Jacquelyn K. Callander, Annabelle R. Charbit, Kritika Khanna, John V. Fahy, Monica Tang, Maude Liegeois, Steven D. Pletcher, Andrew N. Goldberg, Jose G. Gurrola II, Andrew H. Murr, Anna Butrymowicz, Patricia A. Loftus
Publication date 13-09-2024
Abstract Background Practical biomarkers for endotypic characterization of chronic rhinosinusitis (CRS) remain elusive, hindering clinical utility. Eosinophil peroxidase (EPX) is an enzyme released by activated eosinophils. The objective of this study was to evaluate a clinic EPX assay as a marker of eosinophilic CRS.
Methods Subjects with and without CRS presenting to a tertiary care rhinology clinic were prospectively enrolled, and nasal cytology brushings were collected from the middle meatus during in-clinic nasal endoscopy. ELISA assay was used to quantify EPX levels, and a customized multiplex immunoassay was used to quantify inflammatory cytokine mediators. Findings were correlated with clinical data.
Results Forty-two subjects were enrolled, including 31 CRS subjects and 11 controls. Median EPX levels were 125.0 ng/mL (standard deviation SD 1745.8) and 6.5 ng/mL (SD 99.0) for CRS group and controls, respectively (p = 0.003). EPX levels were associated with history of asthma (p = 0.015), allergies (p = 0.028), polyps (p = 0.0006), smell loss (p = 0.006), and systemic eosinophilia or elevated immunoglobulin E (p ≤ 0.0001). Twenty-eight subjects from both the CRS and control groups had prior pathology for comparison, with histologic confirmation of local tissue eosinophilia (>10 eosinophils/hpf) in 11 subjects. This subgroup had a median EPX level of 967.5 ng/mL compared to 10.6 ng/mL in 17 subjects without local tissue eosinophilia (p = 0.0008). EPX levels were positively correlated to interleukin-5 levels (p = 0.0005).
ConclusionEPX levels can be measured via well-tolerated in-clinic collection of nasal mucus. EPX levels are associated with clinical markers of type 2 inflammation and tissue eosinophilia and may provide a valuable diagnostic tool to delineate eosinophilic CRS.
Ryan A. Cotter, Jack T. Garcia, Ahmed Alsayed, Sven Schneider, David T. Liu, Julia Eckl‐Dorna, Firas A. Houssein, Robby S. Boparai, Nikhil A. Parail, Matthew M. Chu, Josh C. Meier, Saad Alsaleh, Katie M. Phillips, Ahmad R. Sedaghat
Publication date 13-09-2024
Abstract Background Overall symptom severity (OSS) and patient-reported chronic rhinosinusitis (CRS) control are global measures of CRS identified as consensus, essential criteria for CRS disease control assessment. We sought to determine the functional relationship between these two metrics.
Methods Using an international multicenter mixed-methods design, 260 CRS patients were recruited. OSS score was measured using a visual analog scale. Patient-reported CRS control was measured as “controlled,” “partly controlled,” and “uncontrolled.” Twelve participants underwent semi-structured interviews to discuss OSS and patient-reported CRS control.
Results The majority of interviewed participants felt OSS and patient-reported CRS control measured different constructs—while OSS only measured symptoms, patient-reported CRS control was more global, including not only symptom severity but also concepts such as medication usage, activity impairment, and exacerbations. Nevertheless, OSS score was strongly correlated with (ρ = 0.67, p < 0.001) and highly predictive of patient-reported CRS control. OSS score of >4 (95% confidence interval CI: 1.8–4.2) had 74.7% sensitivity and 93.2% specificity in identifying patients reporting their CRS as not controlled. OSS score of >6.6 (95% CI: 4.1–7.1) had 77.0% sensitivity and 75.9% specificity in identifying patients reporting their CRS as uncontrolled. The 22-item Sinonasal Outcome Test score was also predictive of patient-reported CRS disease control but OSS was significantly more predictive.
Conclusions Patients conceptually view patient-reported CRS control as a more global measure that subsumes OSS. Quantitatively, however, OSS is highly correlated with patient-reported CRS control, possibly reflecting their redundancy. For ease of use, we recommend patient-reported CRS control be reflected by OSS <4 for controlled, 4 ≤ OSS < 7 for partly controlled, and OSS ≥7 for uncontrolled CRS.
Alan D. Workman, Krithika Kuppusamy, David K. Lerner, John V. Bosso, Jennifer E. Douglas, Michael A. Kohanski, Nithin D. Adappa, James N. Palmer
Publication date 12-09-2024
Abstract Background Endoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments.
MethodsA Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre- and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality-of-life improvements.
Results The CoSI assesses surgical extent on a scale of 0–100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT-22 scores improved at 6 months postoperatively, with durable and consistent improvement at 24 months (p < 0.001). Preoperative CoSI scores in revision surgery patients were 49.4 ± 26.0, improving to 91.0 ± 8.1 postoperatively. SNOT-22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p = 0.029).
Conclusions It is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention.
Amelia S. Lawrence, Jodi Veach, Rahul Alapati, Celina G. Virgen, Robert Wright, Frank Materia, Jennifer A. Villwock
Publication date 12-09-2024
Abstract Introduction While olfactory function decreases with age, it is unknown how age affects olfactory training (OT) efficacy.
This study compared OT in two cohorts of subjects: aged ≤50 (younger cohort) and aged 51+ (older cohort) with olfactory dysfunction (OD) primarily from COVID-19 infection.
Methods Subjects with OD primarily secondary to COVID-19 infection were prospectively recruited and enrolled into an OT registry. Baseline data were collected and they were provided with a training kit and asked to complete OT at home twice daily for 6 months. Participants were asked to follow-up at 3 and 6 months during training for olfactory testing and quality-of-life surveys (Sino-Nasal Outcomes Test-22 SNOT-22 and Questionnaire of Olfactory Disorders Negative Statements QoD-NS).
Results Fifty-six participants completed OT (younger cohort: n = 26, older cohort: n = 30). There were no significant differences between cohorts’ Affordable Rapid Olfactory Measurement Array (AROMA), QoD-NS, or SNOT-22 scores at any time point. Both cohorts showed significant AROMA score improvement of more than 16 points from baseline to 3 months (younger cohort: p = 0.001; older cohort: p = 0.008). The younger cohort had significant improvements in QoD-NS (p = 0.008) and SNOT-22 (p = 0.042) between baseline and 3 months while the older cohort improved from 3 to 6 months (QoD-NS: p = 0.027, SNOT-22: p = 0.049).
Conclusion Both cohorts demonstrated similar significant improvement in olfactory function after 3 months of OT. The timeline of subjective improvement was different between cohorts, with younger patients experiencing earlier improvement.
Nirushan Narendran, Sophia Volpe, Ibrahim Ramadan, Jacob Ryan Herbert, Bonnie LaFleur, Shireen Samargandy, Christopher H. Le, Eugene H. Chang
Publication date 03-09-2024
Abstract Background Acute exacerbations of chronic rhinosinusitis (AECRS) are thought to arise from common viral infections progressing to secondary bacterial infections. However, the pathophysiology of AECRS remains poorly understood due to a lack of prospective longitudinal studies.
Methods We conducted a one-year prospective longitudinal study involving chronic rhinosinusitis (CRS) adults. At baseline, we assessed subjective symptom scores using a validated upper respiratory infection questionnaire (WURSS), sinonasal outcome testing scores (SNOT-22), and endoscopic scores (modified Lund-Kennedy score). Every 2 weeks, we contacted subjects to collect WURSS and SNOT-22 scores. If WURSS scores were ≥1 and SNOT-22 scores were ≥ 8.9 compared with baseline, subjects underwent an AECRS assessment. We identified rhinovirus (RV) incidence through viral nasal brushings at each visit and bacterial infection through bacterial swabs if mucus scores were ≥1.
Results Thiry-five of 80 CRS subjects reported at least one AECRS episode during the year, predominantly occurring in the fall and winter seasons. RV infections were detected in 8 of 35 cases, bacterial infections in 17 of 35, and co-occurring infections in 7 of 35. All subjects with AECRS visits exhibited significantly higher endoscopic scores compared with baseline. Subjects with co-occurring RV and bacterial infections demonstrated higher disease severity compared with those with either RV or bacterial infection, or no infection.
Conclusions In a one-year prospective longitudinal study involving CRS adults, we identified significant risk factors for AECRS including seasonality and the presence of RV and bacterial infections. These data suggest a standard definition of AECRS and the need to target RV and bacterial infections if we are to help reduce disease severity.
Brian H. Cameron, Jason Talmadge, Martin J. Citardi
Publication date 03-09-2024
Key points Bovine-derived collagen matrix (BDCM) is a safe augmentation material in patients with empty nose syndrome.
BDCM augmentation results in clinically and statistically significant improvement in nasal symptoms.
Improvements in nasal symptoms with BDCM augmentation may be durable and can be seen up to 2 years postoperative.
Hyun Jin Min
Publication date 02-09-2024
Christina Liu, Conrad W. Safranek, Rhys Richmond, Trinithas Boyi, Zachary Pickell, Ryan Rimmer, R. Peter Manes
Publication date 02-09-2024
Abstract Background Accurate conflict of interest (COI) information is essential for promoting transparency and trust in research. We aim to assess COI disclosure patterns in monoclonal antibodies (MABs) research for chronic rhinosinusitis with nasal polyposis (CRSwNP) using the Open Payments Database (OPD).
Methods Studies on FDA-approved MABs for CRSwNP (dupilumab, omalizumab, mepolizumab) published between 2019 and 2021 with at least one US author were identified through Pub Med. Industry-reported payments from the manufacturers (Sanofi, Regeneron, Genentech, Novartis, and Glaxo Smith Kline) between 2018 and 2021 in OPDs General Payments category were collected. Authors were cross-checked against OPD metadata using a previously published ChatGPT-based algorithm. Additionally, this novel algorithm analyzed COI statements for relevant author‒company specific disclosures, identifying disclosed and undisclosed payments made 3‒15 months prior to publication.
