T. J. Stack, S. E. Zaidi, T. A. Dickerson, V. Pate, A. S. Monk, E. Benaim, B. D. Thorp, C. Klatt-Cromwell, C. S. Ebert Jr., B. A. Senior, A. J. Kimple
Background: Establishing effective treatment algorithms for chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging, particularly concerning biologic therapies' discontinuation rates. Limited real-world data exist on the persistence of dupilumab, a biologic used in CRSwNP. We conducted a large-scale claims-based analysis to compare dupilumab discontinuation rates. Methodology: Utilizing the IBM MarketScan® Research Database, we identified CRS patients treated with dupilumab from July 2019 to December 2021. We assessed drug discontinuation rates, comorbidities, demographics, and surgical history using Kaplan-Meier curves and Cox proportional hazards models. Results: Of 1718 CRS patients on dupilumab, median age at initiation was 45 years, with 44% male. Dupilumab persistence varied by comorbidity, with patients with comorbid asthma exhibiting the longest median usage (652 days). Statistically significant differences in drug persistence were observed among comorbid conditions (p<0.001). Younger patients (<50 years) had higher discontinuation rates (p<0.001). Conclusions: Our study reveals that many CRS patients without comorbidities discontinue dupilumab within the first year, with a median duration of 366 days. Age and comorbidities significantly influence dupilumab persistence. These findings aid clinicians in counseling CRS patients and underscore the need for further research to optimize treatment strategies.
{"title":"Trends in dupilumab persistence among patients with chronic rhinosinusitis with nasal polyps","authors":"T. J. Stack, S. E. Zaidi, T. A. Dickerson, V. Pate, A. S. Monk, E. Benaim, B. D. Thorp, C. Klatt-Cromwell, C. S. Ebert Jr., B. A. Senior, A. J. Kimple","doi":"10.4193/rhinol/24.003","DOIUrl":"https://doi.org/10.4193/rhinol/24.003","url":null,"abstract":"Background: Establishing effective treatment algorithms for chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging, particularly concerning biologic therapies' discontinuation rates. Limited real-world data exist on the persistence of dupilumab, a biologic used in CRSwNP. We conducted a large-scale claims-based analysis to compare dupilumab discontinuation rates. Methodology: Utilizing the IBM MarketScan® Research Database, we identified CRS patients treated with dupilumab from July 2019 to December 2021. We assessed drug discontinuation rates, comorbidities, demographics, and surgical history using Kaplan-Meier curves and Cox proportional hazards models. Results: Of 1718 CRS patients on dupilumab, median age at initiation was 45 years, with 44% male. Dupilumab persistence varied by comorbidity, with patients with comorbid asthma exhibiting the longest median usage (652 days). Statistically significant differences in drug persistence were observed among comorbid conditions (p<0.001). Younger patients (<50 years) had higher discontinuation rates (p<0.001). Conclusions: Our study reveals that many CRS patients without comorbidities discontinue dupilumab within the first year, with a median duration of 366 days. Age and comorbidities significantly influence dupilumab persistence. These findings aid clinicians in counseling CRS patients and underscore the need for further research to optimize treatment strategies.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Takagi, A. Oka, H. Kitamura, M. Kamitomai, M. Akamatsu, K. Kanai, Y. Watanabe, Y. Imanishi, Y. Noguchi, M. Okano
In January 2020, 14 medical staff members engaged in endona- sal endoscopic pituitary surgery at a hospital in Wuhan, China, were infected with a novel infection, coronavirus disease 2019 (COVID-19) (1). Since the nasal mucosa is a potential source of COVID-19 infection (2), close attention has been paid to infection control in rhinologic surgery during the COVID-19 pandemic (3). There are also many reports from other countries on COVID-19 infection among otolaryngologists, and these reports suggest that the risk of COVID-19 transmission is particularly high in rhinologic surgery (4,5). On the other hand, Sanmark et al. showed that the observed aerosol exposure during rhinologic surgery is lower or similar to exposures during coughing (6).
