International Forum of Allergy & Rhinology最新文献

Background: Precedent chronic rhinosinusitis (CRS) is associated with new-onset asthma and non-cystic fibrosis bronchiectasis (BE).

Objective: To assess if endoscopic sinus surgery (ESS) mitigates the development of lower airway diseases in patients with CRS.

Methods: This retrospective study utilized electronic medical records from an academic center. CRS patients (> 18 years old) without asthma or BE, were identified between January 2006 and December 2013. Charts were reviewed until May 2023. New diagnoses of asthma or BE were identified in patient records following ESS before December 2018 compared to patients without ESS. Lund-Mackay (LM) scores were calculated in a random subset of patients to assess disease severity. Logistic regression was used to estimate the odds of developing asthma or BE by ESS status.

Results: A total of 1877 patients underwent ESS, while 13,453 did not. CRS severity was higher in the ESS group (LM, 9.02) versus no ESS group (LM, 4.28). After up to 17 years of follow-up, 207/1877 (11%) and 40/1877 (2.1%) of patients with ESS had a new asthma or BE diagnosis, respectively. Out of 13,453 patients, 1778 (13.2%) and 293 (2.2%) patients without ESS had a new asthma or BE diagnosis. The unadjusted odds of a new asthma diagnosis were lower by 19% for ESS versus no ESS; OR (95% CI), 0.81 (0.70-0.95). After controlling for confounders (age, gender, race/ethnicity, smoking status, and chronic rhinitis), the association remained significant, with a 15% reduction in the odds of a new asthma diagnosis; OR (95% CI), 0.85 (0.73-0.99). There was no association between ESS status and a new diagnosis of BE.

Conclusions: Despite higher CRS severity, patients undergoing ESS had a lower risk of a new asthma diagnosis and did not have a higher risk of developing BE.

Objective: In the last two decades, transnasal endoscopic surgery (TES) has become pivotal in the management of sinonasal tumors. This approach involves a multiblock tumor resection, adding complexity to the interpretation of surgical margins after pathological examination. This study compares different strategies to infer subclinical local residual disease (SLRD), aiming to identify and validate the best available method for assessing SLRD after transnasal endoscopic resection of sinonasal squamous cell carcinoma (SCC) and intestinal-type adenocarcinoma (ITAC).

Methods: Three methods to estimate SLRD (as either absent-R0 - or microscopically present-R1) were applied in patients who received negative margins-aimed endoscopic resection: sole-pathologist examination, multidisciplinary evaluation, and anatomic diagram-based assessment. The primary outcome to compare methods was time-to-recurrence (TTR) stratification provided by these methods.

Results: 105 patients were included (50 SCC and 55 ITAC). All three methods resulted significantly associated with TTR in both ITAC and SCC populations. In a multivariate model, only SLRD assessed with the anatomical diagram was independently associated with time-to-local-recurrence (TTLR) in SCC and TTR in both ITAC and SCC groups. The concordance index (C-index), the area under the curve (AUC), and the incremental AUC (iAUC) were higher for the anatomical diagram method in the ITAC and SCC cohorts.

Conclusion: The anatomic diagram proved to be the best available strategy, yet with limitations, for assessing SLRD, demonstrating superior TTR stratification compared to traditional methods.

Background: Chronic rhinitis (CR) is currently recognized as a syndrome that manifests in different phenotypes. We aimed to establish an artificial intelligence system (quantitative assessment of nasal inflammatory cytology, QANIC) on the basis of whole-slide images (WSIs) to enable quantitative assessment of nasal inflammatory cells.

Methods: During the development phase of QANIC, we screened nasal secretion smears from 145 CR patients for deep learning and obtaining a robust model. Subsequently, QANIC was applied to an internal cohort (N = 881) and an independent external validation cohort comprising two clinical centers (N = 234). Cluster analysis was employed to analyze two inflammatory variables (nasal and blood eosinophil [Eos] percentages) to investigate the clinical characteristics and inflammatory patterns of different clusters.

Results: Three clusters of inflammatory phenotypes were defined in CR patients: Cluster 1 (high nasal and high blood Eoss, accounted for 17.14% and 16.24% in the two cohorts, respectively), Cluster 2 (high nasal but low blood Eoss, 45.86% and 45.30%), and Cluster 3 (low nasal and low blood Eoss, 37.00% and 38.46%). Compared to Cluster 3, Clusters 1 and 2 demonstrated more severe clinical symptoms and nasal Type 2 inflammation, along with a diagnostic advantage in identifying seasonal allergic rhinitis.

Conclusions: The QANIC marks the first time deep learning has been combined with WSIs for nasal cytology diagnosis. Subtyping rhinitis patients based on nasal cytology play an important role in monitoring inflammation dynamics and individualizing treatment.

Background: Nasal airway obstruction (NAO) is prevalent with substantial health and quality of life burdens. Nasal valve collapse (NVC) is one structural cause of NAO. Temperature-controlled radiofrequency (TCRF) nasal valve remodeling offers an alternative to invasive surgery. Clinical efficacy is established, but the impacts of TCRF on healthcare resource utilization (HRU) and cost in real-world settings remain underexplored.

Methods: Two cohorts with NAO were defined from a large general NAO population: the TCRF cohort with an isolated TCRF (index) procedure and a propensity-matched medically managed (MM) cohort without nasal procedures. HRU and costs were evaluated within a 24-month pre-/post-index period for both.

Results: A total of 10,206 TCRF and 50,766 MM patients were analyzed. Significant post-index reductions were observed for TCRF across all-cause Evaluation & Management (E&M) visits, ENT-related procedures, and sleep-related claim categories. A large reduction in mean daily post-index costs was seen for the TCRF cohort: $68.07 pre-index to $38.75 post-index (-43.1%). Mean daily costs went up in the MM cohort from $42.08 pre-index to $63.26 post-index (+50.4%), resulting in total cost savings of $21,418.26 for the TCRF cohort and a total cost increase of $15,471.99 in the MM cohort in the 24-month post-index period. TCRF cost reductions were driven by reductions in NAO-related HRU.

Conclusions: In this large, real-world analysis, TCRF treatment for NVC-related NAO demonstrated substantial reductions in HRU and total costs of care, demonstrating sustained savings over 2 years relative to MM patients.