title: Chronic rhinosinusitis: risk factors for the recurrence of chronic rhinosinusitis based on 5-year follow-up after endoscopic sinus surgery.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases in the US, and little is understood about its pathogenesis. This study was conducted to characterize, retrospectively, the clinical, objective and immunological parameters that accompany recurrence of CRS during long-term follow-up after surgery.
  
  
  METHODS
  Fifty-six patients with CRS who had undergone endoscopic sinus surgery were followed up for 5 years after the surgery. The CRS parameters chosen were as follows: history of asthma and/or allergic rhinitis, peripheral eosinophilia of at least 520 cells/microl, peripheral eosinophil count, total IgE, presence of polyps, CT score, presence of fungi (positive fungal culture or stain), mucus or mucosal eosinophilia, mucosal eosinophil count, presence of acute infection after surgery, gender and age. Individual correlations and stepwise regression were performed.
  
  
  RESULTS
  Patients with a total peripheral eosinophil count of 520/microl or more and those with asthma were likely to experience recurrence of CRS within 5 years after surgery. Furthermore, patients with mucus or mucosal eosinophilia who were diagnosed as having eosinophilic CRS (ECRS) showed a high incidence of recurrence within 5 years. The parameter of mucus or mucosal eosinophilia (diagnosis of ECRS) had a positive predictive value of 85.7%.
  
  
  CONCLUSIONS
  Surgeons should always examine the inflammatory infiltrate of nasal polyps or the paranasal mucosa, and patients with ECRS require anti-inflammatory medications, such as steroids, for a long time after surgery. Long-term follow-up is also essential.
authors.affiliation: Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo, Japan. matuwaki@jikei.ac.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Matsuwaki
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Ookushi
authors.forename: Daiya
authors.initials: D
authors.lastname: Asaka
authors.forename: Eri
authors.initials: E
authors.lastname: Mori
authors.forename: Tsuneya
authors.initials: T
authors.lastname: Nakajima
authors.forename: Takuto
authors.initials: T
authors.lastname: Yoshida
authors.forename: Junya
authors.initials: J
authors.lastname: Kojima
authors.forename: Shintaro
authors.initials: S
authors.lastname: Chiba
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Ootori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriyama
mesh_terms: D002908:Chronic Disease; D004724:Endoscopy; D004804:Eosinophils / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012220:Rhinitis / Q000097:blood / Q000276:immunology*; D012307:Risk Factors; D012852:Sinusitis / Q000097:blood / Q000276:immunology* / Q000601:surgery
chemical_list: D007073:Immunoglobulin E