A Clinically Relevant Classification and Staging System for Chronic Rhinosinusitis with Nasal Polyposis: A Cross-Sectional Study

Background/Objectives: Tissue eosinophilia plays a central role in chronic rhinosinusitis with nasal polyposis (CRSwNP), yet the spectrum of disease, particularly central compartment atopic disease (CCAD), remains underexplored. This study aimed to classify CRSwNP into three distinct phenotypes, eosinophilic CRSwNP (ECRSwNP), non-eosinophilic CRSwNP (NECRSwNP), and CCAD, based on radiologic and endoscopic features. It also proposes a novel severity-based staging system to guide clinical decision-making. Methods: A cross-sectional observational study was conducted in a single private clinic between January 2019 and August 2025. Patients were assessed using clinical history, paranasal sinus computed tomography (CT), and intranasal endoscopy. Key variables included symptom clusters, comorbidities, hematologic and atopy profiles, radiologic and endoscopic findings, histopathology, and pre-treatment SNOT-22 scores. Results: A total of 2060 patients (mean age: 29.8 ± 11 years; 51.8% male) were included. Asthma was the most frequent comorbidity (23.5%). Classification into ECRSwNP, NECRSwNP, and CCAD was achieved using integrated clinical, radiologic, and histopathologic criteria. Conclusions: This study presents a phenotype- and severity-based classification system for CRSwNP that incorporates endoscopic and radiologic features. This framework may enhance diagnostic accuracy and enable more tailored therapeutic strategies.