Abstract objectives: We aimed to report the prevalence of anatomic variations in Chinese pediatric patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and to explore the correlation between anatomic variations and the extent of chronic sinusitis in children. Design: This retrospective study conducted between January 2018 and June 2020. Setting:This study involved children from the First Affiliated Hospital, Sun Yat-sen University and Guangzhou Women and Children’s Medical Center. Participants: Participants included 50 children with CRSwNP. Main outcome measures: The diagnosis of CRSwNP was based on symptoms, endoscopy, and computed tomography examination according to European criteria on chronic rhinosinusitis. The presence of anatomical variations was determined, and its correlation with disease extension was analyzed. Results: Fifty children were included in the study. The anterior ethmoid sinus was the most commonly affected sinus in children, followed by the maxillary, posterior ethmoid, frontal, and sphenoid sinuses. Agger nasi cells were the most common anatomic variation in children sinus (96%), followed by inferior turbinate hypertrophy (60%), septal deviation (55.1%), concha bullosa (45.8%), Onodi cells (44.9%), Haller cells (38%), and paradoxical middle turbinate (4%). No significant correlation was found between anatomic variation and corresponding sinusitis hypertrophy and maxillary sinusitis (P > 0.05). Conclusions: Our results found no correlation between anatomic variations and sinusitis in pediatric CRSwNP. The occurrence of pediatric CRSwNP is as attributed more to immunological, infectious, or other factors rather than anatomic variations.

Background: The histopathology of pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is rarely reported due to their low prevalence or the unavailability of tissue samples. Hence, we aimed to characterize and compare the histologic features and protein expression of Th1/Th2/Th17-related cytokines in pediatric CRSsNP and CRSwNP. Methods: The histologic characteristics of 15 children with CRSsNP, 52 children with CRSwNP, and 12 control participants were analyzed using hematoxylin and eosin staining. The expression of Th1/Th2/Th17-related cytokines were examined using immunohistochemistry and the enzyme-linked immunosorbent assay. Results: Pediatric subjects with CRSwNP had more intact epithelium and less submucosal mucous glands compared to those with CRSsNP. Tissue eosinophils were more prevalent in the young CRSwNP group compared to the old CRSwNP or the CRSsNP groups. The protein concentrations of Th2 cytokines were significantly higher in the CRSwNP group than the CRSsNP group or the control group. Moreover, the protein concentrations of Th17 cytokines were significantly higher in the young CRSwNP group than the old CRSwNP group or the CRSsNP and control groups. The protein concentrations of Th1 and Th17 cytokines were also significantly higher in the CRSsNP group than the control group. Compared with non-eosinophilic CRSwNP, eosinophilic CRSwNP presented with elevated protein concentrations of Th1 and Th17 cytokines. Conclusion: For the first time, we showed that pediatric CRSwNP presents as eosinophilic with Th2/Th17 inflammation, whereas CRSsNP presents as Th1/Th17 inflammation. Our study may provide a theoretical basis for the precise treatment of pediatric CRS in the future.