Cases Of Chronic Rhinosinusitis Research Articles

Nasal Symptoms of Chronic Rhinosinusitis Were Related to Its Nasoendoscopic Findings: A Retrospective Cohort Study at Dr. Soetomo General Academic Hospital, Surabaya

Highlights: Nasal congestion was the most common symptom presented in CRS patients. Nasal symptoms of CRS were positively associated with nasoendoscopic findings. Abstract Introduction: Chronic rhinosinusitis (CRS) is often encountered in Indonesia. Nasal endoscopy, or nasendoscopy, is considered the gold standard for assessing the severity of CRS. However, as nasendoscopy is unavailable in Indonesia, only symptom assessments can be conducted at primary healthcare facilities. This study aimed to elucidate the relationship between nasoendoscopic findings based on the Lund-Kennedy score (LKS) and symptoms in CRS patients based on the visual analogue scale (VAS) score. Methods: This retrospective analytic study evaluated CRS cases identified in the Ear, Nose, and Throat (ENT) Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, from July 2021 to July 2022. Statistical analysis was conducted using Spearman’s rank correlation test to identify the correlation (R-value) between LKS and the VAS score. Statistical significance was achieved if p-value <0.05. All statistical tests were conducted using the International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 26.0 for Windows. Results: A total of 57 CRS patients were included in this study, mostly females (64.9%) and those aged 50–59 years old (26.9%). Nasal congestion was the dominant nasal symptom (80.7%), with mostly moderate symptom severity (VAS 4-7) reported. Across both nasal cavities, the most frequent nasoendoscopic finding among CRS patients was nasal edema (82.4% and 93%). A positive and weak correlation existed between the total VAS score of all symptoms and the total LKS of both nasal cavities (r = 0.387, p < 0.05). Conclusion: The nasal symptoms of CRS patients were significantly associated with its nasoendoscopic findings.

Lack of association of impaired upper airway sensation with the presence or absence of obstructive sleep apnoea or chronic rhinosinusitis in World Trade Center responders

ObjectiveExamine sensory function of the upper airway in four groups of subjects recruited from the World Trade Centre General Responder Cohort (WTCGRC), with/without obstructive sleep apnoea (OSA), and with/without chronic...

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Oxford Level 3.

Сhronic rhinosinusitis in adult patients with cystic fibrosis receiving CFTR modulators

Cystic fibrosis-associated chronic rhinosinusitis (CRS) is a separate form of CRS that progresses gradually over the course of patient’s life and worsens with age. The reasons for this are the mechanical congestion of mucus in the paranasal sinuses and the persistence of colonies of pathogenic antibiotic-resistant microorganisms. Therapy with CFTR modulators has resulted in a significant reduction in the severity of CRS. The nature of these changes and the dynamics in the microbial landscape of the upper respiratory tract are not sufficiently explored.Aim of the article is to highlight various aspects of the impact of CFTR modulators on the course of CRS in adult patients with cystic fibrosis (CF) based on literature data and a number of our own clinical observations. The article presents a series of clinical cases of CRS in adult CF patients treated with CFTR modulators for different periods of time.Conclusion. During targeted therapy with CFTR modulators, the symptoms of CRS are reversed due to the restoration of normal rheological properties of nasal secretions, the clinical picture improves, and the severity of CRS decreases. However, this type of treatment has no direct effect on the microbial landscape of the respiratory tract and requires additional interventions in the form of local and systemic antibacterial therapy. Therapy with CFTR modulators alters the course of CF in the nasal cavity, as well as in the pharynx and larynx.

Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.

Current update on Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is one of the commonest diseases in otorhinolaryngology and significantly affects thequality of life of patients. Traditionally, CRS has been divided into two phenotypes depending on the presenceor absence of nasal polyposis. Chronic type 2 inflammation is implicated in most cases of CRS. In recent years,increase in the understanding of the various disease entities of CRS has made endotyping of CRS an important toolin managing chronic rhinosinusitis. Newer concepts like super-antigens, enterotoxins, biofilms and fungal elementshave been implicated as the cause of refractory CRS. Evidence-based advancements in the medical and surgicalarmamentarium have resulted in improved treatment of CRS. In recalcitrant cases of CRS, biologics are being seenas an effective treatment modality. This article is a current update on the advances in understanding and managingchronic rhinosinusitis.

