Correlation of Symptoms, Clinical Signs, and Biomarkers of Inflammation in Postsurgical Chronic Rhinosinusitis

• Published in: Annals of otology, rhinology & laryngology rhinology & laryngology, 2017-06, Vol.126 (6), p.455-462
• Main Authors: Racette, Samuel D., Wijewickrama, Rohan C., Jayaprakash, Vijayvel, Sherris, David A., Santos, Carlos, Kita, Hirohito, O’Donnell, Frank E., Ponikau, Jens U.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - analysis; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Mucosa - chemistry; Nasal Polyps - diagnosis; Nasal Polyps - etiology; Postoperative Period; Prospective Studies; Rhinitis - complications; Rhinitis - diagnosis; Rhinitis - diagnostic imaging; Rhinitis - surgery; Sinusitis - complications; Sinusitis - diagnosis; Sinusitis - diagnostic imaging; Sinusitis - surgery; Tomography, X-Ray Computed; Treatment Failure; Young Adult
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/0003489417701939

Objective: The study aimed to evaluate symptoms described by patients with chronic rhinosinusitis with polypoid changes/nasal polyps and their correlation with computed tomography (CT), nasal endoscopy, and intranasal biomarkers. Study Design: Prospective multicenter study symptom data from postsurgical adult chronic rhinosinusitis study participants with recurrent disease refractory to medical therapy were analyzed in comparison with objective data. Methods: Using logistic regression analysis, participant-rated 16-question surveys from 258 participants were assessed for correlation with nasal endoscopy scores, CT percentage of sinus occlusion, and intranasal biomarkers of fungal antigens (Alternaria and Aspergillus), eosinophilic inflammation (eosinophil-derived neurotoxin [EDN] and major basic protein [MBP]), and inflammatory cytokines (interleukins 5 and 13). Results: Study participant assessments revealed increased CT occlusion in participants presenting with greater inability to smell (P < .019). Mucosal inflammation identified on nasal endoscopy was positively correlated with congestion (P < .028), runny nose (P < .002), and ear pain (P < .007). Elevated EDN was positively correlated in patients with bothersome congestion (P < .031) and runny nose (P < .011). Sneezing was positively correlated with multiple markers: Alternaria (P < .024), interleukin-13 (P < .027), MBP (P < .034), and interleukin-5 (P < .019). Conclusion: Nasal endoscopy, not CT imaging, has the strongest correlation with the 2 cardinal symptoms of congestion and runny nose in CRS patients; these correlate with biomarkers of eosinophilic inflammation.