Medical Student Northwestern University Feinberg School of Medicine
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 polyps being associated with the Type 2 endotype. In this study, we evaluate the endotypic underpinnings of discharge or edema without recurrent polyps after ESS.
Methods: Patients underwent endoscopy at 6-12 months post-ESS and middle meatal mucus (MMM) was obtained at that visit. Endoscopy was scored using the modified Lund-Kennedy scale for edema, polyps and discharge. Luminex analysis of MMM was performed for IFN-γ, ECP, or IL-17a, and 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: 123 CRS patients were enrolled at ESS, of which 107 did not have polyps at post-ESS endoscopy. Of these, 48 patients had discharge, 44 patients had edema, and 46 had no recurrence of endoscopic findings. Compared to those without recurrence, patients with discharge or edema reported significantly worse severity as measured by CRS-PRO. In addition, compared to no recurrence, patients with discharge or edema had higher post-ESS IFN-γ, ECP, and IL-17a. Patients with discharge had higher prevalence of T1 and T3 endotypes (p=0.027, p=0.008), while patients with edema had higher prevalence of T3 endotypes (p=0.007).
Conclusions: Post-ESS discharge or edema in the absence of recurrent polyps were associated with higher patient reported outcome severity and were more strongly associated with Type 1 or 3 inflammation.