Rhinology最新文献

Background: This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit.

Methodology: A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications.

Results: The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra- and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone.

Conclusions: This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.

Background: Long COVID frequently presents with persistent olfactory dysfunction (OD), affecting both physical and psychological well-being. This study aims to evaluate the mental health consequences of OD in long COVID patients.

Methodology: A cross-sectional study involved 86 adult patients. Participants presented OD for at least three months post-COVID- 19 and were evaluated using the extended battery of Sniffin' Sticks test (SST). Psychological assessments included the Impact of Event Scale-Revised (IES-R), Beck Hopelessness Scale (BHS), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q).

Results: Significant differences in mental health factors were observed between patients with and without OD: in comparison to normosmic patients, hyposmic patients showed higher IES-R Total, Avoidance, and Hyperarousal scores, along with increased DASS-21 Anxiety scores and BHS total scores.

Conclusions: OD in long COVID patients were significantly associated with increased post-traumatic stress symptoms, anxiety symptoms and hopelessness, and with lower quality of life. Limited sample size, inability to determine causation and exploratory nature of the study may limit the generalizability of results. Comprehensive management addressing both physical and mental health should be assessed in long COVID patients.

Choosing between revision endoscopic sinus surgery (ESS) versus biologic therapy for recurrent chronic rhinosinusitis with nasal polyposis (CRSwNP) is a complex, multifaceted decision that involves not only clinical and financial factors but also patient preferences. Currently, there are no quantitative studies investigating patient preferences for CRSwNP treatment options. Increased awareness of patient-centered approaches to treatment warrant further investigation.

Background: This study aims to digitalize surgical maneuvers in ESS using a motion capture system under standardized conditions provided by 3D printed-sinus models.

Methodology: Forty-seven otolaryngologists performed ESS on 3D printed models manufactured from computed tomography (CT) images of actual patients. Participants were classified to 3 groups according to the objective structured technical skills assessment score. All surgical maneuverers performed during ESS were captured by a motion capture system. The path length, velocity, acceleration, and jerk were calculated for each surgical instrument and compared among the groups. Principle Component Analysis (PCA) was utilized to identify which metrics reflected surgical skill level. In addition, ten registrars repeated the surgical dissection. Their motion metrics were also compared between first training and the repeated training and then subjected to the PCA.

Results: Several metrics such as the angular acceleration and jerk of the cutting forceps were identified by PCA as possible indicators distinguishing the different skill levels for the ESS maneuvers. PCA analysis in the repetitive training also found the angular metrics of the upturned-cutting forceps correlating to their skill improvement.

Conclusions: Combined with the validated 3D-printed sinus models, the motion capture system provided the objective evaluation of the surgical performances of ESS.

Background: Eosinophilic otitis media (EOM) is a recently recognised type 2 inflammatory disease, strongly associated with asthma and chronic rhinosinusitis with nasal polyps. Known as a difficult-to-treat condition, EOM is often refractory to traditional therapies for (chronic) otitis media. This review aims to assess the success rates of the different interventions for patients with EOM including newly available biological therapy.

Methodology: In March 2024 we systematically searched PubMed, Embase, Scopus and Web of Science for studies on more than 5 EOM patients undergoing any medical or surgical intervention with a reported success rate. Proportion meta-analysis on a random effect model was used to synthesize results effectively. Risk of bias was assessed through the Risk Of Bias In Non randomized Studies of Interventions tool (ROBINS-I).

Results: From 1103 potential articles, 14 studies with 361 patients were included. 62% were females and 85% had bilateral presentation. Otorrhoea was present in 68% of patients, tympanic membrane perforation in 50%. The overall success rate was 61.3. However, interventions comprising biological agents targeting type 2 inflammatory cascade showed higher success rates compared to non-biological treatments.

Conclusions: A shift towards biologic-based therapies could be beneficial for managing the challenging condition EOM.

Objective: To validate the French version of the Empty Nose Syndrome Index (Fr-ENSI).

Methods: Patients with ENS, chronic rhinitis/rhinosinusitis, and asymptomatic individuals were recruited from April to August 2024. The internal consistency was evaluated with Cronbach-alpha. The test-retest reliability was assessed with the intraclass correlation coefficient (ICC). The external validity was assessed with a correlation study between the Fr-ENSI and the Sinonasal Outcome Tool-22 (Fr-SNOT-22), and Nasal Obstruction Symptom Evaluation (Fr-NOSE). The Fr-ENSI threshold for suspecting the ENS diagnosis was determined with the receiver operating characteristic (ROC) curve.

