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Nasal nitric oxide as a marker of sinus mucosal health in patients with nasal polyposis
Author(s) -
Lee John M.,
McKnight Carmen L.,
Aves Theresa,
Yip Jonathan,
Grewal Amandeep S.,
Gupta Samir
Publication year - 2015
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21598
Subject(s) - medicine , chronic rhinosinusitis , nasal polyps , gastroenterology , prospective cohort study , cohort , sinusitis , endoscopic sinus surgery , statistical significance , sinus (botany) , cohort study , endoscopy , functional endoscopic sinus surgery , nitric oxide , surgery , botany , biology , genus
Background Reduced nasal nitric oxide (nNO) has been shown in patients with chronic rhinosinusitis (CRS) but its clinical significance remains uncertain. The objective of this study was to measure nNO changes in patients undergoing endoscopic sinus surgery (ESS) for CRS and to explore its relationship to clinical measures of sinus mucosal health postoperatively. Methods This was a prospective study of CRS patients undergoing ESS. Patients had the following measurements at baseline and at 1 and 6 months post‐ESS: nNO levels, Lund‐Kennedy Endoscopy Score (LKES), and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score. Statistical analysis was performed using GraphPad Prism 6. Results Thirty‐nine patients were enrolled, of these 84.6% had CRS with nasal polyps. Baseline Lund‐Mackay computed tomography (CT) score was 16.9 ± 5.1. There was a statistically significant increase in nNO levels from baseline to 1 month and 6 months postoperatively ( p < 0.0001). The SNOT‐22 and LKES followed a similar trend with a significant and sustained improvement at 1 month and 6 months post‐ESS ( p < 0.0001). Subgroup analysis revealed that changes in nNO were driven by the polyp cohort because nonpolyp patients had no significant changes in their nNO postoperatively. No correlation was found between nNO levels and SNOT‐22. However, a significant negative correlation was found between nNO and LKES ( p < 0.0001), suggesting healthier sinus mucosa was associated with higher nNO levels. Conclusion This is the first study to show that nNO levels may be a marker of sinus mucosal health following ESS in patients with polyps. This has important implications for nNO in its potential etiologic role in mediating ongoing sinus inflammation.