BACKGROUND: The aim of this study was to evaluate the efficacy of mepolizumab as add-on therapy to intranasal corticosteroids for the treatment of severe, uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in...BACKGROUND: The aim of this study was to evaluate the efficacy of mepolizumab as add-on therapy to intranasal corticosteroids for the treatment of severe, uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in a real-life setting in the Triveneto region of northeast Italy. METHODS: Patients with severe CRSwNP receiving mepolizumab were followed up at 1, 3, 6, 9 and 12 months from the first administration. At baseline and at each follow-up, patients underwent nasal endoscopy, completed the Sinonasal Outcome Test 22, Visual Analogue Scales for smell, nasal obstruction, rhinorrhoea and facial pain, the Nasal Congestion Score and the Asthma Control Test. Peak nasal inspiratory flow, Sniffin’ Sticks Identification Test and blood eosinophil count were also evaluated. RESULTS: Ninety patients from twelve different rhinological units were enrolled in the study. Both patient- and physician- derived outcome measures significantly improved within the first month after biological treatment initiation, maintaining the benefit at subsequent follow-ups. Nine percent of patients discontinued the treatment due to lack of benefit within the first year. No major adverse events were reported. CONCLUSIONS: Mepolizumab is effective in improving nasal obstruction and the sense of smell in patients with severe uncontrolled CRSwNP, based on both patient- and physician derived outcome measures.
BACKGROUND: Sinonasal mucosal melanoma (SNMM) is a rare malignant melanoma. Histone deacetylase 7 (HDAC7) is involved in the development of various tumours, but its function in SNMM remains underexplored. METHODOLOGY: We...BACKGROUND: Sinonasal mucosal melanoma (SNMM) is a rare malignant melanoma. Histone deacetylase 7 (HDAC7) is involved in the development of various tumours, but its function in SNMM remains underexplored. METHODOLOGY: We retrospectively studied 30 patients with SNMM treated between 2013 and 2023. Immunohistochemistry was used to assess HDAC7, Β-catenin, c-Myc, and Ki-67 expression. Relationships among HDAC7 expression, clinical characteristics, prognosis,Β-catenin, c-Myc, and Ki-67 were analysed. RESULTS: HDAC7 was overexpressed in SNMM tissues compared to normal tissues. Expression was higher in stage IV compared to stage III and in T4 grade compared to T3 grade. The median overall survival (OS) was 29 months, with 8 patients alive. High-HDAC7 expression (in 13 patients) correlated with poorer OS and disease-free survival (DFS). HDAC's carcinogenic role in SNMM may be mediated by Β-catenin/c-Myc. Univariate analysis for OS revealed high-HDAC7, high c-Myc, positive surgical margins, T4 grade, and stage IV were significant factors leading to SNMM's poor prognosis. However, HDAC7 expression was the only independent prognostic factor. Additionally, a nomogram model showed promising results but was not validated in another cohort. CONCLUSIONS: High-HDAC7 expression is associated with advanced T grade, clinical stage, and poor prognosis in SNMM. HDAC7 may influence cell proliferation, invasion and migration by activating the Β-catenin/c-Myc signalling pathway.
BACKGROUND: To develop a prognostic nomogram based on pretreatment 18F-FDG PET-CT radiomics parameters, peripheral blood indicators and clinical characteristics for risk stratification in patients with de novo metastatic...BACKGROUND: To develop a prognostic nomogram based on pretreatment 18F-FDG PET-CT radiomics parameters, peripheral blood indicators and clinical characteristics for risk stratification in patients with de novo metastatic nasopharyngeal carcinoma (dmNPC) receiving immunochemotherapy. METHODOLOGY: The eligible patients were randomly divided into training (n=183) and validation (n=79) cohorts. Least absolute shrinkage and selection operator regression was used for variable selection. Multivariate Cox regression analysis was performed to identify independent prognostic factors for progression-free survival (PFS). The predictive accuracy and discriminative ability of the nomogram were determined with a concordance index (C-index) and calibration curve. RESULTS: Multivariate Cox analysis suggested that total lesion glycolysis, number of metastases, Epsteinâ€"Barr virus DNA, N-stage, lactate dehydrogenase, and total bilirubin were independent predictors of PFS and were used to develop a nomogram that could classify patients into low- and high-risk groups. The C-index of the nomogram for predicting disease progression was 0.75, which was significantly higher than the C-indices of the TNM stage and EBV DNA. The patients were then stratified into low- and high-risk groups based on the calculated scores. The median PFS was significantly higher in the low-risk group than in the high-risk group. CONCLUSIONS: The proposed nomogram with PET-CT parameters, peripheral blood indicators and clinical characteristics resulted in accurate prognostic prediction for patients with dmNPC receiving chemotherapy plus PD-1 inhibitors and could provide risk stratification for these patients.
