Predictive outcomes of functional endoscopic sinus surgery in patients with chronic rhinosinusitis

Abstract

Abstract Objective: This article aims at addressing some inflammatory markers obtained from patients who underwent a functional endoscopic sinus surgery for refractory chronic rhinosinusitis (CRS) to predict the outcome of such surgeries according to the inflammatory load and to determine whether certain immune markers can predict a poor prognosis in these patients. Methods: Fourteen patients (eight women and six men) with diffuse rhinosinusitis as evident from a computed tomography scan but without nasal polyposis underwent ethmoidectomy. All patients had undergone biopsies of the ethmoid sinuses at the time of surgery. All tissue samples were subjected to immunohistochemical staining using CD3, CD4, CD8, and interleukin (IL)-5 antibodies, and the number of lymphocyte subsets (CD3, CD4, and CD8) and IL-5-expressing cells at the time of surgery were compared with the clinical response and nasal endoscopic findings 6 months after surgery. Results: Only six patients showed an improvement with a decrease in nasal symptoms and a decrease in the need for medications. Eight patients had an unchanged status or worsened, with disabling rhinorrhea and repeated sinusitis. Conclusion: Almost more than half of the patients with CRS and a diffuse mucosal disease do not respond to surgery. T lymphocytes play an important role in the pathophysiology of CRS. An increased number of IL-5-expressing cells in the ethmoid sinuses at the time of surgery could predict a poor prognosis. It may eventually be possible to classify patients with CRS into different groups with different prognoses.