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Usefulness of post-operative endoscopic score for optimal treatment selection in recurrent eosinophilic chronic rhinosinusitis

Published online by Cambridge University Press:  24 May 2023

Takahiro Saito Open the ORCID record for Takahiro Saito [Opens in a new window] ,
Ken Okazaki ,
Katsuya Fushimi  and
Kenzo Tsuzuki
Takahiro Saito*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Japan
Ken Okazaki
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Japan
Katsuya Fushimi
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Japan
Kenzo Tsuzuki
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Japan
*
Corresponding author: Takahiro Saito; Email: t-saito@hyo-med.ac.jp
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Abstract

Objective

This study retrospectively analysed post-operative endoscopic scores to determine the optimal post-operative treatment in patients with eosinophilic chronic rhinosinusitis undergoing functional endoscopic sinus surgery.

Methods

In total, 339 adults who underwent initial bilateral functional endoscopic sinus surgery for eosinophilic chronic rhinosinusitis were enrolled. Patients were divided into group A, which required no additional post-operative treatment; group B, which required local/systemic steroids post-operatively; and group C, which further required dupilumab and/or revision surgery.

Results

Sixty-five per cent of patients could be treated with initial functional endoscopic sinus surgery (group A). Post-operative steroids were required in 35 per cent of patients with a post-operative endoscopic score of 30 per cent (group B). Further advanced treatments with dupilumab and/or revision functional endoscopic sinus surgery were required in 10 per cent of patients with a post-operative endoscopic score of 65 per cent (group C).

Conclusion

The post functional endoscopic sinus surgery endoscopic score can be used as an index to determine treatment at the time of eosinophilic chronic rhinosinusitis recurrence.

Keywords

Eosinophiliaoperative proceduresrecurrencerisk factorssteroids

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 2 , February 2024 , pp. 162 - 168
Copyright
Copyright © Hyogo Medical University, 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Takahiro Saito takes responsibility for the integrity of the content of the paper

