Skip to main content
The Egyptian Journal of Otolaryngology
Download PDF

Predictive outcomes of functional endoscopic sinus surgery in patients with chronic rhinosinusitis

The Egyptian Journal of Otolaryngology volume 29, pages 80–85 (2013)Cite this article

En

Abstract

Objective

This article aims at addressing some inflammatory markers obtained from patients who underwent a functional endoscopic sinus surgery for refractory chronic rhinosinusitis (CRS) to predict the outcome of such surgeries according to the inflammatory load and to determine whether certain immune markers can predict a poor prognosis in these patients.

Methods

Fourteen patients (eight women and six men) with diffuse rhinosinusitis as evident from a computed tomography scan but without nasal polyposis underwent ethmoidectomy. All patients had undergone biopsies of the ethmoid sinuses at the time of surgery. All tissue samples were subjected to immunohistochemical staining using CD3, CD4, CD8, and interleukin (IL)-5 antibodies, and the number of lymphocyte subsets (CD3, CD4, and CD8) and IL-5-expressing cells at the time of surgery were compared with the clinical response and nasal endoscopic findings 6 months after surgery.

Results

Only six patients showed an improvement with a decrease in nasal symptoms and a decrease in the need for medications. Eight patients had an unchanged status or worsened, with disabling rhinorrhea and repeated sinusitis.

Conclusion

Almost more than half of the patients with CRS and a diffuse mucosal disease do not respond to surgery. T lymphocytes play an important role in the pathophysiology of CRS. An increased number of IL-5-expressing cells in the ethmoid sinuses at the time of surgery could predict a poor prognosis. It may eventually be possible to classify patients with CRS into different groups with different prognoses.

References

  1. Meltzer EO/, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;114(Suppl.):155–212.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Van Zele T, Claeys S, Gevaert P, Van Maele G, Holtappels G, Van Cauwenberge P, Bachert C. Differentiation of chronic sinus diseases by measurement of inflammatory mediators. Allergy. 2006; 61: 1280–1289.

    Article  PubMed  Google Scholar 

  3. Kern RC, Conley DB, Walsh W, Chandra R, Kato A, Tripathi-Peters A, et al. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. Am J Rhinol. 2008; 22: 549–559.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bassiouni A, Naidoo Y, Wormald PJ. When FESS fails: the inflammatory load hypothesis in refractory chronic rhinosinusitis. Laryngoscope. 2012; 122: 460–466.

    Article  PubMed  Google Scholar 

  5. Sil A, Mackay I, Rowe-Jones J. Assessment of predictive prognostic factors for functional endoscopic sinus surgery in a 5-year prospective outcome study. Am J Rhinol. 2007; 21: 289–296.

    Article  PubMed  Google Scholar 

  6. Stewart MG, Smith TL. Objective versus subjective outcomes assessment in rhinology. Am J Rhinol. 2005; 19: 529–535.

    Article  PubMed  Google Scholar 

  7. Weaver EM, Kapur V, Yueh B. Polysomnography vs self-reported measures in patients with sleep apnea. Arch Otolaryngol Head Neck Surg. 2004; 130: 453–458.

    Article  PubMed  Google Scholar 

  8. Soler ZM, Smith TL. Quality of life outcomes after functional endoscopic sinus surgery. Otolaryngol Clin North Am. 2010; 43: 605–612.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Senior BA, Kennedy DW, Tanabodee J, Kroger H, Hassab M, Lanza D. Long-term results of functional endoscopic sinus surgery. Laryngoscope. 1998; 108: 151–157.

    Article  CAS  PubMed  Google Scholar 

  10. Emanuel IA, Shah SB. Chronic rhinosinusitis: allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg. 2000; 123: 687–691.

    Article  CAS  PubMed  Google Scholar 

  11. Mabry RT. Endoscopic approach to allergy associated chronic rhinosinusitis. Ear Nose Throat J. 2001; 80: 902–905.

    Article  CAS  PubMed  Google Scholar 

  12. Park AH, Lau J, Stankiewicz J, Chow J. The role of functional endoscopic sinus surgery in asthmatic patients. J Otolaryngol. 1998; 27: 275–280.

    CAS  PubMed  Google Scholar 

  13. Riccio AM, Tosca MA, Cosentino C, Pallestrini E, Ameli F, Canonica GW, Ciprandi G. Cytokine pattern in allergic and non-allergic chronic rhinosinusitis in asthmatic children. Clin Exp Allergy. 2002; 32: 422–426.

    Article  CAS  PubMed  Google Scholar 

  14. Jyonouchi H, Sun S, Rimell FL. Cytokine production by sinus lavage, bronchial lavage, and blood mononuclear cells in chronic rhinosinusitis with or without atopy. Arch Otolaryngol Head Neck Surg. 2000; 126: 522–528.

