Risk factors for neo-osteogenesis in cystic fibrosis and non‒cystic fibrosis chronic rhinosinusitis

Peter Karempelis, Emily Karp, Nathan Rubin, Ryan Hunter, Jordan Dunitz, Holly Boyer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The purpose of this retrospective review was to determine how patient-related factors and culture data affect neo-osteogenesis in patients with chronic rhinosinusitis (CRS) and patients with cystic fibrosis (CF) with CRS. Methods: Information from a database associated with a large tertiary medical center was used to assess adult patients with CF CRS and non-CF CRS (total, n = 102; CF CRS, n = 31; non-CF CRS, n = 71). Radiologic evidence of neo-osteogenesis was measured using the Global Osteitis Scoring Scale (GOSS), and mucosal disease was assessed using the Lund-Mackay score (LMS) by 2 independent reviewers who were blinded to the patient's disease state. Bacterial cultures were obtained endoscopically. Multiple logistic regression models were used to evaluate the effect of age, sex, number of previous surgeries, CF, and culture species on the odds of neo-osteogenesis. Results: Fifty-one of the 102 patients (50%) met radiologic criteria for neo-osteogenesis. Sixty-nine patients (67.6%) with CF CRS and non-CF CRS had culture data. In the multiple logistic regression model, male gender was significantly associated with neo-osteogenesis (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.68-17.86; p = 0.006). Pseudomonas aeruginosa was not associated with neo-osteogenesis (OR, 3.12; 95% CI, 0.84-12.80; p = 0.097). Age, number of surgeries, CF, Staphylococcus aureus, and coagulase-negative Staphylococcus were not statistically significant. Conclusion: To our knowledge, this is the first study to assess risk factors associated with neo-osteogenesis and patients with CF CRS. Interestingly, male gender was the only significant predictor of neo-osteogenesis.

Original languageEnglish (US)
Pages (from-to)505-510
Number of pages6
JournalInternational Forum of Allergy and Rhinology
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2020

Bibliographical note

Funding Information:
sources for the study: National Instititutes of Health (NIH P30 CA77598) utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota; National Center for Advancing Translational Sciences of the NIH (UL1TR000114). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding Information:
To our knowledge, this is the first study to assess risk factors associated with neo‐osteogenesis and patients with CF CRS. Interestingly, male gender was the only significant predictor of neo‐osteogenesis. Funding sources for the study: National Instititutes of Health (NIH P30 CA77598) utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota; National Center for Advancing Translational Sciences of the NIH (UL1TR000114). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Potential conflict of interest: J.D.: financial relationships with Hill‐Rom, Vertex Pharmaceuticals, and Proteostasis Therapeutics, Inc (none related to this study). The other authors have no financial disclosures. The main inflammatory site in CRS is the nasal mucosa, but underlying bony changes have also been observed clinically, radiologically, and histologically. Neo‐osteogenesis is the thickening and increased density of the underlying bone observed radiologically in association with persistent mucosal inflammation. The exact pathophysiologic mechanisms contributing to chronic rhinosinusitis (CRS) are unclear, but there is strong evidence to suggest a combination of host and environmental factors lead to the development and persistence of CRS. A recent article by Huang et al investigated predictive factors for neo‐osteogenesis in non‒cystic fibrosis (non‐CF) CRS. In this study, colonization of Currently, there is no clear etiology for neo‐osteogenesis associated with CRS. Although it commonly occurs alongside bacterial infection, it may represent an inflammatory response to the bacteria rather than a direct effect of infection. Pseudomonas aeruginosa was significantly associated with neo‐osteogenesis, whereas Staphylococcus was not, despite both pathogens being implicated in non‐CF CRS. This finding suggests that P aeruginosa is a strong independent risk factor for development of neo‐osteogenesis, and neo‐osteogenesis may be a product of the bacterial environment and related inflammatory state of the sinonasal mucosa. One study showed that prior sinus surgery could contribute to the development of neo‐osteogenesis and greater resistance to surgical treatment may be associated with the degree of neo‐osteogensis. Another study showed that patients with neo‐osteogenesis had significantly worse baseline computed tomography (CT), endoscopy, and olfactory score than patients without osteitis. Finally, in another study, neo‐osteogenesis was associated with the need for a course of oral corticosteroids in the 12 months after endoscopic sinus surgery. Regardless of etiology, observation of neo‐osteogenesis has been associated with persistent mucosal inflammation in CRS, increased disease severity of CRS, and less improvement in quality‐of‐life measures. Multiple previous studies have investigated the association between neo‐osteogenesis and non‐CF CRS outcomes. In addition, recent studies have suggested that the sinuses serve as a reservoir for multiple CF pathogens of the lower airway, such as The relationship between CRS and neo‐osteogenesis in patients with CF has not been investigated previously. Although it is known that In CF patients, the defect in mucociliary clearance and other mucosal abnormalities mediated by the CF transmembrane conductance regulator (CFTR) mutations leads to a higher incidence of CRS than in the general population. P aeruginosa . Pseudomonas is a predominant organism causing disease in the sinuses and lungs of CF patients, it is unclear whether patients with CF have a greater incidence of sinus neo‐osteogenesis. Thus, we sought to investigate the interaction of multiple patient factors to increase our knowledge of how clinical features of CRS and CF correlate with the pathophysiology of the disease state.

Publisher Copyright:
© 2019 ARS-AAOA, LLC

Keywords

  • chronic rhinosinusitis
  • cystic fibrosis
  • imaging
  • neo-osteogenesis
  • quality of life

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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