Published In

International Forum of Allergy & Rhinology

Document Type


Publication Date



Chronic rhinosinusitis, Sinus surgery outcome assessment (healthcare), Cytokine -- Biomarker



It is unclear if chronic rhinosinusitis (CRS) endotypes show differential response to endoscopic sinus surgery (ESS). We explored mucus inflammatory cytokine expression in a cohort with CRS and associations with both patient-reported and clinically measured postoperative outcome measures.


Patients with CRS were prospectively recruited between 2016-2021 into a multi-center observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient reported outcome measures included the Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included Threshold, Discrimination, and Identification (TDI) scores using Sniffin’ Stick testing and Lund-Kennedy endoscopic scores (LKES).


A total of 115 patients were clustered into type 2 inflammatory, non-type 2 inflammatory, non-inflammatory, and 2 indeterminate clusters based upon individual protein levels. Overall, the type 2 inflammatory cluster was found to report the highest mean improvement in both SNOT-22 (-28.3 [SD±16.2]) and TDI (6.5 [SD±7.9]) scores 6 months after ESS. However, all endotype clusters demonstrated improvement in all outcome measures after ESS on average, without statistically significant between-group differences in SNOT-22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures.


All CRS endotype clusters respond favorably to surgery and show improvement in patient reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes.


Copyright (c) 2023 The Authors


This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Locate the Document



Persistent Identifier