The clinical course of nasal polyps in relation with histological and radiological findings

Nasal polyps (NPs) show distinct characteristics in histologic features with different inflammatory cells and stromal changes, but their clinical implications remain poorly understood.

To determine the associations between NP histology, clinical characteristics, radiologic disease burden on osteomeatal unit computed tomography (OMU-CT) findings, and postoperative recurrence.

We retrospectively reviewed 219 patients who underwent nasal polypectomy. NPs were histologically classified by predominant inflammatory cells (eosinophilic vs. lymphoplasmacytic) and stromal features (edematous, glandular, or dense). Clinical variables, preoperative OMU-CT scores, and recurrence rates were analyzed.

Overall, 62.6% (137/219) of NPs were eosinophilic. Edematous stroma was the most common stromal subtype (72.6%, 159/219), predominating in eosinophilic NPs (96.3%, 132/137). Patients with eosinophilic NPs showed higher CT severity scores (18.4 ± 0.7 vs. 15.5 ± 1.1; P = 0.021) and a higher prevalence of extended disease (78.3% vs. 60.0%; P = 0.010) than those with lymphoplasmacytic NPs. CT severity score correlated with blood eosinophil counts (r = 0.17, P = 0.018). Patients with asthma (11.9%) showed higher CT severity scores (22.4 ± 1.4 vs. 16.9 ± 0.6; P = 0.002) and a tendency toward extended disease (92.0% vs. 70.3%; P = 0.052) compared to those without asthma. Among 99 patients with follow-up, recurrence occurred in 16.2%. While recurrence rates did not differ by histologic type, recurrent cases had significantly higher preoperative CT scores than nonrecurrent cases (21.9 vs. 16.9; P = 0.002).

Eosinophilic NPs are associated with greater CT disease burden and extent. Peripheral eosinophil counts reflect tissue eosinophilia and correlate with radiologic severity.