BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is more common in children with limited CRSwNP (L-CRSwNP). L-CRSwNP shares similar clinical phenotypes with recurrent CRSwNP (R-CRSwNP). This study aimed to e...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is more common in children with limited CRSwNP (L-CRSwNP). L-CRSwNP shares similar clinical phenotypes with recurrent CRSwNP (R-CRSwNP). This study aimed to explore the molecular mechanisms of L- and R-CRSwNP in children. METHODOLOGY: Compared clinical characteristics and RNA sequencing data of 20 L-CRSwNP and 5 R-CRSwNP in children. Paired analyzed RNA sequencing data of 6 children with L-CRSwNP polyps and mucosal tissue samples. Conducted GO and KEGG enrichment analyses. Identified hub genes through protein-protein interaction networks (PPI). Validated hub genes in L- and R-CRSwNP using real-time quantitative PCR (RT-qPCR), immunohistochemistry (IHC), and multiplex immunohistochemistry (mIHC). RESULTS: RNA-seq analysis of L- and R-CRSwNP polyp showed no differentially expressed genes (DEGs). RNA-seq paired analysis of L-CRSwNP identified 1419 DEGs. GO enrichment analysis showed significant enrichment for biological processes associated with neutrophils. ITGAM and FCGR3B were identified as hub genes by PPI analysis. RT-qPCR and IHC results suggested the expression levels of ITGAM and FCGR3B were significantly increased in L- and R-CRSwNP. mIHC results suggested ITGAM and FCGR3B were closely associated with neutrophils and M2 macrophages in L- and R-CRSwNP. CONCLUSIONS: L- and R-CRSwNP in children exhibit similar clinical phenotypes and molecular mechanisms. ITGAM and FCGR3B are hub genes contributing to disease through neutrophil- and M2 macrophage-mediated phagosome pathway.
BACKGROUND: Anosmia is a common, debilitating, and often treatment-resistant symptom of CRS. Biological therapies are a novel and promising treatment for severe and uncontrolled CRS, however, the impact of biological the...BACKGROUND: Anosmia is a common, debilitating, and often treatment-resistant symptom of CRS. Biological therapies are a novel and promising treatment for severe and uncontrolled CRS, however, the impact of biological therapy specifically on olfatory dysfunction has not yet been evaluated through systematic review. METHODOLOGY: Systematic searches of Ovid MEDLINE, EMBASE and Cochrane Library were performed on 25/05/2024, assessing olfactory outcomes following treatment with biologics. Random-effects meta-analyses were conducted to generate restricted maximum-likelihood estimates for the absolute improvement in each outcome of interest. RESULTS: Systematic searches yielded 801 papers, of which 37 studies comprising of 3284 patients treated with biologics and 1138 controls. In the RCT-only analysis, biologics conferred significat improvements versus control in UPSIT and VAS olfaction (measured as a 0-10 Likert scale). Across all papers, Dupilumab showed significat improvements versus Omalizumab in UPSIT and VAS. CONCLUSIONS: Biological therapies are effective in improving olfactory dysfunction secondary to treatment-resistant CRS, with VAS olfaction gains being demonstrated up to 12 months after treatment. Dupilumab shows initial promise over omalizumab; however, cost-effectiveness of biological therapies may limit widespread clinical usage currently.
BACKGROUND: Nasal dysbiosis is implicated in the pathogenesis of nasal diseases, yet microbiome-host interplay remains poorly understood. METHODOLOGY: We conducted a cross-sectional analysis comparing 43 CRSwNP patients,...BACKGROUND: Nasal dysbiosis is implicated in the pathogenesis of nasal diseases, yet microbiome-host interplay remains poorly understood. METHODOLOGY: We conducted a cross-sectional analysis comparing 43 CRSwNP patients, 27 NIP patients, and 34 controls using dual 5R 16S rRNA sequencing and host transcriptomics to characterize microbiome profiles and host-microbial interactions. RESULTS: Distinct microbiome patterns were identified in CRSwNP and NIP mucosal microenvironments. Host-microbiome interaction analysis revealed both shared and disease-specific associations. Common to both disorders were immune-related pathway enrichments, while CRSwNP uniquely demonstrated microbial recognition/immune activation links and NIP showed predominant proliferative pathway correlations. Notably, Bayesian network analysis identified Geobacillus stearothermophilus abundance as significantly associated with NF-kB pathway activation in nasal polyps - a finding subsequently experimentally validated. CONCLUSION: Our findings delineate disease-specific microbiome-host interplay in nasal pathologies, with CRSwNP exhibiting immune-focused interactions versus NIP's proliferative associations. These insights advance our understanding of nasal disease mechanisms and support the development of targeted microbiome-modulating therapies.
