Histopathologic differences between adult and pediatric patients with chronic rhinosinusitis

Area of Science:

• Otolaryngology
• Pathology
• Immunology

Background:

• Chronic rhinosinusitis (CRS) management may differ between adult and pediatric populations.
• Limited research exists on sinonasal tissue-level comparisons between these age groups.
• This study aims to elucidate histopathologic differences in CRS between children and adults.

Purpose of the Study:

• To compare histopathologic findings in sinonasal tissue between pediatric and adult patients with chronic rhinosinusitis (CRS).
• To gain insights into the distinct disease pathogenesis in pediatric versus adult CRS.
• To inform the optimization of targeted medical management strategies for both age groups.

Main Methods:

• Retrospective cohort study of patients undergoing functional endoscopic sinus surgery (FESS).
• Analysis of demographic factors, comorbidities, and 13 structured histopathologic variables.
• Comparison between pediatric CRS with and without nasal polyps (pCRSwNP, pCRSsNP) and adult CRS with and without nasal polyps (aCRSwNP, aCRSsNP).

Main Results:

• Adult CRS patients exhibited significantly higher rates of tissue neutrophilia, basement membrane thickening, subepithelial edema, squamous metaplasia, and eosinophil aggregates compared to pediatric CRS patients.
• A lymphoplasmacytic-predominant inflammatory background was more common in adults (66.5%), while a lymphocyte-predominant background was more frequent in children (57.8%).
• Children with CRS had a significantly higher prevalence of comorbid asthma (64.5%) compared to adults (37.2%).

Conclusions:

• Significant histopathologic differences exist in sinonasal tissue between adult and pediatric patients with CRS.
• These findings suggest differing underlying pathophysiology contributing to CRS in children and adults.
• Understanding these distinctions can guide the development of more effective, age-specific therapeutic approaches for CRS.