Relationship between the Severity of Inflammatory Changes in Chronic Sinusitis and the Level of Vitamin D before and after the FESS Procedure

Abstract

There have been a few reports confirming that vitamin D (VD3) deficiency increases inflammation in the paranasal sinuses. The work brings new information that, despite the presence of inflammation before surgery, patients with higher vitamin D levels had less inflammation, and this has been proven on three levels. We show that vitamin D levels clearly correlate with the severity of the disease in chronic sinusitis. These results have been confirmed in imaging studies (Lund MacKay scale), endoscopy (Lund-Kennedy scale) and in the SNOT 20 questionnaire. 40 patients suffering from chronic sinusitis were divided into two equal groups: group 1: with less severe radiological changes (10 or less points on the Lund-Mackay scale), group 2: with a more advanced form (>10 points). The relationship between VD3 and the severity of the disease (clinical and nasal endoscopy) was assessed. The mean VD3 level in patients in group 2 before surgery was lower (23.01 ng/mL) than in group 1 (28.02 ng/mL) (p < 0.05). They presented a higher degree of advanced changes in all the above scales, i.e., before the SNOT 20 procedure, the mean was: group 1: 30.33, group 2: 31.80 (p < NS); Lund-Kennedy: group 1: 3.21, group 2: 6.30 (p < 0.05). After surgery an increase in VD3 levels was observed in both study groups: in group 1 to the value of 37.98 ng/mL (p < 0.002) and in group 2 to 27.67 ng/mL (p < 0.004). Lower VD3 levels were found in patients with a higher stage of the disease. Reduction of inflammation increases the level of VD3 and reduces subjective and objective symptoms of chronic inflammation.

The Correlation Between Vitamin D Deficiency and Chronic Rhinosinusitis: A Systematic Review

“…Zand et al described a negative correlation with SNOT-22, the Lund-Mackay score, and serum vitamin D levels, with mean vitamin D levels of 24.6 ± 16.9 ng/mL [ 13 ]. Likewise, Kalinczak et al demonstrated that levels of vitamin D in group 1 were 28.02 ng/mL, while in group 2, they were 23.01 ng/mL [ 15 ]. Tomaszewska et al revealed a positive correlation with Lund-Mackay scores (R = -0.42) and a negative correlation with SNOT-22 scores (R = -0.3)m while the levels of vitamin D reported were 28.4 ng/mL in CRS without nasal polyps and 21.0 ng/mL in CRS with nasal polyps, whereas in control groups, the levels were 30.9 ng/mL [ 16 ].…”

“…When treatment begins, 25 vitamin D3 is converted to 1.25 vitamin D3, and cathelicidin, an antimicrobial peptide, is produced. The acute-phase reaction is inhibited by vitamin D3, and inflammation resulting from CRS may cause vitamin D3 levels to drop [ 15 ].…”

Role of Vitamin D in the Clinical Course of Nasal Polyposis

“…The proliferation of Th2 cells leads to an increase in interleukin 31 (IL-31) synthesis, an effector cytokine that plays an important role in the pathogenesis of atopic and allergic diseases [ 25 , 26 ]. Given these correlations, a significant correlation between vitamin D deficiency and inflammation in patients with chronic rhinosinusitis with and without nasal polyps is shown [ 27 , 28 , 29 , 30 ].…”

Calcitriol Alleviates AKI Via Inhibiting Intestinal Inflammation and Restoring Intestinal Microbiota

“…Cal inhibits in ammation, oxidative stress and immune responses. There have been many publications con rming that chronic in ammatory diseases are associated with reductions in vitamin D levels 9 . Additionally, the administration of vitamin D compounds at doses near the upper limit of safety may serve to maximize immune health bene ts and mitigate in ammation and disease severity in patients with SARS-CoV-2 infections 10 .…”