Nasal septal perforations (NSPs) are a common referral to specialist rhinology practice. A wide range of management options have been described but to be able to offer the most effective treatment modalities to our patie...Nasal septal perforations (NSPs) are a common referral to specialist rhinology practice. A wide range of management options have been described but to be able to offer the most effective treatment modalities to our patients we must be able to capture quantitative data on patient symptom burden accurately and robustly.
Rampinelli V, Ferrari M, Dohin I
… +27 more, Vinciguerra A, Mattavelli D, Saccardo T, Testa G, Conti C, Frigerio C, Verillaud B, Ajasllari G, Gaudioso P, Cazzador D, Aga A, Taboni S, Daniele Arioso A, Neri L, Borsetto D, Wolf A, Rodriguez-Van Strahlen C, Turri-Zanoni M, Emanuelli E, Schreiber A, Battaglia P, Pagella F, Bignami M, Piazza C, Castelnuovo P, Nicolai P, Herman P
BACKGROUND: This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit. METHODOLOGY: A multicentric retr...BACKGROUND: This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit. METHODOLOGY: A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications. RESULTS: The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra-and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone. CONCLUSIONS: This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.
Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) frequently coexist, forming a complex multimorbid condition often referred to as...Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) frequently coexist, forming a complex multimorbid condition often referred to as "global airway disease". This concept reflects shared pathophysiological mechanisms of eosinophilic inflammation and underscores the need for integrated treatment strategies targeting both upper and lower airway manifestations (1). The burden of severe CRSwNP, asthma, and N-ERD is substantial, particularly in terms of reduced quality of life, recurrent exacerbations, revision endoscopic sinus surgeries (ESS), and healthcare utilization (2). Biologics represent a significant advancement in the treatment of global airway diseases.
BACKGROUND: Long COVID frequently presents with persistent olfactory dysfunction (OD), affecting both physical and psychological well-being. This study aims to evaluate the mental health consequences of OD in long COVID...BACKGROUND: Long COVID frequently presents with persistent olfactory dysfunction (OD), affecting both physical and psychological well-being. This study aims to evaluate the mental health consequences of OD in long COVID patients. METHODOLOGY: A cross-sectional study involved 86 adult patients. Participants presented OD for at least three months post-COVID- 19 and were evaluated using the extended battery of Sniffin' Sticks test (SST). Psychological assessments included the Impact of Event Scale-Revised (IES-R), Beck Hopelessness Scale (BHS), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). RESULTS: Significant differences in mental health factors were observed between patients with and without OD: in comparison to normosmic patients, hyposmic patients showed higher IES-R Total, Avoidance, and Hyperarousal scores, along with increased DASS-21 Anxiety scores and BHS total scores. CONCLUSIONS: OD in long COVID patients were significantly associated with increased post-traumatic stress symptoms, anxiety symptoms and hopelessness, and with lower quality of life. Limited sample size, inability to determine causation and exploratory nature of the study may limit the generalizability of results. Comprehensive management addressing both physical and mental health should be assessed in long COVID patients.
Choosing between revision endoscopic sinus surgery (ESS) versus biologic therapy for recurrent chronic rhinosinusitis with nasal polyposis (CRSwNP) is a complex, multifaceted decision that involves not only clinical and...Choosing between revision endoscopic sinus surgery (ESS) versus biologic therapy for recurrent chronic rhinosinusitis with nasal polyposis (CRSwNP) is a complex, multifaceted decision that involves not only clinical and financial factors but also patient preferences. Currently, there are no quantitative studies investigating patient preferences for CRSwNP treatment options. Increased awareness of patient-centered approaches to treatment warrant further investigation.
