International Forum of Allergy & Rhinology最新文献

Background: Both anxiety and depression are prevalent among patients with chronic rhinosinusitis (CRS) and associated with poorer outcomes following treatment for CRS. However, the impact of treatment on CRS on mental health remains uncertain. Therefore, this study seeks to evaluate if surgical intervention for CRS may alleviate comorbid depression and anxiety.

Methods: PubMed, Embase, and Scopus databases were searched for retrospective and prospective cohort studies, cross-sectional studies, and randomized controlled trials relating to CRS treatment using sinus surgery from inception to April 30, 2024, using the Population, Intervention, Comparison, and Outcomes (PICO) framework. Three blinded reviewers selected observational studies and randomized controlled trials investigating levels of depression and anxiety pre- and post-surgical treatment of CRS. Eleven studies comprising 3067 patients were included, of which five studies were quantitatively analyzed. After which, data were extracted from included articles into a structured proforma and the Newcastle-Ottawa Scale was used to evaluate study bias, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and a PROSPERO-registered protocol (CRD42022351855). Meta-analyses of the ratio of means were conducted in a random-effects model.

Results: Overall, sinus surgery was associated with significant improvement in test scores of depression (ratio of means (ROM) = 1.47, 95% confidence interval [CI] = 1.03‒2.10), anxiety (ROM = 1.10, 95% CI = 0.81‒1.49), and quality of life markers, which are closely correlated to mental health outcomes.

Conclusions: Sinus surgery for CRS may improve mental health outcomes (both depression and anxiety) for patients.

Introduction: Tissue eosinophil counts (TEC) might serve as a biomarker linking chronic rhinosinusitis (CRS) and the presence of adult-onset asthma. This study aimed to determine if TEC in sinus mucosa/polyps in CRS patients is an independent indicator of asthma and to identify its optimal cut-off point.

Methods: This cross-sectional study was conducted on primary CRS patients scheduled for surgery. All patients were assessed by a pulmonologist for asthma diagnosis. Tissues were collected during surgery and evaluated for TEC. Logistic regression and receiver operating characteristic analysis were used to determine significant factors and the optimal cut-off points of TEC associated with asthma.

Results: A total of 103 CRS patients were included. Ten patients (9.7%) had underlying asthma, while 13 (12.6%) were first diagnosed by the pulmonologist. TEC ≥40 cells per high-powered field (HPF) exhibited a significant correlation with asthma (area under the curve = 0.71, p < 0.001). The sensitivity of this cut-off point was 0.70 (95% confidence interval [CI] = 0.47-0.87), and specificity was 0.66 (95% CI = 0.55-0.76). Positive predictive value and negative predictive value were 0.37 and 0.88, respectively. The cut-off point significantly associated with the presence of asthma, with an adjusted odds ratio of 3.13 (95% CI = 1.05-9.35, p = 0.04), controlling for polyps, allergic rhinitis, and computerized tomography (CT) score.

Conclusion: TEC in CRS patients can help determine the presence of adult-onset asthma, with an optimal threshold of ≥40 cells/HPF. This threshold is significantly associated with asthma independent of polyps, allergy, and CT score.

Background: Steroid rinses and steroid-eluting stents are both options for preventing postoperative stenosis after frontal sinus surgery. This study aimed to assess whether steroid-eluting stents offer added benefit over steroid rinses alone in postoperative healing and long-term frontal sinus patency.

Methods: A randomized controlled trial enrolled patients with CRS with nasal polyps (CRSwNP) who underwent surgery for bilateral and equal frontal sinusitis after failing prior medical therapy. Each patient served as their own control, with each patient randomized to stent placement in either right or left frontal sinuses. Exclusion criteria included unequal frontal sinusitis, aspirin exacerbated respiratory disease, cystic fibrosis, primary ciliary dyskinesia, and immunocompromise. All patients used steroid rinses postoperatively. Scarring, edema, patency, and the need for additional treatments were assessed at 1, 3, 12, and 24 weeks postoperatively. Univariate and multivariate analyses were performed.

Results: Sixty-two patients were enrolled. Postoperatively, scarring, edema, patency, and the need for further treatment were similar in both groups at 24 weeks (p = 0.878, 0.688, 0.817, 1.00, and 1.00, respectively). Multivariable regression analysis identified time as an independent risk factor for scarring (OR = 1.32, [1.03‒1.71]) and patency (OR = 1.39, [1.10‒1.82]), while it was an independent protective factor for edema (OR = 0.40, [0.32‒0.49]). The steroid-eluting stent did not significantly affect this.

