\nAudrey Pelletier, \nLeandra Mfuna Endam, \nEmmanuel Gonzalez, \nSheherazade Jannat, \nThea Irani, \nMartin Desrosiers\n
Publicatie 30-12-2024
\nNikita Chapurin, \nZachary M. Soler, \nSofia Khan, \nJennifer K. Mulligan, \nVijay R. Ramakrishnan, \nJess C. Mace, \nTimothy L. Smith, \nJeremiah A. Alt, \nJose L. Mattos, \nVinay K. Rathi, \nRodney J. Schlosser\n
Publicatie 30-12-2024
AbstractBackgroundQuantitative mucus cytokine analysis to examine the sinonasal microenvironment may bridge the gap between patient-reported outcome measures (PROMs) and empirical measures of inflammation in patients with chronic rhinosinusitis (CRS).ObjectiveInvestigate the correlation between mucus cytokine levels and Sino-Nasal Outcome Test (SNOT-22) scores, including individual subdomains.MethodsPatients with CRS were prospectively recruited between 2016 and 2021 into a multi-institutional observational study. Mucus was collected from the olfactory cleft and evaluated for mucus cytokine biomarkers. Spearman correlations (ρ) between cytokine levels and SNOT-22 scores, including individual subdomains, Lund–Mackay (LM) CT and Lund–Kennedy (LK) endoscopy scores were assessed. Subgroup analysis based on nasal polyp status (CRSsNP—without nasal polyps; CRSwNP—with nasal polyps) was also performed. Linear regression was employed to identify multivariate associations between cytokine expression levels, clinical covariates, and SNOT-22 total and domain scores.ResultsA total of 127 patients were included in the study (CRSsNP = 53, CRSwNP = 74). IL-9 (ρ = 0.196, p < 0.05) was the only biomarker that correlated with the SNOT-22 total score. CRSwNP patients had a higher absolute expression level of Type 2 biomarkers (IgE, IL-5, and IL-13), compared to CRSsNP patients. IgE, IL-5, IL-9, and IL-13 significantly correlated with the SNOT-22 rhinologic subdomain scores (p < 0.001), LM scores, and patient reported sense of smell (Question 21). Notably, subgroup analysis showed that CRSsNP patients also demonstrated significant correlations between Type 2 markers (IL-4, IL-5, IL-9, and IL-13) and SNOT-22 rhinologic subdomain scores.ConclusionType 2 mucus cytokine levels, especially IL-9, correlate with SNOT-22, and the rhinologic SNOT-22 subdomain scores for both CRSsNP and CRSwNP patients.
Pubmed PDF Web\nMaxime Fieux, \nBruna R. Castro, \nSophie S. Jang, \nCarol H. Yan, \nZara M. Patel\n
Publicatie 30-12-2024
ABSTRACTBackgroundPlatelet-rich plasma (PRP) injections have previously been shown to benefit coronavirus disease 2019 (COVID-19)-induced smell loss. It is unknown if that benefit is stable over time. The aim of this study was to assess outcomes at 1-year post-intervention.MethodsProspective cohort study. Sixteen patients (10 PRP and six placebo) from the original PRP randomized placebo-controlled clinical trial, and a further 16 patients from smell clinic who were a year out from initial treatment (six PRP patients and 10 non-PRP) were enrolled. University of Pennsylvania Smell Identification Tests (UPSITs) and visual analog scale (VAS) subjective scores were compared to initial scores.ResultsThere was no difference between groups with respect to age, gender, race, duration of smell loss prior to intervention, smoking or diabetes status, Charlson comorbidity index, presence of phantosmia or parosmia, or baseline UPSIT score. The PRP group had a significantly higher change in UPSIT score at 1 year (p = 0.001), a higher number of patients who met the minimal clinically important difference for the UPSIT (87.5% vs. 31.2%, p = 0.004), and a significantly greater change in VAS at 1 year (p = 0.001), compared to those who did not receive injections. On multivariate logistic regression analysis, no factors appeared to have a significant effect on these findings.ConclusionPRP injections into the olfactory cleft now have long-term data suggesting benefit in both subjective and psychophysical measures of smell, and improvements in both realms at 1 year are significantly higher than in those who do not receive the injections.
Pubmed PDF Web\nTheodore V. Nguyen, \nArash Abiri, \nVictoria Idowu, \nSaawan Patel, \nThomas Truong, \nDavid K. Lerner, \nAlan D. Workman, \nPete S. Batra, \nRaewyn G. Campbell, \nJohn R. Craig, \nDana L. Crosby, \nJennifer E. Douglas, \nJacob G. Eide, \nMichael A. Kohanski, \nRijul S. Kshirsagar, \nTran B. Locke, \nPeter Papagiannopoulos, \nBobby A. Tajudeen, \nCharles C. L. Tong, \nNithin D. Adappa, \nJames N. Palmer, \nEdward C. Kuan\n
Publicatie 30-12-2024
\nTary Yin, \nBrett Wagner Mackenzie, \nFiona Radcliff, \nDavid Broderick, \nKristi Biswas, \nRichard Douglas\n
Publicatie 21-12-2024
\nAlejandra Rodas, \nLeonardo Tariciotti, \nYoussef M. Zohdy, \nRoberto M. Soriano, \nGustavo Pradilla, \nC. Arturo Solares, \nJohn M. DelGaudio\n
Publicatie 18-12-2024
ABSTRACTBackgroundEndoscopic endonasal techniques, initially developed for sinonasal tumor resection, have revolutionized the approach to orbital lesions. The emergence of endonasal orbital tumor surgery has prompted anatomical studies focusing on the medial orbit, yet there remains a lack of literature on maneuverability lateral to the optic nerve (ON), with current feasibility assessments relying primarily on the plane of resectability (POR).MethodsBilateral anatomical dissections were conducted on four latex-injected human cadaveric heads using an endoscopic medial and inferior orbitotomy and superomedial displacement of the inferior rectus muscle (IRM) to access the inferolateral intraconal quadrant. Measurements of distances, areas, angles of attack, and volumetric exposure were obtained using stereotactic points from an imaging-based navigation system. Additionally, an illustrative case was presented to demonstrate the endoscopic management of laterally based intraconal lesions.ResultsThe intraconal space was safely accessed through superomedial displacement of the IRM. The mean intraconal volumetric exposure attained through this maneuver was 2.78 cm3 (1.18 cm3). The most superolateral point reachable by the ipsilateral endoscopic endonasal approach was consistently lateral and superior to the ON at a mean absolute distance of 1.45 cm (0.37 cm). Maneuverability at this target point was superior in the sagittal plane, noted by a larger vertical angle of attack compared with the horizontal angle of attack.ConclusionThis study demonstrates that inferolateral intraconal dissection through an ipsilateral endoscopic endonasal approach is feasible via a medial orbitotomy and superomedial retraction of the IRM. Additionally, our findings reaffirm lesions below the POR are suitable for endoscopic endonasal resection.
Pubmed PDF Web\nDaniel Xiao, \nJason Talmadge, \nMartin J. Citardi, \nWilliam C. Yao, \nAmber U. Luong\n
Publicatie 18-12-2024
\nKunjira Sombutpiboonphon, \nKornkiat Snidvongs, \nSaranath Lawpoolsri, \nNutpacha Chotikawichean, \nPatlada Kowatanamongkon, \nKittichai Mongkolkul, \nWirach Chitsuthipakorn\n
Publicatie 16-12-2024
AbstractIntroductionTissue eosinophil count (TEC) is recommended for defining Type 2 chronic rhinosinusitis with nasal polyps (CRSwNP). TEC is usually assessed by a one-time polyp biopsy. Because TEC may change over time, its reliability for diagnosing type 2 CRSwNP has not been previously assessed. This study aims to explore whether TEC fluctuates across different time points.MethodsAdult patients with CRSwNP were prospectively recruited at Rajavithi Hospital, Thailand. Participants who had used any form of steroids within 4 weeks were excluded. Polyps were taken for TEC evaluation upon recruitment and repeated at 3 and 6 months. Participants were assessed using the 22-items Sinonasal Outcome Test (SNOT-22), Lund–Kennedy endoscopic score (LKES), blood eosinophil count, and its percentage at each time point.ResultsThirty-seven participants were enrolled. The medians (Quartiles 1–3) of TEC were 17 (4–53.5), 19 (5–47.5), and 21 (4.5–51) cells/high-powered field at 0, 3, and 6 months, respectively. Friedmans two-way analysis of variance showed no statistical differences across the three time points for TEC (p = 0.53), blood eosinophil counts (p = 0.61), blood eosinophil percentages (p = 0.23), SNOT-22 (p = 0.21), or LKES (p = 0.23). TEC significantly correlated with blood eosinophil counts at 0 and 3 months and with blood eosinophil percentages at 0, 3, and 6 months (all p < 0.05).ConclusionThe study showed that TEC did not significantly fluctuate over time, aligning with blood eosinophil levels, SNOT-22, and LKES. This stability within the 6-month period supports the reliability of TEC from a single biopsy for clinical use in managing CRSwNP.
Pubmed PDF Web\nHaonan Lin, \nHao Chi, \nFan Li, \nKe Xu\n
Publicatie 13-12-2024
\nAntonio Daloiso, \nPiergiorgio Gaudioso, \nAlessandro Vinciguerra, \nMario Turri‐Zanoni, \nGabriele Testa, \nDiego Cazzador, \nAlessia Lambertoni, \nAlberto Daniele Arosio, \nGiacomo Contro, \nStefano Taboni, \nVittorio Rampinelli, \nCesare Piazza, \nMaurizio Bignami, \nEnzo Emanuelli, \nPaolo Battaglia, \nPaolo Bossi, \nPhilippe Herman, \nPaolo Castelnuovo, \nEhab Y. Hanna, \nPiero Nicolai, \nDavide Mattavelli, \nMarco Ferrari\n
Publicatie 11-12-2024
AbstractIntroductionOlfactory neuroblastoma (ONB) is a rare malignant tumor originating from the olfactory neuroepithelium, typically within the sinonasal cavity. Cases of ONB originating outside of the olfactory cleft area are extremely rare and are referred to as “ectopic” (eONB), in contrast to “orthotopic” tumors (oONB). ONB has been associated with paraneoplastic syndromes (PNSs), including the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This study investigate the association between eONB and SIADH and compared the prognosis of eONB to oONB.MethodsA systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, focusing on studies reporting eONB and oONB associated with SIADH. Data from four newly identified eONB cases were reported and a pooled analysis was performed. Statistical analyses were conducted to evaluate the prevalence of SIADH in eONB and oONB and to compare clinical outcomes in the two groups.ResultseONB had a significantly higher prevalence of SIADH (18.3%) compared to oONB (2.0%; p < 0.0001). Patients with eONB were younger, with a slight predominance of females. Recurrence-free survival and time-to-recurrence of eONB were worse than oONB, independently of other prognosticators.ConclusionseONB is associated with a significantly higher incidence of SIADH than oONB, suggesting distinct biological characteristics. Moreover, patients with eONB had worse prognostic outcomes. Further research is needed to understand the underlying mechanisms and improve management strategies for eONB.
Pubmed PDF Web\nJunhao Tu, \nFan Jiang, \nJing Liu, \nHsiao Hui Ong, \nZhiqun Huang, \nKeshuang Wang, \nQing Luo, \nLi Shi, \nJing Ye, \nDeyun Wang\n
Publicatie 09-12-2024
Key pointsSinonasal inverted papilloma (SNIP) is a benign epithelial proliferative disease with a high recurrence rate.The role of epithelial-mesenchymal transition (EMT) in the pathogenesis of SNIP remains unclear.EMT marker expression is elevated in SNIP tissues and is associated with its recurrence.
Pubmed PDF Web\nYiheng Liu, \nWeiran Dai\n
Publicatie 09-12-2024
\nAmber Cradeur, \nMark Knackstedt, \nMackenzie Latour, \nMichael Yim\n
Publicatie 09-12-2024
Key pointsSimulation models have utility in rehearsal of endoscopic skull base repair with a nasoseptal flap.Trainee confidence, technical skill, and repair quality saw significant improvement in this study.
Pubmed PDF Web\nPablo J. Moreno‐Peña, \nNeri Alejandro Álvarez‐Villalobos, \nJose Luis Treviño‐González\n
Publicatie 03-12-2024
\nRory J. Lubner, \nChristina Dorismond, \nMason Krysinski, \nPing Li, \nRakesh K. Chandra, \nJustin H. Turner, \nDawn C. Newcomb, \nKatherine N. Cahill, \nNaweed I. Chowdhury\n
Publicatie 03-12-2024
Key pointsCRS patients with asthma show differential nasal mucus cytokine signatures based on endotype.IL-7 concentration is positively associated with higher %FEV1 and %FVC in CRS patients with asthma.
Pubmed PDF Web\nSaawan D. Patel, \nIsha K. Thapar, \nAlan D. Workman, \nDana F. Lopez, \nBenjamin F. Bitner, \nHannah B. Bukzin, \nDavid K. Lerner, \nJadyn Wilensky, \nJennifer E. Douglas, \nJames N. Palmer, \nNithin D. Adappa, \nCharles C. L. Tong, \nEdward C. Kuan, \nMichael A. Kohanski\n
Publicatie 03-12-2024
AbstractBackgroundRecurrence of sinonasal squamous cell carcinoma (SNSCC) follows an aggressive course, and early detection is paramount. This study identifies the parameters of different surveillance modalities.MethodsWe conducted a retrospective study of 105 SNSCC patients at three academic institutions from November 2009 to July 2024. Patient records were reviewed for demographics, tumor characteristics, endoscopy, CT, PET/CT, and MRI findings. Multivariable analyses were performed in RStudio.ResultsMean time to recurrence was 12.1 months (SD 13.9 months). Patients with higher Charlson Comorbidity Index (p = 0.041), endoscopic surgical approach (p = 0.015), and suspicious surveillance findings (p = 0.029) had higher rates of recurrence. Endoscopy showed a sensitivity of 18.5% and specificity of 99.2%, with a positive predictive value (PPV) of 45.5% and negative predictive value (NPV) of 97.0%. CT had a sensitivity of 75.0% and specificity of 100.0%, with a PPV of 100.0% and NPV of 97.6%. PET/CT demonstrated a sensitivity of 95.2% and specificity of 90.8%, with a PPV of 64.5% and NPV of 97.6%. MRI showed a sensitivity of 72.4% and specificity of 97.1%, with a PPV of 65.6% and NPV of 97.9%. The median time from the last normal surveillance to recurrence was 2.07 months for endoscopy, 8.61 months for CT, 8.15 months for PET/CT, and 6.49 months for MRI.ConclusionsThe high specificity and NPV of endoscopy, alongside the high sensitivity of PET/CT, support a multimodal approach for surveillance. Given the mean onset of SNSCC recurrence at 12.1 months, surveillance beyond the National Comprehensive Cancer Networks asymptomatic 6-month guideline is warranted, and follow-up should be tailored to patient-specific risk factors.
Pubmed PDF Web\nHyun Jin Min, \nJinyoung Jeong\n
Publicatie 03-12-2024
\nFiras Sbeih, \nHenry W. Zhou, \nNoel F. Ayoub, \nBarak Ringel, \nCarolina A. Chiou, \nJoseph F. Rizzo, \nBenjamin S. Bleier\n
Publicatie 02-12-2024
Key pointsPenetrating 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.
Pubmed PDF Web\nZachary T. Root, \nZhenxing Wu, \nThomas J. Lepley, \nAspen R. Schneller, \nRobbie J. Chapman, \nVeronica L. Formanek, \nKathleen M. Kelly, \nBradley A. Otto, \nKai Zhao\n
Publicatie 02-12-2024
AbstractBackgroundA 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.MethodsProspective, 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.ResultsNasal 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).ConclusionWe 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.
Pubmed PDF Web\nAngela S. Zhu, \nRyan A. Bartholomew, \nYan Zhao, \nMargaret B. Mitchell, \nBenjamin S. Bleier, \nBarak Ringel\n
Publicatie 02-12-2024
Key pointsUsing 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.
Pubmed PDF Web\nKeven Ji, \nHunter Kellerman, \nJess C. Mace, \nTimothy L. Smith, \nKara Y. Detwiller, \nShyam R. Joshi, \nMathew Geltzeiler\n
Publicatie 02-12-2024
AbstractBackgroundThe 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.MethodsRetrospective 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).ResultsWithin 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-MacKay scores (p < 0.001). No association between biologic rescue and frontal recess antero-posterior diameter was found (p = 0.20).ConclusionsDraf 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.
Pubmed PDF Web\nRavi Dhamija, \nPeng Ding, \nNikita Das, \nVarunil N. Shah, \nDavid C. Kaelber, \nMohamad R. Chaaban\n
Publicatie 02-12-2024
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.
Pubmed PDF Web\nEstephania Candelo, \nAnyull D. Bohorquez‐Caballero, \nKarol Avila‐Castano, \nHani Wadei, \nAngela M Donaldson\n
Publicatie 02-12-2024
Key pointsThe 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.
Pubmed PDF Web\nNirushan Narendran, \nSophia Volpe, \nIbrahim Ramadan, \nJacob Ryan Herbert, \nBonnie LaFleur, \nShireen Samargandy, \nChristopher H. Le, \nEugene H. Chang\n
Publicatie 02-12-2024
AbstractBackgroundAcute 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.MethodsWe 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.ResultsThiry-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.ConclusionsIn 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.
Pubmed PDF Web\nSarah K. Wise, \nNithin D. Adappa, \nRakesh K. Chandra, \nGreg E. Davis, \nMahboobeh Mahdavinia, \nRamy Mahmoud, \nJohn Messina, \nJames N. Palmer, \nZara M. Patel, \nAnju T. Peters, \nRodney J. Schlosser, \nRaj Sindwani, \nZachary M. Soler, \nAndrew A. White\n
Publicatie 02-12-2024
AbstractBackgroundThe 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 (ReOpen1/2) evaluated EDS-FLU versus EDS-placebo in patients with CRS, stratified by surgical status.MethodsSurgery-naive (n = 332) and prior-surgery (n = 215) patient groups were analyzed as pooled data from ReOpen1/2. 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.ResultsBaseline 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.
Pubmed PDF Web\nFarideh Hosseinzadeh, \nS. Saeed Mohammadi, \nJames N. Palmer, \nMichael A. Kohanski, \nNithin D. Adappa, \nMichael T. Chang, \nPeter H. Hwang, \nJayakar V. Nayak, \nZara M. Patel\n
Publicatie 02-12-2024
Key pointsInverted 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.
Pubmed PDF Web\nNeil P. Monaghan, \nKelsey A. Duckett, \nShaun A. Nguyen, \nAbigail A. Massey, \nVinay Rathi, \nZachary M. Soler, \nRodney J. Schlosser\n
Publicatie 02-12-2024
Key pointsSham procedures produce a clinically significant impact on patient-reported outcome measuresThis effect should be considered when designing and interpreting the results of RCTs
Pubmed PDF Web\nKody A. Waldstein, \nArman Issimov, \nMaria Ganama, \nValerie Jinge, \nStephen Tilley, \nXiaoyang Hua\n
Publicatie 02-12-2024
AbstractBackgroundUpper respiratory viral infections (URVIs) are responsible for 80% of asthma exacerbation episodes. However, the underlying mechanisms remain poorly understood.MethodsIn this study, we used a mouse model of URVI and examined the impact of URVI on asthma phenotypes and the underlying mechanisms.ResultsPreviously, 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.ConclusionsTaken together, our data have shown that URVI enhances the allergic inflammatory response and AHR through a B cell‒monocyte regulatory axis.
Pubmed PDF Web\nHyun Jin Min, \nKyung Soo Kim, \nHyunjung Kim, \nJiyoung Gong, \nJinyoung Jeong\n
Publicatie 02-12-2024
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.
Pubmed PDF Web\nSung‐Woo Cho, \nBhumsuk Keam, \nKeun‐Wook Lee, \nJi‐Won Kim, \nDoo Hee Han, \nHyun Jik Kim, \nJeong‐Whun Kim, \nDong‐Young Kim, \nChae‐Seo Rhee, \nYun Jung Bae, \nJi‐Hoon Kim, \nKeun‐Yong Eom, \nHong‐Gyun Wu, \nYong Hwy Kim, \nChae‐Yong Kim, \nSun Ha Paek, \nHyojin Kim, \nTae‐Bin Won\n
Publicatie 02-12-2024
AbstractObjectivesTo evaluate the treatment outcomes in patients with advanced-stage olfactory neuroblastoma (ONB) who received induction chemotherapy (IC).Materials and methodsThe 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.ResultsSeventeen (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).ConclusionIn 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.
Pubmed PDF Web\nColine Labarre, \nFlorent Carsuzaa, \nMaxime Fieux, \nBenjamin Verillaud, \nAntoine Moya Plana, \nLudovic de Gabory, \nVincent Patron, \nFrancois‐Régis Ferrand, \nJuliette Thariat\n
Publicatie 02-12-2024
Key pointsInterpretation 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.
Pubmed PDF Web\nChristina Liu, \nConrad W. Safranek, \nRhys Richmond, \nTrinithas Boyi, \nZachary Pickell, \nRyan Rimmer, \nR. Peter Manes\n
Publicatie 02-12-2024
AbstractBackgroundAccurate 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).MethodsStudies on FDA-approved MABs for CRSwNP (dupilumab, omalizumab, mepolizumab) published between 2019 and 2021 with at least one US author were identified through PubMed. Industry-reported payments from the manufacturers (Sanofi, Regeneron, Genentech, Novartis, and GlaxoSmithKline) 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.ConclusionThis 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.
Pubmed PDF Web\nHuimin Du, \nTong Wu\n
Publicatie 02-12-2024
\nGuled M. Jama, \nSimon Gane\n
Publicatie 02-12-2024
Key pointsIn patients with severe refractory epistaxis due to hereditary hemorrhagic telangiectasia, the most effective results are achieved by surgical closure of the nares to permanently prevent nasal airflow.Flap failure and dehiscence can occur and result in fistula formation and clinical relapse.We describe the utility of a V-Y advancement flap in repairing localized cutaneous defects in patients who have previously undergone nasal closure for severe HHT.
