Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis.

Abstract

Background: Causes of osteitis in chronic rhinosinusitis (CRS) other than previous surgery are poorly defined. Patients with eosinophilic CRS (ECRS) have more severe disease and poorer outcomes despite repeated surgery. Associations between osteitis and markers of ECRS are not well described. Methods: A cross-sectional study of CRS patients undergoing sinus surgery was conducted. Osteitis was scored radiologically using previously published measures. Associations between osteitis and histopathology, symptoms, endoscopy, CT mucosal score and seromarkers were analyzed. Results: Eighty-eight patients were assessed of whom forty-five had osteitis. Patients undergoing revision surgery recorded higher osteitis scores. Patients with mucosal eosinophilia had higher osteitis score than those without. Patients with osteitis had higher serum eosinophil. Similar relationships were also found in primary surgery. Osteitis was associated with endoscopic and radiologic, but not symptomatic disease severity. Conclusions: Osteitis is associated with tissue and serum eosinophilia in both patients with and without prior surgery. Patients with these features may benefit from post-operative corticosteroid therapy to prevent osteitis.

Osteitis is a misnomer: a histopathology study in primary chronic rhinosinusitis

“…Surgical interventions and the outcome of neo‐osteogenesis may not represent a cause–effect relationship. There is, however, an association between osteitis and tissue eosinophilia, nasal polyps, and serum eosinophilia . When aggressive topical therapy is administered, favorable results in CRS patients with neo‐osteogenesis can be achieved .…”

“…Osteitis has been reported as part of the pathophysiological process of chronic rhinosinusitis (CRS) . The prevalence of bony involvement in CRS is around 51%, with a higher prevalence in patients with previous sinus surgery (76%) than patients with primary surgery (36%) . The correlation of osteitis to greater endoscopic severity of CRS and worse computed tomography (CT) grading has been demonstrated.…”

“…The correlation of osteitis to greater endoscopic severity of CRS and worse computed tomography (CT) grading has been demonstrated. Osteitis is also associated with tissue eosinophilia, nasal polyps, and serum eosinophilia . In addition, osteitis is acknowledged as a poor prognostic factor to outcomes post–endoscopic sinus surgery (ESS) .…”

High tissue eosinophilia as a marker to predict recurrence for eosinophilic chronic rhinosinusitis: a systematic review and meta‐analysis

“…Recently, CRS has also been classified based on underlying inflammatory process into 2 groups: eosinophilic CRS (ECRS) and non‐eosinophilic CRS (NECRS) . Typical features associated with ECRS compared with NECRS are presented in Table . ECRS patients represent a unique subtype, as they appear to be more resistant to current medical and surgical interventions .…”

Correlation of the Kennedy Osteitis Score to clinico‐histologic features of chronic rhinosinusitis

“…The term “osteitis” is used in defining the process of bony paranasal sinus involvement in patients with CRS where neo‐osteogenesis occurs . The prevalence of osteitis in CRS is around 40% to 50% and increases to as much 76% in patients having previous sinus surgery . Patients with osteitis have more disease severity endoscopically and radiographically, which is associated with recalcitrant disease…”