Introduction: Eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with greater inflammation, poorer prognosis, and a high recurrence rate after sinus surgery.
Objective: This study evaluated the clinical and imaging characteristics of eosinophilic CRSwNP in patients aged 12– 17.
Methods: We retrospectively enrolled 139 patients aged 12– 17 with bilateral CRSwNP. Clinical characteristics, computed tomography (CT) features, tissue eosinophil counts, and eosinophil activity were evaluated.
Results: Twenty-three (16.5%) patients had recurrent nasal polyps that required revision surgery. Patients requiring revision surgery had higher tissue eosinophil infiltration in the sinus mucosa than those not requiring revision surgery. The optimal cut-off value to distinguish the need for revision surgery was a tissue eosinophil count > 21.5/high-power field determined by the receiver operating characteristic curve. The Lund-Mackay and olfactory cleft opacification scores on CT images were significant predictors of tissue eosinophil count in the univariate analysis, and only olfactory opacification scores remained statistically significant in the multivariate analysis.
Conclusion: This study revealed that the CT feature of the olfactory cleft opacification score could be a significant characteristic of eosinophilic CRSwNP in adolescents.

Plain Language Summary: Chronic rhinosinusitis (CRS) is an inflammation of the nasal and sinus mucosa characterized by nasal obstruction, mucopurulent rhinorrhea, facial pain/pressure, and decreased or loss of smell for over 12 weeks.
CRS is classified as CRS without nasal polyps or CRS with nasal polyps (CRSwNP), depending on the presence of nasal polyps. Based on the predominance of tissue inflammatory cell infiltration by eosinophils or neutrophils, CRS can be categorized into eosinophilic and neutrophilic entities. Eosinophilic CRSwNP is clinically characterized by a greater extent of inflammation, more severe clinical symptoms and high recurrence rate after sinus surgery. Thus, early identification of the endotypes in patients with CRS is important for determining prognosis and treatment strategies.
This study retrospectively enrolled 139 patients aged 12– 17 with bilateral CRSwNP. Clinical characteristics, CT features, tissue eosinophil counts, and eosinophil activity were evaluated. The results showed that patients requiring revision surgery had higher tissue eosinophil infiltration in the sinus mucosa than those not requiring revision surgery. The optimal cut-off value to distinguish the need for revision surgery was a tissue eosinophil count > 21.5/high-power field. The Lund-Mackay and olfactory cleft opacification scores on CT images were significant predictors of tissue eosinophil count in the regression analysis.

Keywords: adolescent, chronic rhinosinusitis, computed tomography, eosinophil, nasal polyp


中文翻译：

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青少年嗜酸性慢性鼻窦炎伴鼻息肉的临床特点

简介：嗜酸粒细胞性慢性鼻窦炎伴鼻息肉 (CRSwNP) 通常与鼻窦手术后炎症加剧、预后较差和高复发率相关。
目的：本研究评估 12-17 岁患者嗜酸性 CRSwNP 的临床和影像学特征。
方法：我们回顾性纳入 139 名 12-17 岁双侧 CRSwNP 患者。评估了临床特征、计算机断层扫描（CT）特征、组织嗜酸性粒细胞计数和嗜酸性粒细胞活性。
结果： 23 名 (16.5%) 患者患有复发性鼻息肉，需要进行修复手术。需要修复手术的患者比不需要修复手术的患者在窦粘膜中组织嗜酸性粒细胞浸润更高。区分是否需要翻修手术的最佳截止值是组织嗜酸性粒细胞计数 > 21.5/高倍视野，由受试者工作特征曲线确定。在单变量分析中，CT 图像上的 Lund-Mackay 和嗅裂混浊评分是组织嗜酸性粒细胞计数的显着预测因子，而在多变量分析中，只有嗅觉混浊评分仍然具有统计学意义。
结论：本研究表明，嗅裂混浊评分的 CT 特征可能是青少年嗜酸粒细胞性 CRSwNP 的显着特征。

通俗语言摘要：慢性鼻窦炎 (CRS) 是鼻和鼻窦粘膜的炎症，其特征为鼻塞、粘液脓性鼻漏、面部疼痛/压力以及嗅觉减退或丧失超过 12 周。
根据是否存在鼻息肉，CRS 分为不伴鼻息肉的 CRS 或伴鼻息肉的 CRS (CRSwNP)。根据组织炎症细胞以嗜酸性粒细胞或中性粒细胞浸润为主，CRS可分为嗜酸性粒细胞型和中性粒细胞型。嗜酸性粒细胞性鼻窦炎的临床特点是炎症程度更大、临床症状更严重、鼻窦手术后复发率高。因此，早期识别 CRS 患者的内型对于确定预后和治疗策略非常重要。
本研究回顾性纳入了 139 名 12-17 岁双侧 CRSwNP 患者。评估临床特征、CT 特征、组织嗜酸性粒细胞计数和嗜酸性粒细胞活性。结果显示，需要修复手术的患者鼻窦粘膜组织嗜酸性粒细胞浸润高于不需要修复手术的患者。区分是否需要翻修手术的最佳截止值是组织嗜酸性粒细胞计数 > 21.5/高倍视野。CT 图像上的 Lund-Mackay 评分和嗅裂混浊评分是回归分析中组织嗜酸性粒细胞计数的显着预测因子。

关键词：青少年，慢性鼻窦炎，计算机断层扫描，嗜酸性粒细胞，鼻息肉