Correction to: Clinically relevant phenotypes in chronic rhinosinusitis

  • Jessica W. GraysonEmail author
  • Marina Cavada
  • Richard J. Harvey
Open Access

Correction to: J Otolaryngol Head Neck Surg

Following publication of the original article [1], the authors reported an error in Table 1. In the second columns of the ‘Radiology’ row, ‘Normal anterolateral sinus mucosa’ should read ‘Normal superolateral sinus mucosa’. A corrected version of Table 1 is included in this Correction.
Table 1

Summary of Key Findings of CRS Phenotypes




CCAD (IgE mediated)



Clinical Presentation

- Young onset (teens to 20s)

- Rhinitis symptoms

- Smell preserved

- Other atopic disease:

° Childhood asthma

° conjunctival symptoms, dermatitis

- Mid-Life “adult” onset (30–50 yo)

- Occasionally post respiratory virus

- “Completely well” prior to onset or if allergic, then symptoms limited to childhood

- Smell loss (corticosteroid responsive)

- Antibiotic seeking

- Food and alcohol induced flares

- Adult onset asthma linked temporally to CRS onset.

- Older onset 50 yrs.+

- Female, obese

- Cough

- Poor corticosteroid response

- “Asthma” present but often poor response to inhaled preventive therapy (corticosteroid based)


- Middle turbinate edema

- Polypoid changes from turbinates and septum

- No thick mucin

- Normal sinus mucosa on surgery

- Polyps (small, multiple, large) from the middle meatus

- Thick eosinophilic mucin

- Secondary purulence

- Polyps or polypoid edema

- Purulent secretions

- Lack of eosinophilic mucin


- Central thickening of septum and turbinates, peripheral clearing (CCAD)

- Mucus trapping only in sinsues

- Normal superolateral sinus mucosa (“black halo”)

- Pan-sinusitis (Lund-Mackay 24)

- Neo-osteogenesis

- Pan-sinusitis (undistinguishable from eCRS)


- Elevated tissue eosinophilia

- Often without activation (no eosinophil aggregates and charcot-leyden crystals)

- No serum eosinophils

- Elevated total and specific IgE

- Elevated tissue eosinophilia (>10eos/hpf, but often >100eos/hpf)

- Evidence of eosinophil activation (eosinophil aggregates and charcot-leyden crystals)

- Serum eosinophilia

- Lack of tissue eosinophilia (< 10/HPF)


- + allergy testing (dustmite/perennial allergens)

- Often monoallergen-sensitized

- Either negative IgE sensitization or multi-allergen sensitized

- Negative skin prick, immunocap/RAST


- Allergen directed immunotherapy

- Endoscopic sinus surgery

- Topical corticosteroid (spray or irrigation)

- Systemic corticosteroid treatment (up to 2–3 times per year) if limited burden of disease

- Endoscopic sinus surgery (Draf 3)

- Topical corticosteroid irrigations (not sprays)


- Zileuton, Montelukast, Zafirlukast

- Can take selective COX-2 inhibitors (Meloxicam)

- Saline or corticosteroid irrigations

- Endoscopic sinus surgery

- Macrolide therapy (Clarithromycin 250 mg daily for 3 months)

- Continue 3/week until 12 months if responder

Difficult to control disease

- Omaluzimab (anti-IgE)

- Mepoluzimab (anti-IL5)

- Other immune-modulating therapy (Benraluzimab, Dupiliumab, Reslizumab, etc)


- ASA desensitization (1300 mg commencement and 350–700 mg daily maintenance)

- Consider re-biopsy of a patient post-surgery and post-corticosteroid based treatment if not responding and may be re-classified under this phenotype


  1. 1.
    Grayson, et al. Clinically relevant phenotypes in chronic rhinosinusitis. J. Otolaryngol. Head Neck Surg. 2019;48:23 Scholar

Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Jessica W. Grayson
    • 1
    Email author
  • Marina Cavada
    • 1
    • 2
  • Richard J. Harvey
    • 1
    • 2
  1. 1.Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical ResearchUniversity of New South WalesSydneyAustralia
  2. 2.Department of Otolaryngology, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyAustralia

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