Sinonasal Polyps Research Articles

Evaluation of Vitamin D3 level in sino-nasal polypi

Background: Vitamin D is a group of fat-soluble corticosteroid responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and multiple other biological effects. In humans, the most important compounds in this group are vitamin D3 [also known as cholecalciferol] and vitamin D2 [ergocalciferol].Aim of the work: The aim of this thesis is to assess Vitamin D3 [VD3] level in patients with sino-nasal polypi in comparison with normal individuals.Patients and Methods: This prospective comparative [case-control] study conducted by the Department of ENT, Al-Azhar University Hospitals in the period from March 2019 to September 2019 and included 40 individuals who were selected by inclusion and exclusion criteria, both genders, all patients had been counseled about the nature of the study and informed written consent has been obtained.Results: Serum level of VD3 in patients with chronic rhinosinusitis with sinonasal polyps [CRSwNP] and allergic fungal rhinosinusitis [AFRS] was significantly lower than that of control subjects. Vitamin D levels ranged from 8.74 to 39 ng/ml, and there was statistically significant decrease of serum vitamin D levels in patient group when compared to control group [16.20±4.29 vs 30.56±4.83 respectively]. In addition, there was significant increase of patients with deficient and insufficient vitamin D levels in patient group when compared to control group.Conclusion: VD3 may constitute an inexpensive prophylactic and cost effective option in the therapeutic armamentarium in reducing inflammation either by itself or as a synergistic agent to traditional agents in patients suffering from sino-nasal polypi.

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps.

Central compartment atopic disease (CCAD) is a recently described variant of chronic rhinosinusitis with nasal polyp (CRSwNP) associated with inhalant allergy. An association with asthma was noted to be uncommon within our clinical practice. The purpose of this study was to determine allergy and asthma prevalence in CCAD and other CRSwNP subtypes. A retrospective analysis at a tertiary care institution was performed over the period from 2015 to 2019. CRSwNP was grouped into the following subtypes: allergic fungal rhinosinusitis (AFRS); aspirin-exacerbated respiratory disease (AERD); CCAD; and CRSwNP not otherwise specified (CRSwNP NOS). Patients with sinonasal polyps and concomitant polypoid disease in the central compartment (CRSwNP/CC) were analyzed as a separate cohort for the purpose of this study. Prevalence of allergy and asthma was compared between groups. Three hundred fifty-six patients were included. CRSwNP NOS was the most common subtype (37.1%) and CRSwNP/CC was the least common (3.7%), with other CRS subtypes ranging between 11.5% and 24.2%. Asthma prevalence was highest in AERD (100%) and CRSwNP NOS (37.1%), but substantially lower in AFRS (19.0%) and CCAD (17.1%). Asthma was significantly more common in AERD and CRSwNP NOS when compared with CCAD (p < 0.001 and p = 0.039, respectively). Prevalence of allergy was significantly higher in AFRS (100%), CCAD (97.6%), CRSwNP/CC (84.6%), and AERD (82.6%) when compared with CRSwNP NOS (56.1%) (p < 0.001). CCAD represents a clinically distinct phenotype of CRSwNP with a high prevalence of allergy and low prevalence of asthma. Patients with both CCAD and diffuse sinonasal polyps had an allergy prevalence approaching that of CCAD and an asthma prevalence approaching CRSwNP NOS.

Clinicoepidemiological Presentation of Sinonasal Mass in A Nigerian Tertiary Health Care Centre

