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Simpson T, Talati V, Baird AM, Gattuso P, Allen-Proctor MK, Papagiannopoulos P, Batra PS, Filip P, Tajudeen BA. Histopathology of Allergic Fungal Rhinosinusitis Versus Chronic Rhinosinusitis with Nasal Polyps. Laryngoscope 2024; 134:2617-2621. [PMID: 38073117 DOI: 10.1002/lary.31225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Structured histopathology (SHP) is a method of analyzing sinonasal tissue to characterize endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP). Allergic fungal rhinosinusitis (AFRS) shares several features with certain endotypes of CRSwNP. Our objective was to compare the histopathology of AFRS and eosinophilic CRSwNP to further understand whether they are separate endotypes or disease entities altogether. METHODS A retrospective review of AFRS and CRSwNP patients undergoing endoscopic sinus surgery was performed. Data were collected on demographics, comorbidities, subjective and objective severity scores, and 13-variable SHP reports. CRSwNP patients with >10 eosinophils per high-power field (eCRSwNP) were included. Chi-squared and t-tests were used for statistical analysis. RESULTS A total of 29 AFRS and 108 eCRSwNP patients were identified. AFRS patients were younger and more often Black. Symptom severity scores (SNOT-22, Lund-MacKay, and Lund-Kennedy) were uniform between groups. AFRS patients had a higher rate of Charcot-Leyden crystals (41.4% vs. 10.2%; p < 0.001). Severe degree of inflammation, eosinophilic inflammatory predominance, eosinophil aggregates, subepithelial edema, and basement membrane thickening were common in both groups, and their rates were not statistically significantly different between groups. Metaplasia, ulceration, fibrosis, and hyperplastic/papillary change rates were low (<30%) and similar between groups. CONCLUSION The SHP of eCRSwNP and AFRS are highly consistent, which suggests AFRS is a severe subtype of CRSwNP overall rather than a separate disease entity. This also lends credence to AFRS belonging on the endotypic spectrum of CRSwNP. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2617-2621, 2024.
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Affiliation(s)
- Tamara Simpson
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Vidit Talati
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mary K Allen-Proctor
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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Harmon R, Schneider AL, Bai J, Racette SD, Reddy AT, Huang JH, Lehmann DS, Price CPE, Rodeghiero S, Agarwal A, Eide JG, Dong S, Conley DB, Welch KC, Kern RC, Shintani-Smith S, Peters AT, Kato A, Stevens WW, Muhammad LN, Schleimer RP, Tan BK. IL-13 and IL-13-induced periostin levels are specifically decreased in patients following endoscopic sinus surgery for chronic rhinosinusitis. J Allergy Clin Immunol 2024; 153:1292-1305. [PMID: 38157944 PMCID: PMC11070299 DOI: 10.1016/j.jaci.2023.11.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/18/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Type 2 (T2) inflammation plays a pathogenic role in chronic rhinosinusitis (CRS). The effects of endoscopic sinus surgery (ESS) on T2 inflammation are unknown. OBJECTIVE The aim of this study was to compare T2 inflammatory biomarkers from middle meatal (MM) mucus for distinguishing patients with CRS from CRS-free patients, identifying major phenotypes (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]), assessing endotypic change, and establishing cross-sectional and longitudinal outcomes in patients undergoing ESS. METHODS MM mucus samples were collected from patients with CRSsNP and patients with CRSwNP before and 6 to 12 months after ESS and compared with samples from CRS-free control patients. T2 biomarkers were evaluated both continuously and using threshold-based definitions of T2 endotype to identify relationships with patient-reported (based on the 22-Item Sinonasal Outcomes Test and Chronic Rhinosinusitis Patient-Reported Outcomes Measure) and clinician-reported (radiographic and endoscopic) severity. Linear mixed models were developed to analyze clinical variables associated with T2 biomarker levels. RESULTS A total of 154 patients with CRS (89 with CRSsNP and 65 with CRSwNP) were enrolled, with a mean interval of 9 months between ESS and follow-up. An analysis of pre-ESS MM mucus samples revealed elevated levels of T2 mediators in patients with CRSwNP versus in patients with CRSsNP and CRS-free controls. Temporally stable correlations between levels of IL-13 and IL-5, levels of periostin and complement 5a, and levels of eosinophil cationic protein (ECP) and eotaxin-3 were observed. On this basis and on the basis of pathologic significance, levels of IL-13, periostin and ECP were further analyzed. After ESS, levels of IL-13 and periostin decreased significantly, whereas ECP levels remained unchanged. Across pre- and post-ESS evaluation, the T2 endotype was associated with radiographic severity but did not predict outcomes. CRSwNP status and African American race were associated with higher levels of IL-13 and periostin, whereas ECP level was higher in patients undergoing extensive surgery. CONCLUSION ESS decreased levels of IL-13 and periostin in the middle meatus. T2 inflammation after ESS was correlated with patient- and clinician-reported severity across phenotypes. Pre-ESS T2 inflammation did not predict post-ESS outcomes.
