International Forum of Allergy and Rhinology 2022-06-30

Association of computed tomography scores to psychophysical measures of olfaction: A systematic review and meta‐analysis

Tiffany Chen, Shreya Chidarala, Gabrielle Young, Seth S. Jeong, Shaun A. Nguyen, Thomas S. Edwards, Rodney J. Schlosser

Publication date 30-06-2022


Abstract Background While various sinus computed tomography (CT) scoring systems have been proposed and used in the literature, no single system has been identified as superior. Strength of associations between CT scoring systems and measures of olfaction also remain unclear.
MethodsA systematic review of Pub Med, CINAHL, Scopus, and Cochrane Library was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Studies that reported both CT scores and measures of olfaction in a cross-sectional manner were included.
ResultsA total of 37 studies were eligible for meta-analysis. Out of 8035 patients with chronic rhinosinusitis, 55.6% were male patients and 53.2% had chronic rhinosinusitis with nasal polyps. Analysis by meta-regression was performed of Lund-Mackay vs. Smell Identification Test-40 (SIT-40, N = 12 studies), Brief Smell Identification Test (BSIT, N = 10 studies), Sniffin’ Sticks (N = 10 studies), and Toyota & Takagi (T&T) olfactometry (N = 4 studies). Significant moderate association was found between LM and SIT-40 (R2 = 0.612, p<0.001) and LM and Sniffin’ Sticks (R2 = 0.612, p<0.001). Association between LM and BSIT approached significance (R2 = 0.461, p = 0.054). No significant associations were noted between LM and T&T olfactometry and between LM and Sniffin’ Sticks when stratified by nasal polyp status.
Conclusion There is significant moderate association of current CT scoring systems to SIT-40 and Sniffin’ Sticks. Further research should focus on associations of CT scores of the nasal cavity, sinuses, and olfactory cleft as well as other disease markers to objective measures of olfaction.
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Computational fluid dynamic modeling of the effect of dupilumab in the management of anosmia secondary to CRSwNP

Thomas J. Lepley, Zhenxing Wu, Zach Root, Drew Mountain, Bradley A. Otto, Kathleen Kelly, Kai Zhao

Publication date 29-06-2022


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Persistent discharge or edema after endoscopic sinus surgery in patients with chronic rhinosinusitis is associated with a type 1 or 3 endotype

Eli Stein, Alexander L. Schneider, Regan Harmon, Samuel D. Racette, Abhita T. Reddy, Caroline P. E. Price, Julia H. Huang, Atsushi Kato, Stephanie Shintani‐Smith, David B. Conley, Kevin C. Welch, Robert C. Kern, Bruce K. Tan

Publication date 28-06-2022


Abstract Background Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
Methods At a visit 6–12 months post ESS, patients underwent endoscopy and completed the CRS-PRO and SNOT-22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN-γ, ECP, and IL-17a. Type 1, 2, and 3 endotypes were defined as greater than the 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank-sum and chi-squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.
ResultsA total of 122 CRS patients completed a clinical exam (median: 8.2 months post ESS). Of the 122 patients, 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared with those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS-PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs. 7.0, p < 0.001; respectively), and had higher post-ESS IFN-γ, ECP, and IL-17a. Patients with discharge had higher prevalence of only T1 and T3 endotypes, while patients with edema had higher prevalence of only the T3 endotype.
Conclusions Post-ESS discharge or edema in the absence of polyps was associated with higher patient-reported outcome severity and was more strongly associated with type 1 or 3 inflammation.

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Long‐term outcomes following repair of nasal valve collapse with temperature‐controlled radiofrequency treatment for patients with nasal obstruction

Ofer Jacobowitz, Dale Ehmer, Brent Lanier, William Scurry, Bryan Davis

Publication date 27-06-2022


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Parosmia assessment with structured questions and its functional impact in patients with long‐term COVID‐19‐related olfactory dysfunction

Paolo Boscolo‐Rizzo, Claire Hopkins, Anna Menini, Michele Dibattista, Emilia Cancellieri, Nicoletta Gardenal, Margherita Tofanelli, Romina Valentinotti, Jerome R. Lechien, Luigi Angelo Vaira, Giancarlo Tirelli

Publication date 27-06-2022


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Efficacy of the exhalation delivery system with fluticasone in patients with chronic rhinosinusitis with nasal polyps whose symptoms recur after sinus surgery

Randall A. Ow, Zachary M. Soler, Raj Sindwani, Donald A. Leopold, Jivianne T. Lee, Ramy A. Mahmoud, Joseph K. Han

Publication date 26-06-2022


Abstract Background Sinus surgery removes inflamed tissue, restores airflow, and improves delivery of medication into surgically opened spaces. The exhalation delivery system with fluticasone (EDS-FLU; XHANCE®) uses a novel delivery system to create closed-palate, positive-pressure, bidirectional mechanics that significantly alter the deposition of the topically acting anti-inflammatory medication. We ask whether EDS-FLU efficacy differs for patients with recurrent symptoms after sinus surgery versus patients without surgery.
Objective We aimed to compare EDS-FLU treatment responses in patients with recurrent symptoms after endoscopic sinus surgery (ESS) and patients who have never had sinus surgery.
Methods Data were pooled from two large, controlled trials (NAVIGATE I and II) for exploratory analyses. Chronic rhinosinusitis symptoms, polyp grade, and quality-of-life measures were compared between patients with prior ESS and those without prior ESS.
Results Patients with prior ESS (exhalation delivery system–placebo n = 53, EDS-FLU 186 μg n = 52, and EDS-FLU 372 μg n = 49) and unoperated patients (exhalation delivery system–placebo n = 108, EDS-FLU 186 μg n = 108, and EDS-FLU 372 μg n = 111) treated with EDS-FLU reported similar and substantial benefits as measured by multiple symptom and quality-of-life/functioning outcomes (congestion score, 22-Item Sinonasal Outcomes Test SNOT-22, Rhinosinusitis Disability Index RSDI, Patient Global Impression of Change) and by nasal polyp grade. In previously operated patients, unlike surgery-naive patients, multiple outcomes (SNOT-22, RSDI, polyp grade) consistently showed numerically but not statistically greater responses to the higher dose.
Conclusions Patients with recurrent symptoms after sinus surgery who were treated with EDS-FLU demonstrated significant symptom and quality-of-life improvement. Unlike unoperated patients, patients with prior ESS had a numerically but not statistically greater response to the higher dose of EDS-FLU (two sprays per nostril twice a day).

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Bilateral juvenile nasopharyngeal angiofibroma with hepatoblastoma and horseshoe kidney: Implication of common molecular signaling?

Garima Upreti, Regi Thomas, Sharon Milton, Rajan Sundaresan

Publication date 26-06-2022


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Endoscopic surgery is superior to intensity modulated radiotherapy in the treatment of advanced recurrent nasopharyngeal carcinoma

Wanpeng Li, Qianqian Zhang, Fu Chen, Haoyuan Xu, Qiang Liu, Huan Wang, Huankang Zhang, Quan Liu, Yurong Gu, Houyong Li, Xicai Sun, Hongmeng Yu, Dehui Wang

Publication date 24-06-2022


Abstract Background: The choice between endoscopic surgery and re-radiotherapy as the main treatment modality in patients with advanced recurrent nasopharyngeal carcinoma (rNPC) remains controversial. Therefore, in this study, we compared the efficacies of endoscopic surgery and intensity-modulated radiotherapy (IMRT) in patients with rNPC.
Methods: All patients with advanced rNPC (T3 and T4) who underwent salvage treatment were enrolled from January 2009 to December 2020. Overall survival (OS) was analyzed using a log-rank analysis. Univariate and multivariate analyses of OS were performed using a Cox regression model. Common treatment-related complications of endoscopic surgery were compared with those of IMRT.
Results: The numbers of patients with T3 and T4 tumors were 163 (64.2%) and 91 (35.8%), respectively; 192 patients underwent endoscopic surgery, 51 received IMRT, and 11 received three-dimensional conformal radiotherapy (3D-CRT). The 3-year OS of patients treated with endoscopic surgery was 59.3%, which was significantly higher than that of patients treated with IMRT (34.7%, P<0.001) or 3D-CRT (43.6%, P = 0.012). Multivariate analyses showed that IMRT was an independent risk factor for OS compared with endoscopic surgery (hazard ratio, 2.068; 95% confidence interval, 1.395–3.069, P<0.001). Complications of aural fullness (P = 0.001), nasopharyngeal necrosis (P = 0.004), nasopharyngeal hemorrhage (P = 0.004), dysphagia (P<0.001), and cerebral infarction (P = 0.030) were significantly lower in the endoscopic surgery group than in the IMRT group.
Conclusion: Endoscopic surgery may be a more promising salvage treatment than IMRT to maximize survival and minimize treatment-related complications in advanced rNPC. These results will be significant in deciding the optimal treatment for patients with advanced rNPC.
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Can we make biologic therapy more affordable?

Ameen Biadsee, Spencer Payne, Leigh J. Sowerby

Publication date 23-06-2022


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Association of cytokine profile with prior treatment failure and revision surgery in chronic rhinosinusitis

Elizabeth S. Longino, Alex B. Labby, Jeffanie Wu, Nikita Chapurin, Ping Li, Rakesh K. Chandra, Justin H. Turner, Naweed I. Chowdhury

Publication date 23-06-2022


Abstract Background Inflammatory patterns in chronic rhinosinusitis (CRS) may predict disease severity, need for multiple sinus surgeries, and treatment response. This study analyzes nasal mucus inflammatory cytokine patterns in patients with (CRSwNP) and without (CRSsNP) nasal polyposis and their association with revision sinus surgery.
MethodsA total of 319 CRS patients who underwent sinus surgery were included. Cytokines were quantified in intraoperative mucus specimens using a multiplex flow cytometric bead assay. Cytokine expression patterns in patients with 0, 1, and ≥2 previous surgeries were analyzed using Kruskal-Wallis and principal component (PC) regression analyses.
Results There were 122 (38%) patients with CRSsNP and 197 (62%) with CRSwNP. On univariate analysis, interleukin (IL)-1β, IL-6, IL-8, and IL-21 were associated with increasing number of sinus surgeries in CRSsNP, as were IL-2, IL-4, IL-5, IL-6, IL-9, IL-17A, and tumor necrosis factor (TNF)-α in CRSwNP. PC analysis with continuous Poisson regression in CRSwNP demonstrated that high IL-5 and IL-13 and low IL-1β, IL-12, and IL-21 were associated with more prior surgeries. In CRSsNP low IL-13 and high IL-5 and regulated-on-activation, normal T-cell–expressed and secreted (RANTES) were associated with more prior surgeries. Age remained a significant covariate in the full regression model for CRSsNP, but was nonsignificant in CRSwNP.
Conclusion In CRSwNP, elevated IL-5 and IL-13 levels were higher at time of surgery in patients with more prior surgeries. Type 2 cytokines in CRSsNP demonstrated mixed associations with revision surgery. For both phenotypes, IL-10, IL-12, and IL-21 were consistently lower as number of prior surgeries increased, suggesting that treatment-resistant disease may be modulated by impairment in these signaling pathways.

