International Forum of Allergy & Rhinology最新文献

Background: Chronic rhinosinusitis (CRS) and olfactory dysfunction (OD) are highly prevalent among people with cystic fibrosis (PwCF) and negatively impact quality of life. The 40-item Smell Identification Test (SIT) is widely used to assess psychophysical olfaction, but a CF-specific minimal clinically important difference (MCID) has not been established. This study aimed to determine the SIT MCID in PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI) and/or endoscopic sinus surgery (ESS).

Methods: Data from three prospective, multi-institutional observational studies were pooled. Participants were ≥12 years old with confirmed CF and CRS who completed SIT at baseline and ≥1 follow-up (3, 6, 9, 12, or 24 months). Distribution-based MCIDs were calculated using four methods: standard error of measurement (SEM), minimal detectable change (MDC = 1.96 × SEM), 0.5 × baseline standard deviation (SD), and 0.5 × SD of change scores (ΔSD).

Results: A total of 122 participants were enrolled (mean age 32.9 years, 54% female). Of these, 99 contributed follow-up SIT scores (79 ETI, 20 ESS). SIT scores remained stable with ETI, with a small but statistically significant decline at 6 months (-1.4, p = 0.02). ESS was associated with mean gains of 3.1-4.5 points at early follow-up, though these did not reach significance. Pooled distribution-based MCID estimates ranged from 2 to 4 points, with an overall threshold of 3.1 (95% CI: 2.1-4.1).

Conclusions: This CF-specific SIT threshold provides a clinically interpretable cut-off for assessing olfaction. These findings establish a foundation for future work and highlight the importance of developing disease-specific MCIDs to guide clinical care and research.

Background: Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are two highly prevalent airway diseases in the United States. While the coexistence of CRS and asthma is well recognized, less is known about the development of new-onset asthma in CRS, particularly in the context of comorbid AR. This study assessed the impact of CRS and AR on incident asthma using a large electronic health record (EHR) database.

Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, a federated EHR platform encompassing over 100 million patients. Adults ≥ 18 years between January 2009 and December 2019 with CRS were compared to controls without CRS. A second analysis compared patients with CRS and concurrent AR to those with CRS alone. Supplemental analyses substituted chronic rhinosinusitis with nasal polyps (CRSwNP) for CRS. Propensity score matching balanced cohorts on demographics and comorbidities. Primary outcomes were new-onset asthma and asthma exacerbations, assessed at 1, 2, and 5 years.

Results: After matching, pre-existing CRS was associated with higher risk of new-onset asthma (adjusted relative risk [aRR] = 1.42, 95% CI 1.36-1.48) and exacerbations (aRR = 1.87, 95% CI 1.75-2.00) at 1 year versus CRS controls, with similar trends at 2 and 5 years. Coexisting AR further amplified risk: patients with CRS + AR had increased asthma incidence relative to CRS alone at 1 year (aRR = 1.69, 95% CI 1.65-1.73), 2 years (aRR = 1.65, 95% CI 1.62-1.68), and 5 years (aRR = 1.58, 95% CI 1.56-1.60), with more than doubled exacerbation risk across all time points. Directionally similar findings were observed in CRSwNP analyses.

Conclusions: CRS is associated with increased risk of incident asthma and subsequent exacerbations, and coexisting AR identifies a higher-risk phenotype within CRS. These findings highlight the need for phenotype-informed studies to determine whether targeted upper-airway management can mitigate downstream asthma burden.

The endoscopic endonasal approach (EEA) to the skull base has revolutionized the management of ventral skull base lesions, offering superior visualization and reduced morbidity. Yet, iatrogenic cranial nerve (CN) injuries, causing temporary or permanent deficits, remain an underexplored complication that significantly affects quality of life. This systematic review describes the number of reported cases of CN injuries in EEA and the evidence on prevention and management strategies. Following PRISMA-SR guidelines, we searched Medline, Embase, Web of Science, and the Cochrane Library, and screened 2796 studies; 177 were included. Across 18,546 patients, 859 CN injuries were reported. The abducens (24.4%), optic (23.7%), and olfactory (18.6%) nerves were most affected, linked primarily to pituitary adenomas (34.49%) and sellar approaches (34.4%). Full recovery occurred in 38.4% of cases, while 29.9% had permanent deficits. Intraoperative neuromonitoring was reported in 34 studies, showing prognostic value but lacking definitive evidence for injury prevention. Only 5% of studies addressed postoperative management, highlighting a care gap. This review emphasizes the need for standardized reporting, enhanced monitoring, and robust postoperative strategies to optimize EEA outcomes. Future directions include prospective studies and patient-reported outcomes to refine skull base surgery safety.