Background: Sinonasal masses are common worldwide with clinical entity ranges from simple sinonasal polyps to malignancy. This study aimed at determining the prevalence, Sociodemographic features, clinical characteristics, clinical presentation, and management outcome of sinonasal masses. Materials and Methods: This was a retrospective study of patients with sinonasal masses in ear, nose and throat department of our center over a period of ten years (from November 2008 to October 2018). Data were retrieved from the clinic register and hospital medical record. Information on sociodemographic features, the clinical presentation of presentation, examination findings, CT Scan findings, diagnosis and treatment outcomes were retrieved. Data obtained were collated and analysed by using SPSS version 18.0. Results: The total number of patients seen over the studied period was 4,678 Male accounted for 62.9% with male to female ratio of 1.7:1. Sinonasal masses were bilateral in 44.3%, left-sided in 32.0% and right-sided in 23.7. Multiple grapelike sinonasal masses accounted for 50.5% while single sinonasal masses accounted for 49.5%. Commonest anatomical origin was ethmoid sinuses in 50.5%. Main clinical features were nasal blockage 83.5% and nasal discharge 63.9%. Masses extension was into 52.6% Intranasal/sinuses and 34.0% orbital extension. Main histological diagnosis were ethmoidal (simple) nasal polyps in 49.5%, squamous cell carcinoma in 17.5%, antrochoanal polyp in 9 3% and inverted papilloma in 9.3%. Histological examination showed simple inflammatory nasal polyps in 58.8%, benign tumour in 13.4% and malignant tumour in 23.7%. Patients were managed by 76.3% surgery, 16.5% surgery and radiotherapy and 7.2% chemoradiotherapy. Recurrent masses and death from malignancy were 8.2% and 2.1% respectively. Conclusions: Sinonasal masses are perceived and presented as a simple disorder with nasal obstructions and discharge. It consists of polyps and malignant tumour. Nasal Polyps are commoner than the neoplastic tumour. The commonest origin of the sinonasal masses was ethmoid sinuses which may be because polyps are the most common causes of sinonasal masses as shown in our study. Further evaluation revealed that majority of the unilateral sinonasal masses were neoplastic. They are poorly managed and presented in advanced stage to the otorhinolaryngologist, head and neck surgeon. Late presented patients had palliative treatment with resultant high recurrence and fatality. Thus Health education, serial and early screening are highly recommended.

Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS).

Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography. Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS. A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed. Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not. Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.

An atypical presentation of a Respiratory Epithelial Adenomatoid Hamartoma, a case report.

IntroductionRespiratory Epithelial Adenomatoid Hamartoma (REAH) is a benign disease that can resemble other malignant entities. Thus, it is essential to diagnose it accurately as the treatment approach differs, from radical surgeries in malignant cases, to a simple excision in hamartoma. We present an unusual case of bilateral REAH that was misdiagnosed, and hence it was treated aggressively.Case reportA 57-year-old male patient presented with anosmia, 2-years history of bilateral nasal obstruction, and was accompanied with a moderate headache. An impression of olfactory neuroblastoma was made after history taking physical examination, and imaging studies. The patient underwent Functional Endoscopic Sinus Surgery (FESS), excisional biopsy of the cribriform plate mass bilaterally, and superior septectomy. Histopathologic examination of the bilateral masses showed sinonasal polyposis with crypting of surface mucosa and pseudoglandular formation. A diagnosis of sinonasal polyps with REAH was established. The patient's nasal obstruction improved, with no recurrence of sinusitis ± polyposis. However, he still complains of anosmia after 2-years follow-up.ConclusionAlthough REAH is a benign disease, it is critical to reach the correct diagnosis, in order to avoid aggressive treatment. Unfortunately, the preoperative investigations were not consistent with REAH, thus it was misdiagnosed and treated aggressively.

Frequency of recurrence of nasal polyps post endoscopic polypectomy

Background :&#x0D; Enoscopic polypectomy in those patients with chronic rhinosinusitis and nasal polyps have many objects. These are :&#x0D; Opening diseased sinus ostia to help restoration of mucociliary clearence ,removing the diseased tissue to alleviate symptoms of nasal blockage, help in delivery and distribution of topical nasal therapy to the diseased mucosa in the nose and paranasal sinuses, especially to the frontal and sphenoid sinuses and also to open the olfactory cleft area to improve the sense of smell.&#x0D; Objectives : To discover the frequency of recurrence of sinonasal polyp post surgical removal by means of endoscopic polypectomy (EP) also the associated risk factors that predispose to that recurrence.&#x0D; Design : prospective study.&#x0D; Patient and method : Thirty two patients presented to the (E.N.T.) department in ALdiwaniyah general Hospital suffering from sign and symptom of nasal polyp resisting to medical polypectomy, with different ages and sex were studied from period of April 2018 to March 2019 ,and they were submitted for full history, clinical, endoscopic examination, radiological evaluation ,then the patients submit to of Endoscopic polypectomy, later on follow-up was done for period of 12 month that included: frequent endoscopic nasal examination.&#x0D; Results : In this study we evaluate the frequency of the recurrence of nasal polypos post endoscopic polypectomy was 25%.&#x0D; &#x0D; Conclusion: The overall recurrence rate was 25%, the highest frequency of recurrence was during the period of first six months post surgery and especially after the forth month.&#x0D; &#x0D; Aim of the study :&#x0D; To evaluate frequency of the recurrence of sinonasal polyp post endoscopic polypectomy (EP) . also the associated risk factors that predispose to that recurrence.

Clinical profile of cases with sino-nasal polyposis at a tertiary care hospital at North Karnataka: a cross-sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal polyps are defined as pearly white, prolapsed, pendunculated oedematous Sino-nasal mucosa. They are unique in their position and their composition. Many hypotheses concerning its pathogenesis have been proposed. But till now there is no clear evidence for any single cause. This study was taken-up to study the clinical profile of cases with sino-nasal polyps.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Cross-sectional descriptive study was conducted in the Department of Otolaryngology at Vijayanagara Institution of Medical Sciences, Bellary, between January 2016 to April 2016 involving 60 patients fulfilling inclusion and exclusion criteria. Pre-tested and edited proforma was used to collect the data. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 60 participants, 63.4% were males, mean age was 29.5 years. Ethmoidal polyp (63.4%) was the most common polyp followed by antrochoanal polyp (33.4%). Ethmoidal polyp was most commonly observed 31-40 years age while antrochoanal polyp was observed in 11-20 years age. Ethmoidal polyp and antrochoanal polyp were observed more commonly in males and females respectively. The most common presenting symptoms were nasal obstruction and nasal discharge.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Ethmoidal polyps are the most commonly observed sino-nasal polyps followed by antrochoanal polyp. Ethmoidal polyp was more commonly observed in adult age group while antrochoanal polyp was observed in children. The most common presenting symptoms were nasal obstruction and nasal discharge.&lt;/p&gt;

Investigation of factors associated with symptom severity in patients with sinonasal polyposis

&amp;lt;p&amp;gt;Introduction. Chronic rhinosinusitis with sinonasal polyposis is a chronic inflammatory process of the mucous membranes of the nasal and paranasal sinuses, clinically manifested by the appearance of polyps in the nasal cavity. The presence of polyps in the nose and sinuses is the cause of the characteristic symptoms that affect the quality of life of the patient. The study investigates the correlation between endoscopic, microbiological and radiological findings and symptom severity in patients with chronic rhinosinusitis and sinonasal polyposis. Methods. The research included 45 patients with chronic rhinosinusitis and sinonasal polyps, for whom surgery treatment was indicated after the failure of conservative therapy, and 25 healthy subjects. Intensity of symptoms in subjects was assessed by A Visual Analogue Scale. The bacteriological examination of secretion of the medial nasal corridor was carried out. Clinical and radiological assessment of the severity of the condition was done by the endoscopy and computerized tomography score (CT score). Results. A statistically significant difference was found in symptom severity between the experimental and control groups. There was a statistically significant correlation between endoscopy score and the symptom severity (r = 0.315; p = 0.035), CT-score (r = 0.720; p &amp;amp;lt; 0.001) and the presence of asthma (r = 0.335; p = 0.025). Furthermore, there was a statistically significant correlation between CT score and the presence of asthma (r = 0.419; p =0.004). By binary logistic regression, a statistically significant correlation between the endoscopy score and symptom severity (OR = 1.513; p = 0.044) was found. Conclusion. In comparison with the objective clinical parameters, the severity of symptoms in patients with sinonasal polyposis is in a statistically significant correlation with the endoscopy score.&amp;lt;/p&amp;gt;

A Unilateral Protruding Nasal Mass

A 44-year-old chronic smoker presented with complaint of left nasal blockage for three months. The symptoms were accompanied by pain and blood-stained discharge. For this patient, the differential diagnosis includes sinonasal inflammatory polyps, nonkeratinizing respiratory carcinoma and verrucous carcinoma.

