Abstract
Problem: Chronic eosinophilic rhinosinusitis with polyposis is a disease that is frequently recalcitrant to medical and surgical management. Oral corticosteroids are the only medications that yield consistent, albeit temporary, clinical improvement. This study examines the effect of oral corticosteroids on the histopathology of sinonasal polyps in this patient population.
Methods: Sixteen patients with endoscopic findings of sinonasal polyposis and allergic mucin, as well as the established criteria for chronic rhinosinusitis, were identified prospectively in an academic rhinology practice. Biopsies of polyp tissue were obtained either without treatment or following a 1-week course of daily oral corticosteroids. The polyp tissue was processed for histology, and cell counts were performed in a blinded fashion.
Results: Histologic analysis of nasal polyp epithelium from all patients revealed inflammatory cell infiltrates (mean, 1188 cells/mm2). Without oral corticosteroid treatment, eosinophils comprised an average of 53% of the inflammatory cells. In patients treated with 1 week of oral corticosteroids, the total number of inflammatory cells was decreased but not significantly so (1585 to 737 cells/mm2, P = 0.07). However, the number of eosinophils was significantly decreased from a mean of 1033 per mm2 to 82 per mm2 (P = 0.043). Although corticosteroids decreased the number of mononuclear cells and neutrophils, the effect did not achieve statistical significance.
Conclusion: Polyps associated with chronic sinusitis are characterized by an epithelial inflammatory infiltrate consisting primarily of mononuclear cells and eosinophils. A 7-day course of oral corticosteroids leads to a significant reduction in the number of eosinophils, without a similar decrease in the mononuclear population.
Significance: The reduction of mucosal eosinophils by short courses of systemic corticosteroids in chronic polypoid sinusitis is associated with temporary clinical improvement. The relative persistence of infiltrating mononuclear cells may play a role in the rapid recurrence of disease after cessation of steroid therapy.
Support: AAO-HNS 2000 Earleen Elkins Training Award, NIH HL68546, NIH AI44885