title: Clinical implications of mucosal remodeling from chronic rhinosinusitis.
abstract: Prognostic implications of mucosal remodeling in chronic rhinosinusitis (CRS) remain unclear. Remodeling of respiratory mucosa in asthma is associated with greater medication use and decreased function. This study investigates the implications of mucosal remodeling on long-term clinical outcomes in patients with CRS.
  
  
  
  A case-control study of adult patients with CRS undergoing endoscopic sinus surgery (ESS) was performed. Mucosal remodeling was defined by squamous metaplasia, subepithelial fibrosis, and/or basement membrane thickening. The presence of remodeling changes were assessed relative to clinical and treatment outcomes at a minimum of 12 months postoperatively. Clinical outcomes were assessed at baseline and 12 months using a Nasal Symptom Score (NSS) and 22-item Sino-Nasal Outcome Test (SNOT-22). Treatment outcomes were assessed by oral corticosteroid usage (burst/continuous), topical corticosteroid irrigation frequency, and further surgical intervention.
  
  
  
  A total of 110 patients (48.73 ± 14.75 years, 48.2% female) were assessed. Significant improvements where seen for the entire population, in both NSS (2.64 ± 1.06 to 1.34 ± 1.08, p < 0.001) and SNOT-22 (2.05 ± 0.96 to 1.06 ± 0.79, p < 0.001). Patients with remodeling (n = 88) were younger (47.2 ± 14.8 vs 54.7 ± 13.5 years, p = 0.03), but had similar symptom scores. Remodeling was seen in CRS with nasal polyposis (CRSwNP) (54.5%) and eosinophilic chronic rhinosinusitis (eCRS) (59.8%). Symptom improvement at 12 months was similar between remodeled and non-remodeled groups (NSS: Δ1.34 ± 1.20 vs Δ1.12 ± 1.31, p = 0.395; SNOT-22: Δ1.05 ± 0.91 vs Δ0.73 ± 0.95, p = 0.124); however, patients with remodeling had greater corticosteroid irrigation frequency (64.0% vs 31.6% daily use, Kendall's tau-b p = 0.004).
  
  
  
  Established mucosal remodeling predicts a greater reliance on topical therapies to reach similar clinical endpoints as those without remodeling.
authors.affiliation: Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
authors.forename: Timothy Q
authors.initials: TQ
authors.lastname: Do
authors.affiliation: Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Department of Otolaryngology Head and Neck Surgery, Louisiana State University, New Orleans, LA.
authors.forename: Henry P
authors.initials: HP
authors.lastname: Barham
authors.affiliation: Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Earls
authors.affiliation: Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.|Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
authors.affiliation: Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Christensen
authors.affiliation: Department of Thoracic Medicine, St Vincent's Hospital, Sydney, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Rimmer
authors.affiliation: Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.|Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D004724:Endoscopy; D004802:Eosinophilia / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D010256:Paranasal Sinuses / Q000276:immunology / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care; D020545:Respiratory Mucosa / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D012220:Rhinitis / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D012852:Sinusitis / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
keywords: basement membrane; chronic rhinosinusitis; corticosteroid; endoscopic sinus surgery; eosinophilia; fibrosis; remodeling; squamous metaplasia; symptoms; treatment outcome