Non-eosinophilic Rhinosinusitis Research Articles

Diagnosis and treatment of eosinophilic rhinosinusitis

Chronic rhinosinusitis (CRS), a chronic inflammation of the nasal sinus mucosa, is based on a simplified classification of a single clinical phenotype (with or without nasal polyps) that does not adequately reflect the heterogeneity of the pathogenesis of chronic rhinosinusitis complexity. Currently, according to the lesion mucosa or polyps eosinophil infiltration,this type of chronic rhinosinusit is known as eosinophilic chronic rhinosinusitis (ECRS). The curative effect of ECRS is poor than non-eosinophilic rhinosinusitis. This article summarizing the diagnosis and treatment of eosinophilic rhinosinusitis status, is to provide help for clinical diagnosis and treatment.

The inflammatory response of eosinophil-related fungal rhinosinusitis varies with inciting fungi.

Earlier studies demonstrated immunological response to Alternaria alternata in patients with eosinophil-related fungal rhinosinusitis (FRS). However, Aspergillus flavus rather than A. alternata is predominantly isolated from such patients in Asia. We compared immunological response to A. flavus and A. alternata in our patients with eosinophil related FRS. Total immunoglobulin E, absolute eosinophil count (AEC), cytokine response, and in vitro eosinophil degranulation in the presence of A. flavus/A. alternata were compared among patients with eosinophil-related FRS, non-eosinophilic rhinosinusitis (NECRS), and healthy individuals. Eosinophil-related FRS patients were subgrouped into: Group A - presence of mucin with fungus in tissues and positive immediate hypersensitivity; group B - presence of mucin with fungus in biopsies and no immediate hypersensitivity; and group C - presence of mucin without fungi and hypersensitivity. A. flavus was the predominant (89%) isolate. Significantly higher major basic protein (MBP) was induced by A. flavus in Group A (279.15 ± 32.29 ng/2.5 × 10(5) cells) compared to Group B (254.9 ± 17.14 ng), Group C (238.33 ± 17.56 ng), NECRS (56.96 ± 10.97 ng), and normal subjects (28.73 ± 7.04 ng). A. alternata - eosinophil interaction failed to induce detectable MBP. AEC and serum cytokines, interleukin (IL)- 2, IL-4, IL-5, IL-10, tumor necrosis factor α, and interferon-γ were significantly higher (P < 0.001) in eosinophil-related FRS compared to NECRS and control. Thus a mixed Th1 and Th2 cytokine response was observed in eosinophil-related FRS. In conclusion, immune response in eosinophil-related FRS depends on locally inciting fungi rather than A. alternata in all instances, and the categorization of this group appears to be arbitrary.

Cysteinyl leukotrienes in chronic hyperplastic rhinosinusitis.

Our study was designed to demonstrate that, similar to asthma, eosinophilic chronic rhinosinusitis is a disease characterized by activation and the expression of cysteinyl leukotrienes (LTs). Nasal polyp tissue was evaluated from 28 consecutive individuals undergoing elective polypectomy in whom neutrophils were not present on pathologic examination. Tissue was analyzed for pathosis with particular attention to the presence of eosinophils. Patients with moderate to high levels of mucosal eosinophils were classified as having eosinophilic rhinosinusitis (ECRS). Those with few or absent mucosal eosinophils were classified as having noneosinophilic rhinosinusitis (NECRS). Cysteinyl LTs were quantified by a sensitive competitive enzyme immunoassay, and the levels of cysteinyl LTs were compared in the groups. There were 20 patients with ECRS and 8 patients with NECRS. Cysteinyl LTs were identified in polyp tissue from 24 of 28 subjects and were >5 pg/gm tissue in 15 of 28. The average level of LTC(4) in patients with few mucosal eosinophils was 38.3 pg/g. The average amount in those with moderate to large amounts of mucosal eosinophils was 36.7 pg/g. There was no significant difference between the 2 groups. ECRS and NECRS can be considered diseases of excessive expression of cysteinyl LTs. LT expression occurs in patients who demonstrate few or no mucosal eosinophils, which indicates that cell lines other than eosinophils may be responsible for LT production in chronic rhinosinusitis.