Disease involvement in the central compartment in eosinophilic chronic rhinosinusitis

Abstract

Objective: To evaluate disease presence in the central compartment (CC) in patients with eosinophilic chronic rhinosinusitis (CRS).Methods: Patients with eosinophilic CRS were divided into three endotypes: aspirin-exacerbated respiratory disease (AERD), allergic fungal rhinosinusitis (AFRS), and eosinophilic CRS with nasal polyps (eCRSwNP). CT scans were reviewed for CC involvement, defined as the area between the superior nasal septum (SNS) and middle turbinate (MT). CC involvement was measured based on the degree of opacification (0: no opacification, 1: up to 50% opacification, and 2: >50% opacification), and distance from SNS to MT (mm). Patients who had lateralized MTs from prior surgery as the cause of CC widening were excluded. Patients who underwent orbital decompression were included as a control group.Results: Fifty patients in each group (AERD, AFRS, and eCRSwNP) and 50 control patients were included. Average number of surgeries was 2.5 in AERD (p = 0.05), 2 in AFRS (p = 0.4), and 1.7 in eCRSwNP. Preoperative CC distance was significantly higher in AERD versus control, AFRS, and eCRSwNP: 4.2 versus 2.8 mm (p < 0.0001), 4.2 versus 1.9 mm (p < 0.0001), and 4.2 versus 2.7 mm (p < 0.0001), respectively. Postoperatively, CC distance and degree of opacification were significantly higher in AERD versus control, AFRS, and eCRSwNP.Within the AERD group, CC distance was significantly higher postoperatively than preoperatively (6.5 vs. 4.2 mm, p = 0.002). Conclusion:CC involvement is more significant in AERD patients and if present, rhinologists should be suspicious of the diagnosis. This area could represent a source of inflammatory load in patients with AERD.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…In a study by Lin et al., 3016 patients with minor CC radiologic findings and essentially normal endoscopy were included in the CC‐CRSsNP group, which may not meet the definition of CCAD according to DelGaudio et al 1222 . While CCAD is a distinct variant of sinonasal disease, CC disease can be found in other processes such as AERD and respiratory epithelial adenomatoid hamartoma, with studies reporting a positive association with AR 1223,3017,3018 …”

Year in review: 2021 IFAR article summary

“…Meanwhile, a radiologic investigation of central compartment size (defined as the area between superior and middle turbinates) in patients with AERD compared to those with allergic fungal rhinosinusitis (AFRS), eosinophilic CRS with nasal polyposis (CRSwNP), and controls demonstrated a larger central compartment size in patients with AERD, suggesting a possible radiologic marker of AERD. 20 In a study evaluating the utility of eosinophil cationic protein, Lu et al 21 prospectively demonstrated that preoperative evaluation of this laboratory marker was associated with recurrence of polyps postoperatively regardless of atopy status.…”

“…used modern sequencing techniques to demonstrate microbiome dysbiosis characterized by a loss of diversity and a high relative abundance of pathogenic bacterial species in patients with AERD. Meanwhile, a radiologic investigation of central compartment size (defined as the area between superior and middle turbinates) in patients with AERD compared to those with allergic fungal rhinosinusitis (AFRS), eosinophilic CRS with nasal polyposis (CRSwNP), and controls demonstrated a larger central compartment size in patients with AERD, suggesting a possible radiologic marker of AERD 20 . In a study evaluating the utility of eosinophil cationic protein, Lu et al 21 .…”