Polypoid rhinosinusitis in patients with host defence deficiencies: cellular infiltration and disease severity

Polypoid rhinosinusitis is a chronic inflammatory, mucosal disease. Eosinophils may play a key role in driving and maintaining this inflammation. Polyps in conditions associated with chronic infective rhinosinusitis--such as cystic fibrosis (CF) and primary ciliary dyskinesia--however have been described as neutrophilic. We compared cell counts in polyps from 55 patients with host-defence deficiencies (HDD) to polyps from 50 patients without HDD. The CT-scan appearance was also compared to the cell counts in the HDD group. No difference was detected in the percentage of patients with eosinophils from either group. Significantly more patients in the HDD group had polyp neutrophils (p < 0.001). Non-HDD-patient polyps contain more eosinophils (p < 0.000) whilst HDD-patient polyps contained more neutrophils (p = 0.005) and plasma cells (p = 0.05). Significant correlation was found between the neutrophil count and the CT score (p = 0.012) and the mast-cell count and the CT score (p = 0.02). Eosinophils are present in HDD and non-HDD polyps. Whilst the degree of cellular infiltration may vary, to classify polyps as eosinophilic or neutrophilic may be a false distinction.