Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2025, Vol. 39 ›› Issue (1): 46-53.doi: 10.6040/j.issn.1673-3770.0.2023.202

• Original Article • Previous Articles    

Changes of clinical and histopathological characteristics in recurrent chronic rhinosinusitis with nasal polyps

WANG Wenqing1, ZHANG Dan1, ZHU Mengdi2, WANG Luyang3, YANG Peipei1, SUN Sisi2, ZHANG Qiumin1, ZHOU Hui1   

  1. 1. Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu,  China2. Department of Otorhinolaryngology, Suzhou Municipal Hospital, Suzhou 215006, Jiangsu, China3. General Surgery Department, the First Affiliated Hospital of Anhui Medical University, Hefei 230031, Anhui, China
  • Published:2025-01-17

PDF (PC)

3

Abstract: Objective To investigate the differences in clinical and histopathological characteristics between the initial and recurrent operations for chronic rhinosinusitis with nasal polyps(CRSwNP). Methods Retrospective analysis of clinical data from 139 patients with CRSwNP, including 70 in the initial group and 69 in the recurrent group. The initial and the recurrent groups were further divided into different subgroups based on the presence of eosinophilic chronic rhinosinusitis(ECRS), bronchial asthma(BA), and allergic rhinitis(AR). Results In the tissue of nasal polyps, the total inflammatory cell count and the thickness of the basement membrane were decreased(P=0.04,0.016), whereas the percentage of neutrophils, the incomplete epithelialization rate at 3 months after surgery, and the recurrence rate of CRS symptoms within 1 year were increased when comparing the recurrent group with the initial group(P=0.047, 0.003, 0.019). The peripheral blood eosinophils(Eos)count and total inflammatory cell count in the ECRS recurrence group were both lower than those in the ECRS initial group, while the tissue neutrophil percentage and glandular hyperplasia score were both higher than those in the ECRS initial group(P<0.05). The peripheral blood Eos count in the BA recurrent group was lower than that in the BA initial group(P<0.05). The total inflammatory cell count in the AR recurrent group was lower than that in the AR initial group(P<0.001). The peripheral blood Eos count and percentage in the BA+AR+ECRS recurrent group were lower than those in the BA+AR+ECRS initial group, while the tissue Eos percentage and glandular hyperplasia score were higher than those in the BA+AR+ECRS initial group(P<0.05). Basement membrane thickness in the elderly recurrent group was lower than that in the elderly initial group. Conclusion Recurrent patients with BA or ECRS can experience a certain degree of reduction in systemic eosinophilic inflammatory load with no change in local eosinophilic inflammation, whereas recurrent patients with BA, AR, and ECRS, present an increased local eosinophilic inflammatory load and worse tissue remodeling. These research results may provide a basis for personalized treatment of patients with recurrent sinusitis after surgery.

Key words: Chronic sinusitis with nasal polyps, Functional nasal endoscopic surgery, Recurrence, Inflammatory load, Tissue remodeling

CLC Number: 

