J Korean Med Sci.  2021 Oct;36(40):e264. 10.3346/jkms.2021.36.e264.

Risk Model Establishment of Endoscopic Sinus Surgery for Patients with Chronic Rhinosinusitis: a Multicenter Study in Korea

• Min JY
• Kim YM
• Kim DW
• Kim JW
• Kim JK
• Mo JH
• Shin JM
• Cho KS
• Kwak S
• Shin SH

• KMID: 2521428
• DOI: http://doi.org/10.3346/jkms.2021.36.e264

Abstract

Background
Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes.
Methods
Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and LundMackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes.
Results
In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis (P < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and P (the value of prediction probability) = 1 / (1 + exp [−0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) − 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed.
Conclusion
Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.

Keyword

Chronic Rhinosinusitis; Endoscopic Sinus Surgery; Prognostic Factor; Eosinophilia; Computed Tomography; Multicenter Study

Reference

1. 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(Suppl S29):1–464.

2. Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016; 6(Suppl 1):S22–S209. PMID: 26889651.

3. Ference EH, Stubbs V, Lidder AK, Chandra RK, Conley D, Avila PC, et al. Measurement and comparison of health utility assessments in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015; 5(10):929–936. PMID: 26077390.

4. Kim DK, Eun KM, Kim MK, Cho D, Han SA, Han SY, et al. Comparison between signature cytokines of nasal tissues in subtypes of chronic rhinosinusitis. Allergy Asthma Immunol Res. 2019; 11(2):201–211. PMID: 30661312.

5. Veloso-Teles R, Cerejeira R. Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps: clinical outcome and predictive factors of recurrence. Am J Rhinol Allergy. 2017; 31(1):56–62. PMID: 28234156.

6. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017; 127(3):550–555. PMID: 27859303.

7. 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(8):995–1003. PMID: 25945591.

8. Kim JY, Han YE, Seo Y, Choe G, Kim MK, Huh G, et al. Revisiting the clinical scoring system for the prognosis of chronic rhinosinusitis with nasal polyps. Yonsei Med J. 2019; 60(6):578–584. PMID: 31124342.

9. Wu AW, Ting JY, Platt MP, Tierney HT, Metson R. Factors affecting time to revision sinus surgery for nasal polyps: a 25-year experience. Laryngoscope. 2014; 124(1):29–33. PMID: 23712679.

10. Tao X, Chen F, Sun Y, Wu S, Hong H, Shi J, et al. Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice. Laryngoscope. 2018; 128(12):2673–2680. PMID: 30295929.

11. Bhandarkar ND, Mace JC, Smith TL. The impact of osteitis on disease severity measures and quality of life outcomes in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2011; 1(5):372–378. PMID: 22028948.

12. Lee JT, Kennedy DW, Palmer JN, Feldman M, Chiu AG. The incidence of concurrent osteitis in patients with chronic rhinosinusitis: a clinicopathological study. Am J Rhinol. 2006; 20(3):278–282. PMID: 16871929.

13. Ikeda K, Shiozawa A, Ono N, Kusunoki T, Hirotsu M, Homma H, et al. Subclassification of chronic rhinosinusitis with nasal polyp based on eosinophil and neutrophil. Laryngoscope. 2013; 123(11):E1–E9. PMID: 23670893.

14. Nakayama T, Sugimoto N, Okada N, Tsurumoto T, Mitsuyoshi R, Takaishi S, et al. JESREC score and mucosal eosinophilia can predict endotypes of chronic rhinosinusitis with nasal polyps. Auris Nasus Larynx. 2019; 46(3):374–383. PMID: 30243753.

15. Cho JH, Jeong YS, Lee YJ, Hong SC, Yoon JH, Kim JK. The Korean version of the Sniffin' stick (KVSS) test and its validity in comparison with the cross-cultural smell identification test (CC-SIT). Auris Nasus Larynx. 2009; 36(3):280–286. PMID: 18775610.

16. Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg. 1997; 117(3 Pt 2):S35–S40. PMID: 9334786.

17. Grgić MV, Ćupić H, Kalogjera L, Baudoin T. Surgical treatment for nasal polyposis: predictors of outcome. Eur Arch Otorhinolaryngol. 2015; 272(12):3735–3743. PMID: 25634061.

18. Kim DW, Kim JY, Jeon SY. The status of the olfactory cleft may predict postoperative olfactory function in chronic rhinosinusitis with nasal polyposis. Am J Rhinol Allergy. 2011; 25(2):e90–e94. PMID: 21679509.

19. Franzén G, Klausen OG. Post-operative evaluation of functional endoscopic sinus surgery with computed tomography. Clin Otolaryngol Allied Sci. 1994; 19(4):332–339. PMID: 7994891.

20. Szucs E, Ravandi S, Goossens A, Beel M, Clement PA. Eosinophilia in the ethmoid mucosa and its relationship to the severity of inflammation in chronic rhinosinusitis. Am J Rhinol. 2002; 16(3):131–134. PMID: 12141768.

21. Kountakis SE, Arango P, Bradley D, Wade ZK, Borish L. Molecular and cellular staging for the severity of chronic rhinosinusitis. Laryngoscope. 2004; 114(11):1895–1905. PMID: 15510011.

22. Kim DK, Jo A, Lim HS, Kim JY, Eun KM, Oh J, et al. Enhanced type 2 immune reactions by increased IL-22/IL-22Ra1 signaling in chronic rhinosinusitis with nasal polyps. Allergy Asthma Immunol Res. 2020; 12(6):980–993. PMID: 32935490.

23. Van Crombruggen K, Zhang N, Gevaert P, Tomassen P, Bachert C. Pathogenesis of chronic rhinosinusitis: inflammation. J Allergy Clin Immunol. 2011; 128(4):728–732. PMID: 21868076.

24. Lee SH, Kim HJ, Lee JW, Yoon YH, Kim YM, Rha KS. Categorization and clinicopathological features of chronic rhinosinusitis with eosinophilic mucin in a Korean population. Clin Exp Otorhinolaryngol. 2015; 8(1):39–45. PMID: 25729494.

25. Aslan F, Altun E, Paksoy S, Turan G. Could Eosinophilia predict clinical severity in nasal polyps? Multidiscip Respir Med. 2017; 12:21. PMID: 28835819.