ResultsA total of 214 unique authors from 76 studies were included. Of 30 articles that received at least one relevant payment, 21 (70%) were found to have an undisclosed COI, with a mean total undisclosed payment of $4890 and a median of $10,331. Fifty-six authors had relevant OPD payments and 40 (71.4%) authors did not declare a potential COI. Interestingly, 158 authors had no relevant payments and 62 (39.2%) declared a potential COI. Author order was not significantly associated with potential under- or over-disclosure.
Conclusion This study characterizes COI disclosure patterns in rhinosinusitis-relevant MABs research using a novel automated approach. Given the discrepancy between disclosures and industry-reported payments, our findings suggest a need for improved disclosure education and practices.
David R. Grimm, Z. Jason Qian, Michael Yong, Peter H. Hwang
Publication date 02-09-2024
Wirach Chitsuthipakorn, Narissara Pracharktam, Juthaporn Phetpong, Patlada Kowatanamongkon, Kittichai Mongkolkul, Kornkiat Snidvongs
Publication date 30-08-2024
Abstract Introduction Euro Qol-5-dimensions-5-levels (EQ-5D-5L), visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) are used for the assessment of Health Utility Scores (HUS) of chronic rhinosinusitis (CRS). This study aimed to determine the overall HUS of CRS, the factors which influence the HUS, and the preferable method.
MethodsA cross-sectional study was conducted. Patients with primary CRS were recruited. Clinical and socioeconomic data together with HUS were assessed. Four HUS scores determined from the four different methods were compared.
ResultsA total of 335 patients were enrolled. The overall HUS, as measured by EQ-5D-5L, VAS, TTO, and SG, was 0.88 ± 0.14, 0.79 ± 0.17, 0.89 ± 0.15, and 0.86 ± 0.16, respectively. The multivariable linear regression revealed that each increasing 22-item sinonasal outcome test (SNOT-22) score predicted a reduction of 0.002 to 0.003 in HUS (all methods, p < 0.01). Patients who scheduled for endoscopic sinus surgery had 0.06 to 0.11 HUS lower than other groups in EQ-5D-5L and VAS (all p < 0.05). Higher endoscopy score, age, presence of comorbid airway diseases, and lower education correlated with lower HUS (p < 0.05). Given the HUS results and regression models, the EQ-5D-5L is likely the preferable choice.
Conclusion The overall HUS of CRS was approximately 0.79–0.89. High SNOT-22 score and those who failed medications, presence of comorbid AR/asthma, increased age, high endoscopy score, and low education negatively impacted HUS. Our data suggest that EQ-5D-5L is a preferable method for measuring HUS in patients with CRS.
Katie Melder, Jess C. Mace, Garret Choby, Joao Paulo Almeida, Pierre‐Olivier Champagne, Erik Chan, Jeremy Ciporen, Mark B. Chaskes, Juan Fernandez‐Miranda, Nicholas K. Fung, Paul Gardner, Peter Hwang, Keven Seung Yong Ji, Aristotelis Kalyvas, Keonho A. Kong, Chirag Patel, Zara Patel, Maria Peris Celda, Carlos D. Pinheiro‐Neto, Carl Snyderman, Brian D. Thorp, Jamie J. Van Gompel, Georgios Zenonos, Nathan T. Zwagerman, Olabisi Sanusi, Eric W. Wang, Mathew Geltzeiler
Publication date 30-08-2024
Abstract Background With modern treatment paradigms, olfactory neuroblastoma (ONB) has favorable overall survival (OS); however, the incidence of recurrence remains high. The primary aims of this study were to delineate the prognosis of recurrence of ONB and explore how recurrence subsites are associated with OS, disease-specific survival (DSS), and further recurrence.
MethodsA retrospective chart review of ONB cases from nine academic centers between 2005 and 2021 was completed. Tumor characteristics, recurrence subsites, timelines to recurrence, additional recurrences, and survival estimates were determined using descriptive and time-to-event analyses.
ResultsA final cohort of 233 patients was identified, with 70 (30.0%) patients recurring within 50.4 (standard deviation ±40.9) months of diagnosis on average, consisting of local (50%), neck (36%), intracranial (9%), and distant (6%) recurrence. Compared with subjects without recurrence, patients with recurrence had significantly different primary American Joint Committee on Cancer T stage (p < 0.001), overall stage (p < 0.001), and modified Kadish scores (p < 0.001). Histopathology identified that dural involvement and positive margins were significantly greater in recurrent cases. First recurrence was significantly associated with worse 5-year DSS (hazard ratio = 5.62; p = 0.003), and subjects with neck or local recurrence had a significantly better DSS compared to intracranial or distant recurrence.
Conclusions Recurrent cases of ONB have significantly different stages and preoperative imaging factors. Patients with local or neck recurrence, however, have better DSS than those with intracranial or distant recurrence, independent of initial tumor stage or Hyams grade. Identifying specific factors that confer an increased risk of recurrence and DSS is important for patient counseling in addition to surveillance planning.
Alessandro Vinciguerra, Mario Turri‐Zanoni, Marco Ferrari, Davide Mattavelli, Andrea Giorgianni, Enrico Fazio, Francesco Di Pierro, Vittorio Rampinelli, Luca Gazzini, Benjamin Verillaud, Alberto Schreiber, Luca Calabrese, Maurizio Bignami, Paolo Battaglia, Piero Nicolai, Paolo Castelnuovo, Philippe Herman
Publication date 30-08-2024
Key pointsICA coil extrusion (ICA-CE) occurs most frequently in the nasopharyngeal/sinonasal site.
Evaluating the ICA coils stability, through an angiography, is of primary importance.
ICA-CE management needs to be decided based on the patients symptoms and general status.
Firas Sbeih, Noel F. Ayoub, Valerie Gass, Benjamin S. Bleier
Publication date 30-08-2024
Key points The angled tip and small size of the crescent blade provide versatility for its use in a variety of endonasal procedures.
The crescent blade enables cutting along 180° from the tip, ensuring a tangential cut through the mucosa, which is important for flap viability.
The disposable nature of the blade ensures that it is always sharp, allowing for its use in mucosal and cartilaginous cuts.
Yen‐Chi Hsu, Kao‐Tsung Lin, Ming‐Sui Lee, Li‐Sung Shen, Te‐Huei Yeh, Yi‐Tsen Lin
Publication date 30-08-2024
Key points We proposed a hierarchical framework including an unsupervised candidate image selection and a weakly supervised patch image detection based on multiple instance learning (MIL) to effectively estimate eosinophil quantities in tissue samples from whole slide images.
MIL is an innovative approach that can help deal with the variability in cell distribution detection and enable automated eosinophil quantification from sinonasal histopathological images with a high degree of accuracy.
The study lays the foundation for further research and development in the field of automated histopathological image analysis, and validation on more extensive and diverse datasets will contribute to real-world application.
Vinayak Ganeshan, Jonathan Bidwell, Dipesh Gyawali, Thinh S. Nguyen, Jonathan Morse, Madeline P. Smith, Blair M. Barton, Edward D. McCoul
Publication date 30-08-2024
Key pointsA convolutional neural network (CNN)-based model can accurately localize and segment turbinates in images obtained during nasal endoscopy (NE).
This model represents a starting point for algorithms that comprehensively interpret NE findings.
Peter L. Friedland, Thomas M. Polasek, Duncan Topliss
Publication date 30-08-2024
Key pointsPVP-I is a widely used antiseptic but only recently proposed for intranasal use.
The extent of iodine absorption from available PVP-I nasal products is unknown.
Iodine absorption from use of Nasodine (0.5% PVP-I nasal spray) is not clinically significant.
Jennifer E. Douglas, Nithin D. Adappa, Garret Choby, Corinna G. Levine, Mindy R. Rabinowitz, Raj Sindwani, Eric W. Wang, Bradford A. Woodworth, Edward C. Kuan
Publication date 30-08-2024
Abstract The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence for technical factors that optimize outcomes in skull base reconstruction following endoscopic skull base surgery for intradural pathologies. These topics include the use of free mucosal grafts versus vascularized pedicled nasoseptal flaps; the use of autologous versus synthetic grafts; and the roles of lumbar drains, dural sealants, and nasal packing. This EPS was developed following the recommended methodology and approval process as previously outlined. As there are a myriad of techniques and limited agreement on the accepted principles of skull base reconstruction, this EPS aims to summarize the existing evidence and provide clinically meaningful guidance on these divergent practices. Following a modified Delphi approach, five statements were developed, four of which reached consensus and one of which reached near consensus. These statements and the accompanying evidence are summarized along with an assessment of future needs.
Pubmed PDF WebConner J. Massey, Gretchen M. Oakley, Richard R. Orlandi, Shaelene Ashby, Jeremiah A. Alt, Kristine A. Smith, Abigail Pulsipher
Publication date 30-08-2024
Key pointsEPX activity has been correlated with eCRS diagnosis and baseline disease severity.
Herein, EPX activity is shown to correlate with post-operative antibiotic and steroid use in CRS.
EPX activity has potential to act as a prognostic biomarker of CRS disease severity and control.
Vivek C. Pandrangi, Ana Araujo, Michelle Buncke, Brennan Olson, Matthew Jorizzo, Nasser Said‐Al‐Naief, Olabisi Sanusi, Jeremy Ciporen, Maisie Shindo, Joshua Schindler, C. Alessandra Colaianni, Daniel Clayburgh, Peter Andersen, Paul Flint, Mark K. Wax, Mathew Geltzeiler, Ryan J. Li
Publication date 30-08-2024
Key points Virtual reality (VR) and Fitbit devices are well tolerated by patients after skull base surgery.
