Related Experiment Video
Updated: Dec 14, 2025
Rapid Viscoelastic Characterization of Airway Mucus Using a Benchtop Rheometer
Published on: April 21, 2022
Eosinophilic Mucin: A Predictor for Disease Severity in Chronic Rhinosinusitis
Aykut A Unsal1, Camilo Reyes2,3, Paul Biddinger4
1Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Objective:
The presence of tissue eosinophilia is a determinate of disease severity in patients with chronic rhinosinusitis (CRS). The impact of eosinophilic mucin (EM) as an independent variable has not yet been elucidated.
Study Design:
Retrospective review.
Setting:
Tertiary academic clinic.Subjects Methods: CRS patients who failed medical therapy were classified by tissue eosinophilia, presence of polyps and EM. Tissue eosinophilia count per high power field (HPF) as well as the presence of EM were determined by pathologic examination of sinus tissue removed during surgery. Sinonasal Outcomes Test (SNOT-22), Lund-Mackay (LM), and Lund-Kennedy (LK) scores were compared between all groups preoperatively and postoperatively up to two and a half years (30 months).
Results:
192 patients with CRS were included in the study. 87 were diagnosed with eosinophilic CRS with polyps, 58 with eosinophilic CRS without polyps, 14 with noneosinophilic CRS with polyps, and 33 with noneosinophilic CRS without polyps. Only patients with eosinophilia had EM on pathology. Of eosinophilic CRS, 50% of patients with polyps and 12% of cases without polyps demonstrated EM, respectively. EM presence portended more severe disease in patients with eosinophilia on subjective and objective scores preoperatively (P < 0.005). Postoperatively, EM patients experienced a greater improvement of symptoms, but continued to have worse endoscopy scores until 1.5 years. A tissue eosinophil count of 30 or greater per HPF was identified as a potential marker for the development of EM.
Conclusions:
The presence of eosinophilic mucin predicts overall worse disease severity in patients with eosinophilic CRS.
Insights
Eosinophilic mucin (EM) presence indicates more severe chronic rhinosinusitis (CRS) in patients with tissue eosinophilia. While EM patients show symptom improvement, their objective scores remain worse longer, with a count of 30+ eosinophils per HPF potentially predicting EM.
Area of Science:
- Otolaryngology
- Immunology
- Pathology
Background:
- Tissue eosinophilia is a known indicator of chronic rhinosinusitis (CRS) severity.
- The independent role of eosinophilic mucin (EM) in CRS disease severity has not been fully established.
Purpose of the Study:
- To investigate the impact of eosinophilic mucin (EM) as an independent variable in patients with chronic rhinosinusitis (CRS).
- To determine if EM presence correlates with disease severity and treatment outcomes in CRS patients with tissue eosinophilia.
Main Methods:
- Retrospective review of 192 CRS patients who failed medical therapy at a tertiary academic clinic.
- Classification based on tissue eosinophilia, presence of nasal polyps, and EM identified via pathological examination.
- Comparison of preoperative and postoperative Sinonasal Outcomes Test (SNOT-22), Lund-Mackay (LM), and Lund-Kennedy (LK) scores.
Main Results:
- Eosinophilic mucin (EM) was exclusively found in patients with tissue eosinophilia.
- EM presence was associated with significantly worse preoperative subjective and objective CRS severity scores (P < 0.005).
- A tissue eosinophil count of ≥30 per high power field (HPF) was identified as a potential marker for EM development.
Conclusions:
- Eosinophilic mucin (EM) presence is a significant predictor of overall worse disease severity in patients with eosinophilic CRS.
- Patients with EM experienced greater symptom improvement postoperatively but maintained poorer objective endoscopic scores for up to 1.5 years.