BACKGROUND: Chronic rhinosinusitis (CRS) is a highly prevalent upper airway disease. Its pathogenesis remains poorly understood, especially non-eosinophilic CRS. Currently, no validated mouse model exists to study diseas...BACKGROUND: Chronic rhinosinusitis (CRS) is a highly prevalent upper airway disease. Its pathogenesis remains poorly understood, especially non-eosinophilic CRS. Currently, no validated mouse model exists to study disease mechanisms, indicating an important research gap. We aimed at establishing a reproducible mouse model of non-eosinophilic CRS to allow further research on its pathophysiology. METHODOLOGY: Mice were infected with relevant bacteria for sinus disease via surgical insertion of a nasal tampon in their nasal cavity. Inflammatory features in sinus mucosa were evaluated after 4, 8 and 12 weeks on decalcified skulls by histology and immunohistochemistry and by cytospins and enzyme-linked immunoassay on nasal lavage. RESULTS: S. aureus-inoculated mice showed better survival than S. pneumoniae- and P. aeruginosa- inoculated mice. S. aureus and, to lesser extent, P. aeruginosa were still detectable in the nasal lavage up to 12 weeks. Mice with S. aureus and P. aeruginosa-induced CRS showed significant hypertrophia of the epithelium, neutrophilic infiltration and fibrosis in the sinus mucosa, with increased non-Type 2 cytokines in the nasal lavage. CONCLUSIONS: S. aureus and P. aeruginosa are more potent inducers of neutrophilic inflammation than S. pneumoniae in mice. This model allows us to further study non-eosinophilic chronic rhinosinusitis pathophysiology in vivo.
BACKGROUND: Double-blinded placebo-controlled trials have revealed the efficacy of mepolizumab and omalizumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world efficacy (RWE) data...BACKGROUND: Double-blinded placebo-controlled trials have revealed the efficacy of mepolizumab and omalizumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world efficacy (RWE) data, data on therapeutic response and level of disease control for both biologicals are lacking. METHODOLOGY: 167 patients with uncontrolled severe CRSwNP, meeting national reimbursement criteria, were included with follow-up over 24 weeks. Primary outcomes included changes in nasal congestion (NCS), nasal polyp score (NPS), VAS-scores, SNOT-22, ACQ-5, and AQLQ scores. Secondary outcomes were therapeutic response and disease control according to EUFOREA/EPOS criteria. RESULTS: Of the 167 CRSwNP patients, 144 received mepolizumab and 23 omalizumab. After 24 weeks, Patient reported outcomes and NPS significantly improved for both biologicals, with significant effects seen at 12 weeks, with further reduction in NPS by 24 weeks in mepolizumab patients. 74% of patients on omalizumab and 81% of patients on mepolizumab continued their therapy beyond 24 weeks, with 47% and 45% of patients on omalizumab and mepolizumab respectively showing an excellent therapeutic response, with only one out of seven having no/poor response. Disease control was reached in one third of the patients at 24 weeks. CONCLUSIONS: Both mepolizumab and omalizumab significantly improved patient-reported outcomes after 24-weeks, with major effects already observed at 12 weeks. Follow-up beyond 24-weeks might reveal additional effects on both control and remission.
