The anterior superior alveolar nerve (ASAN), a branch of the infraorbital nerve, provides sensory innervation to the anterior maxilla, lateral nasal wall, and maxillary dentition. Owing to its anatomical proximity to the...The anterior superior alveolar nerve (ASAN), a branch of the infraorbital nerve, provides sensory innervation to the anterior maxilla, lateral nasal wall, and maxillary dentition. Owing to its anatomical proximity to the anterior maxillary wall and piri-form aperture, the ASAN is vulnerable during lateral nasal wall surgery. Although postoperative sensory disturbances such as gingival hypoesthesia or dental numbness are frequently re-ported, prospective data combining subjective symptoms with objective sensory testing across different surgical techniques remain limited .
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently coexist. However, the metabolic inter-play between those diseases is poorly understood. We aimed to perform metabolomic profiling of exh...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently coexist. However, the metabolic inter-play between those diseases is poorly understood. We aimed to perform metabolomic profiling of exhaled breath condensate (EBC) from CRSwNP and asthma patients and investigate possible interaction pathways. METHODOLOGY: EBC samples from the upper and lower airways of patients with CRSwNP, asthma, and control subjects were analyzed using untargeted metabolomics. Metabolite consistency and conserved modules between the upper and lower airways were quantified. WGCNA, trend cluste-ring analysis, and a pathway enrichment analysis of differential metabolite expression were performed. RESULTS: A total of 252 metabolites were identified, with a strong correlation between the upper and lower airway profiles. WGCNA analysis showed that each module of the upper or lower airway was conserved, with at least 1 module included in the consensus network. The key enriched pathways for lower airway metabolites showed a continuous increasing or decreasing trend in the control, CRSwNP, and asthma groups, and mainly involved the impact of CRSwNP on asthma. The main enriched pathways for upper airway differential metabolites in the control, asthma, and CRSwNP groups were related to the impact of asthma on nasal polyps. N-(8Z,11Z,14Z-eicosatrienoyl) ethanolamine was significantly down-regulated in the EBC of CRSwNP and asthma patients, and was negatively correlated with the risk for CRSwNP and asthma onset. Leukotriene F4 (LTF4) was up-regulated in the EBC of CRSwNP and asthma patients, and was positively correlated with the risk for CRSwNP onset. CONCLUSION: Non-invasive EBC metabolomics revealed conserved metabolic networks and bidirectional perturbations between CRSwNP and asthma, providing new evidence for the "unified airway" hypothesis.
BACKGROUND: This study was set out to investigate the incidence of revision endoscopic sinus surgery (ESS) in patients treated with dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP). Furthermore, clinical c...BACKGROUND: This study was set out to investigate the incidence of revision endoscopic sinus surgery (ESS) in patients treated with dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP). Furthermore, clinical course and outcome of surgery of these patients was described. METHODS: A prospective observational cohort study of adult and biological-naive patients with CRSwNP treated with dupilu-mab as per EPOS2020 indication criteria (at least one previous ESS) was undertaken. Patients that had ESS due to an insufficient response to dupilumab were compared to those still on treatment. Baseline demographics and clinical characteristics (such as evidence of type 2 inflammation, SNOT-22 score, and nasal polyp score) were compared between the two groups. Furthermore, clinical measurements at indication of surgery, type of surgery and clinical outcomes are described. RESULTS: Discontinuation of dupilumab treatment occurred in 41 out of 394 (10.4%) patients, of whom 10 (2.5%) stopped because of an insufficient response. Seven of these patients (1.8% of total) underwent revision ESS. The patients that needed revision sur-gery for uncontrolled CRSwNP were significantly more often male, had lower baseline serum IgE and longer time since the last ESS compared to those still on dupilumab. Despite revision ESS, disease control postoperatively was insufficient in all but two patients. CONCLUSIONS: Revision endoscopic sinus surgery as an escape-treatment for uncontrolled CRSwNP despite dupilumab is rarely needed. The disappointing results of revision ESS for patients with uncontrolled CRSwNP who failed dupilumab calls for new treatments for this limited group.
