Rhinology最新文献

Introduction: Hereditary haemorrhagic telangiectasia (HHT) is an uncommon genetic disorder characterised by recurrent, severe epistaxis which poses significant management challenges. Nasal closure has emerged as a treatment for refractory cases, however there is limited research on its outcomes. We aim to consolidate existing evidence to assess its efficacy and safety.

Methods: We conducted a systematic search of the Cochrane library, EMBASE, PubMed and non-indexed publications from the past 30 years. Two independent reviewers extracted data and assessed bias from included studies. Findings were summarised via narrative synthesis due to heterogeneity of included studies.

Results: 192 patients from ten studies underwent nasal closure. Frequently used outcome measures were validated epistaxis severity scores, Glasgow Benefit Inventory and haemoglobin trends. Surgery improved quality of life and reduced epistaxis severity post-operatively. Partial dehiscence is a frequently reported complication which is usually successfully treated with revision surgery.

Conclusions: Nasal closure reduces epistaxis severity, improving quality of life in patients with severe, refractory HHT-related epistaxis, providing a valuable treatment option for the most challenging cases. The strength of our conclusions is limited by the heterogeneity of outcome measures. To our knowledge, this is the largest pooled database of patients who have undergone nasal closure.

Background: Delivery mode can influence infant microbial diversity, cause immune dysregulation, and potentially increase the risk of allergic rhinitis (AR).

Methodology: A systematic review and meta-analysis were performed to assess the association between distinct modes of delivery and the development of AR in childhood and adulthood. The primary comparison was vaginal (VD) versus cesarean delivery (CD). Secondary comparisons were specified CD (elective, emergency) versus specified VD (spontaneous, abnormal) and nonmicrobiota-exposed versus microbiota-exposed deliveries. The outcomes were subsequent risks of AR presenting as odd ratios and 95% confidence intervals.

Results: Thirty-seven studies were analyzed. Compared to VD, CD, and its specified modes were associated with higher subsequent risks of AR in the population under age 18. The quality of evidence supporting these effects is rated as very low to low following GRADE. Spontaneous VD was associated with lower AR risk compared to CD, but there was no significant difference between abnormal VD and CD. The distinction between non-microbiota-exposed and microbiota-exposed deliveries did not affect AR risk significantly.

Conclusions: The estimated odds ratios demonstrated a positive association between cesarean section and AR up to 18 years of age. A comprehensive categorization of delivery mode is necessary to interpret the existing evidence thoroughly.

Aim: To provide normative data for the lateralization task in the assessment of intranasal trigeminal function, as well as to investigate potential effects of age, sex and olfactory function.

Methods: The lateralization task using eucalyptus as target stimulus was performed to assess intranasal trigeminal function. Data were collected from: 360 healthy adult participants (mean age 37.5 ± 17.4) for the 40-trial version; 284 participants (mean age 32.6 ± 4.1) for the 20-trial version; and 418 participants (mean age 42.6 ± 15.6) for the 10-trial version. The "Sniffin Sticks" test was used to measure olfactory function.

Results: The mean scores were 35.46 ± 4.50 for the 40-trial version, 15.64 ± 3.65 for the 20-trial version, and 8.14 ± 2.16 for the 10-trial version. In the reference group aged 18-25 years, the 10th percentiles were 33 for the 40-trial version, 11 for the 20-trial version, and 6 for the 10-trial version. Significant effects of age and odor discrimination score were observed on lateralization performance.

Conclusions: We provide reference scores for the lateralization task, in large sample of healthy participants. Among the three examined tasks (40, 20 and 10), the 40-trial task yielded the most reliable information. For the 40-trial version, scores equal or higher to 33 points indicate a normal lateralization ability, whereas scores between 27 and 32 may warrant further assessment. Scores below 27 possibly point towards a decreased trigeminal function. The lateralization task serves as surrogate marker of intranasal trigeminal functions and further studies with pathological cases are needed to explore its clinical usefulness.

Background: In the absence of direct evidence supporting how to use nasal endoscopy findings to judge chronic rhinosinusitis (CRS) disease control, experts' practice patterns could provide guidance.

Methodology: Participants consisted of a diverse group of twenty-nine rhinologists. Participants were presented with every possible combination of bilateral nasal endoscopy findings represented by the modified Lund-Kennedy (MLK; range: 0-12) endoscopic scoring system and Nasal Polyp Score (NPS; range: 0-8). Reflecting the practical consequence of CRS disease control assessment, participants were asked whether they would consider CRS treatment escalation based on each scenario in the absence of any CRS symptoms, and how strongly they considered escalating therapy. The same scenarios were then presented in the context of 1 burdensome CRS symptom and participants again were asked whether they would consider treatment escalation.

Results: The median threshold total MLK score for considering treatment escalation was ≥ 4 and 75.9% of participants' MLK thresholds were within 1 point of 4. The median threshold total NPS for considering treatment escalation was ≥ 3 and 62.5% of participants' NPS thresholds were within 1 point of 3. Endoscopy score thresholds decreased in the presence of 1 burdensome symptom and generally increased when requiring stronger affirmation for considering CRS treatment escalation.

