Clinical Characteristics of Patients with Chronic Rhinosinusitis without Nasal Polyps in an Academic Setting

Abstract

Background: Although patients with chronic rhinosinusitis without nasal polyps (CRSsNP) represent a majority of the chronic rhinosinusitis (CRS) population, they have not been completely characterized phenotypically.

Objective: To perform a comprehensive phenotypic characterization of subjects with CRSsNP, using CRS with nasal polyps (CRSwNP) as a comparator.

Methods: Patients with a history of CRS with positive sinus computed tomography (>18 years old) evaluated in the allergy/immunology or otolaryngology clinics of an academic center between 2002 and 2012 were identified via International Classification of Diseases, Ninth Revision codes. A retrospective chart review was performed on a subset of 507 patients with CRSsNP and 874 with CRSwNP. Characteristics analyzed included demographics, comorbid conditions, and radiologic sinus severity.

Results: Of the total CRS population, approximately 82% had CRSsNP and 18% had CRSwNP. Of the 507 patients in the CRSsNP group, 319 (63%) were female compared with 393 of 847 (45%) in the CRSwNP group. The prevalence of atopy was 52% in CRSsNP versus 76% in CRSwNP (P < .0001). In CRSsNP, atopic patients had more severe radiographic disease compared with nonatopic patients (P < .005). The prevalence of asthma was 36% in CRSsNP versus 56% in CRSwNP (P < .0001). Comorbid asthma was not associated with radiographic sinus disease severity in CRSsNP but was associated with severity in CRSwNP (P < .0001).

Conclusions: The relative prevalence of CRS phenotypes in the western population is approximately 80% CRSsNP and 20% CRSwNP. Patients with CRSsNP were predominantly female, whereas patients with CRSwNP were predominantly male. The prevalence of asthma was higher in our cohort of patients with CRSsNP than previously described. Atopy was associated with more severe radiographic sinonasal disease in CRSsNP, whereas asthma was not associated with radiographic sinonasal disease severity.

Keywords: Allergic rhinitis; Asthma; Chronic rhinosinusitis; Chronic rhinosinusitis without nasal polyps; Nasal polyps.

Conflict of interest statement

Conflicts of Interest:

L. C. Grammer reports grants from NIH, grants from Bazley Foundation, during the conduct of the study; reports personal fees from consultancy with Astellas Pharmaceuticals, lectures including service on speakers’ bureaus from AAAAI, Mount Sinai, New York, NY, grants from NIH, Food Allergy Network and Bazley Foundation, and personal fees from Lippincott, UpToDate, BMJ, Elsevier, Kluwers Wolter, outside the submitted work. R. C. Kern reports serving as a consultant for Sanofi and 480 Biomedical, outside the submitted work. B. K. Tan reports grants from NIH, personal fees from Optinose, Inc, personal fees from Sanofi, and a patent pending for Treatment of Eosinophilic Inflammatory Disease pending, outside the submitted work. R. P. Schleimer Dr. Schleimer reports grants from NIH during the conduct of the study; reports personal fees from serving as a consultant for Intersect ENT, GlaxoSmithKline, Allakos, Aurasense, Merck, BioMarck, Sanofi, AstraZeneca/Medimmune, Genentech, Exicure Inc, Otsuka Inc, Aqualung Therapeutics Corp, ActoBio Therapeutics, outside the submitted work. In addition, R. P. Schleimer has Siglec-8 and Siglec-8 ligand related patents licensed to Allakos Inc. A. T. Peters previously served as a consultant for Sanofi-Regeneron. The rest of the authors declare that they have no relevant conflict of interests.

Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1:

Algorithm for patient selection. Criteria for confirmed diagnosis of chronic rhinosinusitis is detailed in the methods section. Abbreviations: AERD, Aspirin-Exacerbated Respiratory Disease; CRSsNP, Chronic Rhinosinusitis without Nasal Polyps; CRSwNP, Chronic Rhinosinusitis with Nasal Polyps.

Figure 2:

Forced expiratory volume in one second (FEV1) percent predicted in African American patients compared to Non-African American patients with CRSsNP. Statistical significance determined by Mann Whitney test, P = 0.002.

Figure 3:

Radiologic sinus score in patients with chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP), subdivided by presence of comorbid asthma. Statistical significance determined by Kruskal-Wallis test, *** P<0.001.

Figure 4:

Prevalence of comorbid allergic rhinitis in patients with chronic rhinosinusitis without nasal polyps of either mild or moderate to severe status. Mild indicates radiologic sinus scores of 1-2 and moderate to severe indicates scores of 3-5. Statistical significance determined by Chi-square test, ** P<0.005.

Figure 5:

Physician diagnosis of comorbid conditions in patients with chronic rhinosinusitis without nasal polyps. Abbreviations: CVID, Common Variable Immunodeficiency; Specific Ab Def, Specific Antibody Deficiency; Hypogam, Hypogammaglobulinemia.