OBJECTIVE: To validate the French version of the Empty Nose Syndrome Index (Fr-ENSI). METHODS: Patients with ENS, chronic rhinitis/rhinosinusitis, and asymptomatic individuals were recruited from April to August 2024. Th...OBJECTIVE: To validate the French version of the Empty Nose Syndrome Index (Fr-ENSI). METHODS: Patients with ENS, chronic rhinitis/rhinosinusitis, and asymptomatic individuals were recruited from April to August 2024. The internal consistency was evaluated with Cronbach-alpha. The test-retest reliability was assessed with the intraclass correlation coefficient (ICC). The external validity was assessed with a correlation study between the Fr-ENSI and the Sinonasal Outcome Tool-22 (Fr-SNOT-22), and Nasal Obstruction Symptom Evaluation (Fr-NOSE). The Fr-ENSI threshold for suspecting the ENS diagnosis was determined with the receiver operating characteristic (ROC) curve. RESULTS: Ninety-three subjects completed the evaluations. There were 36 ENS patients, 23 patients with chronic rhinosinusitis/rhinitis, and 34 healthy individuals. The mean age was 44.8±14.7 years. Patients with ENS reported significantly higher Fr-ENSI scores compared to others, indicating high internal validity. The Cronbach-alpha of Fr-ENSI was 0.891, which indicates an adequate internal consistency. The test-retest reliability was high. Depression and anxiety scores were associated with sleep disturbances. The Fr-ENSI was significantly correlated with Fr-SNOT-22, which supports a high external validity. The threshold of Fr-ENSI associated with the highest sensitivity and specificity was >23/60. CONCLUSIONS: The Fr-ENSI is a valid and reliable questionnaire for documenting 12 prevalent symptoms of ENS. The consideration of sleep disorders in ENSI is important regarding its association with depression and anxiety.
BACKGROUND: Eosinophilic otitis media (EOM) is a recently recognised type 2 inflammatory disease, strongly associated with asthma and chronic rhinosinusitis with nasal polyps. Known as a difficult-to-treat condition, EOM...BACKGROUND: Eosinophilic otitis media (EOM) is a recently recognised type 2 inflammatory disease, strongly associated with asthma and chronic rhinosinusitis with nasal polyps. Known as a difficult-to-treat condition, EOM is often refractory to traditional therapies for (chronic) otitis media. This review aims to assess the success rates of the different interventions for patients with EOM including newly available biological therapy. METHODOLOGY: In March 2024 we systematically searched PubMed, Embase, Scopus and Web of Science for studies on more than 5 EOM patients undergoing any medical or surgical intervention with a reported success rate. Proportion meta-analysis on a random effect model was used to synthesize results effectively. Risk of bias was assessed through the Risk Of Bias In Non randomized Studies of Interventions tool (ROBINS-I). RESULTS: From 1103 potential articles, 14 studies with 361 patients were included. 62% were females and 85% had bilateral presentation. Otorrhoea was present in 68% of patients, tympanic membrane perforation in 50%. The overall success rate was 61.3. However, interventions comprising biological agents targeting type 2 inflammatory cascade showed higher success rates compared to non-biological treatments. CONCLUSIONS: A shift towards biologic-based therapies could be beneficial for managing the challenging condition EOM.
BACKGROUND: This study aims to digitalize surgical maneuvers in ESS using a motion capture system under standardized conditions provided by 3D printed-sinus models. METHODOLOGY: Forty-seven otolaryngologists performed ES...BACKGROUND: This study aims to digitalize surgical maneuvers in ESS using a motion capture system under standardized conditions provided by 3D printed-sinus models. METHODOLOGY: Forty-seven otolaryngologists performed ESS on 3D printed models manufactured from computed tomography (CT) images of actual patients. Participants were classified to 3 groups according to the objective structured technical skills assessment score. All surgical maneuverers performed during ESS were captured by a motion capture system. The path length, velocity, acceleration, and jerk were calculated for each surgical instrument and compared among the groups. Principle Component Analysis (PCA) was utilized to identify which metrics reflected surgical skill level. In addition, ten registrars repeated the surgical dissection. Their motion metrics were also compared between first training and the repeated training and then subjected to the PCA. RESULTS: Several metrics such as the angular acceleration and jerk of the cutting forceps were identified by PCA as possible indicators distinguishing the different skill levels for the ESS maneuvers. PCA analysis in the repetitive training also found the angular metrics of the upturned-cutting forceps correlating to their skill improvement. CONCLUSIONS: Combined with the validated 3D-printed sinus models, the motion capture system provided the objective evaluation of the surgical performances of ESS.
