Comorbid allergy and immune factors predict revision surgery in chronic rhinosinusitis patients
Comorbid allergy and high tissue interleukin-5 (IL-5) levels were predictive of the need for revision surgery in chronic rhinosinusitis patients with nasal polyposis (CRSwNP) who had undergone endoscopic sinus surgery (ESS) previously, reported Belgian researchers at the European Academy of Allergy and Clinical Immunology (EAACI) Annual Congress 2016 held in Vienna, Austria.
“Long-term control of CRSwNP is a challenge despite medical treatment and ESS,” said principal investigator Dr. Philippe Gavaert, an otorhinolaryngology specialist at the Department of Otorhinolaryngology at the University of Ghent in Ghent, Belgium.
“The study concludes that patients with CRSwNP regard functional ESS as a beneficial procedure to improve their general wellbeing, despite the relapsing character of the disease and the high proportion of patients with a need for revision surgery.”
The prospective cohort study recruited 47 CRSwNP patients who were characterised clinically before undergoing functional ESS and followed-up at six and twelve years after surgery. [J Allergy Clin Immunol 2016, abstract AB238]
Twelve years after primary ESS, the 38 patients who completed follow-up had significantly better symptom score, in terms of improved sense of smell (p=0.006) and nasal obstruction (p<0.001) compared with before surgery.
Nasal polyp score (NP score) was significantly lower 12 years after surgery compared with before surgery (p<0.001). Additionally, total symptom score was higher in patients with comorbid asthma compared with those without asthma (p=0.016).
Within 12 years after primary surgery, 78.9 percent of patients developed recurrent nasal polyps, out of which 36.8 percent underwent subsequent revision surgery.
“[This suggests] that not every NP recurrence has to be followed by a functional ESS reintervention and that surgery is not always indispensable to obtain subjective wellbeing in CRSwNP,” said Gavaert.
More patients who required revision surgery had comorbid allergy compared with those who did not have revision surgery (78.6 vs 37.5 percent, p=0.014).
Patients with comorbid asthma or aspirin sensitive asthma also had a higher NP score, although this was not significantly different than those without.
Tissue IL-5 levels measured before primary ESS were significantly higher in patients who underwent additional revision surgery compared with those who did not require revision surgery (p=0.029).
IL-5 mediates inflammation by recruiting and activating eosinophils, which contribute to the pathophysiology of nasal polyps, according to Gavaert, suggesting this as a reason why IL-5 levels were predictive of the need for revision surgery in CRSwNP patients.