Mucosal eosinophilia and recurrence of nasal polyps - new classification of chronic rhinosinusitis

Abstract

Background: Eosinophils and nasal polyps are believed to affect the surgical outcome of chronic rhinosinusitis (CRS). CRS is classified based on the presence of nasal polyps in western countries. The majority of patients with CRS with nasal polyps (CRS with NP) are characterized by predominantly eosinophilic inflammation. However, Asian patients with CRS with NP show characteristics indicative of neutrophilic inflammation. Therefore, are eosinophils or nasal polyps more important for the classification of CRS? Methods: A prospective cohort study conducted from April 2007 to March 2008 classified patients with CRS based on the presence of nasal polyps and mucosal eosinophilia. The recurrence rate of nasal polyps was compared between the groups. Recurrence rate was analysed as a time-dependent variable by the Kaplan-Meier method. Results: Eosinophilic inflammation was found in 59.6% of patients with CRS with NP. Patients with mucosal eosinophilia had higher polyp recurrence rate than patients without mucosal eosinophilia, whereas patients with nasal polyps did not have higher polyp recurrence rate than patients without nasal polyps. Conclusions: Presence of mucosal eosinophilia is a more important factor than nasal polyps for classifying CRS in terms of the surgical outcome.

Role of periostin in ECRS

“…ECRS is characterized by EOS infilitration, which plays a central role in ECRS pathological progress, and it has been indicated that expression of periostin is associated with EOS [ 53 ]. It is not hard to see that eosinophilis can accelerate periostin expression.…”

Predominant Endotype of Nasal Polyps in a Sample of Filipinos Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

“…The literature is rife with different cut-off values to determine mucosal eosinophilia, ranging from >5/hpf to >350/hpf. [7][8][9][10][11][12]18,19 We selected the cut-off value proposed by Kountakis et al, as their immunohistochemical studies for EG2, a marker for activated eosinophils, stained positive in all nasal polyp tissue specimens with more than 5 eosinophils/HPF, while those with 5 eosinophils or less did not stain positive for EG2. 16 Eosinophilic CRSwNP is also associated with decreased likelihood of surgical success and recurrence of disease within 5 years after surgical intervention with a positive predictive value of 87.5%.…”

The Immune System Throws Its Traps: Cells and Their Extracellular Traps in Disease and Protection

“…Typically, the increase of eosinophils in the blood or the presence of eosinophilic infiltrate in tissues is observed in allergic reactions, such as asthma and chronic rhinosinusitis, in helminth infections, and also in some bacterial and fungal infections [179,180]. Immunoregulatory actions for eosinophils, such as lymphocyte recruitment and tissue repair, have also been described [181].…”