{"title":"COVID-19 control protocol for rhinologic surgery","authors":"R. Takagi, A. Oka, H. Kitamura, M. Kamitomai, M. Akamatsu, K. Kanai, Y. Watanabe, Y. Imanishi, Y. Noguchi, M. Okano","doi":"10.4193/rhinol/24.012","DOIUrl":"https://doi.org/10.4193/rhinol/24.012","url":null,"abstract":"In January 2020, 14 medical staff members engaged in endona- sal endoscopic pituitary surgery at a hospital in Wuhan, China, were infected with a novel infection, coronavirus disease 2019 (COVID-19) (1). Since the nasal mucosa is a potential source of COVID-19 infection (2), close attention has been paid to infection control in rhinologic surgery during the COVID-19 pandemic (3). There are also many reports from other countries on COVID-19 infection among otolaryngologists, and these reports suggest that the risk of COVID-19 transmission is particularly high in rhinologic surgery (4,5). On the other hand, Sanmark et al. showed that the observed aerosol exposure during rhinologic surgery is lower or similar to exposures during coughing (6).","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"98 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Alkhaldi, B. AlRajhi, B. Alghamdi, M. J. Al Mahdi
Background: Allergic Fungal Rhinosinusitis (AFRS) is a chronic, inflammatory, non-invasive fungal disease of the nose, sinuses, and paranasal sinuses. Dupilumab is an emerging biological therapy with promising outcomes in the treatment of patients with refractory AFRS. In this case series, we aimed to assess the effectiveness and safety of dupilumab in the treatment of refractory AFRS. Case description: Our case series included seven patients, all of whom met the inclusion criteria. Of these, four were male (57.1%) and three were female (42.9%). The ages of the patients ranged from 20 to 44 years, with a mean of 30.4. For post-treatment Sinonasal Outcome Test-22 (SNOT-22) scores, six patients (85.7%) reported improvement by one category (two from severe to moderate and four from moderate to mild). Only one patient (14.2%) reported an improvement by two categories (severe to mild). Post-treatment IgE levels ranged from 39 to 590 IU/mL, with a mean of 301.8 IU/mL. There was a significant decrease in the mean IgE level by 93% after dupilumab administration. The average number of surgeries in the included patients ranged from 2 to 4, with a mean of 2.7 surgeries. Post-treatment, none of the patients required revision surgery or steroids after three months of dupilumab therapy. Conclusions: Dupilumab is an emerging biological therapy with promising benefits in the treatment of refractory AFRS. It can be used if functional endoscopic sinus surgery and steroid treatment do not improve symptoms.
{"title":"Dupilumab as an emerging treatment for refractory allergic fungal rhinosinusitis: a case series and literature review","authors":"A. Alkhaldi, B. AlRajhi, B. Alghamdi, M. J. Al Mahdi","doi":"10.4193/rhinol/24.009","DOIUrl":"https://doi.org/10.4193/rhinol/24.009","url":null,"abstract":"Background: Allergic Fungal Rhinosinusitis (AFRS) is a chronic, inflammatory, non-invasive fungal disease of the nose, sinuses, and paranasal sinuses. Dupilumab is an emerging biological therapy with promising outcomes in the treatment of patients with refractory AFRS. In this case series, we aimed to assess the effectiveness and safety of dupilumab in the treatment of refractory AFRS. Case description: Our case series included seven patients, all of whom met the inclusion criteria. Of these, four were male (57.1%) and three were female (42.9%). The ages of the patients ranged from 20 to 44 years, with a mean of 30.4. For post-treatment Sinonasal Outcome Test-22 (SNOT-22) scores, six patients (85.7%) reported improvement by one category (two from severe to moderate and four from moderate to mild). Only one patient (14.2%) reported an improvement by two categories (severe to mild). Post-treatment IgE levels ranged from 39 to 590 IU/mL, with a mean of 301.8 IU/mL. There was a significant decrease in the mean IgE level by 93% after dupilumab administration. The average number of surgeries in the included patients ranged from 2 to 4, with a mean of 2.7 surgeries. Post-treatment, none of the patients required revision surgery or steroids after three months of dupilumab therapy. Conclusions: Dupilumab is an emerging biological therapy with promising benefits in the treatment of refractory AFRS. It can be used if functional endoscopic sinus surgery and steroid treatment do not improve symptoms.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Espetvedt, K. K. Brønnick, S. Wiig, K. V. Myrnes-Hansen, D. A. Lungu
BACKGROUND: The assessment of qualitative olfactory symptoms is characterised by heterogeneous and unstandardised tools. To improve the means of capturing symptoms and subsequent treatment and care, this study aimed to develop a novel questionnaire, the parosmia, phantosmia, and anosmia test (PARPHAIT). METHODS: PARPHAIT was distributed to 165 participants with qualitative olfactory symptoms mainly due to COVID-19. The content was evaluated in participants with olfactory dysfunction, and an exploratory factor analysis (EFA) and internal consistency assessment was performed to assess underlying constructs and their reliability. RESULTS: PARPHAIT was scored as suitable, although suggestions for improvement were made. The EFA suggested a four-factor model with 34 items, all having factor loadings over 0.63. The factors had good to excellent reliability. CONCLUSIONS: This study aimed to develop a novel questionnaire, PARPHAIT, and evaluate its content and factor structure. The content and format were satisfactory, but had potential for improvement. EFA resulted in a four-factor, 34-item model with good to excellent internal consistency. PARPHAIT is only just developed and will need to be validated in different populations and confirmed with respect to its factor structure. However, PARPHAIT bears potential of being a robust, comprehensive - yet symptom-specific -, and standardised tool of capturing olfactory dysfunction.
{"title":"Capturing qualitative olfactory dysfunction with PARPHAIT: the parosmia, phantosmia, and anosmia test","authors":"A. Espetvedt, K. K. Brønnick, S. Wiig, K. V. Myrnes-Hansen, D. A. Lungu","doi":"10.4193/rhinol/23.029","DOIUrl":"https://doi.org/10.4193/rhinol/23.029","url":null,"abstract":"BACKGROUND: The assessment of qualitative olfactory symptoms is characterised by heterogeneous and unstandardised tools. To improve the means of capturing symptoms and subsequent treatment and care, this study aimed to develop a novel questionnaire, the parosmia, phantosmia, and anosmia test (PARPHAIT). METHODS: PARPHAIT was distributed to 165 participants with qualitative olfactory symptoms mainly due to COVID-19. The content was evaluated in participants with olfactory dysfunction, and an exploratory factor analysis (EFA) and internal consistency assessment was performed to assess underlying constructs and their reliability. RESULTS: PARPHAIT was scored as suitable, although suggestions for improvement were made. The EFA suggested a four-factor model with 34 items, all having factor loadings over 0.63. The factors had good to excellent reliability. CONCLUSIONS: This study aimed to develop a novel questionnaire, PARPHAIT, and evaluate its content and factor structure. The content and format were satisfactory, but had potential for improvement. EFA resulted in a four-factor, 34-item model with good to excellent internal consistency. PARPHAIT is only just developed and will need to be validated in different populations and confirmed with respect to its factor structure. However, PARPHAIT bears potential of being a robust, comprehensive - yet symptom-specific -, and standardised tool of capturing olfactory dysfunction.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"3 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The purpose of this study was to evaluate whether office-based endoscopic sinus surgery (ESS) is as safe as tradi- tional outpatient surgery and whether there are differences in the operation results, patient recovery data, or complication and revision surgery rates. Methods: The study involved 164 subjects and data was collected retrospectively from Seinäjoki Central Hospital patient records. The office-based group included 92 patients who had undergone ESS under local anaesthesia in an office-based setting between April 2014 and December 2017, and the outpatient group 72 patients who had done so in an outpatient setting between January 2010 and December 2014. Patients were divided into two groups based on presence (wNPs, n=57) or absence (sNPs, n=107) of nasal polyps. Results: We found statistically significant differences in intraoperative medication in terms of amounts of drugs administrated. Sick leave was on average 2.1 days longer in the outpatient sNPs group and 2.4 days longer in the outpatient wNPs group than in the respective office groups. There were no statistically significant differences between methods in terms of complications. Revision rates for sNPs were 5.6% and 13.9% for the office and outpatient groups, respectively, and for wNPs 4.8% and 19.4%, respectively. Conclusion: Office-based ESS with careful patient selection seems safe, effective, and well tolerated by patients. Office-based intervention may lead to shorter sick leave durations and can reduce the overall use of sedative drugs during the operation.
