Radiological findings in patients with Nasal Polyposis and its relation with chronic allergic disease

doi:10.21203/rs.3.rs-5154267/v1

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Radiological findings in patients with Nasal Polyposis and its relation with chronic allergic disease

https://doi.org/10.21203/rs.3.rs-5154267/v1

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Introduction:

Nasal polyposis is a prevalent chronic inflammatory condition affecting the nasal cavity and paranasal sinuses, leading to significant morbidity and reduced quality of life. Characterized by non-cancerous mucosal growths, nasal polyps result from ongoing inflammation and commonly obstruct airflow, causing distressing symptoms. This study investigates the radiological characteristics of nasal polyposis and their correlation with chronic allergic diseases, particularly allergic rhinitis and asthma.

Methods

A retrospective study was conducted at Damascus Hospital, Syria, analyzing medical records, radiological reports, and surgical findings of 110 patients diagnosed with nasal polyposis from January 2015 to September 2019. A structured questionnaire gathered demographic and clinical data. Radiological assessments were performed using the Lund-Mackay scoring system, while surgical classifications were based on the presence of polyps in specific sinuses. Statistical analyses, including descriptive statistics and t-tests, were employed to identify significant relationships between variables.

Results

The cohort included 57 males (51.8%) and 53 females (48.2%), with a mean age of 37.3 years. Predominant symptoms included nasal obstruction (98.2%), anterior rhinorrhea (80.9%), and hyposmia (80%). Asthma was present in 30% of participants, and aspirin sensitivity was noted in 24.5%. Statistically significant associations were observed between higher radiological and surgical scores and the presence of asthma (p = 0.003 and p = 0.001, respectively), as well as with aspirin sensitivity (p = 0.004 and p = 0.002). No significant correlations were found between classifications and allergic symptoms or sleep apnea.

Discussion

The findings align with previous studies highlighting the relationship between nasal polyposis, asthma, and aspirin sensitivity. Our study’s prevalence rates for asthma and allergic symptoms are consistent with existing literature. Higher polyp scores correlate with asthma presence, suggesting shared inflammatory pathways.

Conclusion

This research underscores the importance of radiological evaluations in understanding nasal polyposis and its associations with chronic allergic diseases. Improved insights into these relationships may enhance diagnostic accuracy and inform targeted therapeutic strategies for affected patients.

Nasal polyposis

asthma

allergic rhinitis

radiological characteristics

Lund-Mackay scoring

chronic inflammation

Nasal polyposis is a relatively common chronic inflammatory condition of the nasal cavity and paranasal sinuses, frequently resulting in significant morbidity and a decreased quality of life for affected individuals (1). The condition is characterized by benign, soft, and non-cancerous growths that emerge from the mucosal lining of the sinuses and nasal passages, often in response to ongoing inflammation (2). These growths can obstruct normal nasal airflow and lead to a variety of distressing symptoms. While nasal polyposis can occur at any age, its prevalence increases with age, particularly in individuals over 40, and it affects approximately 1–4% of the general population globally (3).

Patients with nasal polyps commonly experience symptoms such as persistent nasal obstruction, excessive nasal discharge (rhinorrhea), facial pressure or pain, and a reduction or complete loss of their sense of smell (anosmia) (4). These symptoms not only impair daily function but also increase the likelihood of secondary complications, such as chronic sinus infections, sleep disturbances, and diminished overall well-being. In severe cases, untreated or poorly managed polyposis can significantly hinder respiratory function, particularly in individuals with coexisting respiratory conditions (5).

A well-established connection exists between nasal polyposis and chronic allergic diseases such as allergic rhinitis and asthma. These conditions are thought to contribute to both the development and exacerbation of nasal polyps through persistent, low-grade inflammation of the nasal and sinus mucosa (6). The chronic allergic inflammation that characterizes these diseases leads to hyperplasia of the mucosal lining, which is a key factor in polyp formation (7). The interplay between these conditions is complex, with allergic diseases acting as both a risk factor and a complicating factor in nasal polyposis. Notably, asthma is commonly observed in patients with nasal polyposis, particularly those with more severe or recurrent forms of the disease, suggesting a shared inflammatory pathway (8). Furthermore, the presence of aspirin-exacerbated respiratory disease (AERD), a clinical syndrome characterized by asthma, nasal polyposis, and sensitivity to aspirin or other non-steroidal anti-inflammatory drugs, highlights the importance of inflammation in the pathogenesis of nasal polyps (9).

