American Journal of Rhinology & Allergy最新文献

ObjectivesThis study aims to compare Chitogel^® with topical corticosteroid versus PureRegen^® gel on wound healing and postoperative outcomes in the treatment of chronic rhinosinusitis.MethodsA double-blinded randomized controlled trial was performed with patients undergoing functional endoscopic sinus surgery who were prospectively recruited and randomized to receive Chitogel with triamcinolone to one side of the sinuses and PureRegen to the contralateral sinuses. The patients underwent endoscopic follow-up at 2, 6, and 12 weeks postoperatively. Patient factors including age, gender, smoking status, comorbidities (reflux, allergy, and asthma), and disease specific factor (chronic rhinosinusitis phenotype) were collected. Sinus ostial measurements, adhesions, mucopurulent discharge, edema, crusting, and granulation were assessed. A visual analogue scale questionnaire on quality of life was assessed in each follow-up appointment.ResultsA total of 40 patients were randomized. At 12 weeks, Chitogel had a 10.7 mm² reduction in frontal sinus ostium area compared to 15 mm² in the PureRegen group; Chitogel had a 2.2 mm² increase in maxillary ostium area compared to 0.1 mm² in the PureRegen group; Chitogel had a 27.6 mm² reduction in area of the sinus ostium compared to 28.7 mm² in the PureRegen group. However, these differences were not statistically significant. The difference between the two groups when analysing adhesion, mucopurulent discharge, mucosal oedema, crusting, granulation, and phenotype was not statistically significant. Patient self-directed grading on quality of life was not statistically significant.ConclusionBoth Chitogel with triamcinolone and PureRegen have demonstrated to be great options to prevent adhesion, stenosis, and optimize healing. There were no clinical and statistical differences between both products in wound healing and postoperative outcomes in the treatment of chronic rhinosinusitis.

BackgroundThe diagnosis of chronic rhinosinusitis (CRS) relies upon patient-reported symptoms and objective nasal endoscopy and/or computed tomography (CT) findings. Many patients, at the time of evaluation by an otolaryngologist or rhinologist, lack objective findings confirming CRS and do not have this disease.ObjectiveWe hypothesized that a machine learning model (MLM) could predict probable CRS using patient-reported data acquired prior to rhinologist-directed treatment. We leveraged patient-generated health data using a machine learning approach to predict: (1) the primary endpoint of sinonasal inflammation on CT evidenced by a Lund-Mackay score (LMS) ≥ 5 and (2) the secondary endpoint of LMS ≥ 5 and ≥2 cardinal symptoms of CRS.Methods543 patients were evaluated at a tertiary care rhinology clinic and subsequently underwent CT imaging with LMS. Patient-reported outcome measures and additional patient data were collected via an electronic platform prior to in-person evaluation. Three MLMs, a random forest classifier, a deep neural network, and an extreme gradient Boost (XGBoost) algorithm, were trained on predictors drawn from patient-generated health data and tested on a naïve test set (90:10 training:test set split). Cross-validation was executed, and model performance compared between algorithms and with linear regression techniques.Results57 predictors were extracted from the patient-generated health data. The best model (XGBoost) achieved an area-under-the-curve (AUC) of 71.3% (accuracy 74.5%, sensitivity 38.9%, specificity 91.9%) in predicting the primary endpoint, and an AUC of 79.8% (accuracy 85.5%, sensitivity 36.4%, specificity 97.7%) in predicting the secondary endpoint. This exceeded the performance of a linear regression model.ConclusionA MLM using patient-generated health data accurately predicted patients with probable CRS (≥2 cardinal symptoms and LMS ≥ 5). With further validation on a larger cohort, such a tool could potentially be used by otolaryngologists to inform clinical utility of diagnostic imaging and for screening prior to subspecialty Rhinology referral.

