{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T21:45:36Z","timestamp":1787262336520,"version":"build-2736575974"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Central compartment atopic disease (CCAD) has recently been recognized as a distinct phenotype within the spectrum of type 2\u2013dominant chronic rhinosinusitis (CRS). Although international guidelines highlight polypoid changes in the central nasal cavity, standardized diagnostic and classification criteria are still lacking. This study aims to develop and internally validate a consensus\u2010based classification system through expert agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A two\u2010round modified Delphi study was conducted with 10 international rhinology experts. Participants evaluated the need for a specific grading framework, the relative diagnostic value of nasal endoscopy versus radiology, and the clarity and applicability of the proposed criteria (Grades 0\u2013IV). Six representative endoscopic and radiologic cases were used in each round to assess interpretive accuracy and interobserver agreement. Consensus was predefined as \u2265\u00a080% of ratings in the top two categories (4\u20135) on a 5\u2010point Likert scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty percent of experts identified nasal endoscopy as the primary diagnostic tool in the first Delphi round. The interpretive accuracy of the preliminary grading system was high, with all panelists correctly recognizing the proposed distinctions. Interobserver agreement was substantial (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u00a0=\u00a00.72). In the second round, refined definitions improved overall consensus and reproducibility. Endoscopy was reaffirmed as the cornerstone of diagnosis, while radiology played a complementary role. Diagnostic clarity and agreement increased, reaching\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u00a0=\u00a00.80.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The consensus process confirmed nasal endoscopy as the key diagnostic method for CCAD, supported by substantial interobserver reproducibility. The refined definitions improved clarity and agreement, facilitating differentiation from other CRS phenotypes and establishing a reliable framework for future research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.70114","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T15:06:15Z","timestamp":1770390375000},"page":"670-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rationale of New Grading System: Central Compartment Atopic Disease"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0640-0550","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Moreno\u2010Luna","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology Virgen Macarena University Hospital, University of Seville  Sevilla Spain"},{"name":"Advanced Master's Degree in Rhinology and Anterior Skull Base Universidad Internacional de Andaluc\u00eda (UNIA)  Sevilla Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Palma\u2010Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Virgen Macarena University Hospital, University of Seville  Sevilla Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5897-7821","authenticated-orcid":false,"given":"Serafin","family":"S\u00e1nchez\u2010G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Virgen Macarena University Hospital, University of Seville  Sevilla Spain"},{"name":"Advanced Master's Degree in Rhinology and Anterior Skull Base Universidad Internacional de Andaluc\u00eda (UNIA)  Sevilla Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2557-6017","authenticated-orcid":false,"given":"Isam","family":"Alobid","sequence":"additional","affiliation":[{"name":"Advanced Master's Degree in Rhinology and Anterior Skull Base Universidad Internacional de Andaluc\u00eda (UNIA)  Sevilla Spain"},{"name":"Department of Otorhinolaryngology Hospital Cl\u00ednic, University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-2485","authenticated-orcid":false,"given":"Daniel","family":"Martin\u2010Jimenez","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Hospital Universitario de \u00c1lava and BioAraba Health Research Institute  Vitoria\u2010Gasteiz Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1321-007X","authenticated-orcid":false,"given":"Jos\u00e9 Miguel","family":"Villacampa\u2010Aub\u00e1","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Fundaci\u00f3n Jim\u00e9nez D\u00edaz  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3580-0967","authenticated-orcid":false,"given":"Christian","family":"Calvo\u2010Henr\u00edquez","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Hospital Universitario de Santiago de Compostela  Santiago Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-0920","authenticated-orcid":false,"given":"Alfonso Del","family":"Cuvillo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Hospital De Jerez de La Frontera  C\u00e1diz 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Wales  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0132-8545","authenticated-orcid":false,"given":"John M.","family":"DelGaudio","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"issue":"29","key":"e_1_2_9_2_1","first-page":"1","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens W. 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