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Year in review: 2021 IFAR article summary

Nicholas R. Rowan, Daniel M. Beswick

Publication date 23-06-2022


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Novel intraoperative fast anatomic mapping as teaching adjunct in endoscopic sinus surgery

Jennifer E. Douglas, Tapan D. Patel, Bianca E. Rullan‐Oliver, Michael A. Kohanski, James N. Palmer, Nithin D. Adappa

Publication date 23-06-2022


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Indications for Absorbable Steroid‐Eluting Sinus Implants: Viewpoint via the Delphi Method

"Victoria S. Lee, Prayag Patel, Daniel OBrien, George A. Scangas, Raewyn G. Campbell, Rakesh Chandra, Greg E. Davis, Joseph K Han, Christopher H. Le, Jivianne Lee, Amber U. Luong, David M. Poetker, Hassan Ramadan, Michael Setzen, Kristine Smith, Sarah Wise, Jennifer Villwock, Elisabeth Ference"

Publication date 21-06-2022


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Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

Arash Abiri, Tirth R. Patel, Emily Nguyen, Jack L. Birkenbeuel, Bobby A. Tajudeen, Garret Choby, Eric W. Wang, Rodney J. Schlosser, James N. Palmer, Nithin D. Adappa, Edward C. Kuan

Publication date 21-06-2022


Abstract Background Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence-based guidance.
Methods The Pub Med, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topics aggregate grade of evidence was evaluated.
ResultsA total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction.
Conclusion The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high-quality studies are needed in order to devise optimal postoperative ESBS protocols.

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Prevalence of familiar link in patients affected by chronic rhinosinusitis with nasal polyposis

Francesco Giombi, Alejandra Carrón‐Herrero, Francesca Pirola, Giovanni Paoletti, Emanuele Nappi, Elena Russo, Armando De Virgilio, Giuseppe Mercante, Giorgio Walter Canonica, Giuseppe Spriano, Enrico Heffler, Luca Malvezzi

Publication date 20-06-2022


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Impact of sleep dysfunction on psychological burden in patients with empty nose syndrome

Chien‐Chia Huang, Pei‐Wen Wu, Yun‐Shien Lee, Chi‐Che Huang, Po‐Hung Chang, Chia‐Hsiang Fu, Ta‐Jen Lee

Publication date 19-06-2022


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Temperature‐controlled radiofrequency neurolysis for treatment of chronic rhinitis: 12‐month outcomes after treatment in a randomized controlled trial

Masayoshi Takashima, J. Pablo Stolovitzky, Randall A. Ow, Stacey L. Silvers, Nadim B. Bikhazi, Curtis D. Johnson

Publication date 17-06-2022


Abstract Background: Temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN) area for the treatment of chronic rhinitis was previously reported as superior to a sham control procedure at 3 months postprocedure in this randomized controlled trial (RCT).
The primary endpoint was responder rate: ≥30% improvement (decrease) in 24-hour reflective total nasal symptom score (rTNSS) from baseline. Here, 12-month outcomes following active treatment are reported.
Methods: This was a prospective, multicenter, patient-blinded RCT. Patients in the index active treatment arm were unblinded at 3 months and followed through 12 months. At 3 months, eligible sham control arm patients were invited to crossover to active treatment. Eligibility criteria included rTNSS ≥6, with moderate-severe rhinorrhea and mild-severe congestion. The TCRF stylus was applied bilaterally to non-overlapping areas in the region of the PNN.
Results: Patients in the index active treatment arm had a mean baseline rTNSS of 8.3 (95%CI 7.9 to 8.7), n = 77. At 12 months, the responder rate was 80.6% (95%CI 69.1%-89.2%), n = 67. At 12 months, the mean change in rTNSS was −4.8 (95%CI −5.5 to −4.1); p<.001; a 57.8% improvement. The available initial rTNSS-based outcomes in the crossover active treatment arm (n = 27) were following the same course as the index treatment arm. No serious adverse events and 8 adverse events related to the device/procedure were reported in the trial to date.
Conclusion: TCRF neurolysis of the PNN area is safe and the symptom burden improvement that was superior to a sham procedure at 3 months was sustained through 12 months.
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Improved sinonasal symptom and endoscopy sinus scores with dose‐escalated intranasal mometasone irrigation in patients with refractory chronic rhinosinusitis

Peter Papagiannopoulos, Hannah J. Brown, Young Jae Kim, Thomas K. Houser, Ashwin Ganti, Richard A. Raad, Edward C. Kuan, Phillip Losavio, Pete S. Batra, Bobby A. Tajudeen

Publication date 17-06-2022


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Nasal inflammatory profile in patients with COVID‐19 olfactory dysfunction

Katherine Chang, Dorina Kallogjeri, Jay Piccirillo, Stacey L. House, Justin Turner, John Schneider, Nyssa Fox Farrell

Publication date 17-06-2022


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Assessing the utility of intrathecal fluorescein in endoscopic repair of anterior skull base cerebrospinal fluid leaks

Jeffrey P. Radabaugh, Karim Asi, Zi Y. Jiang, Swetha Jayavelu, William C. Yao, Amber U. Luong, Martin J. Citardi

Publication date 17-06-2022


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Taste receptors in chronic rhinosinusitus, what is the evidence? A systematic review

Jonathan H. Chen, Christopher I. Song, Nanki Hura, Anirudh Saraswathula, Stella M. Seal, Andrew P. Lane, Nicholas R. Rowan

Publication date 17-06-2022


Abstract Background Bitter and sweet taste receptors (T2Rs and T1Rs), respectively, are involved in the innate immune response of the sinonasal cavity and associated with chronic rhinosinusitis (CRS). Growing evidence suggests extraoral TRs as relevant biomarkers, but the current understanding is incomplete. This systematic review synthesizes current evidence of extraoral taste receptors in CRS.
Methods Pub Med, Embase, Cochrane, Web of Science, and Scopus were reviewed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines and included studies of genotypic and phenotypic T2R/T1R status in CRS patients.
Results Twenty-two studies with 3845 patients were included. Seventeen studies evaluated genotype and 10 evaluated taste phenotypes. Four of 6 studies examining the haplotype distribution of the T2R, TAS2R38, demonstrated increased AVI/AVI haplotype (“nontaster”) frequency in CRS. Meanwhile, 2 studies demonstrated decreased bitter sensitivity in CRS with nasal polyposis (CRSwNP), whereas 3 other studies reported decreased bitter sensitivity only in CRS without nasal polyposis (CRSsNP). Findings regarding sweet sensitivity were mixed. Three studies with cystic fibrosis patients (n = 1393) were included. Studies investigating the association between clinical outcomes and TAS2R38 alleles were limited, but the nonfunctional combination of AVI/AVI was associated with increased utilization of sinus surgery and, in CRSsNP patients, with poorer improvement of symptoms postoperatively.
Conclusion Both genotypic and phenotypic assessments of T2Rs suggest a potential association with CRS, particularly CRSsNP. However, limited evidence and mixed conclusions cloud the role of T2Rs in CRS. Future investigations should aim to increase diverse populations, broaden institutional diversity, examine T1Rs, and utilize uniform assessments.

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Venous thromboembolism rates and risk factors following endoscopic skull base surgery

Michael T. Chang, Kawinyarat Jitaroon, Sunhee Song, Pooya Roozdar, Yossawee Wangworat, Nour Ibrahim, Yifei Ma, Vidya K. Rao, Steven D. Chang, Juan C. Fernandez‐Miranda, Zara M. Patel, Robert L. Dodd, Peter H. Hwang, Griffith R. Harsh, Jayakar V. Nayak

Publication date 17-06-2022


Abstract Background Venous thromboembolism (VTE) is a potentially fatal perioperative complication. The objective of this study was to assess the rate and risk factors for VTE in endoscopic skull base surgery (ESBS).
Methods This was a retrospective review of adults undergoing ESBS at a tertiary academic center. Incidence of VTE in the 30-day postoperative period was recorded. Logistic regression analyses identified factors associated with VTE.
ResultsA total of 1122 ESBS cases performed at Stanford University School of Medicine between 2009 and 2019 were studied. Almost all cases (96.1%) did not employ perioperative VTE chemoprophylaxis. The overall incidence of VTE was 2.3% (26/1122). Malignant pathologies had a higher rate of VTE compared with nonmalignant pathologies (4.5% vs 2.0%, odds ratio OR 2.85, 95% confidence interval CI 1.22–6.66). Factors associated with an increased risk of VTE included a Caprini score greater than 5 (OR 1.53, 95% CI 1.28–1.83); multiple preoperative endocrinopathies such as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (OR 22.48, 95% CI 3.93–128.70), adrenal insufficiency (OR 5.24, 95% CI 1.82–15.03), hypercortisolism (OR 4.46, 95% CI 1.47–13.56), and hypothyroidism (OR 3.69, 95% CI 1.66–8.20); each 10-hour increment of lumbar drain duration (OR 1.16, 95% CI 1.08–1.25); and each 10-hour increment for duration of hospitalization (OR 1.05, 95% CI 1.03–1.06).
Conclusions The incidence of VTE following ESBS is relatively low at 2.3%. Factors with a higher association of VTE include malignancy, preoperative endocrinopathies, higher Caprini score, prolonged lumbar drain duration, and prolonged hospitalization. Larger, multi-institutional studies are needed to validate these findings and to better refine clinical decision-making regarding perioperative VTE prophylaxis.

