Risk Factors of Postoperative Residual Sinus Inflammation in Patients with Eosinophilic Chronic Rhinosinusitis and Nasal Polyps

Pei-Wen Wu,1– 3 Po-Hung Chang,1 Chi-Che Huang,1,2 Cheng-I Yen,4 Yu-Hsi Fan,1 Chien-Chia Huang1– 3 1Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 4Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, TaiwanCorrespondence: Chien-Chia Huang, Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, Tel +886-3-3281200 ext. 8466, Fax +886-3-3979361, Email [email protected]: The combination of surgery and biologics may be required for patients with severe eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) and a high inflammatory burden. This study aimed to identify the risk factors for postoperative residual sinus inflammation in patients with eosinophilic CRSwNP.Methods: Adult patients with bilateral CRSwNP planning to undergo endoscopic sinus surgery were prospectively recruited. Their clinical information, computed tomography images, and tissue eosinophil count were evaluated. Postoperative residual mucosal inflammation was defined as a modified Lund-Kennedy endoscopy score of ≥ 5 at three months postoperatively.Results: The study included 143 adult patients with bilateral CRSwNP. Ninety-three patients (65.0%) had eosinophilic CRSwNP based on tissue eosinophil counts of ≥ 10/high power field. Twenty-six patients (28.0%) with eosinophilic CRSwNP experienced postoperative residual sinus inflammation. The prevalence of comorbid asthma, nasal polyp score, Lund-Mackay score, ethmoid/maxillary ratio, olfactory cleft opacification score on computed tomography images, serum eosinophil cationic protein level, and tissue eosinophil count were significantly higher in the patients with than in those without postoperative residual sinus inflammation (all p< 0.05). A nomogram was constructed to predict the probability of experiencing post-op residual sinus inflammation.Conclusion: Comorbid asthma, nasal polyp score, Lund–Mackay score, ethmoid/maxillary ratio, and olfactory cleft opacification score are significant predictors of postoperative residual sinus inflammation in patients with eosinophilic CRSwNP. Clinicians can use a nomogram based on these factors to predict therapeutic outcomes after sinus surgery and the need for postoperative adjuvant therapy such as biologics.Plain Language Summary: The combination of surgery and biologics may be required for patients with severe eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) and a high inflammatory burden. This study included 143 adult patients with bilateral CRSwNP. Ninety-three patients (65.0%) had eosinophilic CRSwNP. Comorbid asthma, nasal polyp score, Lund–Mackay score, ethmoid/maxillary ratio, and olfactory cleft opacification score are significant predictors of postoperative residual sinus inflammation in patients with eosinophilic CRSwNP. Clinicians can use a nomogram based on these factors to predict therapeutic outcomes after sinus surgery and the need for postoperative adjuvant therapy such as biologics.Keywords: chronic rhinosinusitis, eosinophil, endoscopic sinus surgery, Lund-Mackay score, modified Lund-Kennedy endoscopy score, nasal polyp