Rhinology最新文献

Background: Despite advances in digital health, many interventions fail, not due to technical shortcomings, but because they are not meaningfully adopted or sustained in everyday life. Understanding real-world engagement remains a critical gap, especially in under-explored domains such as olfactory health. This study aimed to evaluate the real-world feasibility of a home-based Digital Smell Training (DST) system, focusing on how - participants - engage with it and sustain its use over time.

Methodology: A six-month real-world feasibility study of a DST system, combining a scent-delivery device and mobile app, was tested in 18 UK households with and without olfactory disorders. A mixed methods approach captured adherence and user experiences over time.

Results: Participants completed 74% of 5,600 potential sessions, showing high adherence to twice-daily training. Qualitative data revealed dynamic behavioural patterns: users' motivations fluctuated over time, shaped by perceived progress, novelty effects, and evolving relationships with the intervention.

Conclusions: This study offers rare insight into how people engage with unfamiliar digital health tools outside controlled settings. Beyond the specific use case of smell, our findings highlight design and engagement strategies essential for achieving real-world impact, showing that sustained adoption hinges not just on innovation, but on behavioural understanding.

Background: Biologics targeting key type 2 inflammatory mediators (e.g., IL-4Rα, IgE, IL-5, TSLP) represent a novel therapeutic approach for chronic rhinosinusitis with nasal polyps (CRSwNP). This network meta-analysis (NMA) aimed to compare the efficacy and safety of eight monoclonal antibodies for CRSwNP.

Methodology: We systematically searched PubMed, Embase, Web of Science, CENTRAL Cochrane, and MEDLINE for randomized controlled trials (RCTs) comparing monoclonal antibodies with placebo CRSwNP. A Bayesian Network meta-analysis (NMA) was performed using the R gemtc package.

Results: Sixteen RCTs (n=2,034) evaluating eight monoclonal antibodies were included. All biologics significantly reduced Nasal Polyp Score (NPS); stapokibart (anti-IL-4Rα) ranked first. Both dupilumab and stapokibart improved the University of Pennsylvania Smell Identification Test (UPSIT) score, indicating a recovery of olfactory function. Dupilumab led in improving Sino-Nasal Outcome Test-22 (SNOT-22) scores, whereas stapokibart was most effective in relieving nasal congestion score (NCS). The risk of adverse events was comparable to placebo across all biologics, with GR1802 exhibiting the most favorable safety.

Conclusions: All evaluated biological agents demonstrated efficacy superior to placebo, with IL-4 receptor alpha inhibitors showing the largest and most consistent benefits. All treatments exhibited favorable safety profiles, supporting their use for long-term management of CRSwNP.

We appreciate the thoughtful comments by Dr. Gupta et al. (1) regarding our systematic review (2). Their commitment to this rare, but emerging clinical topic is welcome, and we would like to address the methodological points raised.

The international opinion paper by Whitcroft et al. provides invaluable guidance for the emerging field of olfactory implants (1). While the authors thoroughly address clinical considerations and current technological approaches, we would like to expand upon Statements 9.1 and 9.3 regarding electrode technology limitations and highlight recent advances in brain-computer interface (BCI) technology that could address key technological challenges around electrode longevity and biocompatibility.

Background: Despite optimal medical and surgical therapy, many patients suffering from chronic rhinosinusitis (CRS) experience continuous inflammation for which revision surgery can be indicated. The present work was set out to investigate the extent of prior endoscopic sinus surgery (ESS) performed in CRS patients referred to tertiary rhinologic centers for revision surgery in Western countries.

Methods: A retrospective multicenter study was conducted including patients with any (pheno)type of diffuse CRS, who had undergone at least one prior ESS. All patients had a sinus computed tomography (CT) scan performed before their revision surgery which was used to retrieve the Amsterdam classification of completeness of ESS (ACCESS) scores, which range from 0 (sinuses functionally opened) to 24 (no sinus opening).

Results: 114 patients from 6 different centers were included. The median ACCESS score was 12 (7-17). Most patients had only one previous ESS (70/114, 61%), while 24 (21%) had 2 previous surgeries, 13 (11.4%) patients had three, and 7 (6%) patients had four or more. Median ACCESS scores by number of previous ESS were: 13 (6-16) for one prior surgery, 12 (7-18) for two, 10 (8-13) for three, and 6 (3-13) for four or more surgeries. Multivariate linear regression analysis showed small changes in the patient's ACCESS score in relation to their number of previous surgeries.

Conclusions: Our study underscores a large heterogeneity in extent of prior ESS among patients referred to tertiary rhinologic centers for diffuse CRS, regardless of the number of previous surgeries.

Backgroud: The efficacy of tezepelumab in chronic rhinosinusitis with nasal polyps (CRSwNP) has been demonstrated in clinical trials, but real-world evidence remains limited. Our study investigated the trend of CRSwNP outcomes in patients prescribed with tezepelumab for severe asthma and the impact of upper airways comorbidity on asthma outcomes over a 6 months follow-up.

Methods: Data from 5 referral centres for severe asthma and CRSwNP were retrospectively analysed. Patient reported outcomes and objective measures related to nasal (SNOT-22, VAS, nasal polyp score) and bronchial (asthma control test, lung function) evaluation were assessed at baseline, 3 and 6 months after tezepelumab initiation.

