{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:12:29Z","timestamp":1793211149807,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Tissue eosinophilia plays a central role in chronic rhinosinusitis with nasal polyposis (CRSwNP), yet the spectrum of disease, particularly central compartment atopic disease (CCAD), remains underexplored. This study aimed to classify CRSwNP into three distinct phenotypes, eosinophilic CRSwNP (ECRSwNP), non-eosinophilic CRSwNP (NECRSwNP), and CCAD, based on radiologic and endoscopic features. It also proposes a novel severity-based staging system to guide clinical decision-making. Methods: A cross-sectional observational study was conducted in a single private clinic between January 2019 and August 2025. Patients were assessed using clinical history, paranasal sinus computed tomography (CT), and intranasal endoscopy. Key variables included symptom clusters, comorbidities, hematologic and atopy profiles, radiologic and endoscopic findings, histopathology, and pre-treatment SNOT-22 scores. Results: A total of 2060 patients (mean age: 29.8 \u00b1 11 years; 51.8% male) were included. Asthma was the most frequent comorbidity (23.5%). Classification into ECRSwNP, NECRSwNP, and CCAD was achieved using integrated clinical, radiologic, and histopathologic criteria. Conclusions: This study presents a phenotype- and severity-based classification system for CRSwNP that incorporates endoscopic and radiologic features. This framework may enhance diagnostic accuracy and enable more tailored therapeutic strategies.<\/jats:p>","DOI":"10.3390\/diagnostics15243197","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"3197","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A Clinically Relevant Classification and Staging System for Chronic Rhinosinusitis with Nasal Polyposis: A Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8977-054X","authenticated-orcid":false,"given":"Goran Latif","family":"Omer","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaymaniyah 46001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6419-9704","authenticated-orcid":false,"given":"Stefano","family":"Di Girolamo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7988-3451","authenticated-orcid":false,"given":"Sahand Soran","family":"Ali","sequence":"additional","affiliation":[{"name":"College of Pharmacy, American University of Iraq\u2014Sulaimani (AUIS), Sulaymaniyah 46001, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Maurizi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4255-7477","authenticated-orcid":false,"given":"Sveva","family":"Viola","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"De Donato","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1111\/all.14809","article-title":"Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines","volume":"76","author":"Agache","year":"2021","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinol. Online"},{"key":"ref_3","first-page":"e2022240","article-title":"When rhinosinusitis is not just rhinosinusitis: Clinical characteristics and phenotypes of patients with type 2 chronic rhinosinusitis with nasal polyps","volume":"93","author":"Ciprandi","year":"2022","journal-title":"PubMed"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/all.15982","article-title":"EUFOREA\/EPOS2020 statement on the clinical considerations for chronic rhinosinusitis with nasal polyps care","volume":"79","author":"Hellings","year":"2023","journal-title":"Allergy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"168","DOI":"10.14715\/cmb\/2024.70.7.24","article-title":"Predictive significance of the blood eosinophilia for chronic sinusitis with nasal polyp recurrence: A systematic review and meta-analysis","volume":"70","author":"Omer","year":"2024","journal-title":"Cell. Mol. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/0003489418818578","article-title":"Non-eosinophilic chronic rhinosinusitis with nasal polyps: Eosinophil, basophil, and neutrophil blood counts before and after surgery","volume":"128","author":"Parrino","year":"2018","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kim, D.K., Jin, H.R., Eun, K.M., Mutusamy, S., Cho, S.H., Oh, S., and Kim, D.W. (2015). Non-Eosinophilic nasal polyps shows increased epithelial proliferation and localized disease pattern in the early stage. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139945"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3390\/sinusitis7020003","article-title":"Central compartment atopic disease as a pathophysiologically distinct subtype of chronic rhinosinusitis: A scoping review","volume":"7","author":"Davies","year":"2023","journal-title":"Sinusitis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.alit.2019.07.002","article-title":"Eosinophilic chronic rhinosinusitis","volume":"68","author":"Fujieda","year":"2019","journal-title":"Allergol. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/all.12644","article-title":"Novel scoring system and algorithm for classifying chronic rhinosinusitis: The JESREC Study","volume":"70","author":"Tokunaga","year":"2015","journal-title":"Allergy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1002\/alr.23207","article-title":"Inflammatory characteristics of central compartment atopic disease","volume":"13","author":"Rubel","year":"2023","journal-title":"Int. Forum. Allergy Rhinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1177\/19458924231155012","article-title":"CCAD or eCRS: Defining eosinophilic subpopulations in chronic rhinosinusitis","volume":"37","author":"Sit","year":"2023","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5935\/1808-8694.20130010","article-title":"Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire","volume":"79","author":"Marambaia","year":"2013","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1001\/archotol.133.7.701","article-title":"Total IGE levels and peripheral eosinophilia","volume":"133","author":"Poznanovic","year":"2007","journal-title":"Arch. Otolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/ACI.0000000000000602","article-title":"Systemic biomarkers of eosinophilic