American Journal of Rhinology & Allergy最新文献

BackgroundMicroplastics are increasingly prevalent in daily life. While their adverse effects on health are well-known, their specific role in rhinitis has not been fully established.ObjectiveIt is known that microplastics suspended in the air have toxic effects on cells through inhalation. The primary aim of this study was to investigate the presence of microplastics in nasal lavage samples from patients in both allergic rhinitis (AR) and nonallergic rhinitis (NAR) groups.MethodsDemographic data, allergy test results, respiratory function tests, mini-Rhinoconjunctivitis Quality of Life Questionnaire and Total Nasal Symptom Score of patients aged 18 to 65 years who applied to the allergy clinic were recorded. Nasal lavage fluid (NLF) samples were collected with physiological serum and placed in glass tubes for all cases. After the filtration process of the samples, microplastic counting was performed under a Stereomicroscope.ResultsA total of 90 subjects (AR: 30, NAR: 30, controls: 30), 64.4% females, within the mean age of 30.27 ± 10.53 years were investigated. Microplastic density in NLF was higher in all rhinitis patients (n: 60) with no difference between AR and NAR than controls (all rhinitis = 3.10 ± 1.00 particles/mL, AR = 3.23 ± 1.29 particles/mL, NAR = 2.97 ± 0.57 particles/mL, controls = 1.18 ± 0.52 particles/mL, P < .001). Microplastic density was higher in young subjects than in older ones (values are "years; particles/mL"; 18-30; 2.79 ± 1.22, 31-45; 2.18 ± 1.13, 46-60; 1.5 ± 1.09, P < .05). In logistic procedures, microplastic density of NLF (OR = 2.20, 95% CI [1.02 to 4.75], P = .04) determine the likelihood of sneezing.ConclusionsIn this study, regardless of allergy or nonallergy, higher microplastic density was found in NLF of rhinitis patients than healthy individuals. We also found quantifiable and noteworthy concentrations of microplastics in the nasal lavage of control group. These results support the idea that microplastics cause inflammation in the upper airways.

BackgroundOlfactory dysfunction (OD) is both under-recognized and underdiagnosed in aging adults. Prior studies in chronic rhinosinusitis have demonstrated a correlation between the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and psychophysical olfactory testing, indicating potential utility for screening in this group. This study examined the correlation between QOD-NS scores, psychophysical function, and olfactory-associated patient-reported outcome measures (PROMs) in a novel, aging population. Additionally, we examined the potential utility of the QOD-NS as a screening instrument in this population.MethodsProspective cohort study in which healthy, adult volunteers completed the QOD-NS, olfaction-related visual analog scale (VAS) questions, Sniffin' Sticks (TDI), De Jong Giervald Loneliness Scale, UCLA loneliness survey (UCLA), and the Patient Health Questionnaire-9 (PHQ9).ResultsTwo-hundred and twenty-eight adults with mean age 50.3 ± 17.7 years were included. Subjects ≥50 years old had higher prevalences of hyposmia (58.3% vs 19.8%, P < 0.001) and anosmia (9.1% vs 3.1%, P < 0.001), and had worse QOD-NS and VAS (P < 0.001 for both). Aging subjects had significant correlations between QOD-NS and TDI (r = -0.386, p < 0.001), all VAS scores (P < 0.001), PHQ9 (r = 0.283, P = 0.001). Receiver operating characteristic curve demonstrated a QOD-NS of 8.0 as the optimal cutoff for a Youden's index of 0.23 for detection of dysosmia in aging patients.ConclusionsThe QOD-NS has significant, although weak correlation with psychophysical testing and psychosocial PROMs in aging subjects. However, a low Youden Index suggests limited potential of the QOD-NS as an OD screening tool in this population.

