CORONADO, CALIF. – Eosinophilic chronic rhinosinusitis with nasal polyposis decreases quality of life improvement after sinus surgery in patients with concurrent asthma, results from a retrospective study demonstrated.
Dr. Aykut A. Unsal
They also have significantly higher Lund-Kennedy endoscopy and Lund-McKay CT scores, compared with control groups.
“Patients with concurrent asthma and chronic sinusitis require more aggressive management than nonasthmatics,” one of the study authors, Aykut A. Unsal, DO, said in an interview in advance of the Triological Society’s Combined Sections Meeting. “Additionally, the degree of improvement of not only their sinusitis but possibly their asthma following medical/surgical treatment will also be limited if that patient also suffers from nasal polyps and/or eosinophilia. These patients will ultimately become more difficult to manage.”
In order to examine the relationship of eosinophilia and nasal polyps on quality of life (QOL) in patients with asthma who have chronic rhinosinusitis (CRS) who were treated with surgery, Dr. Unsal and his associates reviewed the records of 457 patients with a diagnosis of CRS who underwent sinus surgery in the department of otolaryngology at the Medical College of Georgia, Augusta. The researchers subdivided patients based on the presence or absence of an asthma diagnosis and further subdivided them based on tissue eosinophilia and nasal polyposis. Next, they compared the Sinonasal Outcome Test (SNOT-22), Lund-Kennedy endoscopy scores, and Lund-McKay CT scores preoperatively and postoperatively at 6 months – 1 year and at 2, 3, 4, and 5 years. They performed a T-test analysis to determine statistical significance.
Of the 457 patients included in the analysis, 92 had asthma and eosinophilic CRS with nasal polyps (eCRScNP), 20 had asthma and eosinophilic CRS without nasal polyps (eCRSsNP), 8 had asthma and noneosinophilic CRS with nasal polyps (neCRScNP), and 16 had asthma and noneosinophilic CRS without nasal polyps (neCRSsNP). The researchers observed that patients in the eCRScNP group showed no difference in QOL preoperatively, but their QOL declined significantly at the 1- and 2-year analysis (P less than .03). No significant QOL improvement appeared in the eCRSsNP group until 4 years (P less than .008), and there was no significant QOL difference among the neCRS groups regardless of nasal polyposis. A statistical difference in endoscopy scores was seen among patients in the preoperative neCRScNP group (P less than .001) and in the eCRScNP group from preoperatively until 5 years postoperatively (P less than .03). Finally, statistical significance appeared in preoperative CT scores analysis among patients in the eCRScNP group (P less than .001).
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Dr. Unsal and his associates launched the study expecting that all patients with asthma were not only going to have worse symptoms scores, but also more recalcitrant disease. “This is based on our clinical experience, as well as previous literature that has shown that patients with exacerbations of asthma or sinusitis can worsen the symptoms of the other comorbid disease,” he said. “The opposite is also true; effective treatment of chronic sinusitis has been shown to also improve asthma symptoms. Our findings partially validated what we expected, as asthma patients were typically worse by symptom, endoscopy, and CT scores across the board.
“What we discovered, however, was there was one population of patients where no differences demonstrated between the two groups preoperatively and postoperatively: Patients who were negative for both polyp disease and eosinophilia, considered the least severe sinus disease. Additionally, generally no statistical differences in disease and symptom severity were identified following surgery between the two groups if they had a moderately severe form of chronic sinusitis [patients who were either positive for polyps or positive for eosinophilia],” Dr. Unsal said.
He and his colleagues also found that the group with the most severe form (positive eosinophila and positive polyps) fared worse symptomatically and objectively both preoperatively and postoperatively, compared with the other groups.
Dr. Unsal acknowledged certain limitations of the study, including that the type of asthma each patient had (whether they were controlled intermittent or whether they had moderate or persistent asthma) was not recorded, “so we don’t actually know to what degree asthma severity played a role in sinus disease, nor the improvement in asthma severity following sinus surgery/medical therapy,” he said. “Lastly, we did lose several patients to follow-up in the later years so the data is not as robust in the very long term.”
The researchers reported having no financial disclosures.
The meeting was jointly sponsored by the Triological Society and the American College of Surgeons.