    Article  CAS  PubMed  Google Scholar 

  15. Muluk NB, Koç C, Atasoy P. Localization of T cells and subtypes in the paranasal sinus and turbinate mucosa in patients with chronic sinusitis. J Otolaryngol. 2004; 33: 235–242.

    Article  PubMed  Google Scholar 

  16. Renno WM, Alkhalaf M, Afsari Z, Abd-El-Basset E, Mousa A. Consumption of green tea alters glial fibriliary acidic protein immunoreactivity in the spinal cord astrocytes of STZ-diabetic rats. Nutr Neurosci. 2008; 11: 32–40.

    Article  CAS  PubMed  Google Scholar 

  17. Anand VK, Osguthorpe JD, Rice D. Surgical management of adult rhinosinusitis. Otolaryngol Head Neck Surg. 1997;117(Suppl.):S50–S52.

    Article  CAS  PubMed  Google Scholar 

  18. Gliklich RE, Metsonc R. Economic implications of chronic sinusitis. Otolaryngol Head Neck Surg. 1998;118(3 I):344–349.

    Article  CAS  PubMed  Google Scholar 

  19. Kennedy DW, Senior BA. Endoscopic sinus surgery: a review. Otolaryngol Clin North Am. 1997; 30: 313–330.

    Article  CAS  PubMed  Google Scholar 

  20. Haynes BF, Fauci AS. Introduction to clinical immunology. In: Braunwald E, Isselbacker KJ, Petersdorf RG, editors. Harrison’s principles of internal medicine 1. 11th ed. New York: Mc Graw-Hill Book Company; 1987. pp. 328–337.

    Google Scholar 

  21. Nishimoto K, Ukai K, Harada T, Shun JC, Sakakura Y. Lymphocyte subsets of maxillary mucosa in chronic inflammation. Acta Otolaryngol. 1988;106(3–4):291–298.

    CAS  PubMed  Google Scholar 

  22. Ying S, Durham SR, Jacobson MR, Rak S, Masuyama K, Lowhagen O, et al. T lymphocytes and mast cells express messenger RNA for interleukin-4 in the nasal mucosa in allergen-induced rhinitis. Immunology. 1994;82:200–206.

    CAS  PubMed Central  PubMed  Google Scholar 

  23. Driscoll PV, Naclerio RM, Baroody FM. CD4+ lymphocytes are increased in the sinus mucosa of children with chronic sinusitis. Arch Otolaryngol Head Neck Surg. 1996; 122: 1071–1076.

    Article  CAS  PubMed  Google Scholar 

  24. Hamilos DL, Leung DYM, Wood R, Cunningham L, Bean DK, Yasruel Z, et al. Evidence for distinct cytokine expression in allergic versus nonallergic chronic sinusitis. J Allergy Clin Immunol. 1995; 96: 537–544.

    Article  CAS  PubMed  Google Scholar 

  25. Kamil A, Ghaffar O, Lavigne F, Taha R, Renzi PM, Hamid Q. Comparison of inflammatory cell profile and Th2 cytokine expression in the ethmoid sinuses, maxillary sinuses, and turbinates of atopic subjects with chronic sinusitis. Otolaryngol Head Neck Surg. 1998; 118: 804–809.

    Article  CAS  PubMed  Google Scholar 

  26. Grevers G, Klemens A, Sturm C, Menauer F. Involvement of inferior turbinate mucosa in chronic sinusitis–localization of T-cell subset. Allergy. 2000; 55: 1155–1162.

    Article  CAS  PubMed  Google Scholar 

  27. Hoover GE, Newman JL, Platts MT, Gross CW. Chronic sinusitis: risk factors for extensive disease. J Allergy Clin Immunol. 1997; 100: 185–191.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Otorhinolaryngology Department, Zagazig University, Cairo, Egypt

    Mohamed M. Talaat El Ghonemy

  2. Otorhinolaryngology Department, October-6 University, 6 October, Giza, Cairo, Egypt

    Wael Shehata

  3. Pathology Department, Ain Shams University, Cairo, Egypt

    Rasha M. Abd El Atti

Authors
  1. Mohamed M. Talaat El Ghonemy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wael Shehata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rasha M. Abd El Atti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed M. Talaat El Ghonemy.

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Talaat El Ghonemy, M.M., Shehata, W. & Abd El Atti, R.M. Predictive outcomes of functional endoscopic sinus surgery in patients with chronic rhinosinusitis. Egypt J Otolaryngol 29, 80–85 (2013). https://doi.org/10.7123/01.EJO.0000426358.31578.1a

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.7123/01.EJO.0000426358.31578.1a

Keywords