International Forum of Allergy & Rhinology最新文献

Background

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease characterized by persistent sinonasal inflammation. There is increasing interest in endotype-based classification, which categorizes CRS based on underlying inflammatory pathways. We applied factor analysis to facilitate continuous endotype assignment to CRS patients and assess cross-sectional and longitudinal CRS outcomes.

Methods

We prospectively enrolled 203 patients (52 controls, 88 CRSsNP, and 63 CRSwNP) undergoing endoscopic nasal or sinus surgery (ESS). Middle meatal mucus biomarkers were analyzed pre-ESS (V0) and 6–12 months post-ESS (V1). Factor analysis was performed to identify latent factors. Factor scores were generated, and statistical analyses were conducted to assess correlations with radiographic (Lund–Mackay [LM]) and patient-reported (SNOT-22, CRS-PRO) outcomes measured at V0, V1, and V2 (1.5–5 years post-ESS).

Results

Four factors were identified: Type 1 (T1), Type 2 (T2), Type 3 (T3), and macrophage-associated (M). CRSwNP patients had higher T2 and M factor scores than CRSsNP and controls. T2, T3, and M factor scores demonstrated stronger or equivalent associations with radiographic and patient-reported outcomes compared to individual biomarkers. Following ESS, median T2 and M factor scores significantly declined, while T1 and T3 remained stable. V0 T1 and T2 were weakly associated with long-term (V2) radiographic and symptom scores. V1 factor scores were more consistently predictive of long-term (V2) outcomes, with T2, T3, and M demonstrating modest correlations with radiographic severity and CRS-PRO.

Conclusions

Factor analysis identifies distinct, quantifiable patterns of inflammation in CRS, offering improved associations with cross-sectional and longitudinal outcomes compared to individual biomarkers.

Key Points

Background

Various interventions have been proposed to enhance surgical field quality during endoscopic sinus surgery (ESS). This study evaluates whether preoperative oral clonidine enhances surgical field quality during ESS.

Methods

PubMed, Scopus, Web of Science, Embase, and CENTRAL databases were searched. Eligible randomized controlled trials (RCTs) were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcome was surgical field quality. Secondary outcomes included intraoperative blood loss (IBL), operative duration, mean arterial pressure (MAP), heart rate (HR), surgeon satisfaction score, and postoperative complications (i.e., nausea and vomiting, bradycardia, and hypotension). Outcomes were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Trial sequential analysis (TSA) was also performed.

Results

Eight RCTs involving 597 patients were included. Preoperative oral clonidine significantly enhanced surgical field quality (MD = −0.65, 95% CI: −0.92, −0.37) and reduced IBL (MD = −44.67 mL, 95% CI: −62.03, −27.32), operative duration (MD = −11.64 min, 95% CI: −22.25, −1.04), MAP (MD = −10.36 mmHg, 95% CI: −18.03, −2.69), and HR (MD = −10.16 bpm, 95% CI: −17.62, −2.70). It was also associated with a significantly higher surgeon satisfaction score (p = 0.01) and comparable rates of postoperative complications (p > 0.05). TSA confirmed conclusive evidence for all outcomes except operative duration.

Conclusion

Preoperative oral clonidine shows potential in enhancing surgical field quality, reducing IBL, MAP, and HR, and enhancing surgeon satisfaction during ESS, without increasing postoperative complications. Its potential to reduce operative duration requires cautious interpretation.

The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence for surveillance strategies following definitive treatment of sinonasal malignancy. Topics discussed include components of surveillance, including endoscopy and imaging subtypes, frequency and length of surveillance, and highlights of some specific pathologies that warrant special consideration. This EPS was developed following the recommended methodology and approval process as previously outlined. A modified Delphi approach with a working group of practitioners was utilized to develop five statements and one proposed algorithm, and all six items reached consensus after two rounds of discussion and modification. These statements and accompanying evidence are summarized, along with an assessment of gaps in the literature to identify future research needs.

Background

Emerging evidence suggests a possible link between rhinosinusitis and systemic rheumatic diseases; however, no meta-analysis has comprehensively examined this association to date. We aimed to investigate if patients with rhinosinusitis have a predisposition to unmasking rheumatic diseases compared to individuals without rhinosinusitis.

Methods

A comprehensive search in MEDLINE, Embase, Cochrane Library, and Web of Science was conducted until February 2025 for studies characterizing rheumatic disease incidence, prevalence, and risk in cohorts of rhinosinusitis patients. The search was limited to records authored in English and involved combining both rhinitis and sinusitis Medical Subject Headings (MeSH) terms. Relative risk and prevalence data were pooled using random-effects models.

Results

Nine studies with 86,081 rhinosinusitis patients were included. Chronic rhinosinusitis (CRS) was significantly associated with increased risk of rheumatoid arthritis (RA) (odds ratio [OR]: 1.70; 95% CI: 1.44–2.00; p < 0.00001), systemic lupus erythematosus (OR: 1.61; 95% CI: 1.25–2.08; p = 0.0002), and ankylosing spondylitis (OR: 1.48; 95% CI: 1.26–1.72; p < 0.00001). Acute rhinosinusitis (ARS) showed weaker associations, notably with seronegative RA. Rheumatic disease prevalence in rhinosinusitis patients was highest for RA (10%, 95% CI: 8.2–13).

Conclusion

Rhinosinusitis, particularly CRS, is associated with several rheumatic diseases. Mechanisms of mucosal immune dysregulation associated with rhinosinusitis may contribute to, or act in parallel with, the pathogenesis of systemic autoimmunity. Management of CRS (surgical or immunomodulatory) may lead to the sentinel presentation and subsequent identification of previously undiagnosed systemic autoimmune conditions. Clinicians should maintain a high index of suspicion for early autoimmune symptoms in rhinosinusitis patients.