  • R765.4
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2):81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001 Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for the diagnosis and treatment of chronic sinusitis(2018)[J]. The Chinese Journal of Otolaryngology Head and Neck Surgery, 2019,54(2):81-100.doi: 10.3760/cma.j.issn.1673-0860.2019.02.001
[2] Wang WQ, Gao YL, Zhu ZZ, et al. Changes in the clinical and histological characteristics of Chinese chronic rhinosinusitis with nasal polyps over 11 years[J]. Int Forum Allergy Rhinol, 2019, 9(2): 149-157. doi:10.1002/alr.22234
[3] Zhu MD, Gao XH, Zhu Z, et al. The roles of nasal nitric oxide in diagnosis and endotypes of chronic rhinosinusitis with nasal polyps[J]. J Otolaryngol Head Neck Surg, 2020, 49(1): 68. doi:10.1186/s40463-020-00465-y
[4] 周兵, 张罗. 不断改进内镜鼻窦外科技术提高慢性鼻窦炎伴鼻息肉的疗效[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(1): 7-10. doi:10.3760/cma.j.cn115330-20200217-00094 ZHOU Bing, ZHANG Luo. Continuously improving the endoscopic sinus surgery so as to enhance the therapeutic effects of chronic rhinosinusitis with nasal polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2021, 56(1): 7-10. doi:10.3760/cma.j.cn115330-20200217-00094
[5] Smith KA, Orlandi RR, Oakley G, et al. Long-term revision rates for endoscopic sinus surgery[J]. Int Forum Allergy Rhinol, 2019, 9(4): 402-408. doi:10.1002/alr.22264
[6] 李静, 施心怡, 杨瑶, 等. 慢性鼻窦炎的临床病理与预后关系的探讨[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(10): 914-919. doi:10.13201/j.issn.2096-7993.2021.10.011 LI Jing, SHI Xinyi, YANG Yao, et al. The relationship between clinical pathology and prognosis of chronic rhinosinusitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(10): 914-919. doi:10.13201/j.issn.2096-7993.2021.10.011
[7] 杨玉成, 张玥. 慢性鼻窦炎伴鼻息肉的整体评估与个体化精准治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(2): 217-221. doi:10.3760/cma.j.cn115330-20210707-00435 YANG Yucheng, ZHANG Yue. The holistic assessment and individualized precision therapy for chronic rhinosinusitis with nasal polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(2): 217-221. doi:10.3760/cma.j.cn115330-20210707-00435
[8] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600
[9] Jiang WX, Cao PP, Li ZY, et al. A retrospective study of changes of histopathology of nasal polyps in adult Chinese in central China[J]. Rhinology, 2019, 57(4): 261-267. doi:10.4193/Rhin18.070
[10] Brescia G, Alessandrini L, Zanotti C, et al. Histopathological and hematological changes in recurrent nasal polyposis[J]. Int Forum Allergy Rhinol, 2019, 9(7): 813-820. doi:10.1002/alr.22314
[11] Bartier S, Coste A, Béquignon E. Biotherapy and treatment of adult primary chronic rhinosinusitis with nasal polyps: cellular and molecular bases[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2021, 138(5): 355-362. doi:10.1016/j.anorl.2020.12.002
[12] Wang XY, Meng YF, Lou HF, et al. Blood eosinophil count combined with asthma history could predict chronic rhinosinusitis with nasal polyp recurrence[J]. Acta Otolaryngol, 2021, 141(3): 279-285. doi:10.1080/00016489.2020.1844288
[13] Yu JQ, Xian M, Piao YS, et al. Changes in clinical and histological characteristics of nasal polyps in Northern China over the past 2-3 decades[J]. Int Arch Allergy Immunol, 2021, 182(7): 615-624. doi:10.1159/000513312
[14] Sella GCP, Tamashiro E, Sella JA, et al. Asthma is the dominant factor for recurrence in chronic rhinosinusitis[J]. J Allergy Clin Immunol Pract, 2020, 8(1): 302-309. doi:10.1016/j.jaip.2019.08.007
[15] 朱真真, 王威清, 陈玉洁, 等. 慢性鼻窦炎伴鼻息肉复发手术时的组织病理学及外周血特征变化[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(3): 249-255. doi:10.3760/cma.j.cn115330-20200628-00532 ZHU Zhenzhen, WANG Weiqing, CHEN Yujie, et al. Changes of histopathological and hematological characteristics in recurrent chronic rhinosinusitis with nasal polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2021, 56(3): 249-255. doi:10.3760/cma.j.cn115330-20200628-00532