Conclusion: Reflecting the practice patterns of a diverse group of rhinologists, MLK score ≥ 4 or NPS ≥ 3 may serve as thresholds for considering CRS treatment escalation. Alternatively, MLK score under 4 or NPS under 3 may serve as endoscopic goals of CRS treatment. These results provide guidance for using nasal endoscopy findings as a criterion of CRS disease control.

In the last decades, various types of endoscopic sinus surgery (ESS) have emerged as treatments for chronic rhinosinusitis (CRS), particularly with the development of personalized, endotype-driven approaches targeting mucosal inflammation and remodeling. Despite these advancements, the literature reports heterogeneous and often divergent outcomes, leaving the actual benefit of more extensive surgical approaches in CRS control a matter of ongoing debate. This discrepancy stems from inconsistent definitions of surgical techniques, leading to variations in osseous and mucosal resections depending on patient phenotype, disease severity and surgeon preference. To address this inconsistency, the Japanese Rhinology Society introduced a classification based on procedure extent, but it lacks details on anatomical structures and mucosal treatment. Similarly, the ACCESS system measures ESS extent with postoperative CT-scans but overlooks mucosal interventions.

Allergic fungal rhinosinusitis (AFRS) is a localized inflammatory, hypersensitivity reaction affecting the nasal cavity and its sinuses secondary to fungal colonization. The burden of surgical revisions and recurrence rates in this disease led to a recent hypothesized advancement in the medical management being experimented, which is the use of biologics. Therefore, this systematic review analyzed nine articles to highlight the significance of biologics in the management of AFRS through a comprehensive strategy, as seen in Supplementary Methods Section.

Background: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited.

Methodology: In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months.

Results: We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months.

Conclusions: This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.

Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and even mental health issues as serious as post-traumatic stress disorder as persistent complications. Optimal management remains controversial and subjective based on the clinician’s judgment, with many factors playing a role in the provider’s decision, including the timing of treatment, the choice between foregoing treatment or choosing to undergo a closed or open reduction, and how to manage subsequent revision surgeries if necessary.

Background: The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) serves as a valuable tool for assessing eustachian tube dysfunction (ETD). We investigated the impact of septal deviation side on ETD using preoperative ETDQ-7 scores and evaluated the effectiveness of septoplasty based on postoperative ETDQ-7 scores.

Methodology: We conducted a retrospective analysis of patients with septal deviation who were scheduled for septoplasty. ETDQ-7 surveys were conducted preoperative and 1 and 3 months postoperative.

Results: 120 patients were included, with 72 completing the ETDQ-7 at all three time points. The average prevalence of ETD was 29.2%. Preoperative ETDQ-7 scores showed no significant difference between convex and concave nasal sides. However, the prevalence of ETD was significantly higher on the convex side (28.3% vs. 15.8%), especially in unilateral ETD cases. Preoperatively, the positive ETD group had significantly higher ETDQ-7 scores on the convex side while no significant difference was found between concave and convex sides in the negative ETD group. Postoperatively, the positive ETD group showed significant improvement in ETDQ-7 scores with significantly higher on the convex side (66.7% vs. 33.3%). ETDQ-7 scores improved after septoplasty, with more improvement in the positive ETD group.

Conclusions: Septoplasty significantly improves ETD, particularly in the preoperative positive ETD group, by reducing ETDQ-7 scores. The prevalence of ETD was higher on the convex side preoperatively, and the positive ETD group exhibited significant postoperative improvements, especially on the convex side. This suggests that the direction of septal deviation influences ETD prevalence and surgery outcomes, although septoplasty alleviates ETD on both sides.

Objective: The aim of this study is to assess the clinical efficacy of olfactory training using aromatic traditional Chinese medicine (TCM) for addressing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-induced olfactory dysfunction, while also exploring the factors that influence the observed efficacy.

Methods: 172 outpatients with SARS-CoV-2-related olfactory dysfunction were randomized into two groups. The experimental group received olfactory training with TCM aromatics (ginger, Pericarpium Citri Reticulatae, Santali Albi Lignum, Styrax), while the control group used non-TCM aromatics (phenyl ethanol-rose, menthol-mint, citronellal-lemon, eugenol-clove) for 24 weeks. Olfactory function was assessed using the Sniffin' Sticks test and TDI (threshold-discrimination-identification) scores at baseline, 1, 3, and 6 months post-treatment.

Results: Response rates at 1, 3, and 6 months post-treatment were 3.66%, 25.61%, and 43.90% in the experimental group, and 4.94%, 23.46%, and 43.21% in the control group. The TDI scores of the experimental group and the control group were statistically different before and after treatment. At 3 and 6 months post-treatment, TDI scores increased significantly, with enhanced odor discrimination and identification capabilities in both groups compared to pre-treatment, while the odor detection threshold was not improved compared with that before treatment. At the 3- and 6-month follow-ups, experimental group showed significantly higher self-rated sleep and anxiety scores than controls, indicating notable improvement in both after treatment.

Conclusion: Olfactory training with aromatic TCM offers an effective treatment for SARS-CoV-2-induced olfactory dysfunction, improving odor discrimination, identification without significant differences compared to conventional aromatics, besides, it may also improve anxiety and sleep quality.