References

Fokkens, WJ, Lund, VJ, Hopkins, C, Hellings, PW, Kern, R, Reitsma, S et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 2020;58:1–464CrossRefGoogle ScholarPubMed
Fujieda, S, Imoto, Y, Kato, Y, Ninomiya, T, Tokunaga, T, Tsutsumiuchi, T et al. Eosinophilic chronic rhinosinusitis. Allergol Int 2019;68:403–12CrossRefGoogle ScholarPubMed
Ho, J, Earls, P, Harvey, RJ. Systemic biomarkers of eosinophilic chronic rhinosinusitis. Curr Opin Allergy Clin Immunol 2020;20:23–9CrossRefGoogle ScholarPubMed
Kato, A. Immunopathology of chronic rhinosinusitis. Allergol Int 2015;64:121–30CrossRefGoogle ScholarPubMed
Eschenbacher, W, Straesser, M, Knoeddler, A, Li, RC, Borish, L. Biologics for the treatment of allergic rhinitis, chronic rhinosinusitis, and nasal polyposis. Immunol Allergy Clin North Am 2020;40:539–47CrossRefGoogle ScholarPubMed
Bachert, C, Han, JK, Desrosiers, M, Hellings, PW, Amin, N, Lee, SE et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019;394:1638–50CrossRefGoogle ScholarPubMed
Fokkens, FW, Lund, V, Bachert, C, Mullol, J, Bjermer, L, Bousquet, J et al. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy 2019;74:2312–19CrossRefGoogle ScholarPubMed
Fujieda, S, Matsune, S, Takeno, S, Ohta, N, Asako, M, Bachert, C et al. Dupilumab efficacy in chronic rhinosinusitis with nasal polyps from SINUS-52 is unaffected by eosinophilic status. Allergy 2022;77:186–96CrossRefGoogle ScholarPubMed
Scangas, GA, Wu, AW, Ting, JY, Metson, R, Walgama, E, Shrime, MG et al. Cost utility analysis of dupilumab versus endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps. Laryngoscope 2021;131:26–33CrossRefGoogle ScholarPubMed
Bachert, C, Bhattacharyya, N, Desrosiers, M, Khan, AH. Burden of disease in chronic rhinosinusitis with nasal polyps. J Asthma Allergy 2021;14:127–341CrossRefGoogle ScholarPubMed
Matsunaga, K, Katoh, N, Fujieda, S, Izuhara, K, Oishi, K. Dupilumab: basic aspects and applications to allergic diseases. Allergol Int 2020;69:187–96CrossRefGoogle Scholar
Gevaert, P, Calus, L, Van Zele, T, Blomme, K, De Ruyck, N, Bauters, W et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol 2013;131:110–16CrossRefGoogle ScholarPubMed
Tsuzuki, K, Hinohira, Y, Takebayashi, H, Kojima, Y, Yukitatsu, Y, Daimon, T et al. Novel endoscopic scoring system after sinus surgery. Auris Nasus Larynx 2014;41:450–4CrossRefGoogle ScholarPubMed
Tokunaga, T, Sakashita, M, Haruna, T, Asaka, D, Takeno, S, Ikeda, H et al. Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study. Allergy 2015;70:995–1003CrossRefGoogle ScholarPubMed
Rosenfeld, RM, Piccirillo, JF, Chandrasekhar, SS, Brook, I, Ashok Kumar, K, Kramper, M et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015;152:1–39Google ScholarPubMed
Konno, W, Kashiwagi, T, Tsunemi, Y, Goto, K, Haruna, S. Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid. Auris Nasus Larynx 2019;46:365–73CrossRefGoogle ScholarPubMed
Saito, T, Okazaki, K, Hamada, Y, Hashimoto, K, Tsuzuki, K. Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery. J Laryngol Otol 2021;135:858–63CrossRefGoogle ScholarPubMed
Tsetsos, N, Goudakos, JK, Daskalakis, D, Konstantinidis, I, Markou, K. Monoclonal antibodies for the treatment of chronic rhinosinusitis with nasal polyposis: a systematic review. Rhinology 2018;56:11–21CrossRefGoogle ScholarPubMed
Lund, VJ, Mackay, IS. Staging in rhinosinusitus. Rhinology 1993;31:183–4Google ScholarPubMed
Takebayashi, H, Tsuzuki, K, Oka, H, Fukazawa, K, Daimon, T, Sakagami, M. Clinical availability of a self-administered odor questionnaire for patients with olfactory disorders. Auris Nasus Larynx 2011;38:65–72CrossRefGoogle ScholarPubMed
Oka, H, Tsuzuki, K, Takebayashi, H, Kojima, Y, Daimon, T, Sakagami, M. Olfactory changes after endoscopic sinus surgery in patients with chronic rhinosinusitis. Auris Nasus Larynx 2013;40:452–7CrossRefGoogle ScholarPubMed
Fluss, R, Faraggi, D, Reiser, B. Estimation of the Youden Index and its associated cut-off point. Biom J 2005;47:458–72CrossRefGoogle Scholar
Shah, SA, Ishinaga, H, Takeuchi, K. Pathogenesis of eosinophilic chronic rhinosinusitis. J Inflamm (Lond) 2016;13:11CrossRefGoogle ScholarPubMed
Takabayashi, T, Schleimer, RP. Formation of nasal polyps: the roles of innate type 2 inflammation and deposition of fibrin. J Allergy Clin Immunol 2020;145:740–50CrossRefGoogle ScholarPubMed
Akiyama, K, Makihara, S, Uraguchi, K, Samukawa, Y, Oka, A, Hoshikawa, H. Impact of preoperative systemic corticosteroids on the histology and diagnosis of eosinophilic chronic rhinosinusitis. Int Arch Allergy Immunol 2019;179:81–8CrossRefGoogle ScholarPubMed
Hong, SJ, Lee, JK, Lee, HS, Lee, JY, Pyo, JS, Lee, KC. Availability of preoperative systemic steroids on endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Yonsei Med J 2014;55:1683–90CrossRefGoogle ScholarPubMed
Grennan, D, Wang, S. Steroid side effects. JAMA 2019;322:282CrossRefGoogle ScholarPubMed
Sweeney, J, Patterson, CC, Menzies-Gow, A, Niven, RM, Mansur, AH, Bucknall, C et al. Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax 2016;71:339–46CrossRefGoogle ScholarPubMed
Hopkins, C, Wagenmann, M, Bachert, C, Desrosiers, D, Han, JK, Hellings, PW et al. Efficacy of dupilumab in patients with a history of prior sinus surgery for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2021;11:1087–101CrossRefGoogle ScholarPubMed
Tsuzuki, K, Hashimoto, K, Okazaki, K, Nishikawa, H, Sakagami, M. Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis. J Laryngol Otol 2019;133:678–84CrossRefGoogle ScholarPubMed