International Forum of Allergy & Rhinology最新文献

Key points: Dupilumab targets Th2-associated inflammatory mediators to reduce disease burden in CRSwNP. While rare, potential sequelae include viral, helminth, and potentially amebic infections.

Background: Quantitative mucus cytokine analysis to examine the sinonasal microenvironment may bridge the gap between patient-reported outcome measures (PROMs) and empirical measures of inflammation in patients with chronic rhinosinusitis (CRS).

Objective: Investigate the correlation between mucus cytokine levels and Sino-Nasal Outcome Test (SNOT-22) scores, including individual subdomains.

Methods: Patients with CRS were prospectively recruited between 2016 and 2021 into a multi-institutional observational study. Mucus was collected from the olfactory cleft and evaluated for mucus cytokine biomarkers. Spearman correlations (ρ) between cytokine levels and SNOT-22 scores, including individual subdomains, Lund-Mackay (LM) CT and Lund-Kennedy (LK) endoscopy scores were assessed. Subgroup analysis based on nasal polyp status (CRSsNP-without nasal polyps; CRSwNP-with nasal polyps) was also performed. Linear regression was employed to identify multivariate associations between cytokine expression levels, clinical covariates, and SNOT-22 total and domain scores.

Results: A total of 127 patients were included in the study (CRSsNP = 53, CRSwNP = 74). IL-9 (ρ = 0.196, p < 0.05) was the only biomarker that correlated with the SNOT-22 total score. CRSwNP patients had a higher absolute expression level of Type 2 biomarkers (IgE, IL-5, and IL-13), compared to CRSsNP patients. IgE, IL-5, IL-9, and IL-13 significantly correlated with the SNOT-22 rhinologic subdomain scores (p < 0.001), LM scores, and patient reported sense of smell (Question 21). Notably, subgroup analysis showed that CRSsNP patients also demonstrated significant correlations between Type 2 markers (IL-4, IL-5, IL-9, and IL-13) and SNOT-22 rhinologic subdomain scores.

Conclusion: Type 2 mucus cytokine levels, especially IL-9, correlate with SNOT-22, and the rhinologic SNOT-22 subdomain scores for both CRSsNP and CRSwNP patients.

Background: Platelet-rich plasma (PRP) injections have previously been shown to benefit coronavirus disease 2019 (COVID-19)-induced smell loss. It is unknown if that benefit is stable over time. The aim of this study was to assess outcomes at 1-year post-intervention.

Methods: Prospective cohort study. Sixteen patients (10 PRP and six placebo) from the original PRP randomized placebo-controlled clinical trial, and a further 16 patients from smell clinic who were a year out from initial treatment (six PRP patients and 10 non-PRP) were enrolled. University of Pennsylvania Smell Identification Tests (UPSITs) and visual analog scale (VAS) subjective scores were compared to initial scores.

Results: There was no difference between groups with respect to age, gender, race, duration of smell loss prior to intervention, smoking or diabetes status, Charlson comorbidity index, presence of phantosmia or parosmia, or baseline UPSIT score. The PRP group had a significantly higher change in UPSIT score at 1 year (p = 0.001), a higher number of patients who met the minimal clinically important difference for the UPSIT (87.5% vs. 31.2%, p = 0.004), and a significantly greater change in VAS at 1 year (p = 0.001), compared to those who did not receive injections. On multivariate logistic regression analysis, no factors appeared to have a significant effect on these findings.

Conclusion: PRP injections into the olfactory cleft now have long-term data suggesting benefit in both subjective and psychophysical measures of smell, and improvements in both realms at 1 year are significantly higher than in those who do not receive the injections.

Background: Endoscopic endonasal techniques, initially developed for sinonasal tumor resection, have revolutionized the approach to orbital lesions. The emergence of endonasal orbital tumor surgery has prompted anatomical studies focusing on the medial orbit, yet there remains a lack of literature on maneuverability lateral to the optic nerve (ON), with current feasibility assessments relying primarily on the plane of resectability (POR).

Methods: Bilateral anatomical dissections were conducted on four latex-injected human cadaveric heads using an endoscopic medial and inferior orbitotomy and superomedial displacement of the inferior rectus muscle (IRM) to access the inferolateral intraconal quadrant. Measurements of distances, areas, angles of attack, and volumetric exposure were obtained using stereotactic points from an imaging-based navigation system. Additionally, an illustrative case was presented to demonstrate the endoscopic management of laterally based intraconal lesions.

Results: The intraconal space was safely accessed through superomedial displacement of the IRM. The mean intraconal volumetric exposure attained through this maneuver was 2.78 cm³ (1.18 cm³). The most superolateral point reachable by the ipsilateral endoscopic endonasal approach was consistently lateral and superior to the ON at a mean absolute distance of 1.45 cm (0.37 cm). Maneuverability at this target point was superior in the sagittal plane, noted by a larger vertical angle of attack compared with the horizontal angle of attack.

Conclusion: This study demonstrates that inferolateral intraconal dissection through an ipsilateral endoscopic endonasal approach is feasible via a medial orbitotomy and superomedial retraction of the IRM. Additionally, our findings reaffirm lesions below the POR are suitable for endoscopic endonasal resection.