Conclusion: For CRSwNP, with or without asthma, without other underlying systemic disease factors, steroid-eluting stents may not add benefit over steroid rinses in reducing postoperative scarring and edema, improving long-term frontal sinus patency, or reducing the need for additional treatments, as long as patients continue topical therapy and know how to rinse effectively.

Background: Dysbiosis of the bacterial and fungal microbiome has been increasingly implicated in the pathogenesis of chronic rhinosinusitis (CRS). This study explores the relationship between microbiome and mycobiome biodiversity and type 2 (T2) versus non-type 2 (NT2) inflammation.

Methods: Mucosal tissues from the ethmoid sinus were collected during endoscopic sinus (CRS) and skull base (controls) surgery between January 2020 and July 2021. Specimens underwent 16S rRNA (bacterial) and internal transcribed spacer (fungal) gene sequencing, along with cytokine analysis using the Luminex assay. Based on cytokine (IL-4, IL-5, IL-13) concentrations and the presence of eosinophils, CRS cases were classified into T2 or NT2 inflammatory profiles. The relationships between CRS endotype and the biodiversity of the microbiome and mycobiome were assessed.

Results: Specimens from 92 patients (30 control, 31 CRSwNP, 31 CRSsNP) were included in the analyses. Among 62 CRS cases, 20 exhibited T2 inflammation and 42 exhibited NT2 inflammation. Compared with control specimens, NT2 specimens exhibited significantly lower amplicon sequence variants (mean difference -149, 95% CI [-261, -37], p = 0.007), Shannon index (-0.48 [-0.79, -0.16], p = 0.002), and Simpson index (-0.003 [-0.005, -0.001], p = 0.002) for bacterial alpha diversity. However, no significant differences in bacterial alpha diversity were observed between T2 specimens and controls, or between T2 and NT2 specimens. Fungal biodiversity did not differ significantly across endotype and control groups.

Conclusion: Dysbiosis of the sinus bacterial microbiome is more strongly associated with a NT2-mediated inflammatory profile than with a T2-mediated inflammatory profile.

Background: We developed and assessed the performance of a machine learning model (MLM) to identify, classify, and segment sinonasal masses based on endoscopic appearance.

Methods: A convolutional neural network-based model was constructed from nasal endoscopy images from patients evaluated at an otolaryngology center between 2013 and 2024. Images were classified into four groups: normal endoscopy, nasal polyps, benign, and malignant tumors. Polyps and tumors were confirmed with histopathological diagnosis. Images were annotated by an otolaryngologist and independently verified by two other otolaryngologists. We used high- and low-quality images to mirror real-world conditions. The models used for classification (EfficientNet-B2) and segmentation (nnUNet) were trained, validated, and tested at an 8:1:1 ratio. The performance accuracy was averaged across a 10-fold cross-validation assessment. Segmentation accuracy was assessed via Dice similarity coefficients.

Results: A total of 1242 images from 311 patients were used. The MLM was trained, validated, and tested on 663 normal, 276 polyps, 157 benign, and 146 malignant tumors images. Overall, the model performed at 84.1 ± 4.3% accuracy in the validation set and 80.4 ± 1.7% in the test set. The model correctly identified the presence of a sinonasal mass at 90.5 ± 1.2% accuracy rate. The MLM accuracy performance rates were 86.2 ± 1.0% for polyps and 84.1 ± 1.8% for tumors. Benign and malignant tumor subclassification achieved 87.8 ± 2.1% and 94.0 ± 2.4% accuracy, respectively. Segmentation accuracies for polyps were 72.3% and 72.8% for tumors.

Conclusions: An MLM for nasal endoscopy images can perform with moderate to high accuracy in identifying, classifying, and segmenting sinonasal masses. Performance in future iterations may improve with larger and more diverse training datasets.

Key points: Racial disparities influence the completion of aspirin (ASA) desensitization and ASA-exacerbated respiratory disease (AERD) diagnosis age. Public insurance correlates with an official AERD diagnosis after age 50. Social factors, including race and insurance status, impact AERD diagnosis and adherence to ASA desensitization.

Key points: Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post-operative period has not been studied in live subjects and controversy exists in when to restart this post-operatively. This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post-surgical sphenoid sinus and the mid-nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect.