Nasal Polyp Score and CT Findings in Patients with Chronic Rhinosinusitis with Nasal Polyps

Abstract

Eosinophilic chronic rhinosinusitis (eCRS), an intractable type of sinusitis that recurs easily after endoscopic sinus surgery, for inclusion is designated as an intractable disease by the Japanese Ministry of Health, Labour, and Welfare (MHLW). An anti-IL-4 receptor alpha chain antibody (dupilumab, Dupixent^®) has been approved as a drug that is effective in treating eCRS, and is now covered by the national health insurance in Japan. However, the MHLW has issued a guideline for the optimal use of Dupixent^®, and appropriate use based on this guideline is required. The guideline suggests that Dupixent^® only be used for patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who are insufficiently responsive to existing treatments, in whom the total bilateral nasal polyp score is ≥ 5. The nasal polyp score has been used as the primary endpoint in an international clinical trial of CRSwNP without a clear description, which has led to confusion. In this paper, we provide a clear overview of the nasal polyp score criteria and discuss CT findings that may be useful for the diagnosis of eCRS. We present the CT findings of a case with ethmoid sinus predominance, corresponding to a JESREC score of 2.