Postoperative recovery protocols may benefit from incorporation of these devices.
However, challenges including patient compliance may impact optimal device utilization.
John N. Poche, Stephen C. Hernandez, Katie L. Melder, Michael E. Dunham, Daniel W. Nuss, Zhide Fang
Publication date 30-08-2024
Key points Clear visualization during transnasal endoscopic surgery (TNES) is crucial for safe, efficient surgery.
The endoscopic surgical field clarity index (ESFCI) is an artificial intelligence-enabled measure of surgical field quality.
The ESFCI allows researchers to evaluate interventions to improve visualization during TNES.
Zetian Li, Luisa Richter, Tanja Krueger, Herbert Eichwald, Antje Hähner, Thomas Hummel
Publication date 30-08-2024
Abstract Background Diagnosing parosmia is a challenge. The present study aimed to explore the distinctions between hyposmic patients with and without parosmia utilizing electroencephalography-derived olfactory event-related potentials (ERP).
Methods Forty-four patients with hyposmia were enrolled and divided into a group with parosmia (n = 23, mean age ± standard deviation = 48 ± 14 years, seven men) and a group without parosmia (n = 21, age = 52 ± 12 years, seven men) based on the clinical interview. Additionally, 21 healthy controls (mean age = 45 ± 14 years, six men) were included. Various measurements were obtained, including the Sniffin’ Stick test, threshold tests for the odorants furfural mercaptan and 2,6-nonadienal, a modified Sniffin’ Stick parosmia test, and well-being ratings. Chemosensory ERPs were recorded separately for each nostril using high-precision, computer-controlled air-dilution olfactometry.
Results Patients with parosmia had a decreased olfactory function similar to that observed in patients with hyposmia, although the odor sensitivity of patients with severe parosmia remained relatively unaffected. Patients with parosmia reported a decrease in well-being compared to controls. The severity of parosmia was positively correlated with odor sensitivity. Furthermore, patients with severe parosmia exhibited faster responses to unpleasant odors than patients without parosmia.
Conclusion Overall, the present findings support the idea that parosmia predominantly occurs during olfactory recovery, significantly disturbing patients and warranting the development of effective treatments. Notably, the relatively faster responses of hyposmic patients with severe parosmia suggest that the generation of distorted olfactory responses may involve early stages of the processing of olfactory information.
Akash M. Bhat, Zachary M. Soler, Rodney J. Schlosser, Ralph B. Metson, Vinay K. Rathi
Publication date 30-08-2024
Key points Utilization of orbital decompressions (ODS) increased (CAGR: +3.2%) from 2000 to 2019.
FDA approved teprotumumab in January 2020; ODS utilization decreased (CAGR: −14.9%) from 2019 to 2022.
In 2022, total spending was substantially higher for teprotumumab ($325 million) than surgery ($580,000).
Luke D. Heiland, Alejandro R. Marrero‐Gonzalez, Shaun A. Nguyen, Hannah G. Farmer, Vinay K. Rathi, Zachary M. Soler, Rodney J. Schlosser
Publication date 30-08-2024
Abstract Background Headache and facial pain are common symptoms of chronic rhinosinusitis (CRS). However, given the numerous etiologies that can cause these symptoms, the impact of sinus surgery is not well characterized.
MethodsA systematic review was performed by searching the literature from inception through June 6, 2023. English-language articles reporting outcomes for facial pain/pressure or headache following endoscopic sinus surgery were selected for inclusion. Meta-analyses were performed using random and fixed effect models on continuous measures (mean), mean difference (Δ), and proportions (%).
ResultsA total of 26 articles reporting on 2839 patients were selected for inclusion. The mean patient age was 44.0 ± 3.9 (range 16.0–84.0), with an average symptom duration of 5.3 ± 2.8 years. Among these patients, 56.5% (95% confidence interval CI: 52.3–60.6) were male and 77.0% (95% CI: 56.6–92.3) had nasal polyposis (NP). Patients with and without NP reported substantial reductions in both 22-item sino-nasal outcome test facial pain/pressure (with NP: −1.4 95% CI: −1.6 to −1.2; relative reduction 59.1%; without NP: −1.5 95% CI: −1.9 to −1.1; relative reduction 60.9%) and visual analogue scale (VAS) headache (with NP: −2.5 95% CI: −2.8 to −2.1; relative reduction 67.2%; without NP: −2.8 95% CI: −4.7 to −1.0; relative reduction 42.7%). Symptom reductions were greater in the without NP versus with NP group; VAS facial pain/pressure: Δ0.4 (95% CI: 0.2–0.6; p = 0.0006) and VAS headache: Δ0.4 (95% CI: 0.1–0.7; p = 0.02).
Conclusions Our findings suggest that CRS patients, regardless of polyp status, benefit from significant reductions in facial pain/pressure and headache following surgical therapy.
"Alexander Duffy, Bita Naimi, Emily Garvey, Stephanie Hunter, Ayan Kumar, Chase Kahn, Douglas Farquhar, Glen DSouza, Nancy Rawson, Pamela Dalton, Elina Toskala, Mindy Rabinowitz, Marc Rosen, Gurston Nyquist, David Rosen"
Publication date 30-08-2024
Abstract Background Olfactory dysfunction (OD) affects many survivors of COVID-19. Prior studies have investigated the use of platelet-rich plasma (PRP) injections for OD. We describe the first randomized controlled trial investigating topical PRP for OD treatment and contribute to existing literature illustrating PRP as an emerging therapeutic.
Methods This is a single-blinded, randomized controlled trial conducted from July 2022 to December 2023. Adult patients with OD ≥6 months secondary to COVID-19 with Brief Smell Identification Test (BSIT) scores of ≤8/12 or SCENTinel odor intensity of ≤40/100 were included. Patients were randomized to three, monthly PRP or placebo-impregnated Surgifoam treatments into bilateral olfactory clefts. The BSIT, SCENTinel, and Questionnaire of Olfactory Disorders—Negative Statements (QOD-NS) were completed monthly through month 12.
Results Of 104 patients screened, 83 participated. No significant differences in age, OD duration, BSIT, SCENTinel, or QOD-NS scores were found between PRP (n = 42) and placebo (n = 41) patients at baseline. PRP patients experienced a statistically significant increase in BSIT scores from baseline at months 5‒9, 11, and 12, while placebo patients did not (p < 0.05). However, total BSIT scores were similar between the two groups throughout the study. Neither the SCENTinel odor intensity scores nor the change from baseline were significantly different between the treatment groups. At month 12, PRP patients experienced minor improvement in OD-related quality-of-life compared with placebo.
Conclusions This study is the first to describe topical PRP as a safe, experimental treatment for OD in humans. PRP may impact odor identification in post-COVID-19 OD patients, although the lack of difference in total BSIT scores highlights the need for further study.
Akash M. Bhat, Luke D. Heiland, Shaun A. Nguyen, Vinay K. Rathi, Rodney J. Schlosser, Zachary M. Soler
Publication date 30-08-2024
Abstract Background Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re-examination of the current literature.
Methods Cochrane Library, CINAHL, Pub Med, and Scopus databases were searched from inception to February 13, 2024 for placebo-controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio).
Results Ten trials (N = 751) were included for meta-analysis, with a mean age of 47.5 years (range: 18–80 years; 95% confidence interval CI: 43.9–51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI: 0.3–0.6; p < 0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI: 0.1–0.7; p = 0.01), but not with topical spray (Δ0.04; 95% CI: −0.9 to 1.0; p = 0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio OR: 3.4; 95% CI: 1.9–6.0; p < 0.0001; OR: 12.4; 95% CI: 1.8–83.8; p < 0.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9–4.0; p = 0.12).
Conclusions Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.
Abigail Pulsipher, Kristine A. Smith, Richard R. Orlandi, Conner J. Massey, Jeremiah A. Alt, Gretchen M. Oakley, Shaelene Ashby
Publication date 30-08-2024
Florian Chatelet, Alessandro Vinciguerra, Morgane Marc, Benjamin Verillaud, Philippe Herman
Publication date 30-08-2024
Michael Z Cheng, Varun Vohra, Hang Wang, Akhil Katuri, Jackie Langdon, Qian‐Li Xue, Nicholas R Rowan
Publication date 30-08-2024
Publication date 30-08-2024
Qinwen Xiao, Zhichao Ni, Rongyu Wang, Wen Jiang, Jinyao Yuan
Publication date 30-08-2024
Abstract Background Acupuncture has been shown for the treatment of allergic rhinitis in previous studies. Nevertheless, relevant evidence was lacked for paediatric patients with allergic rhinitis. We aim to validate the efficacy of acupuncture for allergic rhinitis in children by meta-analysis and trial sequence analysis.
Method Comprehensive search of eight databases were conducted until August 27, 2023. Randomized controlled trials comparing acupuncture alone or in combination with drugs versus medication in children with AR were included. The primary outcome was total nasal symptom score (TNSS). The secondary outcomes were serum immunoglobulin E levels, and relapse rates.
Results Thirteen studies involving 1186 participants were included. In results, acupuncture group (AC group) versus medication group (Med group) shows no significant difference in the treatment of AR in children (risk ratio RR = 1.10, 95% CI = 0.97 to 1.24, p = 0.13), while TSA suggested the included sample size did not exceed required information size (RIS). Significant differences were found between the AC + Med group versus the Med group (RR = 1.29, 95% CI = 1.17 to 1.42, p < 0.00001), with sufficient sample size. Results in serum IgE after treatment which favored the Med group (MD = 51.94, 95% CI 22.24, 81.65, p = 0.0006). In terms of relapse rate, The AC group had a lower relapse rate than the Med group (RR = 0.40, 95% CI = 0.26–0.63, p < 0.0001).
