Diagnostic challenges of central compartment atopic disease in type-2 chronic rhinosinusitis

Central compartment atopic disease (CCAD) is an emerging phenotype of type-2 chronic rhinosinusitis (CRS), characterized by inflammation involving the central nasal structures. The absence of standardized diagnostic criteria has hindered its recognition. This study aims to describe the first European cohort of CCAD patients and compare its features with previously published international data.

A retrospective observational study was conducted including adult patients diagnosed with CCAD at a tertiary rhinology unit (2021-2024), based on predefined endoscopic and radiologic criteria. Demographic, clinical, exploratory, analytical and quality-of-life data were collected. Descriptive statistics were used to characterize the baseline profile of the study population.

The cohort of 93 CCAD patients was predominantly male (65.6%) with a mean age of 48.7 ± 12.2 years. The baseline SNOT-22 score averaged 61.5 ± 24.3, with marked olfactory impairment. Asthma and N-ERD were reported in 40.9% and 7.5% of cases, respectively; allergic sensitization was confirmed in 60.2%. The mean endoscopic scores were 4.0 ± 2.2 for the nasal polyp score and 7.5 ± 2.5 for the modified Lund-Kennedy scale, while the mean CT-scan score was 11.7 ± 3.8. Blood eosinophilia >150 cells/μL was present in 77.4% of patients, and tissue eosinophil counts averaged 49.9 ± 43.8 eosinophils per high-power field.

This study reinforces CCAD as a localized type-2 CRS phenotype with a distinctive atopic signature. Findings underscore the need for standardized diagnostic criteria to improve its recognition and guide more personalized therapeutic strategies.