Olfactory testing and training constitute important foundations of diagnostic and therapeutic management of patients presenting with olfactory loss. The precise repertoire of human olfactory receptors engaged by standard...Olfactory testing and training constitute important foundations of diagnostic and therapeutic management of patients presenting with olfactory loss. The precise repertoire of human olfactory receptors engaged by standard odorants in olfactory detection thresholds, identification tests, and training is surprisingly under-investigated, limiting our understanding of these methods.
Gaining the confidence needed for independent practice in septorhinoplasty remains a difficulty for surgeons in training.Gaining the confidence needed for independent practice in septorhinoplasty remains a difficulty for surgeons in training.
BACKGROUND: Negative pressure drainage is a commonly used method in surgery, but studies applying negative pressure drainage in septoplasty are relatively few. METHODOLOGY: A randomized clinical trial was conducted to co...BACKGROUND: Negative pressure drainage is a commonly used method in surgery, but studies applying negative pressure drainage in septoplasty are relatively few. METHODOLOGY: A randomized clinical trial was conducted to compare negative pressure drainage and nasal packing after septoplasty. Patients with nasal septal deviation underwent septoplasty from November 2023 to March 2024 were enrolled. Symptom scores and quality of life scores were assessed on postoperative day 1, day 5, and at 1 month to evaluate postoperative comfort. RESULTS: A total of 95 patients completed the study, the median (IQR) age was 29 (21, 43) years, and 73 (77%) identified as male. 48 (51%) patients were randomized to nasal packing group and 47 (49%) to negative pressure group. On postoperative day 1, the negative pressure group showed significantly lower symptom scores for nasal congestion, rhinorrhea, olfactory dysfunction, headache, eye discomfort, ear fullness, and better quality of life compared to the packing group. On postoperative day 5, the negative pressure group showed significantly lower scores for olfactory dysfunction and ear fullness compared to the packing group. There was no significant difference in effective rate and postoperative complications rate between negative pressure group and packing group. The cost-effectiveness ratio for the negative pressure group was significantly lower than the packing group. CONCLUSIONS: Negative pressure drainage after septoplasty significantly improves postoperative comfort in the first days after surgery, without affecting surgical efficacy or safety, and helps reduce medical costs.
The recurrence of nasal polyps has frequently been observed with chronic rhinosinusitis with nasal polyps (CRSwNP), especially with asthma and N-ERD (NSAID-exacerbated respiratory disease). Patients with eosinophilic tis...The recurrence of nasal polyps has frequently been observed with chronic rhinosinusitis with nasal polyps (CRSwNP), especially with asthma and N-ERD (NSAID-exacerbated respiratory disease). Patients with eosinophilic tissue infiltration are diagnosed as having eosinophilic chronic rhinosinusitis (ECRS), a unique CRSwNP subtype. Since the terminology of CRSwNP might include the patients with inflammatory polyps in addition to ECRS, the classification of CRSwNP by endotype is necessary to select the patients who require T2I-targeted biologic treatments. The concept of ECRS was established in 2001. However, a global consensus has not been reached regarding its definition due to the lack of standard histopathologic criteria and methodology for its classification.
BACKGROUND: Patients seeking rhino(septo)plasty need to be adequately informed by their surgeon or surgical team members about the procedure, the expected outcomes, complication risks and post-operative care, and the ava...BACKGROUND: Patients seeking rhino(septo)plasty need to be adequately informed by their surgeon or surgical team members about the procedure, the expected outcomes, complication risks and post-operative care, and the available alternatives. A consensus on the content of an informed consent in rhino(septo)plasty is currently lacking despite the high unmet need. METHODOLOGY: The extended international faculty of the European Rhinoplasty Course in Brussels organized by EUFOREA has generated an overview of the current literature on rhinoplasty outcomes and complication rates, and available informed consents. A proposal for informed consent was elaborated, consensus reached and checked for legal validity. RESULTS: An overview of reported outcomes and complication rates of rhino(septo)plasty are provided. Additionally, contents of existing consent forms for rhino(septo)plasty surgery are compared with requirements found in literature on informed consent, leading to a proposal of informed consent including relevant information according to expert consensus. CONCLUSIONS: An informed consent form for rhino(septo)plasty is proposed by the international faculty of the European Rhinoplasty Course, that might serve rhinoplasty surgeons in the development of their informd consent documents.
OBJECTIVE: The purpose of this study was to compare the impact of using fascia lata versus a nasoseptal flap for skull base repair on olfactory function following endoscopic endonasal skull base surgery. METHODS: Patient...OBJECTIVE: The purpose of this study was to compare the impact of using fascia lata versus a nasoseptal flap for skull base repair on olfactory function following endoscopic endonasal skull base surgery. METHODS: Patients who underwent the endoscopic endonasal transsphenoidal approach (EETA) or the extended endoscopic endonasal transsphenoidal approach (EEETA) were included in this study. The study included 80 patients who underwent skull base defect repair using fascia lata, while the control group consisted of 160 patients who underwent skull base defect repair using a nasoseptal flap. Preoperative demographic data, skull base repair techniques, postoperative sinonasal symptoms and the incidence of cerebrospinal fluid (CSF) leakage were compared between the two groups. RESULTS: Olfactory dysfunction was significantly worse at 3, 6 and12 months after surgery than before surgery in the nasoseptal flap repair group, although olfactory function partially recovered at 12 months after surgery. Additionally, we found that non-validated visual analogue scale (VAS, 0â€"100 mm) and validated cross-cultural smell identification test (CC-SIT) and the butanol threshold test (BTT) olfactory impairment at 12 months after surgery were significantly worse in the nasoseptal flap repair group than in the fascia lata repair group. Furthermore, no significant difference in the incidence of CSF leakage was noted between the two groups. CONCLUSIONS: For endoscopic endonasal surgery, the use of a nasoseptal flap for skull base repair can cause severe olfactory impairment. The use of fascia lata for skull base repair can be considered an alternative method to minimize damage to olfactory function.
BACKGROUND: Recent studies suggest that intranasally administered vitamin D can be an effective treatment for patients with chronic rhinosinusitis (CRS). We performed a double-blind, placebo-controlled, randomized clinic...BACKGROUND: Recent studies suggest that intranasally administered vitamin D can be an effective treatment for patients with chronic rhinosinusitis (CRS). We performed a double-blind, placebo-controlled, randomized clinical trial to evaluate the effect of adding calcifediol to saline sinus irrigation with budesonide for patients with CRS. METHODS: A total of 113 adult patients with CRS were enrolled. Patients were randomized to either calcifediol (n = 58, 51%) or placebo (n = 55, 49%) lavage and were instructed to irrigate both nasal cavities twice daily for 21 days, with either calcifediol or placebo dissolved in a solution of saline with budesonide. The primary outcome measure was the change in Sino-Nasal Outcome Test (SNOT-22) scores, endoscopic examination scored by the Lund-Kennedy (L-K) grading system, and physician-reported response to treatment, as measured with decreased need for nasal steroids/cessation of nasal steroids in the calcifediol group compared with the placebo group. The secondary outcome measures included the change in serum 25(OH)D concentration and the correlation of results with other clinical data. RESULTS: 108 patients completed the trial. Significant changes in SNOT-22 score, L-K score and serum 25(OH)D were reported between the 2 study groups. A significant percentage of participants in the calcifediol group could cease nasal steroids. CONCLUSION: Calcifediol in saline nasal lavage with budesonide results in clinically significant benefits beyond the benefits of saline with budesonide alone for patients with CRS.
I would like to welcome you to the August issue of Rhinology. In the latest issue of Rhinology, you will find high quality articles spanning the entire breadth of the field of rhinology. From studies on inflammatory sinu...I would like to welcome you to the August issue of Rhinology. In the latest issue of Rhinology, you will find high quality articles spanning the entire breadth of the field of rhinology. From studies on inflammatory sinus disease to skull base pathology, from medical to surgical treatments, every reader is sure to find studies of interest and applicability to their practice. For the focus of this editorial, I highlight for the reader the article by Le Bon et al., which describes the case of a patient with cystic fibrosis (CF) and chronic rhinosinusitis (CRS) with nasal polyps in whom concomitant NSAID-exacerbated respiratory disease (NERD) was uncovered after the initiation of triple combination CFTR modulatory therapy with elexacaftor-tezacaftor-ivacaftor (ETI).
