Rhinology最新文献

Introduction: Emerging evidence from epidemiological studies highlights the interaction between air quality metrics and sinusitis occurrence. This study investigates the relationship between acute sinusitis incidence, air pollutant levels, and climatic conditions in Taiwan from 2008 to 2017.

Methods: This study extracted outpatient claims data from the Longitudinal Health Insurance Database 2010. We computed seasonal incidence rates of acute sinusitis episodes per 1000 population over 120 months, stratifying the data by gender and three age groups: 20-44, 45-64, and 65 years and older. Addressing the seasonal variability inherent in our dataset, we utilized Auto-Regressive Moving Average (ARMA) models to analyze each variable as a univariate time series influenced by its historical values.

Results: The analysis reveals that, except relative humidity, all other climatic factors including CO, NO2, SO2, PM10, O3, ambient temperature and rainfall demonstrated significant crude correlations with the rates of acute sinusitis. The ARIMA test suggested that seasonality plays a significant role in influencing sinusitis episodes across all age groups. Specifically, individuals experience significantly higher incidence rates during winter compared to spring. These findings underscore winter as a period with notably higher incidence rates of acute sinusitis, even after adjusting for meteorological and air pollution variables.

Conclusions: This study provides comprehensive evidence of the significant associations between acute sinusitis incidence, air quality, and climatic factors in Taiwan.

Introduction: Staphylococcus aureus (S. aureus) in chronic rhinosinusitis (CRS), particularly when localised intracellularly, is linked to disease recalcitrance and poor post-surgical outcomes. Antibiotics frequently fail to penetrate the mammalian cell membrane, resulting in an inability to address the intracellular component of S. aureus. This contributes to treatment failure and development of antimicrobial resistance. We investigated the antimicrobial effects of simvastatin, a widely used, inexpensive medication with extracellular and intracellular antimicrobial properties, against CRS-related S. aureus.

Methods: Simvastatin’s antimicrobial activity, in prodrug and hydroxy acid forms, was assessed against S. aureus using the broth dilution method to determine the minimal inhibitory concentration (MIC). Intracellular activity of simvastatin was evaluated by pre-treating S. aureus-infected LAD2 mast cells with simvastatin and performing colony forming unit (CFU) enumeration and confocal microscopy. Cell viability was assessed using lactate dehydrogenase (LDH) assays.

Results: Simvastatin exhibited an extracellular MIC of 40 mmol/l against S. aureus. Intracellularly, it significantly reduced the bacterial burden by 46-fold in a dose-dependent manner between concentrations of 0.1-100 mmol/l. Toxicity to LAD2 cells was observed at 100 mmol/l. Confocal microscopy revealed a lower percentage of infected cells in the group pretreated with 30 μmol/l simvastatin (15.3%) compared to untreated cells (32.8%). Simvastatin hydroxy acid demonstrated no antimicrobial activity against S. aureus.

Conclusions: Simvastatin demonstrates in vitro antimicrobial activity against CRS-related S. aureus with the potential for repurposing as a novel antibiotic-sparing topical agent for the treatment of refractory CRS. This could improve surgical outcomes andreduce the risk of antimicrobial resistance.

Background: Managing sinonasal malignancies requires a thorough oncological assessment and interdisciplinary collaboration. Patients often present at an advanced tumor stage with a delay in diagnosis. With the recent advancements in imaging techniques along with the growth in molecular testing knowledge, the landscape of these tumors has become increasingly diverse. The pretreatment assessment must include information gathered from radiological and pathological evaluations, as well as intraoperative exploration of the tumors. Only a comprehensive approach allows a personalized treatment plan.

Methodology: This narrative review synthesizes current evidence, encompassing pretherapeutic evaluations and the development of individualized treatment protocols.

Results: Multimodal treatment strategies, including surgical resection, radiotherapy (RT), chemotherapy, and immunotherapy (for sinonasal mucosal melanoma) need to be tailored based on tumor histology, stage, and patient-specific factors. Endoscopic surgical approaches demonstrated oncologic outcomes comparable to traditional open techniques, with reduced perioperative morbidity. Neoadjuvant therapies facilitated improved local control and organ preservation in advanced-stage tumors.

