August 2, 2023

Personalizing treatment for sinus syndrome

Understanding the inflammatory characteristics of subtypes of chronic rhinosinusitis with polyps should assist with selection of effective therapies, Vanderbilt researchers report.

Chronic rhinosinusitis with nasal polyposis is a complex inflammatory syndrome that causes nasal congestion, pain, excess nasal drainage and loss of smell. Understanding the inflammatory characteristics of recently described subtypes of this heterogeneous syndrome has the potential to guide targeted treatment decisions. 

Justin Turner, MD, PhD, associate professor of Otolaryngology–Head and Neck Surgery, and colleagues have identified and compared the inflammatory characteristics of the subtype CCAD (central compartment atopic disease) to other phenotypes of chronic rhinosinusitis with nasal polyposis. 

The researchers evaluated inflammatory molecules in the mucus of 253 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Patients were clinically categorized as having CCAD, aspirin-exacerbated respiratory disease, allergic fungal rhinosinusitis or non-typed chronic rhinosinusitis with nasal polyposis. 

Patients with CCAD were the least likely to have comorbid asthma, and they had a lower overall inflammatory burden with reduced levels of interleukin-6, interleukin-8, interferon gamma and eotaxin compared to other phenotypes. 

The findings, reported in the International Forum of Allergy & Rhinology, further clarify the pathophysiology of CCAD and should assist with selection of effective therapies. Given the lower overall inflammatory burden and a high rate of surgical success shown in previous studies, patients with CCAD should potentially be directed toward surgery and allergy management over other interventions, the researchers note. 

Co-authors of the study include Kolin Rubel, MD, Rory Lubner, MD, Andrea Lopez, Ping Li, MD, Li-Ching Huang, PhD, Quanhu Sheng, PhD, Jeffanie Wu, MD, Sarah Wise, MD, MSCR, John DelGaudio, MD, Rakesh Chandra, MD, and Naweed Chowdhury, MD, MPH. The research was supported by the National Institutes of Health (grants AI142321, AG065550, TR000445).