Clinical Characteristics of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps in Adolescents

Abstract

Introduction

Eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with greater inflammation, poorer prognosis, and a high recurrence rate after sinus surgery.

Objective

This study evaluated the clinical and imaging characteristics of eosinophilic CRSwNP in patients aged 12–17.

Methods

We retrospectively enrolled 139 patients aged 12–17 with bilateral CRSwNP. Clinical characteristics, computed tomography (CT) features, tissue eosinophil counts, and eosinophil activity were evaluated.

Results

Twenty-three (16.5%) patients had recurrent nasal polyps that required revision surgery. Patients requiring revision surgery had higher tissue eosinophil infiltration in the sinus mucosa than those not requiring revision surgery. The optimal cut-off value to distinguish the need for revision surgery was a tissue eosinophil count > 21.5/high-power field determined by the receiver operating characteristic curve. The Lund-Mackay and olfactory cleft opacification scores on CT images were significant predictors of tissue eosinophil count in the univariate analysis, and only olfactory opacification scores remained statistically significant in the multivariate analysis.

Conclusion

This study revealed that the CT feature of the olfactory cleft opacification score could be a significant characteristic of eosinophilic CRSwNP in adolescents.

Plain Language Summary

Chronic rhinosinusitis (CRS) is an inflammation of the nasal and sinus mucosa characterized by nasal obstruction, mucopurulent rhinorrhea, facial pain/pressure, and decreased or loss of smell for over 12 weeks.

CRS is classified as CRS without nasal polyps or CRS with nasal polyps (CRSwNP), depending on the presence of nasal polyps. Based on the predominance of tissue inflammatory cell infiltration by eosinophils or neutrophils, CRS can be categorized into eosinophilic and neutrophilic entities. Eosinophilic CRSwNP is clinically characterized by a greater extent of inflammation, more severe clinical symptoms and high recurrence rate after sinus surgery. Thus, early identification of the endotypes in patients with CRS is important for determining prognosis and treatment strategies.

This study retrospectively enrolled 139 patients aged 12–17 with bilateral CRSwNP. Clinical characteristics, CT features, tissue eosinophil counts, and eosinophil activity were evaluated. The results showed that patients requiring revision surgery had higher tissue eosinophil infiltration in the sinus mucosa than those not requiring revision surgery. The optimal cut-off value to distinguish the need for revision surgery was a tissue eosinophil count > 21.5/high-power field. The Lund-Mackay and olfactory cleft opacification scores on CT images were significant predictors of tissue eosinophil count in the regression analysis.

Keywords:

• adolescent
• chronic rhinosinusitis
• computed tomography
• eosinophil
• nasal polyp

Abbreviations

CRS, Chronic rhinosinusitis; CRSwNP, CRS with nasal polyps; CT, computed tomography; CRS, chronic rhinosinusitis; CT, computed tomography; ESS, endoscopic sinus surgery; HPF, high-power field; IHC, immunohistochemistry; ECP, eosinophilic cationic protein; ROI, regions of interest; EM ratio, ethmoid/maxillary ratio; ROC, receiver operating characteristic; AUC, area under the curve; JESREC, the Japanese Epidemiological Survey of Refractory Eosinophilic CRS study; IL, interleukin.

Terms and Definitions

Chronic rhinosinusitis: an inflammation of the nasal and sinus mucosa for more than 12 weeks.

Nasal polyp: Description of benign inflammatory and hyperplastic outgrowths of the sinonasal mucosa.

Eosinophilia: Description of an unusual infiltration of high number of eosinophils in tissue.

Adolescent: Description of someone between the ages of 12 and 17.

Endoscopic sinus surgery: Description of a procedure to remove blockages and treat other problems in the sinuses using an endoscope.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

The authors received research grants from the Chang Gung Memorial Hospital (CMRPG2K0161) and Taiwan National Science and Technology Council (110-2314-B-182 -063 -; 111-2314-B-182 -067 -;111-2635-B-182A-008 -). The funder had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.