BACKGROUND: Olfactory training is the most widely recommended treatment for smell loss; however, there are no randomised placebo-controlled trials evaluating its effectiveness in COVID-19. We aimed to evaluate the effica...BACKGROUND: Olfactory training is the most widely recommended treatment for smell loss; however, there are no randomised placebo-controlled trials evaluating its effectiveness in COVID-19. We aimed to evaluate the efficacy of isolated training and factors associated to olfactory recovery. METHODS: This is a prospective randomised double-blind controlled trial, using standard olfactory training (OT) and placebo (PB) in COVID-19 patients experiencing smell loss. They were followed up for 180 days and assessed with the Connecticut olfactory test (CCCRC) and with subjective methods on a monthly basis. RESULTS: A total of 123 participants completed follow-up: 68 in the OT group and 55 in the PB group. Overall, 84.5% achieved normosmia, with full recovery (FR) significantly higher in PB. At baseline, OT had lower olfactory scores and higher corticosteroid use. Multivariate analysis showed no significant differences in outcomes between groups. Baseline olfactory test scores were the strongest predictors of recovery. Exploratory analyses stratified participants by time to treatment initiation (early < 30 days; late > 30 days), showing a 58% higher chance of FR in the early group for similar CCCRC scores, regardless of management type. CONCLUSIONS: OT is not superior to PB for treating COVID-19-related smell loss. Better results of first evaluation indicate great chance of full recovery and the use of systemic corticosteroid, in persistent olfactory loss, has not affected outcome.
BACKGROUND: Traditional medicine and herbal medicine are relatively commonly utilized by patients for the treatment of acute (ARS) and chronic rhinosinusitis (CRS). The aim of this study is to review the literature to ev...BACKGROUND: Traditional medicine and herbal medicine are relatively commonly utilized by patients for the treatment of acute (ARS) and chronic rhinosinusitis (CRS). The aim of this study is to review the literature to evaluate scientific evidence regarding the use of herbal preparations in the treatment of rhinosinusitis. METHODOLOGY: We reviewed all published studies until February 2024 in PubMed, EMBASE, and Cochrane, using the followingkeywords: herbal medicine and nasal diseases, herbs and nasal diseases, Traditional Chinese Medicine (TCM) and nasal diseases, traditional medicine and nasal diseases, phytotherapy and nasal diseases. RESULTS: Thirty-three clinical studies met the purpose of this review and were assessed. These studies examine the effect of eleven herbal preparations for the treatment of ARS and CRS. CONCLUSIONS: Herbal preparation BNO-1016 presents significant evidence in the literature regarding its use in the treatment of ARS, while the TCM preparation Xiangju might be a useful component in the treatment of CRS. Specific traditional herbal medicinal products, therefore, show promising results for the treatment of rhinosinusitis, and their use should be examined further. Given the relatively high demand for medicinal herbs, therapeutic use of those preparations should be explored further.
BACKGROUND: Understanding the factors associated with increased rates of restenosis following Draf procedures is crucial for developing targeted strategies to mitigate complications such as mucocele formation, reduce the...BACKGROUND: Understanding the factors associated with increased rates of restenosis following Draf procedures is crucial for developing targeted strategies to mitigate complications such as mucocele formation, reduce the need for revision surgeries, and improve long-term patient outcomes. METHODOLOGY: A systematic search was conducted using Embase, Medline, CINAHL, AMED, PubMed, and the Cochrane Database on January 17th, 2024. Research articles published in English language were included. Abstracts were independently screened by two reviewers, and data were extracted and assessed for quality in adherence to PRISMA guidelines. Meta- and sub-group analyses were conducted using the REML model and random-effects model to address high heterogenity and I2 values. RESULTS: A total of 96 studies met the inclusion criteria. For the Draf IIB subgroup (15 studies, 239 sinuses), the restenosis rate was 7%, compared to 20% in the Draf III subgroup (40 studies, 1,910 sinuses). Revision surgery rates were 5% for Draf IIB versus 12% for Draf III. Adjuvant interventions, such as steroid-impregnated stents, were associated with improved outcomes, showing an ostium patency OR of 2.20. CONCLUSION: Draf IIB had superior outcomes compared to Draf III with respect to restenosis and revision surgery. The use of steroid-impregnated stents appears effective in reducing restenosis rates.
BACKGROUND: Caudal septal deviation accounts for around five percent of patients with septal deviations that require surgery. The caudal septum provides support to the nasal tip and the deviations can narrow the nasal ai...BACKGROUND: Caudal septal deviation accounts for around five percent of patients with septal deviations that require surgery. The caudal septum provides support to the nasal tip and the deviations can narrow the nasal airway and lead to marked asymmetry in nostril shape. Over-resection of this area can compromise the structural support leading to tip collapse or saddle nose deformity. This necessitates alternative techniques to submucosal resection for surgical correction of caudal septal deviations. METHODOLOGY: This study provides a review of different surgical techniques, including open and closed septoplasty in the literature to address caudal septal deviation. Each technique is described along with a surgical illustration, its advantages, limitations, and examples of case studies with surgical outcomes. RESULTS: The submucosal resection is a commonly used method but can only be used if the septal deviation is not involving the L-strut. Other methods include scoring, swinging door, doorstop, and suturing techniques either as a stand-alone or used combined with cutting techniques. Batten graft can be used alone or in conjunction with the other methods. Extracorporeal septoplasty is used in cases of severe deformity. CONCLUSIONS: There is a variety of methods to address caudal septal deviation. Correcting the caudal septal deviation requires proper pre-operative planning and accurate execution of surgical techniques. More research on surgical outcomes is needed to improve the evidence base.
Tumours of the anterior skull base present unique surgical challenges due to critical neurovascular proximity and developing cranial anatomy. While open transcranial approaches (TCAs) have traditionally been used for the...Tumours of the anterior skull base present unique surgical challenges due to critical neurovascular proximity and developing cranial anatomy. While open transcranial approaches (TCAs) have traditionally been used for these tumors, the endoscopic endonasal approach (EEA) is preferred due to reduced morbidity and higher gross total resection (GTR) rates (1). Studies report excellent GTR rates and reconstructive outcomes with EEA in the under-18 paediatric population, with complications including cerebrospinal fluid (CSF) leak, meningitis, and stroke being relatively rare (2-5). However, limitations in anatomy, including restricted sphenoid pneumatization, narrower nasal apertures, and smaller nasoseptal flaps (NSFs), contribute to hesitancy in adopting EEA for younger patients (6,7). Minimal evidence focuses on outcomes in young pediatric patients in particular. This study evaluates outcomes of EEAs for anterior skull base pathologies in young paediatric patients.
The introduction of biologics for the treatment of severe upper and lower (type 2) airway inflammation has been a game changer in the management of these diseases. Biologics are injectable medications targeting different...The introduction of biologics for the treatment of severe upper and lower (type 2) airway inflammation has been a game changer in the management of these diseases. Biologics are injectable medications targeting different molecules relevant in (type 2) inflammation in patients with severe (type 2) airway diseases, like asthma, eosinophilic chronic obstructive pulmonary disease (COPD), chronic rhinosinusitis (CRS) and those who remain uncontrolled despite regular treatment. After the phase 3 trials, showing significant impact on symptoms, quality of life and interventions like surgery (for the upper airways) and exacerbations needing hospitalisation (for the lower airways), biologics are now used in daily practice in many parts of the world. This pocket guide is aimed at all specialists treating adult patients with severe airway disease.
Chronic inflammatory processes of the upper and lower airways can represent a nightmare for both the treating physician as well as suffering patients. The advent of biologicals and use of personalized medicine has revolu...Chronic inflammatory processes of the upper and lower airways can represent a nightmare for both the treating physician as well as suffering patients. The advent of biologicals and use of personalized medicine has revolutionized its management in many ways, still leaving unresolved gaps that need to be closed with innovative approaches and proof of efficacy in everyday life.
