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Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity

  • Woo-Jung SongEmail author
  • Ji-Hyang Lee
  • Ha-Kyeong Won
  • Claus Bachert
Otitis (DP Skoner, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Otitis

Abstract

Purpose of Review

Chronic rhinosinusitis and nasal polyps (CRSwNP) is a common condition that significantly affects patients’ life. This work aims to provide an up-to-date overview of CRSwNP in older adults, focusing on its aging-related clinical presentations, pathophysiology, and comorbidity associations including asthma.

Recent Findings

Recent large population-based studies using nasal endoscopy have shown that CRSwNP is a mostly late-onset disease. Age-related changes in physiologic functions, including nasal epithelial barrier dysfunction, may underlie the incidence and different clinical presentations of CRSwNP in older adults. However, there is still a paucity of evidence on the effect of aging on phenotypes and endotypes of CRSwNP. Meanwhile, late-onset asthma is a major comorbid condition in patients with CRSwNP; they frequently present with type 2 inflammatory signatures that are refractory to conventional treatments when they are comorbid. However, as they are more commonly non-atopic, causative factors other than classical atopic sensitization, such as Staphylococcus aureus specific IgE sensitization, are suggested to drive the type 2 inflammation. There are additional comorbidity associations in older patients with CRSwNP, including those with chronic otitis media and head and neck malignancy.

Summary

Age is a major determinant for the incidence and clinical presentations of CRSwNP. Given the heterogeneity in phenotypes and endotypes, longitudinal investigations are warranted to elucidate the effects of aging on CRSwNP.

Keywords

Chronic rhinosinusitis Nasal polyps Asthma Comorbidity Aging 

Notes

Funding

This work was financially supported by the National Research Foundation of Korea (NRF) grant, funded by the Korean Government (NRF-2018R1D1A1B07049440).

Compliance with Ethical Standards

Conflict of Interest

Woo-Jung Song reports grants from MSD and Astra Zeneca, outside the submitted work. Ji-Hyang Lee, Ha-Kyeong Won, and Claus Bachert declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. 1.Department of Allergy and Clinical Immunology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Internal MedicineVeterans Health Service Medical CenterSeoulSouth Korea
  3. 3.Upper Airways Research LaboratoryGhent University HospitalGhentBelgium

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