Makary Chadi A, Falco Jeffrey, Sussman Sarah, Ryan Lindsey, Reyes Camilo, Ramadan Hassan, Kountakis Stilianos E
Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia-Augusta University, Augusta, Georgia, USA.
Int Forum Allergy Rhinol. 2021 Oct;11(10):1417-1423. doi: 10.1002/alr.22803. Epub 2021 Apr 17.
To evaluate disease presence in the central compartment (CC) in patients with eosinophilic chronic rhinosinusitis (CRS).
Patients with eosinophilic CRS were divided into three endotypes: aspirin-exacerbated respiratory disease (AERD), allergic fungal rhinosinusitis (AFRS), and eosinophilic CRS with nasal polyps (eCRSwNP). CT scans were reviewed for CC involvement, defined as the area between the superior nasal septum (SNS) and middle turbinate (MT). CC involvement was measured based on the degree of opacification (0: no opacification, 1: up to 50% opacification, and 2: >50% opacification), and distance from SNS to MT (mm). Patients who had lateralized MTs from prior surgery as the cause of CC widening were excluded. Patients who underwent orbital decompression were included as a control group.
Fifty patients in each group (AERD, AFRS, and eCRSwNP) and 50 control patients were included. Average number of surgeries was 2.5 in AERD (p = 0.05), 2 in AFRS (p = 0.4), and 1.7 in eCRSwNP. Preoperative CC distance was significantly higher in AERD versus control, AFRS, and eCRSwNP: 4.2 versus 2.8 mm (p < 0.0001), 4.2 versus 1.9 mm (p < 0.0001), and 4.2 versus 2.7 mm (p < 0.0001), respectively. Postoperatively, CC distance and degree of opacification were significantly higher in AERD versus control, AFRS, and eCRSwNP. Within the AERD group, CC distance was significantly higher postoperatively than preoperatively (6.5 vs. 4.2 mm, p = 0.002).
CC involvement is more significant in AERD patients and if present, rhinologists should be suspicious of the diagnosis. This area could represent a source of inflammatory load in patients with AERD.
评估嗜酸性粒细胞性慢性鼻-鼻窦炎（CRS）患者中央腔隙（CC）的病变情况。
将嗜酸性粒细胞性CRS患者分为三种终末型：阿司匹林加重性呼吸系统疾病（AERD）、变应性真菌性鼻-鼻窦炎（AFRS）和伴有鼻息肉的嗜酸性粒细胞性CRS（eCRSwNP）。回顾CT扫描结果以评估CC受累情况，CC受累定义为上鼻中隔（SNS）与中鼻甲（MT）之间的区域。根据混浊程度（0：无混浊，1：混浊程度达50%及以下，2：混浊程度>50%）以及SNS至MT的距离（mm）来测量CC受累情况。因既往手术导致MT侧移而引起CC增宽的患者被排除。接受眼眶减压手术的患者作为对照组。
每组纳入50例患者（AERD、AFRS和eCRSwNP）以及50例对照患者。AERD组的平均手术次数为2.5次（p = 0.05），AFRS组为2次（p = 0.4），eCRSwNP组为1.7次。AERD组术前的CC距离显著高于对照组、AFRS组和eCRSwNP组：分别为4.2 mm对2.8 mm（p < 0.0001）、4.2 mm对1.9 mm（p < 0.0001）、4.2 mm对2.7 mm（p < 0.0001）。术后，AERD组的CC距离和混浊程度显著高于对照组、AFRS组和eCRSwNP组。在AERD组内，术后CC距离显著高于术前（6.5 mm对4.2 mm，p = 0.002）。
AERD患者的CC受累更为显著，若存在这种情况，鼻科医生应怀疑该诊断。此区域可能是AERD患者炎症负荷的来源。
