BACKGROUND: To compare the efficacy of high-dose nasal steroid administered via high-volume irrigation versus spray delivery in patients with chronic rhinosinusitis (CRS) who have not undergone previous sinonasal surgery...BACKGROUND: To compare the efficacy of high-dose nasal steroid administered via high-volume irrigation versus spray delivery in patients with chronic rhinosinusitis (CRS) who have not undergone previous sinonasal surgery. METHODOLOGY: A double-blind randomized clinical trial was conducted. The study comprised two groups receiving 1,000 μg/day of nasal budesonide through two distinct methods over a 3-month period: irrigation and spray delivery. Patients with severe CRS who had never undergone surgery and were on the waiting list for surgery in a public health service were included. Primary outcomes included changes in quality-of-life scores and secondary outcomes included changes in clinical control questionnaire results and nasal endoscopy findings. Assessments were conducted on the total sample, CRS with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and according to the newly defined phenotypes of diffuse primary CRS (central compartment atopic disease [CCAD], eosinophilic chronic rhinosinusitis [eCRS] and non-eosinophilic CRS [neCRS]). RESULTS: Sixth-seven patients completed the study, with 34 in the Irrigation Group and 33 in the Spray Group. The Spray Group demonstrated superior efficacy in improving endoscopic outcomes across the total sample, particularly among CRSwNP and CCAD. No treatment demonstrated superiority in improving the SNOT-22 score. Furthermore, the Spray Group revealed greater efficacy in reducing the number of uncontrolled patients, as evaluated by the clinical control questionnaire, both in the total sample and CRSwNP. CONCLUSIONS: High-dose steroid nasal spray outperformed high-volume steroid nasal irrigation in improving nasal endoscopy outcomes across the total sample, especially in CRSwNP and CCAD.
The detrimental effects of climate change on global health are becoming increasingly evident, also within rhinology. Climate change has been shown to cause a longer and more intense pollen season, while the prevalence of...The detrimental effects of climate change on global health are becoming increasingly evident, also within rhinology. Climate change has been shown to cause a longer and more intense pollen season, while the prevalence of allergic rhinitis is expected to rise due to de novo sensitizations caused by the migration of plants. Chronic rhinosinusitis patients will be affected by increasing air pollution as well as changes in spread of potent pathogens and vectors associated with upper airway infections. Meanwhile, healthcare is an evident contributor to climate change. Operating rooms (ORs) have been identified as carbon hotspots due to their high energy consumption and the use of anaesthetic gases with high Global Warming Potential. Also, ORs have been estimated to generate up to 33% of all hospital waste.
OBJECTIVE: Beyond patient history, clinical examination and psychophysical gustatory testing, no standardized guidelines exist for the diagnosis of unclear taste disorders, especially regarding imaging. We therefore aime...OBJECTIVE: Beyond patient history, clinical examination and psychophysical gustatory testing, no standardized guidelines exist for the diagnosis of unclear taste disorders, especially regarding imaging. We therefore aimed to investigate the frequency of use of magnetic resonance imaging (MRI), the findings, and the cost and benefits in a large cohort of patients with taste disorders presenting at a tertiary referral centre over a period of 10 years. METHODOLOGY: We retrospectively reviewed clinical records of all patients with gustatory disorders presenting at our tertiary smell and taste clinic between 2010 and 2019 who received an MRI. A board-certified neuroradiologist, specialized in head and neck imaging, reviewed all MRIs. MRI findings were classified according to their relevance to the taste disorder. A cost-benefit analysis was performed. RESULTS: Of the 125 patients with taste complaints, 70 underwent MRI. Imaging data were retrievable for 65 patients, representing 52% of the total cohort. Pathological findings were observed in 54 patients; 46 had incidentalomas not related to the initial complaint. Findings potentially related to the gustatory complaint (treatable in 6 cases, not treatable in 2 cases) were seen in only 8 MR scans. The imaging findings matched the clinical findings in only 4 cases, and these were therefore classified as clearly related to the complaint. The total cost of all the MRIs performed was 55,034.89 CHF. The estimated costs per finding attributable to a taste disorder were 13,758.72 CHF. CONCLUSIONS: In this selected cohort of patients with isolated taste disorders, MRI rarely revealed findings clearly attributable to the complaint. While incidentalomas were frequent, clinically relevant abnormalities were uncommon. These results suggest that MRI should be reserved for select cases, and its routine use critically evaluated. Further prospective studies are needed to better define when MRI is warranted in the diagnosis of unclear isolated taste disorders.
BACKROUND: Allergic rhinitis (AR) patients may experience attention deficits (AD), concentration impairment, and learning difficulties. This study aimed to compare AD hyperactivity disorder (ADHD) symptoms in grass polle...BACKROUND: Allergic rhinitis (AR) patients may experience attention deficits (AD), concentration impairment, and learning difficulties. This study aimed to compare AD hyperactivity disorder (ADHD) symptoms in grass pollenâ€"allergic AR patients and controls and to assess their seasonal variation. METHODOLOGY: The study included children aged 6â€"12 with AR who presented to Ankara Bilkent City Hospital between April 15 and June 15 in 2022 and 2023. The Visual Analog Scale (VAS) was used to assess disease severity, and the Conners Parent Rating Scale (CPRS) was employed to evaluate ADHD symptoms. For comparison, the CPRS was also administered to an age-matched control group consisting of children without known allergies or chronic diseases. RESULTS: The study included 146 AR patients (8.9±1.7 years) and 150 controls (9.0±1.8 years). During the grass pollen season, AR patients showed increased rates of AD, hyperactivity, and school absenteeism, along with a decline in academic performance. Compared to the control group, AR patients exhibited significantly higher AD, hyperactivity, and total CPRS scores. Logistic regression analysis identified male sex, high nasal VAS score, and snoring as independent risk factors for AD, while a high ocular VAS score was an independent risk factor for hyperactivity. CONCLUSIONS: Exacerbation of AR symptoms during the grass pollen season leads to a significant increase in ADHD symptoms and a decline in academic performance. Regular monitoring and symptom control in AR patients are crucial for maintaining academic and social success.
BACKGROUND: Olfactory dysfunction (OD) is an underrecognized feature of CHARGE syndrome (CS), often associated with CHD7 mutations and structural anomalies of the olfactory system. This systematic review examines the bur...BACKGROUND: Olfactory dysfunction (OD) is an underrecognized feature of CHARGE syndrome (CS), often associated with CHD7 mutations and structural anomalies of the olfactory system. This systematic review examines the burden, assessment methods, and clinical correlates of OD in CS. METHODOLOGY: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251040500). A comprehensive search of six databases up to May 2025 was performed. Two independent reviewers screened, extracted data, and assessed study quality. A narrative synthesis was performed. RESULTS: From 1,643 records, 16 studies met inclusion criteria. Most were retrospective cohort studies and employed clinical diagnostic criteria for CS, with a subset reporting CHD7 mutation data. OD was most frequently identified radiologically. Psychophysical testing and self/parent reports were less common. Neurodevelopmental delays, feeding/swallowing issues, and reduced quality of life were reported in association with OD, but causal relationships remain unclear. CONCLUSIONS: OD is highly prevalent in CS, often exceeding 80%, yet remains underrecognized. Radiologic imaging and electrophysiological techniques may be alternatives when psychophysical testing is not feasible. Future research should focus on validating paediatric-specific and developmentally appropriate olfactory assessments and integrating olfaction into quality-of-life frameworks. OD should be considered for inclusion in revised CHARGE diagnostic criteria.