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The atopic march in southern China is picking up pace

Rongfei Su, Anni Yang, Kaisen Tan, Jiaoping Mi, Zhenpeng Liao, Yingxiang Xu, Jun Zhang, Yunping Fan, Haiyu Hong

Publication date 17-06-2022


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Olfactory dysfunction in people with cystic fibrosis with at least one copy of F508del

Daniel M. Beswick, Stephen M. Humphries, Connor D. Balkissoon, Matthew Strand, Jessa E. Miller, Aastha Khatiwada, Eszter K. Vladar, David A. Lynch, Jennifer L. Taylor‐Cousar

Publication date 17-06-2022


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Rapid and sustained effects of dupilumab in severe chronic rhinosinusitis with nasal polyps

Peter W. Hellings, Anju T. Peters, Adam M. Chaker, Enrico Heffler, Haixin Zhang, Amy Praestgaard, Scott Nash, Asif H. Khan, Shahid Siddiqui, Juby A. Jacob‐Nara, Paul J. Rowe, Yamo Deniz

Publication date 17-06-2022


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Oral corticosteroid use and the risk of developing avascular necrosis: A large retrospective review

Sarah E Grond, Ryan E Little, David A Campbell, Todd A Loehrl, David M Poetker

Publication date 17-06-2022


Abstract Introduction The risk of adverse events, specifically avascular necrosis (AVN), associated with corticosteroid use is not well reported. The aim of this study was to evaluate the prevalence of AVN among patients with prior oral corticosteroid administration.
Methods An institutional database query recognized 113,734 adult patients with oral corticosteroid administration between January 2006 and May 2017. A temporal query performed on this cohort determined that 789 had a diagnosis of AVN following oral corticosteroids. A retrospective review was performed on this cohort. Data collected included demographics, comorbidities, date of initial oral corticosteroid exposure, and time to diagnosis of AVN. Records without radiographic confirmation of AVN were excluded from analysis. Patients with cumulative lifetime dosages greater than 10,000 mg prednisone were excluded from analysis.
ResultsA total of 789 patients with oral corticosteroid use prior to diagnosis of AVN were identified. Five hundred and seventy-two patients were excluded due to insufficient documentation of oral corticosteroid dosage, no radiographic evidence supporting the diagnosis of AVN, insufficient data confirming the temporal relationship between oral corticosteroids and AVN, and/or a cumulative dosing of >10,000 mg prednisone. This left 217 patients included in the analysis. The mean duration of use prior to diagnosis of AVN was 219 (± 374) days, and mean cumulative dose was 3314 (± 2908) mg prednisone equivalents. Mean time between diagnosis of AVN and onset of pathologic fracture was 379 (± 1046) days.
Conclusion For patients receiving low cumulative doses of oral corticosteroids, corticosteroids pose a small risk of development of AVN. More studies are required to better characterize risk.

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Are nonsteroidal anti‐inflammatory drugs effective enough for postoperative pain control after functional endoscopic sinus surgery and septoplasty? A randomized, controlled study

Alok T. Saini, Zi Y. Jiang, Nicole C. Starr, Jason Talmadge, Isaac Schmale, Paul Radabaugh, William C. Yao, Amber U. Luong, Martin J. Citardi

Publication date 17-06-2022


Abstract Background Endoscopic sinus surgery (ESS) and septoplasty are commonly performed procedures without standardized postoperative pain regimens. There is reluctance to prescribe opioids for postoperative pain given their potential for abuse. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been demonstrated to reduce or even obviate the need for opioid pain medications after otolaryngologic surgeries, but prospective validation is lacking.
MethodsA randomized, controlled study comparing the efficacy of diclofenac sodium to hydrocodone/acetaminophen (APAP) after ESS with or without septoplasty was performed. Participants were given a 100-mm visual analog pain scale (VAS) at postoperative days (PODs) 1, 2, 3, and 5 after ESS. Two-sample t tests were used to compare pain scores between groups.
Results One hundred patients enrolled, and 74 patients provided pain scores to the survey. Pain was greatest for both groups on POD 1. Treatment with diclofenac sodium vs hydrocodone/APAP did not statistically impact pain scores at PODs 1, 2, 3, or 5. No cases of epistaxis requiring an emergency room visit or return to the operating room were noted during the study period.
Conclusion Diclofenac sodium may be non-inferior to hydrocodone/APAP in treating pain after ESS with or without septoplasty in opioid naive patients without pre-existing pain conditions. Further studies with larger samples are warranted to investigate the potential superiority of diclofenac to hydrocodone/APAP in certain patients after ESS and septoplasty.

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Issue Information

Publication date 17-06-2022


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Corrigendum

Publication date 17-06-2022


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Eustachian tube dysfunction (ETD) in chronic rhinosinusitis with comparison to primary ETD: A systematic review and meta‐analysis

Tiffany Chen, Michael C. Shih, Thomas S. Edwards, Shaun A. Nguyen, Ted A. Meyer, Zachary M. Soler, Rodney J. Schlosser

Publication date 17-06-2022


Abstract Background Otologic symptoms consistent with Eustachian tube dysfunction (ETD) are common in patients with chronic rhinosinusitis (CRS), but can also occur independently of CRS as primary ETD. It is unclear if CRS+ETD is similar to primary ETD or how treatment outcomes compare.
MethodsA systematic search of Pub Med, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Any study describing ETD in CRS was included. Primary ETD studies were limited to those with preoperative and postoperative Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores in ETD treated only with Eustachian tube balloon dilation (ETBD).
Results Sixteen studies were included: nine studies with 1336 consecutive patients with CRS and seven studies with 161 patients with primary ETD. In studies with specific data, 225 (47.2%) patients with CRS had a score >14.5, consistent with ETD. In CRS+ETD, baseline mean ± standard deviation (SD) ETDQ-7 score was 20.7 ± 8.4 and did not differ by polyp status. In primary ETD, mean ETDQ-7 score was significantly higher than CRS+ETD (29.5 ± 8.1, p < 0.0001). Regarding treatment outcomes, CRS+ETD treated with endoscopic sinus surgery (ESS) alone resulted in mean ETDQ-7 in the normal range (13.2 ± 5.3), with a mean change of −7.4 (95% confidence interval CI, −10.82 to −3.99) (p < 0.00001). Patients with primary ETD treated with ETBD had postoperative ETDQ7 scores of 14.9 ± 7.5 with mean change of −13.9 (95% CI, −18.01 to −9.88), p < 0.00001.
ConclusionETD is noted in approximately half of patients with CRS. Outcomes of CRS+ETD treated with ESS alone are similar to those of patients with primary ETD treated with ETBD.

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Treatment decision‐making among Asian Americans with chronic rhinosinusitis

Francis Reyes Orozco, Jaynelle Gao, Kevin Hur

Publication date 17-06-2022


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Histopathologic differences between adult and pediatric patients with chronic rhinosinusitis

Hannah J. Brown, Sarah Khalife, Veena Ganesan, Pedro Escobedo, Peter Filip, Jill Jeffe, Anatoli Karas, Peter Papagiannopoulos, Paolo Gattuso, Pete Batra, Bobby Tajudeen

Publication date 16-06-2022


Abstract Background Adult and pediatric patients with chronic rhinosinusitis (CRS) may have differing philosophies in therapeutic management. Few studies hav examined sinonasal tissue-level comparisons of these groups. This study examines histopathologic differences between children and adults with CRS, with the goal of understanding disease pathogenesis and optimizing medical management for both populations.
Methods In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery (FESS), demographic factors, pertinent comorbidities, and a structured histopathologic report of 13 variables were compared across pediatric and adult CRS patients with and without nasal polyps (pCRSwNP, pCRSsNP, aCRSwNP, aCRSsNP, respectively).
Results378 adult (181 aCRSsNP, 197 aCRSwNP) and 50 pediatric (28 pCRSsNP, 22 pCRSwNP) patients were analyzed. Significantly more children compared to adults had a comorbid asthma diagnosis (64.5% vs. 37.2%, p = 0.003). Adults with CRS exhibited significantly more tissue neutrophilia (28.9% vs. 12.0%, p = 0.006), basement membrane thickening (70.3% vs. 44.0%, p<0.001), subepithelial edema (61% vs. 30.0%, p<0.001), squamous metaplasia (22.0% vs. 4.0%, p<0.001), and eosinophil aggregates (22.8% vs. 4.0%, p<0.001), than children with CRS. The majority (66.5%) of adult CRS patients exhibited a lymphoplasmacytic predominant inflammatory background, whereas the majority (57.8%) of children with CRS exhibited a lymphocyte predominant inflammatory background.
Conclusions Sinonasal tissue of adult and pediatric CRS patients demonstrates clear histopathologic differences. Our findings provide insight into differing pathophysiology, which may enable optimization of targeted therapies for patients in each of these unique clinical groups.
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Improvement in sinonasal quality‐of‐life indicators for pediatric patients with cystic fibrosis treated with elexacaftor‐tezacaftor‐ivacaftor

Carlos X. Castellanos, Beth Osterbauer, Steven Hasday, Thomas G. Keens, Jeffrey Koempel, Elisabeth H. Ference

Publication date 12-06-2022


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Corrigendum

Publication date 02-06-2022


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Injection of cyanoacrylate glue for hereditary hemorrhagic telangiectasia

Maeva Anciaux, Jean‐Pascal Lebreton, Denis Tonnerre, Justine Leclerc, Xavier Dufour, Florent Carsuzaa

Publication date 02-06-2022


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Effect of body position on reaction time: A simulation for foot pedal‐activated instruments

Connor S. Breinholt, Bennett E. Ahearn, Matthew Liu, Patrick A. Williams, Taylor Fish, Roman A. Fernandez, Leon Bunegin, Byeongyeob Choi, Philip G. Chen

Publication date 30-05-2022


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Pretreatment neutrophil‐lymphocyte ratio predicts the long‐term survival of patients with sinonasal malignancy

Kyung Won Kwon, Jeong Heon Kim, Dong Kyu Lee, Yoo‐Sam Chung, Yong Ju Jang, Ji Heui Kim, Myeong Sang Yu

Publication date 30-05-2022


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Periostin as a biomarker in chronic rhinosinusitis: A contemporary systematic review

Gerasimos Danielides, Spyridon Lygeros, Menelaos Kanakis, Stephanos Naxakis

Publication date 30-05-2022


Abstract Background The role of periostin, a matricellular protein encoded by the POSTN gene, in chronic rhinosinusitis with nasal polyposis (CRSwNP) is reviewed. Periostin is considered a potential biomarker of endotype and may be useful for evaluating response to treatment.
Methods Search terms in Pub Med and Web of Science (1990–March 2022) included: ((periostin) OR (POSTN)) AND ((sinusitis) OR (nasal polyp) OR (CRSwNP) OR (CRS). The primary outcomes were differences in tissue, serum, and nasal lavage between CRSwNP and CRS without NP (CRSsNP) or controls. Associated factors reported to affect periostin expression, data regarding participants’ clinical characteristics, disease endotypes, laboratory methods, and samples’ origin were also pooled. Studies on <10 patients were excluded.
Results Out of 101 records harvested through database searching, 29 prospective cross-sectional or case-control studies were eligible for review and qualitative analysis. Tissue sample origin, concurrent infection, current and past medication, primary or recurrent disease, allergic rhinitis, and smoking status should be considered as confounding factors for periostin levels. Periostin and POSTN messenger RNA (mRNA) levels were consistently and significantly higher in CRSwNP than CRSsNP and controls. Despite the distinctly different inflammation patterns among CRSwNP endotypes, periostin-related remodeling patterns seemed to be similar.
Conclusion Tissue and serum periostin levels, and POSTN expression appear elevated in CRSwNP, especially in eosinophilic inflammation, compared to CRSsNP and controls. Disease severity and comorbidities are also reflected in periostin and POSTN values. Carefully designed prospective studies may establish the role of periostin as a biomarker in CRSwNP and allow its incorporation in clinical practice.

