Rhinology最新文献

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.

Background: Various factors affect the immunopathogenesis of chronic rhinosinusitis (CRS). Although the relationship between allergies and CRS has attracted considerable attention, it remains controversial. Notably, little is known about whether the clinical characteristics and immunological profiles differ based on allergic sensitization status among patients with CRS.

Methodology: This study included 209 patients with CRS with nasal polyps (CRSwNP) who underwent endoscopic sinus surgery, and their nasal polyp tissues were obtained. Patients were divided into two groups according to allergic sensitization status: "allergic" and "non-allergic" groups. The clinical characteristics and immunological profiles were compared between the two groups. Ex vivo phenotypes of nasal CD4+ T cells were analyzed using flow cytometry.

Results: Compared to the non-allergic group, the allergic group exhibited a significantly higher prevalence of comorbid asthma, serum total IgE levels, SNOT-22 scores, JESREC scores, blood/ tissue eosinophil counts, the proportion of eosinophilic histologic type, and lower gustatory function test scores. Additionally, the frequencies of nasal T helper 2 (TH2) and proallergic TH2 (TH2A) cells were significantly higher in the allergic group than in both the non-allergic and the control groups, and these frequencies were significantly correlated with eosinophilic inflammation.

Conclusions: Our study demonstrates that allergic sensitization is closely associated with eosinophilic inflammation, as indicated by elevated levels of blood/tissue eosinophils and nasal TH2A cells, and by worse symptom scores in CRSwNP. Given the distinct immunological features of allergic patients, considering allergic sensitization within nasal tissue when managing CRSwNP is crucial.

In recent years, the role of the medical specialist has undergone a substantial evolution, increasingly intersecting with the fields of healthcare management and economics. Many clinicians are now gaining skills in areas such as cost-effectiveness analysis, health policy, and service organization. While such competencies can enhance awareness of the broader healthcare context, it is critical to reaffirm that the primary duty of a specialist - particularly in the field of otorhinolaryngology - is to ensure clinical appropriateness based on current evidence and guidelines, not to account for economic variables.

We read with great interest the recent study by Fieux et al. (1), which developed an evaluation model based on clinical practices, public health insurance, and private insurance systems in France. Through rigorous cost-effectiveness analysis, the authors concluded that initiating biologic therapy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) without previous endoscopic sinus surgery (ESS) imposes excessive economic burdens. This finding aligns with the current guideline regarding the indications for biological treatment in CRSwNP, which reserves biologics primarily for patients with prior ESS history.

Background: Patients seeking rhino(septo)plasty need to be adequately informed by their surgeon or surgical team members about the procedure, the expected outcomes, complication risks and post-operative care, and the available alternatives. A consensus on the content of an informed consent in rhino(septo)plasty is currently lacking despite the high unmet need.

Methodology: The extended international faculty of the European Rhinoplasty Course in Brussels organized by EUFOREA has generated an overview of the current literature on rhinoplasty outcomes and complication rates, and available informed consents. A proposal for informed consent was elaborated, consensus reached and checked for legal validity.

Results: An overview of reported outcomes and complication rates of rhino(septo)plasty are provided. Additionally, contents of existing consent forms for rhino(septo)plasty surgery are compared with requirements found in literature on informed consent, leading to a proposal of informed consent including relevant information according to expert consensus.

Conclusions: An informed consent form for rhino(septo)plasty is proposed by the international faculty of the European Rhinoplasty Course, that might serve rhinoplasty surgeons in the development of their informd consent documents.

Background: The factors affecting postoperative olfactory recovery in chronic rhinosinusitis with nasal polyps (CRSwNP) remain unclear. This study explores postoperative pathological classification and the impact of different middle turbinate management strategies on olfactory recovery.

Methodology: Seventy-two CRSwNP patients undergoing functional endoscopic sinus surgery (FESS) with ≥6 months follow-up were classified into eosinophilic (ECRSwNP) and non-eosinophilic (nECRSwNP) groups. Based on middle turbinate management, patients were further divided into resection (partial/complete) and preservation groups. Olfactory scores, clinical characteristics, and nasal endoscopy findings were analyzed, and multifactorial analysis identified factors influencing olfactory recovery.

Results: TDI scores in the ECRSwNP group remained lower than those in the nECRSwNP group preoperatively and postoperatively. However, olfactory score improvement and the proportion of significantly improved patients did not differ significantly between the two groups. Middle turbinate management was associated with greater olfactory improvement, particularly in nECRSwNP patients. Although the complete middle turbinate resection group had lower preoperative olfactory scores than the partial resection group, no significant difference was observed in postoperative olfactory improvement between the two approaches.Higher preoperative polyp scores and middle turbinate management predicted olfactory improvement.

Conclusions: FESS significantly improves the olfactory function in CRSwNP patients, and the extent of olfactory improvement is independent of pathological type. Patients with higher preoperative Lildholdt polyp scores and those who underwent middle turbinate management during FESS were more likely to exhibit improved olfactory function at 6 months postoperatively.