus surgery. They help in assessing the extent of sinus disease and to know the variations and vital relations of the paranasal sinuses. Computed tomography scan assists the surgeon as a “road map” during endoscopic sinus surgery. How to cite this article Chakraborty P, Jain RK, Joshi P, Kumari R, Pradhan S. Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature. Clin Rhinol An Int J 2016;9(1):13-17.

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Diagnostic Value of Nasal Cytology in Chronic Rhinosinusitis Assessed by a Liquid-based Cytological Technique

American Journal of Rhinology and Allergy ◽

10.1177/1945892418768581 ◽

2018 ◽

Vol 32 (3) ◽

pp. 181-187 ◽

Cited By ~ 7

Author(s):

Wenyu She ◽

Jun Yang ◽

Chengshuo Wang ◽

Luo Zhang

Keyword(s):

Maxillary Sinus ◽

Chronic Rhinosinusitis ◽

Inflammatory Cell ◽

Chronic Sinusitis ◽

Inferior Turbinate ◽

Inflammatory Cells ◽

Diagnostic Value ◽

Cell Counts ◽

Nasal Cytology ◽

Sinus Mucosa

Back ground: Nasal cytology has generally been employed as a useful diagnostic tool in the differentiation of rhinopathies. Objective The aim of this study was to assess the extent and diagnostic value of inflammation of nasal and paranasal sinus mucosa in chronic rhinosinusitis patients by employing a combination of nasal brushings and a liquid-based cytological technique. Methods Forty-eight patients with chronic sinusitis and 20 control subjects without any sign of sinusitis undergoing endoscopic surgery, although not all underwent endoscopic sinus surgery, were recruited to the study. Nasal cytology samples were collected from all subjects using nasal brush and processed a liquid-based cytological technique for evaluation of total and differential inflammatory cell counts. Biopsies were also taken from the inferior turbinates from its anterior margin in all subjects and from identical lateral maxillary sinus mucosa in patients with chronic sinusitis during surgery and routinely processed for staining and evaluation of inflammatory cells. Results Total and individual inflammatory cell counts in nasal brushings were significantly correlated with the respective inflammatory cell counts in biopsies obtained from the inferior turbinate (eosinophils: r = .519 and P = .016; neutrophils: r = .540 and P = .012; lymphocytes: r = .540 and P = .011) but not in biopsies obtained from the maxillary sinus. No correlation was observed between the inflammatory cells in biopsies from the inferior turbinate and biopsies from the maxillary sinus. The liquid-based cytological technique showed higher sensitivity (94.1%), specificity (76.9%), and positive predictive value (84.2%) for inflammation in the inferior turbinates than for inflammation in the maxillary sinus (sensitivity = 63.4% and positive predictive value = 63.4%). Conclusion Nasal cytology evaluated by use of nasal brushings processed by a liquid-based cytological technique is likely to have higher diagnostic value for the inflammatory response in noninfectious rhinitis than in chronic rhinosinusitis.

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A comparative study between ciliary count and the degree of opacity of paranasal sinus CT scans in chronic sinusitis pre and post FESS

The Journal of Laryngology & Otology ◽

10.1258/002221505775010643 ◽

2005 ◽

Vol 119 (12) ◽

pp. 950-954 ◽

Cited By ~ 5

Author(s):

Ahmed Bassiouny ◽

Mahmoud Abd El Raouf ◽

Ahmed Atef ◽

Safaa Nasr ◽

Soha Talaat ◽

...

Keyword(s):

Ct Scan ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Ct Scans ◽

Sinus Disease ◽

Before And After ◽

The Relationship ◽

Radiological Stage ◽

Sinus Mucosa

Objective: To investigate the relationship between the extent of sinus disease in chronic sinusitis as detected radiologically by computed tomography (CT) scan and the population of cilia (ciliary area) both before and after functional endoscopic sinus surgery (FESS). In a simple way this is a trial to statistically prove that the CT scan could be a valid indicator and a mirror of the histological status of the sinus mucosa.Design: Twenty adult patients were enrolled in this study. Radiological extension of the sinus disease was quantitated using the classification proposed by Kennedy in 1992 and the ciliary population was studied using scanning electron microscopy and image analysis softwares.Results and conclusion: The more advanced the sinusitis, as evidenced by CT scans, the more the expected reduction in the ciliary area (CA) and in the ciliary count. But after FESS the degree of ciliary regeneration does not depend statistically on the radiological condition of the sinuses and the degree of opacity prior to intervention, i.e. a statistically valid inverse relationship exists between the radiological stage of sinusitis and the ciliary population pre-operatively but the same relation does not extend to the ciliary population post-operatively.