UNLABELLED: BACKGROUND A patient-centered and directly measurable definition for acute exacerbation of chronic rhinosinusitis (AECRS) has been developed as "a flare up of symptoms beyond day-to-day variation, lasting at...UNLABELLED: BACKGROUND A patient-centered and directly measurable definition for acute exacerbation of chronic rhinosinusitis (AECRS) has been developed as "a flare up of symptoms beyond day-to-day variation, lasting at least 3 days, and to which a distinct negative impact on a patient's quality of life (QOL) or functionality can be attributed". Our aim is to understand how this definition correlates with previously used metrics. METHODOLOGY: Cross-sectional study of chronic rhinosinusitis (CRS) patients. The number of AECRS (using this novel definition), courses of CRS-related systemic antibiotics and corticosteroids taken for these AECRS, and number of asthma exacerbations in the past 6 months was queried. Disease-specific quality of life was measured using the 22-item Sinonasal Outcome Test. RESULTS: A total of 237 CRS patients were enrolled. In the 6-month period prior to study enrollment, the mean number of AECRS was 4.2 while the mean number of systemic antibiotics or corticosteroids taken for these AECRS was 1.6 reflecting patients received rescue medication for 33% of AECRS. The number of AECRS was weakly correlated with number of systemic rescue medications and SNOT-22 score. For asthmatic CRS patients, numbers of AECRS and asthma exacerbations were correlated. Finally, comorbidities were associated with higher AECRS frequency by 29% in migraine and 41% in active tobacco users. CONCLUSIONS: We achieved our aim by showing the AECRS definition correlates with systemic rescue medication usage, disease-specific QOL and asthma exacerbations. Our results demonstrate that indirect measures of AECRS may not capture all AECRS. Furthermore, comorbid migraine and tobacco use are associated with AECRS frequency.
Olfactory dysfunction affects a large proportion of the general population and causes significant personal and societal burden. At present, there are limited treatment options available. Though as yet experimental and un...Olfactory dysfunction affects a large proportion of the general population and causes significant personal and societal burden. At present, there are limited treatment options available. Though as yet experimental and untested in people, olfactory implants are a novel form of neuroprosthesis, modelled on existing implants for other sensory deficits such as hearing loss. Advances in this field have been rapid, yet there have been no unified efforts to collate current knowledge or guide such advances towards maximum patient benefit. In this Opinion Paper, leaders in the field have come together to provide an overview of current and emerging knowledge and technology relating to olfactory implants. In an effort to guide innovation towards maximum patient benefit, we also provide expert agreed statements on theoretical clinical aspects of olfactory implantation, including patient selection, implantation sites and potential complications, as well as post-implantation support requirements. Technical aspects will be discussed, with a clinical, device orientated focus. Finally, the ethics of olfactory implantation will be considered. We hope this document will serve as a useful roadmap to guide future clinical and basic research in the field.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition with severe impacts on quality of life and substantial economic costs. Dupilumab targeting the underlying T2 inflammation in CRSwNP...Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition with severe impacts on quality of life and substantial economic costs. Dupilumab targeting the underlying T2 inflammation in CRSwNP showed promising results; however, it is unknown if intensive regimens must be maintained in responders to prevent relapse. In 2019, FDA and the European Commission approved Dupilumab 300 mg administered subcutaneously every two weeks for CRSwNP. We hypothesized that disease control might be maintained by reducing the frequency of administration in patients who initially well answered to the standard treatment. To date the benefit of de-escalation was only analyzed in short time. We wanted to understand if a de-escalation regimen could be introduced without compromising disease control in long follow-up; to this aim we de-escalated Dupilumab at 300 mg every four weeks following a year of conventional bi-weekly administration.
BACKGROUND: The sphenopalatine artery (SPA) runs in close proximity to the branches of the trigeminal nerve and to the sympathetic and parasympathetic secretomotor fi bers. In refractory epistaxis, monopolar cautery of t...BACKGROUND: The sphenopalatine artery (SPA) runs in close proximity to the branches of the trigeminal nerve and to the sympathetic and parasympathetic secretomotor fi bers. In refractory epistaxis, monopolar cautery of the SPA during surgery is of widespread use. The eff ect of coagulation on adjacent trigeminal and parasympathetic branches, and thus intranasal sensitivity and secretory function, is unknown. METHODS: To investigate intranasal trigeminal function (INTF) by means of CO2 stimuli intranasally, at baseline and after decongestion, before and after local anaesthesia (xylocaine) in healthy subjects and after monopolar cautery in patients treated for refractory epistaxis. In the latter, INTF and secretory function were tested by comparing the treated with the untreated side. Nasal and lacrimal secretions were measured with intranasal sponges and Schirmer’s tests. SETTING: Monocentric cohort study in tertiary referral centre. RESULTS: A total of 37 healthy participants and 17 patients were included. Nasal decongestion had no eff ect on CO2 measurements, whereas local anaesthesia signifi cantly decreased INTF in healthy subjects. In patients, the operated side showed signifi cantly lower INTF, lower nasal secretory function but no signifi cant changes in lacrimal function. CONCLUSION: Local anaesthesia and surgical treatments have measurable eff ects on INTF. Monopolar cautery of the SPA and its branches aff ects nasal secretory function. These eff ects may lead to symptoms and surgeons should be aware of the potential harm in epistaxis treatments.
