xRead - Nasal Obstruction (September 2024) Full Articles

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Orlandi et al.

X.C.6 Contributing Factors for CRSwNP: Gastroesophageal Reflux Because of limited data, CRSsNP and CRSwNP are com bined in Section IX.C.5 . X.C.7 Contributing Factors for CRSwNP: Vitamin D Deficiency Vitamin D deficiency (VD3) is classically known for its actions in bone and calcium homeostasis. Recently, how ever, it has also been shown to be a potent immunomodula tory steroid hormone involved in the regulation of epithe lial cell, dendritic cell, monocyte, macrophage and T-cell functions. 710,711 The literature on Vitamin D3 in CRSwNP largely consists of case series, case-control and in vitro studies. Several reports have linked CRSwNP and low 25VD3. Adult and pediatric CRSwNP and AFRS patients had sig nificantly lower serum 25VD3 than controls and in adults, low 25VD3 correlated with greater sinus bone erosion as measured on CT scan. 718 A more recent study similarly found that CRSwNP patients and CF patients with nasal polyps (CFwNP) also demonstrated low serum 25VD3 levels and that 25VD3 inversely correlated with Lund Kennedy and Lund-Mackay scores in CRS patients and CF patients. 714 In a retrospective analysis of 70 CRSwNP patients, 55% of patients were 25VD3 insufficient ( < 30 ng/mL) and an additional 30% deficient ( < 20 ng/mL). 1415 The lowest lev els were in African American patients with nearly 80% insufficient. Severity of mucosal disease (defined by Lund Mackay Score on CT) also correlated with low 25VD3 level. In Taiwanese patients with CRSwNP, a study found sig nificantly lower 25VD3 in CRSwNP patients compared to CRSsNP patients. 720 Low 25VD3 also correlated with more severe polyp grade. 25VD3 was inversely related to Lund Mackay score, consistent with US patients. 1415 With regard to allergic status, a study found that Turk ish patients with concurrent CRSwNP and AR had sig nificantly lower serum 1,25VD3 than healthy controls. 1416 This effect was not seen in CRSwNP without AR, imply ing that allergy is associated with VD3 deficiency. This contrasts with US reports where CRSwNP alone was asso ciated with low 25VD3. The 2 groups however measured different molecules with the Turkish work measuring the active 1,25VD3 and the US studies measuring 25VD3, con ventionally considered the more accurate marker of Vita min D3 status due to its longer half-life. The Taiwanese study examining interplay of allergic factors in CRSwNP

TABLE X-7 Evidence for biofilms as a contributing factor for CRSwNP Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Danielsen 1401 2016 3 Cross-sectional study of biofilm presence 27CRSsNP 34CRSwNP 25Control Biofilm presence from intranasal biospy 97% of CRSwNP subjects, 82% of CRSsNP subjects, and 56% of control subjects had bacterial biofilms present. Wang 1402 2014 3 Cross-sectional study of biofilm presence 15CRSsNP 19CRSwNP 13Control Biofilm presence from intranasal biopsy 73% of CRSsNP subjects, 74% of CRSwNP subjects, and 0% of control subjects had bacterial biofilms present. No significant difference in

inflammatory cells in individuals with and without biofilms.

Eosinophil major basic protein staining is significantly higher in biofilm-positive patients.

Eosinophil major basic protein staining

Arjomandi 1403 2013 4 Eosinophilia vs biofilm presence 20CRS 9Control