Pubmed PDF Web\nRyan S. Ziltzer, \nSameer Shetty, \nDominic Coutinho, \nRafka Chaiban, \nChadi A. Makary\n
Publicatie 02-12-2024
\nMichael J. Ye, \nRodney J. Schlosser, \nZachary M. Soler, \nJonathan B. Overdevest, \nDavid A. Gudis\n
Publicatie 02-12-2024
Publicatie 02-12-2024
\nRongrong Song, \nHuanlei Zhang, \nZhuoping Liang\n
Publicatie 02-12-2024
AbstractOX40/OX40L are costimulatory molecules in the tumor necrosis factor superfamily. Numerous studies have shown that OX40/OX40L are involved in immune regulation, especially in the proliferation and differentiation of T cells and the generation of memory T cells, which play important roles in allergic diseases. In recent years, the use of OX40/OX40L as therapeutic targets for treating T-cell-mediated diseases has attracted the interest of scholars. This paper reviews the role of OX40/OX40L in allergic diseases and the progress in clinical treatments targeting this signaling pathway.
Pubmed PDF Web\nHong‐Ho Yang, \nDavid Grimm, \nEsther Velasquez, \nPeter H. Hwang\n
Publicatie 29-11-2024
\nXiangmei Li\n
Publicatie 29-11-2024
\nShravan Asthana, \nAlan D. Workman, \nDavid K. Lerner, \nRani M. Randell, \nDana F. Lopez, \nMichael A. Kohanski, \nJames N. Palmer, \nNithin D. Adappa, \nJennifer E. Douglas, \nJohn V. Bosso\n
Publicatie 27-11-2024
Key pointsRacial disparities influence the completion of aspirin (ASA) desensitization and ASA-exacerbated respiratory disease (AERD) diagnosis age.Public insurance correlates with an official AERD diagnosis after age 50.Social factors, including race and insurance status, impact AERD diagnosis and adherence to ASA desensitization.
Pubmed PDF Web\nJenny B. Xiao, \nHelen Hsiao, \nCarlos Khalil, \nJohn M. Lee\n
Publicatie 26-11-2024
\nAnthony Tang, \nSuchet Taori, \nNicholas Fung, \nJoao Paulo Almeida, \nPierre‐Olivier Champagne, \nJuan C. Fernandez‐Miranda, \nPaul Gardner, \nPeter H. Hwang, \nJayakar V. Nayak, \nChirag Patel, \nZara M. Patel, \nMaria Peris Celda, \nCarlos Pinheiro‐Neto, \nOlabisi Sanusi, \nCarl Snyderman, \nBrian D. Thorp, \nJamie J. Van Gompel, \nGeorgios A. Zenonos, \nNathan T. Zwagerman, \nEric W. Wang, \nMathew Geltzeiler, \nGarret Choby\n
Publicatie 13-11-2024
AbstractObjectiveNeck metastases are a poor prognostic factor in olfactory neuroblastoma (ONB). Pathologic dural invasion (pathDI) may increase the risk of neck metastases due to invasion of dural lymphatics. We aim to evaluate the prognostic value of pathDI in predicting rates of neck metastases and recurrence using a large, multicenter database of ONB patients.Data sourcesRetrospective review of a prospective, multicenter database of electronic health records of all patients who presented with ONB between 2005 and 2021 at nine tertiary academic care centers within North America.Review methodsClinicopathologic features including modified Kadish staging systems, margin status, treatment modalities, Hyams grading, follow-up time, and survival.ResultsOf 258 ONB patients, 189 patients met the inclusion criteria. The 10-year neck recurrence-free survival (neck-RFS) rates were 85.7% (75.6‒97.3) and 61.8% (47.9‒79.8) for patients without and with pathDI, respectively (p = 0.018). Time-to-event multivariable regression analysis found pathDI to have an odds ratios of 9.7 (95% confidence interval CI 1.2–80.4, p = 0.04) for neck-RFS and 9.5 for RFS at any site (95% CI 1.1–83.3, p = 0.04).ConclusionIn multivariable analysis, the presence of pathDI appears to be the strongest predictor of neck recurrence and recurrence at any site. Future studies exploring the benefit of elective neck dissection or radiation for patients with pathDI may impact disease management.
Pubmed PDF Web\nYobouet Ines Kouakou, \nJoel C. Thompson, \nLi Hui Tan, \nZoey A. Miller, \nRay Z. Ma, \nNithin D. Adappa, \nJames N. Palmer, \nNoam A. Cohen, \nRobert J. Lee\n
Publicatie 13-11-2024
AbstractBackgroundRoutine prescription of antibiotics to treat chronic rhinosinusitis (CRS) exacerbations may contribute to the propagation of antibiotic resistance. Hops bitter β-acids lupulone and colupulone possess potent antibacterial activities and, as T2R1, T2R14, and/or T2R40 agonists, may improve the impaired mucociliary clearance described in CRS patients. We investigated these molecules as alternative treatments to antibiotics in CRS management based on their antibacterial and T2Rs agonists properties.MethodsHuman nasal primary cells (HNECs) and RPMI2650 cells cultures were used as study models. T2Rs expression in cell culture models and human nasal tissue was assessed using immunofluorescence, quantitative PCR, and Western blot. We performed calcium imaging and cilia beat frequency experiments to investigate T2Rs activation in study models in response to lupulone and colupulone stimulations. Finally, we studied hops β-acids cytotoxicity on cells using CellEvent, crystal violet, lactate dehydrogenase assays, immunofluorescence, and transepithelial electrical resistance assays.ResultsWe confirmed lupulone and colupulone potent antibacterial effect on CRS-relevant methicillin-resistant Staphylococcus aureus but found minimal impact on P. aeruginosa. We also report T2R1, T2R14 and T2R40 expression in HNECs and RPMI2650 cell cultures. Lupulone and colupulone induced an increase in cytosolic calcium that appeared dependent on T2Rs signaling. This response was accompanied by mitochondrial membrane depolarization, cellular energy stress, decreased cell proliferation, ciliostasis, and HNECs remodeling after a single exposure to lupulone at micromolar concentrations.ConclusionOur data suggest that hops β-acids may not be beneficial as treatments in CRS patients and instead contribute to the disease by impairing cell health and further deteriorating the MCC.
Pubmed PDF Web\nChristina Dorismond, \nMason R. Krysinski, \nYash Trivedi, \nRory J. Lubner, \nRakesh K. Chandra, \nNaweed I. Chowdhury, \nJustin H. Turner\n
Publicatie 13-11-2024
AbstractBackgroundDespite increasing dupilumab use for chronic rhinosinusitis with nasal polyps (CRSwNP), little is known about the factors influencing its use in real-world practice. We aimed to identify factors that may predict dupilumab prescription in CRSwNP patients who have undergone endoscopic sinus surgery (ESS).MethodsA single-institution, retrospective cohort study of patients who underwent ESS for CRSwNP between 2015 and 2023 was conducted. Demographics, comorbidities, 22-item sinonasal outcome test (SNOT-22) scores, and dupilumab prescription date were extracted from patient records. Intraoperative nasal mucus cytokine levels were measured using a multiplex bead assay. Univariate logistic regression analysis was performed to identify factors associated with dupilumab prescription, and multivariate logistic regression was used to adjust for surgery date.ResultsA total of 299 CRSwNP patients were included, including seventy (23.4%) who were prescribed dupilumab postoperatively. Patients were more likely to be prescribed dupilumab if they had asthma (odds ratio OR 2.304), aspirin-exacerbated respiratory disease (AERD, OR 3.375), elevated tissue eosinophils (OR 1.005), and higher 3-month postoperative SNOT-22 scores (OR 1.027). Patients prescribed dupilumab also had greater odds of having elevated mucus interleukin (IL)-5 (OR 1.128) and IL-13 (OR 1.213). When adjusting for surgery date, associated factors included: asthma (OR 2.444), AERD (OR 3.750), allergic rhinitis (OR 1.833), higher tissue eosinophils (OR 1.005), elevated 3-month SNOT-22 scores (OR 1.028), and higher IL-5 (OR 1.123) and IL-13 (OR 1.202) levels.ConclusionAsthma, AERD, allergic rhinitis, and elevated tissue eosinophil, IL-5, and IL-13 levels are predictive of dupilumab prescription in CRSwNP patients. These may serve as clinical and inflammatory biomarkers and can aid in counseling patients about expected disease trajectory.