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Affiliation(s)
- Regan Harmon
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alexander L Schneider
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Junqin Bai
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Samuel D Racette
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Abhita T Reddy
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Julia H Huang
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David S Lehmann
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Caroline P E Price
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Samuel Rodeghiero
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Aditi Agarwal
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jacob G Eide
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Siyuan Dong
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kevin C Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Anju T Peters
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Atsushi Kato
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lutfiyya N Muhammad
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Gill AS, Tullis B, Mace JC, Massey C, Pandrangi VC, Gutierrez JA, Ramakrishnan VR, Beswick DM, Soler ZM, Smith TL, Alt JA. Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease? Int Forum Allergy Rhinol 2024. [PMID: 38367249 DOI: 10.1002/alr.23337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes. METHODS A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φc ) with 95% confidence interval (CI) were calculated. RESULTS A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φc = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found. CONCLUSIONS Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.
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Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benton Tullis
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Conner Massey
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Vivek C Pandrangi
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Indiana, Indianapolis, Indiana, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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4
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Hentati F, Kim J, Hoying D, D'Anza B, Rodriguez K. Race and Area of Deprivation Index Predict Outcomes of Endoscopic Sinus Surgery for Chronic Sinusitis. Am J Rhinol Allergy 2024; 38:6-13. [PMID: 37796754 DOI: 10.1177/19458924231204129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The purpose of this study is to characterize the presentation, outcomes, and barriers to care for White and non-White patients undergoing endoscopic sinus surgery (ESS). BACKGROUND ESS is often successful in providing long-term relief for patients suffering from chronic rhinosinusitis (CRS). Literature that uses robust measures of socioeconomic status (SES) and barriers to care to assess ESS outcomes is limited. METHODS A retrospective matched cohort study of patients who underwent ESS for CRS between 1/1/2015 and 6/1/2021 at a single tertiary care academic center was conducted. White and non-White patients were matched 1-to-1 by sex and age (± 5 years). SES was evaluated using the area of deprivation index (ADI). RESULTS Of the 298 patients included in the study, 149 are White and 149 are non-White, 111 (37.2%) have CRS with nasal polyposis (CRSwNP), 141 (47.3%) had allergic rhinitis, 90 (30.2%) had asthma and 22 (7.4%) required revision ESS. Non-White patients were 3.62 times more likely to present with CRSwNP (95% confidence interval [CI] 2.2-5.96) and had 2.87 times increased odds for requiring revision ESS than age and sex-matched White patients (95% CI 1.090-7.545). The median ADI for non-White (6.00) patients was higher than for White patients (3.00) (P < .001) and 21.5% more non-White patients presented with Medicaid (P < .001). CONCLUSION Non-White patients undergoing ESS for CRS are more likely to present from areas with fewer resources and be underinsured. Using robust measures of SES, such as ADI, may allow for care to be tailored to patients with barriers to care.
