Rhinology最新文献

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.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits sex-specific differences in prevalence and clinical presentation. However, the underlying histopathological characteristics and recurrence remain underexplored.

Methodology: A retrospective cohort of 410 CRSwNP patients (287 males, 123 females) undergoing endoscopic sinus surgery between January 2021 and June 2024 was analyzed. Histological evaluation was employed by H&E staining and features of inflammatory profile were identified by immunohistochemistry. Multivariate logistic regression and receiver operating characteristic analyses were performed to assess predictors of recurrence.

Results: Males exhibited higher body mass index (BMI) and greater allergic rhinitis prevalence, while females had more asthma comorbidity and higher SNOT-22 scores. While no significant sex differences were observed in histopathological endotypes, elevated BMI was more likely to exacerbate inflammation in males than females. Additionally, males showed a higher recurrence rate, with male sex being identified as an independent risk factor. However, females who experienced recurrence exhibited more severe eosinophilic and T2 inflammation compared to their male counterparts. Therefore, higher threshold values for tissue eosinophil counts and Charcot-Leyden crystals were required to predict recurrence in female patients.

Conclusions: These findings underscore the necessity for sex tailored therapeutic strategies, particularly emphasizing weight control in male patients and intensified anti-T2 inflammation management in female patients with recurrent CRSwNP. Further research is needed to investigate the underlying causes and to offer evidence-based treatment guidelines.

Squamous cell carcinoma (SCC) is the most common histological subtype of sinonasal malignancies. Due to non-specific symptoms, sinonasal SCC (SNSCC) is often diagnosed late, posing challenges for management. SNSCC can arise de novo (DN-SCC) or from the malignant transformation of inverted papilloma (IP-SCC). Prior studies have reported inconsistent outcomes comparing these two subtypes. This study compares recurrence patterns and survival outcomes of DN-SCC and IP-SCC, identifies predictors of recurrence and survival, and aims to inform clinical decision-making and patient counselling.

Olfactory dysfunction is a frequent yet underrecognized manifestation of chronic rhinosinusitis in cystic fibrosis. Despite widespread reports of OD in CF, the impact of CFTR modulator therapy on smell outcomes remains unclear. We conducted a prospective study to evaluate olfactory function changes in CF-related CRS patients, as defined by EPOS2020, following 12 months of elexacaftor/tezacaftor/ivacaftor therapy, exploring clinical and biological correlates. From 120 ETI-treated CF patients at the University Hospital of Careggi, 45 adults diagnosed with CRS completed pre- and post-treatment assessments, including olfactory evaluation via the 16-item Sniffin’ Sticks Identification Test for its feasibility and longitudinal applicability.

Background: Chronic rhinosinusitis (CRS) is a common cause of olfactory dysfunction (OD), and eosinophilic CRS is one of the subtypes characterized by eosinophilic infiltration. Animal models of olfactory dysfunction in eosinophilic CRS are necessary for exploring potential therapeutic strategies. Glucocorticoids are therapeutic for eosinophilic CRS-OD and the mechanism of action requires further exploration.

Methodology: The eosinophilic CRS-OD rat model was induced by intranasal administration of ovalbumin (OVA) and Aspergillus oryzae protease (AP) for 8 weeks, followed by intraperitoneal injection of dexamethasone. Olfactory function was assessed behaviorally, neuronal activity electrophysiologically, and neurotransmitter/inflammatory factor levels via high-performance liquid chromatography (HPLC). Histological analyses of nasal tissue and the olfactory bulb were performed.

Results: All OVA/AP-induced eosinophilic CRS-OD rats developed chronic nasal inflammation and olfactory dysfunction. Reduced olfactory bulb (OB) volume was accompanied by thinning of the olfactory neuron layer (ONL) and the glomerular layer (GL). The OB exhibited increased microglia and elevated inflammatory cytokine expression. Further analysis revealed decreased glutamate (Glu), increased γ-aminobutyric acid (GABA), and a significant reduction in the spontaneous firing rate (SFR) of mitral/tufted cells (M/Ts) within the OB. Dexamethasone treatment significantly ameliorated olfactory impairment in this model, decreasing OB microglia numbers and inflammatory cytokine levels, and significantly increasing M/T SFR.

Conclusions: Microglia-mediated neuroinflammation contributes to abnormal neural activity in the olfactory bulb, which may be one mechanism for the development of eosinophilic CRS-OD. The neuroprotective effect of dexamethasone, mediated through microglial inhibition, highlights microglia as an important therapeutic target for eosinophilic CRS-OD.

Introduction: The autonomic nervous system (ANS) regulates respiratory mucosal inflammation and is linked to various airway diseases. However, the relationship between ANS dysfunction and chronic rhinosinusitis (CRS) has not been fully investigated. This study aimed to explore the association between ANS and CRS using a battery of quantitative autonomic function tests.

Methods: Patients with CRS undergoing surgery were prospectively enrolled. Subjective evaluation of disease severity was assessed using the sino-nasal outcome test-22 questionnaires for CRS and the 31-item composite autonomic symptom score questionnaires for ANS dysfunction, while computed tomography and endoscopic scores represented objective severity. A battery of autonomic function tests was conducted, and the results were used to generate the modified composite autonomic scoring scale (mCASS) to provide a quantitative evaluation of ANS function.

Results: A total of 49 patients were enrolled. The most common dysautonomic symptoms were dry mouth (73.5%), dizziness (71.4%), and dry eyes (55.1%). Twenty-six patients (53.1%) had a positive mCASS score, indicating abnormal autonomic function. Within the subdomains, most abnormalities were observed in the sudomotor score (28.6%). The mCASS score showed a positive correlation with the endoscopic score, with marginal significance. Notably, the sudomotor subdomain score was significantly correlated with the endoscopic score.

Conclusion: A significant correlation was found between objective autonomic nervous system function and severity of chronic rhinosinusitis, particularly in the sudomotor subdomain, suggesting a link between peripheral cholinergic activity and sinonasal inflammation. Further research is needed to clarify the underlying mechanisms.

Nasal septal perforation occurs when both mucoperichondrial layers surrounding the septal cartilage are compromised. While richly vascularized, this tissue is particularly vulnerable to ischaemic injury caused by intranasal cocaine use. Cocaine inhibits catecholamine reuptake, leading to vasoconstriction, tissue necrosis, and, ultimately, septal damage. Furthermore, the adulterant levamisole, present in up to 80% of seized cocaine in Germany, is a known trigger for vasculitis, compounding this effect.

Background: New CFTR Modulator triple therapy Elexacaftor-Tezacaftor-Ivacaftor (ETI) has proven efficacy in pulmonary outcomes. However, its qualitative impact via sinonasal imaging in children has not been specifically studied. The aim of our study is to assess the impact of ETI triple therapy through sinus imaging in children with Cystic Fibrosis (CF) aged 6â€"12 years.

Methods: This prospective, single-center study, covered children with CF aged 6-12 years, all undergoing annual low-dose CT scans of the sinuses and lungs. The main objective of our study is the evaluation of the evolution of the modified Lund-Mac Kay (mLMK) score. Evaluations occurred at baseline and after one year of ETI therapy. Secondary objectives included the identification of potential associations between mLMK score and Sinus and Nasal Quality of Life Survey Score (SN-5) score, as well as examination of mLMK score changes in individual sinuses.

Results: 26 patients were enrolled in our study. The median mLMK score significantly improved after one year of ETI therapy. Significant correlation was observed between mLMK and SN-5 scores.

Conclusion: This study highlights ETI's efficacy in improving sinonasal involvement in children aged 6 to 12 with CF. This is in line with the observations of clinical improvement, and presents an alternative to sinus surgery, thus potentially leading to a reduction in surgical interventions.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to poor sleep quality and fatigue. Many patients with CRSwNP are also at risk for obstructive sleep apnea (OSA). This study examined how mepolizumab and/or endoscopic sinus surgery (FESS) affect sleep quality and OSA in patients with severe uncontrolled CRSwNP.

Methods: In a randomised trial with 58 patients, participants received mepolizumab alone or combined with FESS. Sleep quality was measured using FOSQ-10 and ESS, and OSA severity via AHI from home sleep apnea tests.

Results: At baseline, 70% of participants had OSA (AHI ≥5), with 34.6% having moderate-to-severe OSA. After six months, there were significant improvements in sleep quality (SNOT-22, FOSQ-10, ESS) in both groups but no significant change in objective OSA measures (AHI, ODI). Patients with OSA showed a reduction in severity, however non-significant. There were no severe adverse events (SAE) during the follow-up.

Conclusions: Mepolizumab, with or without FESS, improved subjective sleep quality and reduced fatigue but did not significantly affect OSA severity. This suggests that while treatment eases sleep-related symptoms, it may not resolve underlying OSA, particularly in more severe cases.

Background: Chronic rhinosinusitis with olfactory dysfunction (CRS-OD) affects both peripheral and central olfactory pathways. Persistent olfactory loss may induce neuroplastic changes in brain regions involved in olfactory processing. We hypothesized that CRS-OD is associated with gray matter atrophy in olfactory-related regions, accompanied by alterations in global functional connectivity as a manifestation of compensatory or maladaptive reorganization. To test this, we performed voxel-based morphometry (VBM) to identify gray matter differences, followed by seed-based functional connectivity (FC) analysis using the altered regions.

Methodology: We prospectively recruited 23 CRS-OD patients and 23 healthy controls (HCs). All patients presented with persistent olfactory dysfunction lasting 6 to 240 months. All participants underwent MRI scanning at the same time point. Olfactory function was assessed in CRS-OD patients using the Threshold-Discrimination-Identification (TDI) test, the Questionnaire of Olfactory Disorders (QOD), and the Olfactory-Evoked Cognitive Score (OECS). MRI analyses included VBM, FC, and olfactory bulb volume on DRIVen Equilibrium turbo spin echo (TSE) images.

Results: CRS-OD patients exhibited significantly reduced olfactory bulb (OB) volumes compared to HCs and gray matter atrophy in the inferior frontal orbital gyrus, parahippocampal gyrus, hippocampus, thalamus, and putamen. FC analysis revealed decreased connectivity in sensory-integration networks and increased FC in the superior occipital gyrus, suggesting compensatory reorganization.

Conclusions: CRS-OD is characterized by OB atrophy, gray matter atrophy, and disrupted FC, reflecting both peripheral and central neural alterations. Multimodal MRI may provide new insights into CRS-OD pathophysiology, warranting further longitudinal studies.