Abstract
This study investigated the relationship between sinonasal inflammatory involvement according to the computed tomography (CT) staging system (Lund–Mackay score) with clinical, laboratory, histopathological and prognostic features of chronic rhinosinusitis with nasal polyps (CRSwNP). Seventy-eight patients with CRSwNP who had undergone surgery were enrolled. Total (p = 0.0062), ethmoid (p = 0.0496), sphenoid (p = 0.0335), ostiomeatal complex (OMC) (p = 0.0235) and frontal (p = 0.0164) CT scores were predictive of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD) in the univariate analysis. Total (p = 0.0022), ethmoid (p = 0.0290), sphenoid (p = 0.0370), frontal (p = 0.0116), maxillary (p = 0.0357) and OMC (p = 0.0058) CT scores were predictve of asthma at the univariate analysis. No significant differences were found between patients with vs. without allergy in terms of total and partial CT scores. High blood eosinophil counts (>0.24 vs. ≤0.24 cells × 109/L) resulted in being associated with total (p = 0.0213), maxillary (p = 0.0227) and ethmoid (p = 0.0491) CT scores in the univariate analysis. Higher ethmoid (p = 0.0006) and total sinonasal (p = 0.0027) CT scores were found to predict histopathologically eosinophil CRSwNPs in the univariate analysis. CT scores did not result as predictive of NSAID-exacerbated respiratory disease, asthma, or blood eosinophil count at the multivariate analysis. Risk of relapse was related to the presence of NERD (p = 0.0207, HR [95% CI] 3.914 [1.232–12.435]), higher preoperative total (HR = 1.098 95%CI: 1.001–1.204, p = 0.0486) and frontal sinus CT scores (HR = 1.555 95%CI: 1.006–1.886, p = 0.0218), but these results were not confirmed by the multivariable analysis. Sinonasal CT scores showed significant differences in this heterogeneous inflammatory condition. Identifying CRSwNP characteristics is necessary to avoid generic treatments with poor outcomes.
Highlights
Chronic rhinosinusitis (CRS) is divided into two phenotype-based groups according to the presence (CRSwNPs) or absence of nasal polyps
Since total and frontal sinus Computed tomography (CT) scores are associated, in the multivariable model we considered non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD) and frontal CT scores that resulted anymore associated with disease recurrence (NERD: p = 0.2605, HR [95% confidence interval (CI)] 2.213 [0.555–8.829; frontal CT score: p = 0.1640 HR [95% CI] 1.367 [0.880–2.124])
The main strengths of the investigation lie in the homogeneity of the series of patients considered since: (i) only cases of chronic rhinosinusitis with nasal polyps (CRSwNP) were considered; (ii) histopathological analyses were all undertaken by a dedicated head and neck pathologist; (iii) endoscopic sinus surgery (ESS) was performed by the same team of surgeons; (iv) the endoscopic follow-up after surgery was conducted by the same team; (v) recurrent CRSwNPs was always confirmed endoscopically
Summary
Chronic rhinosinusitis (CRS) is divided into two phenotype-based groups according to the presence (CRSwNPs) or absence of nasal polyps. This is definitely an overly simple classification given that CRS appears clinico-pathologically to be a very heterogeneous inflammatory condition. Rhinologists consider that CRSwNP is no longer a “unicum” but a group of several sub-types with different patho-physiological features, the so-called endotypes. Computed tomography (CT) is the most common imaging modality in CRSwNPs for the evaluation of inflammatory sinus mucosal disease [4,5]. CT scores have received further attention as potential hallmarks for recognizing CRSwNPs phenotypes, endotypes, and prognosis [7,9,10]. In a cohort of patients with CRS, olfactory test resulted as correlated negatively with the overall and ipsilateral LMS [12]
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