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Journal of Otolaryngology - Head & Neck Surgery logoLink to Journal of Otolaryngology - Head & Neck Surgery
. 2019 Jul 11;48:31. doi: 10.1186/s40463-019-0355-6

Correction to: Clinically relevant phenotypes in chronic rhinosinusitis

Jessica W Grayson 1,, Marina Cavada 1,2, Richard J Harvey 1,2
PMCID: PMC6625072  PMID: 31296254

Correction to: J Otolaryngol Head Neck Surg

https://doi.org/10.1186/s40463-019-0350-y

Following publication of the original article [1], the authors reported an error in Table 1. In the second columns of the ‘Radiology’ row, ‘Normal anterolateral sinus mucosa’ should read ‘Normal superolateral sinus mucosa’. A corrected version of Table 1 is included in this Correction.

Table 1.

Summary of Key Findings of CRS Phenotypes

Phenotype
Characteristics CCAD (IgE mediated) eCRS (AERD) Non-eCRS
Clinical Presentation

- Young onset (teens to 20s)

- Rhinitis symptoms

- Smell preserved

- Other atopic disease:

° Childhood asthma

° conjunctival symptoms, dermatitis

- Mid-Life “adult” onset (30–50 yo)

- Occasionally post respiratory virus

- “Completely well” prior to onset or if allergic, then symptoms limited to childhood

- Smell loss (corticosteroid responsive)

- Antibiotic seeking

- Food and alcohol induced flares

- Adult onset asthma linked temporally to CRS onset.

- Older onset 50 yrs.+

- Female, obese

- Cough

- Poor corticosteroid response

- “Asthma” present but often poor response to inhaled preventive therapy (corticosteroid based)

Endoscopy

- Middle turbinate edema

- Polypoid changes from turbinates and septum

- No thick mucin

- Normal sinus mucosa on surgery

- Polyps (small, multiple, large) from the middle meatus

- Thick eosinophilic mucin

- Secondary purulence

- Polyps or polypoid edema

- Purulent secretions

- Lack of eosinophilic mucin

Radiology

- Central thickening of septum and turbinates, peripheral clearing (CCAD)

- Mucus trapping only in sinsues

- Normal superolateral sinus mucosa (“black halo”)

- Pan-sinusitis (Lund-Mackay 24)

- Neo-osteogenesis

- Pan-sinusitis (undistinguishable from eCRS)
Histopathology

- Elevated tissue eosinophilia

- Often without activation (no eosinophil aggregates and charcot-leyden crystals)

- No serum eosinophils

- Elevated total and specific IgE

- Elevated tissue eosinophilia (>10eos/hpf, but often >100eos/hpf)

- Evidence of eosinophil activation (eosinophil aggregates and charcot-leyden crystals)

- Serum eosinophilia

- Lack of tissue eosinophilia (< 10/HPF)
Allergy

- + allergy testing (dustmite/perennial allergens)

- Often monoallergen-sensitized

- Either negative IgE sensitization or multi-allergen sensitized - Negative skin prick, immunocap/RAST
Treatment

- Allergen directed immunotherapy

- Endoscopic sinus surgery

- Topical corticosteroid (spray or irrigation)

- Systemic corticosteroid treatment (up to 2–3 times per year) if limited burden of disease

- Endoscopic sinus surgery (Draf 3)

- Topical corticosteroid irrigations (not sprays)

For AERD:

- Zileuton, Montelukast, Zafirlukast

- Can take selective COX-2 inhibitors (Meloxicam)

- Saline or corticosteroid irrigations

- Endoscopic sinus surgery

- Macrolide therapy (Clarithromycin 250 mg daily for 3 months)

- Continue 3/week until 12 months if responder

Difficult to control disease - Omaluzimab (anti-IgE)

- Mepoluzimab (anti-IL5)

- Other immune-modulating therapy (Benraluzimab, Dupiliumab, Reslizumab, etc)

For AERD:

- ASA desensitization (1300 mg commencement and 350–700 mg daily maintenance)

- Consider re-biopsy of a patient post-surgery and post-corticosteroid based treatment if not responding and may be re-classified under this phenotype

Reference

  • 1.Grayson, et al. Clinically relevant phenotypes in chronic rhinosinusitis. J. Otolaryngol. Head Neck Surg. 2019;48:23. doi: 10.1186/s40463-019-0350-y. [DOI] [PMC free article] [PubMed] [Google Scholar]

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