The recently published EUFOREA pocket guide "Biologics in Upper and Lower Airway Diseases" summarises recommendations on the use of biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma and offers adv...The recently published EUFOREA pocket guide "Biologics in Upper and Lower Airway Diseases" summarises recommendations on the use of biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma and offers advice on biologic choice for practicing clinicians. The creation of this pocket guide, in the absence of any head-to-head studies at that time, drew on expert opinions and published indirect treatment comparison (ITC) approaches. It makes a single recommendation for a preferred biologic, in patients affected by CRSwNP, without concomitant asthma (apart from specific cases such as pregnancy), whilst offering different options in asthma endotypes and phenotypes. We wish to draw the attention of the readership to some additional considerations relating to biologic choice for these diseases and how they are classified.
We read with great interest the article by Pan et al.: "Endosco-pic endonasal versus transcranial approaches for trigeminal schwannomas: choosing the optimal surgical corridor based on tumour traits," recently published...We read with great interest the article by Pan et al.: "Endosco-pic endonasal versus transcranial approaches for trigeminal schwannomas: choosing the optimal surgical corridor based on tumour traits," recently published in Rhinology (1). The authors provide a valuable trait-based framework comparing endosco-pic endonasal (EEA) (trans-meckel's cave, transclival, trans-lamina papyracea, and trans-prelacrimal recess approaches) and transcranial approaches (TCA) (intra/extradural subtemporal with or without anterior petrosectomy, Kawase, and zygoma-tic middle fossa approach) in the management of trigeminal schwannomas (TS), according to the Samii's classification (2).
BACKGROUND: Dupilumab has demonstrated efficacy in Chronic Rhinosinusitis with Nasal Polyps. While its impact on sinonasal and asthma symptoms is well established, less is known about its effects on the demand for concom...BACKGROUND: Dupilumab has demonstrated efficacy in Chronic Rhinosinusitis with Nasal Polyps. While its impact on sinonasal and asthma symptoms is well established, less is known about its effects on the demand for concomitant medications in long-term routine care. METHODOLOGY: This retrospective longitudinal real-world study included 224 patients diagnosed with Chronic Rhinosinusitis with Nasal Polyps and treated with Dupilumab at a tertiary centre between 2019 and 2025, with a maximum follow-up of up to 4.5 years. At each visit, use of nasal sprays, asthma drugs, and other disease-related drugs was recorded. Linear mixed-effects models were fitted to assess longitudinal changes. RESULTS: At baseline, patients reported a mean of 1.6 concomitant medications, most commonly INCS and inhaled asthma drugs. The total number of concomitant medications, the number of nasal sprays, asthma medications, and other disease-related drugs decreased significantly over time. Parallel improvements were observed in patient-reported outcome measures (SNOT-22, TNSS, ACT, miniAQLQ). CONCLUSIONS: In this real-world cohort, Dupilumab treatment led to a sustained overall reduction in concomitant medication use, thereby lowering pharmacological burden while improving disease control.
BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumour affecting adolescent males, originating near the sphenopalatine foramen and often expanding aggressively. This nationwide study examines the...BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumour affecting adolescent males, originating near the sphenopalatine foramen and often expanding aggressively. This nationwide study examines the clinical presentation, treat-ment, and prognosis of patients diagnosed from 2003 until mid-2022. METHODS: Patients were identified in the national patho-logy database. The Kaplan-Meier estimator calculated event-free survival, and t-test and Fisher's exact test compared variables. The incidence rates were determined using the 2000 World Health Organization World Standard Population. RESULTS: Sixty-one male patients were included (median age: 16.5 years). The national incidence was 0.12 per 100,000 male person-years (0.43 per 100,000 men at risk (10-24 years)). Common symptoms included nasal obstruction (90%) and epistaxis (59%). Predominant tu-mour stages were Radkowski IIB (31.3%) and Chandler III (65%). Most patients (97%) underwent preoperative embolization, with image-guided endoscopic sinus surgery (ESS) as the primary treatment (86%). Median intraoperative blood loss (IBL) was 500 mL. Radkowski staging correlated with IBL, tumour devascularization, and internal carotid artery (ICA) blood supply. No major compli-cations occurred. Recurrence (25%) was associated with Chandler stage III-IV, with a two-year recurrence-free survival rate of 77%. CONCLUSIONS: Tumour stage correlated with IBL, tumour devascularization, and ICA supply. Recurrence mainly occurred within two years post-surgery, exclusively in advanced-stage cases. With close collaboration between interventionists and rhinologists, preoperative embolization followed by image-guided ESS is recommended as a safe approach with minimal risks.
Chronic rhinosinusitis (CRS) is an inflammatory disorder of the sinonasal mucosa that occurs with or without nasal polyps (NPs). Compared with CRS without NPs, CRS with NPs (CRSwNP) is associated with more severe and unc...Chronic rhinosinusitis (CRS) is an inflammatory disorder of the sinonasal mucosa that occurs with or without nasal polyps (NPs). Compared with CRS without NPs, CRS with NPs (CRSwNP) is associated with more severe and uncontrolled sinonasal symptoms. Type 2 inflammation, driven by TH2 cytokines (interleukins 4, 5, and 13), promotes eosinophilic infiltration into NPs and contributes to disease progression and recurrence. Although recent studies have emphasized biological phenotyping and identified genetic/epigenetic endotypes to optimize treatment strategies for CRSwNP, clinical translation remains limited. Because cellular phenotypes are strongly influenced by metabolic alterations, profiling of the metabolic landscape may provide insight into CRSwNP pathogenesis and identify bio-markers of type 2 inflammationâ€"related symptom exacerbation, treatment resistance, and recurrence. However, metabolomic characterization of CRSwNP remains underexplored.
Zhou S, Kwizera R, Bongomin F
… +8 more, Okema L, Okot J, Alcanzo EM, Ekeng BE, Kang Y, Denning DW, de Hoog S, Ahmed SA
Rhinology
· 2026 Jun · PMID 41785015
BACKGROUND: Fungal rhinosinusitis (FRS) comprises subtypes with varying epidemiology and outcomes. Global comparative data remain limited. METHODS: Following PRISMA guidelines (CRD42023481670), a systematic review and me...BACKGROUND: Fungal rhinosinusitis (FRS) comprises subtypes with varying epidemiology and outcomes. Global comparative data remain limited. METHODS: Following PRISMA guidelines (CRD42023481670), a systematic review and meta-analysis was conducted. Cases were categorized into seven subtypes to assess variation across regions. RESULTS: 2,031 studies (40,860 cases, 77 countries) were included. Non-invasive forms accounted for 60% (n=24,582) of cases, mainly fungal ball (35%, n=14,280) and allergic FRS (25%, n=10,302). Invasive subtypes were more frequent in tropical climates, with the hyperacute rhino-orbito-cerebral mucormycosis predominating. This subtype differed from acute and subacute invasive FRS in risk factors (diabetes and COVID-19 vs. leukemia) and geography. Aspergillus species appeared in ~60% of cases: A. fumigatus dominated in temperate/continental zones, while A. flavus was frequent in dry/tropical regions. Non-invasive FRS showed high surgical cure rates (>64%), whereas invasive forms had substantial morbidity and mortality. CONCLUSIONS: FRS represents a substantial yet underrecognized global health concern. Non-invasive forms are predominating, while invasive subtypes cause major morbidity and mortality, especially in tropical regions. Notably, our findings reveal distinct geographic and climatic preferences for Aspergillus species: A. fumigatus in temperate/continental zones and A. flavus in dry/tropical regions. This ecological divergence underscores the importance of environmental surveillance and climate-informed diagnostic strategies.
