Hubungan Gambaran Histopatologi Dan Derajat Konka Hipertrofi Dengan Sumbatan Hidung Pada Rinosinustis Kronik

Latar belakang : Hidung tersumbat dapat disebabkan karena kelainan struktur hidung seperti deviasi septum, atresia koana, konka hipertrofi, celah palatum, hipertrofi adenoid, dan neoplasma. Dua puluh persen populasi dengan hidung tersumbat disebabkan konka hipertrofi. Konka hipertrofi merupakan pembesaran konka akibat bertambahnya ukuran sel konka, yang disebabkan hiperplasia dan hipertrofi lapisan mukosa dan tulang konka. Gambaran hipertrofi dan hiperplasi dapat dilihat melalui pemeriksaan histopatologi. Tujuan penelitian ini untuk mengetahui hubungan gambaran histopatologi dan derajat konka hipertrofi dengan sumbatan hidung pada pasien rinosinusitis kronik (RSK). Metode : Desain penelitian korelasi dengan metode belah lintang pada pasien RSK dengan konka hipertrofi yang menjalani operasi Bedah Sinus Endoskopik Fungsional (BSEF) dan konkotomi. Derajat konka hipertrofi dinilai berdasarkan nasoendoskopi, sedangkan sumbatan hidung menggunakan kuesioner Nasal Obstruction Symptom Evaluation (NOSE). Uji hipotesis yang digunakan adalah uji korelasi Spearman. Hasil : Karakteristik subyek penelitian sebanyak 33 orang, perempuan 60% lebih banyak daripada laki-laki 40%. Derajat sumbatan hidung ringan (30%), sedang (27%), berat (30%) dan sangat berat (13%). Konka hipertrofi terbanyak yaitu derajat 3 (54,5%). Hasil analisis dengan uji korelasi Spearman menunjukkan terdapat korelasi positif dengan nilai korelasi sedang antara derajat konka hipertrofi dengan derajat sumbatan hidung (p=0.02 dan rho = 0.404. Tidak terdapat hubungan yang bermakna antara derajat sumbatan hidung dengan gambaran histopatologi konka inferior (hiperplasia sel goblet, pembentukan kelenjar submukosa, eosinofil, limfosit, neutrofil). Simpulan : Derajat konka hipertrofi berpengaruh terhadap sumbatan hidung. Gambaran histopatologi konka hipertrofi tidak berpengaruh terhadap derajat sumbatan hidung pada pasien RSK. Kata kunci : Rinosinusitis kronik, sumbatan hidung, konka hipertrofi Background: Nasal congestion can be caused by abnormalities of nasal structures such as deviation of the septum, choanal atresia, turbinate hypertrophy, cleft palate, adenoid hypertrophy, and neoplasms. Twenty percent of the population with nasal congestion is due to turbinate hypertrophy. Turbinate hypertrophy is an enlargement of turbinate due to an increase in the size of turbinate cells, which is caused by hyperplasia and hypertrophy of the mucosal layers and turbinate bones. Description of hypertrophy and hyperplasia can be seen through histopathological examination. The purpose of this study was to determine the relationship between histopathological features and the degree of turbinate hypertrophy with nasal obstruction in patients with chronic rhinosinusitis (CRS). Methode: The correlative study design with a cross-sectional method in CSR patients with turbinate hypertrophy who underwent Functional Endoscopic Sinus Surgery (FESS) and turbinectomy. The degree of turbinate hypertrophy was assessed based on nasoendoscopy, whereas nasal obstruction used the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. The hypothesis test used is the Spearman correlation test. Result: The characteristics of the study subjects were 33 people, more women (60%) than men (40%). The degree of nasal obstruction is mild (30%), moderate (27%), severe (30%) and very severe (13%). Turbinate hypertrophy grade 3 was the most (54,5%). The analyzed using Spearman correlative test showed a positive correlation with a moderate correlation between the degree of turbinate hypertrophy with the degree of nasal obstruction (p=0.02 dan rho = 0.404). There was no significant relationship between the degree of nasal obstruction with histopathological features of the inferior turbinate (goblet cell hyperplasia, the formation of submucosal glands, eosinophils, lymphocytes, and neutrophils). Conclusion: The degree of turbinate hypertrophy affects nasal obstruction. Histopathological features of turbinate hypertrophy do not affect the degree of nasal obstruction in CSR patients. Keyword: Chronic rhinosinusitis, nasal obstruction, turbinate hypertrophy

