Use of intraoperative frontal sinus mometasone-eluting stents decreased interleukin 5 and interleukin 13 in patients with chronic rhinosinusitis with nasal polyps

Alexander L. Schneider, Samuel D. Racette, Anthony K. Kang, Abhita T. Reddy, Julia H. Huang, David S. Lehmann, Caroline P.E. Price, Jacob G. Eide, Samuel R. Rodeghiero, David B. Conley, Kevin C. Welch, Robert C. Kern, Stephanie Shintani-Smith, Anju T. Peters, Atsushi Kato, Whitney S. Stevens, Robert P. Schleimer, Bruce K. Tan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Mometasone-eluting stents (MES) have demonstrated improvement in short-term endoscopic outcomes and reduce short- to medium-term rescue interventions. Their effect on the local inflammatory environment, longer-term patient-reported outcomes, and radiographic severity have not been studied. Methods: Middle meatal mucus and validated measures of disease severity were collected before and 6 to 12 months after endoscopic surgery in 52 patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Operative findings, type 2 mediator concentrations, intraoperative variables, and disease severity measures were compared between those who did and those who did not receive intraoperative frontal MES. Results: A total of 52 patients with CRSwNPs were studied; 33 received frontal MES and were compared with 19 who did not. Pre–endoscopic sinus surgery (ESS) middle meatus (MM) interleukin (IL) 13 and eosinophil cationic protein (ECP) were higher in the stented group (p < 0.05), but pre-ESS clinical measures of disease severity were similar as were surgical extent and post-ESS medical management. Intraoperative eosinophilic mucin was more frequent in the stented group (58% vs 11%, p = 0.001). IL-5 (p < 0.05) and IL-13 (p < 0.001) decreased post-ESS in the stented group, but this was not observed in the nonstented group. Post-ESS IL-4 and IL-13 were higher in the nonstented vs stented group (p < 0.05 for both). Conclusion: Although patients who received intraoperative frontal MES had significantly higher pre-ESS MM IL-13 and ECP, patients who received frontal MES had lower concentrations of IL-4 and IL-13 than those who did not at a median of 8 months post-ESS. However, these changes did not correspond to significantly different measures of symptomatic or radiographic disease severity.

Original languageEnglish (US)
Pages (from-to)1330-1339
Number of pages10
JournalInternational Forum of Allergy and Rhinology
Volume12
Issue number11
DOIs
StatePublished - Nov 2022

Keywords

  • CRSwNP
  • endotype
  • mometasone
  • nasal polyps
  • patient-reported outcome measures
  • sinus stent

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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