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Backgroud: Presently, the impact of Chronic rhinosinusitis with nasal polyps (CRSwNP) on asthma onset is unknown., Aims: To evaluate the role of CRSwNP in asthma onset., Materials and Methods: A total of 3107 CRSwNP patients were retrospectively screened from 1 January 2018, to 31 May 2021; 624 patients were enrolled. Clinical data regarding nasal symptoms, Lund-Mackay scores, blood eosinophil percentage, and onset of asthma were analyzed. Patients were divided into different groups according to past history of nasal polyps, Lund-Mackay score, and the extent of blood eosinophilia. Asthma-free rates between these subgroups were analyzed by Kaplan-Meier curves and Cox regression models., Results: The prevalence of asthma was 10.90% in patients with CRSwNP, and new-onset asthma occurred in 3.14% of these patients. Higher Lund-Mackay scores for ethmoid sinus and maxillary sinus (E/M) and blood eosinophil percentages were two independent risk factors for new-onset asthma, with hazard ratios of 1.267 (95%CI, 1.155-1.390) and 1.224 (95%CI, 1.054-1.422), respectively. CRSwNP patients with an E/M ratio > 2.33 or a blood Eos percentage > 5.5% were at risk for asthma onset., Conclusions and Significance: Blood eosinophilia and a higher E/M score ratio were associated with new-onset asthma in patients with CRSwNP.

Background: The prevalence of eosinophilic CRSwNP in China has increased significantly over the last 20 years, noninvasive methods that could assist in diagnosis are urgently needed., Aims: The aim of this study is to explore the clinical significance of peripheral blood eosinophil in diagnosing ECRS., Materials and Methods: We conducted a prospective study of 221 patients diagnosed with CRS. Lund-Mackay score, peripheral blood eosinophil absolute count, peripheral blood eosinophil percentage were detection to compare the clinical features with ECRS and non-ECRS. ROC curve was performed to assess the efficiency of clinical index to predict ECRS., Results: The ECRS group of patients had significantly higher scores compared with those of the non-ECRS group. Different extent and severity of mucosal thickening on total Lund-Mackay scores, anterior ethmoidal, posterior ethmoidal and ostiomeatal complex have confirmed different blood eosinophil levels in CRS patients. The combination of peripheral blood eosinophil percentage and posterior ethmoidal score to predict ECRS was 0.807., Conclusions and Significance: The increase in peripheral blood eosinophil percent indicates the deterioration the inflammation of chronic rhinosinusitis and the level of posterior ethmoidal score and peripheral blood eosinophil percentage have a positive predictive value regarding ECRS identification.

Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease. Eosinophilic CRSwNP (ENP) exhibits a strong tendency for recurrence after surgery. Given that the treatment strategy of ENP differs from that of non-eosinophilic CRSwNP (nENP), clinical diagnostic criteria that distinguish ENP from nENP are needed., Methods: In total, 94 CRSwNP patients were enrolled in the cohort. Factors associated with ENP were determined with regression analysis, and optimal cutoff points of the predictors were determined by a receiver operating characteristic curve., Results: Serum periostin levels, blood eosinophils and basophils counts significantly differed between ENP and nENP. A combination of the cut-off values for the three predictors, including absolute blood eosinophil and basophil counts, yielded a sensitivity of 79.2% and 70.8%, and a specificity of 84.8% and 73.9%, respectively. Serum periostin levels yielded a sensitivity of 72.9% and a specificity of 60.9% for the diagnosis of ENP. The predicted probability of periostin in combination with blood eosinophils and basophils counts (AUC, 0.872) exhibited moderate accuracy. In addition, patients with ENP displayed an increased prevalence of smoking., Conclusions: Periostin in combination with blood eosinophils and basophils counts has the potential to better refine current CRSwNP phenotypes.

