Differential histopathological features and comorbidity profiles in chronic rhinosinusitis phenotypes.

BACKGROUND AND

OBJECTIVES

The aim of this study was to analyze histopathological (HP) changes, blood eosinophil levels, and comorbidities associated with Type 2 inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP), in order to determine the prevalence of inflammatory endotypes among chronic rhinosinusitis (CRS) patients in Romania.

PATIENTS, MATERIALS AND

METHODS

This retrospective, observational, nonrandomized study has been conducted between January 2021-December 2022 enrolling 186 consecutive patients with CRSwNP (Group A, n=119 patients) and CRSsNP (Group B, n=67 patients), for whom endoscopic sinus surgery (ESS) have been performed.

RESULTS

Among the CRSwNP group, 27 (23%) patients had asthma, and 22 (18.48%) patients had associated nonsteroidal anti-inflammatory drugs (NSAIDs) hypersensitivity, in comparison with CRSsNP group, where we found two (3.03%) patients who had associated asthma and one (1.51%) patient who had associated NSAIDs hypersensitivity. Among the CRSsNP (Group B) patients, 18 (27%) had peripheral blood hypereosinophilia, while eosinophilic infiltration was identified in the HP analysis of biopsy samples from 18 (27%) individuals in this group. Among the cohort of patients diagnosed with CRSwNP, 56 (47%) had blood hypereosinophilia, while eosinophils were detected in the HP analysis of biopsy samples from 73 (61%) individuals.

CONCLUSIONS

This research reinforces the critical role of endotyping in CRS, moving beyond simple phenotypic classification. By identifying specific biological mechanisms, clinicians can better predict disease behavior and treatment response.