Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent disease which can be classified as eosinophilic or neutrophilic based on dominant inflammatory cell type at tissue. The aim of this study was to evaluate the clinical relevance of classifying nasal polyps as eosinophilic or neutrophilic on treatment outcomes. The study was conducted with 40 patients who underwent either surgical or medical treatment with the diagnosis of CRSwNP. The patients were classified into two groups for further assessment up to eosinophil intensity at polyp tissue. All patients were examined by nasal endoscopy and paranasal computed tomography (CT). Before treatment, subjective symptom score, nasal endoscopy score, and CT score were measured. Subsequently, they were reevaluated by similar diagnostic tests after either medical or surgical treatment at sixth month. The preoperative subjective symptom score, endoscopy score, and paranasal CT score were compared between chronic rhinosinusitis (CRS) with eosinophilic nasal polyps (E-NP) (CRSwE-NP) group and CRS with neutrophilic nasal polyps group and there was no difference between the two groups (p = 0.369, p = 0.310 and p = 0.494 respectively). Although after treatment in both groups symptom score and endoscopy score were significantly improved but not the CT score, we found no difference in between the groups at sixth month. In most of the previous studies, patients with CRSwE-NP were assumed to have poor prognosis and high recurrence rate despite surgical or medical treatment. However, we did not find any association between eosinophilic or neutrophilic nature of nasal polyp tissue and disease severity.

We want to give a brief reply to those questions raised by that reader. (1) The endoscopic grading was done by the same author (Hancer Tecimer S.), thus there was no interpersonal variability with regard to Lund-Kennedy staging system. (2) The patients were operated by two senior surgeons (Kasapoglu F. and Demir U. L.). (3) We have already mentioned in the discussion section of the article that small sample size and relatively short follow-up duration might be the reasons why we found no difference at treatment outcomes between eosinophilic and neutrophilic patient groups. We have already indicated the necessity of further blinded and randomized clinical studies for a definite conclusion, in our manuscript. We are now studying on a similar randomized clinical study with equal number of sample sizes.This reply refers to the comment available at