The role of immune cells in chronic rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a heterogenous disease characterised by the symptomatic inflammation of the nose and paranasal sinuses for more than 12 weeks. These symptoms include nasal obstruction, nasal discharge, facial pain and pressure, resulting in a considerable impairment of a patients’ quality of life. CRS is subcategorised into two types based on the absence (CRSsNP) and presence of nasal polyps (CRSwNP) visualised within the middle meatus. Interestingly, although CRSsNP patients may lack easily identifiable polyps, the mucosa of these patients may show variable degrees of polypoid change. This raises the question as to whether the proposed classification system is an over simplification and that CRSsNP and CRSwNP in fact only represent two extremes of phenotype along a broader spectrum of immunologically different disease processes. Recently, research into CRS has identified a dysregulated immune response as a major contributor to the aetiopathology of disease, however few studies have utilised flow cytometry to phenotype the cells present. This thesis examines both the local and systemic populations of different adaptive and innate immune cells in the tissue and blood of CRSsNP and CRSwNP patients along different degrees of polypoid change within the same patient.