[16] Brescia G, Parrino D, Zanotti C, et al. Blood eosinophil and basophil values before and after surgery for eosinophilic-type sinonasal polyps[J]. Am J Rhinol Allergy, 2018, 32(3): 194-201. doi:10.1177/1945892418768590
[17] Cataldo Russomando A, Steinberg D, Gati I, et al. Sinonasal stent coated with sustained-release varnish of mometasone furoate inhibits pro-inflammatory cytokine release from macrophages: an in vitro study[J]. Pharmaceutics, 2023, 15(3): 1015. doi:10.3390/pharmaceutics15031015
[18] 王宠舒, 郭翠莲, 刘争. 内在型对慢性鼻窦炎患者临床结局的影响[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(5): 644-648. doi:10.3760/cma.j.cn115330-20210509-00262 WANG Chongshu, GUO Cuilian, LIU Zheng. The effect of endotypes on the prognosis of patients with chronic rhinosinusitis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(5): 644-648. doi:10.3760/cma.j.cn115330-20210509-00262
[19] Tajudeen BA, Ganti A, Kuhar HN, et al. The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement[J]. Laryngoscope, 2019, 129(4): 794-799. doi:10.1002/lary.27693
[20] Poposki JA, Klingler AI, Stevens WW, et al. Elevation of activated neutrophils in chronic rhinosinusitis with nasal polyps[J]. J Allergy Clin Immunol, 2022, 149(5): 1666-1674. doi:10.1016/j.jaci.2021.11.023
[21] 谷钰, 万鑫, 肖自安. 中性粒细胞和嗜酸性粒细胞在慢性鼻窦炎中的相互影响及临床治疗思考[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 56-63.doi: 10.6040 /j.issn.1673-3770.0.2021.513 GU Yu, WAN Xin, XIAO Zian. The interaction between neutrophils and eosinophils in chronic rhinosinusitis and the implications on treatment options[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 56-63.doi: 10.6040 /j.issn.1673-3770.0.2021.513
[22] Zeng M, Wang H, Liao B, et al. Clinical and biological markers predict the efficacy of glucocorticoid- and macrolide-based postoperative therapy in patients with chronic rhinosinusitis[J]. Am J Rhinol Allergy, 2021, 35(5): 596-606. doi:10.1177/1945892420982236
[23] Siddiqui S, Bachert C, Bjermer L, et al. Eosinophils and tissue remodeling: relevance to airway disease[J]. J Allergy Clin Immunol, 2023. doi: 10.1016/j.jaci.2023.06.005
[24] 熊攀辉, 沈暘, 杨玉成. 基于表型和内在型的慢性鼻窦炎诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 15-19. doi:10.6040/j.issn.1673-3770.0.2022.034 XIONG Panhui, SHEN Yang, YANG Yucheng. Advancements in the diagnosis and treatment of chronic sinusitis based on phenotypes and endotypes[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 15-19. doi:10.6040/j.issn.1673-3770.0.2022.034
[25] 王成硕, 张罗. 生物制剂治疗慢性鼻窦炎伴鼻息肉[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(3): 193-199. doi:10.3760/cma.j.cn115330-20220831-00532 WANG Chengshuo, ZHANG Luo. Biologics treatment of chronic rhinosinusitis with nasal polyps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2023, 58(3): 193-199. doi:10.3760/cma.j.cn115330-20220831-00532
[26] Morse JC, Li P, Ely KA, et al. Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria[J]. J Allergy Clin Immunol, 2019, 143(3): 990-1002.e6. doi:10.1016/j.jaci.2018.10.056
[27] Christensen DN, Franks ZG, McCrary HC, et al. A systematic review of the association between cigarette smoke exposure and chronic rhinosinusitis[J]. Otolaryngol Head Neck Surg, 2018, 158(5): 801-816. doi:10.1177/0194599818757697
[28] 陈世琴, 卫平存, 胡云龙, 等. 糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 195-201. doi:10.6040/j.issn.1673-3770.0.2020.477 CHEN Shiqin, WEI Pingcun, HU Yunlong, et al. Effects of three different nasal uses of glucocorticoid on mucosal outcome after endoscopic sinus surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 195-201. doi:10.6040/j.issn.1673-3770.0.2020.477
