Histopathologic parameters in chronic rhinosinusitis with nasal polyposis: impact on quality of life outcomes

Chronic rhinosinusitis (CRS) is a common disease with a significant impact on health-related quality of life (QOL) of the patient. Histologic inflammatory markers in CRS are an important marker in determining the severity of the disease. In this study, we evaluated the association of histopathologic parameters with QOL questionnaires in patients with CRS with nasal polyposis after endoscopic sinus surgery (ESS).

A total of 57 patients were included in this study. Preoperative patient characteristics, clinical findings, and computed tomography scores were recorded. Two QOL measures, the Rhinosinusitis Disability Index (RSDI) and Short Form-36 General Health Survey (SF-36) were analyzed preoperatively and postoperatively. Sinus mucosal specimens were collected at the time of surgery. Presence of the inflammation was evaluated with cellular (eosinophils, neutrophils, lymphocytes, mast cells, macrophages), epithelial (basement membrane thickness [BMT], goblet cell) and stromal markers (subepithelial edema). The histopathological findings were compared statistically with the QOL measures.

In comparison of the absolute change of the RSDI and SF-36 scores with mucosal eosinophilia, patients with eosinophilia showed significantly less improvement only in the SF-36 physical functioning subscale (p = 0.004). There was a statistically significant relationship between BMT and RSDI total (p = 0.042), emotional scores (p = 0.003), SF-36 general health (p = 0.032), SF-36 physical function (p = 0.007), SF-36 bodily pain (p = 0.044), and SF-36 mental health (p = 0.022).

For most patients QOL significantly improved after surgery. Mucosal eosinophilia did not correlate with the absolute change of the RSDI. However, thickening of basal membrane adversely affects symptoms of the patients and correlates with the disease severity.