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Distribution of Eosinophils Across Multiple Paranasal Sinuses Within Patients With Chronic Rhinosinusitis With Nasal
Aris I Giotakis1, Athanasios Ioannidis1, Efthymios Kyrodimos1
1First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece.
Background:
A single nasal polyp is frequently used for research purposes. We intended to investigate whether a single nasal polyp reflects the total inflammatory load in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
Methods:
We intended to prospectively collect polyps from four sites of 30 subjects during surgery for CRSwNP. We collected the most anterior located polyp and polyps of the posterior ethmoidal area on each side. A pathologist, blinded to the sampling sites, quantified the tissue eosinophilic count in the three most dense high-power fields with hematoxylin and eosin staining. We investigated the coefficient of variation within subjects and compared differences across the four sites with the Friedman's test. Moreover, we examined how many subjects had more or less than 10 eosinophils across all four sites and could be characterized as eosinophilic- or non-eosinophilic CRSwNP according to recent guidelines.
Results:
The mean coefficient of variation was high (82%). The tissue eosinophilic count differed significantly across the four sites when sorted from the lowest to the highest tissue eosinophilic count (Friedman's test; p < 0.001), with significant differences between each rank (Wilcoxon signed-rank test; all p < 0.001). The median tissue eosinophilic counts across the four different sites, when sorted from the lowest to the highest rank, were 7, 27, 52, and 161 eosinophils. Only 14 of 30 subjects had more or fewer than 10 eosinophils across all sites.
Conclusion:
The distribution of eosinophils may differ substantially across the paranasal sinuses. Investigation of a single nasal polyp may not reflect the total inflammatory load.