Results: Ninety-three subjects completed the evaluations. There were 36 ENS patients, 23 patients with chronic rhinosinusitis/rhinitis, and 34 healthy individuals. The mean age was 44.8±14.7 years. Patients with ENS reported significantly higher Fr-ENSI scores compared to others, indicating high internal validity. The Cronbach-alpha of Fr-ENSI was 0.891, which indicates an adequate internal consistency. The test-retest reliability was high. Depression and anxiety scores were associated with sleep disturbances. The Fr-ENSI was significantly correlated with Fr-SNOT-22, which supports a high external validity. The threshold of Fr-ENSI associated with the highest sensitivity and specificity was >23/60.

Conclusions: The Fr-ENSI is a valid and reliable questionnaire for documenting 12 prevalent symptoms of ENS. The consideration of sleep disorders in ENSI is important regarding its association with depression and anxiety.

Background: Corticosteroids are used in managing Chronic Rhinosinusitis (CRS) through several formulations, including oral steroids and nasal sprays. More recently, incorporating concentrated budesonide respules into high-volume saline irrigations has been proposed to enhance the penetration of topical steroids into the paranasal sinuses. We aim to evaluate the safety and efficacy of budesonide nasal irrigation (BNI) in managing CRS.

Methodology: A systematic review with meta-analysis was performed following PRISMA guidelines. Data were extracted independently from the eligible studies. In double-arm and single-arm meta-analyses, continuous outcomes were pooled using mean difference (MD) with a 95% confidence interval (CI).

Results: Twenty-six studies were reviewed, comprising 1464 patients. BNI had better outcomes than saline nasal irrigation (SNI) regarding Sino-Nasal Outcome Test score (SNOT-22). Lund-Kennedy Endoscopy scores (LKES) changed from baseline. Regarding safety, there was no significant difference between BNI and SNI regarding Intraocular Pressure (IOP). Single-arm analysis showed a pooled mean serum cortisol level within the normal range after BNI.

Conclusions: BNI demonstrated improved SNOT-22 and LKES scores, with normal post-treatment IOP and cortisol levels, indicating a beneficial impact on CRS while maintaining safety.

In our recent study, increased viscosity, delayed mucociliary clearance as well as hyposensitivity/dysesthesia of the nasopharynx seemed to play a relevant role in the pathophysiology of postnasal drip (PND) (1). Earlier concepts of PND, regarding an increased volume of secretions and atopy, do not seem to hold true since our latest analyses showed no significant difference between cases and controls (1). However, to this day its therapy is debated and the evidence for an effective treatment of PND is lacking so far. The fundamental rheological properties of nasal mucus constitute of the viscosity and elasticity (2-4).

Background: The mucosal epithelial barrier, the first line of immune defense, is vulnerable to allergens, pathogens, and inflammatory cytokines, contributing to CRS development. Our previous studies found high interleukin-17A(IL-17A) expression correlated with CRS severity and low glucocorticoid efficacy. The role of IL-17A in disrupting the nasal mucosal epithelial barrier leading to CRS remains unclear. We aimed to investigate how IL-17A promoting epithelial barrier damage and identify new treatment targets for CRS.

Methodology: Nasal tissue samples from 36 CRSwNP, 34 CRSsNP, and 39 controls were examined for the expression of IL-17A and tight junction (TJ) proteins using qRT-PCR, immunohistochemistry and immunofluorescence. The integrity of TJs and signaling pathways activation were observed using western blot, immunofluorescence, TEER and FITCâ€"FD4, transmission electron microscopy before and after IL-17A stimulation in human primary nasal epithelial cells (hNECs). Concurrently, studies were also conducted in an CRS mouse model induced by anti-IL-17A neutralizing antibody administration.

Results: TJs expression in the nasal mucosa of CRS patients was lower than in controls. IL-17A stimulation reduced TJs expression and TEER while increasing hNECs permeability. Inhibition of the (ERK/STAT3) pathway reversed the downregulation of TJs and the disruption of the epithelial barrier induced by IL-17A stimulation. In the CRS mouse model, anti-IL-17A antibody treatment rescued the nasal mucosal epithelial barrier.

Conclusions: IL-17A disrupts the nasal mucosal epithelial barrier by activating the ERK/STAT3 pathway in patients with CRS.