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VOLUME 15 , ISSUE 2 ( May-August, 2023 ) > List of Articles

Original Article

Comparison of Neutrophil Eosinophil Ratio (NER) in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Chronic Rhinosinusitis without Nasal Polyps (CRSsNP)

Iriana Maharani, Monica Intan, Rus Suheryanto, Dhaniel Abdi Wicaksana, Fifin Pradina Duhitatrissari

Keywords : Chronic rhinosinusitis with nasal polyps, Chronic rhinosinusitis without nasal polyps, Neutrophil eosinophil ratio

Citation Information : Maharani I, Intan M, Suheryanto R, Wicaksana DA, Duhitatrissari FP. Comparison of Neutrophil Eosinophil Ratio (NER) in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Chronic Rhinosinusitis without Nasal Polyps (CRSsNP). Int J Otorhinolaryngol Clin 2023; 15 (2):59-63.

DOI: 10.5005/jp-journals-10003-1449

License: CC BY-NC 4.0

Published Online: 21-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Chronic rhinosinusitis is one of the most common world health problems and affects the quality of life. Recent research suggests differences in immunological mechanisms in immunological endotypes between chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). Identifying the neutrophil eosinophil ratio (NER) in CRSwNP and CRSsNP is important to determine the type of inflammation so that pathophysiological differences can be known and appropriate therapy can be given. Materials and methods: Cross-sectional study involved 24 subjects. The subjects are divided into two groups based on the phenotype, 12 CRSwNP and 12 CRSsNP. This research uses maxillary sinus mucosa to identify the levels of neutrophils and eosinophils in the maxillary sinus mucosa using flow cytometry. NER in CRSwNP and CRSsNP was analyzed statistically using student t-test. Results: The mean of neutrophils in CRSwNP: 5.31 ± 0.24% (N:1.1–1.7%) and CRSsNP: 4.29 ± 2.42% (N:1.1–1.7%). The mean of eosinophils in CRSwNP: 4.76 ± 2.55% (N: 0.3–0.7%) and CRSsNP 3.60 ± 2.88% (N: 0.3–0.7%). The average NER in CRSwNP was 1.33 ± 0.71 (N:2.8), and CRSsNP was 2.58 ± 3.07 (N:2.8). The results were not significantly different in the two groups (p = 0.196). In CRSwNP and CRSsNP, as many as 83.33% of the subjects had an eosinophilic type of inflammation. Conclusion: There were no significant differences in NER and type of inflammation between chronic rhinosinusitis with polyps and without polyps.

  1. Geramas I, Terzakis D, Hatzimanolis E, et al. Social factors in the development of chronic rhinosinusitis: A systematic review. Curr Allergy Asthma Rep 2018;18(2). DOI: 10.1007/s11882-018-0763-0.
  2. Lal D, Hopkins C, Divekar RD. SNOT-22–based clusters in chronic rhinosinusitis without nasal polyposis exhibit distinct endotypic and prognostic differences. Int Forum Allergy Rhinol 2018;8(7):797–805. DOI: 10.1002/alr.22101.
  3. Fokkens WJ, Lund VJ, Hopkins C, et al. Classification, definitions and terminology allergy. Eur Position Pap Rhinosinusitis Nasal Polyps 2020;Suppl. 29:37. DOI: 10.4193/Rhin20.600.
  4. Ikeda K, Shiozawa A, Ono N, et al. Subclassification of chronic rhinosinusitis with nasal polyp based on eosinophil and neutrophil. Laryngoscope 2013;123(11):1–9. DOI: 10.1002/lary.24154.
  5. Delemarre T, Holtappels G, Ruyck N De, et al. Type 2 inflammation in chronic rhinosinusitis without nasal polyps: Another relevant endotype. J Allergy Clin Immunol 2020;146(2):337–343.e6. DOI: 10.1016/j.jaci.2020.04.040.
  6. Kim DW, Eun KM, Roh EY, et al. Chronic rhinosinusitis without nasal polyps in Asian patients shows mixed inflammatory patterns and neutrophil-related disease severity. Mediators Inflamm 2019;2019. DOI: 10.1155/2019/7138643.
  7. Stevens WW, Peters AT, Tan BK, et al. Associations between inflammatory endotypes and clinical presentations in chronic rhinosinusitis. J Allergy Clin Immunol Pract 2019;7(8):2812-2820.e3. DOI: 10.1016/j.jaip.2019.05.009.
  8. Xu X, Ong YK, Wang DY. Novel findings in immunopathophysiology of chronic rhinosinusitis and their role in a model of precision medicine. Allergy Eur J Allergy Clin Immunol 2020;75(4):769–780. DOI: 10.1111/all.14044.
  9. Radabaugh JP, Han JK, Moebus RG, et al. Analysis of histopathological endotyping for chronic rhinosinusitis phenotypes based on comorbid asthma and allergic rhinitis. Am J Rhinol Allergy 2019;33(5):507–512. DOI: 10.1177/1945892419846263.
  10. Wang H, Pan L, Liu Z. Neutrophils as a protagonist and target in chronic rhinosinusitis. Clin Exp Otorhinolaryngol 2019;12(4):337–347. DOI: 10.21053/ceo.2019.00654.
  11. Duhitatrissari FP, Retnoningsih E, Maharani I. Korelasi IgE terhadap rasio neutrofil/eosinofil jaringan dan darah penderita rhinosinusitis kronik Aspergillus fumigatus. Oto Rhino Laryngol Indones 2018;48(1):46. DOI: 10.32637/orli.v48i1.255.
  12. Wicaksana DA, Suheryanto R, Maharani I. Correlation between β-glucan and neutrophil/eosinophil ratio of paranasal sinus mucosa and blood in the diagnosis of chronic fungal rhinosinusitis. Oman Med J 2018;33(5):393–400. DOI: 10.5001/omj.2018.73.
  13. Won HK, Kim YC, Kang MG, et al. Age-related prevalence of chronic rhinosinusitis and nasal polyps and their relationships with asthma onset. Ann Allergy, Asthma Immunol 2018;120(4):389–394. DOI: 10.1016/j.anai.2018.02.005.
  14. Brescia G, Sfriso P, Marioni G. Role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps. Acta Otolaryngol 2019;139(1):48–51. DOI: 10.1080/00016489.2018.1538567.
  15. Kilty SJ, Ted McDonald J, Johnson S, et al. Socioeconomic status: A disease modifier of chronic rhinosinusitis? Rhinology 2011;49(5): 533–537. DOI: 10.4193/Rhino10.298.
  16. Talat R, Speth MM, Gengler I, et al. Chronic rhinosinusitis patients with and without polyps experience different symptom perception and quality of life burdens. Am J Rhinol Allergy 2020;34(6):742–750. DOI: 10.1177/1945892420927244.
  17. Tecimer SH, Kasapoglu F, Demir UL, et al. Correlation between clinical findings and eosinophil/neutrophil ratio in patients with nasal polyps. Eur Arch Oto-Rhino-Laryngology 2015;272(4):915–921. DOI: 10.1007/s00405-014-3174-4.
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