Neutrophil Extracellular Traps as a Biomarker in Refractory Non-Type 2 CRSwNP.

Chronic rhinosinusitis (CRS) is classified into type 2 (T2) and non-T2 inflammation. T2 CRS presents as a severe form, CRS with nasal polyps (CRSwNP), which often occurs with asthma as a comorbidity worldwide. Some cases of non-T2 CRS show nasal polyposis and refractoriness, mainly in Asian countries. However, its mechanism remains elusive. To investigate a biomarker for the refractoriness of non-T2 CRSwNP via RNA sequencing. RNA sequencing by using nasal polyps (NPs) and ethmoidal mucosa (EM) from CRS subjects and uncinate tissues from controls was performed, and differentially expressed genes (DEGs) were analyzed (cutoffs: expression change > 2-fold, P < 0.01). Immunofluorescence staining and enzyme-linked immunosorbent assay were performed. We identified DEGs among T2-NP, non-T2-NP, T2-EM, non-T2-EM, and controls (NP vs. controls: 1,877 genes, EM vs. controls: 1,124 genes, T2-NP vs. controls: 1,790 genes, non-T2-NP vs. controls: 2,012 genes, T2-EM vs. controls: 740 genes, non-T2-EM vs. controls: 1,553 genes). The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that neutrophil extracellular trap (NET) formation, systemic lupus erythematosus, and the phagosome were enriched in non-T2-NP vs. controls and non-T2-EM vs. controls. Immunofluorescence staining confirmed that NETs were elevated in non-T2-NP. Cytokine analysis demonstrated that NETs were significantly related to the refractoriness in non-T2-NPs. This study demonstrated DEGs between T2 and non-T2 inflammation. These results suggest that NETs may contribute to the refractoriness in non-T2-NPs and have a promise as a therapeutic strategy for patients with refractory non-T2-NP.

Biologics for Chronic Rhinosinusitis-A Modern Option for Therapy.

Chronic rhinosinusitis (CRS) is an important ENT pathology which affects about 5-12% of the general population. The treatment of CRS can be pharmacological (nasal sprays, douches, systemic antibiotics and steroids), surgical (endoscopic sinus surgery) or immunological according to established algorithms. CRS was divided for many years into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). New ways of classifying CRS by endotypes (presence of neutrophilia, eosinophilia, fibrosis, glandular hypertrophy and epithelial dysmorphisms) appeared after the most recent understandings of the pathophysiology of the disease. Other classifications divide CRS into primary and secondary forms, localized/diffuse types and anatomical presentation. A new type of treatment has been administered in the last years, biologics. For the moment, biologics are indicated just in the cases of the patients who have undergone ESS or have contraindications for surgery and have bilateral polyps and meet a minimum of three of the following criteria: the necessity for systemic therapies with oral or parenteral corticosteroids or contraindications to systemic steroids, significant loss of smell or impaired QoL score, comorbid asthma and type 2 inflammation. This article aims to present the most relevant studies which used the three types of biologics (anti-IgE, anti-IL5 and anti-IL4/IL3) and wishes to increase the awareness of this new type of treatment that can be used in some CRS cases.

SYMPTOMATIC OUTCOME IN CHRONIC RHINOSINUSITIS PATIENTS AFTER ENDOSCOPIC SINUS SURGERY - A PROSPECTIVE OBSERVATIONAL STUDY

Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses that is frequent. Endoscopic sinus surgery (ESS) is commonly used to treat intractable CRS cases. Although the effect of ESS on CRS symptoms has been researched, the pattern of symptom relief after ESS for CRS remains unknown. The purpose of this study was to investigate the extent and order of symptom improvement following ESS for CRS. This was a long-term prospective study of 54 CRS patients. The Sino-nasal Outcome Test- 22 (SNOT-22) questionnaire was utilised for assessment at five periods throughout the study: pre-ESS, one week after ESS, one month, three months, and six months after ESS. The following differences in mean scores were seen between pre-ESS and 6 months post-ESS for the five SNOT-22 domains: rhinologic symptoms, extra-nasal rhinologic symptoms, ear/facial symptoms, psychological dysfunction, and sleep dysfunction (p-value = 0.001). Understanding the pattern of symptom improvement after ESS for CRS will benefit in patient counselling and the optimisation of current treatment protocols in order to maximise surgical results and quality of life.

