Postoperative evaluation of olfactory dysfunction in eosinophilic chronic rhinosinusitis – comparison of histopathological and clinical findings

Kashiwagi, Takashi; Tsunemi, Yuichiro; Akutsu, Makoto; Nakajima, Itsuo; Haruna, Shinichi

doi:10.1080/00016489.2019.1654131

Cited by 12 publications

(14 citation statements)

References 18 publications

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“…Of note, a direct correlation was found between the cytokine levels in the OC and levels in the middle meatus, 90 which suggests that cytokine changes are found simultaneously in the respiratory mucosa and the olfactory mucosa. These results are consistent with the previous observation of a significant correlation between the eosinophil counts in the respiratory and olfactory mucosa 67,75 …”

Section: Olfaction Indicates the Degree Of Inflammation And May Be A supporting

confidence: 93%

“…[72][73][74] Compared with the noneosinophilic CRS group, eosinophilic CRS patients have a more pronounced smell loss, fewer OMP (olfactory marker protein: a protein that marks mature olfactory neurons used in immunohistochemistry) positive cells and greater epithelial erosion. 75 Recent work in mice suggests that type 2 inflammation decreases the number of immature olfactory neurons, but not the mature olfactory neurons, indicating that it may interfere with the process of olfactory neurogenesis. 76 After some time, this may lead to reduced mature olfactory neuron populations, resulting in reduced OMP+ cells, as mentioned above.…”

Section: Mechanisms For Olfactory Loss In Crsmentioning

confidence: 99%

“…These results are consistent with the previous observation of a significant correlation between the eosinophil counts in the respiratory and olfactory mucosa. 67,75 Olfactory loss seems to be more severe and occurs at earlier stages of the disease in patients with eosinophilic infiltration. 9 The smell reduction of CRS has been reported to show correlations with blood and nasal mucosa eosinophil count.…”

Section: Olfaction Indicates the Degree Of Inflammation And May Be mentioning

confidence: 99%

“…Eosinophilic inflammation directly impairs or even kills olfactory sensory neurons, resulting possibly from neurotoxic effects from the release of eosinophilic granule proteins and eosinophil‐related cytokine damage 72‐74 . Compared with the noneosinophilic CRS group, eosinophilic CRS patients have a more pronounced smell loss, fewer OMP (olfactory marker protein: a protein that marks mature olfactory neurons used in immunohistochemistry) positive cells and greater epithelial erosion 75 . Recent work in mice suggests that type 2 inflammation decreases the number of immature olfactory neurons, but not the mature olfactory neurons, indicating that it may interfere with the process of olfactory neurogenesis 76 .…”

Section: Mechanisms For Olfactory Loss In Crsmentioning

confidence: 99%

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Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Xing

Whitcroft

Hummel

2020

Laryngoscope Investig Oto

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Background and Objective: Olfactory dysfunction has a high prevalence in chronic rhinosinusitis (CRS) patients and significantly affects quality of life. CRS is recognized as a complex disorder encompassing heterogeneous inflammatory processes in the nose and paranasal sinuses. Olfactory dysfunction in CRS patients is associated with the level of inflammatory mediators and the efficiency of inflammatory control. Learning about the association between CRS-related inflammation and olfactory function will provide clues to the pathogenesis of CRS. Structure: The first section of this review describes the assessment of olfactory function using various measures, from ratings to MR based imaging. Then, we discuss the conductive and inflammatory mechanisms related to olfactory dysfunction in CRS: olfaction is associated with certain inflammatory patterns and is potentially a marker of CRS subtype. Finally, we review anti-inflammatory therapies including conservative and surgical approaches, and their effectiveness in olfactory dysfunction in CRS. Conclusion: Assessment of olfactory function should be considered in the clinical evaluation of CRS patients, not only for detecting and quantifying patients' symptom, but also because it appears to be useful to objectively assess the efficacy of CRS treatment over time. In addition, olfaction can be expected to expand the library of CRS phenotypes and endotypes and, hence, pave the way for more precise, tailored treatment options.

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Section: Olfaction Indicates the Degree Of Inflammation And May Be A supporting

confidence: 93%

Section: Mechanisms For Olfactory Loss In Crsmentioning

confidence: 99%

Section: Olfaction Indicates the Degree Of Inflammation And May Be mentioning

confidence: 99%

Section: Mechanisms For Olfactory Loss In Crsmentioning

confidence: 99%

See 2 more Smart Citations

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Xing

Whitcroft

Hummel

2020

Laryngoscope Investig Oto

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“…Approximately 25% to 30% of patients with CRS are estimated to have nasal polyps (CRSwNP), and these patients often have significant impairment in quality of life and require treatment with systemic corticosteroids and/or endoscopic sinus surgery. 1 Although there has been a substantial focus on the role of eosinophils in CRSwNP, [2][3][4] it is apparent that there is immunologic dysfunction involving the epithelium, innate lymphoid cells, eosinophils, basophils, and mast cells among other effector cells. 5 T-cell or transmembrane immunoglobulin and mucin domain protein-3 (TIM-3) is a receptor that acts as an immune checkpoint, modulating immediate-phase degranulation and late-phase cytokine production downstream of FcεR1 in mast cells, promoting mast cell activation and cytokine production.…”

Section: Introductionmentioning

confidence: 99%

Association of Mast Cell Burden and TIM-3 Expression with Recalcitrant Chronic Rhinosinusitis with Nasal Polyps

Belsky

Corredera

Banerjee

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: Previous work showed that higher polyp mast cell load correlated with worse postoperative endoscopic appearance in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Polyp epithelial mast cells showed increased expression of T-cell/transmembrane immunoglobulin and mucin domain protein 3 (TIM-3), a receptor that promotes mast cell activation and cytokine production. In this study, CRSwNP patients were followed post-operatively to investigate whether mast cell burden or TIM-3 expression among mast cells can predict recalcitrant disease. Methods: Nasal polyp specimens were obtained via functional endoscopic sinus surgery (FESS) and separated into epithelial and stromal layers via enzymatic digestion. Mast cells and TIM-3-expressing mast cells were identified via flow cytometry. Mann-Whitney U tests and Cox proportional hazard models assessed whether mast cell burden and TIM-3 expression were associated with clinical outcomes, including earlier recurrence of polypoid edema and need for treatment with steroids. Results: Twenty-three patients with CRSwNP were studied and followed for 6 months after undergoing FESS. Higher mast cell levels were associated with earlier recurrence of polypoid edema: epithelial HR = 1.283 ( P = .02), stromal HR = 1.103 ( P = .02). Percent of mast cells expressing TIM-3 in epithelial or stromal layers was not significantly associated with earlier recurrence of polypoid edema. Mast cell burden and TIM-3+ expression were not significantly associated with need for future treatment with steroids post-FESS. Conclusions: Mast cell load in polyp epithelium and stroma may predict a more refractory postoperative course for CRSwNP patients. The role of TIM-3 in the chronic inflammatory state seen in CRSwNP remains unclear.

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Olfactory cleft mucus eosinophil‐derived neurotoxin better reflects olfactory loss than blood eosinophil counts in patients with chronic rhinosinusitis

Wu,

Liu,

Bleier

et al. 2023

Int Forum Allergy Rhinol

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BackgroundEosinophils are associated with olfactory dysfunction in chronic rhinosinusitis (CRS) and eosinophil‐derived neurotoxin (EDN) is a sensitive marker of intense eosinophil activation. This study aimed to analyze olfactory cleft mucus and olfactory mucosa EDN levels and their association with olfactory dysfunction in CRS.MethodsWe prospectively recruited 150 patients with CRS electing endoscopic sinus surgery and 25 healthy controls. Both superior turbinate biopsy specimens and olfactory cleft mucus were collected to analyze EDN levels. Sniffin’ Sticks test scores, olfactory cleft computed tomography (CT) scores, and olfactory cleft endoscopy scale (OCES) were obtained. Multivariable logistic regression analysis was applied to analyze the predictability of EDN levels for olfactory dysfunction in CRS.ResultsChronic rhinosinusitis with olfactory dysfunction presented significantly higher olfactory mucosa (p = 0.016) and olfactory cleft mucus (p < 0.001) EDN levels than CRS without olfactory dysfunction. Mucus EDN levels were positively correlated with blood eosinophils (r = 0.625, p = 0.002), olfactory cleft CT scores (r = 0.738, p < 0.001), and OCES (r = 0.605, p = 0.004) in CRS. Furthermore, mucus EDN levels were significantly negatively correlated with threshold, discrimination, and identification (TDI) (r = ‐0.688), olfactory threshold (r = ‐0.606), olfactory discrimination (r = ‐0.608), and olfactory identification (r = ‐0.697) scores. After adjusting for patient demographics and comorbidities, mucus EDN levels were significantly associated with olfactory dysfunction in CRS (odds ratio = 2.162; p = 0.027). Mucus EDN levels showed a significantly better performance for predicting olfactory dysfunction than blood eosinophil counts (area under the curve, 0.873 vs. 0.764, p = 0.024).ConclusionOlfactory cleft mucus EDN level may be a better biomarker for predicting olfactory dysfunction in CRS than blood eosinophil counts.

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Postoperative evaluation of olfactory dysfunction in eosinophilic chronic rhinosinusitis – comparison of histopathological and clinical findings

Cited by 12 publications

References 18 publications

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Association of Mast Cell Burden and TIM-3 Expression with Recalcitrant Chronic Rhinosinusitis with Nasal Polyps

Olfactory cleft mucus eosinophil‐derived neurotoxin better reflects olfactory loss than blood eosinophil counts in patients with chronic rhinosinusitis

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