INTRODUCTION: Staphylococcus aureus (S. aureus) in chronic rhinosinusitis (CRS), particularly when localised intracellularly, is linked to disease recalcitrance and poor post-surgical outcomes. Antibiotics frequently fai...INTRODUCTION: Staphylococcus aureus (S. aureus) in chronic rhinosinusitis (CRS), particularly when localised intracellularly, is linked to disease recalcitrance and poor post-surgical outcomes. Antibiotics frequently fail to penetrate the mammalian cell membrane, resulting in an inability to address the intracellular component of S. aureus. This contributes to treatment failure and development of antimicrobial resistance. We investigated the antimicrobial effects of simvastatin, a widely used, inexpensive medication with extracellular and intracellular antimicrobial properties, against CRS-related S. aureus. METHODS: Simvastatin’s antimicrobial activity, in prodrug and hydroxy acid forms, was assessed against S. aureus using the broth dilution method to determine the minimal inhibitory concentration (MIC). Intracellular activity of simvastatin was evaluated by pre-treating S. aureus-infected LAD2 mast cells with simvastatin and performing colony forming unit (CFU) enumeration and confocal microscopy. Cell viability was assessed using lactate dehydrogenase (LDH) assays. RESULTS: Simvastatin exhibited an extracellular MIC of 40 mmol/l against S. aureus. Intracellularly, it significantly reduced the bacterial burden by 46-fold in a dose-dependent manner between concentrations of 0.1-100 mmol/l. Toxicity to LAD2 cells was observed at 100 mmol/l. Confocal microscopy revealed a lower percentage of infected cells in the group pretreated with 30 μmol/l simvastatin (15.3%) compared to untreated cells (32.8%). Simvastatin hydroxy acid demonstrated no antimicrobial activity against S. aureus. CONCLUSIONS: Simvastatin demonstrates in vitro antimicrobial activity against CRS-related S. aureus with the potential for repurposing as a novel antibiotic-sparing topical agent for the treatment of refractory CRS. This could improve surgical outcomes andreduce the risk of antimicrobial resistance.
De Corso E, Corbi M, De Maio G
… +11 more, Mastrapasqua R, Montuori C, D'Auria LM, Rizzuti A, Spanu C, Pisciottano S, Dâ Agostino G, Pacilli MC, Ortolan A, Rizzi A, Galli J
BACKGROUND: This study aimed to evaluate the effectiveness of mepolizumab in the treatment of severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) as add-on therapy to intranasal corticosteroids (INCS)...BACKGROUND: This study aimed to evaluate the effectiveness of mepolizumab in the treatment of severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) as add-on therapy to intranasal corticosteroids (INCS) in a real-life setting over the first year of treatment. METHODOLOGY: We included 50 patients (28 males; mean age: 56.4 years, range 35-77) who received mepolizumab 100 mg every 4 weeks. The primary objective of this study was to evaluate the reduction in nasal polyp size and improvement in patients' quality of life, measured through symptom-based questionnaires. The secondary objective was to evaluate improvements in smell dysfunction, severity of comorbidities, blood eosinophilia, and the need for surgery or systemic steroids. RESULTS: After 12 months of treatment, the median nasal polyp score (NPS) decreased from 5 to 2 and the mean sino-nasal outcome test-22 (SNOT-22) score decreased from 58.4±21 to 26.1±17.5. Olfaction only slightly improved with a median VAS score decreasing from 10 at baseline to 6 at 12 months. Seven patients remained uncontrolled and required systemic steroids and in 5 cases also endoscopic sinus surgery. CONCLUSIONS: The results support the use of mepolizumab as an effective option in the current standard of care for patients affected by severe, uncontrolled CRSwNP especially in decreasing nasal polyps’ size and improving quality of life, although a minor impact was observed on recovery of smell.
