Clinical and Radiological Characteristics of Central Compartment Atopic Disease in Korea

Abstract

Background and Objectives Central compartment atopic disease (CCAD) has been studied with increasingly more importance as a distinct subtype of chronic rhinosinusitis with nasal polyp (CRSwNP). Studies have shown that CCAD in Western populations show a strong association with allergy and typical features of medial nasal structure and sinus involvement. The purpose of this study was to evaluate the clinical characteristics of CCAD and compare them to those of other subtypes of CRS in Korea.Subjects and Method A chart review was performed retrospectively at two tertiary rhinologic centers for patients who were treated with bilateral endoscopic sinus surgery for CRS with or without nasal polyp from January 2019 to December 2021. Patients were divided into three groups, namely CCAD, CRSwNP, and CRS without nasal polyps (CRSsNP), and demographics, clinical characteristics, and imaging data were compared among the three groups.Results A total of 150 patients were included in this study (50 patients in each group). CCAD showed similar nasal symptoms with CRSwNP, but higher rates of olfactory impairment than CRSsNP did. Allergy prevalence, serum total immunoglobulin E, and serum eosinophil were significantly higher in CCAD than in CRSwNP or CRSsNP. In CT scans of paranasal sinuses, CCAD showed significantly less haziness of maxillary sinus and higher ethmoid/maxillary score ratio than the other two groups. In addition, CT scans showed mucosal involvements of central compartment in CCAD.Conclusion CCAD has characteristic endoscopic and imaging findings, showing a high prevalence of allergy and a strong association with the markers of type 2 inflammation. Therefore, CCAD is a distinct disease of CRSwNP and its allergic etiology should be considered in the management of patients with CCAD phenotype.