Nasal Polyposis in Churg‐Strauss Syndrome

Abstract

Objectives: Churg‐Strauss syndrome (CSS) is a systemic vasculitic disorder of unknown etiology that affects small‐to‐medium‐size blood vessels. Patients affected by CSS frequently show ear, nose, and throat manifestations, which are often present at the time of disease onset. The purpose of this study was to determine the frequency of nasal polyposis in a series of 29 patients with CSS and to correlate the nasal findings to the total health situation of these patients. Study Design: Retrospective analysis. Setting: Department of Otolaryngology and Department of Clinical Medicine, Nephrology and Health Science, University of Parma. Methods: Twenty‐nine patients with CSS were identified. Of the 29 patients, 17 (58.6%) had nasal polyposis and were enrolled in this study. The nasal polyps were graded according to the Lund and Mackay endoscopic and radiological classifications. Results: At diagnosis, endoscopic intranasal evaluation identified nasal polyposis of grade 3 in nine cases (52.9%), grade 2 in six cases (35.2%), and grade 1 in the remaining case (5.8%). After corticosteroid and immunosuppressive therapy, clinical remission was achieved in 14 patients (82.3%), whereas 3 patients experienced a relapse. Posttreatment endoscopic evaluation showed a permanent disappearance (grade 0) of nasal polyps in eight patients (47%). The other nine patients (52.92%) were found to have a small polyp situated in the middle meatus (grade 1). Conclusions: Nasal polyposis in patients with CSS may represent the initial phase of the syndrome, though patients often have concurrent pulmonary disease. Corticosteroid therapy either alone or combined with immunosuppressive drugs usually yielded improvement or stabilization.

Clinical and Serological Features of Eosinophilic and Vasculitic Phases of Eosinophilic Granulomatosis with Poliangiitis: a Case Series of 15 Patients

“…However, the two patients in the vasculitic phase did not have nasal polyposis. These rates were similar to those of other studies [10][11][12]. The rate of NSAID hypersensitivity was similar (66%) to our previous study [12].…”

“…Nasal polyps affect approximately half of the patients and can recur after surgery in patients not receiving immunosuppressive therapy [11]. In our study, the upper airways were affected in all patients, and two thirds of the patients had nasal polyposis.…”

Ear, nose, and throat involvement in eosinophilic granulomatosis with polyangiitis

“…Management of ENT manifestations in EGPA can be challenging (12,13,38). For patients with chronic sinusitis, multiple daily nasal rinses with normal saline may provide some symptomatic benefit but are unlikely to provide lasting relief.…”

“…Nasal polyps were frequent in some studies, in up to three-quarters of patients, and were usually present before diagnosis (12,13). Polyps are often diffuse and bilateral (13). Crusting is rarer and more typically a hallmark of GPA, but it can occur in EGPA (B15%), usually associated with polyposis.…”

“…Chronic sinusitis has been reported in 60Á80% of cases, sinusitis and polyposis in about 40%, and 'paranasal sinus involvement' in 75% (6Á13, 16, 17, 20Á22). Nasal polyps were frequent in some studies, in up to three-quarters of patients, and were usually present before diagnosis (12,13). Polyps are often diffuse and bilateral (13).…”