S. aureus biofilm metabolic activity correlates positively with patients’ eosinophil frequencies and disease severity in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a persistent inflammation of the sinus mucosa. Recalcitrant CRS patients are unresponsive to medical and surgical interventions and often present with nasal polyps, tissue eosinophilia, and Staphylococcus aureus dominant mucosal biofilms. However, S. aureus sinonasal mucosal colonisation occurs in the absence of inflammation, questioning the role of S. aureus in CRS pathogenesis. Here, we aimed to investigate the relationship between S. aureus biofilm metabolic activity and virulence genes, innate immune cells, and disease severity in CRS. Biospecimens, including sinonasal tissue and nasal swabs, and clinical datasets, including disease severity scores, were obtained from CRS patients and non-CRS controls. S. aureus isolates were grown into biofilms in vitro, characterised, and sequenced. The patients’ innate immune response was evaluated using flow cytometry. S. aureus was isolated in 6/19 (31.58%) controls and 23/53 (43.40%) CRS patients of 72 recruited patients. We found increased S. aureus biofilm metabolic activity in relation to increased eosinophil cell frequencies and disease severity in recalcitrant CRS cases. Mast cell frequencies were higher in tissue samples of patients carrying S. aureus harbouring lukF.PV, sea, and fnbB genes. Patients with S. aureus harbouring lukF.PV and sdrE genes had more severe disease. This offers insights into the pathophysiology of CRS and could lead to the development of more targeted therapies.

Effect of Dupilumab on Sleep Apnea Severity in Patients With Chronic Rhinosinusitis

Patients with chronic rhinosinusitis (CRS) report improved sleep quality after dupilumab, an anti IL4/13 therapy. Concurrent CRS and obstructive sleep apnea (OSA) cases are not rare, and CRS seemingly raises nasal resistance. Thus, we hypothesized that improved sleep quality by dupilumab therapy in CRS patients might be due to lowered nasal resistance and subsequent improvement of unrecognized comorbid OSA. Patients with concurrent CRS and OSA were recruited. Nasal resistance was measured invasively with transnasal pressure and flow data collected during normal respiration in the supine position. Results from the first five participants did not support our hypothesis. Subjective and objective measures for CRS and nasal resistance values were improved with dupilumab therapy in CRS patients with nasal polyps. However, apnea severity and sleep-related subjective parameters did not change. In the patients with CRS without nasal polyps, no significant changes in either CRS or OSA-related measures were observed.

Sinonasal Outcome Test (Snot-22) Scores as a Predictor of Outcome in Patients Undergoing Functional Endoscopic Sinus Surgery (FESS) for Chronic Rhinosinusitis (CRS) at a Tertiary Care Centre in Eastern Nepal

Background: Sino nasal outcome test (SNOT) is a subjective tool in which both nasal and health-related symptomatic improvements are assessed in cases of Chronic Rhinosinusitis (CRS). We aim to report the demography of CRS patients and magnitude of symptoms, along with its improvement over time after the surgery, using SNOT questionnaire. Methods: A hospital based prospective, descriptive study was done in 35 patients with medically refractory CRS cases who underwent Functional endoscopic sinus surgey (FESS), over one year. All patients were routinely examined the 1st week, the 4th week, and 3 months after surgery. The cases were assessed preoperatively and then after surgery, using the Sino-nasal Outcome Test-22 (SNOT-22) questionnaire, for a maximum of 3 months period. The results were expressed in number and percentage. Mean and standard deviation were used to describe the findings and compare the initial and follow up values. Association between preoperative and postoperative symptoms was analyzed using paired sample t-test and p value less than 0.05 were considered significant. Results: The age range was 14-64 years, with a mean age of 33.11 ± years. 12(34.28%) were male and 23(65.71%) were female. Polyps were present in 12 (34.28%). 23 (65.71%) cases were without polyp. The mean SNOT score overall preoperatively was 33.94±SD, while postoperative SNOT score was 19.05±SD. There was a significant improvement in nasal, ear and facial symptoms, quality of life symptoms and psychological symptoms. Conclusion: There was an overall improvement in all the symptoms postoperatively, though the Cough and dizziness improvement was not statistically significant.