BackgroundSinonasal pathology, such as chronic inflammatory disease or neoplasm, can cause secondary nasolacrimal duct obstruction (sNLDO). There is a paucity of data on dacryocystorhinostomy (DCR) techniques and outcomes for NLDO secondary to known sinonasal pathologies.ObjectiveTo describe case characteristics, management, and surgical outcomes of sNLDO at a tertiary academic center.MethodsCharts of DCR cases with at least 3 months follow-up done at a single institution over a 5-year period (2018-2022) were reviewed. Patient and surgical characteristics were recorded and compared between secondary and primary NLDO groups. The primary outcome was early functional success of DCR, assessed by improvement or resolution of epiphora at 3 months.ResultsA total of 236 cases were included. Of those, 79 (33.5%) were classified as secondary NLDO associated with sinonasal pathology. Reasons for sNLDO were sinonasal cancer (46.8%), chronic inflammatory disease (24.1%), trauma (16.5%), or prior head and neck radiation (31.6%). When comparing primary acquired NLDO to sNLDO cases, DCR for sNLDO was more likely to be performed endoscopically (68.4% vs 31.8%, P < .01), by a multidisciplinary team of rhinologist and oculoplastic surgeon (70.9% vs 8.3%, P < .01), and required bilateral surgery (36.7% vs 5.7%, P < .01). The overall functional success rate was 79.7% for sNLDO compared to 87.9% for primary acquired NLDO (P < .01). Revision surgery for sNLDO, history of sinonasal malignancy, and radiation were associated with lower functional success rates (66.7%, 70.3%, and 68.0%, respectively). Canalicular pathology was more common in sNLDO cases (29.0% vs 8.3%, P < .01).ConclusionsSecondary NLDO was more commonly managed with an endoscopic approach by a multidisciplinary team. Revisions for sNLDO, as well as cases with a history of sinonasal malignancy and radiation, had a markedly lower success rate, and sNLDO was frequently associated with canalicular obstruction. These findings may facilitate surgical planning and patient counseling.

ObjectiveChronic rhinosinusitis with nasal polyp (CRSwNP) is a chronic inflammatory disease characterized by epithelial remodeling. This study aimed to investigate the role of peroxiredoxin 2 (PRDX2) in CRSwNP and its potential mechanisms.MethodsProteomics analysis was conducted on nasal tissues from CRSwNP patients and healthy controls. Top-rank differentially expressed proteins were validated by immunofluorescence (IF) staining and reverse transcription quantitative-polymerase chain reaction (RT-PCR). In vitro experiments validated the effects and regulatory mechanisms of PRDX2 on nasal epithelial remodeling.ResultsProteomics results revealed a disease-specific protein expression profile in CRSwNP polyp tissues, with DEGs primarily associated with oxidative stress. Our validation results demonstrated elevated reactive oxygen species (ROS) levels in CRSwNP with predominant accumulation in the nasal epithelium. Among these DEGs, PRDX2 was the most significantly downregulated, which was further confirmed by RT-PCR and IF. Moreover, PRDX2 was primarily expressed in nasal epithelial cells (NECs). RT-PCR results indicated that tissue PRDX2 expression was positively correlated with E-cadherin and negatively correlated with TGF-β1 and Vimentin expression in CRSwNP. In vitro experiments demonstrated that H₂O₂ stimulation promoted ROS and epithelial-mesenchymal transition (EMT) in NECs, while PRDX2 overexpression (OE) mitigated these effects. Furthermore, PRDX2 OE suppressed the H₂O₂-induced activation of the TGF-β1/SMAD signaling pathway, which plays a crucial role in regulating EMT in NECs.ConclusionOur findings suggest that the accumulation of ROS plays a critical role in the pathogenesis of CRSwNP. PRDX2 modulates ROS-induced epithelial remodeling, contributing to disease progression by activating the TGF-β1/Smad signaling pathway.

BackgroundRecurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS) is common, with reported rates varying considerably depending on follow-up duration. A clinically practical and reliable model for predicting long-term recurrence risk remains an unmet need.ObjectiveTo identify clinical predictors of recurrence and develop a prognostic model for estimating recurrence-free survival at 2, 5, 10, and 15 years after ESS.MethodsA retrospective, single-institution cohort study of 437 patients with CRSwNP who underwent ESS was analyzed for time-to-event recurrence. Candidate predictors, including age, sex, smoking status, asthma, NSAID hypersensitivity, symptom duration, blood eosinophil count (BEC), modified Lund-Kennedy (MLK) score, and Lund-Mackay (LM) score, were entered into a LASSO penalized Cox model for variable selection. A nomogram was constructed to estimate recurrence-free survival at predefined time points. Model performance was assessed using time-dependent area under the ROC curve (AUROC), Brier scores, calibration curves, internal validation via 1000 bootstrap resamples, and clinical utility through decision curve analysis (DCA).ResultsRecurrence occurred in 54.0% of patients. The LASSO-penalized Cox model identified age, NSAID hypersensitivity, asthma, symptom duration, BEC, MLK, and LM scores as significant predictors. The nomogram demonstrated strong discrimination, with AUROCs of 0.878, 0.870, 0.886, and 0.873 at 2, 5, 10, and 15 years post-ESS, respectively. Corresponding Brier scores were 0.150, 0.147, 0.135, and 0.138, indicating low prediction error. Internal validation confirmed the model's stability, with AUROCs of 0.873, 0.866, 0.879, and 0.864 at the same time points. Calibration plots showed good agreement between predicted and observed outcomes across all time horizons. DCA demonstrated greater net benefit compared to treat-all or treat-none strategies across the 0.1 to 0.9 threshold range.ConclusionThe nomogram developed using a LASSO-penalized Cox model offers a robust, well-calibrated, and clinically applicable tool for individualized long-term recurrence risk prediction in patients with CRSwNP following ESS.

BackgroundBurn injuries and surgical drape fires are known potential complications of endoscopic surgery. Automatic standby technology (AST) triggers the light source to immediately enter "standby mode" when the light cable disconnects from the endoscope, which should reduce the likelihood of patient and caregiver injuries and operating room drape fires.ObjectiveThis study compared AST versus a conventional light source without this technology, examining temperature differences at the endoscope tip and adapter, as well as the propensity of disconnected light cables to burn surgical drapes.MethodsAST and conventional light sources with standard light cables were connected to 4 mm rigid nasal endoscopes. Temperature was measured using a thermocouple sensor at the endoscope tip (112 time points at 15 s intervals) and adapter (52 time points at 15 s intervals), comparing AST and conventional light sources. A thermal camera assessed the temperature of the light cable ends immediately upon disconnection. Light cables were held to standard surgical drapes immediately after disconnection, both with direct and indirect contact.ResultsAverage endoscope tip temperature was 24.0 °C for AST and 25.2 °C for conventional (p < 0.001). Average adapter temperature was 26.6 °C for AST and 27.3 °C for conventional (p = 0.003). Immediately upon disconnection, light cable temperature averaged 40.9 °C for cables attached to AST, versus 56.8 °C for conventional light sources. Conventional light cables showed notable drape burns at all time intervals with both direct and indirect contact. Damage was significantly greater with indirect contact via thermal radiation. The AST system did not burn drapes with either direct or indirect contact.ConclusionAST technology provides significant safety value by removing radiative heat transfer as a possible agent of patient and caregiver harm, rapidly lowering the temperature of an accidentally disconnected light cable to levels well below the threshold for causing skin injury and drape burns.

BackgroundSeptoplasty is a common cause of nasal septal perforation (NSP), especially when bilateral apposing septal mucosal tears (BATs) occur intraoperatively. While prior studies have largely focused on NSP management once formed, there is limited evidence on how to prevent NSPs should BATs occur during septal surgery.ObjectiveThe purpose of this study was to assess the efficacy of intraseptal synthetic interposition graft (SIG) placement to prevent NSPs following BATs during septal surgery.MethodsA single-institution retrospective cohort study was conducted with adult patients who underwent septoplasty or septorhinoplasty by 2 surgeons. Patients who had BATs intraoperatively had SIGs placed between the septal flaps (cadaveric acellular dermal or porcine collagen grafts). Patients were monitored endoscopically for NSP development at a minimum of 2 months postoperatively.ResultsOf 1132 operative patients between January 2016 and July 2024, 50 patients (4.4%) experienced BATs and had SIGs placed intraoperatively. Of the 50 patients, the median age was 52.7 years, 72.0% were males, and the median follow-up duration was 4.8 months (range: 2.0-85.4). Regarding the SIGs placed, 54.0% were porcine collagen and 46.0% were cadaveric dermis. While 46/50 patients experienced complete mucosalization of their BATs (92.0%), 4 developed NSPs postoperatively (8.0%). Two NSPs occurred within 2 months postoperatively, and 2 were delayed after complete mucosalization. All NSPs occurred following porcine collagen grafts.ConclusionIntraseptal synthetic IP graft placement demonstrated 92% success in preventing NSPs following BATs during septal surgery. Future studies should explore the efficacy of different SIGs at preventing NSPs following BATs during septal surgery.

