The Histological Changes of Bones and Lining Mucosa in the Middle and Inferior Turbinate in Chronic Rhinosinusitis
Journal of Otorhinolaryngology and Facial Plastic Surgery,
Vol. 9 No. 1 (2023),
2 September 2023
,
Page 1-9
https://doi.org/10.22037/orlfps.v9i1.45853
Abstract
Background: There is an association between osteitis and symptoms in chronic rhinosinusitis (CRS), but the exact clinical significance of osteitis is unclear. Most histological studies on osteitis of paranasal sinuses are limited to the ethmoid bone.
Aim: The current study examined the histologic changes of mucosa and bone in the middle turbinate and sphenoid sinus for comparison.
Methods: The current observational, cross-sectional study was conducted in a tertiary referral university hospital, from September 2017 to September 2021. Consecutive adult patients with chronic rhinosinusitis symptoms who underwent endoscopic sinus surgery were enrolled in the study. Histopathological evaluations for the existence and level of inflammation were performed by a blinded pathologist regarding the history and imaging results. SPSS (version 26) was used to analyze the data and other analyses.
Results: Inflammatory changes of mucosa in the middle and inferior turbinates and sphenoid sinuses were more severe than inflammatory changes of bone in these areas (p values 0.006, 0.003, and 0.046, respectively).
There was no significant difference in the prevalence of bone and mucosal inflammation between the patients with polyps and the ones without polyps. We did not observe a significant difference in the prevalence of osteitis between the primary and revision surgery nor between patients with asthma and without asthma. There was an association between the severity of inflammatory changes of mucosa with bone in the middle and inferior turbinates and sphenoid sinus (p values 0.007, 0.002, and 0.037, respectively).
Conclusion: The present study indicates that chronic rhinosinusitis is not a disease that only involves mucosa. It is thus necessary to expand the boundaries of treatment beyond mere mucosa.
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References
Zhao YC, Wormald PJ. Biofilm and osteitis in refractory chronic rhinosinusitis. Otolaryngologic Clinics of North America. 2017 Feb 1;50(1):49-60.
Snidvongs K, Earls P, Dalgorf D, Sacks R, Pratt E, Harvey RJ. Osteitis is a misnomer: a histopathology study in primary chronic rhinosinusitis. InInternational Forum of Allergy & Rhinology 2014 May (Vol. 4, No. 5, pp. 390-396).
Khalmuratova R, Shin HW. Crosstalk between mucosal inflammation and bone metabolism in chronic rhinosinusitis. Clinical and Experimental Otorhinolaryngology. 2021 Feb 14;14(1):43-9.
Khalid AN, Hunt J, Perloff JR, Kennedy DW. The role of bone in chronic rhinosinusitis. The Laryngoscope. 2002 Nov;112(11):1951-7.
Leung N, Mawby TA, Turner H, Qureishi A. Osteitis and chronic rhinosinusitis: a review of the current literature. European Archives of Oto-Rhino-Laryngology. 2016 Oct; 273:2917-23.
Snidvongs K, McLachlan R, Sacks R, Earls P, Harvey RJ. Correlation of the Kennedy Osteitis Score to clinico‐histologic features of chronic rhinosinusitis. InInternational forum of allergy & rhinology 2013 May (Vol. 3, No. 5, pp. 369-375).
Lee JT, Kennedy DW, Palmer JN, Feldman M, Chiu AG. The incidence of concurrent osteitis in patients with chronic rhinosinusitis: a clinicopathological study. American journal of rhinology. 2006 May;20(3):278-82.
Van Drunen CM, Reinartz S, Wigman J, Fokkens WJ. Inflammation in chronic rhinosinusitis and nasal polyposis. Immunology and Allergy Clinics. 2009 Nov 1;29(4):621-9.
Sonone J, Solanke P, Nagpure PS, Garg D, Puttewar M. Effect of anatomical variations of Osteomeatal Complex on Chronic Rhinosinusitis: a propective study. Indian Journal of Otolaryngology and Head & Neck Surgery. 2019 Nov; 71:2199-202.
Bhandarkar ND, Mace JC, Smith TL. The impact of osteitis on disease severity measures and quality of life outcomes in chronic rhinosinusitis. InInternational forum of allergy & rhinology 2011 Sep (Vol. 1, No. 5, pp. 372-378). Hoboken: Wiley Subscription Services, Inc., A Wiley Company.
Giacchi RJ, Lebowitz RA, Yee HT, Light JP, Jacobs JB. Histopathologic evaluation of the ethmoid bone in chronic sinusitis. American journal of rhinology. 2001 May;15(3):193-8.
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Anselmo-Lima WT. European position paper on rhinosinusitis and nasal polyps 2020.
Senior BA, Kennedy DW, Tanabodee J, Kroger H, Hassab M, Lanza D. Long‐term results of functional endoscopic sinus surgery. The Laryngoscope. 1998 Feb;108(2):151-7.
Biedlingmaier JF, Whelan P, Zoarski G, Rothman M. Histopathology and CT analysis of partially resected middle turbinates. The Laryngoscope. 1996 Jan;106(1):102-4.30.
Perloff JR, Gannon FH, Bolger WE, Montone KT, Orlandi R, Kennedy DW. Bone involvement in sinusitis: an apparent pathway for the spread of disease. The Laryngoscope. 2000 Dec;110(12):2095-9.
