Rhinology最新文献

Background: Criteria for biologic treatment of uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) differ across international recommendations and prescription of biologics depends on national reimbursement criteria. CHRINOSOR offers an opportunity to analyse biologic indications in the real-world setting according to international recommendations.

Methods: CRSwNP patients who received dupilumab treatment in the ENT clinic of 6 tertiary centres (5 countries) were included. Baseline demographic and lifestyle factors, NP score, SinoNasal Outcome Test-22 score, visual analogue scale for sinus symptoms, and Asthma Control Test score were retrieved from the medical records. Indication criteria for biologic treatment according to EUFOREA 2021, and EPOS/EUFOREA 2023 recommendations was applied. Dupilumab effectiveness was assessed at baseline, 24 and 52 weeks in relation to these criteria.

Results: 61.8% and 79.8% of patients met respectively the EUFOREA 2021 or the EPOS/EUFOREA 2023 indication criteria for biologic treatment. Dupilumab was effective in patients who met or did not meet international criteria for biologic indication. However, patients who met the indication criteria showed overall a more pronounced effect on most of the outcome parameters than patients who did not meet the criteria.

Conclusions: Real-world management of CRSwNP with biologics does not strictly follow the indication criteria established by international recommendations but depends on management criteria established by local authorities. These vary significantly and are either more or less stringent from one country to another. Dupilumab effectiveness in CRSwNP, whether these criteria are met or not, suggests that a broader CRSwNP population may benefit from dupilumab.

Skull base reconstruction is a critical component of endoscopic endonasal skull base surgery (EESBS). Bed rest remains an indispensable element of post-operative care, which should be carefully considered for reducing the risk of cerebrospinal fluid (CSF) leaks and enhancing surgical outcomes (1, 2). However, the necessity of bed rest continues to be controversial as indicated by the expert consensus on perioperative management of skull base reconstruction, due to a lack of high-quality evidence to support its effectiveness (1-4). This study focuses exclusively on anterior skull base reconstruction, which is frequently employed in EESBS but has not been sufficiently investigated. In this study, we retrospectively collected patient data from three skull base centres to analyse the impact of bed rest on the occurrence of post-operative CSF leakage.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition with severe impacts on quality of life and substantial economic costs. Dupilumab targeting the underlying T2 inflammation in CRSwNP showed promising results; however, it is unknown if intensive regimens must be maintained in responders to prevent relapse. In 2019, FDA and the European Commission approved Dupilumab 300 mg administered subcutaneously every two weeks for CRSwNP. We hypothesized that disease control might be maintained by reducing the frequency of administration in patients who initially well answered to the standard treatment. To date the benefit of de-escalation was only analyzed in short time. We wanted to understand if a de-escalation regimen could be introduced without compromising disease control in long follow-up; to this aim we de-escalated Dupilumab at 300 mg every four weeks following a year of conventional bi-weekly administration.

We would like to sincerely thank Zhong et al. for their thoughtful and well-articulated letter in response to our recent systematic review (1). Their commentary offers interesting perspectives on the landscape of traditional herbal medicine research and the role of Chinese-language databases.

Background: Anosmia is a common, debilitating, and often treatment-resistant symptom of CRS. Biological therapies are a novel and promising treatment for severe and uncontrolled CRS, however, the impact of biological therapy specifically on olfatory dysfunction has not yet been evaluated through systematic review.

Methodology: Systematic searches of Ovid MEDLINE, EMBASE and Cochrane Library were performed on 25/05/2024, assessing olfactory outcomes following treatment with biologics. Random-effects meta-analyses were conducted to generate restricted maximum-likelihood estimates for the absolute improvement in each outcome of interest.

Results: Systematic searches yielded 801 papers, of which 37 studies comprising of 3284 patients treated with biologics and 1138 controls. In the RCT-only analysis, biologics conferred significat improvements versus control in UPSIT and VAS olfaction (measured as a 0-10 Likert scale). Across all papers, Dupilumab showed significat improvements versus Omalizumab in UPSIT and VAS.

