Central compartment atopic disease: outcomes compared with other subtypes of chronic rhinosinusitis with nasal polyps

Abstract

Background: Central compartment atopic disease (CCAD) is a variant of chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) characterized by polypoid changes of the superior nasal septum, middle (MT), and/or superior turbinates (ST). This study evaluates surgical outcomes in patients with CCAD compared with other CRSwNP subtypes. Methods: Retrospective analysis was performed at Emory University from May 2012 to November 2019. Patients undergoing primary endoscopic sinus surgery (ESS) for CCAD, aspirin-exacerbated respiratory disease (AERD), allergic fungal rhinosinusitis (AFRS), and CRSwNP not otherwise specified (CRSwNP NOS) were included consecutively, beginning with the earliest date of CCAD patient. Outcome measures included polyp recurrence, revision ESS, oral steroid use, and oral antibiotic use. Pearson chi-square and univariate analysis of variance (ANOVA) were performed for group comparisons.Results: Data was collected for 132 patients (CCAD = 38, AERD = 20, AFRS = 37, CRSwNP NOS = 37; 58 females, mean age 42.9 years [range, 13-85 years]). CCAD patients demonstrated polyp recurrence less frequently than expected, whereas AFRS patients had polyp recurrence more frequently than expected (p = 0.003; phi 0.32). CCAD patients underwent revision ESS less frequently than expected; AFRS and CRSwNP NOS underwent revision ESS more frequently than expected (p = 0.03; phi 0.26). CRSwNP NOS patients received more total antibiotic courses than those with CCAD (p = 0.01; eta-squared 0.09) and more courses of antibiotics per month than those with AFRS (p = 0.03; eta-squared 0.07). There was no significant difference in follow-up measures across groups (number of visits, total months, or visits per month). Conclusion:Rates of polyp recurrence and revision ESS were significantly lower in CCAD patients compared with patients with other CRSwNP subtypes, suggesting durable benefit of ESS and postoperative medical therapy in CCAD patients.

Chinese Central Compartment Atopic Disease: The Clinical Characteristics and Cellular Endotypes Based on Whole-Slide Imaging

“… 7 Eosinophilic CRSwNP was defined when the percentage of tissue eosinophils exceeded 10% of total infiltrating cells. 1 CCAD was identified as previously reported, 2 , 11 positive inhalant allergen test was accompanied with polypoid changes of MT, ST, and PSNS. These central compartment polypoid changes are evident both with nasal endoscopy and radiographic imaging.…”

“…Patients with sinonasal polyps but without a polypoid change in the central compartment, or not meeting the criteria for aspirin exacerbated respiratory disease (AERD), and AFRS were listed as CRSwNP not otherwise specified. 11 Patients with polypoid changes in the central compartment and concomitant sinonasal polyps were also analyzed with the CCAD cohort. 11 Allergic rhinitis was diagnosed based on the concordance between a typical history of allergic symptoms and positive atopy test.…”

“… 11 Patients with polypoid changes in the central compartment and concomitant sinonasal polyps were also analyzed with the CCAD cohort. 11 Allergic rhinitis was diagnosed based on the concordance between a typical history of allergic symptoms and positive atopy test. 23 Asthma was diagnosed based on Global Initiative for Asthma guideline.…”

“…Opening of diseased sinuses is also performed if they are involved. 11 Postoperative standard maintenance therapy in any CRSwNP subtype typically includes steroid sprays, oral steroids, antibiotics, saline irrigation, and regular clinic follow-up for interval nasal endoscopy.…”

“… 9 Different inflammatory cell endotypes contribute to distinct treatment strategy. 10 CCAD, as a new phenotype of CRS, has been studied in the North America and Australia previously, 2 , 5 , 11 while the investigation of CCAD in Chinese populations has been limited. Moreover, current understanding of CCAD lacks detailed recognition of its cellular endotypes.…”