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Quality of Life after FESS among Patients with Nasal Polyps Using the NOSE Questionnaire Translated in Filipino (NOSE-Ph)

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v31i1.305 ◽

2016 ◽

Vol 31 (1) ◽

pp. 17-21

Author(s):

Mary Ann V. Macasaet ◽

Emmanuel Tadeus S. Cruz

Keyword(s):

Quality Of Life ◽

Nasal Obstruction ◽

Nasal Polyposis ◽

Nasal Congestion ◽

Sinus Surgery ◽

Government Hospital ◽

Cross Sectional ◽

Symptom Evaluation ◽

Nasal Tumors

Objective: To evaluate the quality of life before, and after Functional Endoscopic Sinus Surgery (FESS) among patients with nasal obstruction due to nasal polyposis using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire translated in Filipino (NOSE-Ph) in a tertiary government hospital in Metro Manila. Methods: Design: Cross-Sectional QOL Study Setting: Tertiary Government Hospital Subjects: 40 patients with nasal polyposis who underwent FESS from April 2014 to June 2015 were included in the study. Patients who underwent FESS due to other nasal tumors other than nasal polyp were excluded. The subjects answered the previously-validated NOSE-Ph questionnaire pre- and post-operatively and the scores were gathered and analyzed. Results: Based on the pre and post-operative scores, there was a statistically significant improvement in all 5 parameters (1. nasal congestion, 2. nasal obstruction, 3. trouble breathing, 4. trouble sleeping, and 5. inability to get enough air through the nose during exercise). Conclusion: There was a statistically significant improvement in the quality of life of patients who underwent FESS based on the pre and post-operative scores using the NOSE-Ph questionnaire translated in Filipino. Keywords: nasal obstruction symptom evaluation scale

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The impact of chronic rhinosinusitis on sleep-disordered breathing

Rhinology Journal ◽

10.4193/rhino15.204 ◽

2016 ◽

Vol 54 (1) ◽

pp. 75-79

Author(s):

Rong-San Jiang ◽

Kai-Li Liang ◽

Chung-Han Hsin ◽

Mao-Chang Sun

Keyword(s):

Sleep Quality ◽

Chronic Rhinosinusitis ◽

Nasal Obstruction ◽

Sleep Disordered Breathing ◽

Sleep Problems ◽

Sleep Apnea Syndrome ◽

Sinus Surgery ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Background: The nose plays an important role in sleep quality. Very little is known about sleep problems in patients with chronic rhinosinusitis (CRS). The aim of this study was to investigate the impact of CRS on sleep-disordered breathing. Methodology: CRS patients who underwent functional endoscopic sinus surgery were collected between July 2010 and May 2015. Before surgery, they filled 20-item Sino-Nasal Outcome Test and Epworth Sleepiness Scale questionnaires, were asked about the severity of nasal obstruction, and received acoustic rhinometry, smell test, an endoscopic examination, sinus computed tomography, and a one-night polysomnography. Sleep quality was evaluated in these patients and was correlated with the severity of rhinosinusitis. Results: One hundred and thirty-nine CRS patients were enrolled in the study. Among them, 38.1% complained of daytime sleepiness, and this sleep problem was correlated with the symptom of nasal obstruction. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 64.7% of the patients, but there was no correlation with the severity of rhinosinusitis. Nasal polyps did not worsen sleep problems in the CRS patients. Conclusions: This study showed that CRS patents had a high prevalence of OSAS, and worse OSAS in CRS patients was not correlated with the severity of rhinosinusitis.

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Does surgical treatment of nasal airway obstruction improve sexual functions?