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Local nasal immunotherapy for allergic rhinitis: A systematic review and meta‐analysis

Navarat Kasemsuk, Premyot Ngaotepprutaram, Dichapong Kanjanawasee, Triphoom Suwanwech, Stephen R. Durham, Giorgio Walter Canonica, Pongsakorn Tantilipikorn

Publication date 23-05-2022


Abstract Introduction Local nasal immunotherapy (LNIT), an alternative noninjection immunotherapy method, is theoretically an efficient method for inducing immunotolerance directly in the affected organ. LNIT is more convenient and less invasive than injection immunotherapy, with fewer systemic reactions. The development of adjuvants to overcome LNITs limitations raises the possibility of it being an alternative allergen immunotherapy.
Objectives To evaluate the clinical and immunological efficacy and safety of LNIT for patients with allergic rhinitis.
MethodsA systematic search for randomized controlled trials comparing LNIT and placebo was performed using OVID Medline and Embase. Outcomes were total nasal symptom score (TNSS), symptom–medication score (SMS), medication score, immunological assessment, and nasal provocation threshold. Data were pooled for meta-analysis.
ResultsA total of 20 studies with 698 participants were included. The LNIT group had greater posttreatment improvement in TNSS, SMS, and medication score than control (TNSS: standardized mean difference SMD, –1.37 95% confidence interval CI, –2.04 to –0.69; SMS: SMD, –1.55 95% CI, –2.83 to –0.28; and medication score: SMD, –1.09 95% CI, –1.35 to –0.83). Immunological assessments showed no significant differences in serum-specific IgE (mean difference MD, 6.35; 95% CI, –4.62 to 17.31), nasal IgE (MD, –0.59; 95% CI, –1.99 to 0.81), or nasal eosinophil cationic protein (MD, 7.63; 95% CI, –18.65 to 33.91). Only serum IgG significantly increased with LNIT (MD, 0.45; 95% CI, 0.20, 0.70). Posttreatment, nasal provocation threshold was higher with LNIT (MD, 27.30; 95% CI, 10.13–44.46). No significant adverse events were reported.
ConclusionsLNIT is a safe alternative allergen immunotherapy route without significant adverse events. It improves clinical symptoms, reduces medication usage, and increases the nasal provocation threshold.

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Objective and patient‐based measures of chronic rhinosinusitis in people with cystic fibrosis treated with highly effective modulator therapy

Daniel M. Beswick, Stephen M. Humphries, Jessa E. Miller, Connor D. Balkissoon, Aastha Khatiwada, Eszter K. Vladar, Vijay R. Ramakrishnan, David A. Lynch, Jennifer L. Taylor‐Cousar

Publication date 20-05-2022


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COVID‐19 pandemic: do surgical masks impact respiratory nasal functions?

Margaux Petitjean, Émilie Béquignon, Maxime Fieux, Bruno Louis, Françoise Zerah, André Coste, Sophie Bartier

Publication date 20-05-2022


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Use of intraoperative frontal sinus mometasone‐eluting stents decreased interleukin 5 and interleukin 13 in patients with chronic rhinosinusitis with nasal polyps

Alexander L. Schneider, Samuel D. Racette, Anthony K. Kang, Abhita T. Reddy, Julia H. Huang, David S. Lehmann, Caroline P.E. Price, Jacob G. Eide, Samuel R. Rodeghiero, David B. Conley, Kevin C. Welch, Robert C. Kern, Stephanie Shintani‐Smith, Anju T. Peters, Atsushi Kato, Whitney S. Stevens, Robert P. Schleimer, Bruce K. Tan

Publication date 19-05-2022


Abstract Background Mometasone-eluting stents (MES) have demonstrated improvement in short-term endoscopic outcomes and reduce short- to medium-term rescue interventions. Their effect on the local inflammatory environment, longer-term patient-reported outcomes, and radiographic severity have not been studied.
Methods Middle meatal mucus and validated measures of disease severity were collected before and 6 to 12 months after endoscopic surgery in 52 patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Operative findings, type 2 mediator concentrations, intraoperative variables, and disease severity measures were compared between those who did and those who did not receive intraoperative frontal MES.
ResultsA total of 52 patients with CRSwNPs were studied; 33 received frontal MES and were compared with 19 who did not. Pre–endoscopic sinus surgery (ESS) middle meatus (MM) interleukin (IL) 13 and eosinophil cationic protein (ECP) were higher in the stented group (p < 0.05), but pre-ESS clinical measures of disease severity were similar as were surgical extent and post-ESS medical management. Intraoperative eosinophilic mucin was more frequent in the stented group (58% vs 11%, p = 0.001). IL-5 (p < 0.05) and IL-13 (p < 0.001) decreased post-ESS in the stented group, but this was not observed in the nonstented group. Post-ESS IL-4 and IL-13 were higher in the nonstented vs stented group (p < 0.05 for both).
Conclusion Although patients who received intraoperative frontal MES had significantly higher pre-ESS MM IL-13 and ECP, patients who received frontal MES had lower concentrations of IL-4 and IL-13 than those who did not at a median of 8 months post-ESS. However, these changes did not correspond to significantly different measures of symptomatic or radiographic disease severity.

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Outcomes of endoscopic endonasal resection of pediatric craniopharyngiomas

Tapan D. Patel, Bianca Rullan‐Oliver, Heather Ungerer, Phillip B. Storm, Michael A. Kohanski, Nithin D. Adappa, James N. Palmer

Publication date 16-05-2022


Abstract Background Craniopharyngiomas have traditionally been treated via open transcranial approaches. More recent, endoscopic endonasal approaches have been increasingly used; however, there has been limited evaluation of long-term outcomes for this approach.
MethodsA retrospective review was performed to analyze patients with pediatric craniopharyngioma undergoing endonasal endoscopic resection from 2012 to 2020. Demographic information, clinicopathologic factors, and outcomes including follow-up and recurrences were analyzed.
Results All 42 patients, with a mean age of 8.0 years, were included. The median follow-up time was 49 months. Mean tumor diameter was 3.6 cm. All of the tumors had sellar and suprasellar components. The most common presenting symptoms were headaches (64.3%), visual changes (59.5%), and nausea/vomiting (38.1%). Most patients (73.3%) had resolution of their presenting symptoms by their first postoperative visit. Vision improved or remained normal in 69.0% of patients. Postoperatively, incidence of panhypopituitarism or diabetes insipidus developed in 89.7% and 77.8% of patients, respectively. The postoperative cerebrospinal fluid leak rate was 7.1%. The recurrence rate was 9.5%.
Conclusion Endoscopic endonasal resection for pediatric craniopharyngiomas can achieve high rates of resection with low rates of disease recurrence when compared with the outcomes of open transcranial resection reported in the literature. However, hypothalamic-pituitary dysfunction remains a significant postoperative morbidity in both approaches.

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Novel triple‐pedicled mucoperiosteal flaps in reconstruction of neo‐ostium after Draf III frontal sinusotomy for refractory frontal sinusitis

Hao Zheng, Shao‐peng Huang, Xiao‐yan Wang, Qing‐hua Liu, Yong Chen, Qing Ye

Publication date 16-05-2022


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Comparison of validated psychophysical olfactory tests and olfactory‐specific quality of life

Michael C. Shih, Zachary M. Soler, Matthew Germroth, Jacob Snyder, Shaun A. Nguyen, Rodney J. Schlosser

Publication date 08-05-2022


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Combined medical therapy in the treatment of allergic rhinitis: Systematic review and meta‐analyses

Wirach Chitsuthipakorn, Minh P. Hoang, Dichapong Kanjanawasee, Kachorn Seresirikachorn, Kornkiat Snidvongs

Publication date 08-05-2022


Abstract Background Antihistamines (ATH) and intranasal corticosteroids (INCS) are primary treatments for patients with allergic rhinitis (AR). When monotherapy of either primary treatment fails to control symptoms, combined medical therapy is an option. In this meta-analysis we assessed the additional effects of different medical combinations compared with primary treatments.
Methods Systematic searches on Pub Med and EMBASE were updated on November 4, 2021. Randomized, controlled trials comparing the effects of combinations with monotherapy were included.
There were 7 comparisons: (1) ATH-decongestant vs ATH; (2) ATH-leukotriene receptor antagonist (LTRA) vs ATH; (3) INCS-ATH vs INCS; (4) INCS-LTRA vs INCS; (5) INCS-decongestion vs INCS; (6) INCS-saline irrigation vs INCS; and (7) ATH-saline irrigation vs ATH. Data were pooled for meta-analysis. Outcomes were composite nasal symptom score, composite ocular symptom score, quality of life (QoL), and adverse events.
Results Fifty-three studies were included. Compared with ATH alone, the ATH-decongestant combination improved composite nasal symptoms; ATH-LTRA improved nasal symptoms in patients with perennial AR; and ATH-nasal saline improved both symptoms and QoL. Compared with INCS alone, the INCS-intranasal ATH combination improved nasal symptoms, ocular symptoms, and QoL; INCS-LTRA improved ocular symptoms but not nasal symptoms; and INCS-nasal saline improved QoL but not symptoms. There were no additional effects observed from adding oral ATH or topical decongestant to INCS.
Conclusion After ATH monotherapy fails to control symptoms, addition of decongestant, saline, or LTRA can improve the outcomes. When INCS monotherapy is ineffective, addition of intranasal ATH can improve nasal symptoms; LTRA can improve ocular symptoms, and saline irrigation can improve QoL.