Conclusion: Ongoing advancements in imaging, surgical interventions, as well as (neo)adjuvant therapies have significantly improved the prognostic landscape of sinonasal malignancies. A multidisciplinary, personalized treatment approach remains pivotal in optimizing patient outcomes.

BACKGROUND A patient-centered and directly measurable definition for acute exacerbation of chronic rhinosinusitis (AECRS) has been developed as "a flare up of symptoms beyond day-to-day variation, lasting at least 3 days, and to which a distinct negative impact on a patient's quality of life (QOL) or functionality can be attributed". Our aim is to understand how this definition correlates with previously used metrics.

Methodology: Cross-sectional study of chronic rhinosinusitis (CRS) patients. The number of AECRS (using this novel definition), courses of CRS-related systemic antibiotics and corticosteroids taken for these AECRS, and number of asthma exacerbations in the past 6 months was queried. Disease-specific quality of life was measured using the 22-item Sinonasal Outcome Test.

Results: A total of 237 CRS patients were enrolled. In the 6-month period prior to study enrollment, the mean number of AECRS was 4.2 while the mean number of systemic antibiotics or corticosteroids taken for these AECRS was 1.6 reflecting patients received rescue medication for 33% of AECRS. The number of AECRS was weakly correlated with number of systemic rescue medications and SNOT-22 score. For asthmatic CRS patients, numbers of AECRS and asthma exacerbations were correlated. Finally, comorbidities were associated with higher AECRS frequency by 29% in migraine and 41% in active tobacco users.

Conclusions: We achieved our aim by showing the AECRS definition correlates with systemic rescue medication usage, disease-specific QOL and asthma exacerbations. Our results demonstrate that indirect measures of AECRS may not capture all AECRS. Furthermore, comorbid migraine and tobacco use are associated with AECRS frequency.

Background: Negative pressure drainage is a commonly used method in surgery, but studies applying negative pressure drainage in septoplasty are relatively few.

Methodology: A randomized clinical trial was conducted to compare negative pressure drainage and nasal packing after septoplasty. Patients with nasal septal deviation underwent septoplasty from November 2023 to March 2024 were enrolled. Symptom scores and quality of life scores were assessed on postoperative day 1, day 5, and at 1 month to evaluate postoperative comfort.

Results: A total of 95 patients completed the study, the median (IQR) age was 29 (21, 43) years, and 73 (77%) identified as male. 48 (51%) patients were randomized to nasal packing group and 47 (49%) to negative pressure group. On postoperative day 1, the negative pressure group showed significantly lower symptom scores for nasal congestion, rhinorrhea, olfactory dysfunction, headache, eye discomfort, ear fullness, and better quality of life compared to the packing group. On postoperative day 5, the negative pressure group showed significantly lower scores for olfactory dysfunction and ear fullness compared to the packing group. There was no significant difference in effective rate and postoperative complications rate between negative pressure group and packing group. The cost-effectiveness ratio for the negative pressure group was significantly lower than the packing group.

Conclusions: Negative pressure drainage after septoplasty significantly improves postoperative comfort in the first days after surgery, without affecting surgical efficacy or safety, and helps reduce medical costs.

Background: Recent clinical studies have alluded to an association between chronic rhinosinusitis (CRS) and cognition, possibly mediated by local and systemic neuroinflammation. This meta-analysis seeks to clarify the association of CRS diagnosis or treatment with cognitive function and dementia.

Methodology: Two blinded reviewers searched PubMed, Embase, and Scopus for studies comparing cognitive function (global/domain-specific) or dementia in patients with/without CRS or pre/post-CRS treatment. The risk of bias was assessed using ROBINS-I/ROBINS-E. Random-effects models were used to pool the ratio of means (RoM) for cognitive scores and the odds ratio (OR) for dementia.

Results: From 1,149 records, 10 studies encompassing 107,610 patients were included. CRS was associated with poorer global cognitive function compared to healthy. CRS treatment was associated with improvements from baseline in processing speed and working memory. There was no significant cross-sectional association between CRS and dementia.

Conclusion: CRS is associated with 9% poorer global cognitive function, while CRS treatment is associated with 8-9% improvements in processing speed and working memory. Larger longitudinal studies are needed to fully elucidate these relationships.

