Rhinology最新文献

Background: Endoscopic sinus and skull base surgeons are at high risk of work-related musculoskeletal disorders (WRMD) due to the unique ergonomic risks inherent in this specialty. These musculoskeletal disorders may negatively impact surgeons and their patients. The primary aim of this international survey was to quantify this problem globally and evaluate its associated factors.

Methods: A 46-item electronic survey was distributed to endoscopic sinus and skull base surgeons at any career stage via multiple international professional societies.

Results: We received 1385 responses. The prevalence of WRMD in the previous week and 12 months was 44.2% and 66.5%, respectively. The neck, shoulders, lumbar spine and wrists were the most commonly involved body parts, and most surgeons had symptoms in multiple body parts. Work-related musculoskeletal disorders were reported to negatively impact work, hobbies, activities of daily living and sleep, and to shorten careers in respondents. Factors associated with higher odds of WRMD included female sex, BMI ≥30kg/m2, being an attending otolaryngologist, having a high surgical and clinic caseload (performing >100 ESSB procedures annually), and operating in standing. Regular exercise (>7 hours weekly) and an endomorphic somatotype were associated with lower odds of WRMD.

Conclusions: Endoscopic sinus and skull base surgeons have a high prevalence of WRMD. Modifiable risk factors include surgical volume, clinic time, operating position, and regular exercise. We make recommendations to assist in the reduction of WRMD in this population.

Background: Non-keratinizing nasopharyngeal carcinoma (NPC) is closely related to Epstein-Barr virus (EBV) infection. Patients with NPC often exhibit diverse treatment responses due to tumor heterogeneity. Thus, identifying molecular subgroups based on EBV involvement holds promise for refining personalized treatment strategies and improving treatment outcomes in NPC patients.

Methods: 193 treatment-naive NPC specimens with comprehensive clinical and pathological data were procured from Fujian Cancer Hospital. RNA sequencing was employed to acquire the gene expression profiles, followed by the re-annotation of 100 EBV-associated genes leveraging the EBV sequence. Molecular subtypes were conducted via consensus clustering, with an external NPC cohort serving as a validation dataset. Scissor method was applied to identify survival-associated cell subpopulations from single-cell data, following comprehensive bioinformatic analyses.

Results: Three molecular subtypes of NPC-CoriLyt, Cneg, and CEB1-were identified, each with specific clinical profiles. The CEB1 subtype is distinguished by its heightened metabolic activity and immunosuppressive environment. A hub-gene-based risk model for these subtypes strongly predicted disease-free survival, with replicated results in the validated cohort. The model's predictive accuracy was high, with areas under the curve for 1, 3, and 5-year survival rates at 0.79, 0.86, and 0.88, respectively. M2-type macrophages exhibit a high-risk score profile and play a critical role in EBV infection, with prominent activation of the TNF-II and TGF-B signaling pathways.

Conclusions: This study introduced a new EBV-related transcriptomics-based classification system for NPC that showed great promise in predicting patient survival outcomes.

Introduction: This systematic review and meta-analysis evaluated the effect of oral corticosteroid (CS) treatment on tissue eosinophil count (EC) in chronic rhinosinusitis (CRS) patients.

Methodology: A comprehensive database search identified 16 studies with 1,003 patients for the systematic review. Nine studies with 493 patients reporting mean tissue EC per high-power field (HPF) with 400x magnification were included in the meta- analysis. Within-subject (pre- vs. post CS treatment) and controlled comparisons (oral CS vs. no CS or topical CS) were analyzed.

Results: Results showed a significant reduction in tissue EC following oral CS treatment in both within-subject analyses and controlled trials. A similar effect was found when comparing oral vs. topical CS treatment. Meta-regression showed a significant negative association between cumulative CS dose and post-treatment EC/HPF.

Conclusion: These findings provide strong evidence that oral CS significantly reduces tissue eosinophilia in CRS, including comparisons with topical CS. The effect was consistent across study designs and should be considered when assessing endotypes in CRS with nasal polyps.

Background: Olfactory dysfunction is a common issue among the older population and has been associated with both frailty and increased mortality risk. Telomere length (TL), a marker of biological aging, may provide insights into these associations. This study investigates the relationship between TL and olfactory function in older adults.

Methodology: We conducted a prospective observational study involving 138 participants aged 65 and above, recruited from a preoperative anesthesia clinic. Olfactory function was assessed using the Sniffin' Sticks test, and TL was measured in leukocytes using the Flow-FISH technique. Data analysis included comparisons between short TL ((lower than the 10th percentile) and normal TL (above the 10th percentile) groups, considering factors like age, sex, and frailty.

Results: Short TL was found in 27.5% of participants. Those with short TL had significantly lower TDI (threshold, discrimination, identification) scores. Specifically, 46.2% of participants with a TDI score lower or equal than 10th percentile had short TL compared to 23.2% with higher TDI scores. Adjusting for frailty attenuated this relationship, indicating a shared biological component between olfactory function and TL.

Conclusions: Our study reveals a significant association between lower olfactory function and shorter TL in older adults, suggesting that olfactory impairment may reflect underlying biological aging. Further research is needed to elucidate the complex interactions between olfactory function, TL, and frailty.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly recognized as a biologically heterogeneous disorder, in which patient-specific factors strongly influence outcomes. Among these, sex-related differences have been observed clinically, yet their underlying pathological basis and impact on postoperative recurrence remain incompletely understood.

Background: The anatomy of the sphenoethmoidal recess is of clinical importance, however, the literature focuses on the superior turbinate and the sphenoid ostium. We analyzed the entire junction of the posterior ethmoidal region and the sphenoid sinus (SEJ) to define possible regularities.

Methods: We analyzed the junction between the posterior ethmoidal region and the sphenoid sinus on CT scans of 100 paranasal sinuses from 50 individuals using the 3D Slicer software.

Results: The SEJ had two components: medially the sphenoethmoidal recess, laterally the wall between these aeriated regions, the latter built by the basal lamella of the superior turbinate (4BL) in 92.0%. The 4BL was a constant structure (100.0%), its most frequent phenotype was a frontally oriented pentangular wall without dehiscences (44.0%). There were no bony walls between the 3BL and the anterior wall of the sphenoid sinus in 49.0% and there was one wall in 42.0%. The 4BL had three complicating factors: firstly, it shifted to anterior, if the supreme turbinate was present (43.0%). Secondly, the pneumatization of the 4BL and the superior turbinate (25.0%) was related to an incomplete-dehiscent anterior 4BL wall. Thirdly, sphenoethmoidal cells (36.0%) led to a bony contact of the optic canal and the 4BL (33.0%).

Conclusions: The 4BL is an important landmark for endoscopic sinus and skull base surgery with highly constant morphology and a typical phenotype. Surgeons should be aware that after dissection of the 3BL the next wall is likely the 4BL which mostly merges to the ASW. This study can help surgeons to detect anatomical variations and improve their intraoperative orientation.

Background: A healthy olfactory cleft is critical to normal olfactory function. The aim of this study was to explore the differential orthonasal and retronasal olfactory functions in patients with olfactory cleft (OC) obstructions including a combination of OC syndrome, chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), and respiratory adenomatoid epithelial hamartoma (REAH).

Methods: Patients (n = 93) presenting to an ENT clinic with OC obstruction underwent nasal endoscopy, chemosensory event-related potential (ERP) recordings, and radiologic assessment, and were subsequently diagnosed with OC syndrome, CRSsNP with OC syndrome, CRSwNP in the OC, REAH, and CRSwNP with REAH. Orthonasal and retronasal function were assessed using the complete Sniffin’ Sticks test and a set of 30 powders, respectively.

Results: Orthonasal function was lower in patients with REAH and CRSwNP+REAH compared to CRSwNP in OC patients. Retronasal function was similarly diminished in REAH compared to CRSwNP in OC. Patients with OC syndrome alone had higher orthonasal scores than those with CRSsNP plus OC syndrome and CRSwNP in OC but not statistically different retronasal function. There was no significant difference in orthonasal or retronasal scores in REAH patients based on concurrent CRSwNP.

Conclusions: REAH corresponded with greater orthonasal and retronasal olfactory loss compared to other olfactory cleft obstructions, indicating a greater effect on the olfactory mucosa beyond disrupting airflow. The difference between CRS and OC syndrome is more pronounced orthonasally than retronasally.

