Polypoid Change of the Middle Turbinate and Paranasal Sinus Polyposis Are Distinct Entities

Abstract

Objectives Polypoid change of the middle turbinate (PCMT) is a finding on intranasal examination whose significance is not well understood. We present a comparison of the clinical characteristics of PCMT with paranasal sinus polyposis (PSP), a common condition with potentially similar appearance. Study Design Parallel case series. Setting Tertiary rhinology clinic. Subjects and Methods Data were prospectively compiled from consecutive patients during a 12-month period with either PSP arising from the middle meatus or PCMT limited to the middle turbinate as identified on nasal endoscopy. Recorded data included comorbidities, the 22-item Sinonasal Outcome Test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), Lund-Mackay score from computed tomography (CT) imaging, and total eosinophil levels. Results Of 593 patients, 23 (3.9%) had PCMT and 44 (7.4%) had PSP. The PSP group was predominantly male (75% vs 52%, P < .001) with an older mean age (53.4 vs 35.4 years, P < .0001). PCMT was more often associated with allergic rhinitis (83% vs 34%, P < .001), whereas PCMT was rarely associated with chronic rhinosinusitis (10% vs 100%, P < .0001). Mean eosinophil count (7.1 vs 3.1, P = .096) was not significantly different between groups, whereas mean Lund-Mackay score was higher in PSP (14.9 vs 2.8, P < .0008). Mean NOSE score was greater in PSP (65.3 vs 46.8, P = .025), whereas SNOT-22 score was comparable between groups (40.6 vs 34.6, P = .29). Conclusion PCMT is a unique physical finding with clinical associations that distinguish it from PSP. PCMT has greater association with allergic rhinitis than chronic rhinosinusitis, and both PCMT and PSP are associated with impaired quality of life.

Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease

“…Recently, a study on middle turbinate polyposis described the endoscopic equivalent of what is radiologically described as CCAD . Brunner et al described this group as distinct from true nasal polyposis as they were younger (35.4 ± 12.5 years vs 53.4 ± 16.4 years, P < .001), more likely to have allergic rhinitis (83% vs. 34%, P < .001), less likely to have aspirin exacerbated respiratory disease (16% vs. 0%, P = .024), and had less symptom burden.…”

“…This centrally limited disease has been described as middle turbinate polyp with secondary sinus involvement . In this study, allergy was suspected as an underlying pathophysiology, as this entity differed from classic sinonasal polyposis with allergic rhinitis over‐represented (83% vs. 34%, P < .001) .…”

“…This centrally limited disease has been described as middle turbinate polyp with secondary sinus involvement . In this study, allergy was suspected as an underlying pathophysiology, as this entity differed from classic sinonasal polyposis with allergic rhinitis over‐represented (83% vs. 34%, P < .001) . In contrast, eosinophilic CRS is primarily a non–IgE‐mediated inflammatory disorder of the sinuses, classically occurring in adults with or without history of prior inhalant allergy .…”

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

“…An association between edematous/polypoid changes of the middle turbinate (MT) and positive allergy status was first described in 2014 . This association was further supported by 2 additional studies . CCAD, described in 2017, is a nasal inflammatory polypoid condition strongly associated with inhalant allergy, involving the superior nasal septum (NS) with or without the MT and/or superior turbinate (ST) .…”

“…4 This association was further supported by 2 additional studies. 5,6 CCAD, described in 2017, is a nasal inflammatory polypoid condition strongly associated with inhalant allergy, involving the superior nasal septum (NS) with or without the MT and/or superior turbinate (ST). 7,8 Inhalant allergen deposition in these central compartment structures is related to the course of normal nasal airflow.…”