The clinical course of nasal polyps in relation with histological and radiological findings

Background: Nasal polyps (NPs) show distinct characteristics in histologic features with different inflammatory cells and stromal changes, but their clinical implications remain poorly understood. Objective: To determine the associations between NP histology, clinical characteristics, radiologic disease burden on osteomeatal unit computed tomography (OMU-CT) findings, and postoperative recurrence. Methods: We retrospectively reviewed 219 patients who underwent nasal polypectomy. NPs were histologically classified by predominant inflammatory cells (eosinophilic vs. lymphoplasmacytic) and stromal features (edematous, glandular, or dense). Clinical variables, preoperative OMU-CT scores, and recurrence rates were analyzed. Results: Overall, 62.6% (137/219) of NPs were eosinophilic. Edematous stroma was the most common stromal subtype (72.6%, 159/219), predominating in eosinophilic NPs (96.3%, 132/137). Patients with eosinophilic NPs showed higher CT severity scores (18.4 ± 0.7 vs. 15.5 ± 1.1; P = 0.021) and a higher prevalence of extended disease (78.3% vs. 60.0%; P = 0.010) than those with lymphoplasmacytic NPs. CT severity score correlated with blood eosinophil counts ( r = 0.17, P = 0.018). Patients with asthma (11.9%) showed higher CT severity scores (22.4 ± 1.4 vs. 16.9 ± 0.6; P = 0.002) and a tendency toward extended disease (92.0% vs. 70.3%; P = 0.052) compared to those without asthma. Among 99 patients with follow-up, recurrence occurred in 16.2%. While recurrence rates did not differ by histologic type, recurrent cases had significantly higher preoperative CT scores than nonrecurrent cases (21.9 vs. 16.9; P = 0.002). Conclusion: Eosinophilic NPs are associated with greater CT disease burden and extent. Peripheral eosinophil counts reflect tissue eosinophilia and correlate with radiologic severity.