Mometasone furoate sinus implant – a new targeted approach to treating recurrent nasal polyp disease

ABSTRACTIntroduction: Chronic rhinosinusitis (CRS) is a broad heterogeneous inflammatory disorder of the nose and paranasal sinuses, resulting from the dysfunctional interplay between host immunity, defective epithelial barrier, and environmental factors. CRS with nasal polyps (CRSwNP) is considered a more severe clinical phenotype with greater burden of symptoms and higher relapse rate, especially with comorbid asthma or aspirin sensitivity. Available treatment options after endoscopic sinus surgery (ESS) – systemic corticosteroids or revision surgery – have significant risks and limitations.Areas covered: Bioabsorbable, steroid-eluting implants have been studied extensively for the ability to dilate and re-establish sinus patency by the localized, controlled delivery of topical corticosteroids to diseased sinonasal lining and nasal polyps. This review provides a comprehensive, up to date analysis of the literature regarding a novel, office-based, mometasone furoate (MF) sinus implant that may treat patients with recurrent CRSwNP after ESS.Expert commentary: Clinical evidence has demonstrated the safety and efficacy of steroid-eluting implant in the reduction of polyp size, symptom burden, and the need for revision sinus surgery. MF sinus implants may play an important role in the management of patients with recurrent polyposis after sinus surgery.

The value of the apparent diffusion coefficient calculated from diffusion-weighted magnetic resonance imaging scans in the differentiation of maxillary sinus inflammatory diseases

This study examined the value of the apparent diffusion coefficient (ADC) calculated by using diffusion-weighted imaging (DWI) in the differentiation of inflammatory lesions of the maxillary sinus. Sixty-five maxillary sinus magnetic resonance imaging (MRI) scans with findings suggestive of inflammatory lesions were qualitatively categorized into 4 distinct groups by using T2-weighted images: group 1: presence of mucosal thickening; group 2: presence of sinonasal polyps or mucous retention cysts; group 3: presence of fluid identified by air-fluid levels with a homogeneous signal intensity; and group 4: presence of fluid identified by air-fluid levels with a heterogeneous signal intensity. The ADC of each imaging finding was measured by using a 5-mm area of interest. Statistical differences between the groups were determined by using nonparametric tests with a 5% significance level. Statistically significant differences were observed between group 1 and the other groups. Mucosal thickening was associated with lower ADC values compared with the other inflammatory lesions. The ADC can be useful in differentiating mucosal thickening from other inflammatory alterations in the maxillary sinuses. Mucosal thickening had more restricted water diffusion compared with the other inflammatory lesions.

Prognosis of Chronic Rhinosinusitis With Nasal Polyps Using Preoperative Eosinophil/Basophil Levels and Treatment Compliance.

Background Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a high risk of disease recurrence and revision surgery. The ability to predict a polyp recurrence in this patient population is critical in order to provide adequately tailored postoperative management. Objective We aim to explore the role of appropriate postoperative care in the prognosis of CRSwNP patients in relation to preoperative eosinophil and basophils levels. Methods This was a retrospective case series; data were collected for 102 CRSwNP patients over a period of 15 months after surgery. Baseline eosinophil and basophil levels were compared between patients with and without polyp recurrences. The analysis was then stratified based on clinical diagnosis, comorbidities (atopy, asthma, and aspirin allergy), a single versus multiple episodes of sinonasal polyp recurrences, and medication adherence. Results Of the 102 included patients, 65 (63.7%) of the patients experienced no recurrences, 26 (25.5%) experienced a single episode of recurrence, and 11 (10.8%) experienced multiple recurrences. Mean baseline eosinophil count and percentage of total white blood cells were significantly higher in the multiple recurrences group (0.70 × 109/L and 10%) compared with the no recurrences group (0.36 × 109/L and 5%). Adherence to prescribed medical therapy prior to the first episode of recurrence was significantly lower for the single exacerbations group (42.3%) than the multiple recurrences group (88.9%). Conclusions Patients with multiple recurrences of nasal polyps had significantly higher baseline eosinophil counts and significantly higher medication adherence compared to single exacerbations of nasal polyps. Single exacerbations may not reflect true failures of surgery but rather a failure of postoperative medical care. Basophil levels were inadequate to predict polyp recurrence rates.

Diagnostic Evaluation of Chronic Nasal Obstruction Based on Nasal Endoscopy and CT Scan Paranasal Sinus.

