Categorization of Nasal Polyps

Abstract

Chronic rhinosinusitis (CRS) with nasal polyps (NP) represents a diverse group of potential etiologies, many of which may be overlapping. The clinical symptoms of NP do not differentiate between etiologies. Symptoms in patients with NP can be categorized by symptom scores from several instruments, although none are specific for NP and none correlate with the extent of objective disease. Sinus CT scans can be categorized by a variety of scoring systems; however, correlation between sinus symptoms and CT findings is generally poor; the most widely utilized is the Lund–Mackay scoring system. NP can be categorized endoscopically by size through several staging systems, which demonstrate intra and interrater concordance, but again without demonstrated correlation to symptoms. Objective verification of symptoms can be performed through nasal airway patency assessment and smell testing. NP can be categorized by the presence of predominant inflammatory cell population into eosinophilic, neutrophilic, and mixed types. Presence of coexisting pathogens such as bacteria or fungus and the inflammatory response (eosinophilic vs. noneosinophilic) can be utilized to further differentiate NP into distinct categories; the significance of categorization in this manner is under investigation. Categorization by severity should reflect objective disease state, medications required for control, and risks of treatment and untreated disease. A NP categorization system that incorporates sinonasal symptoms scores, objective evidence of disease (CT and endoscopic scores), known risk factors for recalcitrant NP disease, and extent of disease control with medical and surgical treatment over time is most likely to accurately assess the severity of NP disease, assist in the patient’s treatment, and facilitate optimal study of NP.