The diagnosis and management of nasal polyposis rely heavily on radiological imaging, particularly computed tomography (CT) (10). CT scans are invaluable in assessing the extent of sinus involvement, the degree of mucosal thickening, and the presence of opacification within the sinuses. CT imaging also plays a critical role in detecting anatomical variations that may predispose patients to polyp formation or exacerbate their symptoms, such as deviations in the nasal septum or abnormalities in sinus drainage pathways (11). The detailed information obtained from radiological imaging allows for a more comprehensive evaluation of the severity of nasal polyposis, and the Lund-Mackay scoring system is frequently employed to quantify this severity. This system assigns scores based on the degree of opacification in different sinus regions, providing an objective measure to guide treatment decisions and assess disease progression (12).

The current study aims to investigate the radiological characteristics of nasal polyposis and explore their correlation with chronic allergic diseases, with a particular focus on allergic rhinitis and asthma. By analyzing the extent and severity of polyposis alongside clinical presentations such as asthma, sinusitis, and aspirin sensitivity, this research seeks to better understand the relationship between nasal polyps and chronic allergic conditions (13). In doing so, we hope to uncover insights that can contribute to more effective diagnostic approaches, targeted therapeutic interventions, and ultimately improved outcomes for patients suffering from these interconnected conditions.

Study design and participants:

A retrospective study was conducted at Damascus Hospital, located in Damascus, Syria, specifically within the Department of Otorhinolaryngology. All data were recorded anonymously to protect patient identity. The study included the medical records, radiological reports, and surgical findings of patients diagnosed with nasal polyposis who visited Damascus Hospital.

Data were collected from 110 participants using a structured questionnaire. Ethical approval was obtained from the Institutional Review Board (IRB) of the Faculty of Medicine at the Syrian Private University. Following the approval from the Deanship of the Faculty of Medicine and the management of Damascus Hospital, the study analyzed archived reports covering the period from January 1, 2015, to September 17, 2019. All medical files, CT scan reports, and surgical records of patients within this timeframe were reviewed, and questionnaires were completed, which had been pre-prepared in collaboration with the supervising faculty member. The questionnaires included personal information, symptoms, and clinical manifestations of the patients.

Tools:

The presence of radiological densities in the nasal cavity and sinuses of patients was assessed using the Mackay and Lund Staging of Rhinosinusitis. This scoring system assigns two points for complete opacification of a sinus, one point for partial opacification, and zero points for no opacification, with a maximum total score of 24. (14)

The prevalence of nasal polyps in the nasal cavity and sinuses was determined based on surgical reports using a specific scoring system adopted from previously published research. In this system, each of the following sinuses—nasal cavity, maxillary sinus, anterior ethmoid sinus, posterior ethmoid sinus, sphenoid sinus, and frontal sinus—was assigned one point for involvement, resulting in a total possible score of 12. (15)

Statistical Analysis:

The participants' data were tabulated and entered into a computer, and the Statistical Package for the Social Sciences (SPSS) version 26 was used to analyze this data. The following statistical methods were used in the analysis:

Descriptive Statistics: This involves finding the relative frequency distributions of the categorical study variables (gender, social status, etc.).

Analytical (Inferential) Statistics: The analytical statistics portion of the analysis aimed to present and interpret the results to meet the study's objectives. A t-test was conducted to assess differences between groups and evaluate statistical relationships among continuous variables. The significance level was set at 0.05, which is a standard threshold in clinical research.

Statistical decisions were based on the P-value: if the P-value was greater than 0.05, it indicated no significant differences or relationships; conversely, if the P-value was less than 0.05, it suggested significant statistical differences. This analysis allowed for a comprehensive understanding of the relationships between the variables under investigation.

The study comprised 110 participants, with a gender distribution of 57 males (51.8%) and 53 females (48.2%). The age range of the participants varied, with 4 individuals (3.6%) aged between 0–10 years, 20 individuals (18.2%) aged 11–20 years, 16 individuals (14.5%) aged 21–30 years, 24 individuals (21.8%) aged 31–40 years, 19 individuals (17.3%) in the 41–50 age group, 19 individuals (17.3%) aged 51–60 years, 6 individuals (5.5%) aged 61–70 years, and 2 individuals (1.8%) aged 71–80 years. In terms of lifestyle habits, 75 participants (68.2%) reported no harmful habits, while 30 (27.3%) were smokers, 1 (0.9%) consumed alcohol, and 4 (3.6%) engaged in both smoking and alcohol consumption.

Clinical symptoms were prevalent among the participants, with 108 individuals (98.2%) experiencing nasal obstruction, 89 (80.9%) reporting anterior rhinorrhea, and 88 (80%) suffering from a decreased sense of smell and taste. Allergic symptoms were noted in 78 participants (70.9%), and headaches were reported by 67 individuals (60.9%). Additionally, 67 participants (60.9%) experienced posterior rhinorrhea, 40 (36.4%) had snoring issues, and 22 (20%) reported ear pain. Other symptoms included sleep apnea in 18 individuals (16.4%), hearing loss in 17 (15.5%), epistaxis in 11 (10%), and ear discharge in 3 (2.7%).