Evaluation of the accuracy of objective diagnostic modalities for nasal obstruction and their comparison to each other to reach the correct diagnosis with minimum cost and highest accuracy. This study was conducted in the Department of Otorhinolaryngology and Head Neck Surgery, Chirayu Medical College and Hospital, Bhopal from August 2016 to September 2017. A total of 50 patients from age group 1-70years irrespective of sex with complaints of chronic nasal obstruction, which were unresponsive to routine appropriate medical therapy, were selected for this study. Comparative study among findings of nasal endoscopy and CT scan of the paranasal sinuses done. After clinical examination, patients were subjected to high resolution computed tomography (HRCT) of paranasal sinuses and diagnostic nasal endoscopy (DNE). The diagnostic results of both modalities were compared. The most common symptoms were nasal obstruction and nasal discharge 100%, followed by post nasal drip 62%. The complaints related to eye and ears were less frequent, found in 4% only. CRS (Chronic Rhinosinusitis) was most common pathology of nose for nasal obstruction which is in 72% cases. Sinonasal polyp is present in 20% of cases. Inverted papilloma in 4% cases. Granulomatous disease (Rhinosporidiosis) in 2% cases. Malignancy in 2% cases. In this series of 50 cases, nasal endoscopy revealed various pathological abnormalities mainly in the osteomeatal area. These include mucopurulent discharge in middle meatus seen in 100% of cases (50 patients). This could not be revealed in HRCT. Oedematous and polypoid infundibular mucosa/polyp in nasal cavity in 28% cases (14 patients) where it was not diagnosed in HRCT in three patients. Hence DNE proved superior to HRCT. Other abnormalities detected on nasal endoscopy were septal deviation 80% of cases (40 patients), inferior turbinate hypertrophy 66% of cases (33 patients), middle turbinate hypertrophy/concha bullosa in 48% of cases (24 patients). DNS was diagnosed in 42 patients in HRCT other causes of nasal obstruction such as Agar nasi cell is detected in 16% (8 patients), medialised uncinate process in 16% (8 patients), paradoxical MT in 30% cases were diagnosed more accurately in nasal endoscopy than HRCT. So nasal endoscopy proved better than CT scan. Nasal obstruction is the most common presenting complaint in day to day otolaryngology practice. Nobody would disagree with the role of CT scan and diagnostic nasal endoscopy in diagnosing the nasal and paranasal pathologies. But as a treating physician we are always concerned about early diagnosis and cost effectiveness. At the same time we also have to consider about patient waiting and work load. In this study we attempted to find out whether diagnostic nasal endoscopy can be better then CT scan, so that we can treat our patient appropriately. Though there has been an increased demand for imaging the paranasal sinuses with coronal CT because of functional endoscopic sinus surgery, nasal endoscopy is a better option in diagnosing and assessing the extent of disease and anatomy.

Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment

Rhinogenic contact point headache (RCPH) is a headache syndrome secondary to mucosal contact points in the sinonasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sinonasal polyps, or masses. It may result from pressure on the nasal mucosa due to anatomic variations among which the septal deviation, septal spur, and concha bullosa, are the most commonly observed. In recent years, RCPH has remained a subject of controversy regarding both its pathogenesis and treatment. This study aimed to investigate the effect of surgical and medical treatment of pain relief in patients with RCPH, evaluating the intensity, duration, and frequency of headaches, and the impact of different treatments on quality of life. Ninety-four patients with headache, no symptoms or signs of acute and chronic sinonasal inflammation and who present with intranasal mucosal contact points positive to the lidocaine test were randomized into 2 equal groups and given medical or surgical treatment. The authors used visual analog scale, number of hours, and days with pain to characterize the headache and Migraine Disability Assessment score (MIDAS) to assess the migraine disability score before and 3 to 6 months after treatment. After treatment the severity, duration, and frequency of the headache decreased significantly (P < 0.001, P < 0.001, and P = 0.031, respectively) as well as the MIDAS in the surgical group compared with medical group. Our results suggest that surgical removal of mucosal contact points is more effective than local medical treatment improving the therapeutic outcomes in patients with contact point headache.