Lee JT, Kennedy DW, Palmer JN, Feldman M, Chiu AG. The incidence of concurrent osteitis in patients with chronic rhinosinusitis: a clinicopathological study. American journal of rhinology. 2006 May;20(3):278-82.
Kennedy DW, Senior BA, Gannon FH, Montone KT, Hwang P, Lanza DC. Histology and histomorphometry of ethmoid bone in chronic rhinosinusitis. The Laryngoscope. 1998 Apr;108(4):502-7.
Cho SH, Min HJ, Han HX, Paik SS, Kim KR. CT analysis and histopathology of bone remodeling in patients with chronic rhinosinusitis. Otolaryngology—Head and Neck Surgery. 2006 Sep;135(3):404-8.
Telmesani LM, Al-Shawarby M. Osteitis in chronic rhinosinusitis with nasal polyps: a comparative study between primary and recurrent cases. European archives of oto-rhino-laryngology. 2010 May;267:721-4.
Günel C, Yükselen OO, Başak HS, Eryilmaz A, Başal Y. Chronic rhinosinusitis; histopathologic study of osteitis in surgery cases. B-ent. 2015 Jan 1;11(2):135-9.
Grevers G, Klemens A, Sturm C, Menauer F. Involvement of inferior turbinate mucosa in chronic sinusitis–localization of T‐cell subset. Allergy. 2000 Dec;55(12):1155-62.
Snidvongs K, McLachlan R, Chin D, Pratt E, Sacks R, Earls P, Harvey RJ. Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis. Rhinology. 2012 Sep 1;50(3):299-305.
Hyun DW, Min HJ, Kim MS, Whon TW, Shin NR, Kim PS, Kim HS, Lee JY, Kang W, Choi AM, Yoon JH. Dysbiosis of inferior turbinate microbiota is associated with high total IgE levels in patients with allergic rhinitis. Infection and immunity. 2018 Apr;86(4):10-128.
Giacchi RJ, Lebowitz RA, Yee HT, Light JP, Jacobs JB. Histopathologic evaluation of the ethmoid bone in chronic sinusitis. American journal of rhinology. 2001 May;15(3):193-8.
Chiu AG. Osteitis in chronic rhinosinusitis. Otolaryngologic Clinics of North America. 2005 Dec 1;38(6):1237-42.
Woodworth BA, Parker RO, Schlosser RJ. Modified endoscopic medial maxillectomy for chronic maxillary sinusitis. American journal of rhinology. 2006 May;20(3):317-9.
Wang EW, Gullung JL, Schlosser RJ. Modified endoscopic medial maxillectomy for recalcitrant chronic maxillary sinusitis. InInternational Forum of Allergy & Rhinology 2011 Nov (Vol. 1, No. 6, pp. 493-497). Hoboken: Wiley Subscription Services, Inc., A Wiley Company.
Thulasidas P, Vaidyanathan V. Role of modified endoscopic medial maxillectomy in persistent chronic maxillary sinusitis. International Archives of Otorhinolaryngology. 2014 Apr;18(02):159-64.
Tan NC, Goggin R, Psaltis AJ, Wormald PJ. Partial resection of the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis does not lead to an increased risk of empty nose syndrome: a cohort study of a tertiary practice. InInternational forum of allergy & rhinology 2018 Aug (Vol. 8, No. 8, pp. 959-963).
Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection. Annals of Otology, Rhinology & Laryngology. 2000 Jul;109(7):634-40.
Otto KJ, DelGaudio JM. Operative findings in the frontal recess at time of revision surgery. American journal of otolaryngology. 2010 May 1;31(3):175-80.
Han JK, Ghanem T, Lee B, Gross CW. Various causes for frontal sinus obstruction. American journal of otolaryngology. 2009 Mar 1;30(2):80-2.
Levine CG, Casiano RR. Revision Functional Endoscopic Sinus Surgery. Otolaryngol Clin North Am. 2017 Feb;50(1):143-164. doi: 10.1016/j.otc.2016.08.012. PMID: 27888911.
Bassiouni A, Naidoo Y, Wormald PJ. When FESS fails: the inflammatory load hypothesis in refractory chronic rhinosinusitis. The Laryngoscope. 2012 Feb;122(2):460-6.
Jankowski R, Pigret D, Decroocq F, Blum A, Gillet P. Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis. A retrospective study. Revue de laryngologie-otologie-rhinologie. 2006 Jan 1;127(3):131-40.
Catalano PJ, Setliff III RC, Catalano LA. Minimally invasive sinus surgery in the geriatric patient. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2001 Jun 1;12(2):85-90.
Chiu AG, Kennedy DW. Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis. Current Opinion in Otolaryngology & Head and Neck Surgery. 2004 Feb 1;12(1):38-42.
DeConde AS, Suh JD, Mace JC, Alt JA, Smith TL. Outcomes of complete vs targeted approaches to endoscopic sinus surgery. InInternational forum of allergy & rhinology 2015 Aug (Vol. 5, No. 8, pp. 691-700).
Naeimi M, Azarnoosh E, Gholparvar MS, Naeimi MR. Histopathologic relationship between ethmoid sinus and ipsilateral middle turbinate in non-polypose chronic sinusitis by FESS. Indian Journal of Otolaryngology and Head & Neck Surgery. 2013 Aug; 65:324-8.
Berger G, Finkelstein Y, Ophir D, Landsberg R. Old and new aspects of middle turbinate histopathology. Otolaryngology—Head and Neck Surgery. 2009 Jan;140(1):48-54.
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