We read with great interest the article by Ouyang et al. in a recent issue of Rhinology, which compares the effectiveness of endoscopic surgery and conservative therapy for nasopharyn-geal necrosis (NN) in patients with...We read with great interest the article by Ouyang et al. in a recent issue of Rhinology, which compares the effectiveness of endoscopic surgery and conservative therapy for nasopharyn-geal necrosis (NN) in patients with nasopharyngeal carcinoma (NPC) (1). The authors are to be commended for their rigorous work on a large cohort, employing propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to balance baseline characteristics. Their conclusion that endo-scopic surgery offers superior overall survival (OS) compared to conservative treatment, particularly for middle necrosis, provi-des a crucial benchmark for managing this severe complication.
Miwa T, Tsuzuki K, Suzaki I
… +22 more, Kondo K, Mori E, Kobayashi M, Suzuki M, Fushimi K, Saito T, Hirose T, Shiga H, Takeuchi M, Okuzawa N, Ogawa K, Sekine R, Nagai M, Tei M, Tanaka H, Kishimoto Y, Morishita H, Ishigami E, Nakanishi H, Ueha R, Iinuma Y, Iida Y
INTRODUCTION: Olfactory dysfunction (OD) is a common symptom of COVID-19. However, prevalence and clinical characteristics of OD due to COVID-19 (COVID-19-OD) differ from those of conventional post-viral OD (PVOD). Even...INTRODUCTION: Olfactory dysfunction (OD) is a common symptom of COVID-19. However, prevalence and clinical characteristics of OD due to COVID-19 (COVID-19-OD) differ from those of conventional post-viral OD (PVOD). Even among COVID-19-OD cases, they vary depending on the virus subtype. We aimed to compare the differences between COVID-19-OD and PVOD, as well as the differences across viral variants within COVID-19-OD. METHODS: This is a multicenter retrospective study. The subjects were PVOD patients from 2017 to 2019 and COVID-19-OD patients from 2020 to 2022. Patient backgrounds, olfactory cleft condition, and olfactory function were obtained from medical records and compared. RESULTS: Of the 649 patients, 269 had COVID-19-OD (pre-Omicron: 191; Omicron: 78) and 380 had PVOD. Compared to the PVOD group, the COVID-19-OD group was younger and exhibited a higher rate of olfactory cleft obstruction and a greater prevalence of parosmia or phantosmia. The severity of OD was milder in the COVID-19-OD group. Even after controlling for age, the severity of OD remained milder in the COVID-19-OD group. Compared to the Omicron group, the pre-Omicron group was younger and had a higher incidence of parosmia or phantosmia. CONCLUSION: COVID-19-OD and PVOD differ significantly in clinical features and in the pathophysiology of OD. Moreover, even within COVID-19-OD, there are differences between the variants, which are thought to reflect biological differences in the virus.
BACKGROUND: Olfactory training (OT) has been linked to changes in olfactory function and structural modifications in the olfactory bulb (OB); however, the neuroplastic potential in the OB remains unclear. In this pilot s...BACKGROUND: Olfactory training (OT) has been linked to changes in olfactory function and structural modifications in the olfactory bulb (OB); however, the neuroplastic potential in the OB remains unclear. In this pilot study, we investigate how OT with different exposure lengths influences olfactory bulb volume (OBV) and olfactory function in individuals with normosmia. METHODOLOGY: Seventy-seven normosmic individuals were assigned to either standard OT, extended OT, or a control group. The intervention groups performed OT for three months, sniffing four odours - eucalyptus, lavender, mint and lemon â€" for 10 seconds per bottle, twice daily, totalling either 40 seconds (standard OT) or 4 minutes (extended OT), while the control group did not perform any OT. OBV (manual segmentation of 3-Tesla magnetic resonance images) and olfactory function (Sniffin' Sticks test) were assessed at baseline, post-intervention and at one-year follow-up. RESULTS: OBV increased significantly in both the standard and extended OT groups after the intervention and at follow-up, compared to controls. There were no differences between the training methods and no significant changes in olfactory function. CONCLUSIONS: In normosmic individuals, OBV increased after both standard and extended OT, with no differences between training methods. The volume increase was evident at three-month assessment and persisted at one-year follow-up, indicating that neuroplastic changes induced by OT occur rapidly and may extend beyond the duration of the training itself, an effect not previously reported. However, the OBV changes were not accompanied by improve-ments in olfactory function.
Sir William Osler once said "Treat the patient, not the disease", already touching on the principles of precision or personalised medicine, realising that the one-size-fits all approach does not work. Obviously, the same...Sir William Osler once said "Treat the patient, not the disease", already touching on the principles of precision or personalised medicine, realising that the one-size-fits all approach does not work. Obviously, the same is true in rhinology. We strive to achieve better results by tailoring diagnostics and therapy to the individual patterns of diseases and patients’ requirements.
Bartosik T, Seys SF, de Kinderen J
… +20 more, Wagenmann M, Bruch M, Andrianakis A, Gonzalez-Compta X, Hox V, Pardo Muà Oz L, Schneider S, Bettio G, Burian M, Eckl-Dorna J, Golet Fors M, Marien G, Morgenstern C, Scheckenbach K, Tomazic PV, Tu A, Allu S, Diamant Z, Bachert C, Isam Alobid Carlo Cavaliere Wytske Fokkens Peter W Hellings Claire Hopkins Adriana Izquierdo-Dominguez Xavier Jaumont Anette Kjeldsen Anu Laulajainen-Hongisto Valerie Lund Geoffrey Mortuaire Petter Olsson Laura Van Gerven Sietze Reitsma CC
Omalizumab is a recombinant DNA-derived humanized monoclonal antibody targeting free immunoglobulin E. In the omalizumab phase III studies for chronic rhinosinusitis with nasal polyp (CRSwNP), a clinically relevant reduc...Omalizumab is a recombinant DNA-derived humanized monoclonal antibody targeting free immunoglobulin E. In the omalizumab phase III studies for chronic rhinosinusitis with nasal polyp (CRSwNP), a clinically relevant reduction of the nasal polyp score (NPS) was observed leading to improved SinoNasal Outcome Test-22 (SNOT-22). In the extension study, sustained or further improvement of symptoms and NPS reduction were observed up to 52 weeks. Real-world data is needed to establish effectiveness in uncontrolled severe CRSwNP, but so far, data on long-term omalizumab treatment is sparse .
INTRODUCTION: Postoperative olfactory outcomes after endoscopic endonasal approaches (EEA) vary, and the influence of age remains uncertain. This study evaluated whether age affects postoperative olfaction in patients un...INTRODUCTION: Postoperative olfactory outcomes after endoscopic endonasal approaches (EEA) vary, and the influence of age remains uncertain. This study evaluated whether age affects postoperative olfaction in patients undergoing EEA with a uniformly performed nasal phase including olfactory strip elevation. Age-related histologic features of the olfactory mucosa were also exa-mined. METHODS: We retrospectively reviewed patients who underwent EEA with olfactory strip elevation for sellar or parasellar tumors. Olfactory function was assessed preoperatively and at 6 months postoperatively using the Cross-Cultural Smell Identifica-tion Test (CCSIT) and the Korean Olfactory Questionnaire (OQ). In a subgroup, olfactory mucosa was immunostained for markers of horizontal basal cells (HBCs), olfactory sensory neurons (OSNs), and olfactory ensheathing cells (OECs) to evaluate age-related histologic patterns and associations with postoperative olfaction. RESULTS: Forty-three patients (mean age 53.7 years) were analy-zed. CCSIT decreased from 8.0 to 7.3 and OQ from 39.9 to 33.1. Age >=50 years was associated with lower postoperative CCSIT and OQ. Olfactory mucosa available for analysis showed negative correlations between age and OSN counts, HBC counts, and S100 expression intensity. S100 expression correlated positively with postoperative olfactory outcomes. CONCLUSIONS: Patients aged >=50 years showed greater postoperative olfactory decline after EEA with olfactory strip elevation. Increasing age was associated with reduced levels of key olfactory cells. Higher S100 expression was associated with better postoperative olfactory outcomes.
BACKGROUND: New CFTR Modulator triple therapy Elexacaftor-Tezacaftor-Ivacaftor (ETI) has proven efficacy in pulmonary outcomes. However, its qualitative impact via sinonasal imaging in children has not been specifically...BACKGROUND: New CFTR Modulator triple therapy Elexacaftor-Tezacaftor-Ivacaftor (ETI) has proven efficacy in pulmonary outcomes. However, its qualitative impact via sinonasal imaging in children has not been specifically studied. The aim of our study is to assess the impact of ETI triple therapy through sinus imaging in children with Cystic Fibrosis (CF) aged 6â€"12 years. METHODS: This prospective, single-center study, covered children with CF aged 6-12 years, all undergoing annual low-dose CT scans of the sinuses and lungs. The main objective of our study is the evaluation of the evolution of the modified Lund-Mac Kay (mLMK) score. Evaluations occurred at baseline and after one year of ETI therapy. Secondary objectives included the identification of potential associations between mLMK score and Sinus and Nasal Quality of Life Survey Score (SN-5) score, as well as examination of mLMK score changes in individual sinuses. RESULTS: 26 patients were enrolled in our study. The median mLMK score significantly improved after one year of ETI therapy. Significant correlation was observed between mLMK and SN-5 scores. CONCLUSION: This study highlights ETI's efficacy in improving sinonasal involvement in children aged 6 to 12 with CF. This is in line with the observations of clinical improvement, and presents an alternative to sinus surgery, thus potentially leading to a reduction in surgical interventions.
BACKGROUND: Endoscopic sinus and skull base surgeons are at high risk of work-related musculoskeletal disorders (WRMD) due to the unique ergonomic risks inherent in this specialty. These musculoskeletal disorders may neg...BACKGROUND: Endoscopic sinus and skull base surgeons are at high risk of work-related musculoskeletal disorders (WRMD) due to the unique ergonomic risks inherent in this specialty. These musculoskeletal disorders may negatively impact surgeons and their patients. The primary aim of this international survey was to quantify this problem globally and evaluate its associated factors. METHODS: A 46-item electronic survey was distributed to endoscopic sinus and skull base surgeons at any career stage via multiple international professional societies. RESULTS: We received 1385 responses. The prevalence of WRMD in the previous week and 12 months was 44.2% and 66.5%, respectively. The neck, shoulders, lumbar spine and wrists were the most commonly involved body parts, and most surgeons had symptoms in multiple body parts. Work-related musculoskeletal disorders were reported to negatively impact work, hobbies, activities of daily living and sleep, and to shorten careers in respondents. Factors associated with higher odds of WRMD included female sex, BMI ≥30kg/m2, being an attending otolaryngologist, having a high surgical and clinic caseload (performing >100 ESSB procedures annually), and operating in standing. Regular exercise (>7 hours weekly) and an endomorphic somatotype were associated with lower odds of WRMD. CONCLUSIONS: Endoscopic sinus and skull base surgeons have a high prevalence of WRMD. Modifiable risk factors include surgical volume, clinic time, operating position, and regular exercise. We make recommendations to assist in the reduction of WRMD in this population.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly recognized as a biologically heterogeneous disorder, in which patient-specific factors strongly influence outcomes. Among these, sex-related differences h...Chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly recognized as a biologically heterogeneous disorder, in which patient-specific factors strongly influence outcomes. Among these, sex-related differences have been observed clinically, yet their underlying pathological basis and impact on postoperative recurrence remain incompletely understood.
