xRead - Nasal Obstruction (September 2024) Full Articles

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X.B Diagnosis of CRSwNP CRSwNP is defined by greater than or equal to 12 weeks of a combination of subjective and objective metrics as out lined in Section V.B. In distinguishing CRS into CRSsNP and CRSwNP, the only difference in diagnostic criteria between CRSwNP and CRSsNP is the presence of polyps (Table X-1). Definition of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) Sinonasal inflammation persisting for more than 12 weeks, with a combination of at least 2 of the following symptoms and confirmed by endoscopic or radiographic findings: – nasal obstruction/congestion/blockage. – anterior or posterior (mucopurulent) nasal drainage. CRSwNP Because of limited data, CRSsNP and CRSwNP are com bined in Section IX.B.1 . X.B.2 Differential Diagnosis of CRSwNP Several space occupying lesions in the nasal cavity can appear like NPs and must be considered (Table X-2). 1331 Sometimes normal structural variants, such as concha bullosa and medialized uncinate process, are misdiag nosed as NPs. Severely hypertrophied turbinates may also be mistaken as NPs. Although NPs have a char acteristic translucent gray-to-yellow colored, teardrop shaped morphology, those characteristics could be seen in other benign or malignant lesions. Alternatively, NPs may have different morphology involving a significant fibrous component, such that biopsy is needed to con firm the diagnosis. Common benign tumors shaped like NP include inverted papilloma, lobular capillary heman gioma, cavernous hemangioma, and schwannoma. 1332 – loss or decreased sense of smell. – facial pressure/pain/fullness. AND presence of polyps. X.B.1 Establishing the Diagnosis of

Minor complications associated with CRS tend to occur with local tissue alterations and include muco cele formation, 1310,1311 and intrinsic narrowing and tor tuosity of the frontal recess appears to be a predispos ing factor for mucocele formation. 1311 Tissue remodeling can also lead to neo-osteogenesis 648,649,665 bone erosion and expansion 1312,1313 as well as osseous metaplasia. 1314,1315 Sinonasal mucosal remodeling, at times irreversible, can occur. 1316,1317 The varied medical therapies to treat CRSsNP, including antibiotics and systemic corticosteroids, can also cause serious complications and add morbidity to the disease. 1318–1323 Interestingly, recent evidence sug gests that CRSsNP can be precipitated by treatment with anti-tumor necrosis factor-alpha inhibitors for rheumatic conditions. 1291,1324,1325 X Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) X.A Incidence and Prevalence of CRSwNP The epidemiology of CRSwNP has been investigated uti lizing various methods. In France, 2.11% of 10,033 sub jects screened with a questionnaire were identified as hav ing nasal polyposis. 20 In Finland, a survey of 4300 adults found that 4.3% reported having been diagnosed with nasal polyps. 21 Patient-reported surveys, however, lack objective confirmation of polyposis and are at risk of recall bias. Sur veys, therefore, may not accurately estimate the true preva lence of CRSwNP. Interestingly, between 26% and 42% of autopsy specimens contain NP. 24,25 The most accurate method, of diagnosing CRSwNP requires the reporting of symptoms with objective confirmation. 1326 In Sweden, 1387 adults were surveyed regarding CRS symptoms and examined with nasal endoscopy. Within that cohort, 2.7% were found to have nasal polyps. 22 The largest study evaluating the preva lence of CRSwNP was the Korean National Health and Nutrition Examination Survey from 2008-2012 in which 28,912 subjects underwent nasal endoscopy. In that study, the prevalence of CRSwNP was 2.6%. 23 The incidence of symptomatic CRSwNP was estimated by Larsen and Tos in Denmark at 0.627 patients per 1000 per year. The same study found an incidence of 0.86 and 0.39 patients per 1000 per year for males and females, respectively. 1327 Incidence can also be estimated by analyz ing billing codes. In a population-based analysis of ICD 9 codes from patients at the Geisinger Clinic from 2007 through 2009, the incidence of CRSwNP was 83 ± 1.3cases per 100,000 person-years. 17