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CRS Patients Likely to Have a Central Radiological Pattern

by ENTtoday •

Is a centrally limited radiological pattern more likely to be associated with inhalant allergen sensitization among chronic rhinosinusitis (CRS) patients?

Bottom line
A central radiological pattern of mucosal disease is associated with inhalant allergen sensitization.

Background: Polypoid edema of the middle turbinate is a marker of inhalant allergy. Extensive edematous changes may result in limited central nasal and sinus disease, called central compartment atopic disease (CCAD), which may give rise to CRS. Radiologically, this is seen as soft tissue thickening in the central portion of the sinonasal cavity with or without paranasal sinus involvement.

Study design: Diagnostic cross-sectional study of 112 consecutive CRS patients without prior sinus surgery, representing 224 sides, at a tertiary referral clinic.

Setting: St. Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.

Synopsis: Among the allergen sensitized, 53.97% were polysensitized, 68.25% were sensitized to grass, 65.08% to dust, 28.57% to molds, and 25.45% to animal epithelium. Moderate-or-worse nasal symptoms included the need to blow the nose, sneezing, and runny nose. Fifty-one percent of CT scans were performed during pollen season. Baseline characteristics between the nonatopic and allergen-sensitized group were similar, except for age (the allergen-sensitized group was significantly younger). Centrally limited disease classification was found in the sphenoid sinuses, frontal sinuses, posterior ethmoid sinuses, maxillary sinuses, and anterior ethmoids sinuses. There was no association between any individual centrally limited sinus cavity and allergen sensitization. The CCAD radiologic phenotype was associated with allergen sensitization, but there was no difference in the individual rhinologic scores between the CCAD radiologic phenotype and the other non-CCAD radiological patterns of disease. Dust sensitization was more frequent among the CCAD radiologic phenotype. CCAD radiological phenotype gave a sensitivity of 19.84% and a specificity of 90.82% to diagnose allergen sensitization. Limitations included a cross-sectional design representative that was not seasonal and scores that did not differentiate those with clinically significant allergic symptoms.

Citation: Hamizan AW, Loftus PA, Alvarado R, et al. Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease. Laryngoscope. March 30, 2018. doi: 10.1002/lary.27180.