Introduction

In current clinical practice, primary diffuse chronic rhinosinusitis with nasal polyps (CRSwNP) is classified into two endotypes: type 2 and non-type 2. Former clinical investigations have primarily focused on differences of health-related quality of life (QoL) in CRSwNP in the light of phenotypes.

Material and methods

This prospective, single-center study was conducted between 2018 and 2023 on patients with CRSwNP referred for surgery. Sinonasal QoL was assessed using the German validated SNOT-20 questionnaire. Type 2 was defined according to the updated 2023 EPOS/EUFOREA criteria.

Results

A total of 122 patients with CRSwNP were included in our analysis, of whom 113 were classified as type 2. Whereas those had a similar nasal polyp score (NPS) to non-type 2 patients, their SNOT-20 scores were significantly reduced. Two of the four cardinal symptoms of CRS—loss of smell and rhinorrhea—were significantly more severe and more frequent in the type 2 endotype, with loss of smell being particularly specific. This was associated with the NPS-score, and facial pain/pressure inversely correlated with age. Age was significantly associated with loss of smell, but only in non-type 2 CRSwNP.

Discussion

This study is the first to examine the impact of endotypes on symptomatology in CRSwNP. Our preliminary data indicate that the type 2 endotype has a greater impact on QoL than the non-type 2 endotype of CRSwNP. Both endotypes induce nasal obstruction. Hyposmia and rhinorrhea, two other major symptoms of CRS, are predictors for a more type 2 driven diseases.

Dr. Pfaar reports grants and/or personal fees and/or travel support from ALK-Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Laboratorios LETI/LETI Pharma, GlaxoSmithKline, ROXALL Medizin, Novartis, Sanofi-Aventis and Sanofi-Genzyme, Med Update Europe GmbH, streamedup! GmbH, Pohl-Boskamp, John Wiley and Sons/AS, Paul-Martini-Stiftung (PMS), Regeneron Pharmaceuticals Inc., RG Aerztefortbildung, Institut für Disease Management, Springer GmbH, AstraZeneca, IQVIA Commercial, Inmunotek S.L., Ingress Health, Wort&Bild Verlag, Verlag ME, Procter&Gamble, ALTAMIRA, Meinhardt Congress GmbH, Deutsche Forschungsgemeinschaft , Thieme, Deutsche AllergieLiga e.V., AeDA, Alfried-Krupp Krankenhaus, Red Maple Trials Inc., Königlich Dänisches Generalkonsulat, Medizinische Hochschule Hannover, ECM Expro&Conference Management, Technical University Dresden, Lilly, Japanese Society of Allergy , Forum für Medizinische Fortbildung, Dustri-Verlag, Pneumolive, ASIT Biotech, LOFARMA, Almirall, Paul-Ehrlich-Institut, outside the submitted work; and he is Vice President of the European Academy of Allergy and Clinical Immunology (EAACI) and member of EAACI Excom, member of ext. board of directors of the German Society of Allergy and Clinical Immunology (DGAKI); coordinator, main- or co-author of different position papers and guidelines in rhinology, allergology and allergen-immunotherapy; he is associate editor (AE) of Allergy and Clinical Translational Allergy.