Conclusions: Biological therapies are effective in improving olfactory dysfunction secondary to treatment-resistant CRS, with VAS olfaction gains being demonstrated up to 12 months after treatment. Dupilumab shows initial promise over omalizumab; however, cost-effectiveness of biological therapies may limit widespread clinical usage currently.

Background: In the setting of chronic rhinosinusitis (CRS), olfactory improvement with corticosteroids suggests reversibility and preserved function. While self-rated olfactory function does not replace psychophysical measures of olfactory function, our goal is to investigate if self-reported pre-operative corticosteroid-responsive olfactory dysfunction (CROD) is a predictor of post-operative olfactory improvement in patients with CRS undergoing sinus surgery.

Methodology: We performed a prospective, observational study of patients with refractory CRS with and without nasal polyposis and pre-operative olfactory dysfunction undergoing sinus surgery. Patients were characterized into corticosteroid-responsive and non-corticosteroid-responsive based on a survey response. Patient outcome measures for Sniffin Sticks, Olfactory Cleft Endoscopy Score (OCES), Questionnaire of Olfactory Disorders (QOD-NS), and Sino-nasal Outcomes Test (SNOT-22) were recorded pre- and post-operatively.

Results: A total of 253 participants were included. Patients with CROD were more likely to have comorbid nasal polyposis, asthma, and aspirin sensitivity. Patients with CROD had significantly better post-operative improvement in OCES total scores and QOD-NS total scores compared to patients without CROD.

Conclusions: In conclusion, patients with CRS and CROD are more likely to have a greater improvement in olfactory dysfunction post-operatively by several measures of olfactory outcomes. This suggests that corticosteroid responsiveness is a clinical predictor of preserved function and reversibility and can be used as a simple clinical prognostic factor.

Background: This study aimed to evaluate the presence of Serpentine Signs on computed tomography (CT) images and its impact on the clinical symptoms in patients with empty nose syndrome (ENS).

Methods: A retrospective study analysed patients with ENS enrolled in previous studies. The clinical characteristics and results of ENS-specific questionnaire evaluations were reviewed. The ratio of the maximal to minimal thickness (M/m ratio) of the septal mucosa was also calculated to demonstrate the degree of swelling. Mucosal swelling was defined as a thickness greater than twice that of the surrounding mucosa. A Serpentine Sign was identified by the presence of two or more mucosal swellings on one side of the central nasal septum.

Results: Seventy-one (74.0%) of the 96 enrolled patients with ENS exhibited Serpentine Signs on CT images. Patients with the Serpentine Sign had significantly lower symptom scores on the ENS 6-item Questionnaire (ENS6Q) and 25-Item Sino-Nasal Outcome Test (SNOT-25). Regression analysis revealed that the ENS6Q, SNOT-25, sleep, psychological, and empty nose symptom domains were significantly associated with the Serpentine Sign. The M/m ratio of the nasal septal mucosa significantly decreased in 39 participants with available postoperative CT images 6 months after nasal reconstruction surgery, along with an improvement in ENS6Q and SNOT-25 scores.

Conclusion: The Serpentine Sign was associated with fewer ENS symptoms in patients with ENS. The severity of septal mucosal swelling decreased after surgical reconstruction. These results imply a significant impact of airflow alteration due to over-reduction of the inferior turbinate on the nasal mucosa.

Background: Many Post-Acute COVID-19 Syndrome (PACS) patients continue to experience persistent dysosmia up to two years post-pandemic. Cognitive and semantic memory functions, along with olfactory associative areas, may be affected in PACS without olfactory recovery. Visual-olfactory bimodal olfactory training may stimulate these areas. This study evaluates the olfactory recovery using a new bi-modal training kit, MaMadeleine assisted by a web application.

