Cytokine Association With Chronic Rhinosinusitis With and Without Nasal Polyps and Efficacy of Preoperative Oral Steroids

Abstract

RATIONALE: Oral steroids are commonly given to patients with Chronic Rhinosinusitis (CRS), however no study has looked into their efficacy in the different disease states of CRS on a large scale. METHODS: Our study included 176 adult patients of whom 66 were given preoperative oral steroids including 26 non-polypoid CRS (CRSsNP) and 40 CRS patients with nasal polyps (CRSwNP). The steroid naïve cohort included 30 controls, 40 CRSsNP, and 40 CRSwNP. Extracts from sinus tissue were run on a 23-plex Procarta Cytokine Assay. A student's t-test was performed. Pre-op, 1-month, and 3-month post-op SNOT-22 quality of life surveys were completed for each patient. RESULTS: Cytokines associated with steroid naïve CRSsNP tissue included IL-2, IL-5, IL-7, IL-12(p70), IL-17, IFN-gamma, and MCP-1 compared to control tissue (p<0.05). IL-2, IL-7, IL-12(p70), IFN-gamma, and MCP-1 were significantly lower in steroid exposed CRSsNP (p<0.05). Cytokines associated with steroid naïve CRSwNP tissue included IL-5, IL-10, IL-13, and IL-17, with reduced levels of RANTES and FGF-basic compared to control tissue (p<0.05). IL-5, IL-13, and MCP-1 were lower in steroid exposed CRSwNP (p<0.05). Cytokines not effected by steroids included IL-4, IP-10, IL-10, IL-12(p40), RANTES, GM-CSF, and EOTAXIN. Patients that received preoperative steroids had better SNOT-22 scores at 1 and 3 months post-op. Patients who did not receive preoperative steroids improved at 1 month but had worse SNOT-22 scores at 3 months post-op. CONCLUSIONS: Different cytokines are associated with CRSsNP and CRSwNP. Oral steroids given before surgery reduce the majority of cytokines and may help in long-term improvement in quality of life.