Computed Tomography Findings Can Help Identify Different Chronic Rhinosinusitis With Nasal Polyp Phenotypes

Abstract

Background Chronic rhinosinusitis with nasal polyps (CRSwNPs) has several phenotypes. Objectives The goal of this study was to evaluate computed tomography (CT) findings associated with each CRSwNP phenotype. Methods Patient charts between January 2015 and March 2019 were retrospectively reviewed. Patient groups, including allergic fungal rhinosinusitis (AFRS), aspirin-exacerbated respiratory disease (AERD), central compartment atopic disease (CCAD) and CRSwNP not otherwise specified (CRSwNP NOS), were determined by standard criteria. The oldest CT scan available was reviewed for Lund–Mackay (LM) score, septal involvement of inflammatory disease, opacification of olfactory clefts, nasal cavity opacification, and oblique positioning of the middle turbinates. Nonparametric analyses of variance were performed with correction for multiple comparisons. Results A total of 356 patients had scans available for review; 80 (23%) patients were categorized into the AFRS group, 101 (28%) in the AERD group, 43 (12%) in the CCAD group, and 132 (37%) in the CRSwNP NOS group. Septal inflammatory involvement and oblique middle turbinate orientation on CT scans was higher in both AERD patients and CCAD patients as compared to AFRS and CRSwNP NOS patients ( P < .05). Olfactory cleft opacification was increased in the AERD group compared to all other diagnoses ( P < .05). The CCAD group showed lower LM scores compared to all other groups ( P < .05), and the AFRS group revealed the greatest differences between left and right LM grades, representing unilaterality of disease ( P < .05). Conclusion CRSwNP encompasses many subsets of disease, which have varying treatments and intraoperative findings. Preoperative CT findings can be used to differentiate between these groups to improve prediction of diagnoses and patient counseling.

Disease involvement in the central compartment in eosinophilic chronic rhinosinusitis

“…Our study illustrates that AERD patients have the additional feature of involving the CC more commonly and more extensively compared with other subtypes of CRSwNP. This is in line with previous work by DelGaudio's group 12 . They found high prevalence of olfactory cleft and septal inflammation in patients with AERD, which cause lateralization and oblique MT.…”

“…This is in line with previous work by DelGaudio's group. 12 They found high prevalence of olfactory cleft and septal inflammation in patients with AERD, which cause lateralization and oblique MT.…”

Central compartment atopic disease: the missing link in the allergy and chronic rhinosinusitis with nasal polyps saga

“…The “central” radiologic findings were found to correlate with allergy status in a paper by Hamizan et al 7 . Additional radiologic findings that can distinguish CCAD from other subtypes of CRSwNP include nasal septal thickening and obliquely positioned middle turbinates, due to the central compartment polyps 8 …”

Clinical evaluation and diagnosis of aspirin-exacerbated respiratory disease

“…5 In addition, their CT scans are more likely to show septal involvement and opacification of the olfactory cleft. 79 Plain sinus radiographs have both poor sensitivity and specificity and therefore have no useful role in assessment of patients with NPs. 73…”