B Rhold F, Hagemann J, Klimek L
… +15 more, Huber P, Gr Ger M, Loth AG, Ernst BP, Beutner C, Dombrowski T, F Rster-Ruhrmann U, Olze H, Cuevas M, Gunder N, Malanda J, Laudien M, Albrecht T, Matthias C, Becker S
BACKGROUND: Within the last years, monoclonal antibodies (biologicals) have revolutionized the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and significantly improved symptom control in otherwise refrac...BACKGROUND: Within the last years, monoclonal antibodies (biologicals) have revolutionized the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and significantly improved symptom control in otherwise refractory cases. The effectiveness of the biological mepolizumab, an IL-5 receptor antibody, has not yet been investigated extensively. This multi-centric study assesses its impact on a large German patient cohort including biological naive and switched patients. METHODOLOGY: In this retrospective multi-centric study, patients with the diagnosis of severe CRSwNP treated with mepolizumab by German tertiary referral centers were included. Data were collected retrospectively from patient records. The change from baseline regarding patient reported symptom control, serum biomarkers, nasal polyp score (NPS), and sense of smell were analysed over a course of up to 30 months. RESULTS: 96 patients from 8 tertiary treatment centers were included, 36.5% female, with a mean age of 54.1±14.3 years. Patient reported outcome measures, smell, and NPS improved significantly within 6 months after treatment initiation or switch from a different biological to mepolizumab. Change from baseline in outcome parameters was smaller in the switch-group, whereas comorbid asthma indicated greater treatment success. CONCLUSIONS: Our real-world data show a sustained therapeutic effect of mepolizumab in CRSwNP, including a large proportion of patients who were previously treated with a different biological. This study is the largest real-world cohort to date depicting realistic treatment and disease situations, confirming a broad range of indication for mepolizumab in severe CRSwNP.
BACKGROUND: Recent clinical studies have alluded to an association between chronic rhinosinusitis (CRS) and cognition, possibly mediated by local and systemic neuroinflammation. This meta-analysis seeks to clarify the as...BACKGROUND: Recent clinical studies have alluded to an association between chronic rhinosinusitis (CRS) and cognition, possibly mediated by local and systemic neuroinflammation. This meta-analysis seeks to clarify the association of CRS diagnosis or treatment with cognitive function and dementia. METHODOLOGY: Two blinded reviewers searched PubMed, Embase, and Scopus for studies comparing cognitive function (global/domain-specific) or dementia in patients with/without CRS or pre/post-CRS treatment. The risk of bias was assessed using ROBINS-I/ROBINS-E. Random-effects models were used to pool the ratio of means (RoM) for cognitive scores and the odds ratio (OR) for dementia. RESULTS: From 1,149 records, 10 studies encompassing 107,610 patients were included. CRS was associated with poorer global cognitive function compared to healthy. CRS treatment was associated with improvements from baseline in processing speed and working memory. There was no significant cross-sectional association between CRS and dementia. CONCLUSION: CRS is associated with 9% poorer global cognitive function, while CRS treatment is associated with 8-9% improvements in processing speed and working memory. Larger longitudinal studies are needed to fully elucidate these relationships.
BACKGROUND: Managing sinonasal malignancies requires a thorough oncological assessment and interdisciplinary collaboration. Patients often present at an advanced tumor stage with a delay in diagnosis. With the recent adv...BACKGROUND: Managing sinonasal malignancies requires a thorough oncological assessment and interdisciplinary collaboration. Patients often present at an advanced tumor stage with a delay in diagnosis. With the recent advancements in imaging techniques along with the growth in molecular testing knowledge, the landscape of these tumors has become increasingly diverse. The pretreatment assessment must include information gathered from radiological and pathological evaluations, as well as intraoperative exploration of the tumors. Only a comprehensive approach allows a personalized treatment plan. METHODOLOGY: This narrative review synthesizes current evidence, encompassing pretherapeutic evaluations and the development of individualized treatment protocols. RESULTS: Multimodal treatment strategies, including surgical resection, radiotherapy (RT), chemotherapy, and immunotherapy (for sinonasal mucosal melanoma) need to be tailored based on tumor histology, stage, and patient-specific factors. Endoscopic surgical approaches demonstrated oncologic outcomes comparable to traditional open techniques, with reduced perioperative morbidity. Neoadjuvant therapies facilitated improved local control and organ preservation in advanced-stage tumors. CONCLUSION: Ongoing advancements in imaging, surgical interventions, as well as (neo)adjuvant therapies have significantly improved the prognostic landscape of sinonasal malignancies. A multidisciplinary, personalized treatment approach remains pivotal in optimizing patient outcomes.