BACKGROUND: Chronic rhinosinusitis with olfactory dysfunction (CRS-OD) affects both peripheral and central olfactory pathways. Persistent olfactory loss may induce neuroplastic changes in brain regions involved in olfact...BACKGROUND: Chronic rhinosinusitis with olfactory dysfunction (CRS-OD) affects both peripheral and central olfactory pathways. Persistent olfactory loss may induce neuroplastic changes in brain regions involved in olfactory processing. We hypothesized that CRS-OD is associated with gray matter atrophy in olfactory-related regions, accompanied by alterations in global functional connectivity as a manifestation of compensatory or maladaptive reorganization. To test this, we performed voxel-based morphometry (VBM) to identify gray matter differences, followed by seed-based functional connectivity (FC) analysis using the altered regions. METHODOLOGY: We prospectively recruited 23 CRS-OD patients and 23 healthy controls (HCs). All patients presented with persistent olfactory dysfunction lasting 6 to 240 months. All participants underwent MRI scanning at the same time point. Olfactory function was assessed in CRS-OD patients using the Threshold-Discrimination-Identification (TDI) test, the Questionnaire of Olfactory Disorders (QOD), and the Olfactory-Evoked Cognitive Score (OECS). MRI analyses included VBM, FC, and olfactory bulb volume on DRIVen Equilibrium turbo spin echo (TSE) images. RESULTS: CRS-OD patients exhibited significantly reduced olfactory bulb (OB) volumes compared to HCs and gray matter atrophy in the inferior frontal orbital gyrus, parahippocampal gyrus, hippocampus, thalamus, and putamen. FC analysis revealed decreased connectivity in sensory-integration networks and increased FC in the superior occipital gyrus, suggesting compensatory reorganization. CONCLUSIONS: CRS-OD is characterized by OB atrophy, gray matter atrophy, and disrupted FC, reflecting both peripheral and central neural alterations. Multimodal MRI may provide new insights into CRS-OD pathophysiology, warranting further longitudinal studies.
BACKGROUND: Biologics targeting key type 2 inflammatory mediators (e.g., IL-4Rα, IgE, IL-5, TSLP) represent a novel therapeutic approach for chronic rhinosinusitis with nasal polyps (CRSwNP). This network meta-analysis...BACKGROUND: Biologics targeting key type 2 inflammatory mediators (e.g., IL-4Rα, IgE, IL-5, TSLP) represent a novel therapeutic approach for chronic rhinosinusitis with nasal polyps (CRSwNP). This network meta-analysis (NMA) aimed to compare the efficacy and safety of eight monoclonal antibodies for CRSwNP. METHODOLOGY: We systematically searched PubMed, Embase, Web of Science, CENTRAL Cochrane, and MEDLINE for randomized controlled trials (RCTs) comparing monoclonal antibodies with placebo CRSwNP. A Bayesian Network meta-analysis (NMA) was performed using the R gemtc package. RESULTS: Sixteen RCTs (n=2,034) evaluating eight monoclonal antibodies were included. All biologics significantly reduced Nasal Polyp Score (NPS); stapokibart (anti-IL-4Rα) ranked first. Both dupilumab and stapokibart improved the University of Pennsylvania Smell Identification Test (UPSIT) score, indicating a recovery of olfactory function. Dupilumab led in improving Sino-Nasal Outcome Test-22 (SNOT-22) scores, whereas stapokibart was most effective in relieving nasal congestion score (NCS). The risk of adverse events was comparable to placebo across all biologics, with GR1802 exhibiting the most favorable safety. CONCLUSIONS: All evaluated biological agents demonstrated efficacy superior to placebo, with IL-4 receptor alpha inhibitors showing the largest and most consistent benefits. All treatments exhibited favorable safety profiles, supporting their use for long-term management of CRSwNP.