BACKGROUND: Olfactory dysfunction is a common issue among the older population and has been associated with both frailty and increased mortality risk. Telomere length (TL), a marker of biological aging, may provide insig...BACKGROUND: Olfactory dysfunction is a common issue among the older population and has been associated with both frailty and increased mortality risk. Telomere length (TL), a marker of biological aging, may provide insights into these associations. This study investigates the relationship between TL and olfactory function in older adults. METHODOLOGY: We conducted a prospective observational study involving 138 participants aged 65 and above, recruited from a preoperative anesthesia clinic. Olfactory function was assessed using the Sniffin' Sticks test, and TL was measured in leukocytes using the Flow-FISH technique. Data analysis included comparisons between short TL ((lower than the 10th percentile) and normal TL (above the 10th percentile) groups, considering factors like age, sex, and frailty. RESULTS: Short TL was found in 27.5% of participants. Those with short TL had significantly lower TDI (threshold, discrimination, identification) scores. Specifically, 46.2% of participants with a TDI score lower or equal than 10th percentile had short TL compared to 23.2% with higher TDI scores. Adjusting for frailty attenuated this relationship, indicating a shared biological component between olfactory function and TL. CONCLUSIONS: Our study reveals a significant association between lower olfactory function and shorter TL in older adults, suggesting that olfactory impairment may reflect underlying biological aging. Further research is needed to elucidate the complex interactions between olfactory function, TL, and frailty.
Squamous cell carcinoma (SCC) is the most common histological subtype of sinonasal malignancies. Due to non-specific symptoms, sinonasal SCC (SNSCC) is often diagnosed late, posing challenges for management. SNSCC can ar...Squamous cell carcinoma (SCC) is the most common histological subtype of sinonasal malignancies. Due to non-specific symptoms, sinonasal SCC (SNSCC) is often diagnosed late, posing challenges for management. SNSCC can arise de novo (DN-SCC) or from the malignant transformation of inverted papilloma (IP-SCC). Prior studies have reported inconsistent outcomes comparing these two subtypes. This study compares recurrence patterns and survival outcomes of DN-SCC and IP-SCC, identifies predictors of recurrence and survival, and aims to inform clinical decision-making and patient counselling.
BACKGROUND: Disease control assessment for chronic rhinosinusitis (CRS) remains a challenge. In this study, we develop and psychometrically validate a new patient-reported outcome measure, the Chronic Rhinosinusitis Cont...BACKGROUND: Disease control assessment for chronic rhinosinusitis (CRS) remains a challenge. In this study, we develop and psychometrically validate a new patient-reported outcome measure, the Chronic Rhinosinusitis Control Test (CRCT), for assessing CRS control. METHODOLOGY: The CRCT, which includes 8 items and has a score that ranges from 0-31, incorporates the perspectives of key stakeholders (patients and healthcare providers) and was developed incorporating methodologic guidance from the COSMIN initiative and United States Food and Drug Administration. Psychometric validation was performed in line with recommendations from the COSMIN initiative to establish validity, reliability and responsiveness in a sample of 545 CRS patients and with the participation of 23 expert rhinologists. RESULTS: The CRCT has excellent face validity, content validity, concurrent validity, internal consistency, test-retest reliability, and responsiveness. Factor analysis reveals that the CRCT has 2 subdomains: sinonasal and impairment subdomains in addition to a final item related to CRS-related oral corticosteroid usage in the past 3 months. Using a distribution-based and multiple anchorbased methods, the CRCT has a minimal clinically important difference (MCID) of 4 points. After 23 expert rhinologists independently classified all possible combinations of scoring on the CRCT, scores of ≤7 indicate controlled CRS, 8 to 15 (inclusive) partly controlled CRS and ≥16 uncontrolled CRS. CONCLUSION: The CRCT is a psychometrically validated measure of CRS control. CRS may be classified as controlled based on CRCT score ≤7, partly controlled with CRCT score of 8 to 15 (inclusive) and uncontrolled with CRCT score ≥16. The MCIDs for improvement and worsening are both 4.
When going through the table of contents for this issue of Rhinology, I noticed a few titles containing "real-world" or "real-life", Real-world evidence, real-life evidence, real-world experience, et cetera, all refer to...When going through the table of contents for this issue of Rhinology, I noticed a few titles containing "real-world" or "real-life", Real-world evidence, real-life evidence, real-world experience, et cetera, all refer to data obtained from day-to-day practice.
Olfactory dysfunction is a frequent yet underrecognized manifestation of chronic rhinosinusitis in cystic fibrosis. Despite widespread reports of OD in CF, the impact of CFTR modulator therapy on smell outcomes remains u...Olfactory dysfunction is a frequent yet underrecognized manifestation of chronic rhinosinusitis in cystic fibrosis. Despite widespread reports of OD in CF, the impact of CFTR modulator therapy on smell outcomes remains unclear. We conducted a prospective study to evaluate olfactory function changes in CF-related CRS patients, as defined by EPOS2020, following 12 months of elexacaftor/tezacaftor/ivacaftor therapy, exploring clinical and biological correlates. From 120 ETI-treated CF patients at the University Hospital of Careggi, 45 adults diagnosed with CRS completed pre- and post-treatment assessments, including olfactory evaluation via the 16-item Sniffin’ Sticks Identification Test for its feasibility and longitudinal applicability.
INTRODUCTION: This systematic review and meta-analysis evaluated the effect of oral corticosteroid (CS) treatment on tissue eosinophil count (EC) in chronic rhinosinusitis (CRS) patients. METHODOLOGY: A comprehensive dat...INTRODUCTION: This systematic review and meta-analysis evaluated the effect of oral corticosteroid (CS) treatment on tissue eosinophil count (EC) in chronic rhinosinusitis (CRS) patients. METHODOLOGY: A comprehensive database search identified 16 studies with 1,003 patients for the systematic review. Nine studies with 493 patients reporting mean tissue EC per high-power field (HPF) with 400x magnification were included in the meta- analysis. Within-subject (pre- vs. post CS treatment) and controlled comparisons (oral CS vs. no CS or topical CS) were analyzed. RESULTS: Results showed a significant reduction in tissue EC following oral CS treatment in both within-subject analyses and controlled trials. A similar effect was found when comparing oral vs. topical CS treatment. Meta-regression showed a significant negative association between cumulative CS dose and post-treatment EC/HPF. CONCLUSION: These findings provide strong evidence that oral CS significantly reduces tissue eosinophilia in CRS, including comparisons with topical CS. The effect was consistent across study designs and should be considered when assessing endotypes in CRS with nasal polyps.
BACKGROUND: Predicting symptom improvement after nasal airway obstruction surgery remains difficult, as objective airflow metrics correlate poorly with patient-reported outcomes. Since trigeminal afferents are key in sen...BACKGROUND: Predicting symptom improvement after nasal airway obstruction surgery remains difficult, as objective airflow metrics correlate poorly with patient-reported outcomes. Since trigeminal afferents are key in sensing nasal airflow, this study evaluated whether individual differences in nasal chemosensory functionâ€"particularly trigeminal sensitivityâ€"are associated with subjective airflow perception and predict outcomes in patients undergoing surgery for nasal obstruction. METHODOLOGY: A prospective cohort study was conducted in 43 participants (32 patients with nasal airway obstruction scheduled for surgery, 11 healthy controls). Trigeminal sensitivity was assessed using measures including the menthol lateralisation detection thresholds, TRPV1/TRPM8 gene expression, and the trigeminal subtest of the Barcelona Smell Test-24. Olfactory and gustatory function were also evaluated. Nasal obstruction perception was measured pre- and postoperatively using the NOSE-e questionnaire and a visual analogue scale. Patients were followed for a mean of 10.9 months. RESULTS: Trigeminal sensitivity did not differ significantly between patients and controls. However, baseline trigeminal Barcelona Smell Test-24 scores correlated with greater improvement in NOSE-e scores and satisfaction. Patients with NOSE-e improvement >6 points had lower baseline trigeminal scores than those with lesser gains. No other baseline chemosensory measures were correlated with postoperative outcomes. CONCLUSIONS: Trigeminal sensitivityâ€"particularly as assessed by the Barcelona Smell Test-24 testâ€"may serve as a predictor of both symptom improvement and overall satisfaction after surgery for nasal airway obstruction, underscoring the importance of sensory processing in shaping patient-perceived surgical outcomes.
BACKGROUND: A healthy olfactory cleft is critical to normal olfactory function. The aim of this study was to explore the differential orthonasal and retronasal olfactory functions in patients with olfactory cleft (OC) ob...BACKGROUND: A healthy olfactory cleft is critical to normal olfactory function. The aim of this study was to explore the differential orthonasal and retronasal olfactory functions in patients with olfactory cleft (OC) obstructions including a combination of OC syndrome, chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), and respiratory adenomatoid epithelial hamartoma (REAH). METHODS: Patients (n = 93) presenting to an ENT clinic with OC obstruction underwent nasal endoscopy, chemosensory event-related potential (ERP) recordings, and radiologic assessment, and were subsequently diagnosed with OC syndrome, CRSsNP with OC syndrome, CRSwNP in the OC, REAH, and CRSwNP with REAH. Orthonasal and retronasal function were assessed using the complete Sniffin’ Sticks test and a set of 30 powders, respectively. RESULTS: Orthonasal function was lower in patients with REAH and CRSwNP+REAH compared to CRSwNP in OC patients. Retronasal function was similarly diminished in REAH compared to CRSwNP in OC. Patients with OC syndrome alone had higher orthonasal scores than those with CRSsNP plus OC syndrome and CRSwNP in OC but not statistically different retronasal function. There was no significant difference in orthonasal or retronasal scores in REAH patients based on concurrent CRSwNP. CONCLUSIONS: REAH corresponded with greater orthonasal and retronasal olfactory loss compared to other olfactory cleft obstructions, indicating a greater effect on the olfactory mucosa beyond disrupting airflow. The difference between CRS and OC syndrome is more pronounced orthonasally than retronasally.
Nasal septal perforation occurs when both mucoperichondrial layers surrounding the septal cartilage are compromised. While richly vascularized, this tissue is particularly vulnerable to ischaemic injury caused by intrana...Nasal septal perforation occurs when both mucoperichondrial layers surrounding the septal cartilage are compromised. While richly vascularized, this tissue is particularly vulnerable to ischaemic injury caused by intranasal cocaine use. Cocaine inhibits catecholamine reuptake, leading to vasoconstriction, tissue necrosis, and, ultimately, septal damage. Furthermore, the adulterant levamisole, present in up to 80% of seized cocaine in Germany, is a known trigger for vasculitis, compounding this effect.
BACKGROUND: Various factors affect the immunopathogenesis of chronic rhinosinusitis (CRS). Although the relationship between allergies and CRS has attracted considerable attention, it remains controversial. Notably, litt...BACKGROUND: Various factors affect the immunopathogenesis of chronic rhinosinusitis (CRS). Although the relationship between allergies and CRS has attracted considerable attention, it remains controversial. Notably, little is known about whether the clinical characteristics and immunological profiles differ based on allergic sensitization status among patients with CRS. METHODOLOGY: This study included 209 patients with CRS with nasal polyps (CRSwNP) who underwent endoscopic sinus surgery, and their nasal polyp tissues were obtained. Patients were divided into two groups according to allergic sensitization status: "allergic" and "non-allergic" groups. The clinical characteristics and immunological profiles were compared between the two groups. Ex vivo phenotypes of nasal CD4+ T cells were analyzed using flow cytometry. RESULTS: Compared to the non-allergic group, the allergic group exhibited a significantly higher prevalence of comorbid asthma, serum total IgE levels, SNOT-22 scores, JESREC scores, blood/ tissue eosinophil counts, the proportion of eosinophilic histologic type, and lower gustatory function test scores. Additionally, the frequencies of nasal T helper 2 (TH2) and proallergic TH2 (TH2A) cells were significantly higher in the allergic group than in both the non-allergic and the control groups, and these frequencies were significantly correlated with eosinophilic inflammation. CONCLUSIONS: Our study demonstrates that allergic sensitization is closely associated with eosinophilic inflammation, as indicated by elevated levels of blood/tissue eosinophils and nasal TH2A cells, and by worse symptom scores in CRSwNP. Given the distinct immunological features of allergic patients, considering allergic sensitization within nasal tissue when managing CRSwNP is crucial.