[29] Wu J, Lai YY, Wang KH, et al. Therapeutic potential of recombinant human basic fibroblast growth factor on postoperative patients with chronic rhinosinusitis with nasal polyps[J]. Clin Otolaryngol, 2023, 48(2): 294-304. doi:10.1111/coa.13955
[30] 叶婷, 李骋, 张晓晴, 等. 鼻腔黏膜瓣在额窦磨削手术中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(8): 915-922. doi:10.3760/cma.j.cn115330-20211215-00797 YE Ting, LI Cheng, ZHANG Xiaoqing, et al. The application of nasal mucosal flaps in frontal drill out procedures[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(8): 915-922. doi:10.3760/cma.j.cn115330-20211215-00797
[31] Cui YM, Wang KH, Shi JB, et al. Endotyping difficult-to-treat chronic rhinosinusitis with nasal polyps by structured histopathology[J]. Int Arch Allergy Immunol, 2023, 184(10): 1036-1046. doi:10.1159/000530864
[1] LI Ting, ZHAO Chong, WU Xian. The relationship between miR-34a expression in nasal mucosa tissue and postoperative recurrence in patients with chronic sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(5): 20-25.
[2] ZHANG Shihan, LIU Hongbing. Effect of matrix metalloproteinase on tissue remodeling in chronic rhinosinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 116-123.
[3] LV Ping, LI Dandan, SONG Wei, HONG Liu. Nasolacrimal duct recanalization under nasal endoscopy for neonatal dacryocystitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 71-74.
[4] FAN Li, LI Yue, XU Ximing. Changes in and prognostic value of the inflammatory index before and after concurrent chemoradiotherapy for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 36-41.
[5] Jingrong, CHEN Chun, MA Yan, XIE Jin. Clinical characteristics and risk factors for differentiated thyroid carcinoma in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 88-94.
[6] XIE Shuhua, YANG Zhumei, LIU Huiru, DONG Jing. Value of NLR, LMR, and PLR in predicting chronic sinusitis recurrence after endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 54-57.
[7] Huijun CHEN,Shenghua SONG,Han ZHOU,Weida DONG,Mingzhe QIAO,Xi CHEN,Jin XU,Ziping LIN,Guangqian XING. Preoperative platelet-lymphocyte ratio is an independent prognostic factor for laryngeal squamous cell carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 106-110.
[8] Yan JIANG. Recurrence of nasopharyngeal carcinoma and application of endoscopic surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 1-11.
[9] Dongping CHEN,Zhihuan YANG,Yan ZHANG,Nan FANG,Bin QI. Status of surgical treatment for recurrent nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 12-16.
[10] Wenrui XU,Yan JIANG. Surgery Treatment for Recurrent Nasopharyngeal Carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 35-38.
[11] LUN Jie, ZHANG Ya′nan. Analysis on the factors related to the recurrence of chronic rhinosinusitis with nasal polyps. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(3): 80-83.
[12] BAO Weijing, NING Jiayu, ZHU Zhongshou, WEI Rifu, LIN Chang. A clinical analysis of CO2 laser microsurgery for early glottic laryngeal carcinoma with anterior commissure involvement. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(5): 101-105.
[13] JIA Yanfeng, YANG Chunwei, SONG Fuchun, YANG Xiangli, WANG Lin, LIU Jixiang. Efficacy of CO2 laser combined with proton pump inhibitors in the treatment of recurrent vocal process granuloma. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(5): 106-109.
[14] JIN Shu. Influence of tracheal infection after total laryngectomy on pulmonary function and tumor recurrence rate in patients with laryngocarcinoma. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(3): 37-39.
[15] LI Xue-sheng, QIAN　Jin， LI Hou-en， LI Jin-rang. A review of tissue remodeling in chronic rhino-sinusitis [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2014, 28(1): 84-86.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd