Rhinology[JOURNAL]
Sun
200 papers
In vitro selection of human cerebrospinal fluid-specific aptamers using clinical samples.
Abiri A, Chen X, Latifi B … +4 more , Hsu FPK, Luptak A, Khine M, Kuan EC
Rhinology · 2025 Feb · PMID 39405420 · Publisher ↗
BACKGROUND: Cerebrospinal fluid (CSF) leaks may occur due to numerous etiologies and are associated with severe morbidity. Currently in the U.S., confirming the presence of a CSF leak requires protein electrophoresis tes...
BACKGROUND: Cerebrospinal fluid (CSF) leaks may occur due to numerous etiologies and are associated with severe morbidity. Currently in the U.S., confirming the presence of a CSF leak requires protein electrophoresis testing, oftentimes involving specialized processing, and there exists no point-of-care (POC) device for CSF detection. We aimed to discover a single-stranded deoxyribonucleic acid (ssDNA) aptamer capable of selectively binding to CSF-specific biomarkers, with the future goal of developing an aptamer-based POC CSF detection device. METHODS: To identify a candidate aptamer, we performed Systematic Evolution of Ligands by EXponential enrichment (SELEX) using a DNA library containing a randomized 63-nucleotide (nt) stretch flanked by 2 primer-binding sites. Quantitative polymerase chain reaction (qPCR) and fluorescence anisotropy (FA) assessed aptamer binding affinity and kinetics. RESULTS: Following 14 SELEX cycles, 2 dominant and functionally viable 98-nt ssDNA sequences (C2 and C3) were found. C2 and C3 demonstrated ~586x and ~82x higher affinity for CSF compared to serum, respectively. Increases in FA upon aptamer exposure to higher CSF concentrations demonstrated a K1/2 of 5.0% and 14.1% for C2 and C3, respectively. CONCLUSIONS: In vitro selection of a diverse pool of ssDNA sequences yielded 2 aptamers with high selectivity for CSF-specific biomarkers, with potential for integration into a rapid POC electrochemical diagnostic system.
Clinical efficacy of olfactory training using aromatic traditional Chinese medicine in managing olfactory dysfunction induced by SARS-CoV-2.
Qiao XF, Han LY, Li YF … +5 more , Li H, Zhen HM, Dang HR, Chen Y, Li X
Rhinology · 2025 Feb · PMID 39404183 · Publisher ↗
OBJECTIVE: The aim of this study is to assess the clinical efficacy of olfactory training using aromatic traditional Chinese medicine (TCM) for addressing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-indu...
OBJECTIVE: The aim of this study is to assess the clinical efficacy of olfactory training using aromatic traditional Chinese medicine (TCM) for addressing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-induced olfactory dysfunction, while also exploring the factors that influence the observed efficacy. METHODS: 172 outpatients with SARS-CoV-2-related olfactory dysfunction were randomized into two groups. The experimental group received olfactory training with TCM aromatics (ginger, Pericarpium Citri Reticulatae, Santali Albi Lignum, Styrax), while the control group used non-TCM aromatics (phenyl ethanol-rose, menthol-mint, citronellal-lemon, eugenol-clove) for 24 weeks. Olfactory function was assessed using the Sniffin' Sticks test and TDI (threshold-discrimination-identification) scores at baseline, 1, 3, and 6 months post-treatment. RESULTS: Response rates at 1, 3, and 6 months post-treatment were 3.66%, 25.61%, and 43.90% in the experimental group, and 4.94%, 23.46%, and 43.21% in the control group. The TDI scores of the experimental group and the control group were statistically different before and after treatment. At 3 and 6 months post-treatment, TDI scores increased significantly, with enhanced odor discrimination and identification capabilities in both groups compared to pre-treatment, while the odor detection threshold was not improved compared with that before treatment. At the 3- and 6-month follow-ups, experimental group showed significantly higher self-rated sleep and anxiety scores than controls, indicating notable improvement in both after treatment. CONCLUSION: Olfactory training with aromatic TCM offers an effective treatment for SARS-CoV-2-induced olfactory dysfunction, improving odor discrimination, identification without significant differences compared to conventional aromatics, besides, it may also improve anxiety and sleep quality.
Influence of septal deviation side on preoperative eustachian tube dysfunction and the effectiveness of septoplasty in alleviating eustachian tube dysfunction.
Lee C, Lee E, Park M … +5 more , Kim D, Jung YG, Kim HY, Ryu G, Hong SD
Rhinology · 2025 Feb · PMID 39387820 · Publisher ↗
BACKGROUND: The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) serves as a valuable tool for assessing eustachian tube dysfunction (ETD). We investigated the impact of septal deviation side on ETD using preoperativ...
BACKGROUND: The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) serves as a valuable tool for assessing eustachian tube dysfunction (ETD). We investigated the impact of septal deviation side on ETD using preoperative ETDQ-7 scores and evaluated the effectiveness of septoplasty based on postoperative ETDQ-7 scores. METHODOLOGY: We conducted a retrospective analysis of patients with septal deviation who were scheduled for septoplasty. ETDQ-7 surveys were conducted preoperative and 1 and 3 months postoperative. RESULTS: 120 patients were included, with 72 completing the ETDQ-7 at all three time points. The average prevalence of ETD was 29.2%. Preoperative ETDQ-7 scores showed no significant difference between convex and concave nasal sides. However, the prevalence of ETD was significantly higher on the convex side (28.3% vs. 15.8%), especially in unilateral ETD cases. Preoperatively, the positive ETD group had significantly higher ETDQ-7 scores on the convex side while no significant difference was found between concave and convex sides in the negative ETD group. Postoperatively, the positive ETD group showed significant improvement in ETDQ-7 scores with significantly higher on the convex side (66.7% vs. 33.3%). ETDQ-7 scores improved after septoplasty, with more improvement in the positive ETD group. CONCLUSIONS: Septoplasty significantly improves ETD, particularly in the preoperative positive ETD group, by reducing ETDQ-7 scores. The prevalence of ETD was higher on the convex side preoperatively, and the positive ETD group exhibited significant postoperative improvements, especially on the convex side. This suggests that the direction of septal deviation influences ETD prevalence and surgery outcomes, although septoplasty alleviates ETD on both sides.
Nasal endoscopy score thresholds to trigger consideration of chronic rhinosinusitis treatment escalation and implications for disease control.
Sedaghat AR, Cotter RA, Alobid I … +30 more , Alsaleh S, Anselmo-Lima WT, Bernal-Sprekelsen M, Chandra RK, Constantinidis J, Fokkens WJ, Franzese C, Gray ST, Halderman AA, Holbrook EH, Hopkins C, Hwang PH, Kuan EC, Landis BN, Lund VJ, McCoul ED, Niederberger-Leppin V, O'Brien EK, Philpott CM, Pletcher SD, Pynnonen MA, Reitsma S, Rimmer J, Toppila-Salmi S, Wang EW, Wang MB, Wise SK, Woodworth BA, Yao WC, Phillips KM
Rhinology · 2025 Feb · PMID 39385734 · Publisher ↗
BACKGROUND: In the absence of direct evidence supporting how to use nasal endoscopy findings to judge chronic rhinosinusitis (CRS) disease control, experts' practice patterns could provide guidance. METHODOLOGY: Particip...
BACKGROUND: In the absence of direct evidence supporting how to use nasal endoscopy findings to judge chronic rhinosinusitis (CRS) disease control, experts' practice patterns could provide guidance. METHODOLOGY: Participants consisted of a diverse group of twenty-nine rhinologists. Participants were presented with every possible combination of bilateral nasal endoscopy findings represented by the modified Lund-Kennedy (MLK; range: 0-12) endoscopic scoring system and Nasal Polyp Score (NPS; range: 0-8). Reflecting the practical consequence of CRS disease control assessment, participants were asked whether they would consider CRS treatment escalation based on each scenario in the absence of any CRS symptoms, and how strongly they considered escalating therapy. The same scenarios were then presented in the context of 1 burdensome CRS symptom and participants again were asked whether they would consider treatment escalation. RESULTS: The median threshold total MLK score for considering treatment escalation was ≥ 4 and 75.9% of participants' MLK thresholds were within 1 point of 4. The median threshold total NPS for considering treatment escalation was ≥ 3 and 62.5% of participants' NPS thresholds were within 1 point of 3. Endoscopy score thresholds decreased in the presence of 1 burdensome symptom and generally increased when requiring stronger affirmation for considering CRS treatment escalation. CONCLUSION: Reflecting the practice patterns of a diverse group of rhinologists, MLK score ≥ 4 or NPS ≥ 3 may serve as thresholds for considering CRS treatment escalation. Alternatively, MLK score under 4 or NPS under 3 may serve as endoscopic goals of CRS treatment. These results provide guidance for using nasal endoscopy findings as a criterion of CRS disease control.
Normative data for the lateralization task in the assessment of intranasal trigeminal function.
Mai Y, Hernandez AK, Konstantinidis I … +2 more , Haehner A, Hummel T
Rhinology · 2025 Feb · PMID 39382022 · Publisher ↗
AIM: To provide normative data for the lateralization task in the assessment of intranasal trigeminal function, as well as to investigate potential effects of age, sex and olfactory function. METHODS: The lateralization...
AIM: To provide normative data for the lateralization task in the assessment of intranasal trigeminal function, as well as to investigate potential effects of age, sex and olfactory function. METHODS: The lateralization task using eucalyptus as target stimulus was performed to assess intranasal trigeminal function. Data were collected from: 360 healthy adult participants (mean age 37.5 ± 17.4) for the 40-trial version; 284 participants (mean age 32.6 ± 4.1) for the 20-trial version; and 418 participants (mean age 42.6 ± 15.6) for the 10-trial version. The "Sniffin Sticks" test was used to measure olfactory function. RESULTS: The mean scores were 35.46 ± 4.50 for the 40-trial version, 15.64 ± 3.65 for the 20-trial version, and 8.14 ± 2.16 for the 10-trial version. In the reference group aged 18-25 years, the 10th percentiles were 33 for the 40-trial version, 11 for the 20-trial version, and 6 for the 10-trial version. Significant effects of age and odor discrimination score were observed on lateralization performance. CONCLUSIONS: We provide reference scores for the lateralization task, in large sample of healthy participants. Among the three examined tasks (40, 20 and 10), the 40-trial task yielded the most reliable information. For the 40-trial version, scores equal or higher to 33 points indicate a normal lateralization ability, whereas scores between 27 and 32 may warrant further assessment. Scores below 27 possibly point towards a decreased trigeminal function. The lateralization task serves as surrogate marker of intranasal trigeminal functions and further studies with pathological cases are needed to explore its clinical usefulness.
Blood transcriptomics reveal systemic eosinophilic and neutrophilic inflammation patterns in patients with nasal polyps.
Liu W, Wang K, Guan H … +6 more , Ma L, Cui Y, Liu C, Shi J, Fan Y, Sun Y
Rhinology · 2024 Dec · PMID 39365558 · Publisher ↗
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic sinonasal disease characterized by heterogeneous inflammation. However, the presence of systemic inflammation heterogeneity in CRSwNP patients re...
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic sinonasal disease characterized by heterogeneous inflammation. However, the presence of systemic inflammation heterogeneity in CRSwNP patients remains unknown. This study aims to profile transcriptomic alterations in the blood of CRSwNP patients and characterize the CRSwNP heterogeneity based on blood transcriptomic biomarkers. METHODOLOGY: Patients with CRSwNP were prospectively recruited from three hospitals and chronologically divided into exploratory (n=123) and independent validation (n=46) cohorts. Transcriptomic profiles were generated by whole blood mRNA sequencing and subjected to patient clustering, differential expression, and pathway analysis. Differences in immune pattern and clinicopathologic features between clusters were assessed. A transcriptomic signature was defined and applied to an independent cohort to validate the findings. RESULTS: CRSwNP patients showed diverse blood transcriptomic profiles versus healthy controls, or when stratified by tissue and blood eosinophils and asthma comorbidity. Transcriptome-wide correlation analysis revealed a transcriptional signature associated with blood eosinophil levels, consisting of nine T2-related genes (CLC, SIGLEC8, ALOX15, IL5RA, PTGDR2, CCL23, CCR3, EPX and IL1RL1). Three distinct clusters with differing systemic eosinophilic and neutrophilic inflammation patterns and asthma comorbidity were identified based on transcriptomic profiling of T2 and T1/3-related blood biomarkers. A 36-gene signature was developed by machine learning and accurately predicted the three CRSwNP subtypes. Validation on an independent cohort confirmed the prediction robustness. CONCLUSIONS: There is heterogeneous systemic inflammation associated with eosinophilic and neutrophilic patterns in patients with CRSwNP. Endotyping based on blood transcriptomic biomarkers might lead to more personalized treatment strategies for CRSwNP in the future.
IL-17A disrupts the nasal mucosal epithelial barrier in patients with chronic rhinosinusitis by activating the ERK/STAT3 pathway.
Wu H, Li Y, Li X … +8 more , Huang W, Huang Z, Lai X, Ma J, Jiang Y, Zhang Y, Chang L, Zhang G
Rhinology · 2024 Dec · PMID 39365556 · Publisher ↗
BACKGROUND: The mucosal epithelial barrier, the first line of immune defense, is vulnerable to allergens, pathogens, and inflammatory cytokines, contributing to CRS development. Our previous studies found high interleuki...
BACKGROUND: The mucosal epithelial barrier, the first line of immune defense, is vulnerable to allergens, pathogens, and inflammatory cytokines, contributing to CRS development. Our previous studies found high interleukin-17A(IL-17A) expression correlated with CRS severity and low glucocorticoid efficacy. The role of IL-17A in disrupting the nasal mucosal epithelial barrier leading to CRS remains unclear. We aimed to investigate how IL-17A promoting epithelial barrier damage and identify new treatment targets for CRS. METHODOLOGY: Nasal tissue samples from 36 CRSwNP, 34 CRSsNP, and 39 controls were examined for the expression of IL-17A and tight junction (TJ) proteins using qRT-PCR, immunohistochemistry and immunofluorescence. The integrity of TJs and signaling pathways activation were observed using western blot, immunofluorescence, TEER and FITCâ€"FD4, transmission electron microscopy before and after IL-17A stimulation in human primary nasal epithelial cells (hNECs). Concurrently, studies were also conducted in an CRS mouse model induced by anti-IL-17A neutralizing antibody administration. RESULTS: TJs expression in the nasal mucosa of CRS patients was lower than in controls. IL-17A stimulation reduced TJs expression and TEER while increasing hNECs permeability. Inhibition of the (ERK/STAT3) pathway reversed the downregulation of TJs and the disruption of the epithelial barrier induced by IL-17A stimulation. In the CRS mouse model, anti-IL-17A antibody treatment rescued the nasal mucosal epithelial barrier. CONCLUSIONS: IL-17A disrupts the nasal mucosal epithelial barrier by activating the ERK/STAT3 pathway in patients with CRS.
Ligation of anterior ethmoidal artery nasal branch: anatomical-based management of recalcitrant epistaxis.
Vinciguerra A, Daloiso A, Dohin I … +6 more , Boaria F, Marc M, Ferrari M, Verillaud B, Chatelet F, Herman P
Rhinology · 2025 Apr · PMID 39365314 · Publisher ↗
Recurrent epistaxis, despite conservative therapies (i.e. nasal packing or direct vessel coagulation), is generally treated with ligation of the sphenopalatine artery (SPA). Indeed, the rationale behind SPA ligation lies...
Recurrent epistaxis, despite conservative therapies (i.e. nasal packing or direct vessel coagulation), is generally treated with ligation of the sphenopalatine artery (SPA). Indeed, the rationale behind SPA ligation lies in its ability to disrupt arterial blood supply to the nasal mucosa, thereby reducing the likelihood of recurrent bleeding episodes (1). Nevertheless, in some cases, nosebleeds persist despite appropriate SPA ligation, opening discussion of the anterior ethmoidal artery (AEA) contribution in recalcitrant epistaxis that, for some authors, is up to 28.8% (2). From an anatomical point of view, the AEA leaves the orbital cavity and passes the ethmoidal roof through the ethmoidal canal, before entering inside the anterior cranial fossa via the lateral lamella (3). Endocranially, the AEA gives posterior branches which vascularize the anterior cribriform plate, whereas its many trunk continues anteriorly and divides into two branches: the anterior meningeal branch, and a second vessel that enters inside the nasal fossa through the cribroethmoidal foramen located 2.86 ± 1.93 mm (range, 1-7 mm) (4) anteriorly to the first olfactory phylum, giving rise to the so-called nasal branch (NbAEA) (5).
Clinical research and observations - they do matter.
Landis BN
Rhinology · 2024 Oct · PMID 39340767 · Publisher ↗
The new issue of Rhinology is full of articles focusing on clinical aspects and analysis of surgical and medical treatments we provide to our patients.
The new issue of Rhinology is full of articles focusing on clinical aspects and analysis of surgical and medical treatments we provide to our patients.
Omalizumab reduces allergic rhinitis symptoms due to Japanese cedar pollen by improving eosinophilic inflammation.
Hirano K, Suzaki I, Okuzawa N … +9 more , Oki A, Otani Y, Takeuchi M, Minoura A, Murakami K, Ihara Y, Kato H, Watanabe Y, Shimane T
Rhinology · 2025 Feb · PMID 39323201 · Publisher ↗
Seasonal allergic rhinitis caused by Japanese cedar pollen (SAR-JCP) is a serious social problem in Japan, affecting 38.8% of the population. Omalizumab, a recombinant humanised monoclonal anti-immunoglobulin (Ig)E antib...
Seasonal allergic rhinitis caused by Japanese cedar pollen (SAR-JCP) is a serious social problem in Japan, affecting 38.8% of the population. Omalizumab, a recombinant humanised monoclonal anti-immunoglobulin (Ig)E antibody, reduces serum-free IgE levels by 84â€"99%. The reduction of serum-free IgE levels induced by omalizumab ultimately downregulates FcÎ#181;RI expression in basophils and mast cells. Omalizumab significantly reduces nasal symptoms and improves the quality of life in patients with allergic rhinitis ; however, other than a decrease in free IgE, its biomarker activity is unclear. Allergic rhinitis reactions are more pronounced in nasal secretions and mucosa than in serum; however, no studies have examined the changes in proteins in nasal secretions after omalizumab administration. In this study, we aimed to elucidate the pathophysiology of the effect of omalizumab. This may serve as a basis for the identification of new biomarkers through the examination of proinflammatory proteins in nasal secretions, which may reflect the pathophysiology more accurately than peripheral blood.
Correlations of pre- and post-operative symptoms with cytokines in different phenotypes and endotypes of chronic rhinosinusitis.
Han SA, Cha H, Park JA … +8 more , Jo A, Kim DW, Ryu HT, Yang SK, Hong SN, Kim JY, Oh SH, Kim DW
Rhinology · 2024 Dec · PMID 39323199 · Publisher ↗
BACKGROUND: Recognising inflammatory endotypes in chronic rhinosinusitis (CRS) has become more important, especially with the advent of biological treatments. In this study, we investigated the correlations of pre- and p...
BACKGROUND: Recognising inflammatory endotypes in chronic rhinosinusitis (CRS) has become more important, especially with the advent of biological treatments. In this study, we investigated the correlations of pre- and post-operative symptoms with cytokine positivity in different endotypes and phenotypes of CRS. METHODOLOGY: In total, 102 patients undergoing routine functional endoscopic sinus surgery were enrolled. The endotype classification (type 1, 2, or 3 CRS) was defined based on positivity for interferon-Α, interleukin (IL)-5, or IL-17 respectively, in sinonasal tissue samples. Clinical symptom scores were evaluated pre- and post-operatively using the 22-item Sinonasal Outcome Test and its four symptom subdomains: sleep, nasal, otologic/facial symptoms, and emotional function. Symptoms were compared between endotypes and phenotypes, and exploratory factor analysis (EFA) based on principal component analysis (PCA) was performed. The correlations of cytokine levels with baseline symptoms and changes in symptoms after 1 year were analysed. RESULTS: Symptoms in the otologic/facial pain category were associated with non-type 2 endotypes in PCA and confirmatory analysis. Non-type 2 CRS patients exhibited significantly more improvement in facial symptoms 1 year after surgery. Neutrophil-associated cytokines, such as IL-17, matrix metalloproteinase 9, and myeloperoxidase, were significantly correlated with baseline otologic/facial pain symptoms and changes in those symptoms after surgery. CONCLUSIONS: Otologic/facial pain symptoms may be indicative of non-type 2 endotypes. Neutrophil-associated cytokines, such as IL-17, MMP-9, and MPO, were significantly correlated with these symptoms. The establishment of links between specific symptoms and certain cytokines may help use and develop biological therapies for CRS.
Sphenopalatine ganglion block for pain control after septoplasty: a systematic review and meta-analysis with trial sequential analysis.
Albazee E, AlRajhi B, Alfadhli A … +2 more , Alharran AM, Al-Qudah M
Rhinology · 2024 Dec · PMID 39323198 · Publisher ↗
INTRODUCTION: Septoplasty corrects a deviated nasal septum (DNS) and improves nasal obstruction. Sphenopalatine ganglion block (SPGB) effectively reduces postoperative pain after septoplasty, but conclusive evidence is s...
INTRODUCTION: Septoplasty corrects a deviated nasal septum (DNS) and improves nasal obstruction. Sphenopalatine ganglion block (SPGB) effectively reduces postoperative pain after septoplasty, but conclusive evidence is still lacking. This systematic review and meta-analysis aim to comprehensively evaluate the analgesic efficacy of SPGB in septoplasty patients. METHODS: We systematically searched PubMed/Medline, Scopus, Web of Science, Embase, and CENTRAL from inception to April 10th, 2024. Randomized controlled trials (RCTs) were assessed using the RoB-2 tool. The primary outcomes were postoperative pain scores, analgesic consumption, surgery duration, postoperative nausea and vomiting (PONV), and patient satisfaction. Continuous data were pooled as mean difference (MD), and dichotomous data as risk ratio (RR) with a 95% confidence interval (CI) using STATA software. Additionally, trial sequential analysis (TSA) was conducted. RESULTS: Three RCTs with 180 patients were included. Two RCTs had a 'low risk' of bias, while one RCT had 'some concerns'. The SPGB group had significantly lower postoperative pain within 24 hours compared to controls, particularly after particularly after 1-2 hours (MD = -1.85), 4-6 hours (MD = -2.02), 12 hours (MD = -2.14), and 24 hours (MD = -2.36) TSA confirmed the conclusive evidence. Analgesic use was significantly reduced in the SPGB group. No significant differences were observed in surgery duration or PONV rates between groups. Patient satisfaction was significantly higher in the SPGB group. CONCLUSION: SPGB demonstrates efficacy and safety in managing postoperative pain in patients undergoing septoplasty for DNS.
The impact of mepolizumab on sleep impairment in CRSwNP: post hoc analyses of SYNAPSE and MUSCA.
Mullol J, Fokkens WJ, Smith SG … +5 more , Keeley T, Zhang L, Howarth P, Chan RH, Bachert C
Rhinology · 2024 Dec · PMID 39323188 · Publisher ↗
BACKGROUND: The impact of mepolizumab on impaired sleep, one of the most bothersome symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), is unknown. This study aimed to determine the effect of mep...
BACKGROUND: The impact of mepolizumab on impaired sleep, one of the most bothersome symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), is unknown. This study aimed to determine the effect of mepolizumab and impact of comorbid upper and lower airway disease and blood eosinophil count (BEC) on sleep-/fatigue-related outcomes in CRSwNP. METHODS: This was an analysis of the Phase III SYNAPSE and MUSCA (NCT03085797/NCT02281318) trials of mepolizumab in patients with severe CRSwNP and severe asthma, respectively. Endpoints included change from baseline in 22-item Sino-Nasal Outcome Test (SNOT-22) sleep and fatigue domains (SYNAPSE: Weeks 24 and 52; MUSCA: Week 24) in the overall populations and post hoc subgroups (SYNAPSE: comorbid asthma, comorbid non-steroidal anti-inflammatory drug-exacerbated respiratory disease [N-ERD] and BEC; MUSCA: comorbid CRSwNP). RESULTS: In SYNAPSE, 289/407 patients with severe CRSwNP had comorbid asthma, 108 had N-ERD, and 278 had BEC ≥300 cells/µL. In MUSCA, 105/551 patients with severe asthma had comorbid CRSwNP. Baseline sleep and fatigue scores were worse in patients with comorbid airway disease and higher BEC. Improvements from baseline in sleep and fatigue scores were greater with mepolizumab versus placebo at Week 52 in SYNAPSE (difference in least squares mean change: -2.7 [sleep], -3.4 [fatigue], and Week 24 in SYNAPSE (-1.6 and -2.2) and MUSCA (-0.8 and -1.2), with consistent results across comorbidity and BEC subgroups. CONCLUSION: Mepolizumab improves sleep and fatigue in severe CRSwNP, irrespective of comorbid airway disease and BEC, with consistent effects in severe asthma with and without comorbid CRSwNP.
Technical skills of endoscopic sinus surgery for performance assessment using the Delphi methodology.
Guldager MJ, Wuyts Andersen SA, Melchiors J … +3 more , Prokopakis E, Hopkins C, von Buchwald C
Rhinology · 2024 Dec · PMID 39323187 · Publisher ↗
BACKGROUND: In surgical residency, competence has traditionally been defined by a specified number of surgical procedures. Modern advances in medical education and surgical fellowships have challenged this approach. It i...
BACKGROUND: In surgical residency, competence has traditionally been defined by a specified number of surgical procedures. Modern advances in medical education and surgical fellowships have challenged this approach. It is widely accepted that a definition of a skill set, enabling a systematic, competency-based assessment is mandatory in surgical education. METHODOLOGY: We conducted an international Delphi study with panelists from the European Rhinologic Society, representing 27 countries. Through four rounds, the panel reached consensus on the phrasing of an assessment tool-, for the technical skills of endoscopic sinus surgery (ESS). RESULTS: Thirty panelists participated throughout the study. The median age of the panelists was 54 years (range 31-66 years) with a median experience of 25 years (range 6-40 years). All were experts in the field of endoscopic sinus surgery. Consensus was reached. The final assessment tool consists of 21 items with descriptive anchors. CONCLUSION: The assessment tool, European Endoscopic Sinus Surgery â€" Technical Skills Assessment (EE-TSA), enables a competency-based approach to acquiring and maintaining essential elements of endoscopic sinus surgery. The international Delphi panel makes the tool internationally applicable. Further research should gather validity evidence for EE-TSA, enhancing the assessment of ESS by setting a pass/fail-standard ultimately improving surgical outcomes and patient safety.
Analysis of nasal fracture management and subsequent surgical outcomes across demographics.
Karasik D, Politano S, O'Neil TJ … +3 more , Baglam T, Rabbani CC, Thuener J
Rhinology · 2025 Feb · PMID 39323186 · Publisher ↗
Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hemat...
Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and even mental health issues as serious as post-traumatic stress disorder as persistent complications. Optimal management remains controversial and subjective based on the clinician’s judgment, with many factors playing a role in the provider’s decision, including the timing of treatment, the choice between foregoing treatment or choosing to undergo a closed or open reduction, and how to manage subsequent revision surgeries if necessary.
Dual blockade of IL-4 and IL-13 with dupilumab ameliorates sensorineural olfactory dysfunction in mice with eosinophilic sinonasal inflammation.
Yeh CF, Lan MY, Lin CC … +3 more , Hung YW, Huang WH, Lai YL
Rhinology · 2025 Feb · PMID 39254928 · Publisher ↗
BACKGROUND: Dupilumab, an antibody that binds IL-4Rα and inhibits IL-4 and IL-13 signals, has demonstrated efficacy in chronic rhinosinusitis with nasal polyps (CRSwNP) primarily characterized by type 2 inflammation. Cu...
BACKGROUND: Dupilumab, an antibody that binds IL-4Rα and inhibits IL-4 and IL-13 signals, has demonstrated efficacy in chronic rhinosinusitis with nasal polyps (CRSwNP) primarily characterized by type 2 inflammation. Current evidence suggests that the rate of improvement in olfactory dysfunction with dupilumab exceeds that of nasal polyp reduction, yet the underlying mechanism remains undisclosed. We hypothesize that dupilumab may initially ameliorate sensorineural olfactory dysfunction. METHODOLOGY: Male BALB/c mice were intranasally administered ovalbumin and Aspergillus protease for 12 weeks to induce eosinophilic sinonasal inflammation. Dupilumab treatment was also administered. The mice underwent histological assessment, olfactory behavioural test, and gene expression profiling to identify neuroinflammatory markers within the olfactory bulb. RESULTS: Dupilumab treatment resulted in a reduction in the number of mucosal protruding lesions, as well as decreased infiltration of eosinophils and neutrophils, along with a decrease in olfactory sensory neuron injury. Furthermore, there was a downregulation in the mRNA expression related to microglia activation and neuroinflammation in the olfactory bulb. CONCLUSIONS: Dupilumab improves the sensorineural pattern of olfactory dysfunction in mice, potentially explaining why olfaction improves more rapidly than polyp reduction in patients with CRSwNP.
Predictive model for postoperative unrecovered olfactory function in CRSwNP patients with olfactory disorder.
Chen JY, Wang X, Luo X … +11 more , Jian F, Zhou W, Xiao Z, Chen JH, Fang P, Wu S, Liu Q, Huang X, Shi Z, Yang Q, Zhang Y
Rhinology · 2024 Dec · PMID 39254606 · Publisher ↗
BACKGROUND: Olfactory disorder (OD) is a prevalent and challenging symptom in chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to investigate the risk factors and develop a predictive model for poor olf...
BACKGROUND: Olfactory disorder (OD) is a prevalent and challenging symptom in chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to investigate the risk factors and develop a predictive model for poor olfactory prognosis in CRSwNP patients with OD after endoscopic sinus surgery (ESS). METHOD: Seventy-eight CRSwNP patients with OD who underwent ESS were enrolled. Preoperative and 6-month-postoperative olfactory function were assessed using Sniffin' Sticks. Receiver operating characteristics (ROC) curves were constructed to set the cutoff points. Risk factors were determined by logistic models. A power analysis was conducted to evaluate the sample size. RESULTS: Overall, 66.7% of CRSwNP patients had unrecovered olfaction after surgery. Patients with unrecovered olfaction displayed higher preoperative threshold-discrimination-identification (TDI) score, lower Questionnaire for Olfactory Disorders-Negative Statements (QOD-NS) score, lower total olfactory cleft score (TOCS), and fewer tissue eosinophils than those of the improved/recovered group. QOD-NS ≤ 5.0, preoperative TOCS ≤ 4.5 and tissue eosinophil count ≤ 8.3 were independent risk factors for unrecovered olfaction. Based on these variables, a predictive model was developed. The area under the ROC curve for the model was 0.845, and the optimal cutoff value was 2.0 points, with a sensitivity of 82.7% and specificity of 80.8%. CONCLUSIONS: Low levels of QOD-NS score (preoperative), TOCS (preoperative) and tissue eosinophil count are independent risk factors for short-term unrecovered olfaction in CRS patients with OD postoperatively. The predictive model developed here is practical and convenient for the early identification of poor prognosis of OD, enabling early additional intervention.
Do not ignore mouth breathing syndrome: respiratory functions are affected in early childhood.
Atar Bese S, Ozdemir O, Tuncerler G … +2 more , Erge D, Uysal P
Rhinology · 2024 Dec · PMID 39254513 · Publisher ↗
INTRODUCTION: Impulse oscillometry (IOS) is a useful test for measuring pulmonary resistance and reactance from the early ages. We aimed to investigate the etiological factors of mouth breathing syndrome (MB), its effect...
INTRODUCTION: Impulse oscillometry (IOS) is a useful test for measuring pulmonary resistance and reactance from the early ages. We aimed to investigate the etiological factors of mouth breathing syndrome (MB), its effects on respiratory functions, and to compare the results with those of children with nasal breathing (NB). METHODS: This prospective cross-sectional study investigated children aged 3-7 years with MB (n=202) and NB (n=127) admitted to the pediatric allergy clinic between January 2023-2024. The MB group was evaluated for etiological factors by means of otorhinolaryngological examination. Respiratory function tests were evaluated using IOS and were repeated two months after appropriate treatment. RESULTS: Adenoid hypertrophy (AH-44.0%), allergic rhinitis (AR-11.3%) and AH co-existent with AR (34.6%) were the principal causes of MB. Entire airway resistance was higher, upper and lower airway reactance were lower in the MB group compared to the NB group. No difference was detected in terms of IOS parameters between the first and second visits of MB group. Upper and entire airway resistance parameters were higher in children with AH and AH co-existent with AR groups compared to the non-obstructive group. Entire airway resistance was higher, upper and lower airway reactance were lower, in children with adenoid size>50% compared to those with adenoid size mouth breathing, allergic rhinitis, adenoids, respiratory function test, pediatrics.
SNOT-22 in general population, a Spanish cohort study with an updated meta-analysis.
Pineros-Garcia LN, Gonzalez-Sanchez NI, Calvo-Henrique C … +4 more , Rojas-Lechuga MJ, Hopkins C, Mullol J, Alobid I
Rhinology · 2024 Dec · PMID 39254484 · Publisher ↗
BACKGROUND: Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of...
BACKGROUND: Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of olfactory training (OT) on orthonasal and retronasal olfactory function in a cohort of individuals with persistent post-COVID-19 OL. METHODOLOGY: Participants with post-COVID-19 olfactory impairment underwent 4 months of OT, self-assessing their smell perception and undergoing comprehensive psychophysical evaluation of orthonasal and retronasal olfaction at baseline and after training. Orthonasal olfactory function was assessed using the extended Sniffin' Sticks test battery. Retronasal olfactory function was tested with powdered aromas. RESULTS: Among 114 participants with post-COVID-19 olfactory loss, adherence to OT was 60%. In adherents, the average increase in composite TDI score was 6.0 points compared to 2.6 points in non-adherents. Fifty-seven percent of adherent participants achieved a clinically significant improvement in TDI score (≥ 5.5 points), compared to 22% of non-adherents. In retronasal olfactory identification, 56% of adherents achieved a clinically significant improvement (≥4 points), compared to 16% of non-adherents. CONCLUSION: Adherence to a 4-month OT regimen can yield clinically meaningful improvements in both orthonasal and retronasal olfactory function among individuals with persistent post-COVID-19 olfactory dysfunction.
Adherence to olfactory training improves orthonasal and retronasal olfaction in post-COVID-19 olfactory loss.
Boscolo-Rizzo P, Hummel T, Menini A … +4 more , Maniaci A, Uderzo F, Bigolin L, Tirelli G
Rhinology · 2024 Dec · PMID 39158581 · Publisher ↗
BACKGROUND: Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of...
BACKGROUND: Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of olfactory training (OT) on orthonasal and retronasal olfactory function in a cohort of individuals with persistent post-COVID-19 OL. METHODOLOGY: Participants with post-COVID-19 olfactory impairment underwent 4 months of OT, self-assessing their smell perception and undergoing comprehensive psychophysical evaluation of orthonasal and retronasal olfaction at baseline and after training. Orthonasal olfactory function was assessed using the extended Sniffin' Sticks test battery. Retronasal olfactory function was tested with powdered aromas. RESULTS: Among 114 participants with post-COVID-19 olfactory loss, adherence to OT was 60%. In adherents, the average increase in composite TDI score was 6.0 points compared to 2.6 points in non-adherents. Fifty-seven percent of adherent participants achieved a clinically significant improvement in TDI score (≥ 5.5 points), compared to 22% of non-adherents. In retronasal olfactoryidentification, 56% of adherents achieved a clinically significant improvement (≥ 4 points), compared to 16% of non-adherents. CONCLUSION: Adherence to a 4-month OT regimen can yield clinically meaningful improvements in both orthonasal and retronasal olfactory function among individuals with persistent post-COVID-19 olfactory dysfunction.
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