Marko Grgić

Histopathologic Parameters as Predictors of Response to Endoscopic Sinus Surgery in Nonallergic Patients with Chronic Rhinosinusitis

OBJECTIVE: To estimate the predictable value of histopathologic parameters in chronic rhinosinusitis (CRS) for response to endoscopic sinus surgery (ESS). STUDY DESIGN: Symptomatology was rated in 100 patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were examined and scored for goblet cells, subepithelial thickening, mast cells, and eosinophils. Multiple regression analysis was performed to predict the total score of subjective symptoms before treatment by histopathologic parameters. The correlation between histopathologic parameters and postoperative symptoms was then evaluated. RESULTS: Goblet cells were the best predictor correlating with 5 symptoms. Subepithelial thickening correlated with 4 symptoms. Mast cell infiltration correlated with 3 symptoms. Eosinophilic infiltration correlated with only one symptom (P < 0.05). CONCLUSION: Certain histopathologic parameters in CRS are predictive of favorable response to ESS. SIGNIFICANCE: Pathologic evaluation may help the ENT surgeon to predict the persistence of certain CRS symptoms after ESS, even in patients at low risk for surgical failure. EBM rating: C-4

Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps

Objective of this study was to test whether there is a difference between chronic rhinosinusitis patients with (CRSwNP) and without (CRSsNP) nasal polyps in the association of extent of disease on CT scans with symptom severity and health-related quality-of-life (HRQL) impairment. Data sets from 271 chronic rhinosinusitis (CRS) patients who completed the Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scores were subjected to principal component analysis (PCA) to identify a symptom components related to CRS. After controlling for demographics, medical therapy, and comorbidities, the association between symptom components/items excluded from PCA and Lund–Mackay score (LMS) was evaluated. No association was found between the total SNOT-22 score and LMS in CRS patients. There was an independent association between a higher “nasal” symptom component derived from SNOT-22 PCA and LMS in patients with CRSwNP (p < 0.001), but not in CRSsNP patients, with a statistically significant difference between two patient subsets (p = 0.003). In patients with CRSsNP, higher (worse) SNOT-22 “facial pain” was associated with lower LMS (p = 0.022), although the estimated change in LMS was modest. Considering VAS PCA components, higher “nasal” symptoms were associated with higher LMS in CRSwNP patients (p < 0.001) but not in CRSsNP, with a statistically significant difference between CRS groups (p = 0.024). A higher “pain” PCA component was associated with lower LMS in CRSsNP patients (p = 0.019). This study found significant differences in the relationship between symptom burden and CT scores between CRS phenotypes and no association between HRQL impairment and CT scores.

Algorithm for navigated ESS.

ENT navigation has given new opportunities in performing Endoscopic Sinus Surgery (ESS) and improving surgical outcome of the patients` treatment. ESS assisted by a navigation system could be called Navigated Endoscopic Sinus Surgery (NESS). As it is generally accepted that the NESS should be performed only in cases of complex anatomy and pathology, it has not yet been established as a state-of-the-art procedure and thus not used on a daily basis. This paper presents an algorithm for use of a navigation system for basic ESS in the treatment of chronic rhinosinusitis (CRS). The algorithm includes five units that should be highlighted using a navigation system. They are as follows: 1) nasal vestibule unit, 2) OMC unit, 3) anterior ethmoid unit, 4) posterior ethmoid unit, and 5) sphenoid unit. Each unit has a shape of a triangular pyramid and consists of at least four reference points or landmarks. As many landmarks as possible should be marked when determining one of the five units. Navigated orientation in each unit should always precede any surgical intervention. The algorithm should improve the learning curve of trainees and enable surgeons to use the navigation system routinely and systematically.

08:36 AM: Predictors of Response to Surgery in Chronic Rhinosinusitis

OBJECTIVE: To analyze histopathologic mucosal findings as predictors of response to endoscopic sinus surgery (ESS) in allergic and nonallergic patients with chronic rhinosinusitis (CRS). METHODS: Fifty allergic and 50 nonallergic patients with CRS who underwent ESS were enrolled in the study. Patients completed a questionnaire concerning sinusitis symptoms (congestion, discharge, nasal secretion, headache, sneezing, cough, facial swelling and olfaction) before intervention and at 12 and 24 months after surgery. The following histopathologic parameters were assessed: goblet cells, subepithelial thickening, mast cells and eosinophils. Multiple regression analysis was performed to evaluate prediction of total score of subjective symptoms by histopathologic findings. The correlation between histopathologic findings and postoperative symptoms was then evaluated. The results in the two groups were compared. RESULTS: Analysis showed prediction of improvement in total scores at 12 and 24 months after surgery by subepithelial thickening and mast cells in allergic patients (P 0.001). Analysis showed prediction of outcome in nonallergic patients (P 0.05) was not possible. The following histopathologic findings correlate with symptoms at both observed terms in allergic patients: goblet cells correlate with 3 symptoms as well as subepithelial thickening (P 0.005). Mast cells infiltration correlate with 1 symptom (P 0.005). Eosinophilic infiltration does not correlate with any symptom (P 0.05). In the nonallergic patients goblet cells correlate with 4 symptoms (P 0.005). Subepithelial thickening correlates with 3 symptoms (P 0.005). Mast cells infiltration correlates with 2 symptoms as well as eosinophilic infiltration (P 0.005). CONCLUSIONS: Certain histopathologic findings in CRS are predictive of favorable response to ESS.