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Affiliation(s)
- Firas Hentati
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jaehee Kim
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian D'Anza
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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5
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Hentati F, Kim J, Hoying D, D'Anza B, Rodriguez K. Revision Rates and Symptom Trends Following Endoscopic Sinus Surgery: Impact of Race on Outcomes. Laryngoscope 2023; 133:2878-2884. [PMID: 36971208 DOI: 10.1002/lary.30647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the impact of demographics and sinonasal comorbidities on the revision rate of functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). BACKGROUND Although endoscopic sinus surgery (ESS) is often successful in providing long-term relief for patients suffering from CRS, revision surgery can occur. There is conflicting literature on the impact of race on FESS outcomes. METHODS A single-center retrospective cohort study of patients that underwent FESS for CRS between January 1, 2015 and June 1, 2021 at a single tertiary care academic center. RESULTS A total of 682 patients between the ages of 18 and 89 underwent primary ESS between January 1, 2015 and June 1, 2021 and were included in this study. Of these patients, 388 (56.9%) were female, with an average age of 48.6 ± 16.7. Thirty-eight patients (5.6%) underwent revision sinus surgery during the study period. Patients that identified as White had significantly lower rates of revision sinus surgery (4.1%) than non-White patients (10.7%), including those identifying as Asian, Black, multiracial, or other. On multivariate analysis, non-White race (OR 4.933), polyposis (3.175), and high preoperative SNOT-22 scores (OR 1.029) were independently associated with revision sinus surgery. The mean preoperative SNOT-22 for all participants was 39.1 ± 22.0, whereas the mean postoperative SNOT-22 was 20.6 ± 17.5 (p < 0.001). CONCLUSION Race plays an important role in outcomes following revision sinus surgery that is independent of location and insurance status. More studies are required to assess the reason race plays an important role in outcomes following revision sinus surgery. LEVEL OF EVIDENCE Level 3 Laryngoscope, 133:2878-2884, 2023.
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Affiliation(s)
- Firas Hentati
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Jaehee Kim
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Brian D'Anza
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Kenneth Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
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Kelly G, Idubor OI, Binney S, Schramm PJ, Mirabelli MC, Hsu J. The Impact of Climate Change on Asthma and Allergic-Immunologic Disease. Curr Allergy Asthma Rep 2023; 23:453-461. [PMID: 37284923 PMCID: PMC10613957 DOI: 10.1007/s11882-023-01093-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources. RECENT FINDINGS Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.
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Affiliation(s)
- Grace Kelly
- Epidemiology Elective Program, National Center for STLT Public Health Infrastructure and Workforce, and Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Osatohamwen I Idubor
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Sophie Binney
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Paul J Schramm
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Maria C Mirabelli
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Joy Hsu
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA.
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Peterson R, Keswani A. The Impact of Social Determinants and Air Pollution on Healthcare Disparities in Chronic Rhinosinusitis With Nasal Polyps. Am J Rhinol Allergy 2023; 37:147-152. [PMID: 36848276 DOI: 10.1177/19458924231153483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND/OBJECTIVE Multiple factors affect healthcare disparities in chronic rhinosinusitis (CRS) with and without nasal polyps. These factors include access to care, economic burdens to treatment, and differences in air pollution and air quality. In this paper, we will discuss how socioeconomic status, race, and air pollution burden influence healthcare disparities in the diagnosis and treatment outcomes of chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS A literature search was performed via PubMed for articles related to CRSwNP, healthcare disparities, race, socioeconomic status, and air pollution in September 2022. Original studies from 2016 to 2022, landmark articles, and systematic reviews were included. We summarized these articles to cohesively discuss factors contributing to healthcare disparities in CRSwNP. RESULTS Literary search produced 35 articles. Individual factors such as socioeconomic status, race, and air pollution influence CRSwNP severity and treatment outcomes. Correlations were noted with socioeconomic status, race, and air pollution exposure and CRS severity and post-surgical outcomes. Air pollution exposure was also associated with histopathologic changes in CRSwNP. Lack of access to care was a notable contributor to healthcare disparities in CRS. CONCLUSION Healthcare disparities in the diagnosis and treatment of CRSwNP differentially affect racial minorities and individuals of lower socioeconomic status. Increased air pollution exposure in areas of lower socioeconomic status is a compounding factor. Clinician advocacy for greater healthcare access and reductions in environmental exposures for patients, among other societal changes, may help improve disparities.