chronic rhinosinusitis","volume":"20","author":"Ho","year":"2019","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Grayson, J.W., Cavada, M., and Harvey, R.J. (2019). Clinically relevant phenotypes in chronic rhinosinusitis. J. Otolaryngol. Head Neck Surg., 48.","DOI":"10.1186\/s40463-019-0350-y"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1002\/oto2.106","article-title":"Blood eosinophil percentage and improved sinus CT score as diagnostic tools for ECRS","volume":"8","author":"Li","year":"2024","journal-title":"OTO Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.1749-4486.2010.02218.x","article-title":"Global Osteitis Scoring Scale and chronic rhinosinusitis: A marker of revision surgery","volume":"35","author":"Georgalas","year":"2010","journal-title":"Clin. Otolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1001\/jama.2024.0530","article-title":"Allergic rhinitis","volume":"331","author":"Bernstein","year":"2024","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4168\/aair.2011.3.1.3","article-title":"Aspirin-Exacerbated Respiratory Disease: Evaluation and management","volume":"3","author":"Lee","year":"2010","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1097\/00005537-199808000-00027","article-title":"Nasal polyps in the olfactory cleft","volume":"108","author":"Masaki","year":"1998","journal-title":"Laryngoscope"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1159\/000276804","article-title":"Distribution of Eosinophil Granule Proteins in Nasal Mucosa of Atopic Patients with Nasal Polyposis","volume":"58","author":"Min","year":"1996","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2500\/105065890782009433","article-title":"The differentiation of polyps and their mucosal ultrastructure","volume":"4","author":"Takasaka","year":"1990","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"279","DOI":"10.2500\/105065800781329573","article-title":"Nasal polyposis: From cytokines to growth","volume":"14","author":"Bachert","year":"2000","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"275","DOI":"10.4193\/Rhin08.109","article-title":"Relationship between epithelial damage or basement membrane thickness and eosinophilic infiltration in nasal polyps with chronic rhinosinusitis","volume":"47","author":"Saitoh","year":"2009","journal-title":"Rhinol. Online"},{"key":"ref_26","first-page":"1447","article-title":"Histopathological classification of refractory chronic rhinosinusitis with nasal polyps","volume":"30","author":"Mortuaire","year":"2015","journal-title":"PubMed"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bachert, C., Hicks, A., Gane, S., Peters, A.T., Gevaert, P., Nash, S., Horowitz, J.E., Sacks, H., and Jacob-Nara, J.A. (2024). The interleukin-4\/interleukin-13 pathway in type 2 inflammation in chronic rhinosinusitis with nasal polyps. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1356298"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00130832-200302000-00001","article-title":"Nasal polyposis: An update","volume":"3","author":"Pawankar","year":"2003","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4055","DOI":"10.2147\/JIR.S466944","article-title":"Correlation of Eosinophils and Type 2 Inflammatory Mediators with Osteitis in Chronic Rhinosinusitis with Nasal Polyps","volume":"17","author":"Zhang","year":"2024","journal-title":"J. Inflamm. Res."},{"key":"ref_30","first-page":"944","article-title":"To explore the role of CT scan in the diagnosis of eosinophilic chronic rhinosinusitis","volume":"32","author":"Zhu","year":"2018","journal-title":"PubMed"},{"key":"ref_31","first-page":"1774","article-title":"Different phenotypes in patients with chronic sinusitis with bilateral nasal polyps","volume":"32","author":"Zhang","year":"2018","journal-title":"PubMed"},{"key":"ref_32","first-page":"340","article-title":"Eosinophil-derived TGF\u03b21 controls the new bone formation in chronic rhinosinusitis with nasal polyps","volume":"61","author":"Jo","year":"2023","journal-title":"Rhinol. Online"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"523","DOI":"10.2147\/JAA.S275536","article-title":"The Clinical and Radiological Characterizations of the Allergic Phenotype of Chronic Rhinosinusitis with Nasal Polyps","volume":"13","author":"Abdullah","year":"2020","journal-title":"J. Asthma Allergy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"230","DOI":"10.21053\/ceo.2022.00052","article-title":"Clinical and Laboratory Features of Various Criteria of Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis","volume":"15","author":"Kim","year":"2022","journal-title":"Clin. Exp. Otorhinolaryngol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bjorl.2016.01.012","article-title":"Distinct characteristics of nasal polyps with and without eosinophilia","volume":"83","author":"Sun","year":"2016","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/coa.13536","article-title":"Comorbidities associated with eosinophilic chronic rhinosinusitis: A systematic review and meta-analysis","volume":"45","author":"McHugh","year":"2020","journal-title":"Clin. Otolaryngol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"NP741","DOI":"10.1177\/01455613221083793","article-title":"Osteitis in eosinophilic chronic rhinosinusitis","volume":"103","author":"Tsuda","year":"2022","journal-title":"Ear Nose Throat J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1002\/alr.23416","article-title":"Diagnostic criteria for eosinophilic chronic rhinosinusitis: Comparative analysis and novel scoring system","volume":"14","author":"Lee","year":"2024","journal-title":"Int. Forum. Allergy Rhinol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/24\/3197\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T05:27:32Z","timestamp":1766035652000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/24\/3197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,14]]},"references-count":38,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["diagnostics15243197"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15243197","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,14]]}}}