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Use of a novel chinchilla skull base repair model to test a photo‐initiated thiol‐ene biopolymer

Adam M. Terella, Peter Mariner, Carlyne D. Cool, Vijay R. Ramakrishnan

Publication date 04-05-2022


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Inhibiting the type 2 inflammatory pathway with dupilumab is associated with an increase in interleukin‐4 and interleukin‐18 production

Jymirah Morris, Tolani F. Olonisakin, John A. Moore, BaDoi Phan, Dana M. Parker, Bliss A. Uribe, Stephanie J. Barel, Eve M.R. Bowers, Kathleen M. Buchheit, Tanya M. Laidlaw, Stella E. Lee

Publication date 29-04-2022


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Long‐term oncologic outcomes in esthesioneuroblastoma: An institutional experience of 143 patients

"Ryan A. McMillan,, Jamie J. Van Gompel,, Michael J. Link,, Eric J. Moore,, Daniel L. Price,, Janalee L. Stokken,, Kathryn M. Van Abel,, Jamie OByrne,, Caterina Giannini,, Ashish Chintakuntlawar,, Carlos D. Pinheiro Neto,, Maria Peris Celda,, Robert Foote,, Garret Choby,"

Publication date 25-04-2022


Abstract Objective Esthesioneuroblastoma (ENB) is a rare malignant neoplasm arising from the olfactory epithelium of the cribriform plate. The goal of this study was to update our oncologic outcomes for this disease and explore prognostic factors associated with survival.
Materials and methods We performed a retrospective analysis of patients with ENB treated at a single tertiary care institution from January 1, 1960, to January 1, 2020. Univariate and multivariate analysis was performed. Overall survival (OS), progression-free survival (PFS), and distant metastasis–free survival (DMFS) were reported.
Results Among 143 included patients, the 5-year OS was 82.3% and the 5-year PFS was 51.6%; 5-year OS and PFS have improved in the modern era (2005–present). Delayed regional nodal metastasis was the most common site of recurrence in 22% of patients (median, 57 months). On univariate analysis, modified Kadish staging (m Kadish) had a negative effect on OS, PFS, and DMFS (p < 0.05). Higher Hyams grade had a negative effect on PFS and DMFS (p < 0.05). Positive margin status had a negative effect on PFS (p < 0.05). Orbital invasion demonstrated worsening OS (hazard ratio, 3.1; p < 0.05). On multivariable analysis, high Hyams grade (3 or 4), high m Kadish stage (C+D), and increasing age were independent negative prognostic factors for OS (p < 0.05). High Hyams grade (3+4), high m Kadish stage (C+D), age, and positive margin status were independent negative prognostic factors for PFS (p < 0.05). High Hyams grade (3+4) was an independent negative prognostic factor for DMFS (p < 0.05).
Conclusions Patients with low Hyams grade and m Kadish stage have favorable 5-year OS, PFS, and DMFS.

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CRS‐PRO and SNOT‐22 correlations with type 2 inflammatory mediators in chronic rhinosinusitis

Samuel D. Racette, Alexander L. Schneider, Meera Ganesh, Julia H. Huang, David S. Lehmann, Caroline P.E. Price, Samuel G. Rodegherio, Abhita T. Reddy, Jacob G. Eide, David B. Conley, Kevin C. Welch, Robert C. Kern, Stephanie Shintani‐Smith, Atsushi Kato, Robert P. Schleimer, Bruce K. Tan

Publication date 24-04-2022


Background The 22-item Sino-Nasal Outcome Test (SNOT-22) and 12-item Patient Reported Outcomes in Chronic Rhinosinusitis (CRS-PRO) instrument are validated patient-reported outcomes measures in CRS. In this study we assess the correlation of these with type 2 (T2) biomarkers before and after endoscopic sinus surgery (ESS).
Methods Middle meatal mucus data were collected and the SNOT-22 and CRS-PRO were administered to 123 patients (71 CRS without nasal polyps CRSsNP, 52 CRS with nasal polyps CRSwNP) with CRS before and 6 to 12 months after undergoing ESS. Interleukin (IL)-4, IL-5, IL-13, and eosinophilic cationic protein (ECP) were measured using a multiplexed bead assay and enzyme-linked immunoassay. Pre- and post-ESS SNOT-22 and CRS-PRO were compared with T2 biomarkers.
Results Before ESS neither PROM correlated with any biomarker. After ESS, CRS-PRO showed a correlation with 2 mediators (IL-5 and IL-13: p = 0.012 and 0.003, respectively) compared with none for the SNOT-22. For CRSwNP patients, pre-ESS CRS-PRO and SNOT-22 correlated with IL-4 (p = 0.04 for both). However, after ESS, CRS-PRO correlated with 3 biomarkers (IL-5, IL-13, and ECP: p = 0.02, 0.024, and 0.04, respectively) and SNOT-22 with 2 biomarkers (IL-5 and IL-13: p = 0.038 and 0.02, respectively). There were no significant relationships between any of the T2 biomarkers pre- or post-ESS among patients with CRSsNP. Exploratory analyses of the subdomains showed the SNOT-22 rhinologic and CRS-PRO rhinopsychologic subdomains correlated better with the T2 biomarkers. On individual item analysis, IL-13 correlated significantly post-ESS with 8 of 12 items on the CRS-PRO vs 6 of 22 items on the SNOT-22.
Conclusion The CRS-PRO total score showed a significant correlation with T2 biomarkers especially when assessed post-ESS and among CRSwNP patients.

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Particulate matter air pollution exposure disrupts the Nrf2 pathway in sinonasal epithelium via epigenetic alterations in a murine model

Bongsoo Park, Nyall R. London, Anuj Tharakan, Palanivel Rengasamy, Sanjay Rajagopalan, Shyam Biswal, Jayant M. Pinto, Murugappan Ramanathan

Publication date 24-04-2022


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Analysis of competing endogenous RNA (ceRNA) crosstalk in eosinophilic chronic rhinosinusitis with nasal polyps

Ke Li, Fang‐Fang Liu

Publication date 20-04-2022


Abstract Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the most common chronic inflammatory diseases, and has various phenotypes. Although its pathophysiology remains obscure, evidence has shown that dysregulation of noncoding RNAs (ncRNAs) is associated with CRSwNP. ncRNAs in the cytoplasm can act as competing endogenous RNAs (ceRNAs), which are involved in many inflammatory processes. However, the ceRNA crosstalk in CRSwNP is still unclear Methods We investigated expression profiles of messenger RNA (mRNA), microRNAs (miRNAs), and long noncoding RNAs (lncRNAs) in eosinophilic CRSwNP and constructed a global triple ceRNA network.
Results As a result, 964 differentially expressed mRNAs (DEm Rs), 207 differentially expressed miRNAs (DEmi Rs), and 15 differentially expressed lncRNAs (DElnc Rs) were identified, and a ceRNA network containing 598 miRNA-mRNA pairs and 70 lncRNA-miRNA pairs was finally constructed. Gene set enrichment analysis (GSEA) results indicated these DEm Rs were mainly enriched in “cytokine-cytokine receptor interaction,” “salivary secretion,” “hematopoietic cell lineage,” and “chemokine signaling pathway.” Moreover, we also predicted the subcellular localization of the DElnc Rs identified in the network via bioinformatics approaches Conclusion In summary, the present study provided the first comprehensive assessment of the ceRNA crosstalk in eosinophilic CRSwNP. These findings will be of interest to the understanding of the potential pathophysiology of this disease.

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A comparison of central compartment atopic disease and lateral dominant nasal polyps

Liang‐Chun Shih, Bing‐Han Hsieh, Jia‐Hung Ma, Shuang‐Shuang Huang, Yung‐An Tsou, Chia‐Der Lin, Kuang‐Hua Huang, Chih‐Jaan Tai

Publication date 11-04-2022


Abstract Background The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population.
Methods This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed.
Results Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p < 0.01) and histopathologic profiles (57.0 vs 17.3, p < 0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: −31.82 vs −22.66, p < 0.01; MCT: −233.06 vs −191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups.
Conclusion Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD.

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See many, do one, teach many more: Assessing quality and reliability of publicly available endoscopic videos in rhinology

Benjamin F. Bitner, Sanjita Gowda, Michelle E. Mark, Danielle C. Warner, Bobby A. Tajudeen, Edward C. Kuan

Publication date 11-04-2022


Abstract Objectives The use of video recording is commonplace in rhinology given the increased use of endoscopes when evaluating patients in the office and the operating room and for its educational potential. This study aimed to determine the quality of publicly available endoscopic videos in rhinology.
MethodsA video search was performed on You Tube in April 2020 and included all videos since its inception in 2005 using terms related to rhinology found in the Accreditation Council for Graduate Medical Education (ACGME) Case Log Coding Guide.
Videos which met inclusion criteria were evaluated for video metrics and quality using validated scoring systems: Video Power Index (VPI), modified Journal of American Medical Association (JAMA) benchmark criteria, modified global quality score (GQS), and modified DISCERN criteria.
ResultsA total of 138 videos were evaluated, 114 of which were uploaded independently, and 24 videos were uploaded by an academic institution. Academic-affiliated videos have higher like ratio at 91.7 ± 7.55% compared with 86.27 ± 17.44% (p = 0.018). Academic-affiliated videos have higher JAMA benchmark scores, DISCERN criteria scores, and GQS values (1.71 ± 0.55 vs. 1.66 ± 0.49 p = 0.66), (3.33 ± 0.56 vs. 2.85 ± 0.65 p < 0.001), (4.38 ± 0.81 vs. 3.43 ± 1.01 p < 0.001), respectively. There was no significant difference in VPI (p = 0.73).
Conclusions Endoscopic videos are rapidly growing in prominence and remain an important part of surgical education, but overall are heterogeneous in quality and reliability, necessitating an effort to establish both video sharing regulations and objective standards of quality.

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The roles of eosinophils and interleukin‐5 in the pathophysiology of chronic rhinosinusitis with nasal polyps

Philippe Gevaert, Joseph K. Han, Steven G. Smith, Ana R. Sousa, Peter H. Howarth, Steven W. Yancey, Robert Chan, Claus Bachert

Publication date 11-04-2022


Abstract Chronic rhinosinusitis with nasal polyps (CRSwNP) is generally associated with eosinophilic tissue infiltration linked to type 2 inflammation and characterized by elevated levels of interleukin (IL)-5 and other type 2 inflammatory mediators. Although distinct and overlapping contributions of eosinophils and IL-5 to CRSwNP pathology are still being explored, they are both known to play an important role in NP inflammation. Eosinophils secrete numerous type 2 inflammatory mediators including granule proteins, enzymes, cytokines, chemokines, growth factors, lipids, and oxidative products. IL-5 is critical for the differentiation, migration, activation, and survival of eosinophils but is also implicated in the biological functions of mast cells, basophils, innate lymphoid cells, B cells, and epithelial cells. Results from clinical trials of therapeutics that target type 2 inflammatory mediators (including but not limited to anti-IL-5, anti-immunoglobulin-E, and anti-IL-4/13) may provide further evidence of how eosinophils and IL-5 contribute to CRSwNP. Finally, the association between eosinophilia/elevated IL-5 and greater rates of NP recurrence after endoscopic sinus surgery (ESS) suggests that these mediators may have utility as biomarkers of NP recurrence in diagnosing and assessing the severity of CRSwNP. This review provides an overview of eosinophil and IL-5 biology and explores the literature regarding the role of these mediators in CRSwNP pathogenesis and NP recurrence following ESS. Based on current published evidence, we suggest that although eosinophils play a key role in CRSwNP pathophysiology, IL-5, a cytokine that activates these cells, also represents a pertinent and effective treatment target in patients with CRSwNP.

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Triamcinolone‐impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial

Justin P. McCormick, Jeffrey D. Suh, Hong‐Ho Yang, Jivianne T. Lee, Marilene B. Wang

Publication date 08-04-2022


Abstract Introduction Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone-impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS).
Methods This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone-impregnated packing in one sinus cavity and normal saline-soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund–Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit.
Results The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09 ± 1.23 versus 2.18 ± 1.01 (p = 0.79) and 1.79 ± 1.08 versus 1.68 ± 1.16 (p = 0.77), respectively. POSE scores were 2.59 ± 1.71 versus 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 versus 1.95 ± 1.22 (p = 0.59).
Conclusion The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone-treated and non-triamcinolone-treated sinuses. There were no adverse effects from the use of triamcinolone-impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone-impregnated absorbable packing following ESS.

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Mental health burden of empty nose syndrome compared to chronic rhinosinusitis and chronic rhinitis

Meredith Lamb, Daniel R. Bacon, Abdullah Zeatoun, Princess Onourah, Brian D. Thorp, Jonathon Abramowitz, Charles S. Ebert, Adam J. Kimple, Brent A. Senior

Publication date 07-04-2022


Abstract Background Empty nose syndrome (ENS) is characterized by the paradoxical perception of nasal obstruction despite patent sinonasal anatomy after surgery. We investigated the relationship between ENS, and anxiety, depression, obsessive-compulsive disorder, and somatic symptom disorder (SSD) compared to individuals with chronic rhinitis (CR) and chronic rhinosinusitis (CRS).
Methods This cross-sectional survey study compared ENS and CR and CRS patients.
A total of 116 patients participated: 58 ENS patients from digital support groups, and 58 CRS and CR patients from tertiary rhinology clinics.
Study participants completed four validated surveys: (1) Empty Nose Syndrome 6-Item Questionnaire, (2) Rhinosinusitis Disability Index (RSDI), (3) Obsessive Compulsive Inventory – Revised (OCI-R), and (4) PRIME MD Patient Health Questionnaire (PHQ).
ResultsENS patients exhibited a mean RSDI of 78.6, 95% confidence interval CI 72.8–84.5, compared to 25.2, 95% CI 18.6–31.8 for CRS/CR patients (p < 0.0001). This difference was seen across all subdomains. Using the PHQ, 53% of ENS patients met diagnostic thresholds for SSD compared to 14% of CRS patients (p < 0.0001). In relation to obsessive compulsive disorder (OCD), 18.37% of ENS patients compared to 8.62% of CRS/CR patients scored above the diagnostic threshold (>21) on the OCI-R questionnaire (p = 0.159).
ConclusionENS patients had diminished sinonasal quality of life and a higher prevalence of comorbid anxiety and depression, compared to CR and CRS. ENS patients were more likely to exceed thresholds for OCD and SSD compared to controls. Future studies are needed to assess the role of SSD in ENS to help optimize treatment for these complex patients.

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Chitogel following endoscopic sinus surgery promotes a healthy microbiome and reduces postoperative infections

Anna Megow, Yazeed Alsuliman, George Bouras, Martha Menberu, Erich Vyskocil, Sarah Vreugde, Peter‐John Wormald

Publication date 07-04-2022


Abstract Background Postoperative infections following endoscopic sinus surgery (ESS) impair wound healing and lead to poor outcomes. The aim of this study is to assess the effectiveness of Chitogel to reduce postoperative infections and restore a healthy microbiome following ESS.
Methods In this double-blinded randomized control trial, 25 patients undergoing ESS were prospectively recruited. At the end of surgery, patients were randomized to receive Chitogel to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-up with nasoendoscopies performed at 2, 6, and 12 weeks postoperatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral sides were collected intraoperatively and at 12 weeks postoperatively. Additional swabs were collected if infection was present.
Results Improved endoscopic appearance of the sinuses (p = 0.03) and ostial patency were noted on the Chitogel side compared with control at 12 weeks (p < 0.001). A significant decrease in infections on the Chitogel side (12.0%) compared with control (52.0%) (p = 0.005) was evident. Following the use of Chitogel, there was a significant increase in the combined relative abundance of commensals Corynebacterium and Cutibacterium (Propionibacterium) from 30.15% at baseline to 46.62% at 12 weeks compared with control (47.18% to 40.79%) (p.adj = 0.01).
Conclusion Chitogel significantly improved both the nasoendoscopic appearance of the sinuses and sinus ostial patency at 12 weeks postoperatively. Chitogel used following ESS helps restore an improved microbiome resulting in an increase in the relative abundance of commensals Corynebacterium and Cutibacterium (Propionibacterium). A significant decrease in postoperative infections was noted following use of Chitogel.

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Open and endoscopic surgery improve survival for squamous and nonsquamous cell nasopharyngeal carcinomas: An NCDB cohort study

Andrey Finegersh, Mena Said, Adam Deconde, Peter H. Hwang, Floyd Christopher Holsinger, Ryan K. Orosco

Publication date 31-03-2022


Abstract Background Nasopharyngeal tumors (NPTs) are primarily treated with nonsurgical therapy. Recent studies have demonstrated endoscopic salvage surgery for NPT recurrences may improve survival relative to reirradiation. However, there are very limited data on open compared with endoscopic approaches for NPTs. We investigated whether endoscopic and open surgical approaches to the nasopharynx improve overall survival for all histologic subtypes of NPTs.
Methods We performed a retrospective cohort study using the National Cancer Database (NCDB). All adult patients with NPTs from 2004 to 2016 without distant metastasis who underwent treatment with curative intent were included. We extracted clinical and treatment variables to assess our primary outcome of overall survival.
Results On univariate analysis, patients undergoing endoscopic surgery, but not open surgery, had significantly improved overall survival relative to those undergoing nonsurgical treatment. Post hoc analysis demonstrated significantly improved overall survival for surgery in patients with minor salivary gland histology, but not squamous cell carcinoma (SCC) histology or by T or N classification. A Cox proportional hazards model was used for multivariate regression. After adjusting for covariates, both endoscopic and open approaches were associated with improved overall survival relative to nonsurgical treatment for all tumor types. A multivariate regression of SCC found that open surgery, but not endoscopic surgery, was significantly associated with improved overall survival.
Conclusion Both endoscopic and open surgical approaches are associated with improved overall survival of patients with NPT. These findings highlight important oncologic validity as endoscopic and robotic platforms to the nasopharynx become more widely adopted.

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Vision loss caused by immunoglobulin G4–related disease of the skull base complicated by a mucocele of the sphenoid sinus

Sanne E. Detiger, Dion Paridaens, Robert M. Verdijk, Jan A.M. Laar, Ruben Dammers, Dominiek A. Monserez, A. Paul Nagtegaal

Publication date 27-03-2022


Abstract Background Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory disorder and manifestation in de paranasal and sphenoid sinus is well recognized. In this patient, IgG4-RD presented in an unusual manner with vision loss due to mucocele formation in the sphenoid sinus.
Case DescriptionA 19-year-old man, with an unremarkable medical history, was referred with decreased vision in the left eye, headaches, and a sharp pain in the left orbit and ear. Compression of the left optic nerve due to a large mucocele caused papillary edema and emergency endoscopic marsupialization of the mucocele was performed. When the vision decreased again, a more extensive decompressing sphenoidotomy was performed. Histopathology showed IgG4-RD. Despite dexamethasone, the lesion expanded to the anterior skull base and the patient required repeat endoscopic surgery. After 3 months, a decrease in smell and vision warranted for a fourth extensive endoscopic decompressing surgery, complicated by a cerebrospinal fluid leak. Prednisone and later rituximab were commenced. Unfortunately, the patient reported a complete loss of vision after 4 months of rituximab due to increased mass effect on the optic nerve. An extensive combined craniofacial-endoscopic surgery was performed to remove the entire mucocele and to prevent further contralateral and intracranial progression. Methylprednisolone monthly was commenced to prevent further complications.
Discussion This case illustrates that in therapy-resistant sino-orbital IgG4-RD, extensive surgery might be necessary at an earlier stage. It may even be the only option to prevent irreversible damage to the surrounding tissues. A multidisciplinary approach in the management of sino-orbital IgG4-RD is therefore warranted.

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Coronavirus disease 2019 (COVID‐19)–related smell and taste impairment with widespread diffusion of severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) Omicron variant

Paolo Boscolo‐Rizzo, Giancarlo Tirelli, Pierluigi Meloni, Claire Hopkins, Giordano Madeddu, Andrea De Vito, Nicoletta Gardenal, Romina Valentinotti, Margherita Tofanelli, Daniele Borsetto, Jerome R. Lechien, Jerry Polesel, Giacomo De Riu, Luigi Angelo Vaira

Publication date 24-03-2022


Abstract Background The aim of this study was to estimate the prevalence of self-reported chemosensory dysfunction in a study cohort of subjects who developed a mild-to-moderate coronavirus disease 2019 (COVID-19) in the period from January 17, 2022, to February 4, 2022 (Omicron proxy period) and compared that with a historical series of patients testing positive for severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2) infection between March and April, 2020 (comparator period).
Methods Prospective study based on the 22-item Sino-Nasal Outcome Tool (SNOT-22), item “sense of smell or taste” and additional outcomes.
Results Patients’ characteristics and clinical presentations of COVID-19 were evaluated and compared in 779 patients, 338 of the study cohort and 441 of the historical series. The prevalence of self-reported chemosensory dysfunction during the proxy Omicron period (32.5%; 95% confidence interval CI, 27.6–37.8) was significantly lower from that during the comparator period (66.9%; 95% CI, 62.3–71.3) (p < 0.001). Nearly one-quarter of patients (24.6%; 95% CI, 20.1–29.5) reported an altered sense of smell during the proxy Omicron period compared to 62.6% (95% CI, 57.9–67.1) during the comparator period (p < 0.001). Similarly, the prevalence of an altered sense of taste dropped to 26.9% (95% CI, 22.3–32.0) during the proxy Omicron period from 57.4% (95% CI, 52.6–62.0) during the comparator period (p < 0.001). The severity of chemosensory dysfunction was lower in the proxy Omicron period compared to the comparator period (p < 0.001).
Conclusion The prevalence and the severity of COVID-19–associated smell and taste dysfunction has dropped significantly with the advent of the Omicron variant but it still remains above 30%.

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The digital scent device as a new concept for olfactory assessment

Marcio Nakanishi, Marco Aurélio Fornazieri, Pedro Lança Gomes, Luis Augusto de Miranda Dias, Gustavo Subtil Magalhães Freire, Luís Gustavo do Amaral Vinha, Leonardo Conrado Barbosa de Sa, Richard Louis Voegels, Claudia Galvão, Wilma Terezinha Anselmo Lima

Publication date 18-03-2022


Abstract Background There are major challenges in olfactory measurements in clinical practice; therefore, a handheld digital scent device (DSD; Noar Multi Scent 20) was developed as a tablet with an integrated storage system for odors. The DSD is a self-administered, handheld device that controls the duration of odor release to the nasal cavity through a touchscreen digital interface with automatic database generation. In this study we aimed to determine the feasibility of this DSD as an olfactory assessment test.
Methods We recruited 180 participants (age mean ± standard deviation, 34.58 ± 9.71 years; 114 women and 66 men) to participate in smell tests using both the DSD and the 40-item Smell Identification Test (SIT-40), which contained the same type and order of odors and the same multiple-choice answers. The scores were compared and evaluated for correlation between the tests, and test-retest reliability was calculated.
Results The DSD test scores were higher than the SIT-40 scores (median interquartile range, 32 5.0 vs 31 7.0; p = 0.005). The completion time was less for the DSD test than for the SIT-40 (12.5 5.0 vs 16 6.0 minutes; p < 0.001). The tests were strongly correlated (Spearman rho = 0.74; p < 0.001) and exhibited a high level of agreement (Bland-Altman regression coefficient = 0.672; p = 0.003). The DSD test-retest reliability coefficient was 0.820.
Conclusion The DSD is feasible as an olfactory assessment test. The digitalization of olfactory assessment combined with data science may enable new research perspectives in the field of olfaction.

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A review of frontal sinus balloon dilation

Kevin Fujita, R. Peter Manes

Publication date 16-03-2022


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Applications of vibrational energy in the treatment of sinonasal disease: A scoping review

Katie M. Phillips, Pooya Roozdar, Peter H. Hwang

Publication date 09-03-2022


Abstract Background Acoustic energy and vibration therapy are emerging as helpful adjuncts among many disease states. There has been interest in how this technology can either serve as an alternative treatment or enhance delivery of medications to treat pathology within the nasal cavity and paranasal sinuses. Our objective was to perform a scoping review of the state of the science of vibration treatment used in sinonasal disease.
MethodsA search of Embase, Pub Med, and CINAHL databases was performed in November 2021. Included studies evaluated acoustic energy as a means of treatment in sinonasal diseases. Data points collected included type of technology utilized, disease state treated, and outcomes.
Results The initial search identified 2902 studies, of which 44 met inclusion criteria. A wide array of vibrational technology such as ultrasound, sonic aerosols, and phonophoresis, with varying frequency and amplitude were described. Twenty-six studies evaluated the use of acoustic energy to treat sinonasal disease itself, while 18 studies evaluated the use of acoustic energy to facilitate drug delivery to the sinonasal cavity. Outcome measures among studies were highly varied.
Conclusions Vibration technology used in patients with sinonasal pathology has been shown to improve pain, sinonasal symptoms, and radiologic outcome measures in small studies. Given the heterogeneous study populations and outcomes, no conclusion could be reached regarding overall effectiveness of acoustic energy as a primary treatment. Further research is required to study specific treatment indications in larger patient populations to fully understand the potential clinical benefit and to determine optimal therapeutic characteristics of sound energy.

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Long‐term olfactory dysfunction in COVID‐19 patients: 18‐month follow‐up study

Fabio Ferreli, Francesca Gaino, Elena Russo, Matteo Di Bari, Vanessa Rossi, Armando De Virgilio, Arianna Di Stadio, Giuseppe Spriano, Giuseppe Mercante

Publication date 09-03-2022


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Analysis of internet search trends for balloon sinuplasty: A cross‐sectional study

Vivek C. Pandrangi, Kara Y. Detwiller, Mathew Geltzeiler, Jess C. Mace, Nyssa Fox Farrell

Publication date 08-03-2022


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Maxillary sinus volume changes after functional endoscopic sinus surgery in patients with chronic maxillary atelectasis and silent sinus syndrome

Juan Carlos Hernaiz‐Leonardo, Marwan Alqunaee, Saba Moghimi, Bader M. Alim, Farnaz Javadian, Saba Vafaei‐Nodeh, Athenea Pascual, Amin Javer

Publication date 07-03-2022


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Gender gap among rhinology and skull base surgeons

Patricia G Johnson, Kristen A Echanique, Chandala Chitguppi, Jivianne T Lee, Elina Toskala

Publication date 07-03-2022


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Similarities between allergen sensitivity patterns of central compartment atopic disease and allergic rhinitis

Siddhant H. Tripathi, Heather N. Ungerer, Bianca Rullan‐Oliver, Tapan Patel, Auddie M. Sweis, Ivy W. Maina, Michael A. Kohanski, James N. Palmer, Nithin D. Adappa, John V. Bosso

Publication date 23-02-2022


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Unique volatile metabolite signature of sinonasal inverted papilloma detectable in plasma and nasal secretions

Mark B. Chaskes, Young Eun Lee, Elina Toskala, Gurston Nyquist, Marc Rosen, Bruce Kimball, Mindy Rabinowitz

Publication date 23-02-2022


Background Sinonasal inverted papilloma (SNIP) is a benign neoplasm with aggressive features, including a high recurrence rate and a propensity for malignant transformation. Accurate diagnosis with complete resection and the need for close long-term surveillance is widely accepted as standard management. In this study, we investigate whether SNIP produces a unique volatile metabolite signature, which may ultimately lead to a novel approach to diagnose and monitor SNIP.
Methods Whole blood and nasal secretions from patients with SNIP and healthy age-, sex-, and smoking-status-matched controls, were collected. There were 56 blood samples and 42 nasal secretion samples collected. The volatile metabolite signature of SNIP plasma and nasal secretion samples were compared with those of healthy controls using chromatography.
Results Seventy-two volatiles were identified in plasma samples. Multivariate analysis of variance results, even when controlled for smoking status, indicated toluene as a significant univariate result with lower levels of toluene identified in SNIP plasma samples than healthy control plasma samples. A linear discriminant analysis (LDA) model for plasma volatiles correctly classified 23 of 24 SNIP patients and 26 of 27 control patients, with a cross-validation error rate of 6.02%. Sixty-nine volatiles were identified in nasal samples. For nasal secretion samples, no single univariate response was significant. The LDA model correctly classified 21 of 21 SNIP patients and 11 of 12 control patients, with a cross-validation error rate of 6.55%.
Conclusion This study suggests that SNIP produces a unique, detectable volatile metabolite signature. With further investigation, this can have dramatic clinical implications for diagnosis and monitoring. Although most volatile metabolite studies have investigated solid-organ malignancy, this novel study addresses a benign sinonasal neoplasm by using nasal secretions and plasma as an analysis medium, representing the first such study.

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Cystic Fibrosis Foundation otolaryngology care multidisciplinary consensus recommendations

Adam J. Kimple, Brent A. Senior, Edward T. Naureckas, David A. Gudis, Ted Meyer, Sarah E. Hempstead, Helaine E. Resnick, Dana Albon, Wayne Barfield, Margo McKenna Benoit, Daniel M. Beswick, Eliza Callard, Shelagh Cofer, Veronica Downer, E. Claire Elson, Angela Garinis, Ashleigh Halderman, Lisa Hamburger, Meagan Helmick, Michael McCown, Cameron J. McKinzie, Hanna Phan, Kenneth Rodriguez, Ronald C. Rubenstein, Ashley Severin, Gopi Shah, Ambika Shenoy, Brittney Sprouse, Frank Virgin, Bradford A. Woodworth, Stella E. Lee

Publication date 22-02-2022


Abstract Background Cystic fibrosis (CF) is a multisystem disease that often requires otolaryngology care. Individuals with CF commonly have chronic rhinosinusitis but also present with hearing loss and dysphonia. Given these manifestations of CF, otolaryngologists are frequently involved in the care of patients with CF; however, there is limited consensus on optimal management of sinonasal, otologic, and laryngologic symptoms.
Methods The Cystic Fibrosis Foundation convened a multidisciplinary team of otolaryngologists, pulmonologists, audiologists, pharmacists, a social worker, a nurse coordinator, a respiratory therapist, two adults with CF, and a caregiver of a child with CF to develop consensus recommendations. Workgroups developed draft recommendation statements based on a systematic literature review, and a ≥80% consensus was required for acceptance of each recommendation statement.
Results The committee voted on 25 statements. Eleven statements were adopted recommending a treatment or intervention, while five statements were formulated recommending against a specific treatment or intervention. The committee recommended eight statements as an option for select patients in certain circumstances, and one statement did not reach consensus.
Conclusion These multidisciplinary consensus recommendations will help providers navigate decisions related to otolaryngology consultation, medical and surgical management of CF-CRS, hearing, and voice in individuals with CF. A collaborative and multidisciplinary approach is advocated to best care for our patients with CF. Future clinical research is needed utilizing standardized, validated outcomes with comprehensive reporting of patient outcome, effects of modulator therapies, and genetic characteristics to help continue to advance care, decrease morbidity, and improve the quality of life for individuals with CF.

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Ecological momentary assessment of outcomes in allergic rhinitis and chronic rhinosinusitis: A review

Rachel A. Schusteff, Margaret A. Chervinko, Sharmilee M. Nyenhuis, Victoria S. Lee

Publication date 14-02-2022


Abstract Background Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) rely on patient-reported symptoms and quality-of-life measures, which are subject to bias. Ecological momentary assessment (EMA) captures data in real time through repeated short surveys, thus reducing errors/biases. EMAs use in sinonasal conditions has not been well described, and the goal of this study was to examine the literature on EMA and AR/CRS.
 MethodsA literature review was performed using the following search terms: AR, CRS, and EMA. Inclusion criteria were the use of EMA reporting of sinonasal symptoms at more than one time point. Systematic reviews and non-full text articles were excluded. Population demographics, sinonasal disease, type of EMA platform used, type and severity of symptoms reported, medication use and symptom correlation with location/pollen/pollution were collected.
Results Eight studies met the inclusion criteria, and all focused on AR. All studies were conducted outside the United States in both children and adults. Seven studies used a smartphone application for reporting symptoms, and one used We Chat surveys. EMA data collection varied, with repetitive survey intervals determined either by patients (n = 6) or research team (n = 2). All studies reported sinonasal severity scores, while six reported additional symptoms (e.g., ocular, pulmonary, sleep, general health). Five collected self-reported allergy medication use. Seven studies correlated symptoms with location, pollen, or pollution.
Conclusions Few studies in AR and no studies in CRS assessed the use of EMA. EMA may provide a better understanding of the real-time relationship of environmental triggers with symptoms, in turn guiding treatment decisions.