Association of CYP1A2 and GST gene variants with asthma in cases presenting with allergic chronic rhinosinusitis

BackgroundInter-individual differences in regulation and activity of xenobiotic metabolizing enzymes (XMEs) CYP1A and GST might cause distinct susceptibility to chronic rhinosinusitis (CRS) phenotypes that need to be explored. Therefore, the present study aimed to evaluate the role and risk of CYP1A and GST gene variants in allergic CRS subjects with and without asthma. A total of 224 allergic CRS cases with asthma, 252 allergic CRS cases without asthma, and 350 healthy control subjects were subjected to genetic analysis. Gene variants of cytochrome P450 (CYP1A1 T3801 rs4646903, A2455G rs1048943, C2453A rs1799814 and CYP1A2 G3858A rs2069514, T739G rs2069526, C163A rs762551) and glutathione S-transferase P (GSTP1 A313G rs1605 & C341T rs1799811) were investigated by polymerase chain reaction-restriction fragment length polymorphism and GSTM1null, and GSTT1null by multiplex PCR methods.ResultsTG genotype of CYP1A2 rs2069526 (OR 1.73, 95% CI 1.20–2.50, p < 0.002), TC genotype of CYP1A1 rs4646903 (OR 1.43, 95% CI 1.03–1.98, p < 0.031) and GSTM1del (OR 1.87, 95% CI 1.24–2.81, p < 0.003) and were found to be significantly associated with only allergic CRS cases. CYP1A2 rs2069526 (OR 2.33, 95% CI 1.61–3.37, p < 0.001), GG genotype of GSTP1 rs1605 (OR 4.75, 95% CI 2.62–8.63, p < 0.001), GSTM1del (OR 1.82, 95% CI 1.19–2.78, p < 0.006), GSTM1/GSTT1 double null (OR 2.58, 95% CI 1.36–4.87, p < 0.004) and were found to be significantly associated with asthma in allergic CRS cases. Further, G-G-C haplotype of CYP1A2 rs2069514, rs2069526 and rs762551 gene variants was found to increase the risk for asthma by 5 folds in allergic CRS subjects (OR 5.53, 95% CI 1.76–17.31, p < 0.003) while T-G-C haplotype of CYP1A1 rs4646903, rs1048943, rs1799814 (OR 0.11, 95% CI (0.01–0.95, p < 0.045) and A-T haplotype of GSTP1 rs1605, rs1799811 (OR 0.27, 95% CI (0.08–0.89, p < 0.032) showed protective effect in allergic CRS group.ConclusionThe present study reports the significantly increased association of CYP1A2, GSTM, and GSTP gene variants with asthma in allergic CRS.

Pathogenesis and Biomarkers of Eosinophilic Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is divided into CRS with nasal polyp formation (CRSwNP) and CRS without NP formation (CRSsNP) according to the phenotype classification. CRS is also divided into type 1/type 2/type 3 according to the endotype classification. CRSwNP and type 2 CRS are caused by eosinophilic inflammation in most cases, and are intractable. Useful biomarkers for such cases of eosinophilic CRS (eCRS) are desired for predicting their severity and postoperative courses.

FEATURES OF THE COURSE OF CHRONIC RHINOSINUSITIS AGAINST THE BACKGROUND OF COVID-19

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the upper respiratory tract with a wide range of clinical variants. As our understanding of the pathophysiology of the disease develops, so does our philosophy regarding the approach and treatment of CRS. Endotyping gains an advantage over phenotype-based classifications due to its potential to predict disease severity and provide accurate treatment. Endotyping is particularly useful in complex cases of CRS with a nasal polyp, for which new treatment options such as biologics are now available. The latest European position paper on rhinosinusitis and nasal polyps (EPOS2020) reflects these developments with updated rhinosinusitis classifications and new integrated care schemes.

