Clinical Characteristics of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps in Adolescents

Chien-Chia Huang,1,2 Po-Hung Chang,1,* Yen-Lin Huang,3– 5 Ta-Jen Lee,1,2,6 Chi-Che Huang,1,2 Pei-Wen Wu1,2,* 1Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 4School of Medicine, National Tsing-Hua University, Hsinchu, Taiwan; 5Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 6Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Pei-Wen Wu, Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, Tel +886-3-3281200 ext. 8466, Fax +886-3-3979361, Email a9665@cgmh.org.twIntroduction: 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 poly