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Affiliation(s)
- Rachel Peterson
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, District of Columbia
| | - Anjeni Keswani
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Talati VM, Brown HJ, Kim YJ, Allen-Proctor MK, Gattuso P, Mahdavinia M, Papagiannopoulos P, Batra P, Tajudeen BA. Histopathologic Features of Chronic Rhinosinusitis in Diabetic Patients. Otolaryngol Head Neck Surg 2023. [PMID: 36939423 DOI: 10.1002/ohn.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore how diabetes mellitus impacts chronic rhinosinusitis clinically and on structured histopathology to provide insights on new potential chronic rhinosinusitis endotypes. STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic center. METHODS A retrospective study of chronic rhinosinusitis patients who underwent functional endoscopic sinus surgery from 2015 to 2020 was performed. Structured 13-variable histopathology reports were generated from intraoperative sinonasal specimens. These variables were compared against demographic factors, comorbidities, culture data, and preoperative Lund-Mackay and SNOT-22 scores using logistic regression. RESULTS There were 411 patients, including 52 diabetics. Diabetes was associated with higher mean body mass index (34.9 vs 29.2; p < .001), age (57.8 vs 48.0; p < .001), and Gram-negative (40.2% vs 22.7%; p < .030) and coagulase-negative Staphylococcus (49.0% vs 28.5%; p = .008) culture rates. Black (23.1% vs 18.7%) and Hispanic (23.1% vs 8.6%) races were more common with diabetes (p = .026). Gender, smoking, polyp status, and Lund-Mackay and SNOT-22 scores did not differ between groups. Diabetics had more fungal elements (13.5% vs 3.3%, p = .018); no other histopathological differences were seen. When controlling for demographic variables and comorbidities, diabetes independently predicted the presence of fungal elements (HR 4.38, p = .018). CONCLUSION Diabetic chronic rhinosinusitis patients demonstrated increased fungal elements on structured histopathology. Other histopathological features were unaffected by diabetes. These findings may have important implications on the medical and surgical management of diabetic chronic rhinosinusitis patients in which early fungal disease assessment is paramount.
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Affiliation(s)
- Vidit M Talati
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hannah J Brown
- Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Young-Jae Kim
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Mahboobeh Mahdavinia
- Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA.,Section of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Pete Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA
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9
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Randhawa A, Randhawa KS, Tseng CC, Fang CH, Baredes S, Eloy JA. Racial Disparities in Charges, Length of Stay, and Complications Following Adult Inpatient Epistaxis Treatment. Am J Rhinol Allergy 2022; 37:51-57. [PMID: 36221850 DOI: 10.1177/19458924221130880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although recent studies have identified an association between race and adverse outcomes in head and neck surgeries, there are limited data examining the impact of racial disparities on adult inpatient outcomes following epistaxis management procedures. OBJECTIVE To analyze the association between race and adverse outcomes in hospitalized patients undergoing epistaxis treatment. METHODS This retrospective cohort analysis utilized the 2003 to 2014 National Inpatient Sample. International Classification of Diseases, Ninth Revision codes were used to identify cases with a primary diagnosis of epistaxis that underwent a procedure for epistaxis control. Cases with missing data were excluded. Higher total charges and prolonged length of stay (LOS) were indicated by values greater than the 75th percentile. Demographics, hospital characteristics, Elixhauser comorbidity score, and complications were compared among race cohorts using univariate chi-square analysis and one-way analysis of variance (ANOVA). The independent effect of race on adverse outcomes was analyzed using multivariate binary logistic regression while adjusting for the aforementioned variables. RESULTS Of the 83 356 cases of epistaxis included, 80.3% were White, 12.5% Black, and 7.2% Hispanic. Black patients had increased odds of urinary/renal complications (odds ratio [OR] 2.148, 95% confidence interval [CI] 1.797-2.569, P < .001) compared to White patients. Additionally, Black patients experienced higher odds of prolonged LOS (OR 1.227, 95% CI 1.101-1.367, P < .001) and higher total charges (OR 1.257, 95% CI 1.109-1.426, P < .001) compared to White patients. Similarly, Hispanic patients were more likely to experience urinary/renal complications (OR 1.605, 95% CI 1.244-2.071, P < .001), higher total charges (OR 1.519, 95% CI 1.302-1.772, P < .001), and prolonged LOS (OR 1.157, 95% CI 1.007-1.331, P = .040) compared to White patients. CONCLUSION Race is an important factor associated with an increased incidence of complications in hospitalized patients treated for epistaxis.
