Correlation of Symptoms, Clinical Signs, and Biomarkers of Inflammation in Postsurgical Chronic Rhinosinusitis

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The study aimed to evaluate symptoms described by patients with chronic rhinosinusitis with polypoid changes/nasal polyps and their correlation with computed tomography (CT), nasal endoscopy, and intranasal biomarkers.

Study Design:

Prospective multicenter study symptom data from postsurgical adult chronic rhinosinusitis study participants with recurrent disease refractory to medical therapy were analyzed in comparison with objective data.


Using logistic regression analysis, participant-rated 16-question surveys from 258 participants were assessed for correlation with nasal endoscopy scores, CT percentage of sinus occlusion, and intranasal biomarkers of fungal antigens (Alternaria and Aspergillus), eosinophilic inflammation (eosinophil-derived neurotoxin [EDN] and major basic protein [MBP]), and inflammatory cytokines (interleukins 5 and 13).


Study participant assessments revealed increased CT occlusion in participants presenting with greater inability to smell (P < .019). Mucosal inflammation identified on nasal endoscopy was positively correlated with congestion (P < .028), runny nose (P < .002), and ear pain (P < .007). Elevated EDN was positively correlated in patients with bothersome congestion (P < .031) and runny nose (P < .011). Sneezing was positively correlated with multiple markers: Alternaria (P < .024), interleukin-13 (P < .027), MBP (P < .034), and interleukin-5 (P < .019).


Nasal endoscopy, not CT imaging, has the strongest correlation with the 2 cardinal symptoms of congestion and runny nose in CRS patients; these correlate with biomarkers of eosinophilic inflammation.

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