Prognosis and prediction of response to surgery in allergic patients with chronic sinusitis

Background: Chronic rhinosinusitis (CRS) occurs frequently in patients with atopy, but little is known of the prognosis after surgery and of factors t hat may predict a poor outcome. Objective: Our purpose was to assess the long-term prognosis in atopic pati ents with CRS who undergo surgery and whether certain immune markers could predict a worse prognosis in this setting. Methods: Fifteen patients with diffuse involvement of the sinuses on comput ed tomographic (CT) scan but without nasal polyposis underwent ethmoidectom y with middle meatotomy for CRS when it was clinically indicated. All patie nts had a biopsy of the inferior turbinate and of the most inflamed areas o f the maxillary and ethmoid sinuses at the time of surgery. Follow-up was p erformed by video endoscopy and by assessment of 2 chronic sinusitis questi onnaires at 0, 6, and 24 months postoperatively. The number of lymphocyte s ubsets (CD3, CD4, CD8), mast cells and eosinophils, and cells expressing IL -4 and IL-5 messenger RNA (mRNA) in all 3 biopsy sites at the time of surge ry were compared with the clinical response after surgery. Results: Seven patients had persistent improvement after surgery, with a de crease in pain, rhinorrhea, or nasal obstruction and a decrease in the need for medication. Eight patients were unchanged or worsened after surgery wi th disabling rhinorrhea and repeated sinusitis. We found no difference in t he number of inflammatory cells, lymphocyte subsets, or IL-4 mRNA-positive cells in the sinus mucosa between responders and nonresponders, However, an increased number of cells expressing IL-5 mRNA was found in the ethmoid si nus at the time of surgery in patients who did not respond to the surgical intervention (P =.007). Conclusion: More than 50% of patients with perennial rhinitis and CRS do no t improve after surgery, a response that may be predicted by more cells exp ressing IL-5 mRNA in the ethmoid sinuses. The increased number of cells exp ressing IL-5 mRNA may have the potential to be used as a marker for predict ion of the response to surgery. The worsening of symptoms in some patients with CRS after sinus surgery could be a result of the disturbance of the an atomy of the sinuses and exposure to the environmental allergens.