Tympanometry and endoscopic diagnosis of eustachian tube dysfunction in patients with chronic rhinosinusitis.

This study assessed the eustachian tube (ET) function in adult patients with chronic rhinosinusitis (CRS) using tympanometry and nasal endoscope. This was a hospital-based cross-sectional study conducted for 9 months. All participants underwent endoscopic evaluation of the pharyngeal end of their ETs, and the middle ear function was assessed using tympanometry. Endoscopic findings were graded based on a validated mucosal inflammatory endoscopic grading scale. Statistical analysis was carried out using SPSS version 24. A total of 102 CRS patients and age- and sex-matched controls were recruited. Tympanograms suggestive of eustachian tube dysfunction (ETD) types B and C were found among 7.8% and 12.8% of the right and left ears of the CRS groups, respectively. Mucosal inflammatory endoscopic grade that is diagnostic of ETD Grades 3 and 4 was found among 24.5% and 38.2% of the right and left ET of CRS cases, respectively. CRS predisposes patients to anatomical and functional impairment of ET. The relationship between tympanometry and mucosal inflammatory endoscopic grading scale in detecting ETD among CRS patients showed a strong relationship. However, a combination of the two will improve the diagnosis of ETD by evaluating the ET function directly and indirectly.

Occupational and environmental exposures, the association with chronic sinusitis.

Objectives:To find the association between environmental and occupational exposures and chronic rhinosinusitis (CRS) development.Methods:The Preferred Reporting Items Of Systematic Reviews Guidelines were used when a systematic literature review was conducted to find all published cases of CRS by searching PubMed database and Google Scholar. Published articles between 1989 and 2021 that reported chronic and occupational rhinosinusitis were included. However, articles that reported allergic rhinitis or upper airway diseases and non-English articles were excluded from this study.Results:A total of 97 articles were extracted initially, and 15 articles were reviewed after excluding 82 articles that did not match our inclusion criteria. Most studies linked CRS development to smoke exposure (n=9734), followed by living in rural areas as farms (n=5504). Exposure to pesticides (n=4248) contributed to a higher prevalence of CRS. Blue-collar occupations, such as fire fighters, farmers, and fishermen were significantly related to CRS development in a total of 5260 patients. Chronic rhinosinusitis mainly affected more men (n=8912) than women (n=8076).Conclusion:We found that smoking was the most aggravating environmental factor. Chronic rhinosinusitis symptoms’ severity increased with direct contact with allergens. Thus, the greatest proportion of patients with CRS was those with blue-collar occupations, such as firefighters, farmers, and fishermen.

Frequency and causes of self-medication in patients with chronic rhinosinusitis, North of Iran, 2018-2019.

Chronic rhinosinusitis (CRS) is a frequent respiratory disease. As self-medication is a common issue in the world, this study aimed to estimate its frequency in patients with CRS. 144 CRS patients referred to a university hospital, were evaluated for self-medication, included type, duration, frequency, and its causes, their SNOT-22 questionnaire and Lund-MacKay scores. The data were analyzed using SPSS v.21 and the level of significance was considered as P ≥ 0.05. 30.6% of the cases used self-medication (65.9% used chemical drugs and 63.6% used herbal drugs), not associated with their age, gender, educational or economic level. The most common chemical drugs were antibiotics, analgesics and decongestants (75.9%, 55.2% and 10.3%, respectively) and the most common non-pharmaceutical agents included steam inhalation and herbal infusions (71.4%). The efficacy of self-medication was rated as "none" to "little" in 54.64% of cases. The mean SNOT-22 score was 59.54 ± 10.93 and 73.27 ± 8.12 in cases without and with self-medication (P = 0.034), and the mean Lund-MacKay score was 11.8 ± 5.3 and 17.2 ± 4.3 in cases without and with self-medication, respectively (P = 0.002). The top reasons for self-medication were "considering the disease unimportant" and believing chemical drugs being "harmful", "expensive", or "non-effective". Most patients who used self-medication did "not" advise it to others (80%). The high rate of self-medication in CRS patients calls for greater attention to this issue in these patients. It seems that self-medication is significantly associated with more severe grades of disease and lower QOL in CRS cases.

