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Chronic rhinosinusitis without nasal polyps: clinical characteristics and comorbid diseases

Published online: October 24, 2018

Chronic rhinosinusitis (CRS) is a common disease that is characterized by chronic inflammation of the paranasal sinuses ongoing for at least 12 weeks. CRS has been divided into two subtypes based on the presence of nasal polyps: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). These two subgroups not only differ in terms of presence of polyps, but also appear to have distinct pathogenesis and clinical presentations. There have been few studies that characterize CRSsNP patients, even though they make up the majority of the CRS patient population. Improved knowledge about this unique subtype of CRS patients can potentially lead to improvements in disease treatments and outcomes.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Benjamin et al sought to perform a comprehensive phenotypic characterization of subjects with CRSsNP in an academic clinic setting, using patients with CRSwNP as a comparator. All patients with CRS (5,525 patients) who were seen in the Allergy/Immunology or Otolaryngology clinics of an academic center between 2002 to 2012 were identified via diagnosis codes for acute sinusitis, chronic sinusitis, or nasal polyps or via procedure code for surgery for chronic sinusitis or nasal polyps. A retrospective chart review was then performed on a random subset of 507 patients with CRSsNP and 874 patients with CRSwNP. All charts were manually reviewed to confirm that the diagnosis of CRS was accurate and based on objective evaluation by CT scan and often endoscopy. They analyzed characteristics including demographics, comorbid conditions including allergic rhinitis and asthma, and severity of sinus computed tomography (CT) imaging.

This is the largest cohort of patients with CRSsNP characterized to date. The study was also unique in that it included both medically and surgically managed patients, whereas most prior studies focused only on surgical patients with CRSsNP. The researchers found that out of all patients identified to have CRS, approximately 80% had CRSsNP and approximately 20% had CRSwNP. The majority of CRSsNP patients were female, whereas CRSwNP patients were predominantly male. The prevalence of asthma in patients with CRSsNP was 36% versus 56% in those with CRSwNP. The severity of asthma, as measured by the forced expiratory volume in one second (FEV1), was similar between CRSsNP and CRSwNP patients. Those CRSsNP patients with asthma had similar radiologic disease severity to those without asthma. Over half (52%) of patients with CRSsNP also had comorbid allergic rhinitis, and these patients had a higher prevalence of severe sinus disease radiographically compared with those without allergic rhinitis. The prevalence of autoimmune diseases in patients with CRSsNP was approximately 15% and the prevalence of humoral immunodeficiency was approximately 6%.

In summary, the researchers found that CRSsNP and CRSwNP are distinct subgroups of CRS that differ in clinical presentation. By using objective diagnostic criteria, they were able to provide accurate epidemiologic data regarding the relative prevalence of patients with CRSsNP and CRSwNP in the United States. There was a large gender difference, with females being the majority of patients with CRSsNP, in this study. The researchers found a higher prevalence of comorbid asthma in patients with CRSsNP than previously reported, and therefore, physicians treating patients with CRSsNP need to be aware of this strong association and consider screening for asthma. In addition, comorbid allergic rhinitis seems to affect radiologic sinus disease severity. Though the prevalence of autoimmune diseases in CRSsNP was higher than expected, the contribution of these comorbidities to CRS disease severity is unknown. Further studies are needed to evaluate the impact of comorbidities such as asthma, allergic rhinitis, humoral immunodeficiency and autoimmune diseases on the clinical expression and severity of CRSsNP.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

18-00479, Clinical characteristics of patients with chronic rhinosinusitis without nasal polyps in an academic setting