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Biomarkers Indicate Potential Need for Chronic Rhinosinusitis Surgery


Outcomes were investigated among 541 patients who had chronic rhinosinusitis; they accounted for 435 primary surgeries and 106 revisionist surgeries.

Optimizing treatment selection and assessing disease severity in individuals who are living with chronic rhinosinusitis (CRS) could be helped along by evaluating certain peripheral blood hematological indices prior to surgery, according to new study findings in European Archives of Otorhinolaryngology.

A retrospective, cross-sectional, single-center study was conducted to evaluate outcomes among 541 patients who had CRS, 435 of whom had only undergone primary surgery and 106 who needed to undergo revisionist endoscopic sinus surgery (ESS). All patients had undergone their ESS at the Medical University of Vienna, as well as undergoing a routine blood test a mean (SD) 8.8 (6.2) days before surgery.

“The aim of this study was to assess whether hematological indices of the peripheral blood are associated with revision surgery in patients with CRS undergoing ESS,” the study authors wrote. The hematological measures they evaluated were neutrophil-to-lymphocyte ratio (NLR), basophil-to-lymphocyte ratio (BLR), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-neutrophil ratio (ENR), “all previously described as potential markers for disease recurrence in CRS patients,” they added. They also evaluated outcomes in connection with clinical characteristics and absolute blood counts of different leukocyte types.

Most study participants were men (54.9%), and the mean overall age was 42.0 (15.4) years. Among the demographic conditions measured, smoking was more prevalent among the primary surgery group, at 29.2% vs 26.4% (P = .570). Allergies, asthma, and nasal polyps were all more prevalent among those undergoing revision ESS:

  • Allergy: 27.8% vs 47.2% (P < .001)
  • Asthma: 3.7% vs 17.9% (P < .001)
  • Nasal polyps: 69.9% vs 80.2% (P = .034)

Patients undergoing revision surgery were also significantly older: 46.5 (13.8) vs 40.9 (15.6) years (P = .001).

Not only was eosinophil count significantly higher in the revision surgery cases (P < .001), but this group also had an ELR and an ENR (both P < .001) that were significantly higher compared with the primary surgery cohort.

Delving deeper, the investigators wanted to delineate which factors were associated specifically with revision surgery, and through univariate analysis, they found the following:

  • Older age: β = 1.02 (95% CI, 1.01-1.04)
  • Presence of aeroallergen allergies: β = 2.32 (95% CI, 1.50-3.58)
  • Asthma: β = 5.72 (95% CI, 2.83-11.56)
  • Nasal polyps:β = 1.74 (95% CI, 1.04-2.93)
  • Higher peripheral blood eosinophil counts: β = 1.00 (95% CI, 1.00-1.00)
  • Higher ELR: β = 335.01 (95% CI, 47.16,2379.77)
  • Higher ENR: β = 3182.88 (95% CI, 132.02-76,736.86)

The first multivariate analysis, which considered such factors as absolute lymphocyte count, presence of physicians-diagnosed asthma, and smoking status, produced similar results, with the following significantly associated with need for revision surgery:

  • Older age: β = 1.03 (95% CI, 1.01-1.04)
  • Presence of aeroallergen allergies: β = 1.91 (95% CI, 1.16-3.16)
  • Asthma: β = 3.96 (95% CI, 1.77-8.86)
  • Higher peripheral blood eosinophil counts: β = 1.00 (95% CI, 1.00-1.00)

A second multivariate analysis that included hematological indices continued this trend:

  • Older age: β = 1.03 (95% CI, 1.01-1.04)
  • Presence of aeroallergen allergies: β = 1.87 (95% CI, 1.13-3.08)
  • Asthma: β = 3.73 (95% CI, 1.68-3.31)
  • Higher ELR: β = 155.66 (95% CI, 2.66-8636.86)

“Up to 20% of patients undergoing ESS experience disease recurrence and require one or several revision surgeries, which is frequently associated with complications, lengthy treatment, and compromised quality of life,” the authors noted. “Therefore, it is of interest to elucidate factors associated with revision ESS and disease recurrence.”

Further, identifying biomarkers for persons who have CRS can help to facilitate easier treatment because they are minimally invasive and inexpensive to evaluate.

Therefore, they suggest routine evaluation of peripheral eosinophil counts to not only optimize and individualize treatment selection, but to provide more treatment options, “including biological agents targeted to suppress type 2 inflammatory patterns.”


Bayer K, Hamidovic S, Brkic FF, Besser G, Mueller CA, Liu DT. Peripheral eosinophil count and eosinophil-to-lymphocyte ratio are associated with revision sinus surgery. Eur Arch Otorhinolaryngol. 2023;280(1):183-190. doi:10.1007/s00405-022-07497-2

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