Association Between Endoscopic, Radiologic and Patient-reported Chronic Rhinosinusitis with Nasal Polyps

A. Luukkainen1, 2, J. Numminen3, M. Rautiainen3, A. Julkunen1, H. Huhtala4, J. Lampi5, 6, A. Markkola7, J. Myller8, A.K. Andiappan9, D.Y. Wang2, S. Toppila-Salmi1, 10, *
1 Haartman Institute, University of Helsinki, Helsinki, Finland
2 Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore 119228, Singapore
3 Department of Otorhinolaryngology, Tampere University Hospital and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
4 Faculty of Social Sciences, Tampere University, Tampere, Finland
5 Living Environment and Health Unit, National Institute for Health and Welfare, Helsinki, Finland
6 Environment Health Unit, National Institute for Health and Welfare, PO Box 95, FI-70701, Kuopio, Finland
7 Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
8 Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland
9 Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
10 Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

© 2019 Luukkainen et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Skin and Allergy Hospital, Helsinki University Hospital, PO BOX 160 (Meilahdentie 2), 00029 Hospital District of Helsinki and Uusimaa, Helsinki, Finland; Tel: +358-9-4711;
Fax: +358-9-19125155, E-mail:



Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) and with Nasal Polyps (CRSwNP) affect 10% and 1-4% of the general population respectively. Early detection and treatment of CRSwNP might prevent recalcitrant disease forms. The aim of this prospective controlled study was to evaluate association between endoscopic, radiologic, and self-reported CRSwNP, and a family history in defining CRSwNP.


This study involved 73 CRS patients aged 18 years or over undergoing CRS-surgical consultation at the Tampere University Hospital. Data of sinus Computed Tomography (CT) scans and nasal endoscopy was obtained from patient records. Sixty controls ±allergic rhinitis underwent clinical examination. All subjects filled a questionnaire. Associations were analyzed by Chi square and adjusted regression models. The predictive performance of various parameters was assessed using the Area Under the Receiver Operating Characteristic curve (AUROC).


A total of 33% of CRSwNP patients reported not having Nasal Polyps (NPs), while 18% of CRSsNP patients reported having NPs (p < 0.001). Radiologic Nasal Polyp (NP) score differentiated CRSwNP from CRSsNP with an AUROC of 0.95 (95% CI 0.91-1.00). The AUROC value for Lund-Mackay (LM) score was 0.84 (0.75-0.94). Positive family history of NP did not differ significantly between CRS and control groups. Family history of allergy or asthma was given with certainty, whereas CRS patients had uncertainty of reporting NPs in family compared to controls (adjusted OR=6.02, 95% CI 1.98-18.30, p = 0.002).


Our findings suggest that in situations where nasal endoscopy cannot be performed, early detection of CRSwNP could result from information obtained from sinus CT scans and patients, in comparison to family history which has lower predictive value. However validation studies with larger sample sizes are still needed.

Keywords: Allergic rhinitis, Asthma, Nasal polyps, Rhinosinusitis, Nasal endoscopy, CT scan.