Conclusions Acupuncture is an efficacious treatment for allergic rhinitis in children, but this conclusion might be limited by the generally low quality of evidence. TSA suggested additional high-quality trials with larger sample sizes and longer treatment durations were needed.
Akash M. Bhat, Zachary M. Soler, Rodney J. Schlosser, George A. Scangas, Alan D. Workman, Vinay K. Rathi
Publication date 30-08-2024
Key points The original manufacturer of azelastine‒fluticasone (AZ‒FL) prevented generic availability until 2020 via patent enforcement.
Following generic availability of AZ‒FL, Medicare utilization increased and spending decreased.
Retail prices for generic AZ‒FL remain high due to markup by manufacturers and pharmacies.
Ebraheem Albazee, Abdullah M. Alharran, Mooza M. Alzayed
Publication date 30-08-2024
Key points The evidence regarding the open-label placebo effect on allergic rhinitis symptoms remains uncertain.
Open-label placebo significantly reduced the frequency of symptoms in allergic rhinitis patients with similar safety profiles; however, there was no effect on the severity of symptoms and impairment due to symptoms.
The statistically significant impact on symptom frequency can be considered not clinically significant.
Tristan Tham, Felisha A. Li, Jacob R. Schneider, Matthew I. Saleem, Michael T. Werner, Mark B. Chaskes, Charles C. L. Tong, Judd H. Fastenberg
Publication date 30-08-2024
Abstract Background Cystic fibrosis transmembrane conductance regulator (CFTR) modulators improve pulmonary outcomes in cystic fibrosis (CF) by stabilizing the CFTR protein on respiratory epithelial surfaces. To determine the efficacy of CFTR modulators on sinonasal outcomes in patients with CF, we performed a meta-analysis of clinical trials to date that include functional and radiographic evidence of sinus disease.
Methods English full-text articles were searched in Pub Med, Embase, and Scopus databases. Two reviewers screened articles and a third reviewer resolved disagreements. Articles were included if they reported functional or radiological sinonasal outcomes in patients with CF before and after CFTR modulator therapies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the risk of bias in non-randomized studies of interventions tool was used for quality assessment. The generic inverse variance method with random effects model was used for meta-analysis. Standardized mean difference (SMD) and mean difference (MD) were used as effect measurements.
Results Seven prospective and two retrospective studies representing 248 patients were included in this analysis. There was a significant improvement in sinonasal outcome test-22 scores on elexacaftor‒tezacaftor‒ivacaftor (MD = 12.80, 95% confidence interval, CI: 10.46‒15.13, p < 0.001, n = 222), with no heterogeneity detected (I2 = 0%, p = 0.820). There was also a significant improvement in Lund‒Mackay scores (SMD = 1.25, 95% CI: 0.58‒1.91, p < 0.001, n = 88), with heterogeneity detected (I2 = 67%, p = 0.030).
ConclusionsCFTR modulators improve functional and radiologic sinonasal outcomes. Given the utility of CFTR modulators, the treatment paradigm for CF-related chronic rhinosinusitis promises to evolve.
Saartje Uyttebroek, Lieven Dupont, Jeroen Wagemans, Rob Lavigne, Maya Merabishvili, Tom Coenye, Laura Van Gerven
Publication date 30-08-2024
Key points Treatment of cystic fibrosis-related chronic rhinosinusitis should target sinonasal biofilms.
NaHCO3 salts with/without xylitol have limited antibiofilm properties, whereas rhDNAse has not.
Phage effectivity varies and depends on the phage and the combination with antibiotics.
"Glen E. DSouza, Alexander Duffy, Shreya Mandloi, Emily Garvey, Bita Naimi, Paavali Hannikainen, Peter Benedict, Gurston N. Nyquist, Christopher Farrell, Marc Rosen, Elina Toskala, James Evans, Mindy R. Rabinowitz"
Publication date 30-08-2024
Key Points Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post-operative period has not been studied in live subjects and controversy exists in when to restart this post-operatively.
This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post-surgical sphenoid sinus and the mid-nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect.
Farideh Hosseinzadeh, S. Saeed Mohammadi, James N. Palmer, Michael A. Kohanski, Nithin D. Adappa, Michael T. Chang, Peter H. Hwang, Jayakar V. Nayak, Zara M. Patel
Publication date 26-08-2024
Key Points Inverted papilloma conversion to squamous cell carcinoma is not always easy to predict.
AutoML requires much less technical knowledge and skill to use than traditional ML.
AutoML surpassed the traditional ML algorithm in differentiating IP from IP-SCC.
Sarah K. Wise, Nithin D. Adappa, Rakesh K. Chandra, Greg E. Davis, Mahboobeh Mahdavinia, Ramy Mahmoud, John Messina, James N. Palmer, Zara M. Patel, Anju T. Peters, Rodney J. Schlosser, Raj Sindwani, Zachary M. Soler, Andrew A. White
Publication date 26-08-2024
Abstract Background The inability of topical medications to reach sinus cavities is a potential reason for lack of efficacy in chronic rhinosinusitis (CRS). One purpose of endoscopic sinus surgery (ESS) is to enable delivery of medications into the sinus cavities. The exhalation delivery system with fluticasone (EDS-FLU; XHANCE) creates unique biomechanics that enable deposition of intranasal corticosteroid into sinuses and sinus drainage pathways but may have differing efficacy in operated versus unoperated sinuses. Two 24-week randomized trials (Re Open1/2) evaluated EDS-FLU versus EDS-placebo in patients with CRS, stratified by surgical status.
Methods Surgery-naive (n = 332) and prior-surgery (n = 215) patient groups were analyzed as pooled data from Re Open1/2. Outcome measures (least-squares mean change from baseline) included combined symptom score (CSS) and congestion score at weeks 4, 8, and 12 and average of percentages of opacified volume (APOV) of ethmoid/maxillary sinuses on CT and Sinonasal Outcome Test 22 (SNOT-22) total score at week 24.
Results Baseline scores suggested moderate–severe disease: mean CSS = 5.8; APOV = 67.2%. EDS-FLU produced significant improvement versus placebo (p < 0.05): CSS (surgery-naive, −0.68 vs. −1.42; prior ESS, −0.70 vs. −1.87); congestion (surgery-naive, −0.24 vs. −0.59; prior ESS, −0.24 vs. −0.69); and SNOT-22 (surgery-naive, −7.56 vs. −18.30; prior ESS, −10.72 vs. −18.74). Similar results were observed for APOV (p < 0.05). No statistically significant difference was observed between surgery subgroups with either EDS-FLU dose.
ConclusionEDS-FLU improved symptoms, sinus opacification, and quality of life in patients with CRS with or without prior ESS, suggesting a role for EDS-FLU in both populations.
Le Xu, WenJie Zheng, JiaLin Feng, QinYi Zhou, Jun Chen
Publication date 26-08-2024
Estephania Candelo, Anyull D. Bohorquez‐Caballero, Karol Avila‐Castano, Hani Wadei, Angela M Donaldson
Publication date 24-08-2024
Key points The study found a higher incidence of chronic rhinosinusitis (CRS) and recalcitrant CRS in cadaveric organ transplant recipients compared to those receiving living donor transplants. Recipients of cadaveric transplants were 1.32 times more likely to develop CRS and 1.68 times more likely to develop medically recalcitrant CRS.
Living kidney transplants significantly reduced the risk of developing CRS (OR = 0.12) and recalcitrant CRS (OR = 0.11), highlighting a potentially protective effect against these conditions. In contrast, cadaveric liver transplants were associated with an increased risk of CRS and medically recalcitrant CRS.
Kaplan–Meier survival analysis indicated a significant difference in time to CRS onset between cadaveric and living donor transplants. Median time to CRS onset was longer for living donor recipients (21.1 months) compared to cadaveric recipients (15.6 months). This study underscores the need for transplant teams and otolaryngologist to consider donor type during transplant follow-up due to differing risks of CRS development.
Briana R. Halle, Edward C. Kuan, Melissa Shive
Publication date 23-08-2024
Sung‐Woo Cho, Bhumsuk Keam, Keun‐Wook Lee, Ji‐Won Kim, Doo Hee Han, Hyun Jik Kim, Jeong‐Whun Kim, Dong‐Young Kim, Chae‐Seo Rhee, Yun Jung Bae, Ji‐Hoon Kim, Keun‐Yong Eom, Hong‐Gyun Wu, Yong Hwy Kim, Chae‐Yong Kim, Sun Ha Paek, Hyojin Kim, Tae‐Bin Won
Publication date 20-08-2024
Abstract Objectives To evaluate the treatment outcomes in patients with advanced-stage olfactory neuroblastoma (ONB) who received induction chemotherapy (IC).
Materials and methods The clinical data of 38 patients with advanced-stage ONB who received initial IC were retrospectively analyzed. The response was defined using the Response Evaluation Criteria in Solid Tumors version 1.1. Patients with complete remission or partial remission were defined as responders.
Results Seventeen (44.7%) patients responded to IC. The response rate was higher in patients with high Hyams grade tumor (III/IV) compared to those with low-grade tumors (I/II) (60% vs. 22.2%, p = 0.038). Overall, the 5-year cancer-specific survival (CSS) rate was 76.0%. Among nonresponders to IC, a significant difference in 5-year CSS rates was observed between surgery with adjuvant radiotherapy (RT) (100%) versus definitive RT or chemoradiotherapy (CRT) (68.6%) (log-rank p = 0.006). However, for responders, there was no significant difference in 5-year CSS rates between surgery with adjuvant therapy (75%) and definitive RT or CRT (51.1%) (log-rank p = 0.536). When only high-grade tumors were considered among responders, the 5-year CSS rate was significantly higher in patients who received RT or CRT (51.4%) compared to those who underwent surgery with adjuvant therapy (0%) (log-rank p = 0.008).