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001798 ◽

2019 ◽

Vol 133 (09) ◽

pp. 805-809 ◽

Cited By ~ 2

Author(s):

S Cayir ◽

O Hizli ◽

M Gul

Keyword(s):

Surgical Treatment ◽

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Erectile Function ◽

Sinus Surgery ◽

Concha Bullosa ◽

Sexual Performance ◽

Symptom Evaluation ◽

Operative Evaluation ◽

Operative Assessment

AbstractObjectiveTo investigate the effects of surgical treatment for nasal obstruction on sexual functions, regardless of the condition causing the nasal obstruction.MethodsOf 238 patients identified with nasal obstruction, 57 complained of erectile dysfunction and were included in the analysis. Patients underwent septoplasty, functional endoscopic sinus surgery, concha bullosa excision or radiofrequency ablation of the inferior turbinates, depending on their obstruction-causing disease. Pre- and post-operative evaluation of perceived nasal obstruction was performed using the Nasal Obstruction Symptom Evaluation questionnaire. Pre- and post-operative assessment of sexual functions was performed using the International Index of Erectile Function.ResultsMean post-operative scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall sexual satisfaction were significantly higher compared to the pre-operative scores (p = 0.022, p = 0.036, p = 0.033, p = 0.016 and p = 0.029, respectively).ConclusionSurgical treatment of nasal obstruction by septoplasty, endoscopic sinus surgery, concha bullosa excision or radiofrequency can significantly improve sexual performance.

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Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

10.53350/pjmhs211571860 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1860-1863

Author(s):

Bakht Zada ◽

Ejaz Ahmed ◽

Muhammad Habib ◽

Zafar Iqbal ◽

Rehan Saleem ◽

...

Keyword(s):

Risk Factors ◽

Nasal Septum ◽

Nasal Polyps ◽

Bone Erosion ◽

Histopathological Examination ◽

Sinus Surgery ◽

Fungal Sinusitis ◽

Deviated Nasal Septum ◽

Allergic Fungal Sinusitis ◽

Turbinate Hypertrophy

Aim: To govern the incidence of allergic fungal sinusitis in patients with nasal polyposis. Various anatomical risk factors were also investigated, including turbinate hypertrophy, deviated nasal septum and comorbidities such as asthma and diabetes. Study Design: This is a Descriptive cross-sectional study. Place and duration of study:The study was conducted at ENT Head &Neck Surgery department, Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for the duration of six months from May 2020 to October 2020. Methods: 110 patients with nasal polyps were evaluated and operated on. Samples were sent for histopathological examination and culture. All patients were assessed with clinical examination and detailed history. Laboratory tests were performed including complete blood counts, urea, electrolytes, ECG and chest radiographs for the suitability of general anesthesia as a prerequisite for surgery. In 95% of cases, computed tomography was recommended to check for sinus involvement, bone erosion, osteo-hypertrophic complex, turbinate hypertrophy, nasal septal deviation, and intracranial and intra-orbital enlargement. MRI examinations were also recommended in cases of suspected intraocular and intracranial disease (5%). Data was scrutinized on a computer using SPSS version 22.0. Results:Of the 110 patients, 65 were male and 45 were female, with a mean age of 1and ranged from 7 to 80 years. All patients had nasal polyps. The incidence of AFS was approximately 29.1% and the remaining 78 had a different pathology. Major deviation of the nasal septum and bilateral hypertrophy of the inferior turbinate’s were observed in 6 (18.7%) and 4 (12.5%) patients, respectively. Unilateral nasal polyps were observed in 7 (21.9%) patients and bilateral nasal polyps in 18 (52.3%). 19/32 (59.4%) of the cases underwent functional endoscopic surgery of the paranasal sinuses, and in 6 (18.7%) external fronto-ethmoidectomy. Two patients underwent nasal ethmoidectomy. Septoplasty and endoscopic sinus surgery were performed in a total of 3 (9.37%) cases. Key words:Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal sinusitis (AFS).

