Rhinology最新文献

Background: To compare the efficacy of high-dose nasal steroid administered via high-volume irrigation versus spray delivery in patients with chronic rhinosinusitis (CRS) who have not undergone previous sinonasal surgery.

Methodology: A double-blind randomized clinical trial was conducted. The study comprised two groups receiving 1,000 μg/day of nasal budesonide through two distinct methods over a 3-month period: irrigation and spray delivery. Patients with severe CRS who had never undergone surgery and were on the waiting list for surgery in a public health service were included. Primary outcomes included changes in quality-of-life scores and secondary outcomes included changes in clinical control questionnaire results and nasal endoscopy findings. Assessments were conducted on the total sample, CRS with nasal polyps (CRSwNP), CRS without nasal polyps (CRSsNP), and according to the newly defined phenotypes of diffuse primary CRS (central compartment atopic disease [CCAD], eosinophilic chronic rhinosinusitis [eCRS] and non-eosinophilic CRS [neCRS]).

Results: Sixth-seven patients completed the study, with 34 in the Irrigation Group and 33 in the Spray Group. The Spray Group demonstrated superior efficacy in improving endoscopic outcomes across the total sample, particularly among CRSwNP and CCAD. No treatment demonstrated superiority in improving the SNOT-22 score. Furthermore, the Spray Group revealed greater efficacy in reducing the number of uncontrolled patients, as evaluated by the clinical control questionnaire, both in the total sample and CRSwNP.

Conclusions: High-dose steroid nasal spray outperformed high-volume steroid nasal irrigation in improving nasal endoscopy outcomes across the total sample, especially in CRSwNP and CCAD.

Introduction: Recurrent anterior idiopathic epistaxis is common in children, yet optimal management remains debated. This study compared the efficacy of antiseptic cream, antiseptic plus corticosteroid cream, and silver nitrate cautery in reducing epistaxis severity in paediatric patients.

Methodology: In a prospective randomised dual-centre clinical trial, 136 children with recurrent idiopathic anterior epistaxis were evenly allocated to antiseptic cream, antiseptic plus corticosteroid cream, or silver nitrate cautery. Epistaxis Severity Score was assessed at baseline, 2 weeks, and 1, 3, and 6 months.

Results: All groups showed significant reductions in ESS over time. At 2 weeks, silver nitrate cautery produced the most rapid early improvement, compared with antiseptic cream and the combination cream. By 1 month, the antiseptic plus corticosteroid group showed the greatest improvement, with further reductions at 3 months and 6 months. At 6 months, improvement rates were highest with the combination therapy, followed by antiseptic cream and cautery.

Conclusions: Cautery achieves rapid short-term control, but antiseptic plus corticosteroid cream provides the most durable improvement following a short, two-week course. It should be considered a first-line therapy for recurrent idiopathic anterior epistaxis in children.

Patients with chronic rhinosinusitis (CRS) commonly have ear complaints (ECs) (1). Reported prevalences in CRS-patients vary up to 61% (2, 3), and even higher (82%) in patients with nasal polyps (CRSwNP) with an indication for surgery (4). These data, however, are not based on validated otologic surveys. Instead, the ear-related questions of the SinoNasal Outcome Test 22-items (SNOT-22) (5) are used. ECs are often overlooked as CRSwNP patients present primarily with nasal complaints, despite the impact on quality of life of this co-morbidity (2, 4). With the advent of biological therapy for severe uncontrolled CRSwNP, comorbidities are increasingly appreciated including the rare but debilitating eosinophilic otitis media (EOM) (6). This study investigates ECs, evaluated by otologic questionnaires, in a severe uncontrolled CRSwNP population. It also investigates the use of single SNOT-22 ear items as proxy for relevant ECs.

Topical corticosteroids are standard therapy in chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma, administered as nasal corticosteroids (NCS) and inhaled corticosteroid (ICS). Suboptimal adherence is associated with impaired health-related quality of life (1).

Background: Postoperative cerebrospinal fluid (CSF) leak is a significant complication of endoscopic skull base surgery (ESBS) that increases meningitis risk, a serious and potentially life-threatening infection. This study aimed to delineate the risk factors associated with the development of meningitis in patients who experienced postoperative CSF leakage.

Methodology: We reviewed 1,303 ESBS cases for skull base lesion between January 2020 and July 2024 at a single tertiary center. Patient demographics, pathology, intraoperative CSF leak grade, reconstruction techniques, and postoperative CSF leak management strategies-including the use of nasoseptal flaps, fat grafts, and lumbar drains-were collected. Clinical and surgical factors were analyzed among patients with postoperative CSF leak to identify associations with the development of meningitis.

Results: Postoperative CSF leak was suspected in 49 patients (3.8%). Among them, 36 (2.8%) underwent repair surgery, while 13 (1.0%) were treated conservatively without surgical confirmation. Meningitis occurred in 21 of these patients. Multivariate analysis revealed that intraoperative CSF leak grade, use of fat grafts, lumbar drain insertion, and delayed CSF leak recognition were significantly associated with meningitis development. Patients with grade 3 intraoperative leaks had 3.21-fold increased odds of developing meningitis compared to grade 0. Tumor pathology, nasoseptal flap viability, and hydroxyapatite use were not significantly associated.

Conclusions: The transition from postoperative CSF leak to meningitis is influenced by the severity of intraoperative leakage, reconstructive choices, and the timing of leak detection. Restricting fat grafts and lumbar drains to selected cases and ensuring close postoperative rhinologic surveillance are critical in mitigating infectious complications following ESBS.

