{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:54:19Z","timestamp":1790916859278,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":["The Laryngoscope"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Allergic fungal rhinosinusitis (AFRS) and eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) overlap clinically. Whether they represent distinct entities or points on the same spectrum is debated, and structured histopathology data from the Middle East are limited. The aim of this study was to compare clinical, radiographic, laboratory, and 13\u2010variable structured histopathological (SHP) profiles between AFRS and eCRSwNP in a Saudi tertiary\u2010care cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 415 adults who underwent functional endoscopic sinus surgery (FESS) at a Saudi tertiary referral center between January 2017 and January 2024. AFRS was defined by Bent and Kuhn criteria, and eCRSwNP by EPOS 2020 criteria plus 10 or more tissue eosinophils per high\u2010power field. We compared 13\u2010variable structured histopathology, clinical, radiographic, and laboratory features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty patients (12.0%) met AFRS criteria. AFRS patients were younger (median 27 vs. 38\u2009years;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), had higher total serum IgE (869 vs. 191\u2009IU\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and more often had unilateral disease on CT (58.0% vs. 19.6%; OR 5.66, 95% CI 3.05\u201310.51). AFRS showed less neutrophilic infiltration, less subepithelial oedema, less hyperplastic or papillary change, and less squamous metaplasia. Recurrence was similar between groups (40.9% vs. 42.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.872).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AFRS and eCRSwNP differ across clinical, radiographic, laboratory, and SHP domains in this Saudi cohort, supporting AFRS as a distinct phenotype within the CRSwNP spectrum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70961","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:15:38Z","timestamp":1790914538000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structured Histopathology Distinguishes\n                    <scp>AFRS<\/scp>\n                    From\n                    <scp>eCRSwNP<\/scp>"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9155-3302","authenticated-orcid":false,"given":"Ali G.","family":"Alrashidi","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"},{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery King Salman Specialized Hospital  Hail Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6451-1326","authenticated-orcid":false,"given":"Nasir","family":"Magboul","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery Jazan Armed Forces Hospital  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2151-8198","authenticated-orcid":false,"given":"Ali M.","family":"Alsudays","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery King Fahad Specialist Hospital  Buraidah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7908-9023","authenticated-orcid":false,"given":"Ali J.","family":"Asiry","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"},{"name":"Department of Otorhinolaryngology, Head and Neck Department Aseer Central Hospital  Abha Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3787-6480","authenticated-orcid":false,"given":"Abdulrahman K.","family":"Badghaish","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimah F.","family":"Alsalem","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5275-0255","authenticated-orcid":false,"given":"Ahmad","family":"Alroqi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2286-7492","authenticated-orcid":false,"given":"Saud","family":"Alromaih","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3665-647X","authenticated-orcid":false,"given":"Abdulaziz S.","family":"Alrasheed","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-4550","authenticated-orcid":false,"given":"Yousif","family":"Alammar","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head &amp; Neck Surgery College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1236-2098","authenticated-orcid":false,"given":"Saad","family":"Alsaleh","sequence":"additional","affiliation":[{"name":"Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1111\/j.1398-9995.2011.02646.x","article-title":"Chronic Rhinosinusitis in Europe: An Underestimated Disease. 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In Practice"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1177\/19458924231152983","article-title":"New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment","volume":"37","author":"Cameron B. H.","year":"2023","journal-title":"American Journal of Rhinology & Allergy"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1002\/alr.21292","article-title":"Markers of Disease Severity and Socioeconomic Factors in Allergic Fungal Rhinosinusitis","volume":"4","author":"Miller J. 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Series B, Statistical Methodology"},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/j.jaci.2023.11.925","article-title":"Aggregated Eosinophils and Neutrophils Characterize the Properties of Mucus in Chronic Rhinosinusitis","volume":"153","author":"Miyabe Y.","year":"2024","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"e_1_2_10_27_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1002\/alr.22454","article-title":"Central Compartment Atopic Disease: Prevalence of Allergy and Asthma Compared With Other Subtypes of Chronic Rhinosinusitis With Nasal Polyps","volume":"10","author":"Marcus S.","year":"2020","journal-title":"International Forum of Allergy & Rhinology"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70961","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.70961","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70961","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:15:42Z","timestamp":1790914542000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.70961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":26,"alternative-id":["10.1002\/lary.70961"],"URL":"https:\/\/doi.org\/10.1002\/lary.70961","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"assertion":[{"value":"2026-06-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"lary.70961"}}