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Comment & Response |

The Link Between Cytokine Levels and Loss of Olfaction in Chronic Rhinosinusitis ONLINE FIRST

Swathikan Chidambaram, BSc1; En Lin Goh, BSc1
[+] Author Affiliations
1School of Medicine, Imperial College London, United Kingdom
JAMA Otolaryngol Head Neck Surg. Published online September 01, 2016. doi:10.1001/jamaoto.2016.2424
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To the Editor We thank Schlosser et al1 for their study investigating the link between cytokine levels and loss of olfaction in patients with chronic rhinosinusitis (CRS). By analyzing the composite threshold discrimination identification (TDI) scores and cytokine levels in the mucus, the authors conclude an association with the objective olfactory function.

However, we urge caution with accepting the validity of these results for multiple reasons, all of which can be attributed to the labile nature of cytokines. The study was conducted on the grounds of laboratory ex vivo experiments on olfactory epithelium and animal studies that characterized a consistent profile of inflammatory cytokines in subjects with CRS. However, it is questionable how translatable this relationship is to an in vivo setting because cytokines are soluble mediators that are both pleiotropic and redundant in nature.2 Chronic rhinosinusitis, as an inflammatory process, will stimulate an abundance of cytokines that in turn manifest a range of symptoms. Given the redundancy of cytokines, it is challenging to definitively link the cytokine profile to the loss of olfaction instead of other predominant symptoms experienced by the patient, and the use of knock-out and knock-in studies could shed light on this phenomenon. Often, cytokines work in a cascade at the molecular level, and evaluating the role of a specific cytokine does not provide clinically relevant correlations. From a therapeutic perspective, targeting these cytokines remains a challenge as well.

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September 1, 2016
Rodney J. Schlosser, MD; Jennifer K. Mulligan, PhD; Zachary M. Soler, MD, MSc
1Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. Published online September 01, 2016.;():. doi:10.1001/jamaoto.2016.2427.
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