Squamous Metaplasia and Chronic Rhinosinusitis: A Clinicopathological Study

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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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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Correlation of Computed Tomographic Findings and Intraoperative Findings in Patients with Chronic Sinusitis

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1313 ◽

2017 ◽

Vol 10 (2) ◽

pp. 78-85

Author(s):

Anjali Prakash ◽

Anoop Raj ◽

Vikram Wadhwa ◽

Swati Tandon ◽

Praveen K Rathore

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Multidetector Ct ◽

Sinus Surgery ◽

Prospective Clinical Study ◽

Computed Tomographic ◽

Preoperative Ct ◽

Left Maxillary Sinus ◽

Operating Surgeon

ABSTRACT Objective Chronic sinusitis affects more than 30 million people each year worldwide. Computed tomography (CT) has become a standard diagnostic tool in the evaluation of paranasal sinuses (PNS), but medical literature lacks studies correlating preoperative CT and intraoperative findings of functional endoscopic sinus surgery (FESS). The aim of our study was to evaluate ostiomeatal unit on multidetector CT (MDCT) and correlate findings of MDCT with intraoperative findings during FESS in patients with chronic sinusitis and hence check for its usefulness during surgery. Study design Prospective clinical study. Materials and methods Forty-nine patients with chronic sinusitis who visited the Lok Nayak Hospital, Delhi, India, between October 2010 and February 2012 were included in the study. All such patients underwent preoperative CT scan of PNS before surgery, i.e., FESS with or without septoplasty under general anesthesia. Results Maxillary sinus was found to be the most common sinus involved in chronic sinusitis. Preoperative CT findings correlated well with intraoperative findings for all sinuses except left maxillary sinus. Conclusion Multiplanar CT of nose and PNS helps to delineate the anatomy of nose and PNS, and drainage pathways of sinuses preoperatively. Therefore, the operating surgeon should be well versed with it. Progress of endoscopic sinus surgery can be partially attributed to revolution in imaging modalities. How to cite this article Tandon S, Rathore PK, Raj A, Prakash A, Wadhwa V. Correlation of Computed Tomographic Findings and Intraoperative Findings in Patients with Chronic Sinusitis. Clin Rhinol An Int J 2017;10(2):78-85.

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

American Journal of Rhinology ◽

10.1177/194589240201600301 ◽

2002 ◽

Vol 16 (3) ◽

pp. 131-134 ◽

Cited By ~ 38

Author(s):

Eva Szucs ◽

Saied Ravandi ◽

Anita Goossens ◽

Mieke Beel ◽

Peter A.R. Clement

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Staging System ◽

Inflammatory Cells ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Tissue Eosinophilia ◽

Eosinophilic Infiltrate ◽

Preoperative Ct ◽

Sinus Mucosa

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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Effect of Chronic Rhinosinusitis on Liver Transplant Patients

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2009.23.3352 ◽

2009 ◽

Vol 23 (5) ◽

pp. 492-496 ◽

Cited By ~ 3

Author(s):

Byoung Jae Moon ◽

Ju Hee Han ◽

Yong Ju Jang ◽

Bong-Jae Lee ◽

Yoo-Sam Chung

Keyword(s):

Liver Transplantation ◽

Chronic Rhinosinusitis ◽

Sinus Surgery ◽

Wound Infections ◽

Transplant Recipients ◽

Liver Transplants ◽

Transplant Patients ◽

Urinary Infections ◽

Clinical Records ◽

Overall Mortality

Background The use of immunosuppressant after liver transplantation makes transplant recipients susceptible to infections. Most infections that can alter mortality after liver transplantation are wound infections, urinary infections, and pneumonias. There is no evidence, however, that chronic rhinosinusitis can alter mortality in patients awaiting liver transplantation. We have therefore assessed the association of rhinosinusitis with mortality and prognosis after liver transplantation. Methods The clinical records of 996 patients who received liver transplants between January 1995 and March 2005 were reviewed and the collected data were analyzed. Results Of the 996 patients who received liver transplants between January 1995 and March 2005, 28 (2.8%) had pretransplant rhinosinusitis. Of the latter, 5 patients were treated medically, 1 patient had endoscopic sinus surgery, and 22 patients had no treatment before liver transplantation. Untreated rhinosinusitis before liver transplantation was associated with aggravated rhinosinusitis after transplantation but did not contribute to an increase in infectious mortality or overall mortality rate. Conclusion Pretransplant chronic rhinosinusitis does not contribute to mortality in patients undergoing liver transplantation.

