Alterations in Periostin Expression Associated With Combined Corticosteroid and Antibiotic Therapy in Patients Suffering From Chronic Rhinosinusitis With Nasal Polyps.

INTRODUCTION: One of the most common complications during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) is bleeding, which increases the time of surgery. A strategy for reducing intraoperative bleeding is the administration of preoperative corticosteroids and antibiotics.

METHODS: We aimed to assess the degree and intensity of inflammation in CRSwNP histological specimens from patients who received immediate preoperative treatment with oral corticosteroids and antibiotics, compared with those who did not. The study group consisted of 50 patients who received preoperative corticosteroids and antibiotics, and the control group consisted of 50 patients who had not received any pretreatment. Immunohistochemical expression of periostin in nasal polyp tissue from each group was evaluated and compared to assess the prognostic value of this protein.

RESULTS: There is a statistically significant difference between the control group and the study group in periostin expression (increased in the former) (p < 0.001). The pretreatment group has a significantly lower score (study group means H-score = 112.7 (standard deviation (SD) = 40.4)/control group mean H-score = 159.4 (SD = 42.3)). Moreover, a statistically significant positive correlation between periostin concentration and vascularity (microvessel density and optical density of the vascular endothelial marker) in the pretreatment group is not observed (rho = -0.02, p = 0.907; rho = 0.07, p = 0.713, respectively).

CONCLUSIONS: The results support the preoperative administration of systemic corticosteroids and antibiotics to reduce the degree and intensity of inflammation in CRSwNP; this may impact the surgical field during ESS. Further cohort studies are needed to validate this recommendation.