Diagnostic challenges of central compartment atopic disease in type-2 chronic rhinosinusitis.

Ramón Moreno Luna, Julissa Vizcarra Melgar, Daniel Martín Jiménez, Meritxell Clari Comes, Pedro Infante Cossio, Serafín Sánchez Gómez
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Abstract

Background: Central compartment atopic disease (CCAD) is an emerging phenotype of type-2 chronic rhinosinusitis (CRS), characterized by inflammation involving the central nasal structures. The absence of standardized diagnostic criteria has hindered its recognition. This study aims to describe the first European cohort of CCAD patients and compare its features with previously published international data.

Materials and methods: A retrospective observational study was conducted including adult patients diagnosed with CCAD at a tertiary rhinology unit (2021-2024), based on predefined endoscopic and radiologic criteria. Demographic, clinical, exploratory, analytical and quality-of-life data were collected. Descriptive statistics were used to characterize the baseline profile of the study population.

Results: The cohort of 93 CCAD patients was predominantly male (65.6%) with a mean age of 48.7 ± 12.2 years. The baseline SNOT-22 score averaged 61.5 ± 24.3, with marked olfactory impairment. Asthma and N-ERD were reported in 40.9% and 7.5% of cases, respectively; allergic sensitization was confirmed in 60.2%. The mean endoscopic scores were 4.0 ± 2.2 for the nasal polyp score and 7.5 ± 2.5 for the modified Lund-Kennedy scale, while the mean CT-scan score was 11.7 ± 3.8. Blood eosinophilia >150 cells/μL was present in 77.4% of patients, and tissue eosinophil counts averaged 49.9 ± 43.8 eosinophils per high-power field.

Conclusion: This study reinforces CCAD as a localized type-2 CRS phenotype with a distinctive atopic signature. Findings underscore the need for standardized diagnostic criteria to improve its recognition and guide more personalized therapeutic strategies.

背景:中央室特应性疾病(CCAD)是2型慢性鼻窦炎(CRS)的一种新兴表型,其特征是炎症累及中央鼻结构。缺乏标准化的诊断标准阻碍了对该病的认识。本研究旨在描述首个欧洲CCAD患者队列,并将其特征与先前发表的国际数据进行比较。材料和方法:根据预先确定的内镜和放射学标准,对三级鼻科诊断为CCAD的成年患者(2021-2024)进行了一项回顾性观察研究。收集了人口学、临床、探索性、分析性和生活质量数据。描述性统计用于描述研究人群的基线概况。结果:93例CCAD患者以男性为主(65.6%),平均年龄48.7±12.2岁。基线SNOT-22评分平均为61.5±24.3,有明显的嗅觉障碍。哮喘和N-ERD分别占40.9%和7.5%;60.2%为过敏性致敏。鼻息肉内镜评分平均为4.0±2.2分,改良Lund-Kennedy评分平均为7.5±2.5分,ct扫描评分平均为11.7±3.8分。77.4%患者血嗜酸性粒细胞为bb0 150个/μL,高倍视场组织嗜酸性粒细胞平均为49.9±43.8个。结论:本研究强调CCAD是一种具有独特特应性特征的局部2型CRS表型。研究结果强调需要标准化的诊断标准,以提高对其的认识,并指导更个性化的治疗策略。
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