Rhinology最新文献

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.

The nasal and paranasal cavities constitute integral components of the vocal tract resonator system, yet their precise contribution to voice quality remains a subject of debate. While early anatomical and acoustic models (1-3) suggested that sinus coupling through open ostia may introduce anti-resonances and spectral alterations, subsequent investigations employing cadaveric dissections, physical simulations, and three-dimensional replicas (4, 5) have confirmed notable effects on frequency response and formant balance. Clinical studies, including those examining patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery (FESS), have shown that surgical management can improve both sinonasal and vocal quality of life without adverse effects on voice characteristics (6,7). However, conventional acoustic measures such as jitter and shimmer frequently fail to detect such changes (8). In contrast, Mel-frequency cepstral coefficients (MFCCs), which transform the speech spectrum into a perceptually weighted domain, have shown superior sensitivity to resonance-related shifts and hypernasality (9). Based on this evidence, we investigated whether MFCCs and spectral flatness can more accurately identify post-operative alterations in resonance that are not captured by traditional acoustic parameters.

We read with keen interest the article by Kawabata et al. titled "Olfactory disorder after COVID-19 vaccination," which explores 16 cases of olfactory dysfunction temporally associated with vaccination (1). The paper addresses an important and under-recognized topic; however, several methodological aspects warrant clarification to aid accurate interpretation. First, the inclusion of five institutional cases within a review otherwise presented as PRISMA-compliant raises questions regarding methodological consistency. Under PRISMA, all included studies should be identified through transparent and reproducible database searches (2). Clarifying whether institutional data were processed separately from literature-derived cases would strengthen transparency and avoid confusion about the evidence level.

Background: Emerging evidence has highlighted a potential link between chronic rhinosinusitis with nasal polyps (CRSwNP) and coronavirus disease 2019 (COVID-19). However, the exact mechanism driving this association is not well understood. We aimed to explore the biological pathways and differentially expressed genes (DEGs) involved in CRSwNP and COVID-19 by performing bioinformatic analyses.

Methods: Data from the GEO database was analyzed using the "limma" package to identify DEGs. Techniques like weighted gene co-expression network analysis (WGCNA), protein-protein interaction (PPI) networks, and machine learning were employed to pinpoint key genes. Single-sample gene set enrichment analysis (ssGSEA) was used to assess immune cell infiltration. Key gene expression in macrophages was verified using single-cell analysis and immunofluorescence. Genetranscription factor-microRNA (gene-TF-miRNA) regulatory networks were constructed via NetworkAnalyst. Potential therapeutic agents were identified through DGIdb. Nasal polyps and control nasal tissues were surgically obtained for validation purposes.

Results: The findings revealed 19 co-DEGs common to both CRSwNP and COVID-19, which were enriched in pathways related to inflammation and the immune response. Among these genes, CD163 was identified as the key gene. The infiltration of CD163+ macrophages was substantially greater in the nasal tissues of CRSwNP and COVID-19 patients than in those of control subjects. Fluticasone was determined to be a promising drug that targets CD163.

Conclusion: This study highlights CD163 as a promising diagnostic marker for CRSwNP and COVID-19, suggesting that targeting CD163 may be pivotal in the management of these conditions.

Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a significant burden on the healthcare system. Xian et al. discussed several aspects of our economic model, based on French pricing, that may impact the cost-effectiveness of biologics . Briefly, they outlined the regional disparities in the cost of biologics, the potential better outcomes of biologics in real-world evidence, and the recurrence rate after endoscopic sinus surgery (ESS). We think that these aspects may be further discussed.

Biologic therapies targeting type 2 inflammation, such as dupilumab, omalizumab, and mepolizumab, have been developed to manage chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in patients with comorbid asthma or aspirin-exacerbated respiratory disease (AERD). Functional endoscopic sinus surgery (FESS) remains the mainstay of treatment in patients who are refractory to medical therapy (1,2). However, direct comparisons between biologic therapy and FESS are limited. This systematic review and meta-analysis aimed to compare sinonasal outcomes between FESS and biologic therapy in real-world settings.

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.