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Affiliation(s)
- Avneet Randhawa
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey
| | - Karandeep S Randhawa
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey
| | - Christopher C Tseng
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey
| | - Christina H Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, 2013Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Neurological Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Ophthalmology and Visual Science, 12286Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey
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10
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Konsur E, Rigg L, Moore D, Patel M, Batra PS, Mahdavinia M. Race and ethnicity define disparate clinical outcomes in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2022; 129:737-741. [PMID: 35623587 DOI: 10.1016/j.anai.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common upper airways inflammatory disease requiring multidisciplinary care. OBJECTIVE To evaluate if African Americans (AA), Latinxs, and nonLatinx White (White) patients have different chronic rhinosinusitis outcomes and to identify associated factors impacting these outcomes. METHODS We conducted a large prospective cohort study of CRS patients who were evaluated and followed for several clinical variables at the initial encounter and after continuous management of CRS for a mean of 40 months. The Sinonasal Outcome Test (SNOT-22) and Lund-MacKay scores were measured on initial visits, and SNOT-22 was repeated at the end of follow-up. Logistic regression was used to compare outcomes between the different groups adjusted for comorbidities and demographics. RESULTS Among the 977 enrolled CRS cases, 615 (63.0%), 235 (24.1%) and 138 (13.0%) were White, AA and Latinx respectively. There was no difference in severity of CRS based on Lund-MacKay scores and SNOT-22 scores, and frequency of other comorbidities at presentation among the 3 groups. During the follow-up period, compared with Whites, AA and Latinx were less frequently evaluated by an allergist. AAs had less frequent CRS related visits and lower final SNOT-22 score compared with Whites. CONCLUSION Although our enrolled patients from the 3 ethnic groups had similar clinical characteristics and disease burden at baseline, AAs had less frequent follow-up visits and worse final SNOT-22 after 40 months of follow-up. The observed poorer outcomes in AAs are likely owing to inequity in healthcare access evidenced by differences in insurance and suboptimal management of CRS.
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Affiliation(s)
- Evelyn Konsur
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
| | - Lauren Rigg
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Donyea Moore
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Malina Patel
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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11
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Abstract
It is established that non-white people experience worse health outcomes than white people within the same population. Equity addresses differences between patient subgroups, allowing needs-based distribution of resources. The use of quality-of-life (QoL) tools to assist clinical decision making such as the SNOT-22 for chronic rhinosinusitis promotes equality, not equity, as quality-of-life (QoL) tools provide the same criteria of symptom scoring across diverse populations. We considered the effects of ethnicity and race on SNOT-22 scores and whether these scores should be adjusted to improve equity. PubMed and MEDLINE provided papers for a scoping review. A combination of the following search terms was used: patient-reported outcome measures (PROM) (OR) quality of life; (AND) race (OR) ethnicity (OR) disparities; (AND) otolaryngology (OR) SNOT-22 (OR) sinusitis. The first study identified no evidence of ethnic variability in SNOT-22 scores. However, the study did not represent the local population, including 86% white people. Other studies identified baseline SNOT-22 disparities with respect to population demographics, gender, and age. Ethnic differences appear to exist in acute sinusitis symptomatology. In other fields both within and outside of otorhinolaryngology, ethnic differences exist with regard to QoL tools. This scoping review identified a paucity of data in rhinology. However, evidence implies some form of correction to QoL scores could help promote equity for non-white patients.
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12
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Spielman DB, Schlosser RJ, Liebowitz A, Sharma R, Overdevest J, Mattos J, Gudis DA. Do Federal Regulations Affect Gender, Racial, and Ethnic Disparities in Chronic Rhinosinusitis Research? Otolaryngol Head Neck Surg 2021; 166:1211-1218. [PMID: 34126802 DOI: 10.1177/01945998211021011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Food and Drug Administration and the National Institutes of Health (NIH) have asserted that diverse demographic representation in clinical trials is essential. In light of these federal guidelines, the objective of this study is to assess the racial, ethnic, and gender demographics of patients enrolled in clinical trials registered with the NIH that evaluate chronic rhinosinusitis with nasal polyposis (CRSwNP) relative to the demographics of the US population. STUDY DESIGN Cross-sectional study. SETTING Not applicable. METHODS ClinicalTrials.gov was queried to identify all prospective clinical trials for CRSwNP. Individual study and pooled data were compared with national US census data. RESULTS Eighteen studies were included comprising 4125 patients and evaluating dupilumab, mepolizumab, omalizumab, fluticasone/OptiNose, MediHoney, mometasone, and