BackgroundThe representation of women in otolaryngology has increased significantly over recent decades, yet discrepancies remain in certain subspecialties, including rhinology. Despite overall improvements in gender equity within otolaryngology, the specific demographic trends and scholarly productivity of fellowship-trained rhinologists have not been thoroughly examined.ObjectiveWe aimed to address this gap by examining demographic trends and academic productivity among rhinology fellowship graduates.MethodsThis cross-sectional study examined publicly available data to analyze fellowship-trained rhinologists in the United States, focusing on gender, career stage, practice setting, h-index, and academic rank. Statistical analyses included Fischer's exact test, Wilcoxon rank sum test, ANOVA, and η².ResultsWe included 477 fellowship-trained rhinologists who trained at 31 fellowships. No gender differences in career stage or practice type were found. Despite an absolute increase in women per year (0 to 9, η² = 0.65), the percentage of women in rhinology fellowships has plateaued since 2002 (η² = 0.001), averaging 21.1% (SD = 10.8%). Most fellowship-trained rhinologists were mid-career, with a median of 7 practice years; 55% worked in academics, mainly as assistant professors. Overall, women rhinologists had a slightly lower h-index than men (7 vs 9; P = .01), but when stratified by academic rank, there was no difference in h-index between men and women.ConclusionThe percentage of women fellowship-trained rhinologists has not increased since 2002 (η² = 0.001), remaining at a mean of 21.1%. Contrasting with other subspecialties, women and men rhinologists have similar h-indices by academic rank. However, there are still fewer women in rhinology overall than men.

Objectives: To meet the high demand for polymerase chain reaction (PCR) tests to diagnose COVID-19 and rapidly control the outbreak, an efficient and safe molecular diagnostic protocol is necessary. In this study, we evaluated the efficacy and safety of the medical robot developed for non-face-to-face nasopharyngeal swab specimen collection.

Methods: In a nonclinical study, an otorhinolaryngologist collected swab specimens manually and using a medical robot. In a single-institution, randomized, open-label, prospective, exploratory clinical trial, nasopharyngeal swab specimens were collected from the enrolled participants both manually and by using the medical robot.

Results: Evaluation of the efficacy and safety of nasopharyngeal swab collection using a medical robot was assessed. After the operation of the robot, subjective discomfort experienced by the participants and any side effects or abnormalities in the nose were also monitored. Preliminary nonclinical data revealed comparable results between robotic and manual methods in terms of RNA metrics and cytokeratin-8 expression. Minor initial damage to A549 cells by the robot improved with subsequent use. In the clinical setting, the robot-assisted technique yielded a 92.31% detection rate for human RNase P, while the manual method achieved 100%. Post-swabbing discomfort reported by participants was similar for both methods and resolved within 48 h.

Conclusions: The medical robot system could efficiently, safely, and accurately collect nasopharyngeal swab samples in a non-face-to-face manner. Its installation in respiratory clinics, airports, or ports could minimize the infection risk between individuals and healthcare workers, thereby contributing to an efficient distribution of medical resources.

Objective: Conductive olfactory losses mainly involve obstruction of the olfactory cleft (OC) and diminished OC airflow. This study investigated the association between abnormal nasal structure and OC airflow.

Methods: A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis to identify studies on the effect of the nasal structure on the OC airflow and olfaction.

Results: A total of 11 studies were included. Nasal vestibule morphological variabilities directly impact the transport of molecules in odorant-laden air to the OC. A greater airflow vortex and a narrower vestibule region intensified the airflow vortex toward the olfactory region. Middle turbinectomy significantly increased the average flux to the OC. The location of the major airflow and airflow velocity maxima shifted towards the OC in patients with septal deviation. The airflow has been redirected into the upper part of the nasal airway in patients with inferior turbinate hypertrophy. For patients with unilateral cleft lip, unilateral nasal airflow on the cleft side has a lower rate and flow. The mean velocity in the posterior OC correlated well with olfaction compared to that in the anterior OC. The nasal polyps (NP) within the middle meatus increased the olfactory airflow but did not enhance the olfaction. NP in the olfactory region or anterior to the olfactory region significantly decreased the olfactory airflow and olfaction. Furthermore, obstruction of the OC did not change the nasal patency. When the OC shape presented with a stenotic slit or lumen structure among patients with conductive olfactory dysfunction without NP, the inspiratory velocity and flow rate within OC were significantly lower than in the healthy control group.

Conclusion: Various nasal structural factors affect patterns of OC airflow and olfaction. Identifying the related airflow-limiting structures may promote the comprehensive evaluation of conductive olfactory losses in patients with olfactory dysfunction.

Background: To reduce recurrence rates of inverted papilloma (IP), some have argued for the use of intraoperative frozen margins; results remain mixed and studies critically lack lengthy surveillance periods.

Objective: We aim to elucidate the impact of prolonged surveillance and intraoperative frozen margins on IP recurrence.

Methods: This is a retrospective analysis of patients who underwent resection of IP at a tertiary care center over a 10-year period from 2008 to 2018 followed by subsequent surveillance. Patient demographics, tumor and operative characteristics, and recurrences were analyzed.

Results: Our analysis includes 199 patients, with 37 recurrences and an average recurrence time of 44.4 months; 57% of patients received intraoperative frozen sections and recurrence rates were similar between those who received frozen sections and those who did not (20.1% vs 15.5%, P = .36). Patients with recurrences within 5 years of surgery were more likely to have received frozen sections than those with recurrences beyond 5 years (P < .01). There was no difference in surgical approach or extent of disease in those who received frozen margins. Patients that received frozen sections were more likely to have multiple sites of attachment (56.5% vs 38.1%, P = .01) and persistent disease following a previous resection at an outside institution (67.0% vs 44.0%, P = .001).

Conclusion: Our average time to recurrence was 44.4 months, significantly longer than surveillance times reported in the literature, indicating that longer periods of surveillance are necessary to capture late recurrences. Our analysis is the first and largest American cohort to look at IP resection in a standardized fashion and find that recurrence rates are similar between patients receiving frozen sections or not.

Background: Radiomics is a quantitative approach to medical imaging, aimed to extract features into large datasets. By using artificial intelligence (AI) methodologies, large radiomic data can be analysed and translated into meaningful clinical applications. In rhinology, there is heavy reliance on computed tomography (CT) imaging of the paranasal sinus for diagnostics and assessment of treatment outcomes. Currently, there is an emergence of literature detailing radiomics use in rhinology.

Objective: This systematic review aims to assess the current techniques used to analyze radiomic data from paranasal sinus CT imaging.

Methods: A systematic search was performed using Ovid MEDLINE and EMBASE databases from January 1, 2019 until March 16, 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and Cochrane Library Systematic Reviews for Diagnostic and Prognostic Studies. The QUADAS-2 and PROBAST tools were utilized to assess risk of bias.

Results: Our search generated 1456 articles with 10 articles meeting eligibility criteria. Articles were divided into 2 categories, diagnostic (n = 7) and prognostic studies (n = 3). The number of radiomic features extracted ranged 4 to 1409, with analysis including non-AI-based statistical analyses (n = 3) or machine learning algorithms (n = 7). The diagnostic or prognostic utility of radiomics analyses were rated as excellent (n = 3), very good (n = 2), good (n = 2), or not reported (n = 3) based upon area under the curve receiver operating characteristic (AUC-ROC) or accuracy. The average radiomics quality score was 36.95%.

Conclusion: Radiomics is an evolving field which can augment our understanding of rhinology diseases, however there are currently only minimal quality studies with limited clinical utility.

Background: Sinonasal mucosal melanoma has poor survival despite multimodality treatment. While the impact of immunotherapy (IT) on metastatic cutaneous melanoma is well-defined, there are relatively little data on sinonasal mucosal melanoma.

Objective: We sought to define immunotherapy outcomes in patients with sinonasal mucosal melanoma.

Methods: A retrospective cohort study evaluated patients treated with IT during their overall treatment strategy for SNMM. Patient demographics, treatment, and survival outcomes were recorded.

Results: 52 patients had IT treatment for SNMM from 2000 to 2022, with an average age of 69.1 ± 11.9 years. The most common treatment was surgery with radiation and IT (n = 26, 50%). Most regimens consisted of a combination of Nivolumab and Ipilimumab (n = 17, 32.7%) or pembrolizumab (n = 14, 26.9%). 44.2% of patients experienced reported complications. Overall survival at 1-, 2-, and 5 years was 86.9%, 74.1%, and 39.1%, respectively.

Conclusion: Approximately half of patients will have a local response following immunotherapy, but it is rare to have improvement at metastatic locations. Further research within our group will assess optimal timing and markers that are predictive of response.

Background: The Sino-nasal Outcome Test (SNOT-22) is a 22-question survey that is utilized to evaluate health-related quality of life of patients with chronic rhinosinusitis (CRS). The Patient Global Impression Symptom Severity (PGISS) is a similar yet versatile instrument that combines features of both a Likert scale and a visual analog to assess symptom severity in CRS patients. While previous studies have evaluated the validity of SNOT-22 as an instrument to measure CRS patients' symptom severity, no studies have evaluated PGISS scale's ability to evaluate and guide treatment plans for CRS patients.

Objective: The primary objective of this study was to analyze the clinical utility of PGISS in assessing subjective symptom severity and objective disease status in CRS patients. We additionally aimed to investigate if PGISS scores could serve as predictors for treatment strategies in CRS patients.

Methods: Electronic medical records of CRS patients were retrospectively reviewed between January 2020 and January 2021 from Eastern Virginia Medical School and Sentara Healthcare. Information on demographics, objective disease metrics, treatment, and labs were collected. Statistical analyses were conducted using SAS 9.4 software.

Results: A total of 150 patients were included in our study. A statistically significant positive correlation was found between PGISS and SNOT-22 scores (r(131) = 0.701, P < .0001). Patients with moderate to severe PGISS scores had significantly higher odds of changing their treatment course (odds ratio [OR] = 6.813, P = .001, and OR = 5.491, P = .018, respectively). Additionally, patients with severe PGISS scores had decreased odds of receiving biological intervention (OR = 0.048, P = .043), but they had considerably higher odds of pursuing surgery (OR = 15.939, P = .046). No significant associations were seen between PGISS scores and receiving topical steroids, systematic steroids, nonsteroidal medical treatment, or imaging interventions (P > .05).

Conclusion: Clinicians may consider using the PGISS scale as an alternative method to the SNOT-22 to evaluate subjective symptom severity and guide treatment plans for patients with CRS.

Background: Epistaxis is one of the most common and debilitating symptoms of hereditary hemorrhagic telangiectasia (HHT), significantly impacting patients' quality of life. While various medical and surgical interventions exist for managing epistaxis in patients with HHT, patients with moderate to severe epistaxis are high health-care utilizers who frequently need surgical treatment.

Objective: To compare the efficacy, complications, and patient-reported outcomes for common surgical interventions utilized in treating epistaxis in patients with HHT.

Methods: Studies were identified in PubMed, Embase, Scopus, Redalyc, and LILACS databases and uploaded to Covidence. A systematic review following PRISMA guidelines was conducted on studies evaluating outcomes in adults with HHT with moderate to severe epistaxis who had undergone surgical interventions. We compared the respective outcomes for pre-operative and post-operative epistaxis severity/intensity, need for further interventions or transfusions, estimated blood loss, length of surgery, complications, and patient satisfaction.

Results: Twenty studies with a total of 546 patients were included. The most common surgeries studied were nasal closure and laser photocoagulation. Seven studies recorded the change in epistaxis severity score and observed a significant reduction postoperatively (3.91, [95% CI 2.73-5.09]). Eleven studies found a decrease in the number of transfusions and a rise in hemoglobin levels post-operatively. Common complications reported were partial dehiscence of a nasal closure, septal perforation, and continued bleeding requiring re-operation. Most patients report improved quality of life and satisfaction with surgical intervention.

Conclusion: Surgery can significantly reduce the severity of epistaxis in patients with HHT and improve quality of life. Further studies should focus on head-to-head comparisons of procedures and standardization of outcome measures.