Abstract
Objectives Chronic rhinosinusitis is a heterogenous disease with
variation in the endotypes of nasal polyps, with type 2 inflammation
being more prevalent in Caucasian populations and papers describing as
many as 5 different types of inflammation in Chinese populations. We aim
to describe the variation in endotypes for patients with chronic
rhinosinusitis with nasal polyposis in our unique multiracial
population, together with associated demographic and clinical
biomarkers. Design: Retrospective analysis Setting and Participants:
Demographic, clinical and structured histopathological data of 67
patients who underwent sinus surgery for nasal polyposis by a single
surgeon in Singapore General Hospital were evaluated. Results: In our
population, 46.2% had eosinophil-predominant disease, and 53.7% had
lymphoplasmacytic disease, with no significant demographic differences
between the 2 populations. There were significantly higher peripheral
eosinophil levels in patients with eosinophil predominant inflammation
on tissue histology (absolute eosinophil count 0.69 ± 0.17 x 109) vs
lymphoplasmacytic disease (0.22 ± 0.09 x 109) (p = 0.00). Structured
histopathological reporting revealed that patients with eosinophilic
disease tended to have more severe inflammation and basement membrane
thickening, though this did not reach statistical significance.
Conclusion: Understanding the underlying inflammatory patterns of
patients with nasal polyposis paves the way to personalised therapy and
better prognostication of disease. Our population is shown to have a
slight preponderance toward lymphoplasmacytic disease, especially
amongst the Chinese majority. Serum eosinophilia and the presence of
asthma seems to correlate well with tissue eosinophilia, which can
potentially be utilised as a marker of type 2 inflammatory disease.