Nasal Polyps and Its Histo-Pathological Evaluation

Background: Nasal polyposis are considered a sign or a physical finding rather than a disease resulting from a complex process that is found in some individuals, such as people suffering from chronic sinusitis, rhinitis, Kartagener’s syndrome, or cystic fibrosis. Sinonasal polyps can have four distinct histological subtypes, which include eosinophilic polyp, chronic inflammatory polyp, hyperplastic polyp, and polyp with stromal atypia. Aim: In this review, we aim to study the presentation, classification and diagnosis of nasal polyps in the light of histopathological findings. Materials and methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 2001, through February 2017. The following search terms were used: nasal polyp, inflammation of nasal mucosa, chronic inflammation, histology of nasal mucosa, pathology of nasal polyps. Conclusion: Polyposis does not have histological problems and complications. However, they may be clinically disturbing. Polyps are not classified into allergic and non-allergic, and are rather stratified according to histological findings, making histological investigation crucial for diagnosis.

Pre- and postoperative blood neutrophil-to-lymphocyte and eosinophil-to-lymphocyte ratios in patients with sinonasal polyps: A preliminary investigation.

Identifying specific endotypes within the broad picture of chronic rhinosinusitis with nasal polyps (CRSwNP), by using biomarkers for instance, remains a challenge. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and the eosinophil-to-lymphocyte ratio (ELR) as potential markers of inflammation has already been discussed. The aim of the present study was to compare NLR and ELR before and after endoscopic sinus surgery (ESS) and nasal mometasone furoate for CRSwNP by stratifying patients by their clinical and histologic features. The study included 115 consecutive patients with CRSwNP treated with ESS and nasal mometasone furoate, with a postoperative follow-up of >12 months. Eosinophilic-type CRSwNP was histopathologically defined after hematoxylin and eosin tissue staining. In the subcohort of patients with an histologic diagnosis of eosinophilic-type CRSwNP, the mean ± standard deviation ELR significantly decreased after surgery (0.22 ± 0.16 versus 0.18 ± 0.12; p = 0.04), whereas, among patients with a histologic diagnosis of noneosinophilic-type CRSwNP, the mean NLR significantly decreased after surgery (1.98 ± 0.98 versus 1.90 ± 0.90; p = 0.04). Different CRSwNP endotypes are characterized by different biohumoral patterns. It is reasonable to assume that surgery enables clearance of the polyps and polypoid mucosa, which reduces the load of antigens that triggers the inflammation. Consistent with the above-mentioned biologic mechanism, ESS could correspond to a reduction in blood ELR values and eosinophil count in eosinophilic-type CRSwNP. Analysis of the data did not demonstrate an added value of measuring pre- versus postoperative ELR compared with measuring the blood eosinophil count. When used after ESS, topical corticosteroids also had more significant anti-inflammatory effects. As for the subcohort of patients with noneosinophilic CRSwNP, the fact that the mean NLR dropped significantly after surgery was definitely an original finding. Unlike eosinophilic inflammation, the inflammatory patterns seen in noneosinophilic CRSwNP are still poorly understood.

Blood eosinophil-to-basophil ratio in patients with sinonasal polyps: Does it have a clinical role?

BackgroundIn a recent preliminary study, eosinophil and basophil counts were calculated in chronic rhinosinusitis with nasal polyps (CRSwNP) using conventional histologic and immunohistochemical methods. The tissue eosinophil-to-basophil ratio differed in the CRSwNP endotypes considered. ObjectiveTo compare the blood eosinophil-to-basophil ratio (bEBR) in a large series of patients with CRSwNP with that in a control group of consecutive rhinological patients with no evidence of nasal, paranasal, or systemic inflammatory disorders. MethodsA retrospective study was performed on 334 patients with CRSwNP to compare the preoperative bEBR among different endotypes and with controls (69 cases). ResultsThe mean bEBR was significantly higher in the CRSwNP group than in the control group (P = .0006). The eosinophil and basophil counts were significantly and directly correlated in the CRSwNP cases (P = .0000). The mean bEBR was significantly higher in the sub-cohorts of CRSwNP with allergy (P = .0007), asthma (P = .0000), and aspirin-exacerbated respiratory disease (P = .0153). The mean bEBR was significantly higher in the sub-cohort with eosinophilic CRSwNP than in the sub-cohort with noneosinophilic CRSwNP (P = .0000). ConclusionThis study confirms the increasingly interesting role emerging for blood eosinophils and basophils in different CRSwNP endotypes. The bEBR seems to be a parameter worth investigating in different CRSwNP endotypes, because it is significantly higher in patients with allergy, asthma, and aspirin-exacerbated respiratory disease.