Correlation between Peripheral Blood Eosinophilia and the Histopathological Changes in Nasal Mucosal in Chronic Rhinosinusitis

Background: Chronic rhinosinusitis(CRS) has emerged as one of the major causes of significant morbidity in otorhinolaryngology, as it is often noted to be refractory to medical management and has a tendency to recur post-surgery. Limited research has shown that peripheral eosinophilia is related to the presence of nasal polyps, the extent of the mucosal disease, the severity of tissue eosinophilia, and the risk of recurrence.&#x0D; Aim: This study aimed to establish the significance of peripheral blood eosinophilia, both differential (EC) and absolute eosinophil counts (AEC) - in adult CRS, to correlate the tissue eosinophilia and peripheral blood eosinophilia, and compare the observations in the two types of CRS with nasal polyp and without nasal polyp.&#x0D; Material and Methods: A total of 50 adult patients with CRS who underwent FESS were included in the study and were divided based on the presence (Group 1) or absence (Group 2) of peripheral blood eosinophilia.&#x0D; Results: There were equal number of cases of chronic rhinosinusitis with nasal polyp (CRSwNP) and without polyp (CRSsNP); 25 each. With regard to clinical features, Group 1 had a higher number of cases with nasal obstruction (p-value = 0.023), post-nasal drip (p-value = 0.035), and hyposmia (p-value = 0.021) when compared to Group 2. On histopathology, Group 1 had more areas of edema (p-value = 0.027), and mucous gland hyperplasia (p-value = 0.013) while Group 2 had prominent lymphoplasmacytic infiltrates (p-value = 0.035), neutrophilia (p-value = 0.047), and tissue infiltration of macrophages (p-value = 0.027). Tissue eosinophilia was present in 32 out of the total cases; 20 (71.43%) in Group 1 and 12 (53.33%) in Group 2. The group with tissue eosinophilia had significantly higher eosinophil count (9.24 ± 4.26% vs 5.32 ± 2.9%; p-value &lt; 0.01) as well as AEC (823.335 ± 434.357/µl vs 485.128 ± 285/µl. 907; p-value &lt; 0.01).&#x0D; Conclusion: The study demonstrated that CRS cases with tissue eosinophilia exhibit an elevated peripheral eosinophil count when compared to non-eosinophilic CRS.

Prevalence of Bacterial Biofilms in Patients of Chronic Rhino Sinusitis (CRS) with or Without Nasal Polyposis

Background: Objective. There is growing evidence that bacterial biofilms may play a role in certain cases of recalcitrant CRS that do not respond to traditional medical and surgical therapies. Aim: The aim of this study was to determine the prevalence of biofilm-forming bacteria in clinical isolates of CRS patients with or without nasal polyposis. Methods: A Prospective observational study conducted in the Department of ENT &amp; HNS GMC Srinagar and Department of Microbiology, from September 2018 to August 2020. 60 patients were enrolled in this study who reported to ENT &amp; HNS OPD of Govt. Medical College Srinagar and diagnosed with CRS according to “clinical practice guidelines” 2015 criteria, and were willing to participate in the study. Samples were harvested in the OPD and/or intraoperatively for microscopic examination to determine biofilm presence. Statistical analysis was performed. For all statistical tests, P = .05 was considered significant. Results: In this study on 60 patients Biofilms were present in 32 (53.3%) patients whereas in 28 (46.7%) patients Biofilms were absent (includes 14 culture positive and 14 culture negative patients). Biofilm formation was detected by three different phenotypic methods. Biofilm detection rate were highest by Tissue Culture Plate (TCP) method (56.3%) followed by Tube method (TM) as (46.9%) and Congo Red Agar (CRA) method as (43.8%). Conclusion: This study further elucidates the prevalence of bacterial Biofilms in sinonasal mucosa of CRS patients as Biofilms existed in 53% of the patients under study.