Conclusion: IgG4-related disease involves nasal manifestations with chronic rhinosinusitis (CRS). This type of sinusitis is a new clinical entity of nasal disease associated with a high level of serum IgG4 for which steroid therapy is effective. Objectives. To confirm whether IgG4-related disease has distinctive chronic rhinosinusitis., Methods: We compared serum IgG4 levels as well as nasal computed tomography (CT) and clinicopathological findings before and after glucocorticoid treatment in 31 patients diagnosed as having IgG4-related disease with nasal manifestations. To evaluate immunohistochemical findings of nasal mucosa, we compared them with IgG4-related CRS and common CRS., Results: All patients had levels of high serum IgG4. Ten of the 31 patients had nasal obstruction, nasal discharge, postnasal discharge, hyposmia, and dull headache. They also demonstrated sinus lesions on radiological findings. After glucocorticoid treatment, serum IgG and IgG4 levels were markedly decreased and along with improvement of the symptoms, nasal sinus CT findings also revealed improvement of the sinus opacification. In immunohistochemical examination, the magnitude of IgG4-positive plasma cell infiltration in common CRS was almost the same as in the IgG4-related CRS group. Therefore, in nasal mucosa immunocytochemical positive staining for IgG4 is not specific for definition of IgG4-related disease.

Conclusions: C-reactive protein (CRP) levels may predict the extent of acute rhinosinusitis disease in the computed tomography (CT) scans, as well as the specific symptom severity. High levels may direct the physician to change the treatment., Objective: To establish tools to define 'high risk' patients suffering from acute rhinosinusitis., Methods: Patients suffering from severe unresponsive acute rhinosinusitis filled in health-related quality of life questionnaires and rated their symptoms. Blood tests and CT scans were performed. We examined the value of imaging and inflammatory markers, especially CRP, as predictors of disease severity, defined by subjective and objective means; need for surgery; and occurrence of ocular complications., Results: Thirty-two patients were prospectively recruited. A significant association was found between CRP levels, imaging scores, and symptoms severity. Neither ocular complications nor the need for surgery were present in the group with low CRP level.

Nasal polyps develop out of an oedematous swelling of the mucous membrane, which is probably a localized mediator-dependent reaction of the mucous membrane in the lamina propria. Among other things, eosinophil cationic protein (ECP) is released from activated eosinophils. In previous studies, ECP was considered as measuring the degree of allergic dermatological illnesses and therapy was given accordingly. A group of 54 patients with massive polyposis requiring functional endoscopic sinus surgery was examined. After surgery they were treated with local and systemic cortisone. Polypous tissue samples were collected and counted for the number and ratio of activated and non-activated eosinophils, and the serum titre of ECP was measured simultaneously using a fluoroimmunoassay (test kit, Kabi Pharmacia, Sweden). The aim of the study was to evaluate the activity of the disease and to gain hints for a specific therapy. The presence of these eosinophils was demonstrated by immunohistochemical methods, using EG1 antibodies against non-activated and EG2 antibodies against activated (i.e. secreted form of ECP) eosinophils. Depending on the duration of treatment with systemic and local corticosteroids, there was a considerable decrease in activated eosinophils and the level of serum ECP. Consequently, cortisone can be applied in the treatment of eosinophilic nasal polyps. As the number of activated eosinophils in the tissue is an indicator for the activity of the chronic inflammation it can be deduced from our study that local and/or systemic cortisone application successfully stops the growth of eosinophilic nasal polyps. The number and ratio of activated and non-activated eosinophils seem to be reliable indicators for the activity of chronic polyposis.

The penetration of azidocillin into the sinus mucosa and secretion as well as into tonsils and adenoids was studied. Altogehter 73 patients were included and they were arranged in four groups according to age, diagnosis and drug dose. The average azidocillin concentration was satisfactory and predictable in all tissues and well over the MIC for most upper respiratory tract pathogens studied. In the maxillary antrum secretion the values were much lower and in many cases under the MIC for hemophilus. This is thought to depend upon the drug's being bound to proteins in the secretions. The clinical results were good in all cases and the contribution of the surgical operation, particularly in providing drainage for the secretion, is obvious.

Granulocytes in sinus pus and in peripheral blood in 28 patients with maxillary sinus empyema were compared to blood granulocytes obtained from healthy blood donors. A flow cytofluorometric assay technique was used to establish the C3b-mediated phagocytosis and the CR1-receptor expression. The results indicate that a subpopulation of viable granulocytes in situ was activated with an increased ability to ingest particles. From 11 of 28 patients, an increased CR1-expression was also demonstrated in the blood samples, reflecting a priming of the circulating granulocytes before extravasation.