BACKGROUND: Corticosteroids are used in managing Chronic Rhinosinusitis (CRS) through several formulations, including oral steroids and nasal sprays. More recently, incorporating concentrated budesonide respules into hig...BACKGROUND: Corticosteroids are used in managing Chronic Rhinosinusitis (CRS) through several formulations, including oral steroids and nasal sprays. More recently, incorporating concentrated budesonide respules into high-volume saline irrigations has been proposed to enhance the penetration of topical steroids into the paranasal sinuses. We aim to evaluate the safety and efficacy of budesonide nasal irrigation (BNI) in managing CRS. METHODOLOGY: A systematic review with meta-analysis was performed following PRISMA guidelines. Data were extracted independently from the eligible studies. In double-arm and single-arm meta-analyses, continuous outcomes were pooled using mean difference (MD) with a 95% confidence interval (CI). RESULTS: Twenty-six studies were reviewed, comprising 1464 patients. BNI had better outcomes than saline nasal irrigation (SNI) regarding Sino-Nasal Outcome Test score (SNOT-22). Lund-Kennedy Endoscopy scores (LKES) changed from baseline. Regarding safety, there was no significant difference between BNI and SNI regarding Intraocular Pressure (IOP). Single-arm analysis showed a pooled mean serum cortisol level within the normal range after BNI. CONCLUSIONS: BNI demonstrated improved SNOT-22 and LKES scores, with normal post-treatment IOP and cortisol levels, indicating a beneficial impact on CRS while maintaining safety.
In our recent study, increased viscosity, delayed mucociliary clearance as well as hyposensitivity/dysesthesia of the nasopharynx seemed to play a relevant role in the pathophysiology of postnasal drip (PND). Earlier con...In our recent study, increased viscosity, delayed mucociliary clearance as well as hyposensitivity/dysesthesia of the nasopharynx seemed to play a relevant role in the pathophysiology of postnasal drip (PND). Earlier concepts of PND, regarding an increased volume of secretions and atopy, do not seem to hold true since our latest analyses showed no significant difference between cases and controls. However, to this day its therapy is debated and the evidence for an effective treatment of PND is lacking so far. The fundamental rheological properties of nasal mucus constitute of the viscosity and elasticity.
BACKGROUND: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinic...BACKGROUND: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited. METHODOLOGY: In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months. RESULTS: We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months. CONCLUSIONS: This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.
BACKGROUND: Allergen-specific immunotherapy (AIT) is a disease-modifying therapy and is effective to reduce the symptoms of grass pollen-allergy. The airway epithelium of these patients releases inflammatory mediators in...BACKGROUND: Allergen-specific immunotherapy (AIT) is a disease-modifying therapy and is effective to reduce the symptoms of grass pollen-allergy. The airway epithelium of these patients releases inflammatory mediators including type-2 cytokines, which are associated with cellular processes involved in the symptomatic response of the affected tissue. Aim of the study was to identify epithelial biomarkers indicating AIT progress. METHODS: In an exploratory, observational allergy cohort, we longitudinally phenotyped 56 grass pollen-allergic patients undergoing AIT for over three years and 18 controls using nasal secretions at critical time windows during therapy to assess peak-season responses along the course of therapy. Type-2 cytokine protein levels were analyzed using the high-sensitivity multiplex electrochemiluminescence mesoscale technique. RESULTS: The type-2 cytokines CCL26 and POSTN oscillated seasonally, in contrast to TSLP and IL-33. However, only POSTN was reduced over the three-year AIT progression. In addition to POSTN, IL-24 and IL-37 levels were continuously reduced during AIT, while IFN-g and CCL27 were increased. Compared to healthy individuals, AIT did not restore healthy secretion levels but rather induced a novel homeostasis CONCLUSION: Nasal secretions trace the epithelial response during different phases of AIT. We demonstrate that AIT only partially controls the epithelial type 2 cytokine CCL26, which also adapts to seasonal changes, while POSTN and IL-24 are potential indicators of therapy success. Therefore, nasal secretions represent a promising, non-invasive tool for monitoring seasonal progress of AIT.