Conclusion In advanced-stage ONB, RT or CRT may be preferable for high-grade tumor responding to IC. Higher response rate and a potential role for induction IC in determining the optimal definitive treatment modality suggest a positive role for advanced-stage high-grade ONB.
Coline Labarre, Florent Carsuzaa, Maxime Fieux, Benjamin Verillaud, Antoine Moya Plana, Ludovic de Gabory, Vincent Patron, Francois‐Régis Ferrand, Juliette Thariat
Publication date 20-08-2024
Key points Interpretation of surgical mapping is essential for postoperative radiotherapy planning.
Operative and pathological reports lack comprehensive information on margins quality and tissue block mapping.
Standardizing reports is essential to reduce uncertainties, aiming for less morbid poRT.
Zachary T. Root, Zhenxing Wu, Thomas J. Lepley, Aspen R. Schneller, Robbie J. Chapman, Veronica L. Formanek, Kathleen M. Kelly, Bradley A. Otto, Kai Zhao
Publication date 12-08-2024
Abstract BackgroundA patients subjective response to topical nasal decongestant is often used to screen for turbinate reduction surgery suitability. However, this anecdotal strategy has not been objectively and quantitatively evaluated.
Methods Prospective, longitudinal, and single-blinded cohort study employing computational fluid dynamic modeling based on computed tomography scans at baseline, 30 min postoxymetazoline, and 2 months postsurgery on 11 patients with chronic turbinate hypertrophy.
Results Nasal obstruction symptom evaluation (NOSE) and visual analogue scale (VAS) obstruction scores significantly improved from baseline to postoxymetazoline and again to postsurgery (NOSE: 71.82 ± 14.19 to 42.27 ± 25.26 to 22.27 ± 21.04; VAS: 6.09 ± 2.41 to 4.14 ± 2.20 to 2.08 ± 1.56; each interaction p < 0.05), with significant correlation between the latter two states (r∼0.37–0.69, p < 0.05). Oxymetazoline had a broader anatomical impact throughout inferior and middle turbinates than surgery (many p < 0.05); however, the improvement in regional airflow is similar (most p > 0.05) and predominantly surrounding the inferior turbinate. Strong postoxymetazoline to postsurgery correlations were observed in decreased nasal resistance (r = 0.79, p < 0.05), increased regional airflow rates (r = -0.47 to −0.55, p < 0.05) and regional air/mucosa shear force and heat flux (r = 0.43 to 0.58, p < 0.05); however, only increasing peak heat flux significantly correlated to symptom score improvement (NOSE: r = 0.48, p < 0.05).
Conclusion We present the first objective evidence that the “topical decongestant test” can help predict turbinate reduction surgery outcomes. The predictive effect is driven by similar improvementin regional airflow that leading to improved air/mucosa stimulations (peak heat flux) rather than through reduced nasal resistance.
Angela S. Zhu, Ryan A. Bartholomew, Yan Zhao, Margaret B. Mitchell, Benjamin S. Bleier, Barak Ringel
Publication date 07-08-2024
Key points Using 3D modeling, we studied the influence of orbital tumor morphology on post-operative outcomes.
Orbital tumor volume did not influence postoperative complication rates.
Less spherical tumors may be correlated with a more extensive surgical approach.
Keven Ji, Hunter Kellerman, Jess C. Mace, Timothy L. Smith, Kara Y. Detwiller, Shyam R. Joshi, Mathew Geltzeiler
Publication date 07-08-2024
Abstract Background The indications for endoscopic modified Lothrop procedure (Draf 3) in patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP) remain unclear. This study evaluates the effectiveness of Draf 3 for refractory CRSwNP focusing on improvements in disease severity and need for subsequent dupilumab rescue therapy.
Methods Retrospective review of patients with CRSwNP undergoing Draf 3 surgery at a tertiary center between 2012 and 2022. Clinicodemographic variables were compared across those who did versus did not require rescue with postoperative dupilumab. Time to postoperative dupilumab rescue was analyzed and longitudinal disease-specific outcomes were measured using the sinonasal outcomes test (SNOT-22).
Results Within 87 patients with CRSwNP, 24.1% had aspirin-exacerbated respiratory disease (AERD). Significant improvement in SNOT-22 score was found in CRSwNP with AERD (p < 0.001) and without AERD (p = 0.01) up to 24 months postoperative. 14.9% eventually required rescue with a dupilumab. More specifically, of 21 patients with AERD, 24.1% eventually required rescue with dupilumab. Dupilumab rescue was associated with a greater number of prior sinus surgeries (p = 0.02), prior aspirin desensitization (p = 0.02), and worse preoperative Lund-Mac Kay scores (p < 0.001). No association between biologic rescue and frontal recess antero-posterior diameter was found (p = 0.20).
Conclusions Draf 3 surgery in CRSwNP was associated with significant improvement in SNOT-22 score at 24 months. Furthermore, only 14.9% of patients required dupilumab rescue. Patients with AERD were more likely to require rescue with dupilumab even though 75.1% avoided treatment with the biologic over the study period.
Hyun Jin Min, Kyung Soo Kim, Hyunjung Kim, Jiyoung Gong, Jinyoung Jeong
Publication date 07-08-2024
KEY POINTSHuman nasal cavity samples were collected, and presence of microplastics were evaluated.
Microplastics were present, and major types were polyethylene, polyester, acrylic polymer, and polypropylene.
Further research is needed regarding microplastics and its clinical impact on human nasal cavity.
Kody A. Waldstein, Arman Issimov, Maria Ganama, Valerie Jinge, Stephen Tilley, Xiaoyang Hua
Publication date 07-08-2024
Abstract Background Upper respiratory viral infections (URVIs) are responsible for 80% of asthma exacerbation episodes. However, the underlying mechanisms remain poorly understood.
Methods In this study, we used a mouse model of URVI and examined the impact of URVI on asthma phenotypes and the underlying mechanisms.
Results Previously, we have reported that nasal-restricted infection with respiratory syncytial virus (RSV) only produces mild sino-nasal inflammation and mucus production, without causing direct lung infection. However, such nasal-restricted infection dramatically enhanced TH2 and TH17 inflammatory responses in the lungs and increased airway hyperresponsiveness (AHR) in mice with house dust mite (HDM)-induced asthma. Additionally, nasal-restricted infection with RSV recruited Ly6C+ inflammatory monocytes (IMs) into the lungs of mice with and without HDM-induced asthma. The expression of monocyte chemokines, including CCL2 and CCL7, also increased. Interestingly, nasal virus infection-induced AHR was abolished in mice depleted of IMs and in CCR2−/− mice, indicating that the recruited IMs play a key role in nasal virus infection-induced asthma exacerbations in mice. Lastly, we observed that recruitment of Ly6C+ IMs following URVI was abolished in mice lacking B cells and that nasal-restricted infection with RSV increased numbers of CCL2+CCL7+ B cells in the lungs of mice as compared to controls.
Conclusions Taken together, our data have shown that URVI enhances the allergic inflammatory response and AHR through a B cell‒monocyte regulatory axis.
Ravi Dhamija, Peng Ding, Nikita Das, Varunil N. Shah, David C. Kaelber, Mohamad R. Chaaban
Publication date 05-08-2024
Key pointsIBD patients have a 4.04-fold elevated likelihood of having CRS compared to non-IBD patients.
CRS patients have a 4.23-fold elevated likelihood of having IBD compared to non-CRS patients.
The risk of CRS development after IBD is five times higher than IBD development after CRS.
Neil P. Monaghan, Kelsey A. Duckett, Shaun A. Nguyen, Abigail A. Massey, Vinay Rathi, Zachary M. Soler, Rodney J. Schlosser
Publication date 31-07-2024
Key points Sham procedures produce a clinically significant impact on patient-reported outcome measures This effect should be considered when designing and interpreting the results of RCTs
Pubmed PDF WebRyan S. Ziltzer, Sameer Shetty, Dominic Coutinho, Rafka Chaiban, Chadi A. Makary
Publication date 31-07-2024
Key points Social determinants of health link to worse quality of life in pediatric chronic rhinosinusitis.
The area deprivation index (ADI) may serve to predict health disparities in these patients.
Firas Sbeih, Henry W. Zhou, Noel F. Ayoub, Barak Ringel, Carolina A. Chiou, Joseph F. Rizzo, Benjamin S. Bleier
Publication date 26-07-2024
Key Points Penetrating orbital trauma from marine creatures, especially needlefish, should be considered after injuries sustained in open water.
Advances in endoscopic sinus surgery have enabled surgeons to remove certain orbital foreign bodies through endoscopic endonasal approaches.3D segmentation is a valuable pre-operative tool in complex endoscopic orbital cases.
Arthur W. Wu, Kevin Hur, Aria Jafari, Omar G. Ahmed, Philip G. Chen, Masayoshi Takashima, Elena E. Chang, Bonnie Balzer, Anna Matthew, Haodong Xu, Mukul Divatia, Benjamin Tam, Juliana Robledo, Luv Amin, David J. Cvancara, Amisheila Kinua, Tariq A. Syed, Dominique L. Paderin, Dennis M. Tang
Publication date 24-07-2024
Key points Asian-American (AA) patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have comparable rates of tissue eosinophilia compared to Caucasians when defined as >10 eosinophils/high-powered field (HPF).
AA patients with CRSwNP have significantly higher incidence of mixed inflammation defined as >10 eosinophils/HPF and >10 neutrophils/HPF.
Jae Yoon Lee, Do Hyun Kim, Sung Won Kim, Yeon Hee Im, Chan Soon Park, Dong Hyun Kim, Zainab Alkhars, Soo Whan Kim
Publication date 22-07-2024
Abstract Background Accurate identification of eosinophilic chronic rhinosinusitis is essentialg because its treatment and prognosis substantially differ from other subtypes.
