Devils in the Details: Analysis of Detailed Histopathological Reporting of Tissue Samples in Primary Diffuse Chronic Rhinosinusitis-A Clinical and Pathological Perspective

Chronic rhinosinusitis is essentially the inflammation of the nasal passage and sinuses and is diagnosed as per the diagnostic criteria of European position paper on Rhinosinusitis and nasal polyps 2020 (EPOS2020). Eosinophilic and non-eosinophilic Chronic rhinosinusitis are defined based on the presence of greater than 10 eosinophils per high power field. This study aimed to study whether the use of preoperative steroids for surgical field preparation actually impacted our diagnosis of eosinophilic vs non-eosinophilic CRS contemplating eosinophils > 10/HPF as the cutoff in accordance with the EPOS2020 guidelines and whether any pathological parameter could be noted to predict recurrence. In this retrospective study a total of 53 patients were included and separated into steroid and non steroid groups based on whether they had received any pre-operative oral steroid preparation. We found that the use of pre operative steroid had no influence on the diagnosis of eosinophilic or non-eosinophilic chronic rhinosinusitis. The study also revealed that lack of neutrophilic infiltrates was a prognosticator for recurrence. Questions about pre-operative steroid preparation and tissue diagnosis have been addressed in some detail in Japan, China and even Korea; our study hints towards a similar truth for the Indian populace and in our review of literature we could not find any other study ascertaining the same for the Indian subcontinent.