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Ekspresi cyclooxygenase-2 (COX-2) pada penderita rinosinusitis kronis

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v42i2.25 ◽

2012 ◽

Vol 42 (2) ◽

Author(s):

Agus Multazar ◽

Siti Nursiah ◽

Andrina Rambe ◽

Ida Sjailandrawati Harahap

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Paranasal Sinus ◽

Nasal Congestion ◽

Cyclooxygenase 2 ◽

Sinus Surgery ◽

Descriptive Research ◽

Ostiomeatal Complex ◽

Cox 2 ◽

Frontal Sinuses

Background: Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal sinus mucosa, which are closely related to the involvement of ostiomeatal complex as the drainage pathway of of maxillary and frontal sinuses. Inflammation or edema at the ostiomeatal complex could cause drainage problems leading to rhinosinusitis. Increased expression of COX-2 regulation was considered to play an important role in the development of CRS and increased airway inflammation in the nasal mucosa and paranasal sinuses. Purpose: To find out the expression of Cyclooxygenase-2 in our CRS patients. Methods: This descriptive research was conducted on July 2011 - December 2011 at ENT Department and Pathology Anatomy Department of Medical Faculty of Sumatera Utara University/H. Adam Malik General Hospital, Medan, to all patients diagnosed with CRS and underwent sinus surgery on July 2011 - December 2011. Results: The highest proportion of pain in patients with CRS is facial pain/pressure and headache with nasal congestion which was 78.6%. Multisinusitis on paranasal sinus CT scan was 88.0%. There was a significant correlation between the proportion of pain with the expression of COX-2 (p = 0.033). There was a significant correlation in proportion between the number of sinuses involved with the expression of COX-2 (p = 0.002). Conclusion: This study found positive expression of COX-2 was 84,0%, while negative expression was 16,0% in our rhinosinusitis patients. This lead to conclusion that upregulation of COX-2 expression is thought to play a role as a mediator in the development of CRS. Keywords: chronic rhinosinusitis, ostiomeatal complex, cyclooxygenase-2, immunohistochemical. Abstrak : Latar belakang: Rinosinusitis kronis merupakan peradangan mukosa hidung dan sinus paranasal yang erat hubungannya dengan keterlibatan kompleks ostiomeatal atau celah sempit di etmoid anterior, yang merupakan serambi muka bagi sinus maksila dan frontal. Bila terdapat gangguan di daerah kompleks ostiomeatal seperti inflamasi atau edema maka hal itu akan menyebabkan gangguan drainase sehingga terjadi rinosinusitis. Peningkatan regulasi ekspresi COX-2 diperkirakan memegang peran penting sebagai mediator dalam terjadinya rinosinusitis kronis dan peningkatan inflamasi saluran napas di mukosa hidung dan sinus paranasal. Tujuan: Mengetahui ekspresi cyclooxygenase-2 pada penderita rinosinusitis kronis di RSUP H. Adam Malik, Medan. Metode: Penelitian ini bersifat deskriptif dilakukan di Departemen THT-KL FK USU/RSUP H. Adam Malik, Medan dan Departemen Patologi Anatomi FK USU. Penelitian dilakukan bulan Juli - Desember 2011 pada seluruh penderita yang didiagnosis rinosinusitis kronis, yang menjalani operasi sinus di Divisi Rinologi Departemen THT-KL FK USU/RSUP H. Adam Malik, Medan bulan Juli 2011 - Desember 2011. Hasil: Proporsi rasa nyeri terbanyak pada penderita rinosinusitis kronis adalah rasa nyeri/ nyeri tekan wajah, sakit kepala disertai dengan hidung tersumbat 78,6%. Multi sinusitis pada pemeriksaan CT-Scan sinus paranasal sebanyak 88,0%. Ada hubungan yang bermakna antara jumlah sinus yang terlibat dengan ekspresi COX-2 (p = 0,002). Ada hubungan yang bermakna antara proporsi rasa nyeri dengan ekspresi COX-2 (p=0,033). Kesimpulan: Pada penelitian ini didapati pada penderita rinosinusitis kronis, ekspresi COX-2 yang positif yaitu sebanyak 84,0%, sedangkan yang negatif sebanyak 16,0%. Diperkirakan peningkatan regulasi ekspresi COX-2 berperan sebagai mediator dalam terjadinya rinosinusitis kronis. Kata Kunci: rinosinusitis kronis, kompleks ostiomeatal, cyclooxygenase-2, imunohistokimia.