Methods This retrospective observational study included 640 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis in a single tertiary center from January 2021 to December 2022. Receiver operating characteristic curves were generated to compare accuracy, sensitivity, specificity of the novel scoring system, and previous diagnostic criteria (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis, European Forum for Research and Education in Allergy and Airway Diseases, European Position Paper on Rhinosinusitis and Nasal Polyps, and Sakuma et al.) for predicting eosinophilic chronic rhinosinusitis (ECRS) by tissue eosinophil count ≥70 per high power field.
Results Patients were randomly divided into estimation (n = 430) and validation (n = 210) groups. The area under the receiver operating characteristic curve for the novel score was 0.753 (95% confidence interval CI, 0.670–0.835) in the estimation group, 0.729 (0.629–0.830) in the validation group, and 0.661 (0.584–0.738) in the 20-fold cross-validation with the entire dataset.
Conclusions We propose a novel scoring system that incorporates three key parameters: “novel score = blood eosinophil (%) + total Lund–Mackay score of anterior ethmoid sinuses + 2 if nasal polyp present” greater than 7 can be reliably used for diagnosing ECRS. This system can facilitate decision-making processes regarding the administration of oral steroids and biologics targeting type 2 inflammation prior to surgical intervention.
Catherine Kwiecien, Alan D. Workman, Jadyn Wilensky, David K. Lerner, Vinay K. Rathi, Jennifer E. Douglas, Michael A. Kohanski, Edward C. Kuan, James N. Palmer, Nithin D. Adappa
Publication date 22-07-2024
Abstract Background Sinonasal malignancy surveillance paradigms are often based on Head and Neck National Comprehensive Cancer Network guidelines, which do not recommend standard surveillance imaging beyond 6 months without concerning symptomatology or physical examination findings.
Methods This was a retrospective analysis of all patients who underwent resection of sinonasal malignancy at a tertiary care center over a 20-year period from 2000 to 2020, with an ensuing surveillance period demonstrating recurrence.
Results Fifty-two patients with sinonasal malignancy recurrence were included, with an average time to recurrence of 30.9 months and a follow-up period of over 60 months. Recurrence was diagnosed by routine imaging or endoscopy in asymptomatic patients in a majority (60%) of cases, while the remaining minority of diagnoses followed new symptomatology. Asymptomatic recurrence was associated with perineural spread of tumor at initial resection (p = 0.025), but not with age (p = 0.85) or stage at diagnosis (p = 0.68). Expectedly, positron emission tomography/computed tomography (CT) more often detected regional or distant recurrence, while structural imaging (CT/magnetic resonance imaging) demonstrated more frequent detection of recurrence in those with perineural spread of tumor (p = 0.01).
Conclusions Our findings support high rates of asymptomatic recurrence in sinonasal malignancy, with the majority of recurrences diagnosed by routine endoscopy or imaging. Tailored and extended surveillance guidelines are necessary relative to those utilized for other head and neck mucosal cancers, and are especially appropriate when features such as perineural spread are present.
Guled M. Jama, Simon Gane
Publication date 16-07-2024
Vivienne Li, Andrew Yousef, Divya Prajapati, Michael Oca, Leslie Gomez, Adam S. DeConde, Carol H. Yan
Publication date 16-07-2024
Samuel J. M. Hale, Christian A. Lux, James E. Willoughby, Arne Koefoed, David Broderick, Kristi Biswas, Raymond Kim, Brett Wagner Mackenzie, Richard G. Douglas
Publication date 16-07-2024
Key points Novel topical therapeutics require extensive pre-clinical testing to assess efficacy and safety.
Antibiofilm or immunosuppressant agents can utilize ex vivo models to measure ciliotoxicity.
Agents that are found to be effective and non-toxic ex vivo warrant further investigation in vivo.
Vikram Vasan, Christopher P. Cheng, Shaun Edalati, Shreya Mandloi, David K. Lerner, Anthony Del Signore, Madeleine Schaberg, Satish Govindaraj, Mindy Rabinowitz, Gurston Nyquist, Alfred Marc Iloreta
Publication date 16-07-2024
Key points This follow-up dual-institutional and longitudinal study further evaluated for underlying gender biases in LORs for rhinology fellowship.
Explicit and implicit linguistic gender bias was found, heavily favoring male applicants
Conner J. Massey, Stephen M. Humphries, Jess C. Mace, Timothy L. Smith, Zachary M. Soler, Vijay R. Ramakrishnan
Publication date 12-07-2024
Key PointsAI-based CT sinus analysis may have advantages over visual based systems, for example, Lund–Mackay score.
Here, we show multi-institutional validation of an AI algorithm using novel OMC classification.
Significant, robust correlations are seen between algorithm outputs and clinical outcomes.
Jennifer E. Douglas, Nithin D. Adappa, Garret Choby, Corinna G. Levine, Mindy R. Rabinowitz, Raj Sindwani, Eric W. Wang, Bradford A. Woodworth, Edward C. Kuan
Publication date 12-07-2024
Abstract The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence regarding postoperative precautions for patients following endoscopic skull base surgery for intradural pathology. These topics include the administration of postoperative nasal hygiene; patient mobilization and activity level; the resumption of continuous positive airway pressure in patients with obstructive sleep apnea; and the timing and capacity with which a patient may be subjected to barotrauma, such as air travel postoperatively. This EPS was developed following the recommended methodology and approval process as previously outlined. Given the diverse practices and limited agreement on the accepted principles regarding postoperative precautions for patients following skull base surgery, this EPS seeks to summarize the existing literature and provide clinically relevant guidance to bring clarity to these differing practice patterns. Following a modified Delphi approach, four statements were developed, all of which reached consensus. Because of the paucity of literature on these topics, these statements represent a summation of the limited literature and the experts’ opinions. These statements and the accompanying evidence are summarized below, along with an assessment of future needs.
Pubmed PDF WebDo‐Yeon Cho, Dong Jin Lim, Olivia J. Kelly, Daniel Skinner, Shaoyan Zhang, Martin P. Jones, Jessica Grayson, Bradford A. Woodworth
Publication date 11-07-2024
Key points Chitosan is a promising drug delivery vector for therapeutics owing to its biocompatibility.
Once crosslinked with chitosan, prolonged drug release was noted regardless of hydrophilicity.
Hydrophilic drugs may require different strategies to obtain a sustained release profile.
Tomotaka Hemmi, Kazuhiro Nomura, Mitsuru Sugawara, Ryoukichi Ikeda
Publication date 10-07-2024
Key Points The optimal tilt for anteriorly tilted coronal CT was examined.
A 30° anteriorly tilted coronal CT best visualized the frontal sinus drainage pathway.
Kush Panara, Tan Li Hui, Deepa Keshari, Charles C. L. Tong, James N. Palmer, Nithin D. Adappa, Jennifer E. Douglas, Noam A. Cohen, Michael A. Kohanski
Publication date 05-07-2024
Abstract Background Inverted papilloma (IP) is a benign tumor characterized by epithelial proliferation, which has the potential for malignant transformation. However, the mechanisms driving this transformation are poorly defined. Matrix metalloproteinase-11 (MMP-11), a regulator of the tumor microenvironment that degrades extracellular matrix, is upregulated in IP with dysplasia. Here, we aim to investigate the role of MMP-11 in IP epithelial migration and invasion.
Methods Human IP and contralateral normal sinus mucosa (control) samples were obtained. IP-derived epithelial cultures and normal mucosa-derived epithelial cultures were grown in air‒liquid interface, followed by immunostaining to assess MMP-11 expression in IP. Migration and invasion assays were used to evaluate the role of an anti-MMP-11 antibody on IP and control epithelial cultures.
ResultsIP-derived cultures demonstrated strong MMP-11 expression compared to controls. Treatment with anti-MMP-11 blocking antibody significantly reduced epithelial migration only in IP-derived cells compared to non-treated IP cells, as seen by incomplete wound closure and reduced transepithelial resistance. In addition, inhibition of MMP-11 reduced IP epithelias ability to invade through collagen-coated transwells, suggesting that MMP-11 plays a role in invasion.
Conclusion We established an in vitro model to study IP-derived epithelial cells. MMP-11 is uniquely expressed in IP epithelial cultures compared to control epithelial cultures. Inhibition of MMP-11 limits IP epithelial migration and invasion to levels similar to that of normal sinus mucosa. MMP-11 does not appear to have a functional role in normal sinus epithelium, suggesting that MMP-11 has a role in malignant transformation of IP.
Ethan J. Han, Christine M. Liu, Jakob L. Fischer, Jess C. Mace, Karolin Markarian, Jeremiah A. Alt, Todd E. Bodner, Naweed I. Chowdhury, Patricia H. Eshaghian, Yuqing A. Gao, Anne E. Getz, Peter H. Hwang, Ashoke Khanwalkar, Adam J. Kimple, Jivianne T. Lee, Douglas A. Li, Meghan Norris, Jayakar V. Nayak, Cameran Owens, Zara M. Patel, Katie Poch, Rodney J. Schlosser, Kristine A. Smith, Timothy L. Smith, Zachary M. Soler, Jeffrey D. Suh, Grant A. Turner, Marilene B. Wang, Jennifer L. Taylor‐Cousar, Milene T. Saavedra, Daniel M. Beswick
Publication date 05-07-2024
Abstract Background Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied.
Methods In a prospective, multi-institutional study, adult PwCF completed the 22-Question Sino Nasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund–Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression.