Pubmed PDF Web\nMason R. Krysinski, \nChristina Dorismond, \nYash Trivedi, \nRory Lubner, \nAndrea A. Lopez, \nKolin Rubel, \nRakesh K. Chandra, \nNaweed I. Chowdhury, \nJustin H. Turner\n
Publicatie 13-11-2024
Key pointsFrailty and aging are associated with a shift toward non-type 2 inflammation in chronic rhinosinusitis (CRS).Frailty-related shifts in sinonasal inflammatory mediators may be linked to biological senescence.Understanding the role of aging and frailty in CRS may have important treatment implications.
Pubmed PDF Web\nMahnaz Ramezanpour, \nSholeh Feizi, \nHashan Dilendra Paththini Arachchige, \nGeorge Bouras, \nClare Cooksley, \nGohar Shaghayegh, \nPeter‐John Wormald, \nAlkis James Psaltis, \nSarah Vreugde\n
Publicatie 08-11-2024
AbstractBackgroundChronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinus mucosa. While Staphylococcus aureus has been shown to play a significant role in mucosal barrier disruption in CRS patients, coagulase-negative staphylococci (CoNS) such as Staphylococcus epidermidis and Staphylococcus lugdunensis are also implicated in CRS pathophysiology. This study investigates the effects of exoproteins secreted by planktonic and biofilm forms of clinical isolates of S. epidermidis and S. lugdunensis on the nasal epithelial barrier.MethodsThirty-one clinical isolates of CoNS were grown in planktonic and biofilm forms, and their exoproteins were concentrated. The epithelial barrier structure was assessed by measuring transepithelial electrical resistance (TEER) and the permeability of fluorescein isothiocyanate-dextran. Toxicity and inflammatory response were also studied.ResultsOur findings demonstrate that exoproteins from all planktonic forms of S. lugdunensis disrupted the mucosal barrier, whereas only nine of 16 biofilm-derived exoproteins had similar effects. Conversely, 11 of 15 exoproteins from planktonic S. epidermidis significantly disrupted barrier integrity; however, biofilm exoproteins did not. The study also showed that some exoproteins from planktonic S. epidermidis significantly reduced cell viability, while exoproteins from planktonic and biofilm forms of S. lugdunensis and biofilm S. epidermidis did not induce any statistically significant change in cell viability. Notably, four of 16 biofilm exoproteins from S. lugdunensis induced higher interleukin-6 (IL-6) secretion, whereas none of the S. epidermidis isolates showed a significant increase in IL-6 secretion.ConclusionOur results suggest that CoNS exoproteins may contribute to CRS etiopathogenesis.
Pubmed PDF Web\nJ. Allen Meadows, \nGary N. Gross, \nAnita N. Wasan, \nDole P. Baker, \nAmber Patterson, \nRobert Puchalski, \nAnil Nanda, \nJami Lucas, \nJ. Wesley Sublett, \nPaul V. Williams\n
Publicatie 06-11-2024
\nSophie E. Yu, \nYoun Soo Jung, \nMargaret B. Mitchell, \nSimon Chiang, \nMitali Banerjee, \nMengyuan Ruan, \nTanujit Dey, \nSarah E. Fleet, \nStella E. Lee\n
Publicatie 05-11-2024
Key pointsDecreased overall dietary consumption of micronutrients may be linked to an increased risk of olfactory dysfunction (OD) including subjective report of OD, subjective report of phantosmia, and objective OD.Interactions were identified between these micronutrients, suggesting that outcomes may vary depending on the mixture of micronutrients taken.
Pubmed PDF Web\nHong‐Ho Yang, \nDavid Grimm, \nEsther Velasquez, \nPeter H. Hwang\n
Publicatie 30-10-2024
AbstractBackgroundEmerging evidence has underscored the harmful effects of air pollution on the upper airway. We investigated the relationship between ambient particulate matter (PM) level and the frequency of outpatient visits for chronic rhinosinusitis (CRS).MethodsWe conducted an ecological cohort study of US adults enrolled in The Merative MarketScan outpatient database from 2007 to 2020. For each geographical subunit (core-based statistical area CBSA), we calculated the annual rate of CRS-related outpatient visits per 1000 well-patient checkup visits (CRS-OV). Using data from the Environmental Protection Agencys Air Quality System, we mapped the rolling statistical average of daily PM2.5 and PM10 over the preceding year onto each CBSA × year combination. We employed multivariable negative binomial regression modeling to estimate the association between PM levels and subsequent CRS-OV.ResultsAcross 3933 observations (CBSA × year combinations), encompassing ∼4 billion visits, the median CRS-OV was 164 (interquartile range 110–267). The mean PM2.5 level was 8.9 µg/m3 (SD 2.6) and the mean PM10 level was 20.2 µg/m3 (SD 7.2). Adjusting for patient demographics and respiratory comorbidities, a compounded rise in subsequent CRS-OV was observed with increasing PM levels. Each µg/m3 rise in PM2.5 independently predicted a 10% increase in CRS-OV (adjusted incidence rate ratio aIRR) 1.10, 95% confidence interval CI 1.08–1.13) and each µg/m3 rise in PM10 independently predicted a 3% increase in CRS-OV (aIRR 1.03, 95% CI 1.02–1.04).ConclusionElevated ambient PM2.5 and PM10 levels are associated with a subsequent compounded increase in the frequency of CRS-OV, with PM2.5 predicting a more pronounced rise compared to PM10.
Pubmed PDF Web\nNajm S. Khan, \nHeli Majeethia, \nVincent Provasek, \nFaizaan Khan, \nZain Mehdi, \nAatin K. Dhanda, \nJeffrey T. Vrabec, \nEdward D. McCoul, \nChadi A. Makary, \nMasayoshi Takashima, \nOmar G. Ahmed\n
Publicatie 30-10-2024
Key pointsViral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year.Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year.Recurrent viral infections pose a greater risk of chronic rhinosinusitis than single episodes.