BACKGROUND: Chronic rhinosinusitis (CRS) is common worldwide but scarcely studied among young adults. The aim was to investigate prevalence, clinical features, comorbidity, and mucosal inflammatory patterns of CRS among...BACKGROUND: Chronic rhinosinusitis (CRS) is common worldwide but scarcely studied among young adults. The aim was to investigate prevalence, clinical features, comorbidity, and mucosal inflammatory patterns of CRS among 24-year-olds in a populationbased study. METHOD: 3037 subjects from the birth cohort BAMSE (Barn/children Allergy Milieu Stockholm Epidemiology) had complete questionnaire answers on CRS at the 24-year-follow-up. Subjects fulfilling the European Position Paper on Rhinosinusitis (EPOS) criteria of CRS at 16 and/or 24 years (n=141), were invited to a clinical examination. We examined 81 subjects. Sixty-eight subjects were included, of whom 40 had CRSsNP, 2 CRSwNP and 26 CRS symptoms only. Twenty-three controls without CRS from BAMSE were included. Nasal endoscopy was performed, IgE against airborne allergens and cytokine gene expression in nasal lavage (NAL) were analyzed. RESULTS: The questionnaire-based CRS prevalence was 4.1%, of which 2.2% was endoscopically verified. Sensitization to airborne allergens was more often seen among CRSsNP and "CRS symptoms only", compared to controls. Among CRS subjects overall, the proportion of asthma, AR, atopic eczema, and sensitization to airborne allergens was significantly higher compared to the rest of the cohort. The gene expression of IL-1b and IL-8 in NAL was elevated among CRSsNP and "CRS symptoms only" compared to controls, with a trend for TNF-a and MPO. CONCLUSIONS: The prevalence of primary CRS was estimated to 2-4%. There was a significant association between CRS and atopic diseases in this age group. The NAL profile showed signs of type-1 inflammation.
Hellings PW, De Corso E, Backer V
… +16 more, Bernal-Sprekelsen M, Chan Y, Conti DM, Cornet ME, Fokkens WJ, Gevaert P, Han J, Hopkins C, Landis BN, Lau S, Lee S, Lund VJ, Mullol J, Peters A, Schneider S, Senior B
Remission has recently been proposed as the new goal of care in CRSwNP or Nasal Polyp Syndrome by the European Forum for Research and Education in Allergy and Airway Diseases / European Position Paper on Rhinosinusitis a...Remission has recently been proposed as the new goal of care in CRSwNP or Nasal Polyp Syndrome by the European Forum for Research and Education in Allergy and Airway Diseases / European Position Paper on Rhinosinusitis and Nasal Polyps (EUFOREA/EPOS) (1,2) as well as by global leaders in Rhinology (3). In CRSwNP, remission is defined as a prolonged state of control, without bothersome symptoms reported by the patient for at least 12 months, without the need for either oral corticosteroids or endoscopic sinus surgery (ESS), and without endoscopic signs of active disease (1). This new goal of care is to be encouraged by the ENT community and CRSwNP patients as persistent symptoms unalleviated by historical approaches (4,5) can be reduced by new therapies including biologics. The goal of therapy for CRSwNP has long been to achieve control, with Visual Analogue Scale (VAS) and Sino-Nasal Outcome Test (SNOT-22) scores guiding physicians towards a step-up treatment aiming for control (6,7).