{"title":"Safety and feasibility of endoscopic sinus surgery as an office-based procedure","authors":"S. Abrahamsson, T. Kolari, J. Numminen, H. Irjala","doi":"10.4193/rhinol/23.004","DOIUrl":"https://doi.org/10.4193/rhinol/23.004","url":null,"abstract":"Background: The purpose of this study was to evaluate whether office-based endoscopic sinus surgery (ESS) is as safe as tradi- tional outpatient surgery and whether there are differences in the operation results, patient recovery data, or complication and revision surgery rates. Methods: The study involved 164 subjects and data was collected retrospectively from Seinäjoki Central Hospital patient records. The office-based group included 92 patients who had undergone ESS under local anaesthesia in an office-based setting between April 2014 and December 2017, and the outpatient group 72 patients who had done so in an outpatient setting between January 2010 and December 2014. Patients were divided into two groups based on presence (wNPs, n=57) or absence (sNPs, n=107) of nasal polyps. Results: We found statistically significant differences in intraoperative medication in terms of amounts of drugs administrated. Sick leave was on average 2.1 days longer in the outpatient sNPs group and 2.4 days longer in the outpatient wNPs group than in the respective office groups. There were no statistically significant differences between methods in terms of complications. Revision rates for sNPs were 5.6% and 13.9% for the office and outpatient groups, respectively, and for wNPs 4.8% and 19.4%, respectively. Conclusion: Office-based ESS with careful patient selection seems safe, effective, and well tolerated by patients. Office-based intervention may lead to shorter sick leave durations and can reduce the overall use of sedative drugs during the operation.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"19 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140522573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. I. Vento, I. Taskila, J. Martola, L. Kuusela, G. Kurdo, A. Lyly, J. Hästbacka
BACKGROUND: Studies on the long-term prevalence of smell and taste impairment concerned with severe disease in the acute phase of COVID-19 are limited. The aim of our study was to assess and compare psychophysical testing and self-reported smell and taste disturbances and recovery between three patient groups suffering from critical, severe, or mild COVID-19 in a follow-up at six-months after the acute phase. METHODOLOGY: The prospective controlled study of 227 participants comprised 72 intensive-care-unit-treated (ICU-treated), 53 pulmonology- or infectious-diseases-ward-treated (WARD-treated), and 48 home-isolated patients (HOME) with preceding COVID-19, and 54 individuals with no history of COVID-19 (CONTROL). All participants visited a follow-up clinic for a sense-of-smell screening and underwent Magnetic Resonance Imaging (MRI) of the brain, olfactory bulbs and sinonasal area at six months after acute disease. Before the follow-up visit, the participants received a questionnaire concerning smell and taste function. We sent a supplementary questionnaire including questions about phantosmia and parosmia and taste recovery at a median of 502.5 days after the acute phase. RESULTS: We found no statistically significant differences between the groups in the incidence of smell and taste dysfunction, recovery, or the occurrence of parosmia or phantosmia. There were no statistically significant differences in semi-objective smell performance across the different study groups and controls. The olfactory bulb volume was normal in all patients and controls. Mucosal thickening in paranasal sinuses was rare. CONCLUSIONS: We found no difference in a six-month follow-up in the subjective or semi-objective senses of smell and taste between three severity groups of COVID-19 and controls.