BACKGROUND: The intravenous olfactory test (alinamin test [AT]) is a retronasal olfactory assessment and may evaluate the flavour disorder; however, studies assessing whether AT accurately determines the severity of tast...BACKGROUND: The intravenous olfactory test (alinamin test [AT]) is a retronasal olfactory assessment and may evaluate the flavour disorder; however, studies assessing whether AT accurately determines the severity of taste disorders are lacking. Our study aims to evaluate the relationship between AT and subjective taste disorders in the patiensts with olfactory disorder. METHODS: Between April 2019 and March 2020, 228 patients visited our smell clinic reporting olfactory disorders. Of these, 193 patients who underwent AT were included in this study. We evaluated the differences in AT response, latency time, and duration time between patients with and without subjective taste disorder. We also assessed the degree of subjective taste disorder experienced by patients using the visual analogue scale (VAS) and the correlation between latency and duration time of AT. To assess taste perception more broadly, we inquired about the presence of disorder using the term "taste" rather than "flavour" without focusing on any specific type of taste disorder. RESULTS: Of the included 193 patients, 62 reported awareness of a taste disorder. The duration time of AT was significantly shorter in patients with subjective taste disorder. A weak correlation was found between the VAS scores for subjective taste disorders and the duration time of AT. CONCLUSIONS: Our results showed that among the patients with olfactory disorders, the duration time of AT was reduced for those with subjective taste disorders.
Chronic rhinosinusitis with nasal polyps (CRSwNP) often co-exists with asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), creating a more severe phenotype and an additional burden co...Chronic rhinosinusitis with nasal polyps (CRSwNP) often co-exists with asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), creating a more severe phenotype and an additional burden compared with CRSwNP disease alone. The relationship between these diseases in terms of shared immunological disbalance has been coined in the literature as "global airway disease" or "unified airway disease" and requires integrated treatment strategies. Our post hoc analysis of the Phase III randomised, double-blind, placebo-controlled, multicentre SYNAPSE study (GSK ID: 205687; NCT03085797) assessed the efficacy of mepolizumab, an anti-interleukin-5 monoclonal antibody, in simultaneously improving both CRSwNP and asthma outcomes versus placebo. By utilising a combined measure that accounts for quality of life, sinonasal symptoms and asthma control, we aimed to validate the potential of mepolizumab as an effective therapeutic option for global airway disease.
BACKGROUND: Delivery mode can influence infant microbial diversity, cause immune dysregulation, and potentially increase the risk of allergic rhinitis (AR). METHODOLOGY: A systematic review and meta-analysis were perform...BACKGROUND: Delivery mode can influence infant microbial diversity, cause immune dysregulation, and potentially increase the risk of allergic rhinitis (AR). METHODOLOGY: A systematic review and meta-analysis were performed to assess the association between distinct modes of delivery and the development of AR in childhood and adulthood. The primary comparison was vaginal (VD) versus cesarean delivery (CD). Secondary comparisons were specified CD (elective, emergency) versus specified VD (spontaneous, abnormal) and nonmicrobiota-exposed versus microbiota-exposed deliveries. The outcomes were subsequent risks of AR presenting as odd ratios and 95% confidence intervals. RESULTS: Thirty-seven studies were analyzed. Compared to VD, CD, and its specified modes were associated with higher subsequent risks of AR in the population under age 18. The quality of evidence supporting these effects is rated as very low to low following GRADE. Spontaneous VD was associated with lower AR risk compared to CD, but there was no significant difference between abnormal VD and CD. The distinction between non-microbiota-exposed and microbiota-exposed deliveries did not affect AR risk significantly. CONCLUSIONS: The estimated odds ratios demonstrated a positive association between cesarean section and AR up to 18 years of age. A comprehensive categorization of delivery mode is necessary to interpret the existing evidence thoroughly.