Several population-based studies have reported increased prevalence of autoimmune diseases (AID) in patients with chronic rhinosinusitis (CRS). Large-scale datasets from Taiwan demonstrated associations between CRS and conditions such as rheumatoid arthritis, ankylosing spondylitis, polymyositis, psoriasis, Sjögren's syndrome, and systemic lupus erythematosus (SLE) (1,2). However, sex-specific patterns have not been investigated. We examined associations between CRS and 20 pre-existing AID using a nationally representative primary care database, with a focus on sex-specific differences. Data were drawn from the IQVIA Disease Analyzer (>1,300 general practices in Germany, including diagnoses and prescriptions). Adults with an initial diagnosis of CRS (ICD-10: J32) between 2010-2024 were matched 1:1 to controls without CRS or nasal polyps (J33), based on age, sex, observation time, and CRS-related comorbidities (3) (Figure S1, online supplement). Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals, stratified by sex. We also performed subgroup analyses by age, asthma, allergy, and nicotine dependence.

Background: Biologic therapy has emerged as a key treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in refractory cases, but its effect on healthcare utilization is not well established.

Methodology: We conducted a retrospective big-data analysis using the Clalit Health Services database, identifying all CRSwNP patients treated with dupilumab or mepolizumab following endoscopic sinus surgery (ESS) between 2010-2024. We assessed antibiotic and systemic steroid use, visits to clinics, emergency rooms (ER), hospitalizations, and repeat ESS before and after biologic initiation.

Results: Among 861 patients (54.2% on dupilumab, 45.8% on mepolizumab), 62% had asthma. Median therapy duration was 25 months. Mean follow-up was 130 ± 78 months before treatment and 43 ± 42 months after. Biologics significantly reduced antibiotic and systemic steroid use, as well as community clinic, hospitalization, and revision ESS rates. Serum eosinophils declined from 520 ± 440 to 430 ± 460 cells/μL.

Conclusions: Post-ESS biologic therapy in CRSwNP patients is associated with reduced healthcare utilization and systemic medication use, highlighting its positive impact on disease burden and healthcare efficiency.

The detrimental effects of climate change on global health are becoming increasingly evident, also within rhinology. Climate change has been shown to cause a longer and more intense pollen season, while the prevalence of allergic rhinitis is expected to rise due to de novo sensitizations caused by the migration of plants (1). Chronic rhinosinusitis patients will be affected by increasing air pollution as well as changes in spread of potent pathogens and vectors associated with upper airway infections (2,3). Meanwhile, healthcare is an evident contributor to climate change (4). Operating rooms (ORs) have been identified as carbon hotspots due to their high energy consumption (5) and the use of anaesthetic gases with high Global Warming Potential (6). Also, ORs have been estimated to generate up to 33% of all hospital waste (7).

Objective: Beyond patient history, clinical examination and psychophysical gustatory testing, no standardized guidelines exist for the diagnosis of unclear taste disorders, especially regarding imaging. We therefore aimed to investigate the frequency of use of magnetic resonance imaging (MRI), the findings, and the cost and benefits in a large cohort of patients with taste disorders presenting at a tertiary referral centre over a period of 10 years.

Methodology: We retrospectively reviewed clinical records of all patients with gustatory disorders presenting at our tertiary smell and taste clinic between 2010 and 2019 who received an MRI. A board-certified neuroradiologist, specialized in head and neck imaging, reviewed all MRIs. MRI findings were classified according to their relevance to the taste disorder. A cost-benefit analysis was performed.

Results: Of the 125 patients with taste complaints, 70 underwent MRI. Imaging data were retrievable for 65 patients, representing 52% of the total cohort. Pathological findings were observed in 54 patients; 46 had incidentalomas not related to the initial complaint. Findings potentially related to the gustatory complaint (treatable in 6 cases, not treatable in 2 cases) were seen in only 8 MR scans. The imaging findings matched the clinical findings in only 4 cases, and these were therefore classified as clearly related to the complaint. The total cost of all the MRIs performed was 55,034.89 CHF. The estimated costs per finding attributable to a taste disorder were 13,758.72 CHF.

Conclusions: In this selected cohort of patients with isolated taste disorders, MRI rarely revealed findings clearly attributable to the complaint. While incidentalomas were frequent, clinically relevant abnormalities were uncommon. These results suggest that MRI should be reserved for select cases, and its routine use critically evaluated. Further prospective studies are needed to better define when MRI is warranted in the diagnosis of unclear isolated taste disorders.

Backround: Allergic rhinitis (AR) patients may experience attention deficits (AD), concentration impairment, and learning difficulties. This study aimed to compare AD hyperactivity disorder (ADHD) symptoms in grass pollen-allergic AR patients and controls and to assess their seasonal variation.

Methodology: The study included children aged 6-12 with AR who presented to Ankara Bilkent City Hospital between April 15 and June 15 in 2022 and 2023. The Visual Analog Scale (VAS) was used to assess disease severity, and the Conners Parent Rating Scale (CPRS) was employed to evaluate ADHD symptoms. For comparison, the CPRS was also administered to an age-matched control group consisting of children without known allergies or chronic diseases.

Results: The study included 146 AR patients (8.9±1.7 years) and 150 controls (9.0±1.8 years). During the grass pollen season, AR patients showed increased rates of AD, hyperactivity, and school absenteeism, along with a decline in academic performance. Compared to the control group, AR patients exhibited significantly higher AD, hyperactivity, and total CPRS scores. Logistic regression analysis identified male sex, high nasal VAS score, and snoring as independent risk factors for AD, while a high ocular VAS score was an independent risk factor for hyperactivity.

Conclusions: Exacerbation of AR symptoms during the grass pollen season leads to a significant increase in ADHD symptoms and a decline in academic performance. Regular monitoring and symptom control in AR patients are crucial for maintaining academic and social success.