Asthma was present in 33 participants (30%), while 77 individuals (70%) did not have asthma. Aspirin sensitivity was reported in 27 participants (24.5%), with 83 individuals (75.5%) indicating no such sensitivity. The presence of both asthma and aspirin sensitivity was also observed in 27 participants (24.5%).

Regarding treatment history, 62 participants (56.4%) had previously received corticosteroid therapy, whereas 48 (43.6%) had not undergone such treatment. Surgical interventions had been performed on 26 participants (23.6%), while 84 individuals (76.4%) had not experienced any surgical treatment.

In terms of clinical examination, nasal polyps were identified in 87 participants (79.1%) bilaterally, while 11 (10%) had unilateral left-sided polyps and 9 (8.2%) had unilateral right-sided polyps. Only 3 individuals (2.7%) were found to have no nasal polyps. Deviated nasal septum was noted in 34 participants (30.9%) on the right side, 25 (22.7%) on the left side, and 2 (1.8%) bilaterally, while 49 individuals (44.5%) had no deviation.

The examination also revealed the presence of turbinate hypertrophy, with 62 individuals (56.4%) having bilateral hypertrophy, while 7 (6.4%) had left-sided hypertrophy, 3 (2.7%) had right-sided hypertrophy, and 38 participants (34.5%) showed no hypertrophy.

Statistically, the radiological classification yielded an average score of 14.78 (SD = 7.088), ranging from a minimum of 3 to a maximum of 24. The surgical classification had an average score of 6.15 (SD = 2.526), with scores ranging from 2 to 12.

Statistical analysis, including the t-test and descriptive statistics, was employed to compare the average scores of both radiological and surgical classifications between groups of patients with and without asthma. The results indicated a statistically significant relationship between radiological classification and asthma, with a p-value of 0.003. Similarly, a significant association was found between surgical classification and asthma, yielding a p-value of 0.001. These findings suggest that higher scores in both classifications are more frequently associated with the presence of asthma.

Further analysis was conducted to evaluate the relationship between radiological and surgical classifications and aspirin sensitivity. The results demonstrated a significant relationship between radiological classification and aspirin sensitivity, with a p-value of 0.004, as well as a significant association between surgical classification and aspirin sensitivity, with a p-value of 0.002. This indicates that cases with higher classification scores are more likely to be associated with aspirin sensitivity.

In contrast, the evaluation of the relationship between radiological and surgical classifications and the presence of tri-symptom syndrome revealed no significant associations, with p-values of 0.595 and 0.955, respectively. This suggests that higher scores in these classifications do not correlate with the occurrence of tri-symptom syndrome.

Moreover, when assessing the relationship between radiological and surgical classifications and allergic symptoms, the analysis yielded no significant correlations, as indicated by p-values of 0.066 and 0.103, respectively. This implies that higher scores in these classifications are not associated with an increased presence of allergic symptoms.

Lastly, the examination of the relationship between radiological and surgical classifications and sleep apnea indicated no significant associations, with p-values of 0.081 and 0.714, respectively. Therefore, higher scores in both classifications do not correlate with the presence of sleep apnea.

A study conducted at Mashhad University in Iran found that nasal polyps affect males at a rate of 60.3% and females at 39.7% (16). In our study, we observed that the prevalence among males was 51.8% and among females 48.2% (17). A separate study in Spain reported that nasal polyps affected 63% of males and 37% of females (18). Similarly, a study at the Syrian Private University indicated that nasal polyps were more common in females at a rate of 56.6% compared to 43.3% in males (19).

An American study conducted in Philadelphia indicated that nasal polyps were notably prevalent among middle-aged men (20). The average age of occurrence in our study was 37.3 years, with the most affected age group being between 31 and 40 years. In the Spanish study, the average age of onset was 46.5 years, while in the Iranian study, it was 39.5 years, with peak prevalence occurring in the second decade of life (16, 17). Additionally, a study in Nigeria identified the most common age group as 31 to 40 years, a finding echoed in a study from France and in the previously published research from the Syrian Private University (21, 22).

In our study, 30% of patients had asthma, while the Spanish study found that 36.3% of patients were asthmatic (18). In Iran, the percentage was 10.4% (16). An American study indicated that 50% of asthmatic patients had nasal polyps (23). In a previous study from our university, the prevalence of asthma among patients with nasal polyps was 27.3% (19). A similar study found that the prevalence of asthma among patients with nasal polyps in France was 45% (24).