Clinicopathological study of Sinonasal Masses

Background: Sinonasal mass is a common finding in the Otorhinolaryngology Department. These can be non-neoplastic or neoplastic. Nasal obstruction is the most common clinical presentation. Imaging studies are not always conclusive in these cases. So, the present study aimed at clinical presentation and histopathological classification of sinonasal masses. Methods: All the specimens received as sinonasal mass were included in the present study. The tissues were routinely processed for histopathological examination and were stained by Hematoxylin and Eosin stain. Special stains were used wherever required. Immunohistochemistry was carried on cases with diagnostic difficulties. Result: Non-neoplastic lesions outnumbered the neoplastic lesions. Among the neoplastic lesions, benign tumours were more common than malignant tumours. Non-neoplastic lesions and benign tumours were commonly seen middle age group while malignant tumours were seen in adult patients. Males were predominantly affected in non-neoplastic lesions and benign tumours. Malignant tumours showed female dominance. Nasal obstruction was the most common complaint. Overall, inflammatory nasal polyps were most common lesions. Inverted papillomas were most common benign tumours. Sinonasal undifferentiated carcinomas accounted for majority of malignant tumours. Conclusion: Sino-nasal masses or polyps can be non-neoplastic or neoplastic lesions and histopathological examination remains the mainstay in differentiating these lesions. DOI: 10.21276/APALM.1207

The clinicopathological features of sinonasal angiomatous polyps.

BackgroundSinonasal angiomatous polyp (SAP) is a rare subtype of sinonasal polyp that might be misdiagnosed as a malignant lesion due to its clinical symptoms.MethodsWe retrospectively enrolled the patients who were diagnosed with SAP in our hospital during 2008–2015. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with SAP.ResultsUnilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. SAPs all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction is typical on computed tomography imaging but specific for SAPs. The magnetic resonance revealed high signal intensity on T1-weighted images and hypointense rim on T2-weighted images.ConclusionComputed tomography and magnetic resonance together might give rise to more accurate diagnosis of SAP. Incisional biopsy does help if the clinician suspects a malignant lesion. To treat SAP, complete removal is the optimal choice.

CT and MR findings of the respiratory epithelial adenomatoid hamartoma in the nasal olfactory clefts

Objective To study the CT and MR characteristic features of the respiratory epithelial adenomatoid hamartoma of olfactory clefts. Methods (1)The CT and MRI findings of 29 patients with histologically proved respiratory epithelial adenomatoid hamartoma in the olfactory clefts were retrospectively reviewed. All patients underwent CT and 8 of them underwent MRI. Location, CT and MRI features, and associated findings of the disease were reviewed; (2)The CT findings, olfactory clefts width, total nasal distance, and the ratio of OC to the total nasal distance of the case patients (29 cases) and the control patients (33 patients with sinusitis) were compared to investigate the correlation of the olfactory clefts distance and the incidence of respiratory epithelial adenomatoid hamartoma in olfactory clefts. Results All patients were associated with sinusitis, and 23 had sinonasal polyps, 1 had papilloma. On nonenhanced CT, the OC lesions with the OC widening were isodense to gray matter in all cases, and the lesions caused the adjacent bony expansion and absorption rather than erosion; 15 cases were bilateral diseases and 14 were unilateral; The olfactory clefts width of the case patients and the control patients were (1.03±0.24) cm, (0.71±0.17) cm, respectively. There was statistically significant difference (t=4.963, P 0.05) for the total nasal distance, and was significant difference (t=6.029, P<0.01) in the ratio of OC to the total nasal distance between the two groups. On T1WI, the disease appeared isointense in 6 patients and slightly hypointense in 2 patients compared with gray matter. On T2WI, the lesions revealed heterogeneous isointense in all patients. Regular cribriform pattern was found on MR T2WI and enhanced TlWI. Conclusions The unilateral or bilateral olfactory cleft opacification in chronic sinusitis patients with or without sinonasal polyposis, with involved OC widening and the adjacent bony walls compressed and remodeled may highly suggests the presence of REAH in the OC. The lesions showed inhomogeneous isointense signal on T2WI images, regular cribriform pattern enhancement are typical imaging feature of this entity. Key words: Hamartoma; Respiratory mucosa; Tomography, X-ray computed; Magnetic resonance imaging