Histopathological inflammation and symptom outcomes after endoscopic sinus surgery

To determine if histopathology of the sinus mucosa predicts symptomatic outcomes after endoscopic sinus surgery (ESS).

The histopathology of the sinus mucosa and preoperative and postoperative symptom scores from the Rhinosinusitis Symptom Inventory (RSI) for adults undergoing ESS for chronic rhinosinusitis (CRS) without polyposis were reviewed. Linear regression analysis was conducted to examine the relationship between tissue pathology inflammatory severity score and the postoperative RSI symptom scores, adjusting for baseline RSI scores, Lund score, postoperative topical steroid, antihistamine, and antibiotic use.

A total of 112 patients were enrolled (average age, 41.2 years; 68.8% female) with a follow-up of 19.1 ± 8.7 months (mean ± standard deviation [SD]). Mean preoperative and postoperative RSI domain scores for nasal symptoms and total symptoms were (52.4, 21.4) and (41.2, 17.7), respectively (p < 0.001). Topical steroid utilization increased from 15.3 to 20.7 weeks (p = 0.086) whereas antihistamine use and antibiotic use decreased by 1.4 and 1.6 weeks, respectively (p = 0.594 and 0.092). Pathology severity score did not significantly predict postoperative symptom scores on any of the RSI symptom domains nor the total symptom score (all p > 0.05).

Although pathologic inflammation of the paranasal sinuses is inherent to CRS, increasing pathology severity at ESS does not predict poorer symptomatic outcomes after ESS.