Nasal floor mucosal thickness in chronic rhinosinusitis: a computed tomography-based case-control study
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20260061Keywords:
Rhinosinusitis, Nasal mucosa, Airway remodelling, Computed tomography, Nasal cavity, InflammationAbstract
Background: Tissue remodelling is a hallmark of chronic rhinosinusitis (CRS), yet the nasal floor has received little attention as a potential site of structural change. This study aimed to explore whether radiographic evidence of nasal floor mucosal thickening is a distinctive feature of CRS and a potential endotype marker.
Methods: This case-control study included 80 patients with bilateral CRS who underwent endoscopic sinus surgery and 80 controls. Nasal floor mucosal thickness was measured at two points on coronal paranasal sinus computed tomography (CT): anteriorly, where the inferior turbinate inserts the maxilla, and posteriorly, at the nasolacrimal duct opening into the inferior meatus.
Results: Mean nasal floor mucosal thickness was significantly greater in CRS patients than in controls at both anterior (2.52±0.74 mm vs. 2.02±0.59 mm) and posterior (2.05±0.63 mm vs. 1.52±0.44 mm) sites (p<0.001). Within the CRS cohort, anterior mucosal thickness was significantly higher in eosinophilic CRS compared to non-eosinophilic CRS patients (p=0.006).
Conclusions: Increased nasal floor mucosal thickness is associated with CRS, particularly in the eosinophilic endotype. Given its simplicity and reproducibility, nasal floor thickness may support non-invasive endotype differentiation and aid in clinical decision-making. Further prospective studies are needed to validate its diagnostic and prognostic value.
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References
Barham HP, Osborn JL, Snidvongs K, Mrad N, Sacks R, Harvey RJ. Remodeling changes of the upper airway with chronic rhinosinusitis. International forum of allergy & rhinology. 2015;5(7):565-72. DOI: https://doi.org/10.1002/alr.21546
Lee K, Tai J, Lee SH, Kim TH. Advances in the Knowledge of the Underlying Airway Remodeling Mechanisms in Chronic Rhinosinusitis Based on the Endotypes: A Review. International journal of molecular sciences. 2021;22(2). DOI: https://doi.org/10.3390/ijms22020910
Kuhar HN, Tajudeen BA, Mahdavinia M, Gattuso P, Ghai R, Batra PS. Inflammatory infiltrate and mucosal remodeling in chronic rhinosinusitis with and without polyps: structured histopathologic analysis. International forum of allergy & rhinology. 2017;7(7):679-89. DOI: https://doi.org/10.1002/alr.21943
Bhattacharyya N. Chronic rhinosinusitis: is the nose really involved? American journal of rhinology. 2001;15(3):169-73. DOI: https://doi.org/10.2500/105065801779954184
Ardehali MM, Amali A, Bakhshaee M, Madani Z. Histopathologic characteristics of inferior turbinate vs ethmoidal polypin chronic rhinosinusitis. Ann Diagn Pathol. 2011;15(4):233-6. DOI: https://doi.org/10.1016/j.anndiagpath.2010.10.009
Rai G, Roy P, Gupta N, Sharma S, Dar SA, Ansari MA, et al. Computed Tomography Score an Excellent Marker: Differentiates Eosinophilic and Non-eosinophilic Variants of Chronic Rhinosinusitis with Nasal Polyp. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 3):1787-92. DOI: https://doi.org/10.1007/s12070-017-1154-x
Li F, Wang S, Cha X, Li T, Xie Y, Wang W, et al. Blood Eosinophil Percentage and Improved Sinus CT Score as Diagnostic Tools for ECRS. OTO open. 2024;8(1):e106. DOI: https://doi.org/10.1002/oto2.106
Rosati D, Rosato C, Pagliuca G, Cerbelli B, Della Rocca C, Di Cristofano C, et al. Predictive markers of long-term recurrence in chronic rhinosinusitis with nasal polyps. American journal of otolaryngology. 2020;41(1):102286. DOI: https://doi.org/10.1016/j.amjoto.2019.102286
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. DOI: https://doi.org/10.4193/Rhin20.601
Bachert C, Marple B, Hosemann W, Cavaliere C, Wen W, Zhang N. Endotypes of Chronic Rhinosinusitis with Nasal Polyps: Pathology and Possible Therapeutic Implications. The journal of allergy and clinical immunology In practice. 2020;8(5):1514-9. DOI: https://doi.org/10.1016/j.jaip.2020.03.007
Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology. 1993;31(4):183-4.
Shetty SR, Al-Bayatti SW, Al Kawas S, Al-Rawi NH, Kamath V, Shetty R, et al. A study on the association between the inferior nasal turbinate volume and the maxillary sinus mucosal lining using cone beam tomography. Heliyon. 2022;8(3):e09190. DOI: https://doi.org/10.1016/j.heliyon.2022.e09190
Sharhan SSA, Lee EJ, Hwang CS, Nam JS, Yoon JH, Kim CH, et al. Radiological comparison of inferior turbinate hypertrophy between allergic and non-allergic rhinitis: does allergy really augment turbinate hypertrophy? European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2018;275(4):923-9. DOI: https://doi.org/10.1007/s00405-018-4893-8
Liu Y, Zeng X, Nie Z, Guo Y, Li N, Chen J, et al. Comparison the Impacts of Asthma and Allergic Rhinitis on Chronic Rhinosinusitis With Nasal Polyps. The Laryngoscope. 2025. DOI: https://doi.org/10.1002/lary.32259
Batra PS, Tong L, Citardi MJ. Analysis of comorbidities and objective parameters in refractory chronic rhinosinusitis. The Laryngoscope. 2013;123 Suppl 7:S1-11. DOI: https://doi.org/10.1002/lary.24418
Penezić A, Paić M, Gregurić T, Grgić MV, Baudoin T, Kalogjera L. The impact of asthma on quality of life and symptoms in patients with chronic rhinosinusitis(). Current medical research and opinion. 2020;36(6):1043-8. DOI: https://doi.org/10.1080/03007995.2020.1754189
Saitoh T, Kusunoli T, Yao T, Kawano K, Kojima Y, Miyahara K, et al. Relationship between epithelial damage or basement membrane thickness and eosinophilic infiltration in nasal polyps with chronic rhinosinusitis. Rhinology. 2009;47(3):275-9. DOI: https://doi.org/10.4193/Rhin08.109
Poto R, Pelaia C, di Salvatore A, Saleh H, Scadding GW, Varricchi G. Imaging of chronic rhinosinusitis with nasal polyps in the era of biological therapies. Current opinion in allergy and clinical immunology. 2024;24(4):243-50. DOI: https://doi.org/10.1097/ACI.0000000000000964
Zhu KZ, He C, Li Z, Wang PJ, Wen SX, Wen KX, et al. Development and multicenter validation of a novel radiomics-based model for identifying eosinophilic chronic rhinosinusitis with nasal polyps. Rhinology. 2023;61(2):132-43. DOI: https://doi.org/10.4193/Rhin22.361
Darbari Kaul R, Sacks PL, Thiel C, Rimmer J, Kalish L, Campbell RG, et al. Radiomics of the Paranasal Sinuses: A Systematic Review of Computer-Assisted Techniques to Assess Computed Tomography Radiological Data. American journal of rhinology & allergy. 2025;39(2):147-58. DOI: https://doi.org/10.1177/19458924241304082
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