June 2022

ENT

PERSISTENT DISCHARGE OR EDEMA AFTER ENDOSCOPIC SINUS SURGERY IN PATIENTS WITH CHRONIC RHINOSINUSITIS ARE ASSOCIATED WITH A TYPE 1 OR 3 ENDOTYPE

Featuring: ​ Bruce K Tan, MD​, David B. Conley, MD, Robert C Kern, MD
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Read the full study, published in International Forum of Allergy & Rhinology, here.


Abstract
Background: Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into 3 endotypes, with the presence of polyps associated with the Type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
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Methods: At a visit 6-12 months post-ESS, patients underwent endoscopy and completed the CRS-PRO and SNOT-22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN-γ, ECP, and IL-17a. Type 1, 2, and 3 endotype was defined as greater than 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank-sum and chi-squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.

Results: 122 CRS patients completed a clinical exam (median: 8.2 months post-ESS). 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared to those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS-PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs 7.0, p<0.001; respectively), and had higher post-ESS IFN-γ, ECP, and IL-17a. Patients with discharge had higher prevalence of only T1 and T3 endotypes, while patients with edema had higher prevalence of only the T3 endotype.

Conclusions: Post-ESS discharge or edema in the absence of polyps were associated with higher patient reported outcome severity and were more strongly associated with Type 1 or 3 inflammation. This article is protected by copyright. All rights reserved.


This abstract was originally published in the International Forum Allergy & Rhinology on June 7, 2022. ​
Bruce K Tan, MD​, associate professor of Otolaryngology - Head and Neck Surgery  and Allergy and Immunology in the Department of Medicine.
David B. Conley, MD, associate professor of Otolaryngology - Head and Neck Surgery at Northwestern University's Feinberg School of Medicine.
Robert C Kern, MD, chair of the department of Otolaryngology - Head and Neck Surgery, George A. Sisson, MD, and professor of Otolaryngology - Head and Neck Surgery and Allergy and Immunology in the Department of Medicine.

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