Allergic fungal rhinosinusitis (AFRS) is a localized inflammatory, hypersensitivity reaction affecting the nasal cavity and its sinuses secondary to fungal colonization. The burden of surgical revisions and recurrence ra...Allergic fungal rhinosinusitis (AFRS) is a localized inflammatory, hypersensitivity reaction affecting the nasal cavity and its sinuses secondary to fungal colonization. The burden of surgical revisions and recurrence rates in this disease led to a recent hypothesized advancement in the medical management being experimented, which is the use of biologics. Therefore, this systematic review analyzed nine articles to highlight the significance of biologics in the management of AFRS through a comprehensive strategy, as seen in Supplementary Methods Section.
This review discusses major developments in chronic rhinosinusitis. The latest papers on prevalence of the disease, the burden for patients and society, the lack of awareness, the development of patient classifications a...This review discusses major developments in chronic rhinosinusitis. The latest papers on prevalence of the disease, the burden for patients and society, the lack of awareness, the development of patient classifications and the consequences for the management of the disease. Our discussion includes major developments in the treatment of the disease with biologics but also their limitations. Recent developments also include evolution in the goals of care, where until recently we were content with control of disease but now start to aim for remission and maybe even cure. To reach that aim we need better definitions of disease, outcomes and biomarkers to predict the optimal moment of intervention in the development of the disease. Time will tell whether earlier intervention can prevent development of the disease and later sequelae.
Sanchez-Gomez S, Moreno-Luna R, Martin-Jimenez D
… +7 more, Maza-Solano J, Del Cuvillo A, Villacampa-Auba JM, Gonzalez-Garcia J, Fernandez-Liesa R, Alobid I, Bernal-Sprekelsen M
In the last decades, various types of endoscopic sinus surgery (ESS) have emerged as treatments for chronic rhinosinusitis (CRS), particularly with the development of personalized, endotype-driven approaches targeting mu...In the last decades, various types of endoscopic sinus surgery (ESS) have emerged as treatments for chronic rhinosinusitis (CRS), particularly with the development of personalized, endotype-driven approaches targeting mucosal inflammation and remodeling. Despite these advancements, the literature reports heterogeneous and often divergent outcomes, leaving the actual benefit of more extensive surgical approaches in CRS control a matter of ongoing debate. This discrepancy stems from inconsistent definitions of surgical techniques, leading to variations in osseous and mucosal resections depending on patient phenotype, disease severity and surgeon preference. To address this inconsistency, the Japanese Rhinology Society introduced a classification based on procedure extent, but it lacks details on anatomical structures and mucosal treatment. Similarly, the ACCESS system measures ESS extent with postoperative CT-scans but overlooks mucosal interventions.
INTRODUCTION: Nasopharyngeal cancer (NPC) is a relatively rare yet aggressive malignancy, primarily affecting regions of East and Southeast Asia. This study aims at providing an up-to-date quantification of the associati...INTRODUCTION: Nasopharyngeal cancer (NPC) is a relatively rare yet aggressive malignancy, primarily affecting regions of East and Southeast Asia. This study aims at providing an up-to-date quantification of the association between cigarette smoking and NPC risk, overall and by histological subsites. METHODS: We conducted a systematic review and meta-analysis of case-control and cohort studies on the association between cigarette smoking and NPC risk published up to May 2023. The methodology used is original and efficient and includes both a comprehensive umbrella review and a traditional review. We estimated pooled relative risks (RR) of NPC according to smoking status, intensity, duration, and time since quitting. RESULTS: Among 46 eligible articles, 40 original studies were included in this meta-analysis. Compared with never smokers, the pooled RR of NPC was 1.61 for current, 1.28 for former, and 1.62 for ever smokers. The RR for ever compared with never smokers was 2.37 for squamous cell NPC and 1.06 for undifferentiated NPC. NPC risk significantly increased linearly with smoking intensity and duration, and decreased linearly with increasing time since quitting. CONCLUSION: This meta-analysis confirms the link between tobacco smoking and NPC, highlighting the significant risk posed even by moderate cigarette consumption. Additionally, our findings underscore the differential risk between squamous cell and undifferentiated subtypes of NPC, shedding light on the distinct implications for NPC prevention strategies.