Nasal nitric oxide as a long-term monitoring and prognostic biomarker of mucosal health in chronic rhinosinusitis.

Abstract

Nasal nitric oxide (nNO) is a potential biomarker of chronic rhinosinusitis (CRS), and correlates well with endoscopic and radiologic severity of disease. However, the long-term profile of nNO as a biomarker is not established in the literature. The objectives of our study were to examine whether nNO can maintain this correlation in a 5-year follow-up after endoscopic sinus surgery (ESS) and to investigate whether nNO value can be used to prognosticate revision rates in patients with CRS. We enrolled CRS patients 5 years after initial ESS at our institution. Patients underwent initial ESS at our institution between January 2013 and January 2015. Patients prospectively had the following measurements at baseline, 1 month, 6 months, and 5 years post-ESS: nNO levels, Lund-Kennedy Endoscopy Score (LKES), and 22-item Sino-Nasal Outcome Test-22 (SNOT-22) score. We also compared the nNO levels between patients who underwent revision ESS and those who did not. There were 32 patients included in the study with 8 patients undergoing revision ESS during the 5-year follow-up. nNO levels were elevated at 1 month, 6 months, and 5 years post-ESS compared to baseline. A significant negative correlation between nNO and LKES was found at 5 years post-ESS. nNO levels were significantly reduced at baseline and 6 months post-ESS in the revision cohort compared to the nonrevision cohort despite having comparable radiologic severity. nNO may serve as a noninvasive long-term biomarker to monitor sinus disease severity and to prognosticate results in patients with CRS. This has implications for potential integration into clinical practice.