Background: Allergic rhinitis (AR), an immunoglobulin E (IgE)-mediated inflammatory disease, is frequently associated with house dust mites (HDMs), particularly Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f). While serum allergen-specific IgE (sIgE) is widely used, the diagnostic value of local sIgE and its interplay with systemic IgE and nasal cytokines remains unclear. This study evaluated local sIgE performance, nasal cytokine profiles, and nonlinear local-serum sIgE dynamics for AR patients.

Methodology: This prospective study enrolled 60 HDM-sensitized AR patients and 143 healthy controls from February 2023 to September 2024. Serum and local Der p/Der f sIgE and total IgE were quantified; and nasal cytokines were analyzed by Luminex. Logistic regression, ROC analysis, and Spearman correlation assessed diagnostic performance and associations.Restricted cubic spline (RCS) modeling explored nonlinear local-serum sIgE relationships.

Results: AR patients exhibited elevated local Der p and Der f sIgE logistic regression confirmed their associations with AR, supported by strong diagnostic accuracy. Local sIgE demonstrated stronger correlations with type 2 cytokines (IL-4, IL-5, CCL5, CCL11) than serum sIgE. RCS analysis identified inflection points for Der p and Der f, revealing threshold-dependent nonlinear dynamics between local and serum sIgE.

Conclusions: Local sIgE demonstrates high diagnostic accuracy for HDM-sensitized AR and better reflects local Th2-driven inflammation. The nonlinear local-serum sIgE relationship advocates dual-compartment profiling, advancing precision diagnostics in AR.

Background: Disease control assessment for chronic rhinosinusitis (CRS) remains a challenge. In this study, we develop and psychometrically validate a new patient-reported outcome measure, the Chronic Rhinosinusitis Control Test (CRCT), for assessing CRS control.

Methodology: The CRCT, which includes 8 items and has a score that ranges from 0-31, incorporates the perspectives of key stakeholders (patients and healthcare providers) and was developed incorporating methodologic guidance from the COSMIN initiative and United States Food and Drug Administration. Psychometric validation was performed in line with recommendations from the COSMIN initiative to establish validity, reliability and responsiveness in a sample of 545 CRS patients and with the participation of 23 expert rhinologists.

Results: The CRCT has excellent face validity, content validity, concurrent validity, internal consistency, test-retest reliability, and responsiveness. Factor analysis reveals that the CRCT has 2 subdomains: sinonasal and impairment subdomains in addition to a final item related to CRS-related oral corticosteroid usage in the past 3 months. Using a distribution-based and multiple anchorbased methods, the CRCT has a minimal clinically important difference (MCID) of 4 points. After 23 expert rhinologists independently classified all possible combinations of scoring on the CRCT, scores of ≤7 indicate controlled CRS, 8 to 15 (inclusive) partly controlled CRS and ≥16 uncontrolled CRS.

Conclusion: The CRCT is a psychometrically validated measure of CRS control. CRS may be classified as controlled based on CRCT score ≤7, partly controlled with CRCT score of 8 to 15 (inclusive) and uncontrolled with CRCT score ≥16. The MCIDs for improvement and worsening are both 4.

Background: The role of Th2-related biomarkers as a diagnostic tool for local allergic rhinitis (LAR) remains controversial. This study seeks to assess the clinical utility of these markers and rank their diagnostic accuracy for LAR.

Methods: Systematic searches were conducted across five electronic databases. Pooled outcomes, including sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR), were calculated. Relative diagnostic outcomes with a 95% confidence interval between index tests were computed using the indirect comparison of modalities.

Results: Twenty-one studies met the inclusion criteria, assessing the diagnostic accuracy of three index tests compared to nasal provocation test for LAR. Among the three biomarkers, sensitivities ranged from 48.1% to 69.1%, with nasal eosinophilia (nEos) showing the highest sensitivity but lowest specificity (56.2%). Nasal-specific IgE (nsIgE) demonstrated perfect specificity (100%) but limited sensitivity (48.1%), the highest DOR (significant), and the highest LR+ (not significant). Basophil activation test (BAT) had the lowest LR- with statistical significance. Indirect comparisons showed BAT and nsIgE had significantly higher sensitivities than nEos.

Conclusions: Nasal-specific IgE and the basophil activation test can help diagnose local allergic rhinitis, but their sensitivities are low. Negative results should be confirmed with a nasal provocation test. Heterogeneity in reported sensitivities further underscores the limitations of current diagnostic methods.