Pubmed PDF Web\nZachary M. Soler, \nMathew J. Gregoski, \nPreeti Kohli, \nKristina A. LaPointe, \nRodney J. Schlosser\n
Publicatie 27-10-2024
AbstractBackgroundOlfactory dysfunction (OD) in the elderly is common and associated with numerous comorbidities, yet often underrecognized. This study sought to develop an instrument for widespread screening of this condition.MethodsDemographic factors, comorbidities, and olfactory-related questions were examined in a focus group (N = 20) and development cohort (N = 190). The 4-item Concise Aging adults Smell Test (4-CAST) screening instrument was then developed to predict OD on Sniffin Sticks testing. An independent validation cohort (N = 147) was then examined to confirm ability of the 4-CAST to predict OD on Smell Identification Test 40 (SIT40).ResultsThe most important variables for predicting olfactory loss in older subjects were age, type II diabetes status, Visual Analog Scale (VAS) of overall rating of smell, and VAS of impact of smell upon safety. In the development cohort, the 4-CAST model yielded predictive probability (area under the curve) of 0.805 (p < 0.001) for predicting the bottom 25th percentile on Sniffin Sticks. Results were similar in the validation cohort, as the 4-CAST accurately classified 83.8% subjects (area under the curve AUC 0.789, p < 0.001) in the bottom 25th percentile of SIT40 testing. The 4-CAST was able to accurately classify 89.4% of subjects with anosmia.ConclusionThe 4-CAST is a quick screening instrument for predicting OD in older adults and has similar performance characteristics in independent populations using the two most common validated olfactory tests. Given the high prevalence of unrecognized olfactory loss in this population, this can be a useful tool for practitioners to determine which subjects may benefit from more extensive olfactory testing.
Pubmed PDF Web\nZeinab Mousania, \nDarpan Kayastha, \nRyan A. Rimmer, \nJohn D. Atkinson\n
Publicatie 27-10-2024
AbstractBackgroundOperating rooms generate 1.8 million tons of waste annually, or 20%‒30% of the total healthcare waste in the United States. Our objective was to perform a life cycle assessment (LCA) for endoscopic sinus surgeries (ESSs) in order to analyze its environmental impact.MethodsA comprehensive LCA of ESS was performed considering energy, climate, and water use impacts associated with the materials and processes used. It focuses on the ESS performed at a large tertiary academic hospital and then extends the impacts to consider annual US surgeries. The assessment considers end-of-life waste management at both landfills and incinerators.ResultsSingle-use instrument production constitutes 89%‒96% of the total impacts throughout the life cycle of an ESS. Waste-to-energy incineration is shown to be a preferred end-of-life destination, as it recovers much of the input production energy of plastic items, ultimately reducing the input to 36%, although this is done at the expense of higher greenhouse gas emissions. For multi-use items, decontamination dominates environmental impact (>99% of totals), but consideration of reusable items reduces overall energy consumption and global warming potential (GWP) by 25%‒33%.ConclusionSingle-use items dominate the total environmental impact of ESS. While multi-use items require additional decontamination over their lifetimes, results show that their incorporation reduces energy consumption and GWP by 25%‒33%, demonstrating the clear environmental benefit.
Pubmed PDF Web\nAudrey Pelletier, \nLeandra Mfuna Endam, \nEmmanuel Gonzalez, \nSheherazade Jannat, \nThea Irani, \nMartin Desrosiers\n
Publicatie 23-10-2024
AbstractBackgroundChronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a high rate of disease recurrence following endoscopic sinus surgery (ESS). Type 2 disease is associated with a higher incidence of recurrence and is believed to impact disease resolution via interference with epithelial healing and pathogen immunity. We wished to verify if perioperative control of Type 2 inflammation with an anti-IL4/IL13 targeting monoclonal antibody and during the resolution period following surgery leads to better control of the disease long term.MethodsIn this prospective, placebo-controlled, double-blinded trial. Thirty adult subjects with recurrent CRSwNP underwent ESS plus or minus 14 weeks of perioperative dupilumab, initiated 4 weeks (two injections) pre-ESS. Subjective and objective parameters of nasal patency, olfaction, quality of life (QoL), and adverse events were monitored up to 52 weeks post-ESS. Microbiological culture was performed to characterize pathogens colonization under both conditions.ResultsESS safely improved subjective and objective measures of nasal patency, olfaction, and QoL in both groups. Olfaction was conserved longer in the dupilumab-treated group, with 33.3% of subjects presenting anosmia at 12 months after ESS in the dupilumab group compared to 50.0% with placebo. This was associated with persistent decreases in serum IgE, which were not seen with placebo treatment. No unusual safety signals were observed.ConclusionShort-course adjuvant perioperative treatment with dupilumab is associated with improved long-term olfactory outcomes and persistent lowering of serum IgE.
Pubmed PDF Web\nShunke Li, \nZengxiao Zhang, \nHuijuan Zhao, \nXuehui Li, \nLin Wang, \nJisheng Zhang, \nLin Han, \nXudong Yan, \nLiwei Jiang, \nZhaoxia Wei, \nLonggang Yu, \nYan Jiang\n
Publicatie 23-10-2024
Key pointsSpontaneous cerebrospinal fluid rhinorrhea (sCSFR) is often accompanied by an increase in intracranial pressure (ICP).The widening of optic nerve sheath diameter (ONSD) is an indicator of increased ICP.Using CT to measure ONSD is a simple and noninvasive auxiliary method for determining high ICP in sCSFR patients.
Pubmed PDF Web\nAriel Omiunu, \nLindsey Brown, \nDarpan Kayastha, \nR. Peter Manes\n
Publicatie 23-10-2024
Key pointsDupilumab targets Th2-associated inflammatory mediators to reduce disease burden in CRSwNP.While rare, potential sequelae include viral, helminth, and potentially amebic infections.
Pubmed PDF Web\nMarisa Dorling, \nMasih Sarafan, \nBéatrice Voizard, \nYousif Al Ammar, \nJuan Carlos Hernaiz‐Leonardo, \nKieran Chalmers, \nPatrick MacInnis, \nJames Nugent, \nArif Janjua, \nAmin Javer, \nDoron Sommer, \nJohn Lee, \nYvonne Chan, \nAndrew Thamboo\n
Publicatie 18-10-2024
AbstractBackgroundType 2 biologics have been used increasingly for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, patterns of biologic switching are understudied, and established guidelines for sequential or simultaneous use do not yet exist.MethodsThis is a Canadian multicenter retrospective study of real-world patient data. Patients were included if they had recurrent CRSwNP despite maximal medical and surgical management, and received at least one dose of a type 2 biologic. Patients who remained on their initial biologic comprised the continuous group. Patients with sequential or simultaneous use of more than one biologic comprised the switched group. We compared the characteristics of patients who continued and switched biologics.ResultsNote that 225 consecutive patients were included. Thirty-six (16%) switched biologics at least once, and six (3%) switched twice. The most common switch was from mepolizumab to dupilumab, with poor control of CRSwNP symptoms being the leading cause for this switch. Lack of efficacy was the main reason for switching off mepolizumab and omalizumab, while adverse events were the leading cause for switching off dupilumab. Additionally, mepolizumab patients were more likely to switch biologics late in their treatment, while dupilumab patients rarely switched after 12 months of therapy (p-value < 0.001).ConclusionsSwitching biologics for CRSwNP is frequent in Canadian rhinology practices, with 16% of patients switching at least once. The most common switch is from mepolizumab to dupilumab with inadequate CRSwNP control driving this switch. This study may help guide sequential or simultaneous use of biologics in CRSwNP patients.
Pubmed PDF Web\nDennis M. Tang, \nPhilip G. Chen, \nArthur W. Wu, \nWilliam C. Yao\n
Publicatie 18-10-2024
Key PointsNasal valve treatment with TCRF results in NAO symptom improvement in the presence of septal deviation.Severe septal deviation does not impact the beneficial effect of TCRF nasal valve treatment.Symptoms improve with TCRF nasal valve treatment even if septal deviations involve the nasal valve.
