Asthma, rhinitis, other respiratory diseasesFeatures of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: Is the histopathology similar to asthma?☆
Section snippets
Materials and methods
The Institutional Review Board of Mayo Clinic Rochester approved the study. The diagnostic guidelines established by the American Academy of Otorhinolaryngology—Head and Neck Surgery were met in each patient for the diagnosis of CRS.2 In addition, a coronal computed tomography scan was obtained in all patients demonstrating inflammatory mucosal thickening of >5 mm in >2 sinuses, consistent with CRS. Histologic specimens were processed from 22 randomly selected patients with CRS undergoing
Epithelial damage and basement membrane thickening
The demographics of the patients are shown in Table II. All patients with CRS demonstrated epithelial damage (Fig 2). In fact, 91% (20/22) of patients with CRS had substantial areas of the sinonasal epithelium completely eroded away (stage 3) down to the level of the basement membrane, whereas 9% (2/22) had only the upper layers eroded away (stage 2).
Basement membrane thickening was pathologic in all (22/22) of the patients with CRS. In 95% (21/22) of the patients with CRS, substantial areas of
Discussion
The predominantly eosinophilic inflammation present in CRS is recognized as playing an important role in the pathogenesis of CRS.1, 11 Because less than half of the patients with CRS in this study and in prior studies have elevated specific IgE or positive skin tests, this eosinophilic inflammation is not likely driven by an IgE mechanism. Furthermore, the eosinophilic inflammation is clearly heterogeneous in any given specimen; therefore, careful evaluation of numerous sites of the same
Acknowledgements
We thank Ms Debra Ward for secretarial assistance and Ms Cheryl Adolphson for editorial assistance.
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Supported by grants from the National Institutes of Health (AI 49235, AI 50494-P3) and from the Mayo Foundation.