Results Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (β = ‒4.09, 95% confidence interval CI ‒6.08, ‒2.11, p < 0.001), female sex (β = ‒2.14, 95% CI ‒4.11, ‒0.17, p = 0.034), and increasing age (β = ‒0.14, 95% CI ‒0.22, ‒0.05, p = 0.003) were associated with lower/better endoscopy scores. Private health insurance (β = 17.76, 95% CI 5.20, 30.32, p = 0.006) and >16 educational years (β = 13.50, 95% CI 2.21, 24.80, p = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV1). Medicaid/Medicare insurance was associated with worse endoscopy scores, CFQ-R respiratory scores, and ppFEV1 (all p < 0.017), and Hispanic/Latino ethnicity was associated with worse SNOT-22 scores (p = 0.047), prior to adjustment for other cofactors. No other SDS factors were associated with SNOT-22, QOD-NS, or SIT scores.
Conclusions Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF.
Clinical TrialsNCT04469439
Cameron P. Worden, Brian D. Thorp, Charles S. Ebert Jr., Cristine N. Klatt‐Cromwell, Brent A. Senior, Adam J. Kimple, Meghan E. Rebuli, Ilona Jaspers
Publication date 03-07-2024
Key points Inhalational exposure (IE) history assessment is important and may guide chronic rhinosinusitis disease management.
Combined exposure status was the most significant factor across differential gene expression analyseIE history was associated with pro-inflammatory transcriptome changes and worse clinical outcomes.
Graham Pingree, Mihai Bentan, Thomas Fitzpatrick, Theodore Schuman
Publication date 03-07-2024
Abstract Background Elexacaftor/tezacaftor/ivacaftor (ETI), a combination cystic fibrosis transmembrane receptor (CFTR) modulator, has demonstrated improved pulmonary outcomes in individuals with cystic fibrosis (CF). However, ETIs impact on functional endoscopic sinus surgery (FESS) remains unclear.
Methods The Tri NetX Analytics Research Network, consisting of 120 million global de-identified electronic medical records, was queried from 2012 to 2023 for subjects with CF who underwent sinus surgery.1 Patients on ETI prior to FESS (n = 6,056) were propensity score matched to control individuals with CF not on CFTR modulators (n = 37,906) and those on other FDA-approved CFTR modulators (tezacaftor/ivacaftor, lumacaftor/ivacaftor, and ivacaftor) (n = 2437) based on relevant factors. The primary outcome was the absolute risk reduction (ARR) of undergoing FESS. Secondary outcomes included ARR of CF-related pulmonary exacerbations and hospital admission from 0 to 6, 6 to 12, and 12 to 24 months following FESS.
ResultsETI use demonstrated a significant ARR for FESS when compared to CF patients not on CFTR modulators (2.12%; 95% confidence interval CI 1.5–2.75; p-value < 0.0001) and those on other CFTR modulators (4.7%; 95% CI 3.54–5.85; p-value < 0.0001). No significant differences occurred in secondary outcomes between ETI and non-CFTR modulator groups, except for reduced CF-related pulmonary exacerbations from 0 to 6 months post-FESS. Additionally, a significant reduction in pulmonary exacerbations was observed at all time points and hospital admissions within 6 months following FESS compared to those using other CFTR modulators.
Conclusions In a large dataset, CF patients on ETI demonstrated significantly reduced risk of FESS, pulmonary exacerbations, and hospital admission compared to patients not on CFTR modulators or those on other CFTR modulators, suggesting improved sinonasal disease and overall health status in CF.
Abigail Gaffar, Abdul Rahman Alenezi, Kathleen M. Kelly, Heather M. Kulaga, Hsin‐Tzu Keng, Amy Smith, Andrew P. Lane
Publication date 03-07-2024
Key pointsA persistent type 2 endotype signature exists in recalcitrant chronic rhinosinusitis with nasal polyps mucosa on dupilumab.
Revision sinus surgery immediately prior to dupilumab reduces long-term interleukin (IL)-4/IL-13 tissue mRNA.
Pre-dupilumab revision surgery is associated with reduced tissue eosinophils and GATA-3+ cells.
Kurtis Young, Frances T. Morden, Quinton Blount, Austin Johnson, Sameer Kejriwal, Hannah Bulosan, Elliott J. Koshi, Marianne Abouyared, Farrah Siddiqui, Jee‐Hong Kim
Publication date 30-06-2024
Abstract Introduction This is the first systematic review and meta-analysis to investigate the effectiveness of the nasal airflow-inducing maneuver (NAIM) in olfactory rehabilitation for total laryngectomy (TL) patients.
Methods We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required that patients must have undergone a TL with subsequent NAIM training for at least 2 weeks and olfactory evaluation. The impact of NAIM on olfactory outcomes compared to that at baseline was measured. Olfactory measures included the Sniffin’ Sticks Test, Smell Disk Test, Scandinavian Odor Identification Test, and Quick Odor Detection Test. The primary outcome measures were the proportion of patients with normosmia at baseline and after intervention.
Results Seven studies from 2000 to 2023 comprising a total of 290 TL patients met the inclusion criteria. The meta-analysis revealed that prior to intervention, the pooled proportion of patients with normosmia was 0.16 (95% confidence interval CI: 0.09‒0.27, p = 0.01). After intervention, the same proportion increased to 0.55 (95% CI: 0.45‒0.68, p = 0.001). Among the included patients, 88.3% were initially anosmic or hyposmic, which was reduced to 48.9% after NAIM practice, with 51.1% achieving normosmia. The percent improvement was not found to be significantly associated with the timing of intervention post-TL (p = 0.18).
ConclusionsNAIM increased the proportion of patients who achieved normosmia in TL patients. NAIM stands out as a safe, easily teachable maneuver with promising results. Further efforts are warranted to provide specific recommendations and guidelines for the use of NAIM in clinical practice.
Michael Z. Cheng, Varun Vohra, Hang Wang, Akhil Katuri, Jacqueline M. Langdon, Qian‐Li Xue, Nicholas R. Rowan
Publication date 28-06-2024
Abstract Background Amidst the rise of frailty among a globally aging population, olfactory decline has emerged as a harbinger of frailty and mortality in population-level studies. However, the relationships between frailty and the olfactory subdomains of identification (OI), discrimination (OD), and threshold (OT) remain unexplored. This study prospectively examined the association between olfactory subdomains and the physical frailty phenotype (PFP) to investigate olfactory evaluation as a means of frailty screening.
MethodsA case‒control study of 45 frail and 45 non-frail individuals matched by age and sex. OT, OD, OI (range 0‒16), and composite sum (threshold, discrimination, and identification scores TDI, range 0‒48) were measured with Sniffin’ Sticks.
PFP was defined by presence of three or more criteria: physical inactivity, self-reported exhaustion, muscle weakness, slow gait, and unintentional weight loss. Conditional logistic regression evaluated associations between olfactory subdomains and frailty.
Results Ninety individuals with mean age of 83.1 ± 4.9 years, 60% female (n = 54), and 87.8% white (n = 79) were included. Olfactory scores were significantly lower in the frail group for OI (9.2 vs. 12.1, p < 0.001), OD (8.1 vs. 11.6, p < 0.001), OT (4.4 vs. 8.5, p < 0.001), and TDI (21.7 vs. 32.2, p < 0.001) than in the non-frail group. A single-point decrease in olfactory score was associated with increased odds of frailty in OT (odds ratio OR: 2.21, 95% confidence interval: 1.22, 3.98), OD (OR: 2.19, 95% CI: 1.32, 3.65), OI (OR: 2.29, 95% CI: 1.19, 4.39), and TDI (OR: 1.54, 95% CI: 1.14, 2.08).
Conclusion The robust association between olfactory subdomain scores and frailty suggests that olfaction may be an accessible signifier of frailty. Future studies should investigate this relationship longitudinally to assess predictive relationships.
Florian Chatelet, Alessandro Vinciguerra, Morgane Marc, Philippe Herman, Benjamin Verillaud
Publication date 27-06-2024
Key Points Intralesional cidofovir injections in combination with surgery is an effective treatment for recurrent multifocal sinonasal exophytic papilloma.
No malignant transformation has been observed in our experience.
Anosmia is a potential side effect that patients should be aware of.
Noel F. Ayoub, Firas Sbeih, Benjamin S. Bleier
Publication date 27-06-2024
Key Points Data on current practice patterns for the management of chronic rhinosinusitis with nasal polyps, including which medications are deemed by otolaryngologists to better manage patient symptoms, are limited.
This study demonstrated that contemporary practice patterns are largely consistent with published clinical consensus statements.
Off-label nasal steroid irrigations and dupilumab are the most commonly used topical and systemic therapies for chronic rhinosinusitis with nasal polyps, respectively.
Kevin Hur, Amila Adili, Benjamin Tam, Kevin Herrera, Aditi Agarwal, Dale Rice, Elisabeth Ference, Bozena Wrobel, David Conley
Publication date 27-06-2024
Abstract Background Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan-based polymer in reducing pain during debridement after ESS.
MethodsA prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan-based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12 weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured.
Results Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel-treated side compared to the chitosan-based polymer-treated side. There were no significant differences in bleeding severity, Lund–Kennedy scores, debridement time, or need for further intervention between the two groups.
Conclusion This study demonstrated the efficacy of a peptide hydrogel in minimizing pain during postoperative debridement.
Akash M. Bhat, Zachary M. Soler, Vinay K. Rathi, Rodney J. Schlosser
Publication date 25-06-2024
Key pointsCRSwNP-specific mean total annual spending ranged from $5,837 (EDS-FLU) to $28,058 (dupilumab).
Most CRSwNP patients receiving biologics had comorbid asthma and did not undergo sinus surgery.
While biologics were covered by most Medicare Part D plans, only 37% of plans covered EDS-FLU.