The most prevalent symptom in our study was nasal obstruction, reported at 98.2%, followed by anterior rhinorrhea at 80.9%, and hyposmia at 80%. In the Spanish study, the most common symptoms were nasal obstruction at 88%, hyposmia at 78%, and anterior rhinorrhea at 66%. Another study indicated that nasal obstruction was the most common symptom at 98%, followed by rhinorrhea at 90% and hyposmia at 72% (18, 25). In the Iranian study, patients with epistaxis constituted about 11%, while in our study, this figure was 10%. Many studies have not addressed this symptom, which may explain its lower frequency (18).

Allergic symptoms were present in 70.9% of our patient population, while a previous study indicated that 79% had documented allergies (23). In the Spanish study, the prevalence of ear symptoms was 42%, whereas in the Iranian study, ear symptoms accounted for 5.1%. In our study, this figure was 23.6% (16, 17).

The prevalence of the triad (asthma, nasal polyps, aspirin sensitivity) in our study was 24.5%, while a study conducted at the University of Georgia reported a rate of 4.8% (26). A Swiss study found that 14.68% of patients had a positive triad (27). Additionally, a study conducted in Chicago reported a 16% positivity rate for this triad, which is more aligned with our findings (28). According to the American Academy of Allergy, Asthma & Immunology, the prevalence of aspirin sensitivity among patients with nasal polyps and asthma is 30%, while another study found that 20% of asthmatic patients had aspirin sensitivity and yet another study reported a rate of 55.6% (19). In our study, the rate was significantly higher, reaching 75.7%.

In our findings, the average number of affected sinuses based on surgical classification was greater among asthmatic patients than non-asthmatics. We also identified a correlation between asthma and increased prevalence of polyps based on radiological classification, indicating a statistically significant relationship showing that the number of affected sinuses in patients with nasal polyps was higher among asthmatics than non-asthmatics. This supports previous findings that identified a positive relationship between asthma and the increased number of affected sinuses (29).

Analysis of the results revealed a positive relationship between aspirin sensitivity and the prevalence of polyps in the sinuses based on both surgical and radiological classifications, similar to the findings from a study in Damascus, Syria (19).

In our study, comparisons of average scores between surgical and radiological classifications for groups of patients with and without the triad indicated statistically significant differences in both classifications between the patient groups. However, we were unable to find statistically significant differences in clinical symptoms or habits (such as smoking and alcohol consumption), nor was there any association between nasal polyps and the presence of diabetes or hypertension.

Study's limitations:

This study has several limitations inherent to its retrospective design and reliance on archived medical records. One significant limitation is the potential for bias due to the length of time covered by the records, which may affect the accuracy and completeness of the data collected. As the study relied on previously documented information, discrepancies in record-keeping practices or variations in clinical assessment over the years could introduce inconsistencies in the data. Additionally, the retrospective nature of the study limits the ability to establish causal relationships, as it does not account for confounding variables that could have influenced the outcomes. These factors may impact the generalizability of the findings and should be considered when interpreting the results. Future prospective studies with standardized data collection methods would be beneficial to validate the findings of this research.

In conclusion, this study highlights that nasal polyposis is more prevalent among males compared to females, with bilateral nasal obstruction being the primary complaint among patients. The highest incidence of polyps, both radiologically and surgically, was observed in the nasal cavity, followed closely by the maxillary sinus. Additionally, patients with asthma and/or aspirin sensitivity exhibited a higher prevalence of polyps within the sinuses compared to those without these conditions. Furthermore, a moderate positive correlation was established between the radiological and surgical classifications, as well as between these classifications and the presence of asthma and aspirin sensitivity. These findings underscore the significance of considering gender differences, clinical symptoms, and comorbidities in the assessment and management of nasal polyposis, paving the way for more targeted therapeutic approaches.

Ethical approval:

Ethical approval was obtained from the Institutional Review Board (IRB), Faculty of Medicine, Syrian Private University.

Competing interests:

The authors declare that they have no competing interests.

Funding statement:

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

Acknowledgments:

Not applicable.

Availability of supporting data:

The data that support the findings of this study are available from the Corresponding author, upon reasonable request.

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The authors declare no competing interests.

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You are reading this latest preprint version

Radiological findings in patients with Nasal Polyposis and its relation with chronic allergic disease

Status:

Version 1

Abstract

Introduction:

Methods

Results

Discussion

Conclusion

Introduction

Methods

Study design and participants:

Tools:

Statistical Analysis:

Results

Discussion

Study's limitations:

Conclusion

Declarations

Ethical approval:

Competing interests:

Funding statement:

Acknowledgments:

Availability of supporting data:

References

Additional Declarations

Status:

Version 1