{"title":"Prevalence of smell and taste dysfunction in different clinical severity groups of COVID-19 patients","authors":"S. I. Vento, I. Taskila, J. Martola, L. Kuusela, G. Kurdo, A. Lyly, J. Hästbacka","doi":"10.4193/rhinol/23.024","DOIUrl":"https://doi.org/10.4193/rhinol/23.024","url":null,"abstract":"BACKGROUND: Studies on the long-term prevalence of smell and taste impairment concerned with severe disease in the acute phase of COVID-19 are limited. The aim of our study was to assess and compare psychophysical testing and self-reported smell and taste disturbances and recovery between three patient groups suffering from critical, severe, or mild COVID-19 in a follow-up at six-months after the acute phase. METHODOLOGY: The prospective controlled study of 227 participants comprised 72 intensive-care-unit-treated (ICU-treated), 53 pulmonology- or infectious-diseases-ward-treated (WARD-treated), and 48 home-isolated patients (HOME) with preceding COVID-19, and 54 individuals with no history of COVID-19 (CONTROL). All participants visited a follow-up clinic for a sense-of-smell screening and underwent Magnetic Resonance Imaging (MRI) of the brain, olfactory bulbs and sinonasal area at six months after acute disease. Before the follow-up visit, the participants received a questionnaire concerning smell and taste function. We sent a supplementary questionnaire including questions about phantosmia and parosmia and taste recovery at a median of 502.5 days after the acute phase. RESULTS: We found no statistically significant differences between the groups in the incidence of smell and taste dysfunction, recovery, or the occurrence of parosmia or phantosmia. There were no statistically significant differences in semi-objective smell performance across the different study groups and controls. The olfactory bulb volume was normal in all patients and controls. Mucosal thickening in paranasal sinuses was rare. CONCLUSIONS: We found no difference in a six-month follow-up in the subjective or semi-objective senses of smell and taste between three severity groups of COVID-19 and controls.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"13 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute bacterial rhinosinusitis is a common condition often affecting children with inflammation of the mucous membrane in one or more nasal sinuses. Isolated sphenoid sinus infections can exhibit atypical or no symptoms before potentially severe suppurative complications develop. Awareness of early signs of complications is crucial to avoid delays in referral, diagnosis, and treatment. We present the first detailed report of a child with sphenoid sinus empyema with the symptoms intermittent unilateral esotropia and limb and gait ataxia. This case emphasizes the need to recognise atypical presentations, aiding early diagnosis and treatment to prevent severe, possibly life-threatening complications. Case presentation: A 7-year-old girl, previously healthy, presented with a months-long decline in health marked by general malaise, significant weight loss, and recurrent upper respiratory infections. Despite multiple primary care visits no antibiotics were prescribed because infection parameters were found to be normal. Subsequently, the emergence of intermittent double vision prompted referral to the pediatric emergency department. Examination revealed a wide-based gait, ataxic finger-nose-finger and knee-heel tests, and intermittent esotropia of the left eye. Neurological examination was otherwise unremarkable. Imaging of the cerebrum was performed on the suspicion of intracranial pathology and found isolated empyema within the left sphenoid sinus. Endoscopic sinus surgery and antibiotic treatment led to a full recovery within a month. The accommodative esotropia, likely triggered by the infection, was identified, and successfully treated with spectacles. Conclusion: This case recognises isolated empyema in the sphenoid sinus as a potential cause of intermittent esotropia and limb and gait ataxia. It serves as a reminder for clinicians to be vigilant for early signs of suppurative complications to commence prompt diagnosis and treatment to prevent delayed recognition and severe complications. It advocates the inclusion of images of the sphenoid sinus to accompany the conventional scans of the cerebrum, as patients risk referral on the suspicion of intracranial pathology on the basis of neurological symptoms.
{"title":"Intermittent esotropia and ataxia in a child with late diagnosis of empyema in the sphenoid sinus - a case report","authors":"A. Omari, P. B. Toft, C. von Buchwald","doi":"10.4193/rhinol/23.023","DOIUrl":"https://doi.org/10.4193/rhinol/23.023","url":null,"abstract":"Background: Acute bacterial rhinosinusitis is a common condition often affecting children with inflammation of the mucous membrane in one or more nasal sinuses. Isolated sphenoid sinus infections can exhibit atypical or no symptoms before potentially severe suppurative complications develop. Awareness of early signs of complications is crucial to avoid delays in referral, diagnosis, and treatment. We present the first detailed report of a child with sphenoid sinus empyema with the symptoms intermittent unilateral esotropia and limb and gait ataxia. This case emphasizes the need to recognise atypical presentations, aiding early diagnosis and treatment to prevent severe, possibly life-threatening complications. Case presentation: A 7-year-old girl, previously healthy, presented with a months-long decline in health marked by general malaise, significant weight loss, and recurrent upper respiratory infections. Despite multiple primary care visits no antibiotics were prescribed because infection parameters were found to be normal. Subsequently, the emergence of intermittent double vision prompted referral to the pediatric emergency department. Examination revealed a wide-based gait, ataxic finger-nose-finger and knee-heel tests, and intermittent esotropia of the left eye. Neurological examination was otherwise unremarkable. Imaging of the cerebrum was performed on the suspicion of intracranial pathology and found isolated empyema within the left sphenoid sinus. Endoscopic sinus surgery and antibiotic treatment led to a full recovery within a month. The accommodative esotropia, likely triggered by the infection, was identified, and successfully treated with spectacles. Conclusion: This case recognises isolated empyema in the sphenoid sinus as a potential cause of intermittent esotropia and limb and gait ataxia. It serves as a reminder for clinicians to be vigilant for early signs of suppurative complications to commence prompt diagnosis and treatment to prevent delayed recognition and severe complications. It advocates the inclusion of images of the sphenoid sinus to accompany the conventional scans of the cerebrum, as patients risk referral on the suspicion of intracranial pathology on the basis of neurological symptoms.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"107 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Landsberg, J. Luckman, A. Yakirevitch, A. Margulis, M. Masalha, M. Masarwa, S. Schneider
BACKGROUND: We have previously shown that an adjusted magnetic resonance imaging (MRI) protocol could be used as an alternative for assessing most bony paranasal and vital structures. Here, we aimed to determine the feasibility of using this protocol during endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). METHODS: Three experienced rhinologists used an adjusted MRI scan to plan and perform ESS. They were blinded to the CT images and observed them only postoperatively. They also completed a detailed questionnaire about their experience. RESULTS: Forty-three patients with CRS (60.5% with polyps and 39.5% without polyps) were included in the study. MRI navigation was used in 58.3% and 33.3% of surgeries performed by surgeon #1 and #2, respectively. The median Lund-Mackay score was 12 (interquartile range 2-24). None of the surgeons switched entirely to using CT scans during the procedure; No intra or postoperative complications were observed. Two surgeons reported that it was convenient to work with the MRI scans to visualize all nasal sinuses, but the third surgeon found MRI scans convenient for visualizing the frontal sinus. MRI convenience was considered superior to CT in 7 cases (16.3%), the same as CT in 29 cases (67.4%), and inferior to CT in 7 cases (16.3%). All three surgeons agreed that using MRI scans intraoperatively for ESS is safe and comparable to using CT scans. CONCLUSION: MRI is a well-suited modality for planning and performing ESS. Rhinologists would be able to rely on it in specific and highly selected indications.
{"title":"The feasibility of using magnetic resonance imaging scans for endoscopic sinus surgery","authors":"R. Landsberg, J. Luckman, A. Yakirevitch, A. Margulis, M. Masalha, M. Masarwa, S. Schneider","doi":"10.4193/rhinol/23.015","DOIUrl":"https://doi.org/10.4193/rhinol/23.015","url":null,"abstract":"BACKGROUND: We have previously shown that an adjusted magnetic resonance imaging (MRI) protocol could be used as an alternative for assessing most bony paranasal and vital structures. Here, we aimed to determine the feasibility of using this protocol during endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). METHODS: Three experienced rhinologists used an adjusted MRI scan to plan and perform ESS. They were blinded to the CT images and observed them only postoperatively. They also completed a detailed questionnaire about their experience. RESULTS: Forty-three patients with CRS (60.5% with polyps and 39.5% without polyps) were included in the study. MRI navigation was used in 58.3% and 33.3% of surgeries performed by surgeon #1 and #2, respectively. The median Lund-Mackay score was 12 (interquartile range 2-24). None of the surgeons switched entirely to using CT scans during the procedure; No intra or postoperative complications were observed. Two surgeons reported that it was convenient to work with the MRI scans to visualize all nasal sinuses, but the third surgeon found MRI scans convenient for visualizing the frontal sinus. MRI convenience was considered superior to CT in 7 cases (16.3%), the same as CT in 29 cases (67.4%), and inferior to CT in 7 cases (16.3%). All three surgeons agreed that using MRI scans intraoperatively for ESS is safe and comparable to using CT scans. CONCLUSION: MRI is a well-suited modality for planning and performing ESS. Rhinologists would be able to rely on it in specific and highly selected indications.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138620020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. R. Gyawali, P. Gautam, S. Baidya, U. Gurung, S. Bishowkarma, R. Ghimire, S. Thapa, N. Thapa, B. Pradhan
BACKGROUND: Impact of intranasal corticosteroid (INC) on intraocular pressure (IOP) has been a topic of longstanding debate with various studies showing variable results. This study aims to assess the effect of INC on IOP in the Nepalese population in a tertiary hospital of Nepal. METHODOLOGY: This was prospective observational study conducted in a tertiary hospital from May 2021 to November 2022. IOP of patients who met our inclusion criteria were measured before and after 6 weeks of the initiation of INC. Data were collected and compiled in Microsoft Excel. The statistical test was done using SPSS version 25. RESULTS: A total of 48 cases were evaluated. We observed that the mean IOP difference before and after nasal steroid usage exhibited no statistically significant variance: 0.5 mean IOP in the right eye and 0.12 mean IOP in the left eye. CONCLUSIONS: This study proposes that intranasal steroids pose a minimal risk of inducing ocular hypertension in the Nepalese population. Nonetheless, larger cohort studies with extended follow-up durations are warranted to substantiate these findings.
{"title":"Effect of topical nasal steroids on intra-ocular pressure in a Nepalese population: a tertiary hospital based prospective observational study","authors":"B. R. Gyawali, P. Gautam, S. Baidya, U. Gurung, S. Bishowkarma, R. Ghimire, S. Thapa, N. Thapa, B. Pradhan","doi":"10.4193/rhinol/23.021","DOIUrl":"https://doi.org/10.4193/rhinol/23.021","url":null,"abstract":"BACKGROUND: Impact of intranasal corticosteroid (INC) on intraocular pressure (IOP) has been a topic of longstanding debate with various studies showing variable results. This study aims to assess the effect of INC on IOP in the Nepalese population in a tertiary hospital of Nepal. METHODOLOGY: This was prospective observational study conducted in a tertiary hospital from May 2021 to November 2022. IOP of patients who met our inclusion criteria were measured before and after 6 weeks of the initiation of INC. Data were collected and compiled in Microsoft Excel. The statistical test was done using SPSS version 25. RESULTS: A total of 48 cases were evaluated. We observed that the mean IOP difference before and after nasal steroid usage exhibited no statistically significant variance: 0.5 mean IOP in the right eye and 0.12 mean IOP in the left eye. CONCLUSIONS: This study proposes that intranasal steroids pose a minimal risk of inducing ocular hypertension in the Nepalese population. Nonetheless, larger cohort studies with extended follow-up durations are warranted to substantiate these findings.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"192 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139303462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T V Souza, E S Guimarães, A V Giannetti, C S Caixeta, L O G Vasconcelos, G F Freitas
