Eosinophilic Mucin Research Articles

The Neutralization of the Eosinophil Peroxidase Antibody Accelerates Eosinophilic Mucin Decomposition.

Eosinophilic airway inflammation, complicated by bronchial asthma and eosinophilic chronic rhinosinusitis (ECRS), is difficult to treat. The disease may become refractory when eosinophilic mucin associated with eosinophil peroxidase (EPX) and autoantibodies fills in the paranasal sinus and small airway. This study investigated the functional role of an anti-EPX antibody in eosinophilic mucin of ECRS in eosinophilic airway inflammation. Eosinophilic mucin was obtained from patients with ECRS. The effects of the anti-EPX antibody on dsDNA release from eosinophils and eosinophilic mucin decomposition were evaluated. Immunofluorescence or enzyme-linked immunosorbent assays were performed to detect the anti-EPX antibody and its supernatant and serum levels in eosinophilic mucin, respectively. The serum levels of the anti-EPX antibody were positively correlated with sinus computed tomography score and fractionated exhaled nitrogen oxide. Patients with refractory ECRS had higher serum levels of the anti-EPX antibody than those without. However, dupilumab treatment decreased the serum levels of the anti-EPX antibody. Immunoglobulins (Igs) in the immunoprecipitate of mucin supernatants enhanced dsDNA release from eosinophils, whereas the neutralization of Igs against EPX stopped dsDNA release. Furthermore, EPX antibody neutralization accelerated mucin decomposition and restored corticosteroid sensitivity. Taken together, the anti-EPX antibody may be involved in the formulation of eosinophilic mucin and be used as a clinical marker and therapeutic target for intractable eosinophilic airway inflammation.

Allergic fungal rhinosinusitis and eosinophilic mucin chronic rhinosinusitis: Differential diagnostic criteria. A two-center comparative study following STROBE methodology

ObjectivesAllergic fungal rhinosinusitis (AFRS) and eosinophilic mucin chronic rhinosinusitis (EMRS) are two forms of chronic sinusitis distinguished by the presence (AFRS) or absence (EMRS) of fungal elements in sinus mucin. Detection of the fungal elements, however, is complex and it is difficult to say whether EMRS is in fact an entity distinct from AFRS. The aim of the present study, based on a retrospective series of AFRS and EMRS, was to identify the specific clinical and radiological elements distinguishing between the two. Materials and methodsA 2-center retrospective observational study following STROBE guidelines included patients managed for AFRS or EMRS between 2009 and 2022. Clinical, mycological, pathologic and radiological data were collected. Type of treatment and disease progression were also analyzed. Intergroup comparison used Student's test for mean values of quantitative variables, with calculation of P-values, and Pearson's Chi2 test or Fisher's exact test for categoric variables, with calculation of relative risk and 95% confidence intervals. ResultsThe AFRS group comprised 41 patients and the EMRS group 34. Demographic data were comparable between groups. EMRS showed a higher rate of asthma (79.4 vs. 31.4%; P<0.001), more severe nasal symptomatology (rhinorrhea, P=0.01; nasal obstruction, P=0.001), and more frequent bilateral involvement (85.3 vs. 58.5%; P=0.021). AFRS showed more frequent complications (19 vs. 0%; P=0.006). Radiologically, mucin accumulation was greater in AFRS, filling the sinus in 84.2% of cases, versus 26.3% (P<0.001), with more frequent sinus wall erosion (19 vs. 5.8%; P=0.073). The recurrence rate was higher in EMRS: 38.2 vs.21.9% (P=0.087). ConclusionThe present retrospective study found a difference in clinical and radiological presentation between AFRS and EMRS, with EMRS more resembling the presentation of severe nasal polyposis.

Various Postoperative Medical Lines for Management of Allegic Fungal Rhinosinusitis (Meta-Analyical Study)

Abstract Background Allergic fungal rhinosinusitits (AFRS) is a subset of polypoid chronic rhinosinusitis that is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a type I hypersensitivity to fungi. The treatment of allergic fungal rhinosinusitis usually involves surgery in combination with medical therapies to keep the disease in a dormant state. However, what constitutes an optimal post-operative medical regimen is still controversial. Hence, the purpose of this study is to assess the efficacy of various postoperative medical lines for management of AFRS. Objective To find out the role and efficacy of various medical therapies for postoperative treatment of allergic fungal rhinosinusitis (through a systematic review study). Materials and Methods Fifty studies were included in the present systematic review and meta-analysis, the total number of patients included in all studies (No = 1,655 patients). Our review has investigated the literature on 5 medical therapies (steroids, antifungal, immunotherapy, mepolizumab, and omalizumab) concerning the management of postoperative AFRS patients. Results The results showed that the recurrence rate after postoperative systemic steroids was 26.3%, topical steroids was 38.4%, antifungals therapy was 32.1%, immunotherapy was 17.4%, the percentage of recurrence after combination of antifungal and steroids was 9.6%, recurrence risk difference between antifungal and placebo was 18.2%, recurrence risk difference between steroids and placebo was 6.5%. Base on the above results, the combination of steroids and antifungal therapy is the best treatment for postoperative patients with AFRS. Conclusion This review investigated the literature on 5 medical therapies (steroids, antifungal, immunotherapy, mepolizumab, and omalizumab) concerning the management of postoperative AFRS, and provided an evidence-based review with recommendations, the use of steroids alone or antifungals as well, resulted in some degree of recurrence reduction in disease, the evidence supports the use of postoperative combination (oral steroids and systemic antifungal) as a better line of post-operative medical treatment in AFRS patients.

Role of interleukin-5 in allergic fungal sinusitis: deeper insight

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is an allergic response characterized by type 2 inflammatory reactions mediated by T helper 2 cells (Th2). Th2 is characterized by elevated type 2 cytokines related to the humoral response, including Interleukin-4 (IL-4), IL-5, IL-6, IL-9, IL-10, IL-13, IL-25 and IL-33. Allergic fungal sinusitis (AFS) is a distinguishable form of CRSwNP and is characterized by primary localized disease with non-invasive fungal hyphae, which causes immunoglobulin E (IgE)-mediated mucosal hypersensitivity resulting in the formation of eosinophilic mucin. Interleukin-5 (IL-5) is a pro-inflammatory factor that plays a very important role in eosinophil biology.ObjectiveTo explore the relation between IL-5 tissue protein expression and AFS.MethodsA prospective study performed on 70 patients divided into 2 groups (50 cases of AFS and 20 control who underwent septoplasty and partial inferior turbinectomy) to assess the role of IL5 in AFS compared to control.ResultsIL-5 was overexpressed in polyps of AFS patients compared to the control group denoting AFS as an eosinophilic mediated type 2 inflammation and highlighting a positive correlation with Lund MacKay radiological score and Sino-nasal Outcome Test (SNOT-22) score for severity of chronic rhinosinusitis (CRS) symptoms.ConclusionIL-5 plays a pivotal role in the pathogenesis and severity of AFS. Thus, our results provide encouraging evidence supporting targeting IL5 as an eligible therapy of promising benefits in AFS.

Use of intraoperative frontal sinus mometasone-eluting stents decreased interleukin 5 and interleukin 13 in patients with chronic rhinosinusitis with nasal polyps.

Mometasone-eluting stents (MES) have demonstrated improvement in short-term endoscopic outcomes and reduce short- to medium-term rescue interventions. Their effect on the local inflammatory environment, longer-term patient-reported outcomes, and radiographic severity have not been studied. Middle meatal mucus and validated measures of disease severity were collected before and 6 to 12 months after endoscopic surgery in 52 patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Operative findings, type 2 mediator concentrations, intraoperative variables, and disease severity measures were compared between those who did and those who did not receive intraoperative frontal MES. A total of 52 patients with CRSwNPs were studied; 33 received frontal MES and were compared with 19 who did not. Pre-endoscopic sinus surgery (ESS) middle meatus (MM) interleukin (IL) 13 and eosinophil cationic protein (ECP) were higher in the stented group (p<0.05), but pre-ESS clinical measures of disease severity were similar as were surgical extent and post-ESS medical management. Intraoperative eosinophilic mucin was more frequent in the stented group (58% vs 11%, p=0.001). IL-5 (p<0.05) and IL-13 (p<0.001) decreased post-ESS in the stented group, but this was not observed in the nonstented group. Post-ESS IL-4 and IL-13 were higher in the nonstented vs stented group (p<0.05 for both). Although patients who received intraoperative frontal MES had significantly higher pre-ESS MM IL-13 and ECP, patients who received frontal MES had lower concentrations of IL-4 and IL-13 than those who did not at a median of 8 months post-ESS. However, these changes did not correspond to significantly different measures of symptomatic or radiographic disease severity.

A case report of allergic fungal rhinosinusitis managed with Dupilumab.

IntroductionAllergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyps. It is characterized by eosinophilic mucin, which results from an inflammatory reaction to non-invasive fungal hyphae in the rhino-sinuses. It is clinically recognizable due to the criteria set by Bent and Kuhn. The treatment approach is multimodal, and the main treatment approach is surgical debridement, followed by a course of oral and/or topical corticosteroids to decrease recurrence post-surgery. This case report aims to illustrate the effect of Dupilumab, on the number of relapse episodes in a patient and the associated parameters.Case presentationHerein we report a case of a 40-year-old woman referred to our institution as a case of refractory AFRS for which she underwent four functional endoscopic sinus surgeries (FESS) and was on maximum medical treatment. She presented with complaints of facial fullness and pain, headache, and purulent discharge. After another trial of surgery which did not control her symptoms, she was assessed for criteria to start biological treatment. The symptoms were successfully controlled after initiation of the agent, and she was followed up using multiple subjective and objective measures.ConclusionAFRS is a non-invasive immune-mediated sub-clinical entity of chronic rhinosinusitis. A multimodal approach to its treatment based on surgical debridement with medical therapy has shown positive outcomes. In this case we present significant improvement after administering Dupilumab; therefore, suggesting its addition to the treatment regimen of refractory AFRS.

Pediatric allergic fungal rhinosinusitis: optimizing outcomes.

Allergic fungal rhinosinusitis (AFRS) is a debilitating condition for children. Despite there being several reviews on this topic in the adult population, there is a paucity of reviews of AFRS in the pediatric literature. This article reviews the recent evidence of pediatric AFRS with the aim to optimize outcomes of pediatric patients with this condition. AFRS is clinically characterized by nasal polyposis, a type I hypersensitivity to fungal epitopes, very thick eosinophilic mucin, and peripheral eosinophilia. Pediatric AFRS has similar clinical characteristics to that in adults but is thought to have a more aggressive nature, with higher serum immunoglobulin E and more frequently bone erosion and malformation of facial bones. Diagnosis of pediatric AFRS is made by using the Bent and Kuhn's criteria developed for adult AFRS. The mainstay of treatment is surgery followed by postoperative corticosteroids. Adjunctive therapies, including topical/oral antifungal agents, allergen immunotherapy and biologics may improve outcomes in pediatric AFRS, but to date the current evidence is limited. To optimize the outcome of pediatric AFRS, adequate and early diagnosis and treatment are essential. Appropriate and comprehensive endoscopic sinus surgery to open the sinuses, remove the fungal burden of disease and improve access of the sinuses to postoperative topical corticosteroid remains the standard of care.

Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps.

Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps.

Eosinophilic mucin chronic rhinosinusitis with orbital involvement

Allergic fungal sinusitis (AFS) and eosinophilic mucin chronic rhinosinusitis (EMCRS) are subtypes of a chronic rhinosinusitis with eosinophilia that have different diagnostic criteria but are phenotypically similar. Ophthalmic complications may be the presenting symptoms. Treatment of ophthalmic complications is typically directed at reducing the inflammatory burden in the sinuses and rarely requires direct surgical intervention. However, atypical cases with associated subperiosteal abscess may necessitate orbital surgery. The authors present 2 cases of EMCRS with orbital involvement – one that responded to the traditional treatment of oral corticosteroids and functional endoscopic sinus surgery (FESS), and the other requiring surgical drainage of a subperiosteal abscess in order to describe the management strategies based on clinical presentation.

Dupilumab use in recalcitrant allergic fungal rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) has been described as a distinct subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) characterized by eosinophilic (allergic) mucin, type 1 hypersensitivity to fungi and distinct radiologic findings.1 Allergic fungal rhinosinusitis requires surgical intervention along with adjuvant medical therapy. Topical and oral corticosteroids markedly decrease AFRS recurrence after surgical procedure, but steroid-sparing agents for the refractory disease are lacking.

Eosinophilic Mucin: A Predictor for Disease Severity in Chronic Rhinosinusitis.

The presence of tissue eosinophilia is a determinate of disease severity in patients with chronic rhinosinusitis (CRS). The impact of eosinophilic mucin (EM) as an independent variable has not yet been elucidated. Retrospective review. Tertiary academic clinic.Subjects Methods: CRS patients who failed medical therapy were classified by tissue eosinophilia, presence of polyps and EM. Tissue eosinophilia count per high power field (HPF) as well as the presence of EM were determined by pathologic examination of sinus tissue removed during surgery. Sinonasal Outcomes Test (SNOT-22), Lund-Mackay (LM), and Lund-Kennedy (LK) scores were compared between all groups preoperatively and postoperatively up to two and a half years (30 months). 192 patients with CRS were included in the study. 87 were diagnosed with eosinophilic CRS with polyps, 58 with eosinophilic CRS without polyps, 14 with noneosinophilic CRS with polyps, and 33 with noneosinophilic CRS without polyps. Only patients with eosinophilia had EM on pathology. Of eosinophilic CRS, 50% of patients with polyps and 12% of cases without polyps demonstrated EM, respectively. EM presence portended more severe disease in patients with eosinophilia on subjective and objective scores preoperatively (P < 0.005). Postoperatively, EM patients experienced a greater improvement of symptoms, but continued to have worse endoscopy scores until 1.5 years. A tissue eosinophil count of 30 or greater per HPF was identified as a potential marker for the development of EM. The presence of eosinophilic mucin predicts overall worse disease severity in patients with eosinophilic CRS.

Clinical, Radiological, and Histopathological Patterns of Allergic Fungal Sinusitis: A Single-Center Retrospective Study.

ObjectivesTo explore the clinical, pathological, and imaging characteristics of allergic fungal sinusitis (AFS) and to analyze the correlation of disease duration with imaging and histopathology findings.MethodsWe reviewed all cases of AFS managed at the otorhinolaryngology department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Demographic and clinical features were collected, as well as imaging and histopathological findings, which were analyzed by time from onset.ResultsForty-six patients were diagnosed AFS, representing 11.8% of total sinusitis cases; 25 (54.3%) were female, with mean (SD) age=33.57 (11.76). Patients presented with multiple symptoms of chronic rhinosinusitis (43, 93.5%), chronic headache (14, 30.4%), and hyposmia (2, 4.3%), and 36 (78.3%) were diagnosed late (≥5 years after onset). AFS involved all four sinuses in 32 (69.6%) patients and was bilateral in >53.5% of infected sinuses. Imaging showed increased intrasinus attenuation (88.2%-95.3%), complete opacification (74.4%-85.3%), sinus expansion (35.3%-51.2%), remodeling (20.6%-37.2%), wall thinning (41.2%-58.1%), and involvement of adjacent soft tissue (11.8%-25.6%), depending on the sinus type. Histology evidenced eosinophilic mucin (45.7%), eosinophils (91.3%), fungal hyphae (93.5%), and Charcot-Leyden crystals (6.5%). Patients who were diagnosed late had a higher percentage of imaging and pathological lesions, principally, the expansion and wall thinning of involved sinuses (p<0.050).ConclusionAFS represents a significant proportion of chronic sinusitis cases treated in the otorhinolaryngology department and is often diagnosed late with extensive forms. Major efforts should be made to improve the early diagnosis and management of such disease, including raising awareness about this entity among general practitioners and family physicians to enhance clinical suspicion and detection rate.

Fungal Rhinosinusitis: Prevalence and Spectrum in Singapore.

BackgroundFungal involvement of the paranasal sinuses has been described more than two centuries ago. In the current article, it is referred to as fungal rhinosinusitis (FRS) which is a general term that is used to describe a spectrum of pathologically, immunologically, and clinically different disease entities affecting the paranasal sinuses where fungus is thought to be the major potential etiology.ObjectiveTo determine the incidence and spectrum of FRS in Singapore and to compare our findings with international figures through literature review.MethodsA retrospective review of the clinical charts, radiological and laboratory results, and operative reports of all patients who underwent endoscopic sinus surgery at an ENT department of a tertiary referral hospital in Singapore over five-year period.ResultsOut of 533 functional endoscopic sinus surgeries performed during the period of the study for management of chronic rhinosinusitis, 44 (8.4%) were found to fit the criteria for diagnosis of FRS. Twenty (45.5%) were eosinophilic FRS and 24 (54.5%) were fungal balls. Invasive FRS has not been encountered. Clinical presentation, investigations, and management of both groups of patients are discussed.ConclusionFungal rhinosinusitis is not uncommon in Singapore. Fungal ball and eosinophilic mucin fungal rhinosinusitis are among the most common forms encountered in this part of the world.

Prevalence of Allergic Fungal Rhinosinusitis Among Patients with Nasal Polyps

Objective: The objective of the study was to determine the frequency of allergic fungal rhinosinusitis among patients with nasal polyps.Methods: This study was performed at Department of ENT and Head Surgery, Jinnah Post Graduate Medical Center, Karachi during July 2018 to January 2019. Patients with nasal polyp fulfilling the inclusion criteria were enrolled. Sino-nasal contents were removed during operation and divided into two parts. Sample one was preserved in formalin solution and sent for histopathology to verify eosinophilic mucin and polyps. Another sample was preserved in 10% of potassium hydroxide solution to observe fungal hyphae by culture and fungal staining SPSS v-23.0 was used for the analysis.Results: Total of one hundred and fifty patients was included in the present study. There were sixtyone females (40.7%) and eighty-nine (59.3%) males. The mean age of patients was 30.5 ± 11.4 years. Out of 150 patients with nasal polyps, 33(22.0%) had allergic fungal rhino sinusitis (AFRS). In this study, it was found that, AFRS was associated with gender and smoking (p=0.036).Conclusion: AFRS is perceived generally among patients with nasal polyps. In this way, each patient with nasal polyp ought to be assessed for the existence of AFRS

The use of magnetic resonance imaging in differential diagnosis of allergic fungal sinusitis and eosinophilic mucin rhinosinusitis.

Allergic fungal sinusitis (AFS) and eosinophilic mucin rhinosinusitis (EMRS) represent pathophysiological variants of sinusitis and have similar clinical features. However, to date, few studies have described the differential diagnosis of AFS and EMRS in detail. We therefore investigated the use of magnetic resonance imaging (MRI) in the differential diagnosis of AFS and EMRS. Ninety-three patients (aged 13-75 years) with sinusitis and AFS or EMRS established according to pathological, clinical, or laboratory examinations were enrolled. Each patient was evaluated for demographic and clinical characteristics, fungal-specific immunoglobulin E, peripheral blood eosinophils, histopathology of the sinuses, as well as signal attenuation within the opacified sinuses on computed tomography and MRI scans. Thirty patients presented with AFS and 63 with EMRS. The histopathological characteristics of the secretion and mucosa in the affected sinuses, but not the absolute counts or percentage of blood eosinophils, differed between the 2 groups. The presence of asthma was significantly higher in the EMRS group, whereas allergy to fungi and T2-weighted MRI signal attenuation were significantly increased in the AFS group. MRI features are key to the differential diagnosis of AFS and EMRS.

Clinicopathological and Radiological Features of Chronic Rhinosinusitis with Eosinophilic Mucin in Chungcheong Province of Korea.

Chronic rhinosinusitis (CRS) with eosinophilic mucin is considered rare in Korea. The object of this study was to categorize CRS patients with eosinophilic mucin into several groups and compared the groups based on their clinicopathological and radiological features. In total, 105 CRS patients with eosinophilic mucin from four tertiary medical centers which are located at Chungcheong province of Korea were included for this study. The patients were divided into four groups for analysis, based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin. The following were the four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F-), eosinophilic fungal rhinosinusitis (EFRS, A-F+), and eosinophilic mucin rhinosinusitis (EMRS, A-F-). Their clinical manifestation, the presence of associated disease, radiological finding, treatment, and treatment outcome were reviewed and compared. There were no patients in the AFRS-like sinusitis group, 47 patients were assigned to the AFRS group, 27 to the EFRS group, and 41 to the EMRS group. Patients of AFRS group showed a significantly higher association with allergic rhinitis than did the other groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. In the AFRS group and EFRS group, 67.6% and 74.1% had unilateral disease, respectively, in contrast to the EMRS group (4.9%). The mean Hounsfield unit values of the area of high attenuation in the AFRS patients were significantly higher than those in the other groups. Significant clinicopathological differences existed among the subgroups of CRS with eosinophilic mucin. AFRS tends to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi might play a role in the disease. EMRS is thought to be unconnected with fungal allergies, and it showed different form compared with the AFRS and EFRS groups.

Histopathology of ethmoid mucosa versus polyp tissue in diagnosing eosinophilic mucin rhinosinusitis.

This study aims to compare histopathology of nasal polyp and ethmoid mucosa for diagnosing eosinophilic mucin rhinosinusitis (EMRS). Patients with chronic rhinosinusitis with polyps (CRSwNP) were enrolled. Using eosinophilic mucin as a reference, histopathology of polyp apex, polyp pedicle and ethmoid mucosa was compared for density of tissue eosinophil and sensitivity for diagnosing EMRS. Associations with asthma were assessed for each site. Thirty patients with CRSwNP were enrolled. When polyp apex, polyp pedicle and ethmoid mucosa were assessed for tissue eosinophilia, consistent results were reported in 16 patients (53%). Median tissue eosinophil was greater in polyp apex (58, IQR: 7-100) than ethmoid mucosa (10, IQR: 2-21), but not different from polyp pedicle (22, IQR: 1-96). Sensitivity for diagnosing EMRS were 100% (95%CI: 47.8 - 100) for polyp apex, 60% (95%CI: 14.7 - 94.7) for polyp pedicle, 80% (95%CI: 28.4 â€" 99.5) for ethmoid mucosa. Associations with asthma were significant for polyp pedicle, and ethmoid mucosa but not polyp apex. Density of tissue eosinophil was greater in nasal polyp than in ethmoid mucosa. Histopathology of polyp apex had good sensitivity for diagnosing EMRS. Polyp pedicle and ethmoid mucosal eosinophilia associated with asthma.

Eosinophilic Mucin Rhinosinusitis in Iranian Patients Undergoing Endoscopic Sinus Surgery.

Eosinophilic mucin rhinosinusitis is a type of chronic rhinosinusitis (CRS). Diagnosis and treatment of this condition play a significant role in reducing the patients' clinical symptoms. This type of rhinosinusitis has a higher relapse rate, compared to the other types. This disease is more resistant to treatment and more dependent on corticosteroid therapy, compared to the other types of rhinosinusitis. Regarding this, the present study was designed to evaluate the frequency of eosinophilic mucin rhinosinusitis in patients undergoing sinus surgery in a tertiary referral center and examine some clinical and laboratory characteristics regarding this type of rhinosinusitis. This cross-sectional observational study was performed on patients over the age of 16 years, who were diagnosed with CRS in the otolaryngology clinic of a referral tertiary-level hospital, and were candidates for endoscopic sinus surgery. Based on the detection of eosinophilic mucin, the subjects were divided into two groups of eosinophilic mucin and non-eosinophilic mucin rhinosinusitis (controls). The groups were compared in terms of sino-nasal outcome test (SNOT-22) scores, Lund-Mackay staging scores, osteitis status, immunoglobulin E (IgE) level, and eosinophilia. In this study, 46 subjects participated, 29 (63%) cases of whom had eosinophilic mucin. The SNOT-22 score and serum IgE level were significantly higher in the eosinophilic mucin group, compared to those in the control group. Osteitis and Lund-Mackay scores were also higher in the eosinophilic mucin group than those in the control group; however, this difference was not statistically significant. Patients with eosinophilic mucin rhinosinusitis showed a more severe clinical involvement. Seemingly, the Iranian patients have a lower and higher frequency of eosinophilic mucin rhinosinusitis, compared to the patients from the Western countries and East Asia, respectively.

Complications of Short-Course Oral Corticosteroids for Eosinophilic Chronic Rhinosinusitis during Long-Term Follow-Up

The literature strongly recommends the use of oral corticosteroids in the management of patients with eosinophilic chronic rhinosinusitis (CRS) with nasal polyps. Although potential complications associated with the long-term use of oral corticosteroids for the treatment of CRS have been suggested, no studies have described these effects in detail. Forty-three patients with a mean age of 51 years with eosinophilic CRS were retrospectively evaluated after surgery. Short-course oral prednisolone (PSL, 0.5 mg/kg of body weight) was provided for one week when anosmia and eosinophilic mucin and/or nasal polyps were present. The postoperative follow-up period ranged from 12 to 108 months (average: 62 months). HbA1C showed normal ranges in all except one patient, who had a diabetic pattern of HbA1C of 6.5%. Five patients had serum cortisol levels below the cutoff value. However, re-examination of the serum cortisol and adrenocorticotropic hormone stimulation test showed normal ranges in all five patients who had initially shown abnormal values of serum cortisol. Thus, adrenal insufficiency in all the patients was negligible. Five (3 women and 2 men) out of the 15 patients (6 women and 9 men) who participated in bone mineral density measurement showed significant reductions, suggesting the presence of osteoporosis. Patients taking long-term and repeated short-course use of oral corticosteroids for refractory nasal polyps of eosinophilic CRS are likely to have a potentially increased risk for osteoporosis.

Literature review. Noninvasive fungal rhinosinusitis

AbstractFungus ball (FB) of the paranasal sinuses has a distinctive clinicopathological presentation. The disease occurs more frequently in elderly patients and has a female preponderance. Classically, it involves only one paranasal sinus in more than 90% of the cases, most commonly the maxillary sinus. Imaging characteristics (calcifications and / or erosion of the inner wall of the sinus visible on CT) and histopathological ones (luminal aggregation of fungal hyphae) confirm the diagnosis.Allergic fungal rhinosinusitis (AFRS) usually occurs in younger, immunocompetent patients, with a history of atopy, including allergic rhinitis and / or asthma, or a long clinical picture of chronic rhinosinusitis (CRS), refractory to antibiotic treatment. Nasal polyps (NP) are present in almost all patients, while extra-sinusal complications are described only in some of them. Usually, there is involvement of several sinuses, as well as bilateral damage. The definitive diagnosis is confirmed only by examining surgical specimens - the characteristic appearance of eosinophilic mucin is the most reliable indicator of AFRS.