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were more likely to have a stromal cell distribution but did not reach statistical difference.

TABLE V. The Average Percentage of Cells for CRS Subclasses.

CRS Subclass % CD3 % CD4 % CD8 % CD19 % CD56

Flow Cytometry Fresh mucosal and polyp samples were analyzed for CD3, CD4, CD8, CD19, and CD56 cells (Table V). In regard to the T cells, there was no difference seen for CD3 marker between the control group and CRS groups or among the CRS subclasses. There were higher CD4 cells in both AScA and ASsA, both NAScA and NASsA, and AERD than the control group ( P < .05). The two allergy-based CRS subclasses (AScA, NAScA) had more CD4 cells than CF ( P < .05). For the CD8 cells, the con- trol group had a significantly higher amount of CD8 cells than each nonasthmatic group (NAScA, NASsA) ( P < .05). For the CD19 or B cells, both AFS ( P < .05) and CF ( P < .01) were significantly higher than the control group. Also, CF had significantly more CD19 cells than NASsA and AScA ( P < .05). For the CD56 or natural killer cells, there was no statistical difference between the control group and CRS study groups. Also, there was no differ- ence among the CRS subclasses. We examined several intracellular cytokines: IFN- c , IL4, IL5, IL13, and IL17 (Table VI) in CD45 1 , CD45 1 CD4 1 and CD45 1 Cd4 2 cells. For IL5, IL13, and IL17, only five samples in each CRS subclass and control group were measured. When examining the CD45 1 cells, there was statistical difference for IFN, IL4, and IL5. Nonasthmatic sinusitis without allergy had higher IFN than AFS ( P 5 .03). For IL4, ASsA was statistically higher than the control group ( P 5 .03) and all the CRS subclasses ( P < .05) other than AERD. For IL5, AFS was statistically higher than AERD, both ASsA and AScA, and NASsA. Allergic fungal sinusitis was almost statisti- cally higher for IL5 compared to the control group but did not reach significance ( P 5 .06). There was statistical difference among CD45 1 CD4 1 cells for IFN- c , IL4, IL5, and IL13. Both NAScA, NASsA had statistically elevated IFN- c than the control group ( P < .01) and eosinophilic CRS subclasses (AFS, AERD, AScA) ( P < .05). For IL4 in CD45 1 CD4 1 , ASsA had elevated levels compared to CF ( P 5 .05). For IL5, AFS was statistically higher than the control group ( P < .01). Allergic fungal sinusitis also had higher IL5 than eosinophilic sinusitis (AERD, AScA, ASsA), NASsA, and CF ( P < .05). Allergic fungal sinusitis also had ele- vated IL13 compared to CF ( P < .05). There was statistical difference among CD45 1 CD4 2 cells for IL4 and IL13. For IL4, ASsA had elevated levels of IL4 compared to CF and NAScA ( P < .05). Aspirin-exacerbated respiratory disease was the second highest in the study, but did not reach statistical significance with any of the other groups. For IL13, CF did have higher IL13 than the control group ( P 5 .05). Cystic fibrosis also had higher IL13 compared to both AScA and ASsA ( P < .03) and was close to significance to AERD ( P 5 .06). There were no statistical differences found for IL17 between CRS subclasses and control group or among the CRS subclasses.

AERD

79

36

42

9

6

AFS

67 71

28 26

33 38

15 21

6 5

CF

AScA

76

36

37

9

6

ASsA

74 68

32 37

34 33

14 18

6 7

NAScA

NASsA

72

30

36

11

9

Control

76 73

21 31

53 39

3

12

Total

12

7

AERD 5 aspirin exacerbated respiratory disease also known as aspirin triad; AFS 5 allergic fungal sinusitis; AScA 5 asthmatic sinusitis with allergy; ASsA 5 asthmatic sinusitis without allergy; CF 5 cystic fibrosis; CRS 5 chronic rhinosinusitis; NAScA 5 nonasthmatic sinusitis with allergy; NASsA 5 nonasthmatic sinusitis without allergy.

and NAScA had statistically higher plasma cells than the control group ( P < .05). Cystic fibrosis also had statis- tically higher plasma cells than AERD, AScA, and each nonasthmatic sinusitis ( P < .01). For the lymphocyte analysis, the control group had the highest ratios of lymphocytes, but no statistical dif- ference was achieved between the control group and any of the CRS subclasses. In general, eosinophilic CRS sub- classes (AFS, AERD, AScA, ASsA) had lower lymphocyte ratios. For mast cell analysis, cystic fibrosis had the high- est mast cell ratio, being statistically higher than the control group and all the CRS subtypes other than NAScA ( P < .01). Both allergic-based CRS (AScA, NAScA), AERD, and AFS were higher than the control group ( P < .01) for mast cells. NAScA had higher mast cells than each asthmatic sinusitis (AScA, ASsA) and NASsA ( P < .01). Allergic fungal sinusitis was statistically higher than NASsA ( P < .05) for mast cells. Eosinophilic CRS subclasses (AScA, ASsA, AFS, AERD) had statistically higher cellularity than the con- trol group ( P < .05). Aspirin triad and AFS had higher cellularity than NASsA ( P < .05). There was no statistical difference in the amount of fibrosis between the CRS and the control group. Goblet cell counts ranged from an average eight/ HPF in CF samples to 89/HPF in NASsA (Table IV). Cystic fibrosis had significantly lower number of goblet cells than AERD, AScA, NASsA, and the control group ( P < .05). AFS also had lower goblet cells than AScA, NASsA, and the control group ( P < .05). Eosinophilic CRS subclasses (AFS, AERD, AScA, ASsA) demonstrated the most metaplasia of the surface epithelium but did not reach statistical difference. Aspirin triad and each asth- matic sinusitis had significantly more transitional epithelium when compared to controls, nonasthmatic si- nusitis, and CF ( P < .05). Cell distribution data showed that CF samples had a predominantly subepithelial cell distribution and was statistically higher than the control group ( P < .01). Eosinophilic CRS subclasses (AScA, ASsA, AERD, AFS)

Laryngoscope 123: March 2013

Han: Subclassification of Chronic Sinusitis

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