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Comparing the outcome of septoplasty and septoplasty with turbinectomy in patients with deviated nasal septum

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193616 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1185

Author(s):

Nayanna Karodpati ◽

Mayur Ingale ◽

Sharad Rawat ◽

Vinayak Kuradagi

Keyword(s):

Nasal Obstruction ◽

Nasal Septum ◽

Inferior Turbinate ◽

Symptom Improvement ◽

Deviated Nasal Septum ◽

Medical College ◽

Turbinate Hypertrophy ◽

Symptom Evaluation ◽

Postoperative Symptoms ◽

Inferior Turbinate Hypertrophy

Background: Deviated nasal septum is a bodily disorder results in nasal obstruction. Many surgical procedures are available in correcting the disorder. The present study aimed to compare the surgical outcome of septoplasty alone and septoplasty with turbinectomy in patients with deviated nasal septum.Methods: This prospective study was done on 50 patients attending to the department of ENT of Dr. D. Y. Patil Medical College and Hospital, DPU with complaints of nasal obstruction due to inferior turbinate hypertrophy with deviated nasal septum. The severity of nasal obstruction was assessed by NOSE (nasal obstruction symptom evaluation) scale. Of them, 25 patients were managed with septoplasty alone and other 25 patients with septoplasty and turbinectomy. The outcome of both the procedures was assessed statistically by using NOSE scale. Results: Postoperative symptom improvement was seen in the both groups following surgery (p<0.05). When the NOSE scores are compared between two groups, statistically significant improvement in the symptoms (NOSE score) was seen in the group of patients treated with septoplasty and turbinectomy compared to septoplasty alone (p<0.05).Conclusions: This study re-iterates both septoplasty and concurrent turbinectomy are established mode of treatment in deviated nasal septum along with hypertrophy of inferior turbinates when the preoperative and postoperative symptoms are compared. However, the symptomatic outcomes and diagnostic nasal endoscopic findings are significantly better in patients who underwent septoplasty with concurrent resection of the inferior turbinate.

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Effect of functional endoscopic sinus surgery on the symptom profile in chronic rhinosinusitis cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200154 ◽

2020 ◽

Vol 6 (2) ◽

pp. 375

Author(s):

G. Syam Manohar ◽

Khan Majid Jabbar

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Facial Pain ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Nasal Discharge ◽

Symptom Profile

Background: Chronic rhinosinusitis (CRS) is a common chronic disease, that have considerable impact on quality of life, functional and emotional impairments of affected beings. Post-surgical improvement of quality of life indicates the surgical success. Functional endoscopic sinus surgery (FESS) is the dominating surgical procedure for CRS. This study was designed to assess the symptom profile of patient before and after surgery and the complications after FESS in the post-operative period.Methods: A total of 50 cases attending ENT outpatient department with clinical features and investigations suggestive of chronic sinusitis with infective pathology were randomly considered for this study. Cases were assessed for CRS symptoms pre and post operatively using grading symptoms. Results: Common major symptom was nasal obstruction (93.3%, N=28) followed by post nasal drip (83.33%, N=25), purulent nasal discharge (76.66%, N=23), facial pain/pressure (66.66%, N=20) and hyposmia (60%, N=18). None of the patients reported fever and facial congestion or fullness. Post operatively, cases with nasal obstruction (92.8%), purulent nasal discharge (86.9%), facial pain or pressure (85%), headache (81.8%), post nasal drip (84%), ear pain or fullness or pressure (92.8%) and hyposmia (61.1%) showed improvement after FESS at the end of three follow-up.Conclusions: The most common symptom pre operatively was nasal obstruction which also responded best to FESS, along with all the other minor symptoms including headache. The results of this study confirm that FESS is an excellent method of treatment in patients with CRS refractory to medical treatment.