Pubmed PDF Web\nWenxin Shen, \nQianlan Zhou, \nQinzhen Zhang, \nLina Han, \nLi Chen, \nXiaowen Li, \nBing Dai, \nSi Liu, \nLishen Shan\n
Publicatie 15-10-2024
Key pointsOmalizumab enables children who are intolerant to AIT to initiate AIT successfully.Combination therapy better improves asthma and rhinitis symptoms, FeNO, and lung function compared to single SCIT or omalizumab treatment.Combination therapy reduces the incidence of adverse reactions during the initial phase of SCIT and enhances its safety.
Pubmed PDF Web\nPaolo Boscolo‐Rizzo, \nClaire Hopkins, \nThomas Hummel, \nAnna Menini, \nFrancesco Uderzo, \nGiulia Provenza, \nGiacomo Spinato, \nEnzo Emanuelli, \nGiancarlo Tirelli\n
Publicatie 10-10-2024
AbstractBackgroundOlfactory dysfunction (OD) is a key symptom of chronic rhinosinusitis (CRS). Although extensively studied in CRS with nasal polyps (CRSwNP), OD in CRS without nasal polyps (CRSsNP) remains under-researched. This study aims to assess the prevalence of OD and its evolution in surgically naïve patients with CRSsNP undergoing endoscopic sinus surgery (ESS).MethodsThis prospective study included 97 participants with CRSsNP (mean age, 46.5 years; 70.1% men) and 97 healthy controls (mean age, 46.5 years; 70.1% men). Participants underwent psychophysical evaluations of orthonasal (using the Sniffin’ Sticks test) and retronasal olfaction (using powdered aromas) at enrolment and 6 months post-ESS.ResultsOut of 97 patients, 81 (83.5%) completed all assessments. At enrolment, 23 (28.4%) CRSsNP patients had OD based on composite threshold, discrimination, identification scores, compared with 7 (8.6%) controls (absolute % difference, 19.8% 95% CI, 8.2–31.4). Retronasal olfactory function was also significantly worse in CRSsNP patients. Six months post-ESS, 30 patients (37.0%) experienced a clinically significant improvement in olfactory, whereas nonsignificant changes were observed in retronasal olfactory score, and 3.7% of patients experienced a deterioration of the olfactory function.ConclusionsIn conclusion, although 37% of patients experienced a clinically significant improvement in their sense of smell following ESS, the overall prevalence of OD in this surgically naive population appears relatively low, especially when compared to that observed in patients with CRSwNP. Therefore, ESS may offer some benefits for enhancing orthonasal olfactory function, but the extent of these improvements appears to be limited.
Pubmed PDF Web"\nJayanth Rajan, \nRoss Rosen, \nDaniel Karasik, \nJohn Richter, \nClaudia Cabrera, \nBrian DAnza, \nKenneth Rodriguez, \nSanjeet V. Rangarajan\n"
Publicatie 10-10-2024
Key pointsWhile typically diagnosed with biopsy, ECRS may be predicted preoperatively with the use of AI.Various AI models have been used, with pooled sensitivity of 0.857 and specificity of 0.850.We found no statistically significant difference between the accuracy of various AI models.
Pubmed PDF Web\nMbuyi Madeleine Kabongo, \nJoshua M. Levy, \nLauren T. Roland\n
Publicatie 08-10-2024
Key pointsIn patients with chronic rhinosinusitis and comorbid asthma, patients with surgical intervention required less asthma rescue medication, as compared to those who did not undergo surgery.Following sinus surgery, patients with chronic rhinosinusitis and asthma required more asthma medication, as compared to the time period prior to surgery.
Pubmed PDF Web\nLirit Levi, \nAngela Yang, \nEsmond F. Tsai, \nYifei Ma, \nNour Ibrahim, \nSachi S. Dholakia, \nVidya K. Rao, \nAxel Renteria, \nXueying Cao, \nMichael T. Chang, \nJayakar V. Nayak\n
Publicatie 07-10-2024
AbstractIntroductionDiagnosis of empty nose syndrome (ENS) relies on the ENS six-item questionnaire (ENS6Q) with a score of ≥11, followed by a “positive” cotton test yielding seven-point reduction from baseline ENS6Q score via cotton placement to the inferior meatus (IM). Given the intricacies of diagnosing ENS and the propensity for false positives with the standard cotton test, we modified the classic single-step cotton test into a four-part Stepwise Empty Nose Syndrome Evaluation (SENSE) cotton test to reduce bias and evaluate the placebo effect.MethodsIndividuals diagnosed with ENS underwent the SENSE test, a single-blinded, four-step, office-based cotton test, without topical anesthesia or decongestants. Conditions included: (1) placebo/no cotton placed; (2) complete cotton-blockade of nasal vestibule; (3) cotton placed medially against the nasal septum; and (4) cotton placed laterally in the IM (site of inferior turbinate tissue loss). With each condition, patients completed an ENS6Q.ResultsForty-eight ENS patients were included. Twenty-nine percent demonstrated a placebo effect (p < 0.001), 40.4% had a positive response to complete cotton-blockade (p < 0.001), 64.4% to septum-placed cotton, and 79.1% to IM-placed cotton (p < 0.001), corresponding to a mean ENS6Q reduction of 11.9 points (p < 0.001). Notably, the mean difference in ENS6Q scores between septum and IM placement was 1.7 (p < 0.001).ConclusionsThe SENSE test offers further insight into subtleties of nasal breathing experienced by ENS patients. The placebo effect can be prominent and important to consider with individual patients. While most ENS patients prefer any intranasal cotton placement over baseline, blinded testing reveals these patients can accurately discriminate minimal changes in nasal aerodynamics.
Pubmed PDF Web\nSang Hyeon Ahn, \nJun Taek Oh, \nDae Hyun Kim, \nEun Jung Lee, \nMin‐Seok Rha, \nHyung‐Ju Cho, \nChang‐Hoon Kim\n
Publicatie 05-10-2024
AbstractBackgroundChronic inflammation triggers tissue remodeling in human nasal epithelial (HNE) cells. S100A9, a protein secreted by inflammatory cells, exhibits potent proinflammatory activity. However, its effect on HNE cell remodeling, such as squamous metaplasia, remains unclear. Therefore, this study aimed to determine the effects and underlying pathways of S100A9 on HNE cell remodeling and investigate its clinical implications in chronic rhinosinusitis (CRS).MethodsCultured HNE cells were treated with S100A9. Bulk RNA sequencing was performed to analyze gene ontology (GO). Ingenuity pathway analysis (IPA) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were also analyzed. Additionally, immunohistochemistry and multiplex immunofluorescence were performed on tissue samples obtained from 60 patients, whose clinical informations were also reviewed.ResultsGO enrichment analysis indicated that S100A9 induced tissue remodeling in HNE cells toward squamous metaplasia. IPA and KEGG commonly showed that S100A9 affected HNE cells associated with the IL-17 signaling pathway, including target molecules such as matrix metalloproteinase 1 (MMP1) and small proline-rich protein 2A (SPRR2A). Squamous metaplasia with a marked expression of S100A9 was observed in 50% of CRS with nasal polyps (CRSwNPs). In addition, in multiplex immunofluorescence, the S100A9 in sub-epithelium was co-expressed with myeloperoxidase, a neutrophil marker, and MMP1 and SPRR2A were strongly expressed in epithelial remodeling. Clinically, the expression of S100A9 correlated with sino-nasal outcome test-22 (r = 0.294, p = 0.022) and Lund–Mackay scores (r = 0.348, p = 0.006).ConclusionS100A9 induces tissue remodeling in HNE cells. Its increased expression in CRSwNP, particularly squamous epithelium, correlates with disease severity. This suggests the clinical potential of S100A9 as a biomarker for CRS severity.
