Analysis Of Two Related Factors Affecting Subjective Efficacy In Patients With Chronic Sinusitis Postoperatively

Immunoglobulin E (IgE) is a specific antibody produced by the immune response triggered by certain allergen, which play an important role in type I hypersensitivity. Both of the total IgE and specific IgE increase in asthma, allergic rhinitis, rheumatoid arthritis and other allergic diseases. Therefore, the elevation of total IgE in serum is an important indicator for allergy.It was believed that eosinophils was crucial for chronic inflammation, especially for the genesis and maintenance of allergic diseases. Generally, the accumulation of eosinophils in the related tissues was the symbol of allergy. A close relation was found between the allergic factors and the disease of chronic sinusitis and nasal polyp, part of which was mainly characterized by infiltration of a large number of eosinophils by reviewing their pathological features.Patients suffer a lot from chronic sinusitis and nasal polyps. The final goal for the treatment is to eliminate any kinds of discomfort and to improve the quality of life.In recent years, for some of the objective indicators like endoscopic examination or CT scores are inconsistent with the improvement for subjective symptoms, more and more attention was paid for the evaluation of subjective symptoms and the quality of life by clinicians. As is known to all, allergic inflammation might be responsible for the pathogenesis of chronic sinusitis and nasal polyps. However, the following questions are seldom mentioned:which kind of patients with chronic sinusitis and nasal polyps is influenced by allergic inflammation? What are the differences in the clinical manifestation and therapeutic efficacy between the patients with and without this atopy?Interest in this study is to evaluate the subjective efficacy for surgical treatment by comparing the symptom scores before and after the operation in all the 154 patients with chronic sinusitis. Moreover, the degree of local infiltration for eosinophils in the resected lesions is evaluated, as well as the level of total IgE in serum preoperatively. We would also discuss whether the two related factors for allergy could influence the subjective efficacy for chronic sinusitis patients postoperatively, with the purpose of providing some references for the perioperative medication and further understanding the treatment, prognosis and the evaluation of subjective symptoms and the quality of life,especially for refractory sinusitis.Material and methodsThe selected 154 patients were classified into different groups according to Haikou standards established by the Chinese Medical Association of Otolaryngology Head and Neck Surgery and the Editorial Board of the Journal of Otolaryngology Head and Neck Surgery in 1997, which was showed in tablel. All the patients received functional endoscopic sinus surgery by the skilled fellows in the same medical group. Total serum IgE was quantified by immune nephelometry preoperatively. The degree of local infiltration for eosinophils was assessed by high power microscope after HE staining (x 400). Questionnaires, according to the rating scale for symptoms and quality of life for chronic sinusitis by Michael D et al, were carried out for every patient before and one year after operations.4-point visual analogue scale (Visual Analog Scale, VAS) was applied to evaluate the scores for subjective symptoms. 1. Total serum IgE and VAS evaluation preoperativelyAs shown in Table 2, the average level of total serum IgE was 137.72±268.60KU/Lin all the 154 cases, with 34 patients above the normal level of 158 KU/L and 120patients below that criterion. The difference for preoperative VAS scores between thetwo groups was not statistically significant (t=0.214, P=0.831) 2. Local eosinophils infiltration and VAS evaluation preoperativelyAccording to the degree of local eosinophils infiltration, all the 154 cases were divided into two groups as gradeⅠand gradeⅡ-Ⅲby reviewing all the specimens from the polyp tissues. The difference for preoperative VAS scores between the two groups was not statistically significant (t=1.679, P=0.095). The results were showed in Table 3.3. Evaluation of subjective efficacy postoperativelyThe difference between VAS scores before and one year after operations was regarded as an indicator for the subjective efficacy for patients. The results were showed in Table 4, which indicated that the VAS scores before and one year after operation was statistically significant by t-test(t= 32.879, P<0.001). Meanwhile, the difference for subjective efficacy in the two groups with different level of IgE(Normal level:IgE<158 KU/L, elevated level:IgE> 158KU/L) was statistically significant by t-test (t=3.042, P<0.01). The detailed results were listed in Table 5.Finally, in order to see the correlation between subjective efficacy postoperatively and different degree of local eosinophils infiltration, another t-test for the difference in subjective efficacy for the two groups with different degree of local eosinophils infiltration was performed. The results, which was showed in Table 6, were statistically significant(t=2.543, P<0.01). Conclusions1. Negative correlation was found between the subjective efficacy and the elevated level of IgE, as well as the higher grade of local eosinophils infiltration in patients with chronic sinusitis and nasal polyps.2. Allergic inflammation was confirmed in some of the patients with chronic sinusitis and nasal polyps by two obvious indicators of the elevated level of total serum IgE and significant infiltration of eosinophils. Moreover, the subjective efficacy was worse in those patients with such atopy than in the majority without that.3. It is necessary to pay attention to those patients with atopy, especially to apply the anti-allergic inflammation therapy for them in clinical diagnosis and treatment of chronic sinusitis and nasal polyps.