Methodology: A prospective randomised study (Nov 2021-June 2022) included PACS patients aged >=14 with post-infectious olfactory dysfunction. Patients were randomized for two months of simple (A) or semantic (B) visual-olfactory training. Evaluations included clinical assessments, Sniffin' Sticks Tests, and quality-of-life questionnaires. Adherence to treatment was monitored via the web application.

Results: We included 83 patients, on average 13+-5.6 months after COVID-19. Olfactory training using MaMadeleine led to subjective orthoand retro-nasal olfactory improvement in 79.4% (n=58) and 58.9% (n=43) of patients, respectively, with Sniffin' Sticks Test scores increasing from 26.5+-7.5 to 29.1+-7.4. Both groups saw a 20% decrease in parosmia and phantosmia. No significant differences in recovery were observed between groups, although exploratory findings in a small subgroup (n=10) with semantic memory impairment suggest a possible benefit of bimodal training, warranting further investigation. Quality of life improved significantly in both groups. Adherence was better in group B than in group A.

Conclusions: MaMadeleine training improves subjective olfactory function, psychophysical test results, and quality of life in PACS patients with olfactory dysfunction. Multimodal training enhances adherence. Further studies are needed in semantic memory-impaired patients.

Background: Olfactory dysfunction (OD) is an underrecognized feature of CHARGE syndrome (CS), often associated with CHD7 mutations and structural anomalies of the olfactory system. This systematic review examines the burden, assessment methods, and clinical correlates of OD in CS.

Methodology: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251040500). A comprehensive search of six databases up to May 2025 was performed. Two independent reviewers screened, extracted data, and assessed study quality. A narrative synthesis was performed.

Results: From 1,643 records, 16 studies met inclusion criteria. Most were retrospective cohort studies and employed clinical diagnostic criteria for CS, with a subset reporting CHD7 mutation data. OD was most frequently identified radiologically. Psychophysical testing and self/parent reports were less common. Neurodevelopmental delays, feeding/swallowing issues, and reduced quality of life were reported in association with OD, but causal relationships remain unclear.

Conclusions: OD is highly prevalent in CS, often exceeding 80%, yet remains underrecognized. Radiologic imaging and electrophysiological techniques may be alternatives when psychophysical testing is not feasible. Future research should focus on validating paediatric-specific and developmentally appropriate olfactory assessments and integrating olfaction into quality-of-life frameworks. OD should be considered for inclusion in revised CHARGE diagnostic criteria.

Background: Predicting symptom improvement after nasal airway obstruction surgery remains difficult, as objective airflow metrics correlate poorly with patient-reported outcomes. Since trigeminal afferents are key in sensing nasal airflow, this study evaluated whether individual differences in nasal chemosensory function-particularly trigeminal sensitivity-are associated with subjective airflow perception and predict outcomes in patients undergoing surgery for nasal obstruction.

Methodology: A prospective cohort study was conducted in 43 participants (32 patients with nasal airway obstruction scheduled for surgery, 11 healthy controls). Trigeminal sensitivity was assessed using measures including the menthol lateralisation detection thresholds, TRPV1/TRPM8 gene expression, and the trigeminal subtest of the Barcelona Smell Test-24. Olfactory and gustatory function were also evaluated. Nasal obstruction perception was measured pre- and postoperatively using the NOSE-e questionnaire and a visual analogue scale. Patients were followed for a mean of 10.9 months.

Results: Trigeminal sensitivity did not differ significantly between patients and controls. However, baseline trigeminal Barcelona Smell Test-24 scores correlated with greater improvement in NOSE-e scores and satisfaction. Patients with NOSE-e improvement >6 points had lower baseline trigeminal scores than those with lesser gains. No other baseline chemosensory measures were correlated with postoperative outcomes.

Conclusions: Trigeminal sensitivity-particularly as assessed by the Barcelona Smell Test-24 test-may serve as a predictor of both symptom improvement and overall satisfaction after surgery for nasal airway obstruction, underscoring the importance of sensory processing in shaping patient-perceived surgical outcomes.