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Biofilms and nasal wound healing in postsurgical patients with chronic rhinosinusitis - A review of literature

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0023 ◽

2015 ◽

Vol 5 (20) ◽

pp. 203-208

Author(s):

Veronica Trombitas ◽

Alina Anda Nagy ◽

Diana Vlad ◽

Ilea Aranka ◽

Silviu Albu

Keyword(s):

Chronic Rhinosinusitis ◽

Focal Point ◽

Treatment Strategies ◽

Signs And Symptoms ◽

Bacterial Biofilm ◽

Sinus Surgery ◽

Common Disease ◽

Favourable Evolution ◽

The Relationship ◽

Sinus Mucosa

AbstractChronic rhinosinusitis (CRS), fairly common disease in the field of otorhinolaryngology, is the focal point of thorough study of the pathophysiology and treatment strategies for a favourable evolution of patients with this problem. Although there have been important advances in the treatment of CRS, signs and symptoms still remain long after functional endoscopic sinus surgery (FESS), indicating the persistence of the biofilm infection on the sinus mucosa. This review aims to highlight the relationship between bacterial biofilm and CRS, and also the available treatment strategies of the latter.

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Combined Image Guidance and Intraoperative Computed Tomography in Facilitating Endoscopic Orientation within and around the Paranasal Sinuses

American Journal of Rhinology ◽

10.2500/ajr.2008.22.3242 ◽

2008 ◽

Vol 22 (6) ◽

pp. 635-641 ◽

Cited By ~ 21

Author(s):

Sarah K. Wise ◽

Richard J. Harvey ◽

John C. Goddard ◽

Patrick O. Sheahan ◽

Rodney J. Schlosser

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Paranasal Sinus ◽

Image Guidance ◽

Sinus Surgery ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Significant Difference ◽

Preoperative Ct ◽

Anatomic Region

Background The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Methods Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Results Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Conclusion Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.

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Stent Hypersensitivity and Infection in Sinus Cavities

Allergy & Rhinology ◽

10.2500/ar.2013.4.0071 ◽

2013 ◽

Vol 4 (3) ◽

pp. ar.2013.4.0071 ◽

Cited By ~ 5

Author(s):

Nicholas G. Kounis ◽

George D. Soufras ◽

George Hahalis

Keyword(s):

Chronic Rhinosinusitis ◽

Granulation Tissue ◽

Endoscopic Sinus Surgery ◽

Current Knowledge ◽

Klebsiella Oxytoca ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Coagulase Negative Staphylococcus ◽

Moderate Growth ◽

Beta Hemolytic Streptococcus

Persistent mucosal inflammation, granulation tissue formation, hypersensitivity, and multifactorial infection are newly described complications of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. In an important report published in Allergy and Rhinology, a 45-year-old male patient suffering from recalcitrant chronic rhinosinusitis underwent functional endoscopic sinus surgery and was found, for the first time, to have steroid-eluting catheters that were inadvertently left in the ethmoid and frontal sinuses. The retained catheters had caused persistent mucosal inflammation and formation of granulation tissue denoting hypersensitivity reaction. These consequences had induced perpetuation of symptoms of chronic rhinosinusitis. Meticulous removal of the retained stents with the nitinol wings from inflamed tissues of the frontal, ethmoidal, and sphenoethmoidal recesses in which they were completely imbedded was successfully performed without polypoid regrowth. Cultures of specimens taken from both left and right stents showed heavy growth of Stenotrophomonas maltophilia and moderate growth of Klebsiella oxytoca, coagulase negative Staphylococcus, and beta-hemolytic Streptococcus anginosus. Fungal infection was not detected. The current knowledge and experience regarding stent hypersensitivity and infection in relation with the use of stents in sinus cavities is reviewed.

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