Impact of Obesity on the Structured Histopathology of Chronic Rhinosinusitis Patients

Obesity is an established risk factor for asthma, which shares common inflammatory pathways with chronic rhinosinusitis (CRS). However, the link between obesity and CRS remains poorly understood. By identifying trends in the structured histopathology (SHP) of obese patients with CRS, we aim to better understand how changes in the tissue architecture of obese patients may contribute to CRS.

Retrospective chart review was conducted on 476 patients with CRS with and without nasal polyps who underwent functional endoscopic sinus surgery. Data were collected on SHP, demographics, and comorbidities. Chi-squared, logistic analyses, and multivariate analysis were performed.

The patient cohort was 53.8% female. Mean age was 52.01 years and mean BMI was 29.74. A total of 290 (60.9%) patients were nonobese (BMI < 30), 100 (21.0%) were Class I obese (BMI 30-34.9), 40 (8.4%) were Class II obese (BMI 35-39.9), and 46 (9.7%) were Class III obese (BMI ≥ 40). It was found that class III obesity was associated with statistically significant increases in several histopathological markers, including hyperplastic/papillary changes (17.4% vs. 5.6%, p < 0.026), Charcot-Leyden crystals (17.4% vs. 6.6%, p < 0.037), and squamous metaplasia (26.1% vs. 17.6%, p < 0.028). Multivariate analysis was performed, controlling for asthma, smoking, CRS subtype, and diabetes mellitus status. None of the variables were identified as confounders.

Several SHP variables are significantly more prevalent in obese patients who underwent functional endoscopic sinus surgery. This may serve as a predictor of CRS severity and suggests CRS in Class III obese patients follows a non-type 2 inflammatory pathway.

ClinicalTrials.gov Identifier: NCT03816891.