The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome

Abstract

Objective Patients with diabetes mellitus (DM) are known to be liable to infection. However, the association between diabetes and chronic rhinosinusitis (CRS) has not been well studied. We sought to determine the effects of DM on CRS culture results and quality of life (QOL) after functional endoscopic sinus surgery (FESS). Methods We conducted a retrospective cohort study. Adult CRS patients undergoing FESS were recruited from 10/1/2007 to 12/31/2011. Patient demographics, comorbidities, medication use, Lund-Mackay CT scores were collected prior to FESS. Intraoperative culture was obtained. Preoperative and 1-, 3- and 6-month postoperative QOL was measured by the 22 item Sinonasal Outcome Test (SNOT-22) scores. A mixed effects model was performed for analysis. Results Among the 376 CRS patients included, 19 patients (5.05%) had DM. Compared to non-DM patients, DM patients were significantly more likely to have Pseudomonas aeruginosa (26.32% versus 7.56%, p=0.004) and gram negative rods (26.32% vs. 8.96%, p= 0.013), but there were no significant difference in the prevalence of Staphylococcus aureus; DM patients were also significantly more likely to have nasal polyps and gastroesophageal reflux disease. Additionally, DM patients had significantly less improvement of postoperative SNOT-22 scores from baseline to 6-month follow-up than non-DM patients (adjusted mean=11.14, 95% CI (0.14, 22.15), p=0.047) after adjusting for all the other risk factors for CRS. Conclusion DM patients may be prone to gram negative bacterial sinus infections, and have significantly worse short-term postoperative QOL. Special postoperative care may need to be considered in CRS patients with DM

Different clinical factors associated with Staphylococcus aureus and Pseudomonas aeruginosa in chronic rhinosinusitis

“…This finding from our univariate analysis was reported in a recent publication of our team evaluating the effect of diabetes on CRS outcomes. 38 We found that diabetic patients were significantly more likely to have P. aeruginosa and Gramnegative rods as compared to nondiabetic patients. 38 However, because that previous article had a different focus, multivariate analysis was not performed to assess whether the association between diabetes and P. aeruginosa was significant after adjusting other clinical factors or was confounded by other clinical factors.…”

“…38 We found that diabetic patients were significantly more likely to have P. aeruginosa and Gramnegative rods as compared to nondiabetic patients. 38 However, because that previous article had a different focus, multivariate analysis was not performed to assess whether the association between diabetes and P. aeruginosa was significant after adjusting other clinical factors or was confounded by other clinical factors. The association between P. aeruginosa and diabetes became marginally significant after adjusting for other clinical factors, but we cannot rule out the possibility that this is because of the small sample size of patients with P. aeruginosa.…”

New Insights into Upper Airway Innate Immunity

“…4 This pathway may be particularly important for patients with CRS and/or diabetes mellitus because they exhibit elevated airway surface liquid glucose levels. 76,[83][84][85] …”

Taste receptors in innate immunity

“…Recently, in a retrospective study of CRS patients, diabetics were found to be more likely to have intraoperative microbiology cultures that included gram-negative bacteria such as P. aeruginosa [212]. Previously, it has been speculated that keeping the ASL glucose concentrations low is important for keeping the airways sterile because it limits the nutrients available for bacteria to consume [207,205,206].…”