BackgroundOdontogenic sinusitis (ODS) is a form of maxillary sinusitis caused by dental infections. In patients with ODS, oroantral fistula (OAF) is a common complication often requiring multidisciplinary management. However, clinical indicators of when to perform oral and maxillofacial surgery (OMS) remain unclear, particularly the need for surgical closure and coordination with endoscopic sinus surgery (ESS).ObjectiveTo identify large OAF predictors and determine when OMS co-management is warranted in patients undergoing ESS for ODS.MethodsData of adults with ODS and OAF who underwent ESS at a tertiary center (2014-2021) were retrospectively reviewed, and stratified by concurrent OMS intervention at the time of index surgery (ESS alone vs ESS + OMS). The maximum bony defect diameter of the OAF size on preoperative paranasal sinus computed tomography, measured in millimeters on coronal/axial reformats using the picture archiving and communication system (PACS) caliper, was reported as β with 95% confidence intervals (CIs) and P-values.ResultsNinety-one patients were included (ESS alone, n = 47; ESS + OMS, n = 44). OMS cases had larger OAFs (mean 9.5 ± 5.2 vs 5.6 ± 5.2 mm); the between-group mean difference was 3.9 mm (95%CI 1.8-6.0). In multivariable analysis, odontogenic cysts (β=9.78 mm, 95%CI 5.30-14.25; p < .001) and OMS treatment (β=2.78 mm, 95%CI 0.30-5.26; p = .028) were independently associated with greater OAF size. Gingival pain/swelling and shorter symptom duration were more common among patients with OMS, suggesting more acute presentations.ConclusionAdjusted analyses showed that odontogenic cysts were independently associated with larger OAFs. OMS involvement at the index operation reflected predefined clinical and radiological criteria, rather than cyst status alone. These findings highlight the importance of standardized dental-sinonasal co-planning and provide descriptive insights into surgical patterns and outcomes in ODS with OAF, while recognizing the limitations of a retrospective, single-center cohort.

BackgroundSubjective and objective evaluations of chronic rhinosinusitis with nasal polyps (CRSwNP) are often discordant.ObjectiveThis study aimed to investigate the feasibility of using a newly developed five-item Sino-Nasal Outcome Test (SNOT-5) to evaluate disease severity and to compare its results with objective assessments in patients with CRSwNP.MethodsAdult patients with bilateral CRSwNP planning to undergo sinus surgery were prospectively enrolled. The nasal polyp score (NPS), Lund-Mackay (L-M) score, olfactory cleft opacification (OC) score, and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire were assessed. The SNOT-5 scores were retrospectively extracted from the SNOT-22 results. Three-month postoperative endoscopic modified Lund-Kennedy (MLK) scores and SNOT-22 data were collected when available.ResultsA total of 169 participants were enrolled. The SNOT-5 score rather than the SNOT-22 score, was significantly correlated with objective measurements of disease burden, including NPS, L-M, and OC scores. SNOT-5 score was significantly associated with younger age, comorbid asthma, NPS, L-M, and OC scores in the univariate regression analysis, and with age, L-M, and OC scores in the multivariate analysis. Additionally, the SNOT-5 score also significantly correlated with the MLK score at 3 months after surgery.ConclusionThe SNOT-5, rather than the SNOT-22, correlated more closely with objective measures of disease burden, including the NPS and L-M scores, and postoperative MLK score in patients with CRSwNP. Utilizing the SNOT-5 in clinical practice may help clinicians more accurately assess disease severity and treatment response in patients with CRSwNP.