INTRODUCTION: The olfactory cleft is a region of significant importance within the nasal cavity, given the heightened focus on olfactory disorders in recent years. It is considered a 3-dimensional space that starts at the most anterior olfactory filament and ends just anteriorly to the sphenoid sinus. This study aimed to outline the profile of the olfactory cleft as an anatomical area of extreme relevance in the diagnosis of diseases of the nose, paranasal sinuses and olfactory disorders. The aim to establish parameters of radiological normality for the olfactory cleft enables us to recognize and differentiate nasal disorders by identifying the widening or narrowing of the olfactory cleft during the preoperative assessment, thus facilitating the planning of the optimal treatment. This supports a theory about the evolution and development of the nose (Evo Devo Theory) that shows the olfactory nose (ethmoid and olfactory cleft) represents the seat of most diseases of the nose and paranasal sinuses. MATERIALS AND METHODS: 700 random CT scans of the nose and sinuses have been studied. A homogeneous group of CT scans of patients without paranasal sinus diseases were included in this study, seeking to define a reference anatomical measure as a criterion for tomographic normality. Measurements of the olfactory cleft were taken in the lateral-lateral direction between the middle concha and the septum on each side of the nose cavity at three specific anatomical points in the anterior skull base in the anteroposterior direction, corresponding to the beginning, middle and end of the olfactory cleft. For data analysis, exploratory statistical techniques have been used that allowed a better visualization of the general characteristics of the data. The appropriate statstical analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: According to the statistical analysis performed, the reference values that were found evaluating and studying the three points were: at the first point - First Olfactory Neuron Point (FONP) – was 1.3 to 2.1 mm, at the second point - Middle Point (MP) was 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point (SERP) was 1.1 to 1.8 mm. The average in the first point was 1.78 mm, while in the second and third points were 1.41 and 1.48 mm, respectively. CONCLUSION: It is concluded that the tomographic olfactory cleft reference values are respectively: at the first point – First Olfactory Neuron Point- 1.3 to 2.1 mm, at the second point - Middle Point - 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point -1.1 to 1.8 mm.
{"title":"A new computed tomography protocol to assess the olfactory cleft","authors":"T V Souza, E S Guimarães, A V Giannetti, C S Caixeta, L O G Vasconcelos, G F Freitas","doi":"10.4193/rhinol/22.012","DOIUrl":"https://doi.org/10.4193/rhinol/22.012","url":null,"abstract":"INTRODUCTION: The olfactory cleft is a region of significant importance within the nasal cavity, given the heightened focus on olfactory disorders in recent years. It is considered a 3-dimensional space that starts at the most anterior olfactory filament and ends just anteriorly to the sphenoid sinus. This study aimed to outline the profile of the olfactory cleft as an anatomical area of extreme relevance in the diagnosis of diseases of the nose, paranasal sinuses and olfactory disorders. The aim to establish parameters of radiological normality for the olfactory cleft enables us to recognize and differentiate nasal disorders by identifying the widening or narrowing of the olfactory cleft during the preoperative assessment, thus facilitating the planning of the optimal treatment. This supports a theory about the evolution and development of the nose (Evo Devo Theory) that shows the olfactory nose (ethmoid and olfactory cleft) represents the seat of most diseases of the nose and paranasal sinuses. MATERIALS AND METHODS: 700 random CT scans of the nose and sinuses have been studied. A homogeneous group of CT scans of patients without paranasal sinus diseases were included in this study, seeking to define a reference anatomical measure as a criterion for tomographic normality. Measurements of the olfactory cleft were taken in the lateral-lateral direction between the middle concha and the septum on each side of the nose cavity at three specific anatomical points in the anterior skull base in the anteroposterior direction, corresponding to the beginning, middle and end of the olfactory cleft. For data analysis, exploratory statistical techniques have been used that allowed a better visualization of the general characteristics of the data. The appropriate statstical analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: According to the statistical analysis performed, the reference values that were found evaluating and studying the three points were: at the first point - First Olfactory Neuron Point (FONP) – was 1.3 to 2.1 mm, at the second point - Middle Point (MP) was 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point (SERP) was 1.1 to 1.8 mm. The average in the first point was 1.78 mm, while in the second and third points were 1.41 and 1.48 mm, respectively. CONCLUSION: It is concluded that the tomographic olfactory cleft reference values are respectively: at the first point – First Olfactory Neuron Point- 1.3 to 2.1 mm, at the second point - Middle Point - 1.1 to 1.6 mm, and at the third point – Sphenoethmoidal recess point -1.1 to 1.8 mm.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"85 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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