Pubmed PDF Web\nChristian M. Meerwein, \nPeta‐Lee Sacks, \nJacqueline Ho, \nChristine Choy, \nLarry Kalish, \nRaewyn G Campbell, \nRay R. Sacks, \nRichard J Harvey\n
Publicatie 27-09-2024
AbstractObjectiveTo assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery.MethodsA retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 109/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.ResultsEighty-six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).ConclusionsSurgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.
Pubmed PDF Web\nJohn B. Finlay, \nRalph Abi Hachem, \nPatrick Codd, \nBradley J. Goldstein\n
Publicatie 27-09-2024
KEY POINTSWe developed a culture model of a human olfactory ensheathing cell tumor.Cultured organoids resemble normal ensheathing cells.Assays suggest that this model provides a tool for studying the roles of these glial cells in the maintenance of the peripheral olfactory system.
Pubmed PDF Web\nDavid K. Lerner, \nChau Phung, \nAlan D. Workman, \nSaawan Patel, \nGlenn Pennington, \nRobert Stetson, \nJennifer E. Douglas, \nMichael A. Kohanski, \nJames N. Palmer, \nNithin D. Adappa\n
Publicatie 26-09-2024
AbstractBackgroundFunctional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability.MethodsWe performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed.ResultsA total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n = 99) of nasal polyps and 31.2% (n = 69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p = 0.04), in addition to presence of nasal polyps ($531.96, p = 0.04). There was no significant association between total costs and the remaining clinical and demographic factors.ConclusionsCosts associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.
Pubmed PDF Web\nJonathan Bidwell, \nDipesh Gyawali, \nJonathan Morse, \nVinayak Ganeshan, \nThinh Nguyen, \nEdward D. McCoul\n
Publicatie 24-09-2024
KEY POINTSAI-enabled augmentation of nasal endoscopy video images is feasible in the clinical setting.Edge computing hardware can interface with existing nasal endoscopy equipment.Real-time AI performance can achieve an acceptable balance of accuracy and efficiency.
Pubmed PDF Web\nMatthew M. Chu, \nJack T. Garcia, \nAhmad R. Sedaghat, \nGeorge A. Scangas, \nKatie M. Phillips\n
Publicatie 20-09-2024
AbstractBackgroundThe management of acute exacerbations of chronic rhinosinusitis (AECRS) is understudied and the most cost-effective management of AECRS has not been previously investigated. The aim of this study is to determine the most cost-effective strategy for the initial management of AECRS.MethodsThe study design consisted of a decision-tree economic model comparing three different initial strategies for managing a patient perceived AECRS: observation, upfront rescue medications, or clinic visit with diagnostic nasal endoscopy (DNE). The primary study outcome was the disease burden of a single AECRS, which was determined by the health utility value and the duration of symptoms. Strategies with an incremental cost-effectiveness ratio < $50,000/quality-adjusted life year (QALY) or equivalently < $137/quality-adjusted life day (QALD) were considered cost-effective.ResultsObservation was the most cost-effective strategy at a willingness to pay of $137 per QALD. One-way sensitivity analysis demonstrated that observation was more effective than upfront rescue medications when the probability of bacterial infection as the cause of AECRS was <24.0%. Upfront rescue medications wer more cost effective than observation when the probability of bacterial infection exceeded 49.0%. Clinic visit with DNE was the most effective strategy to manage an AECRS, but it was not considered cost-effective.ConclusionObservation is the most cost-effective strategy for the initial management of AECRS when there is a low likelihood of bacterial infection. When the probability of bacterial etiology of AECRS exceeds 49.0%, upfront rescue medications proved to be the most cost-effective strategy.
Pubmed PDF Web\nMartin Stampe, \nIda Skovgaard Christiansen, \nVibeke Backer, \nKasper Aanæs, \nAnne‐Sophie Homøe, \nJens Tidemandsen, \nEmilie Neumann Nielsen, \nSigrid Louise Hjorth Rasmussen, \nRasmus Hartvig, \nKatalin Kiss, \nThomas Hartvig Lindkær Jensen\n
Publicatie 20-09-2024
Key PointsEosinophilic granulocytes have characteristic morphological features.This makes them prime candidates for utilization of a single cell binary classification network.Single cell binary classification networks can reliably help quantify eosinophils in nasal polyps.
Pubmed PDF Web\nJacquelyn K. Callander, \nAnnabelle R. Charbit, \nKritika Khanna, \nJohn V. Fahy, \nMonica Tang, \nMaude Liegeois, \nSteven D. Pletcher, \nAndrew N. Goldberg, \nJose G. Gurrola II, \nAndrew H. Murr, \nAnna Butrymowicz, \nPatricia A. Loftus\n
Publicatie 13-09-2024
AbstractBackgroundPractical 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.MethodsSubjects 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.ResultsForty-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.
Pubmed PDF Web\nRyan A. Cotter, \nJack T. Garcia, \nAhmed Alsayed, \nSven Schneider, \nDavid T. Liu, \nJulia Eckl‐Dorna, \nFiras A. Houssein, \nRobby S. Boparai, \nNikhil A. Parail, \nMatthew M. Chu, \nJosh C. Meier, \nSaad Alsaleh, \nKatie M. Phillips, \nAhmad R. Sedaghat\n
Publicatie 13-09-2024
AbstractBackgroundOverall 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.MethodsUsing 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.ResultsThe 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.ConclusionsPatients 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.
Pubmed PDF Web\nAlan D. Workman, \nKrithika Kuppusamy, \nDavid K. Lerner, \nJohn V. Bosso, \nJennifer E. Douglas, \nMichael A. Kohanski, \nNithin D. Adappa, \nJames N. Palmer\n
Publicatie 12-09-2024
AbstractBackgroundEndoscopic 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.ResultsThe 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).ConclusionsIt 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.
Pubmed PDF Web\nAmelia S. Lawrence, \nJodi Veach, \nRahul Alapati, \nCelina G. Virgen, \nRobert Wright, \nFrank Materia, \nJennifer A. Villwock\n
Publicatie 12-09-2024
AbstractIntroductionWhile 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.MethodsSubjects 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).ResultsFifty-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).ConclusionBoth 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.
Pubmed PDF Web\nBrian H. Cameron, \nJason Talmadge, \nMartin J. Citardi\n
Publicatie 03-09-2024
Key pointsBovine-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.
Pubmed PDF Web\nAkash M. Bhat, \nZachary M. Soler, \nRodney J. Schlosser, \nGeorge A. Scangas, \nAlan D. Workman, \nVinay K. Rathi\n
Publicatie 30-08-2024
Key pointsThe 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.
Pubmed PDF Web\nEbraheem Albazee, \nAbdullah M. Alharran, \nMooza M. Alzayed\n
Publicatie 30-08-2024
Key pointsThe 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.
Pubmed PDF Web\nSaartje Uyttebroek, \nLieven Dupont, \nJeroen Wagemans, \nRob Lavigne, \nMaya Merabishvili, \nTom Coenye, \nLaura Van Gerven\n
Publicatie 30-08-2024
Key pointsTreatment 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.
Pubmed PDF Web"\nGlen E. DSouza, \nAlexander Duffy, \nShreya Mandloi, \nEmily Garvey, \nBita Naimi, \nPaavali Hannikainen, \nPeter Benedict, \nGurston N. Nyquist, \nChristopher Farrell, \nMarc Rosen, \nElina Toskala, \nJames Evans, \nMindy R. Rabinowitz\n"
Publicatie 30-08-2024
Key PointsPositive 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.
Pubmed PDF Web