BACKGROUND: The role of Th2-related biomarkers as a diagnostic tool for local allergic rhinitis (LAR) remains controversial. This study seeks to assess the clinical utility of these markers and rank their diagnostic accu...BACKGROUND: The role of Th2-related biomarkers as a diagnostic tool for local allergic rhinitis (LAR) remains controversial. This study seeks to assess the clinical utility of these markers and rank their diagnostic accuracy for LAR. METHODS: Systematic searches were conducted across five electronic databases. Pooled outcomes, including sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR), were calculated. Relative diagnostic outcomes with a 95% confidence interval between index tests were computed using the indirect comparison of modalities. RESULTS: Twenty-one studies met the inclusion criteria, assessing the diagnostic accuracy of three index tests compared to nasal provocation test for LAR. Among the three biomarkers, sensitivities ranged from 48.1% to 69.1%, with nasal eosinophilia (nEos) showing the highest sensitivity but lowest specificity (56.2%). Nasal-specific IgE (nsIgE) demonstrated perfect specificity (100%) but limited sensitivity (48.1%), the highest DOR (significant), and the highest LR+ (not significant). Basophil activation test (BAT) had the lowest LR- with statistical significance. Indirect comparisons showed BAT and nsIgE had significantly higher sensitivities than nEos. CONCLUSIONS: Nasal-specific IgE and the basophil activation test can help diagnose local allergic rhinitis, but their sensitivities are low. Negative results should be confirmed with a nasal provocation test. Heterogeneity in reported sensitivities further underscores the limitations of current diagnostic methods.
BACKGROUND: Allergic rhinitis (AR), an immunoglobulin E (IgE)-mediated inflammatory disease, is frequently associated with house dust mites (HDMs), particularly Dermatophagoides pteronyssinus (Der p) and Dermatophagoides...BACKGROUND: Allergic rhinitis (AR), an immunoglobulin E (IgE)-mediated inflammatory disease, is frequently associated with house dust mites (HDMs), particularly Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f). While serum allergen-specific IgE (sIgE) is widely used, the diagnostic value of local sIgE and its interplay with systemic IgE and nasal cytokines remains unclear. This study evaluated local sIgE performance, nasal cytokine profiles, and nonlinear local-serum sIgE dynamics for AR patients. METHODOLOGY: This prospective study enrolled 60 HDM-sensitized AR patients and 143 healthy controls from February 2023 to September 2024. Serum and local Der p/Der f sIgE and total IgE were quantified; and nasal cytokines were analyzed by Luminex. Logistic regression, ROC analysis, and Spearman correlation assessed diagnostic performance and associations.Restricted cubic spline (RCS) modeling explored nonlinear local-serum sIgE relationships. RESULTS: AR patients exhibited elevated local Der p and Der f sIgE logistic regression confirmed their associations with AR, supported by strong diagnostic accuracy. Local sIgE demonstrated stronger correlations with type 2 cytokines (IL-4, IL-5, CCL5, CCL11) than serum sIgE. RCS analysis identified inflection points for Der p and Der f, revealing threshold-dependent nonlinear dynamics between local and serum sIgE. CONCLUSIONS: Local sIgE demonstrates high diagnostic accuracy for HDM-sensitized AR and better reflects local Th2-driven inflammation. The nonlinear local-serum sIgE relationship advocates dual-compartment profiling, advancing precision diagnostics in AR.
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits sex-specific differences in prevalence and clinical presentation. However, the underlying histopathological characteristics and recurrence remain und...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits sex-specific differences in prevalence and clinical presentation. However, the underlying histopathological characteristics and recurrence remain underexplored. METHODOLOGY: A retrospective cohort of 410 CRSwNP patients (287 males, 123 females) undergoing endoscopic sinus surgery between January 2021 and June 2024 was analyzed. Histological evaluation was employed by H&E staining and features of inflammatory profile were identified by immunohistochemistry. Multivariate logistic regression and receiver operating characteristic analyses were performed to assess predictors of recurrence. RESULTS: Males exhibited higher body mass index (BMI) and greater allergic rhinitis prevalence, while females had more asthma comorbidity and higher SNOT-22 scores. While no significant sex differences were observed in histopathological endotypes, elevated BMI was more likely to exacerbate inflammation in males than females. Additionally, males showed a higher recurrence rate, with male sex being identified as an independent risk factor. However, females who experienced recurrence exhibited more severe eosinophilic and T2 inflammation compared to their male counterparts. Therefore, higher threshold values for tissue eosinophil counts and Charcot-Leyden crystals were required to predict recurrence in female patients. CONCLUSIONS: These findings underscore the necessity for sex tailored therapeutic strategies, particularly emphasizing weight control in male patients and intensified anti-T2 inflammation management in female patients with recurrent CRSwNP. Further research is needed to investigate the underlying causes and to offer evidence-based treatment guidelines.
BACKGROUND: The nose is a resonator, the acoustic properties of which are determined by its shape. Due to its complex anatomy and hence intricate acoustical response the identification of universal acoustic characteristi...BACKGROUND: The nose is a resonator, the acoustic properties of which are determined by its shape. Due to its complex anatomy and hence intricate acoustical response the identification of universal acoustic characteristics of nasalized vowels and consonants is challenging. The purpose of this investigation was to 1) elucidate acoustic properties of the nasal resonator, 2) document how the paranasal sinuses affect it, and 3) examine if 3D-replicas of anatomical specimens provide reliable data for acoustic analysis. METHODS: In this experimental study the resonance properties of the nasal tract were analyzed in ex-vivo specimens as well as in their 3-D replicas. Their sound transfer characteristics were recorded by sending a sinewave, gliding from low to high frequency from an earphone airtightly sealed into the velopharyngeal port. The response was picked up at a nostril. The acoustical influence of the sinuses was reversibly eliminated by occlusion of the sinus ostia. RESULTS: Response curves of the nasal tract were found to possess two main resonances, one in the vicinity of 600-750 Hz and one in the 2500 â€" 3500 Hz range. Comparison of the acoustical responses obtained while including and excluding the influence of the paranasal cavities showed a great inter-individual variation in the response curve morphology. The cavities were found to introduce V-shaped sound level minima in the response curves. CONCLUSIONS: When the influence of the paranasal cavities is eliminated, the nasal cavity presents two main resonances, which are determined mainly by its anatomical length. The resonances of the paranasal cavities introduce minima and maxima in the frequency response of the nasal tract at frequencies with substantial inter-individual variation. Replicas of anatomical specimens provide reliable data for acoustic analysis.
Dupilumab is widely recognised as a highly effective therapy for severe chronic rhinosinusitis with nasal polyps (CRSwNP). A rise in blood eosinophil count (BEC) might occur during treatment across all approved indicatio...Dupilumab is widely recognised as a highly effective therapy for severe chronic rhinosinusitis with nasal polyps (CRSwNP). A rise in blood eosinophil count (BEC) might occur during treatment across all approved indications. In CRSwNP, dupilumab-induced blood eosinophilia (DIBE) is typically of early onset, transient, and asymptomatic without impairing the drug’s efficacy. A review including data from 11 clinical trials on all approved dupilumab indications reported eosinophilia-related clinical manifestations in only 7 of 4,666 patients receiving dupilumab. Real-world studies confirm DIBE is largely benign, with only rare AEs requiring dupilumab discontinuation such as eosinophilic pneumonia, especially in eosinophilic granulomatosis with polyangiitis (EGPA) patients. Such exceedingly rare events were mainly described within the first months of treatment, however late onset DIBE (after 6 months) has also been detected, especially in patients dependent on systemic corticosteroids.