Results: Tezepelumab significantly and rapidly improved all the nasal outcomes and asthma-related parameters, irrespective of sex, body mass index, prior biologic use, or disease duration. Furthermore, significant reduction of oral corticosteroid use, hospitalizations and exacerbations were also observed. When comparing patients with and without CRSwNP, no differences were observed in term of treatment response.

Conclusions: In patients with severe asthma and CRSwNP, tezepelumab demonstrated to induce in the real-life setting an overall rapid and sustained improvement of nasal outcomes, as well as of lung function and clinical parameters in asthma patients regardless of upper airway involvement. Although larger studies are needed, these findings contribute to the positioning of tezepelumab in the real-world clinical practice according to a precision medicine approach.

The COVID-19 pandemic brought attention to post-viral smell distortion, or parosmia, which is defined as a qualitative dysfunction resulting from distorted odor perception in the presence of an odorous medium (1). Very often, qualitative and quantitative alterations occur simultaneously. Patients severely affected by qualitative odor disorders find that their quality of life has deteriorated (2). For quantitative loss from viruses, the role of olfactory training has been emphasized (3), along with high volume steroid nasal irrigations (4), and even injections with platelet-rich plasma (5). However, there has been no high-level evidence demonstrating an effective treatment for qualitative olfactory disorders.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition often classified into eosinophilic (Eos) and non-eosinophilic (nonEos) subtypes. While microbial dysbiosis and metabolic disturbance are known contributors to CRSwNP, the interplay between sinonasal microbiota and local metabolic activity remains unclear.

Methods: We conducted 16S rRNA gene sequencing and untargeted metabolomics on sinonasal swabs and tissue samples from patients with Eos-CRSwNP (n = 14), nonEos-CRSwNP (n = 7), and healthy controls (n = 14). Microbial diversity, taxonomic differences, and metabolic alterations were analyzed. Spearman correlation and network modeling were used to explore phenotype-specific microbiota- metabolite interactions and pathway enrichment.

Results: Eos-CRSwNP was characterized by reduced microbial diversity and increased abundance of Staphylococcus and Corynebacterium, along with elevated levels of fumaric acid, linoleic acid, and arachidonic acid-metabolites linked to oxidative stress and lipid-mediated inflammation. In contrast, nonEos-CRSwNP exhibited greater microbial richness, with enrichment of Streptococcus, Anaerococcus, and Clostridium XlVa, and metabolic shifts in amino acid and nitrogen metabolism, including increased glutamine, taurine, and ethanolamine phosphate. Correlation analysis revealed phenotype-specific networks connecting core microbial genera and metabolites, suggesting distinct inflammatory microenvironments between subtypes.

Conclusion: Our integrated multi-omics analysis highlights divergent microbial and metabolic signatures in Eos and nonEos CRSwNP. These findings offer mechanistic insights into subtype-specific disease processes and may guide the future development of targeted diagnostic and therapeutic strategies.

Background: There is often a discrepancy between official recommendations and actual clinical practice on repair of congenital choanal atresia (CA). The objective of this study was to evaluate the current state of care for CA patients in Germany.

Methods: An online survey was conducted in which 108 German ENT departments were consulted on various aspects of CA management, including preoperative diagnosis, surgical procedures, and postoperative care.

Results: 65% of the ENT departments only perform CA repairs at over 3 years of age. Flexible nasal endoscopy (69%), hearing tests (41%), and computed tomography (52%) were preoperative diagnosis tools. Posterior vomer was resected in 56% of the ENT departments. Scar- (60%), granulation tissue (38%), and insufficient vomer resections (21%) caused recurrences. Stents were used by 38%.

Conclusions: Elective unilateral CA repair should be performed in time to minimise symptoms. Preoperative hearing tests should be introduced as routine to identify CA patients with hearing problems. The utilisation of preoperative computed tomography should be discussed individually. Only just over half of the participating ENT departments resected posterior vomer parts. This is a significant starting point with the potential to improve the recurrence rates of this patient cohort. Stent use is still quite common iin Germany. This should be changed in the future.

Background: The impact of endoscopic sinus surgery (ESS) extent on long-term disease control and therapeutic escalation in chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear. This study aims to evaluate the clinical applicability of endoscopy-based criteria for therapeutic escalation and to determine the impact of surgical extent on the risk and timing of treatment intensification.

Methods: A retrospective cohort study with 3-year follow-up was conducted. CRSwNP patients who underwent ESS were included and classified according to Lamella Ostium Extent Mucosa (LOEM) system (t1-t4). Baseline characteristics and disease severity measures were assessed. Therapeutic escalation was defined by endoscopic criteria. Predictors of escalation and the effect of ESS extent on escalation timing across clinical phenotypes were analyzed using multivariate logistic regression, Kaplan-Meier curves and Cox regressions.

Results: In the overall sample (n=172), patients who required escalation showed higher SNOT-22 scores and poorer olfactory function. More extensive ESS (LOEM t3-t4) was associated with significantly reduced escalation risk and prolonged disease control. Post hoc analyses confirmed significant pairwise differences favoring extensive (t3-t4) over limited (t1-t2) surgery. Subgroup analyses demonstrated greater benefits in older subjects, atopic patients, revision surgeries and patients with eosinophils >300cells/μL. Higher baseline SNOT-22 scores remained an independent predictor of escalation after ESS.

Conclusions: Surgical extent appears to influence both escalation risk and timing. More extensive ESS may provide more sustained control, particularly in revision cases and biomarker-defined subgroups, supporting its integration into personalized algorithms.