SINUVA. Women constituted 42.7% of clinical trial participants. Of the 4125 participants, 69.6% identified as White, 6.6% as Black, 20.8% as Asian, 0.1% as Pacific Islander, 0.4% as American Indian, 8.0% as Hispanic, and 2.4% as other. The racial, ethnic, and gender composition of the pooled study population differs significantly from national US census data, with underrepresentation of Black, Hispanic, Pacific Island, and American Indian individuals, as well as females (P < .05). CONCLUSION The racial, ethnic, and gender demographics of patients enrolled in CRSwNP clinical trials registered with the NIH differ significantly from the demographics of the US population, despite federal guidelines advising demographically representative participation. Proactive efforts to enroll participants that better represent anticipated treatment populations should be emphasized by researchers, institutions, and editorial boards.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andi Liebowitz
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rahul Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jose Mattos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
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13
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Patel TR, Tajudeen BA, Brown H, Gattuso P, LoSavio P, Papagiannopoulos P, Batra PS, Mahdavinia M. Association of Air Pollutant Exposure and Sinonasal Histopathology Findings in Chronic Rhinosinusitis. Am J Rhinol Allergy 2021; 35:761-767. [PMID: 33567858 DOI: 10.1177/1945892421993655] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ambient air pollution is well known to cause inflammatory change in respiratory epithelium and is associated with exacerbations of inflammatory conditions such as asthma and chronic obstructive pulmonary disease. However, limited work has been done on the impact of air pollution on pathogenesis of chronic rhinosinusitis and there are no reports in the literature of how pollutant exposure may impact sinonasal histopathology in patients with chronic rhinosinusitis. OBJECTIVE This study aims to identify associations between certain histopathologic characteristics seen in sinus tissue of patients with chronic rhinosinusitis (CRS) and levels of particulate air pollution (PM2.5) and ground-level ozone in their place of residence. METHODS A structured histopathology report was created to characterize the tissues of CRS patients undergoing sinus surgery. An estimate for each patient's exposure to air pollutants including small particulate matter (PM2.5) and ground-level ozone was obtained using the Environmental Protection Agency's (EPA) Environmental Justice Screening and Mapping Tool (EJSCREEN). Mean pollutant exposures for patients whose tissues exhibited varying histopathologic features were compared using logistic regression models. RESULTS Data from 291 CRS patients were analyzed. Higher degree of inflammation was significantly associated with increased ozone exposure (p = 0.031). Amongst the patients with CRSwNP (n=131), presence of eosinophilic aggregates (p = 0.018) and Charcot-Leyden crystals (p = 0.036) was associated with increased ozone exposure. CONCLUSION Exposure to ambient air pollutants may contribute to pathogenesis of CRS. Increasing ozone exposure was linked to both higher tissue inflammation and presence of eosinophilic aggregates and Charcot-Leyden crystals in CRSwNP patients.
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Affiliation(s)
- Tirth R Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois
| | | | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Phillip LoSavio
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois
| | - Peter Papagiannopoulos
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois
| | - Pete S Batra
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois.,Division of Allergy and Immunology, Rush University Medical Center, Chicago, Illinois
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14
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Spielman DB, Liebowitz A, Kelebeyev S, Smith TL, McKinney K, Woodard T, Safi C, Overdevest JB, Gudis DA. Race in Rhinology Clinical Trials: A Decade of Disparity. Laryngoscope 2021; 131:1722-1728. [PMID: 33493376 DOI: 10.1002/lary.29371] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE/HYPOTHESIS The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the corresponding geographic demographics of the United States (U.S.) census data. STUDY DESIGN Systematic Review and Population analysis. METHODS A systematic review was performed to identify CRS clinical trials, conducted in the U.S. and published between 2010 and 2020 in which patients were prospectively enrolled. Pooled racial and ethnicity data were compared to national and corresponding regional census data. RESULTS Eighty-three studies were included, comprising 12,027 patients. 50.4% were male and the average age was 49.2 years. 8,810 patients underwent a surgical procedure. Of the 12,027 patients, 81.67% were identified as White, 5.35% as Black, 1.27% as Asian, 0.02% as Pacific Islander, 0.12% as American Indian, and 11.57% were classified as Other. The racial and ethnic composition of the pooled study population differs significantly from the national U.S. census data with the underrepresentation of each minority population (P ≤ .0002). Regional sub-analyses yield variable results. In the Northeast and West, there was an underrepresentation of all minority populations. In the South and Midwest, Black enrollment was similar to the U.S. census data, while all other minorities were underrepresented. CONCLUSIONS The racial and ethnic composition of patients enrolled in prospective CRS clinical trials differs significantly from the demographics of the U.S. POPULATION The generalizability and external validity of findings derived from studies comprised of demographically mismatched populations has not been established. Future efforts to enroll more representative populations should be emphasized by the research community, funding bodies, and editorial boards. LEVEL OF EVIDENCE NA Laryngoscope, 131:1722-1728, 2021.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Andi Liebowitz