BACKGROUND: Fungus ball (FB) typically presents unilaterally, with the maxillary sinus being the most commonly affected site.Multi-sinus FB cases are seldom discussed. METHODOLOGY: A retrospective study involving 1709 FB...BACKGROUND: Fungus ball (FB) typically presents unilaterally, with the maxillary sinus being the most commonly affected site.Multi-sinus FB cases are seldom discussed. METHODOLOGY: A retrospective study involving 1709 FB patients categorized them into single sinus fungus ball (SSFB), double sinus fungus balls (DSFB), and multiple sinus fungus balls (MSFB) groups for clinical analysis. RESULTS: The SSFB group comprised 1596 patients (93.39%), the DSFB group 111 patients (6.50%), and the MSFB group two patients (0.12%). The prevalence of diabetes mellitus in the DSFB group was higher than that in the SSFB group. A female prevalence was noticed and there was no difference in the sex ratio by age group. On computed tomography (CT), maxillary sinus FB group had higher intralesional hyperdensity than sphenoid sinus FB group. Oppositely, sphenoid sinus FB group had higher lateral sinus wall sclerosis than maxillary sinus FB group. CONCLUSIONS: DSFB occurs in a minority of cases but needs to be investigated especially in diabetics given the link between diabetes mellitus and increased DSFB risk. A female predominance is seen in both pre- and postmenopausal women. On CT, the presence of intralesional hyperdensity and lateral sinus wall sclerosis correlates with the location of the FB.
BACKGROUND: Biological treatment has proven effective for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and is increasingly prescribed. However, in the real-world, strict adherence to the recommended...BACKGROUND: Biological treatment has proven effective for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and is increasingly prescribed. However, in the real-world, strict adherence to the recommended dose may not be feasible and studies on the actual administration patterns of biologics are limited. This study aimed to evaluate the patterns of real-world use of biologics for CRS in Korea, through the National Health Insurance Service (NHIS). METHODS: We analysed data from the NHIS database from January 2010 to March 2024. Patients with CRS or nasal polyp defined by the ICD-10 codes, who had undergone computed tomography, and had a history of being prescribed dupilumab or omalizumab were identified. A total of 808 patients were analysed for their administration patterns and systemic corticosteroid use. RESULTS: Twelve weeks after initiation of therapy, 46.2% of patients received dupilumab at 2-weekly intervals and 53.9% of patients on omalizumab patients were receiving treatment at 2- or 4-week intervals. The annual expense of CRS patients treated with biologics was greater than for those receiving other treatments. The average annual usage of systemic steroids was decreased from 33.0 days to 12.7 days after using biologics. CONCLUSIONS: The results of this study which analysed real-world data in a large population, suggest a discrepancy between the recommended dose and real-world administration of biologics. Further studies are warranted on feasible administration schedules that reflect various patient factors and healthcare costs.
Sinonasal inverted papilloma (IP) often appears as a unilateral sinonasal soft-tissue mass with varying enhancement, often accompanied by bone remodelling, intralesional calcifications, focal hyperostosis, and cone-shape...Sinonasal inverted papilloma (IP) often appears as a unilateral sinonasal soft-tissue mass with varying enhancement, often accompanied by bone remodelling, intralesional calcifications, focal hyperostosis, and cone-shaped bone thickening (observed in 60 to 80% of cases) (1,2). A non-contrast sinonasal CT scan may reveal a soft tissue polypoid mass that closely resembles inflammatory polyps (Figure 1 A-D). While hyperostosis is recognized as a marker of the tumor's point of origin (1), intralesional calcifications are less frequently described but may offer valuable insights. Early studies, such as those by Lund and Lloyd (1984), highlighted the presence of intralesional calcifications as a distinct feature of inverted papilloma, a finding later supported by studies emphasizing the role of bone morphogenic proteins in calcification development (4-7).