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Histopathology in Chronic Rhinosinusitis Varies With Sinus Culture

American Journal of Rhinology and Allergy ◽

10.1177/1945892418762863 ◽

2018 ◽

Vol 32 (2) ◽

pp. 112-118 ◽

Cited By ~ 3

Author(s):

Ashley L. Heilingoetter ◽

Bobby Tajudeen ◽

Hannah N. Kuhar ◽

Paolo Gattuso ◽

Ritu Ghai ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Squamous Metaplasia ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Culturable Bacteria ◽

High Power Field ◽

Basement Membrane Thickening ◽

Histopathologic Changes ◽

Neutrophil Infiltrate

Background Structured histopathology reporting facilitates better understanding of the underlying pathophysiologic mechanisms of chronic rhinosinusitis. The microbiology of chronic rhinosinusitis has been studied extensively; however, distinct histopathologic changes associated with bacteria isolated in chronic rhinosinusitis are largely unknown. Objective The goal of this study is to better understand the relationship between culturable bacteria and histopathology in chronic rhinosinusitis. Methods A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery in a group of patients with chronic rhinosinusitis refractory to medical therapy. Patients with cystic fibrosis or ciliary dysfunction were excluded. Histology variables included eosinophil count per high-power field, neutrophil infiltrate, basement membrane thickening, subepithelial edema, hyperplastic/papillary changes, mucosal ulceration, squamous metaplasia, fibrosis, fungal elements, Charcot-Leyden crystals, and eosinophil aggregates. Baseline Lund-Mackay score and Sinonasal Outcome Test 22 score were also collected. The association of culture data with the aforementioned variables was assessed. Results A total of 59 chronic rhinosinusitis patients who underwent functional endoscopic sinus surgery were included. Chronic rhinosinusitis patients with Pseudomonas aeruginosa had significantly increased neutrophil infiltrate (71.4% vs. 26.9%, p = 0.048), subepithelial edema (28.6% vs. 3.8%, p = 0.047), and a trend toward increased fungal elements (28.6% vs. 5.8%, p = 0.071). Chronic rhinosinusitis patients with Staphylococcus aureus had significantly more hyperplastic changes (20% vs. 2.3%, p = 0.050) and a trend toward increased squamous metaplasia (33.3% vs. 14.2%, p = 0.069). Conclusion Distinct histopathologic changes were noted based on sinus culture data for S. aureus and P. aeruginosa. These findings may have important implications on the extent of surgical management and prognosis after surgery.

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Outcome of endoscopic sinus surgery for chronic rhinosinusitis patients: a Canadian experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215110001003 ◽

2010 ◽

Vol 124 (10) ◽

pp. 1095-1099 ◽

Cited By ~ 9

Author(s):

Y Al Badaai ◽

M Samaha

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

General Health ◽

Chronic Sinusitis ◽

Short Form ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Disease Specific

AbstractObjectives:To determine the effect on patients' quality of life of functional endoscopic sinus surgery performed for chronic rhinosinusitis within a tertiary care centre in Montreal, Canada.Methods:A prospective cohort study was undertaken. Subjects were consecutive patients with a diagnosis of chronic rhinosinusitis who had failed medical treatment and were undergoing functional endoscopic sinus surgery. Questionnaires assessing general health outcomes (i.e. the second version of the Short Form 12 questionnaire) and disease-specific outcomes (i.e. the Chronic Sinusitis Survey) were completed pre-operatively and a minimum of three months post-operatively.Results:A total of 152 patients were enrolled over a seven-month period, of whom 120 completed the post-operative surveys. The most common co-morbidity was asthma (40 per cent). Of the 120 patients with completed questionnaires, 72 per cent reported clinical improvement, 12 per cent reported deterioration and 15 per cent remained unchanged. The average improvement in Chronic Sinusitis Survey score was 17 per cent.Conclusion:Patients with chronic rhinosinusitis achieved a significant improvement in disease-specific quality of life after functional endoscopic sinus surgery. There was no significant improvement in general health related quality of life, as measured using the Short Form 12 questionnaire.

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Incidence of concha bullosa and its role in chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212788 ◽

2021 ◽

Author(s):

Yalagandula Vijaya Lakshmi ◽

Thakur Dinesh Singh ◽

Razia Fathima ◽

Vaddi Hemanth Kumar

Keyword(s):

Chronic Rhinosinusitis ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Sinus Surgery ◽

Concha Bullosa ◽

Medical Sciences ◽

Osteomeatal Complex ◽

History Of ◽

Mucosal Edema ◽

Surgical Manipulation

Background: Pneumatization of nasal turbinates is called concha bullosa. Most often it involves the middle turbinate and is one of the commonest variants of sinonasal anatomy. Bulbous and extensive type of concha bullosa may lead to narrowing or even complete blockage of osteomeatal complex. This alters the normal airflow and drainage pathways of mucous, resulting in mucosal edema which obstructs the ethmoidal infundibulum and osteomeatal obstruction leading to sinusitis. The aim of the study was to determine the incidence of concha bullosa and assess its role in causation of chronic rhinosinusitis. The objective was to determine the incidence of concha bullosa and assess its role in chronic rhinosinusitis.Methods: A retrospective study of 120 patients suffering from chronic sinusitis of age group 18 years to 70 years old were taken between March 2018 to January 2021 at Malla Reddy institute of medical sciences (MRIMS) who had nasal symptoms significant enough to warrant a CT paranasal sinus (CT PNS) with positive findings. All PNSs involved were identified for sinus disease. Concha bullosa identified and graded into small, moderate and large. Patients with history of previous nasal surgeries were excluded.Results: Our study showed 54% cases of chronic sinusitis with concha bullosa.Conclusions: Concha bullosa may be one of the predisposing factors of chronic rhinosinusitis and hence surgical manipulation by functional endoscopic sinus surgery (FESS) is important to prevent recurrence of sinusitis.

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Histopathologic Features of Chronic Sinusitis Precipitated by Odontogenic Infection

American Journal of Rhinology and Allergy ◽

10.1177/1945892418811210 ◽

2018 ◽

Vol 33 (2) ◽

pp. 113-120 ◽

Cited By ~ 8

Author(s):

Anish Raman ◽

Peter Papagiannopoulos ◽

Hannah N. Kuhar ◽

Paolo Gattuso ◽

Pete S. Batra ◽

...

Keyword(s):

Nasal Polyps ◽

Chronic Sinusitis ◽

Squamous Metaplasia ◽

Disease Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Severe Inflammation ◽

Sinonasal Outcome Test ◽

Inflammatory Profile ◽

Histopathologic Features

Background Chronic rhinosinusitis (CRS) is a heterogeneous disease process that can arise in the context of odontogenic disease from the maxillary teeth. The histopathologic features of odontogenic CRS (CRSo) have yet to be determined and may have important implications on disease management and need for escalation of therapy. Objectives The objectives of this study are to characterize the histopathologic features of CRSo and determine whether the inflammatory profile of CRSo contributes to its recalcitrance to medical therapy and need for surgery in a subset of patients with this disease. Methods A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund–Mackay scores (LMS), and Sinonasal Outcome Test-22 scores were compared among CRSo patients, CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients. Results Twenty-three CRSo, 38 CRSwNP, and 53 CRSsNP patients who underwent FESS were analyzed. Compared to CRSsNP, CRSo exhibited increased moderate–severe inflammation (73.9% vs 41.5%, P < .009). Compared to CRSwNP, CRSo had decreased squamous metaplasia (0.0% vs 18.4%, P < .03) and decreased fibrosis (26.1% vs 63.2%, P < .005). Eosinophilia was prevalent in CRSo but to a lesser extent than in CRSwNP (39.1% vs 63.2%, P < .05). CRSo cases had significantly lower mean LMS compared to CRSwNP (7.83 ± 2.77 vs12.18 ± 6.77, P < .005). Conclusion CRSo exhibits histopathologic features similar to those of CRSsNP with more severe inflammation. Moreover, eosinophilia, which is not typically considered to coexist with CRSo, was present in a large portion of CRSo patients. These findings may help explain at the inflammatory level why select cases of CRSo may be recalcitrant to medical and dental therapy.