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Saveliy Kelebeyev
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Kibwei McKinney
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A
| | - Troy Woodard
- Department of Otolaryngology Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Chetan Safi
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - David A Gudis
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
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15
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Ganti A, Brown HJ, Gattuso P, Ghai R, Papagiannopoulos P, Batra PS, Tajudeen BA. Inter-pathologist Agreement on Structured Histopathology Reporting in Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2021; 130:899-903. [PMID: 33412911 DOI: 10.1177/0003489420987970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Structured histopathology reporting is increasingly being utilized in rhinology to characterize endotypes in chronic rhinosinusitis and guide management decisions after sinus surgery. OBJECTIVE The goal of this investigation is to evaluate inter-observer agreement in structured histopathology reporting. METHODS Two experienced head and neck pathologists independently compiled structured histopathology reports for tissue samples collected during functional endoscopic sinus surgery. Cohen's standard kappa (κ) coefficients were calculated for each histopathologic variable to assess inter-pathologist agreement. RESULTS A total of 92 cases were analyzed. Substantial inter-pathologist agreement was reached on tissue eosinophil count (κ = 0.64, P < .001), the presence of eosinophil aggregates (κ = 0.62, P < .001), and the presence of fungal elements (κ = 0.74, P < .001). There was moderate agreement on the degree of inflammation (κ = 0.56, P < .001) and the presence of squamous metaplasia (κ = 0.46, P < .001). There was fair agreement on the presence of neutrophil infiltrates (κ = 0.33, P < .001), the presence of hyperplastic changes (κ = 0.40, P < .001), and the presence of fibrosis (κ = 0.24, P = .022). There was only slight agreement on the degree of subepithelial edema (κ = 0.20, P = .008). The κ coefficients for basement membrane thickening and mucosal ulceration were not statistically significant. CONCLUSION High inter-pathologist agreement was demonstrated for several salient histopathologic variables, including tissue eosinophil count and the presence of eosinophil aggregates. However, refining the definitions of certain histopathologic variables may improve the reproducibility of structured histopathology reporting.
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Affiliation(s)
- Ashwin Ganti
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Peter Papagiannopoulos
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pete S Batra
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
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16
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Ganti A, Brown HJ, Kuhar HN, Gattuso P, Ghai R, Mahdavinia M, Batra PS, Tajudeen BA. Histopathologic Influences of Tissue Eosinophilia Among Chronic Rhinosinusitis Patients. Am J Rhinol Allergy 2019; 34:331-335. [DOI: 10.1177/1945892419896239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background A subset of chronic rhinosinusitis (CRS) patients demonstrates tissue eosinophilia on structured histopathology. Prior studies have suggested that these patients are at increased risk for recurrent disease. The goals of this study are to identify histopathologic features of CRS patients with tissue eosinophilia and compare the influence of tissue eosinophilia to the effects of age and revision surgery on histopathology. Methods A structured histopathology report was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery. Binomial logistic regression analysis was conducted to evaluate the association of age at diagnosis, tissue eosinophil count, and history of revision surgery with histopathology variables. Results A total of 281 CRS patients were included, of which 106 had tissue eosinophilia. Regression analysis demonstrated that tissue eosinophilia was associated with degree of inflammation (odds ratio [OR] 5.744; P < .001), neutrophilic infiltrate (OR 1.882; P = .020), basement membrane thickening (OR 3.561; P < .001), squamous metaplasia (OR 3.315; P < .001), fibrosis (OR 2.246; P = .002), presence of Charcot–Leyden crystals (OR 20.700; P = .004), and eosinophilic aggregates (OR 34.172; P < .001). Age and history of revision surgery were not significant predictors of histopathology variables on multivariate analysis. Conclusion Tissue eosinophilia appears to be the predominant driving factor of histopathologic changes irrespective of previous sinus surgery or age at diagnosis. These findings may have important implications for postsurgical management and prognosis for patients with tissue eosinophilia presenting for revision surgery.
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Affiliation(s)
- Ashwin Ganti
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Hannah J. Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Hannah N. Kuhar
- Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Department of Immunology and Microbiology, Section of Allergy and Immunology, Rush University Medical Center, Chicago, Illinois
| | - Pete S. Batra
- Rush Sinus Program, Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bobby A. Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
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