Pathophysiological classification of chronic rhinosinusitis.
BACKGROUND
Recent consensus statements demonstrate the breadth of the chronic rhinosinusitis (CRS) differential diagnosis. However, the classification and mechanisms of different CRS phenotypes remains problematic.


METHODS
Statistical patterns of subjective and objective findings were assessed by retrospective chart review.


RESULTS
CRS patients were readily divided into those with (50/99) and without (49/99) polyposis. Aspirin sensitivity was limited to 17/50 polyp subjects. They had peripheral blood eosinophilia and small airways obstruction. Allergy skin tests were positive in 71% of the remaining polyp subjects. IgE was<10 IU/ml in 8/38 polyp and 20/45 nonpolyp subjects (p = 0.015, Fisher's Exact test). CT scans of the CRS without polyp group showed sinus mucosal thickening (probable glandular hypertrophy) in 28/49, and nasal osteomeatal disease in 21/49. Immunoglobulin isotype deficiencies were more prevalent in nonpolyp than polyp subjects (p < 0.05).


CONCLUSIONS
CRS subjects were retrospectively classified in to 4 categories using the algorithm of (1) polyp vs. nonpolyp disease, (2) aspirin sensitivity in polyposis, and (3) sinus mucosal thickening vs. nasal osteomeatal disease (CT scan extent of disease) for nonpolypoid subjects. We propose that the pathogenic mechanisms responsible for polyposis, aspirin sensitivity, humoral immunodeficiency, glandular hypertrophy, eosinophilia and atopy are primary mechanisms underlying these CRS phenotypes. The influence of microbial disease and other factors remain to be examined in this framework. We predict that future clinical studies and treatment decisions will be more logical when these interactive disease mechanisms are used to stratify CRS patients.
Baraniuk
James N
JN
Georgetown University Proteomics Laboratory, Division of Rheumatology Immunology and Allergy, Room B105, Lower Level Kober-Cogan Building, Georgetown University, 3800 Reservoir Road, NW Washington, DC 20007-2197, USA. baraniuj@georgetown.edu
Maibach
Hilda
H
D000328:Adult; D001760:Bleeding Time / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012852:Sinusitis / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology