Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis

Abstract

Objectives: (1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predict disease severity in CRSwNP. Methods: Patients with CRSwNP treated at an academic hospital specializing in respiratory and allergic disease from 2008 to 2010 were included in this study. Clinical information was collected retrospectively. Sinus computed tomography (CT) scans were scored by a single author according to the Lund-Mackay (LM-CT) system, and surgical specimens were evaluated by a single author for degree of tissue eosinophilia. Statistical analysis was performed with t test, chi-squared test, Fisher’s exact test, and multiple regression models. Results: Seventy CRSwNP patients were included. They had a mean LM-CT score of 16.7, 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. There was no significant correlation between tissue and serum eosinophil counts ( P = .97). There was a significant positive correlation between CT score and peripheral eosinophil level ( P < .05). Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms ( P = .91), or Lund-Mackay scores ( P = .25), nor did it correlate with presence of asthma, but it may be elevated in aspirin-sensitive patients ( P = .09). Patients with mild asthma had significantly more tissue eosinophils when compared to patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. Conclusions: Higher serum eosinophil levels may indicate worse mucosal disease as measured on CT scan, but neither serum nor tissue eosinophilia predicted disease severity in our population CRSwNP patients.