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The Influence of Functional Endoscopic Sinus Surgery on Sleep Related Outcomes in Patients with Chronic Rhinosinusitis

International Journal of Otolaryngology ◽

10.1155/2019/7951045 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Rong-San Jiang ◽

Kai-Li Liang

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Sleep Apnea Syndrome ◽

Endoscopic Examination ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Apnea Hypopnea Index ◽

Sinonasal Outcome Test ◽

Apnea Syndrome

Purpose. Chronic rhinosinusitis (CRS) patients often complain of nasal obstruction, which may cause sleep impairment for them. The goal of this study was to investigate the influence of functional endoscopic sinus surgery (FESS) on sleep related outcomes in CRS patients. Materials and Methods. CRS patients who received FESS were included in this study. Prior to FESS and 3 months after surgery the patients were asked about the severity of nasal obstruction and completed the 20-item Sinonasal Outcome Test (SNOT-20), along with the Epworth Sleepiness Scale (ESS) questionnaire. Endoscopic examination, acoustic rhinometry, and polysomnography were performed in all patients. They were divided into four groups according to their preoperative apnea hypopnea index (AHI) scores: nonobstructive sleep apnea syndrome (non-OSAS), mild OSAS, moderate OSAS, and severe OSAS. Results. A total of 96 subjects completed the study. The scores of the sleep domain of the SNOT-20 and ESS decreased in all of the AHI groups, with the exception of the severe OSAS group, after FESS. A reduction in the AHI of less than 5 was achieved in 9 patients (13.2%) after FESS. Conclusions. Our results showed that FESS improved sleep quality in CRS patients, except those with severe OSAS, and a preoperative lower AHI was the only significant predictor of post-FESS OSAS outcome.

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Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00515-z ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Nadim Saydy ◽

Sami Pierre Moubayed ◽

Martin Desrosiers

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Nasal Congestion ◽

A Priori ◽

Tertiary Care ◽

Sinus Surgery ◽

Data Set ◽

Patient Goals ◽

Personalized Approach ◽

Minor Disease

Abstract Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract

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Comparison of Sinonasal Histopathological Changes in Biological Treatment of Eosinophilic Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/19458924211021031 ◽

2021 ◽

pp. 194589242110210

Author(s):

Jacqueline Ho ◽

Raquel Alvarado ◽

Janet Rimmer ◽

William A. Sewell ◽

Sophie Walter ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Inflammatory Diseases ◽

Histopathological Examination ◽

Tissue Level ◽

Tissue Response ◽

Sinus Surgery ◽

Biologic Therapies ◽

Eosinophilic Asthma ◽

Cross Sectional ◽

Eosinophilic Chronic Rhinosinusitis

Background Biologic therapies such as mepolizumab and benralizumab are currently utilised in the treatment of eosinophilic asthma, and are emerging in the management of eosinophilic chronic rhinosinusitis (eCRS). These biologics inhibit the interaction of IL-5 with its receptor, thus impairing cytokine signalling and eosinophil inflammation. Mepolizumab does so by targeting IL-5, whereas benralizumab targets the α chain of the IL-5 receptor. This study compares the sinonasal tissue response to anti-IL-5 biologic therapies in patients with eCRS. Methods A cross-sectional study of adult eCRS patients who had completed at least 2 cycles of biologic therapy and underwent endoscopic sinus surgery as part of their management were included. Sinonasal mucosal tissue biopsies were obtained intraoperatively and assessed with structured histopathological examination. Comparisons of tissue histopathology outcomes following treatment with mepolizumab or benralizumab were performed. Results 18 patients (age 49.6 ± 14.2 years, 47% female, 100% co-morbid asthma) were included in this study, comprising 10 patients managed with mepolizumab and 8 patients managed with benralizumab. Even after mepolizumab, the tissue had predominantly eosinophilic inflammation compared to benralizumab (90% v 0%, p < 0.01), which demonstrated a greater lymphoplasmacytic inflammation (10% v 75%, χ2(2) = 14.53, p < 0.01). Compared with benralizumab, mepolizumab had increased tissue eosinophil count (100% v 37.5% >10 eosinophils/HPF, τb = −8.47, p < 0.001) and more severe subepithelial oedema (80% v 37.5% severe, τb = −2.37, p = 0.02). Conclusion Tissue histopathologic outcomes reflect the differing mechanism of action of mepolizumab and benralizumab in eCRS. Further analysis at the tissue level will provide further information to guide application of mAbs in type 2 inflammatory diseases.

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