Abstract

Relevance: All phenotypes of chronic rhinosinusitis (CRS) are characterized by concurrent inflammatory and remodelling processes, the activity of which depends on various factors, including atopic status. It is believed that these processes are more pronounced in CRS with nasal polyposis (CRSwNP), while they are significantly less pronounced in CRS without nasal polyposis (CRSsNP). Considering this, we hypothesized that the recovery of the nasal mucosa after functional endoscopic sinus surgery in patients with CRS may depend on the disease phenotype and will be slower, resulting in higher symptom severity in patients.

Objective: To compare the histopathological picture of postoperative material and the postoperative course in patients with different phenotypes of CRS (CRSwNP and CRSsNP).

Materials and Methods: The study included 87 patients in the main group and 12 patients in the control group. Patients in the main group were divided into 2 subgroups, depending on the phenotype of CRS – CRSwNP (n=38) and CRSsNP (cyst of the maxillary sinuses) (n=49). All patients were surveyed using the NOSE questionnaire on the 3^rd, 7^th, and 14^th days after the postoperative period. Additionally, the frequency of ciliary beatings was evaluated in patients included in the study on the 7^th and 14^th days after the postoperative period. Postoperative material was examined by a pathomorphologist.

Results: In the postoperative period on the 7^th day, for the control group after septoplasty and bilateral ethmoidectomy, the ciliary beat frequency (CBF) reached 4.12±0.53 Hz, for subgroup A (CRSwNP) – 3.53±0.57 Hz, and for subgroup B – 3.82±0.41 Hz. On the 14th day, the mean CBF values for the control group were 5.98±0.36 Hz, for subgroup A – 5.08±0.72 Hz, and for subgroup B – 5.7±0.43 Hz. Regarding the NOSE scale, on the 7^th postoperative day, the average scores for the groups were as follows: control – 70.4, subgroup A – 82.6, subgroup B – 70.4. On the 14^th day, the results were better: Control group – 11.6, subgroup A – 18.5, subgroup B – 15.95 points. Additionally, we found a positive correlation between CBF and NOSE scale values.

Conclusions: The rate of nasal mucosa recovery, its structural units, is higher in patients with less pronounced remodelling processes. Thus, the function of the ciliated epithelium, its cilia, after surgical treatment was higher on each of the studied days in the control group and subgroup B (CRSsNP). The presence of a higher severity of nasal congestion symptom in the postoperative period according to the NOSE scale is more characteristic of CRSwNP. Additionally, an association of this scale with the ciliary beat frequency was found – a lower NOSE scale score corresponds to a higher ciliary beat frequency.

Keywords: chronic rhinosinusitis, nasal polyps, tissue remodelling, surgical treatment, postoperative period, nasal cavity mucosa, pathohistological study, ciliated epithelium, ciliary beat frequency, matrix metalloproteinase.