Daniel Gorelik, Aatin K. Dhanda, Najm S. Khan, Masayoshi Takashima, Tariq Nisar, Ella Brissett, Murugappan Ramanathan Jr., Jayant M. Pinto, Nicholas R. Rowan, Omar G. Ahmed
Publication date 21-06-2024
Abstract Introduction Despite effects on quality of life from olfactory and gustatory dysfunction (OD and GD), screening practices are limited, and patients’ self-reporting of symptoms remains the only way to understand the burden of chemosensory dysfunction (CSD). Using a large population-based database, we sought to understand factors leading to reduced likelihood of discussing CSD with a provider.
Methods The 2013‒2014 National Health and Nutrition Examination Survey (NHANES) chemosensory protocol was queried for factors influencing discussion of OD/GD with a healthcare provider. Sociodemographic, comorbidity, and objective OD/GD testing results were assessed with a multivariate analysis.
Results Out of 146.1 million US adults, there were an estimated 41.4 million individuals with self-reported OD/GD in the prior 12 months (28.3%). A total of 86.8% of participants did not discuss their problem with a healthcare provider. Men were about half as likely to speak with a healthcare provider (odds ratio OR 0.42; 0.26–0.66; p < 0.001) and those with a college education were about nine times more likely to discuss the problem compared to those with less than a ninth-grade educational achievement (OR 8.83; 1.86–41.98; p = 0.02). Those with objective confirmation of CSD were still unlikely to speak with a provider (OR 0.77; 0.44–1.33; p = 0.36).
Conclusion Men and those with less education are less likely to discuss OD/GD with a healthcare provider. These populations tend to be at increased risk for CSD, and there are severe downstream health and quality of life implications related to CSD. Dedicated screening and increased public awareness are critical to ensure more equitable care.
Daniel B. Spielman
Publication date 21-06-2024
Key Points The surgeons hand dominance impacts ergonomics in endoscopic endonasal surgery.
Left-handed trainees experience difficulty learning certain surgical techniques.
OR adjustments optimize ergonomics for left-handed trainees without compromising others.
Gregory S. Hill, Jakob L. Fischer, Nora L. Watson, Charles A. Riley, Anthony M. Tolisano
Publication date 18-06-2024
Key pointsGPT-4 generated moderate quality information in response to questions regarding sinusitis and surgery.
GPT-4 generated significantly higher quality responses to questions regarding treatment of sinusitis.
Future studies exploring quality of GPT responses should seek to limit bias and use validated instruments.
Soraya Fereydooni, Allen Green, Eric X. Wei, Monica K. Rossi‐Meyer, Cherian K. Kandathil, Sam P. Most
Publication date 18-06-2024
Key points Complications in combined surgery are equivalent to ESS but are higher than rhinoplasty alone.
The most common complications are pneumonia, stroke, and epistaxis.
Rhinoplasty surgeries with graft use have a higher risk of complications.
Sabrina L. Maoz, Autreen Golzar, Garret Choby, Peter H. Hwang, Eric W. Wang, Edward C. Kuan, Nithin D. Adappa, Mathew Geltzeiler, Anne E. Getz, Ian M. Humphreys, Christopher H. Le, Carlos D. Pinheiro‐Neto, Jakob L. Fischer, Erik P. Chan, Waleed M. Abuzeid, Eugene H. Chang, Aria Jafari, Todd T. Kingdom, Michael A. Kohanski, Jivianne K. Lee, Jillian W. Lazor, Ali Nabavizadeh, Jayakar V. Nayak, James N. Palmer, Zara M. Patel, Adam C. Resnick, Timothy L. Smith, Carl H. Snyderman, Maie A. St. John, Phillip B. Storm, Jeffrey D. Suh, Marilene B. Wang, Myung S. Sim, Daniel M. Beswick
Publication date 17-06-2024
Abstract Purpose Sinonasal malignancies (SNMs) adversely impact patients’ quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients.
Methods In this prospective, multi-institutional study, 273 patients with SNMs who underwent definitive treatment with curative intent were evaluated. We used the University of Washington Quality of Life (UWQOL) instrument over 5 years from diagnosis to identify demographic, treatment, and disease-related factors that influence each of the 12 UWQOL subdomains from baseline to 5 -years post-treatment.
Results Multivariate models found endoscopic resection predicted improved pain (vs. nonsurgical treatment CI 2.4, 19.4, p = 0.01) and appearance versus open (CI 27.0, 35.0, p < 0.001) or combined (CI 10.4, 17.1, p < 0.001). Pterygopalatine fossa involvement predicted worse swallow (CI −10.8, −2.4, p = 0.01) and pain (CI −17.0, −4.0, p < 0.001). Neck dissection predicted worse swallow (CI −14.8, −2.8, p < 0.001), taste (CI −31.7, −1.5, p = 0.02), and salivary symptoms (CI −28.4, −8.6, p < 0.001). Maxillary involvement predicted worse chewing (CI 9.8, 33.2; p < 0.001) and speech (CI −21.8, −5.4, p < 0.001) relative to other sites. Advanced T stage predicted worse anxiety (CI −13.0, −2.0, p = 0.03).
Conclusions Surgical approach, management of cervical disease, tumor extent, and site of involvement impacted variable UWQOL symptom areas. Endoscopic resection predicted better pain, appearance, and chewing compared with open. These results may aid in counseling patients regarding potential QOL expectations in their SNM treatment and recovery course.
Hawa M. Ali, Evelyn M. Leland, Emily Stickney, Christine M. Lohse, Ehiremen Iyoha, Benita Valappil, Andrey Filimonov, Kaitlin Goetschel, Sarah C. Young, Maryam N. Shahin, Olabisi Sanusi, Davaine Joel Ndongo Sonfack, Sylvie Nadeau, Pierre‐Olivier Champagne, Mathew Geltzeiler, Nathan T. Zwagerman, Paul A. Gardner, Eric W. Wang, Georgios A. Zenonos, Carl Snyderman, Jamie Van Gompel, Michael Link, Maria Peris‐Celda, Janalee Stokken, Garret Choby, Carlos D. Pinheiro‐Neto
Publication date 17-06-2024
Abstract Introduction Surgical techniques for sellar reconstruction include no reconstruction, use of synthetic materials, autologous grafts, and/or vascularized flaps. The aim of this study was to conduct a multi-center study comparing the efficacy and postoperative morbidity associated with different sellar reconstruction techniques.
MethodsA retrospective chart review of patients who underwent endoscopic transsphenoidal surgery for pituitary tumors from five participating sites between January 2021 and March 2023 was performed. The variables included demographics, tumor characteristics, reconstruction technique, postoperative cerebrospinal fluid leak (CSF) leak, and 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Comparisons of postoperative complications, SNOT-22 scores, and duration of surgery by type of onlay reconstruction were evaluated using Fishers exact test, analysis of variance, and Kruskal‒Wallis test.
Results Five hundred and one patients were identified. The median tumor size was 2.1 cm, and 64% were non-functioning. Intraoperative CSF leak was identified in 38% of patients. A total of 89% of patients underwent onlay reconstruction: 49% were reconstructed with mucosal grafts, 35% with nasoseptal flaps, and 5% with other onlay techniques. Nasoseptal flaps were utilized more frequently in the setting of giant pituitary adenomas (>3 cm), medial cavernous sinus wall resection, and high-flow intraoperative CSF leaks. Cases who utilized mucosal grafts had an overall shorter operating time (median: 183 min vs. 240 min; p < 0.001). Five postoperative CSF leaks were identified, and therefore, statistical analysis could not be performed for this complication.
Conclusion The effectiveness and morbidity of different sellar reconstruction techniques are comparable. Vascularized flaps were utilized more frequently in the setting of larger tumors and high-flow intraoperative CSF leaks.
Yuki Yoshiyasu, Mason R. Krysinski, Rakesh K. Chandra, Philip G. Chen
Publication date 10-06-2024
Key points Unilateral or destructive sinonasal disease should raise suspicion for tumor.
Patients receiving biologic therapy for CRSwNP should be carefully selected.
Tissue diagnosis should be considered prior to starting biologics for nasal polyposis.
Jordan Pritikin, Stacey Silvers, Jeffrey Rosenbloom, Bryan Davis, Anthony Del Signore, Ahmad R. Sedaghat, Bobby A. Tajudeen, Isaac Schmale, Rakesh Chandra
Publication date 06-06-2024
Abstract Background Improved nasal airway obstruction (NAO) symptoms were reported at 3 months following temperature-controlled radiofrequency (TCRF) treatment of the septal swell body (SSB). This report provides results from assessments of the long-term safety and efficacy of TCRF treatment of SSB hypertrophy to treat NAO through 12 months posttreatment.
Methods This prospective, multicenter, long-term, open-label study was conducted in nine centers within the United States and included patients with severe/extreme NAO attributed to SSB hypertrophy. Outcome measures included assessments of Nasal Obstruction Symptom Evaluation Score (NOSE), Numeric Rating Scale (NRS) ease-of-breathing, patient satisfaction, and adverse events at 6 and 12 months.
Results Of the 70 patients treated, 65 and 62 patients completed the 6- and 12-month follow-up assessments. Compared to baseline, there was a 67.5% decrease in adjusted mean NOSE scores at 6 months (mean change −49.6, 95% confidence interval CI −54.8 to −44.4; p < 0.001) and a 65.4% decrease at 12 months (mean change −48.1, 95% CI −53.7 to −42.5); p < 0.001), which is consistent with previously published 3-month results. A 62.0% and 62.5% improvement compared to baseline was observed in the NRS ease-of-breathing score at 6 and 12 months, respectively (p < 0.001). No serious adverse were reported overall and no new device- or procedure-related adverse events were reported in the interval between 3 and 12 months posttreatment.
ConclusionTCRF treatment of SSB hypertrophy has a significant and durable effect on improving the symptoms of NAO and health-related quality of life in patients with symptoms of nasal obstruction and congestion through 12 months postprocedure.