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Phenotyping and Endotyping Pediatric Chronic Rhinosinusitis.
Ella Morgan1, Michael J Cunningham1,2, Eelam A Adil1,2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.
Summary
This study classified pediatric chronic rhinosinusitis (CRS) into phenotypes, finding eosinophilic CRS most common and recurrent. A classification system is feasible in children, aiding targeted therapies, though one-third remain uncategorized.
Area of Science:
- Otolaryngology
- Pediatric Allergy and Immunology
- Medical Research
Background:
- Chronic rhinosinusitis (CRS) in children requires better classification for targeted treatment.
- Current classification systems for adult CRS are evolving, but pediatric-specific phenotypes are less defined.
Purpose of the Study:
- To differentiate pediatric chronic rhinosinusitis (CRS) into clinically relevant primary and secondary phenotypes.
- To assess the feasibility of a phenotype- and endotype-based classification system in pediatric CRS patients.
Main Methods:
- Retrospective chart review of 94 pediatric patients with CRS who underwent endoscopic sinus surgery.
- Analysis of clinical, radiographic, laboratory, and intraoperative culture data for phenotype and endotype characterization.
Main Results:
- Eosinophilic CRS was the most common primary phenotype (20.2%), associated with recurrent disease and revision surgery.
- Other identified phenotypes included allergic fungal rhinosinusitis (10.6%) and CRS with cystic fibrosis (13.8%).
- Over one-third of patients (38.2%) could not be classified into a specific phenotype based on current criteria.
Conclusions:
- A phenotype and endotype-based classification is achievable in pediatric CRS, similar to adult systems.
- This classification can facilitate the development of targeted biologic therapies for pediatric CRS.
- Further research is needed to identify the etiology for the significant proportion of unclassified patients.
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