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Role of Anaerobes in Chronic Sinusitis: Will Polymerase Chain Reaction Solve the Debate

Otolaryngology ◽

10.1067/mhn.2002.129037 ◽

2002 ◽

Vol 127 (5) ◽

pp. 384-386 ◽

Cited By ~ 7

Author(s):

Hassan H. Ramadan ◽

Peter H. Mathers ◽

Heather Schwartzbauer

Keyword(s):

Chronic Rhinosinusitis ◽

Chronic Sinusitis ◽

Anaerobic Bacteria ◽

Sinus Surgery ◽

Pcr Analysis ◽

Chain Reaction ◽

Culture Techniques ◽

Standard Culture ◽

Polymerase Chain

BACKGROUND: Bacteriology of chronic sinusitis continues to be a matter of debate, particularly the role of anaerobes. Some authors suggest that anaerobes play a significant role whereas others suggest a minimal role. Those who suggest a significant role argue that standard culture techniques are the culprits. OBJECTIVE: The purpose of this study was to use polymerase chain reaction (PCR) on sinus specimens for the presence of anaerobes and to compare them with standard culture techniques. METHODS: Sixty-four samples were obtained in a sterile fashion during sinus surgery and were sent for standard anaerobic cultures as well as anaerobic PCR analysis. RESULTS: Anaerobic bacteria were demonstrated in 5% of culture specimens, which is similar to recently published data. PCR identified anaerobic bacteria in 19% of the specimens ( P = 0.01) CONCLUSION: PCR analysis of surgical samples obtained during endoscopic sinus surgery for chronic sinusitis identified a significantly higher incidence of anaerobes (x4) compared with standard anaerobic culture technique. Chronic rhinosinusitis is one of the most common chronic diseases that affects individuals in the United States. It is estimated that >25 million office visits are made for sinusitis. 1 The financial impact of chronic sinusitis includes not only the direct medical costs of treatment but also the millions of hours of lost productivity caused by the disease. 1 Chronic rhinosinusitis is defined as the signs and symptoms of sinus inflammation that last longer than 12 weeks associated with documented sinus inflammation with imaging techniques ≥4 weeks after appropriate antibiotic therapy. 2 There is agreement in the literature regarding the bacterial etiology of acute rhinosinusitis. However, the etiology of chronic rhinosinusitis is still unclear despite numerous articles about the bacteriology of chronic rhinosinusitis. 3–10 The role of aerobes is more clear than the role of anaerobes in chronic rhinosinusitis; many conflicting reports have been published about the role of anaerobes as etiologic factors in chronic rhinosinusitis. 3–10 The incidence of anaerobes obtained on standard cultures from patients with chronic rhinosinusitis ranges from 0% to 56%. 3–10 The reports that show a high yield of anaerobes argue that the technique used to obtain the specimens, the method of transportation, and even specimen collection are reasons why other reports did not yield high levels of anaerobes. 4–5 With increasing numbers of patients with chronic rhinosinusitis and with increasing bacterial resistance to antimicrobials, which is blamed on the improper use of antimicrobials, knowledge of the bacteriology becomes important in the treatment. The role of aerobes was addressed in a prior publication 11 ; the role of anaerobic bacteria as an etiologic cause of chronic rhinosinusitis is addressed in this report. The goal of this study was to test specimens, using 2 different techniques, obtained during endoscopic sinus surgery from individuals who had chronic rhinosinusitis.

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