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An algorithm for sellar reconstruction following endoscopic transsphenoidal surgery for pituitary adenoma: A review of 582 cases

Mark B. Chaskes, Blair Barton, Michael Karsy, Chandala Chitguppi, Tory McKnight, Joshua McCambridge, Adam Flanders, Elina Toskala, Mindy R. Rabinowitz, Gurston G. Nyquist, Christopher Farrell, Marc R. Rosen, James J. Evans

Publication date 09-02-2022


Abstract Background Several sellar reconstruction algorithms stratify patients based on risk of postoperative cerebrospinal fluid (CSF) leak. Many proposed algorithms employ techniques that are overly complex and confer morbidity. We review our experience with sellar reconstruction following transsphenoidal pituitary surgery and propose a highly effective, yet simple and low morbidity, algorithm.
MethodsA retrospective review of 582 patients who underwent transsphenoidal surgery for pituitary adenoma by a single neurosurgeon between 2005 and 2020 was performed. Patients without an intraoperative CSF leak and without a patulous diaphragm were repaired with an oxidized cellulose onlay (group 1). Patients with a low-flow intraoperative CSF leak or a patulous diaphragm were repaired with a synthetic dural substitute inlay (group 2). Patients with a persistent leak around the inlay repair or a high-flow leak were reconstructed with a synthetic dural substitute inlay and a nasoseptal flap onlay (group 3).
Results There was an overall leak rate of 1.5% (9/582) to 1.0% (2/197) in group 1, 1.7% (6/347) in group 2, and 2.6% (1/38) in group 3. Group 3 had the highest rate of postoperative morbidity, including sinusitis (23.7% vs. 8.6% and 15.0% in groups 1 and 2, p = 0.018) and crusting (42.1% vs. 4.6% and 6.3% in groups 1 and 2, p < 0.001). All techniques healed equally well radiographically.
Conclusion The proposed algorithm for sellar reconstruction is highly effective and minimizes complexity and morbidity, primarily utilizing single-layer reconstructions without the addition of packing material or lumbar drainage.

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Dupilumab efficacy and biomarkers in chronic rhinosinusitis with nasal polyps: Association between dupilumab treatment effect on nasal polyp score and biomarkers of type 2 inflammation in patients with chronic rhinosinusitis with nasal polyps in the phase 3 SINUS‐24 and SINUS‐52 trials

Claus Bachert, Jonathan Corren, Stella E. Lee, Haixin Zhang, Sivan Harel, Danen Cunoosamy, Asif H. Khan, Juby A. Jacob‐Nara, Shahid Siddiqui, Scott Nash, Paul J. Rowe, Yamo Deniz

Publication date 31-01-2022


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Clinical factors associated with lower health scores in COVID‐19–related persistent olfactory dysfunction

Mena Said, Thanh Luong, Sophie S Jang, Morgan E. Davis, Adam S. DeConde, Carol H. Yan

Publication date 31-01-2022


Abstract Background Patients with persistent COVID-19 olfactory dysfunction (OD) commonly report parosmia. Understanding the impact of COVID-19 OD and parosmia is critical to prioritizing research and interventions. In this study we investigate the impact of parosmia and other clinical and disease characteristics on health state utility values (HUVs) for those with persistent COVID-19 OD.
Methods Patients with a history of COVID-19 diagnosis and persistent OD were recruited from a tertiary medical center and a social media support forum for chemosensory dysfunction. Clinical characteristics and disease-specific symptoms were obtained along with self-reported history of smell function and presence of parosmia. HUVs were calculated using indirect (Euro Qol 5-Dimension EQ-5D) and direct (VAS) measures.
Results Our study included 286 subjects (75.52% women) with persistent COVID-19–related OD. Results (mean ± standard deviation) of HUVs based on EQ-5D and VAS were 0.81 ± 0.14 and 0.73 ± 0.21, respectively. Mean self-reported smell function (on a 0-10 scale) was 9.67 ± 1.25 pre–COVID-19, 0.93 ± 2.34 at diagnosis, and 3.39 ± 2.32 at most current assessment. A total of 89.16% of the subjects reported parosmia and 24.13% sought medical care for anosmia. Seeing an MD for OD (p < 0.001), female gender (EQ-5D only, p = 0.002), a history of chronic pain (p < 0.05) and depression/anxiety (EQ-5D only, p < 0.001) predicted worse health. Parosmia and persistent symptoms, such as shortness of breath, were associated with lower EQ-5D and VAS scores, but did not independently predict poorer health scores on multivariable analysis.
Conclusion Persistent COVID-19 OD results in health states comparable to other chronic diseases.

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Pharmacokinetic‐based failure of a detergent virucidal for severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) nasal infections: A preclinical study and randomized controlled trial

Charles R. Esther, Kyle S. Kimura, Yu Mikami, Caitlin E. Edwards, Suman R. Das, Michael H. Freeman, Britton A. Strickland, Hunter M. Brown, Bronson C. Wessinger, Veerain C. Gupta, Kate Von Wahlde, Quanhu Sheng, Li Ching Huang, Daniel R. Bacon, Adam J. Kimple, Agathe S. Ceppe, Takafumi Kato, Raymond J. Pickles, Scott H. Randell, Ralph S. Baric, Justin H. Turner, Richard C. Boucher

Publication date 31-01-2022


Abstract Background The nose is the portal for severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2) infection, suggesting the nose as a target for topical antiviral therapies. The purpose of this study was to assess both the in vivo and in vitro efficacy of a detergent-based virucidal agent, Johnson and Johnsons Baby Shampoo (J&J), in SARS-CoV-2–infected subjects.
Methods Subjects were randomized into three treatment groups: (1) twice daily nasal irrigation with J&J in hypertonic saline, (2) hypertonic saline alone, and (3) no intervention. Complementary in vitro experiments were performed in cultured human nasal epithelia. The primary outcome measure in the clinical trial was change in SARS-CoV-2 viral load over 21 days. Secondary outcomes included symptom scores and change in daily temperature. Outcome measures for in vitro studies included change in viral titers.
Results Seventy-two subjects completed the clinical study (n = 24 per group). Despite demonstrated safety and robust efficacy in in vitro virucidal assays, J&J irrigations had no impact on viral titers or symptom scores in treated subjects relative to controls. Similar findings were observed administering J&J to infected cultured human airway epithelia using protocols mimicking the clinical trial regimen. Additional studies of cultured human nasal epithelia demonstrated that lack of efficacy reflected pharmacokinetic failure, with the most virucidal J&J detergent components rapidly absorbed from nasal surfaces.
Conclusion In this randomized clinical trial of subjects with SARS-CoV-2 infection, a topical detergent-based virucidal agent had no effect on viral load or symptom scores. Complementary in vitro studies confirmed a lack of efficacy, reflective of pharmacokinetic failure and rapid absorption from nasal surfaces.

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Out‐of‐pocket costs of biologic treatments for chronic rhinosinusitis with nasal polyposis in the Medicare population

Vinay K. Rathi, George A. Scangas, Ralph B. Metson, Roy Xiao, Leonce Nshuti, Stacie B. Dusetzina

Publication date 27-01-2022


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Association between the HLA‐DQA1 rs1391371 risk allele and chronic rhinosinusitis

Monique C. Arnold, Seerat Poonia, Lauren Colquitt, Cailu Lin, Alyssa Civantos, Michael Kohanski, Nithin D. Adappa, James N. Palmer, Danielle R. Reed, Noam A. Cohen

Publication date 25-01-2022


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Factors associated with postoperative radiotherapy at a different facility in sinonasal squamous cell carcinoma

Jeff Gao, Christopher C. Tseng, Gregory L. Barinsky, Christina H. Fang, Wayne D. Hsueh, Jordon G. Grube, Jean Anderson Eloy

Publication date 25-01-2022


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Long‐term ambient air pollution exposure and risk of sinonasal inverted papilloma

Wojciech K. Mydlarz, Nyall R. London, Shyam Biswal, Murugappan Ramanathan, Zhenyu Zhang

Publication date 25-01-2022


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Omalizumab and quality of life in nasal polyps: A post hoc analysis

Joseph K. Han, Bongin Yoo, Rebecca Saenz, Jessica Braid, Lauren A. Millette, Stella E. Lee

Publication date 25-01-2022


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Steroid affected cytokines in aspirin‐exacerbated respiratory disease

Li Hui Tan, Cailu Lin, Heather Ungerer, Ankur Kumar, Anas Qatanani, Nithin D. Adappa, James N. Palmer, John V. Bosso, Danielle Reed, Noam A. Cohen, Michael A. Kohanski

Publication date 24-01-2022


Abstract Background Patients with aspirin-exacerbated respiratory disease (AERD) are among the most challenging rhinologic patients to treat. AERD has a complex inflammatory milieu of lipid mediators and cytokines. In this study we evaluated cytokine differences in the complex AERD environment at the mucus, epithelial, and tissue levels.
Methods Samples were acquired at the time of sinus surgery from 21 patients (seven steroid-treated, 14 untreated) with aspirin challenge-confirmed AERD. Three methods (sponge adsorption, epithelial brushing, tissue biopsy) were used to acquire samples from the respective sinus sampling sites (mucus, polyp epithelium, and full-thickness polyp) of each patient. We measured and compared 16 cytokine concentrations in AERD patients with or without prednisone treatment using the Luminex platform.
Results In most sampling sites, IL-5, IL-6, IL-10, IL-13, IL-33, CCL20, and TNF-α were detected at higher concentrations than IFN-γ, IL-1β, IL-17A, IL-4, IL-22, IL-17E/IL25, and GM-CSF. Each sampling site had a different pattern of cytokine levels, and except for IL-5 and IL-25 there was no correlation among sampling methods for each cytokine tested. The most notable and significant decreases in cytokines from those treated with prednisone were observed in the epithelium for IL-5, IL-10, IL-33, and IFN-γ.
Conclusions In the epithelial samples, type 2-associated cytokines IL-5 and IL-33, the anti-inflammatory cytokine IL-10, and IFN-γ were lower in AERD patients treated with prednisone. This work serves as a basis to assess therapeutic-induced mucosal cytokine responses in AERD and indicates that the site of cytokine measurement is an important consideration when assessing results.

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