Association Between Granular Changes on Epipharyngeal Endoscopy and Allergen Sensitization in Chronic Epipharyngitis

Background: Granular changes observed under band-limited epipharyngeal endoscopy are considered a characteristic finding of chronic epipharyngitis; however, their biological significance remains unclear. This study investigated whether granular changes are associated with allergen sensitization and peripheral allergic biomarkers in patients with chronic epipharyngitis. Methods: A retrospective analysis was conducted in 59 patients with chronic epipharyngitis. Granular changes were graded endoscopically as 0 (absent), 1 (mild-to-moderate), or 2 (severe). Nasal eosinophil counts, peripheral blood eosinophil counts, total immunoglobulin E (IgE), mite-specific IgE, house dust-specific IgE, and peripheral blood CD4/CD8 ratios were evaluated. Comparisons among groups were performed using the Kruskal-Wallis and Mann-Whitney U tests, and correlations were assessed using Spearman's rank correlation analysis. Results: Patients with granular changes demonstrated significantly higher mite-specific IgE and house dust-specific IgE levels than those without granular changes. In comparisons between patients without granular changes (grade 0) and those with granular changes (grades 1 and 2), significant differences were observed for mite-specific IgE (p = 0.016) and house dust-specific IgE (p = 0.016). In contrast, nasal eosinophil counts, peripheral blood eosinophil counts, total IgE levels, and CD4/CD8 ratios showed no significant associations with granular changes. Furthermore, Spearman correlation analysis revealed no significant correlations between granular change scores and any evaluated biomarker. Conclusions: Granular changes on epipharyngeal endoscopy were associated with sensitization to mite and house dust allergens but were not associated with peripheral eosinophil counts, total IgE levels, or CD4/CD8 ratios. These findings suggest that the presence of granular changes may be associated with allergen sensitization; however, no association with increasing granular severity was observed. Further studies incorporating local immune profiling and cytokine analyses are warranted to clarify the biological significance of granular changes.