INTRODUCTION: Hereditary haemorrhagic telangiectasia (HHT) is an uncommon genetic disorder characterised by recurrent, severe epistaxis which poses significant management challenges. Nasal closure has emerged as a treatm...INTRODUCTION: Hereditary haemorrhagic telangiectasia (HHT) is an uncommon genetic disorder characterised by recurrent, severe epistaxis which poses significant management challenges. Nasal closure has emerged as a treatment for refractory cases, however there is limited research on its outcomes. We aim to consolidate existing evidence to assess its efficacy and safety. METHODS: We conducted a systematic search of the Cochrane library, EMBASE, PubMed and non-indexed publications from the past 30 years. Two independent reviewers extracted data and assessed bias from included studies. Findings were summarised via narrative synthesis due to heterogeneity of included studies. RESULTS: 192 patients from ten studies underwent nasal closure. Frequently used outcome measures were validated epistaxis severity scores, Glasgow Benefit Inventory and haemoglobin trends. Surgery improved quality of life and reduced epistaxis severity post-operatively. Partial dehiscence is a frequently reported complication which is usually successfully treated with revision surgery. CONCLUSIONS: Nasal closure reduces epistaxis severity, improving quality of life in patients with severe, refractory HHT-related epistaxis, providing a valuable treatment option for the most challenging cases. The strength of our conclusions is limited by the heterogeneity of outcome measures. To our knowledge, this is the largest pooled database of patients who have undergone nasal closure.
BACKGROUND: Impairment of airflow perception by the intranasal trigeminal system may explain chronic nasal obstruction (CNO),especially in cases where no major deformity or mucosal inflammation can explain reduced airflo...BACKGROUND: Impairment of airflow perception by the intranasal trigeminal system may explain chronic nasal obstruction (CNO),especially in cases where no major deformity or mucosal inflammation can explain reduced airflow. We aim to characterize the effect of topical intranasal anesthesia on intranasal trigeminal sensitivity and consequently the sensation of nasal obstruction. METHODOLOGY: We performed a crossover study of 16 healthy subjects, randomised for either treatment (topical intranasal anesthesia with 10% Xylocaine) or placebo (saline solution). We used the Trigeminal Lateralization Task (TLT) with eucalyptol to assess trigeminal sensitivity. We measured nasal patency objectively with Peak Nasal Inspiratory Flow (PNIF), and subjectively with a Visual Analog Scale (VAS), the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. RESULTS: Topical intranasal anesthesia significantly reduced intranasal trigeminal sensitivity. Further, after topical intranasal anesthesia,reduced trigeminal sensitivity was associated with the subjectively reduced nasal patency, as highlighted by ENS6Q and NOSE scores. CONCLUSIONS: Topical intranasal anesthesia reduces intranasal trigeminal function resulting in subjectively reduced nasal patency. In future studies, the relation of reduced intranasal trigeminal function and subjective nasal obstruction needs to be addressed to open an avenue for potential interventions for an important portion of ENT patients.
BACKGROUND: The COVID-19 pandemic led to a surge in olfactory dysfunction (OD), increasing the need for specialized care. Thi study explores the prevalence, characteristics, and clinical implications of OD in a specializ...BACKGROUND: The COVID-19 pandemic led to a surge in olfactory dysfunction (OD), increasing the need for specialized care. Thi study explores the prevalence, characteristics, and clinical implications of OD in a specialized Smell & Taste Clinic established at the ENT-HNS department of the University Hospitals Leuven (UZ Leuven) in 2021. METHODOLOGY: We included consecutive patients with OD in the observational longitudinal ProspeRo’Scent registry at UZ Leuven between September 2021 and April 2024. Chemosensory assessment was done with psychophysical tests (Sniffin’ Sticks TDI and Taste sprays) and questionnaires. RESULTS: Of the 203 unique, consecutive patients, COVID-19-associated OD (C19OD) was the predominant etiology (50.2%), followed by idiopathic (25.1%), and post-traumatic (8.9%) OD. Parosmia was present in 60.2% of patients, with the highest prevalence in C19OD cases (80.9%). Sniffin’ Sticks TDI testing indicated that patients with parosmia had better olfactory thresholds and discrimination scores than patients without. During follow-up (n=116; average 7.7 months), 31% of C19OD patients exhibited clinically relevant improvement in TDI scores, compared to 13% for the other etiologies. Quality of life, as assessed by sQOD-NS, was not significantly different between etiologies but correlated with higher parosmia scores. CONCLUSIONS: C19OD patients suffered more from parosmia, correlating with worse quality of life, but had better baseline TDI scores and demonstrated a higher likelihood of clinically relevant improvement over time compared to other etiologies.