International Forum of Allergy & Rhinology最新文献

Objective: Healthcare-associated costs as well as carbon dioxide (CO₂) emissions are rising, and identifying means to mitigate these may provide direct benefits to patients as well as overall population health, especially among patients with chronic sinonasal disease. This study aimed to assess potential personal travel costs and CO₂ emissions saved due to telemedicine visits.

Methods: This was a retrospective review of patients within Oregon presenting for telemedicine visits at a tertiary rhinology center from July 2022 to July 2023. Distance from patient's address to clinic (miles), as well as estimated average travel time (min), travel costs (USD), and CO₂ emissions (kg), were calculated per round trip prevented by providing care at a distance. Area deprivation indices (ADI) were obtained based on nine-digit zip codes.

Results: Among 354 included visits, the mean ± standard deviation (SD) age was 57.03 ± 16.58 years. Chronic rhinosinusitis (CRS) was the most common diagnosis (55.4%). The majority of visits were follow-up (65.5%) or preoperative (26.8%). Approximately 64,977.00 miles and 66,988.67 min (∼1,116 h) of roundtrip travel were saved, reducing CO₂ emissions by 26,705.55 kg (equivalent to 3,005 gallons of gasoline consumed or 5.6 homes' electricity use for 1 year). Patients within the highest ADI quartile (Q), indicating highest socioeconomic disadvantage, had the highest travel costs saved (median [interquartile range]; Q1, $12.24 [$18.36]; Q2, $134.33 [$274.38]; Q3, $256.69 [$191.52]; Q4, $364.42 [$154.28]; p < 0.001).

Conclusions: Telemedicine may facilitate reduction in the carbon footprint associated with healthcare as well as reduce indirect healthcare costs associated with travel.

Background: Hyaluronic acid has gained widespread attention for its potential role in sinonasal surgery, especially functional endoscopic sinus surgery (FESS), due to its wound healing and anti-inflammatory properties. However, clinical evidence on its efficacy remains inconclusive. This meta-analysis aims to clarify the efficacy of hyaluronic acid in improving both objective and subjective outcomes after sinonasal surgery.

Methods: Two blinded reviewers searched PubMed, Embase, and Scopus databases, then selected randomized controlled trials (RCTs) on hyaluronic acid use in sinonasal surgery compared to routine post-operative care. The risk of bias was graded using the Cochrane Risk of Bias 2 (RoB 2) tool. Data was analyzed using random-effects models to pool risk ratios for dichotomous outcomes and the ratio of means (RoM) for continuous outcomes. Publication bias was assessed via funnel plots and the trim-and-fill method.

Results: From 244 records, 15 RCTs-13 on FESS and two on septoplasty and inferior turbinoplasty-were selected, with 789 participants. Meta-analysis for the 13 studies on FESS was performed. Hyaluronic acid significantly reduced synechiae formation (relative risk [RR] 0.65, 95% confidence interval [CI] 0.44-0.94), improved epithelialization (RR 0.48, 95% CI 0.27-0.86), and decreased post-operative edema (RR 0.70, 95% CI 0.50-0.97) compared to routine post-FESS care. All included studies had a low to moderate risk of bias, and there was no substantial publication bias. There were no adverse events reported.

Conclusions: Hyaluronic acid dressings are safe and may reduce synechiae, edema, and improve epithelialization after sinonasal surgery. Hyaluronic acid may be considered as an adjunct after FESS to optimize post-operative outcomes.

Background/aim: Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease associated with nasal polyposis. Multiple biologics are used for managing EGPA, including some approved for nasal polyps (NP). This study investigated real-world biologic prescription patterns for EGPA and their impact on NP and endoscopic sinus surgery (ESS) use.

Methods: EGPA patients with NP treated with a biologic at any Mayo Clinic site (January 2010 to January 2024) were identified by querying the unified electronic medical record. Patterns of biologic therapy, clinical course, impact on NP, and performance of ESS were studied.

Results: Eighty patients were identified. Overall, 71 of 80 (88.75%) patients underwent ESS, with 62 of 80 (77.5%) undergoing 131 ESS procedures prior to biologic therapy. ESS for recalcitrant NP (47 episodes) was performed on 38 of 80 (47.5%) patients on biologics. Biologic monotherapy was used in 90% (72) of patients; mepolizumab (81.9%) was the most common, followed by rituximab (23.6%), benralizumab (18.1%), and dupilumab (12.5%). Switching of biologics was observed in 28 of 80 patients. Concurrent dual-biologic therapy was used in eight (10%) patients. For patients on single-agent biologic therapy, ESS was performed on 52.5% of patients on mepolizumab, 23.5% on rituximab, 42.8% on benralizumab, and 22.2% on dupilumab.

Conclusions: Multidisciplinary multi-modality treatment with biologics and ESS appeared to be the mainstay of controlling NP in EGPA. Mepolizumab was the most frequently used biologic. Dual biologic therapy was necessary in 10% of patients. Overall, 71 of 80 (88.75%) patients had ESS, with almost half the study population (47.5%) undergoing ESS after initiating biologic treatment.

Background: Recent studies have extensively explored new non-invasive and side-effect-free therapeutic strategies for the treatment of allergic rhinitis (AR). Photobiomodulation therapy (PBMT) utilizes photons from the red to infrared spectrum to modulate biological processes, exhibiting anti-inflammatory and regenerative properties. The objective of our study was to evaluate the efficacy of PBMT in patients with AR.

Methods: This study was a randomized, placebo-controlled, double-blind clinical trial involving 62 patients with AR. Participants underwent PBMT twice weekly, totaling eight sessions over the course of 1 month. The control group consisted of 29 patients who received treatment with a non-light-emitting device, while 33 patients in the laser therapy group received a protocol of 6 J of red and infrared light administered intranasally, along with 1 J of infrared light applied externally to the nose. Objective, psychophysical, and subjective assessments of nasal obstruction and olfactory function were conducted both before and after the treatment.

Results: PBMT contributed to significant improvements in various nasal and respiratory parameters. The peak nasal inspiratory flow demonstrated significant improvement (p < 0.001), and the Nasal Obstruction Symptom Evaluation scale indicated notable enhancement in nasal obstruction (p = 0.048). Additionally, the Rhinitis Control Assessment Test reflected significant symptom improvement over the past week (p = 0.035). However, the University of Pennsylvania Smell Identification Test showed no significant change in olfactory function (p = 0.251).

Conclusion: Our data suggest that PBMT may serve as a promising therapeutic option for individuals with AR, providing an alternative for those who are unable to tolerate conventional medications. Furthermore, it demonstrates efficacy and safety as a viable treatment alternative.