Background: Within the last years, monoclonal antibodies (biologicals) have revolutionized the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and significantly improved symptom control in otherwise refractory cases. The effectiveness of the biological mepolizumab, an IL-5 receptor antibody, has not yet been investigated extensively. This multi-centric study assesses its impact on a large German patient cohort including biological naive and switched patients.

Methodology: In this retrospective multi-centric study, patients with the diagnosis of severe CRSwNP treated with mepolizumab by German tertiary referral centers were included. Data were collected retrospectively from patient records. The change from baseline regarding patient reported symptom control, serum biomarkers, nasal polyp score (NPS), and sense of smell were analysed over a course of up to 30 months.

Results: 96 patients from 8 tertiary treatment centers were included, 36.5% female, with a mean age of 54.1±14.3 years. Patient reported outcome measures, smell, and NPS improved significantly within 6 months after treatment initiation or switch from a different biological to mepolizumab. Change from baseline in outcome parameters was smaller in the switch-group, whereas comorbid asthma indicated greater treatment success.

Conclusions: Our real-world data show a sustained therapeutic effect of mepolizumab in CRSwNP, including a large proportion of patients who were previously treated with a different biological. This study is the largest real-world cohort to date depicting realistic treatment and disease situations, confirming a broad range of indication for mepolizumab in severe CRSwNP.

Background: The sphenopalatine artery (SPA) runs in close proximity to the branches of the trigeminal nerve and to the sympathetic and parasympathetic secretomotor fi bers. In refractory epistaxis, monopolar cautery of the SPA during surgery is of widespread use. The eff ect of coagulation on adjacent trigeminal and parasympathetic branches, and thus intranasal sensitivity and secretory function, is unknown.

Methods: To investigate intranasal trigeminal function (INTF) by means of CO2 stimuli intranasally, at baseline and after decongestion, before and after local anaesthesia (xylocaine) in healthy subjects and after monopolar cautery in patients treated for refractory epistaxis. In the latter, INTF and secretory function were tested by comparing the treated with the untreated side. Nasal and lacrimal secretions were measured with intranasal sponges and Schirmer’s tests.

Setting: Monocentric cohort study in tertiary referral centre.

Results: A total of 37 healthy participants and 17 patients were included. Nasal decongestion had no eff ect on CO2 measurements, whereas local anaesthesia signifi cantly decreased INTF in healthy subjects. In patients, the operated side showed signifi cantly lower INTF, lower nasal secretory function but no signifi cant changes in lacrimal function.

Conclusion: Local anaesthesia and surgical treatments have measurable eff ects on INTF. Monopolar cautery of the SPA and its branches aff ects nasal secretory function. These eff ects may lead to symptoms and surgeons should be aware of the potential harm in epistaxis treatments.

Background: Nasopharyngeal necrosis is a common sequela after treatment for nasopharyngeal carcinoma (NPC). This study aims to compare the effectiveness of the main interventions, endoscopic surgery and conservative therapy, on nasopharyngeal necrosis and identify potential beneficiaries.

Methodology: This retrospective study was conducted on patients with nasopharyngeal necrosis from September 2008 to December 2020 at the Cancer Hospital of Sun Yat-sen University. The overall survival (OS) of patients with nasopharyngeal necrosis and their mucosal healing status were assessed. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance confounding factors between the two groups.

Results: A total of 517 patients (124 females; 393 males) with nasopharyngeal necrosis were included in this analysis, among whom 287 received conservative therapy and 230 underwent endoscopic surgical treatment. In the unmatched cohort, the endoscopic surgery group had a higher 3-year OS rate than the conservative therapy group. Patients who underwent surgery had higher cure rates than did those who received conservative therapy. PSM and IPTW analyses yielded similar results. Multivariate analyses of the unmatched, PSM, and IPTW cohorts revealed that nasal endoscopic surgery was an independent protective factor for the OS of patients with nasopharyngeal necrosis.

Conclusions: In this retrospective research, endoscopic surgery demonstrated better efficacy than conservative therapy for nasopharyngeal carcinoma patients with nasopharyngeal necrosis, while conservative therapy may be preferred for patients with superficial mucosal necrosis.

This issue of our journal starts with an extremely interesting systematic review on the impact of CRS on cognition measured with objective global cognitive function tests like the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE).