American Journal of Rhinology & Allergy最新文献

BackgroundRace or ethnicity may influence chronic rhinosinusitis (CRS) endotype. Asian patients with CRS with nasal polyps (CRSwNP) may have increased Th1/Th17/mixed endotypes. However, there is a paucity of research concerning the endotype of non-Caucasian and non-Asian patients.ObjectiveThis review seeks to summarize literature as it pertains to associations between race or ethnicity and endotype with the goal highlighting knowledge gaps to guide future inquiry.MethodsSystematic scoping review methodology was used to summarize the current literature in accordance with PRISMA guidelines.ResultsOf the 8877 articles identified, 261 articles pertaining to race or ethnicity and endotype in CRSwNP were included. 163 studies with race or ethnicity-specific data involved Asian patients and demonstrated increased presence of Th1, Th17, and mixed endotypes, but also increasing prevalence of Th2 endotypes in multiple countries across Asia. There were 56 studies involving Caucasian patients demonstrating a predominance of Th2 endotypes though several recent studies also demonstrated that mixed inflammation may contribute to disease. There was a relative lack of literature involving other races and ethnicities, specifically: South Asian (n = 2), Middle Eastern (n = 9), African/African-American (n = 16), and Latino/Hispanic-American (n = 9). Allergic fungal rhinosinusitis appeared relatively prevalent in South Asian, Middle Eastern and African/African-American patients, though, relatively low numbers of studies and patients preclude definitive conclusions.ConclusionThis scoping review demonstrates that both race and ethnicity appear to play a role in affecting CRSwNP endotype. Additional research is necessary to investigate these factors, particularly in non-Caucasian and non-Asian patients.

ObjectivesPosterior nasal nerve (PNN) neurectomy is an effective surgical option for refractory allergic rhinitis (AR), but delayed massive hemorrhage remains a concern. This study aimed to evaluate whether preserving a mucosal flap to cover the sphenopalatine foramen (SPF) affects postoperative efficacy and complications.MethodsThis prospective cohort study included 61 patients with moderate-to-severe AR who underwent PNN neurectomy. Patients were divided into two groups based on whether a mucosal flap was preserved to cover the SPF. Outcomes included mucosal epithelialization time, incidence of delayed bleeding, Visual Analog Scale (VAS), reflective Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal airway resistance (NAR), and inflammatory markers. Follow-up was conducted at 1, 3, 6, and 12 months postoperatively.ResultsNo significant differences were found between groups in baseline characteristics. Both groups showed significant improvements in VAS, rTNSS, RQLQ, and NAR, with sustained benefits up to 12 months. The With Mucosal Flap Preservation group had a significantly shorter epithelialization time (P < .001) and lower incidence of delayed bleeding (P = .046). Mediation analysis indicated that epithelialization time mediated the relationship between the surgical method and delayed bleeding (P = .046), while the direct effect was not significant (P = .748).ConclusionThis study shows that PNN neurectomy with mucosal flap preservation reduces the risk of delayed postoperative bleeding through the key mediating mechanism of accelerated mucosal epithelialization, while achieving comparable improvements in nasal symptom relief and quality of life compared to the procedure without mucosal flap preservation.

BackgroundSinonasal squamous cell carcinoma (SNSCC) is an aggressive subtype of sinonasal cancer. While elective neck dissection (END) is not typically recommended for SNSCC, occult nodal involvement (ONI) may be present. We therefore sought to evaluate the incidence, associated factors, and survival impact of ONI in SNSCC.MethodsThe National Cancer Database was queried for patients with SNSCC from 2004 to 2016. Data regarding patient demographics, clinicopathology, and treatment were obtained. Univariate and multivariate logistic regression and Kaplan-Meier analyses were conducted to identify predictors of ONI with odds ratios (ORs) and overall survival.ResultsIn total, 522 patients satisfied inclusion criteria. Most patients were elderly (>60 years old, 55.0%), male (67.2%), White (86.4%), and insured with Medicare (44.1%). Cases of SNSCC most frequently involved the paranasal sinuses (69.7%), were T-stage 4 (50.6%), moderately differentiated (52.5%), underwent treatment at academic centers (76.4%), and lacked lymphovascular invasion (LVI, 84.4%). ONI was observed in 10.9% of patients. Following propensity score matching, ONI significantly negatively impacted survival: 3 year survival was 65% for patients without ONI and 35% for patients with ONI (log-rank P < .001). The highest rate of ONI was observed in patients with LVI (31.4%). On multivariate analysis, LVI was the sole predictor of ONI (OR: 6.75, 95% confidence interval: 3.09-14.73, P < .001).ConclusionsONI was identified in 10.9% of patients with SNSCC and was found to be a negative prognostic factor for survival. Patients with identified LVI may benefit from END.Level of Evidence: 4.

BackgroundMiddle turbinate (MT) medialization after endoscopic skull base surgery (ESBS) allows natural positioning of the turbinate, re-opening of the osteomeatal complex, and potential skull base protection from iatrogenic injury by endonasal device insertion. Our institution routinely preserves and medializes the MTs in ESBS by placing bioabsorbable nasal packing in both middle meatuses.ObjectiveThe goal of our study was to use postoperative endoscopic MT scoring to objectively assess the efficacy and durability of our simple technique, in which bioabsorbable nasal packing is placed in both middle meatuses to position the MTs against the septum, following trans-sphenoidal skull base surgery.MethodsA single-center retrospective review was performed of consecutive trans-sphenoidal ESBS patients from 2023 to 2024 to assess postoperative MT positioning. Patients with recorded postoperative nasal endoscopies more than 20 days after surgery were included. Recorded endoscopies were evaluated by 2 independent raters using 2 standardized MT scoring systems assessing station and apposition. An additional subgroup analysis was performed in patients with multiple postoperative endoscopies to assess effect of time on MT position.ResultsFifty patients (100 turbinates) scored by 2 raters were included for a total of 200 turbinate ratings. One hundred ninety-two turbinates (96%) had station assessed as 1+, signifying medialization, and 176 turbinates (88%) demonstrated direct apposition to the septum. Nasal endoscopies were analyzed 43.5 days (median) after surgery. Cohen's kappa coefficient was 0.90 for station and 0.63 for apposition, signifying substantial inter-rater reliability. Subgroup analysis demonstrated no significant effect of time on turbinate station or apposition.ConclusionsOur experience with bioabsorbable nasal packing in the middle meatus demonstrates that a simple technique can achieve durable MT medialization in many patients following ESBS. Optimizing MT positioning can improve postoperative sinus function and help protect against inadvertent skull base injuries in ESBS patients.

BackgroundParabens and phenols (PAPs) are widely used in consumer and personal care products. Although prior studies suggest links between PAP exposure and allergic outcomes, evidence across adolescents and adults remains limited.ObjectiveTo investigate associations between urinary PAPs and allergy-related outcomes.MethodsWe conducted a cross-sectional analysis of NHANES 2005-2006. Eight urinary PAPs were considered; three with >33.3% values below the limit of detection were excluded. Allergic symptoms and sensitization were assessed based on participants' self-reported health conditions. Three survey-weighted generalized linear models (crude model: unadjusted; Model I: partially adjusted; Model II: fully adjusted) and weighted quantile sum regression were used to evaluate the associations between PAPs exposure and allergy-related outcomes in both adolescents and adults.ResultsAmong adolescents, higher triclosan (TCS) exposure was positively associated with allergic rhinitis, allergies, sinus infection, and sneezing; in the fully adjusted model, odds ratios (ORs) were 2.04 (95% CI: 1.18-3.54), 2.36 (1.25-4.47), 3.28 (1.36-7.91), and 2.12 (1.27-3.52), respectively. Higher TCS, methyl paraben (MPB), and propyl paraben (PPB) were associated with dust-mite sensitization, with ORs of 2.00 (1.16-3.45), 2.09 (1.05-4.17), and 3.87 (2.09-7.16). Among adults, MPB was positively associated with allergic rhinitis (OR = 1.95, 95% CI: 1.26-3.00) and sneezing (OR = 1.99, 1.27-3.10), and TCS was associated with hay fever (OR = 1.99, 1.22-3.23) and plant sensitization (OR = 1.40, 1.03-1.91). In mixture analyses, PAPs were positively associated with allergies (adjusted OR = 1.27, 95% CI: 1.07-1.51), sneezing (1.15, 1.00-1.33), and plant sensitization (1.21, 1.02-1.43) in adolescents, but no significant mixture associations were found in adults.ConclusionHigher levels of specific PAPs, particularly TCS, MPB, and PPB, and PAP mixtures were associated with increased risks of allergy-related outcomes in adolescents. In adults, TCS and MPB showed positive associations with multiple outcomes, whereas the overall PAP mixture was not statistically significant.

BackgroundTreatment of postoperative exacerbations with topical antibiotics has grown in popularity due to their ability to administer a high local drug concentration to the sinuses and mitigate systemic side effects. Published literature on the efficacy of topical levofloxacin for treating CRS is scarce.ObjectivePatients who started levofloxacin 100 mg nasal rinses twice daily following functional endoscopic sinus surgery (FESS) were retrospectively identified. Data collected included rinse duration, bacterial cultures, Sino-Nasal Outcome Test-22 (SNOT-22) scores, Lund-Kennedy (LK) scores, and adverse effects. SNOT and LK scores were compared at 3 time points: pre-operative (Baseline), 3 month postoperative pre-rinse (PostOp), and at the completion of rinse therapy (PostRinse). Analysis of variance (ANOVA) and Wilcoxon rank sum tests were used for pairwise comparisons.ResultsOne hundred and thirty-three patients received levofloxacin rinses for a mean 8.4 ± 18.9 months. On pairwise comparison for LK scores, the difference between PostOp and PostRinse LK scores was -1.0 ± 1.7 (P < .001). The change from Baseline to PostOp was -2.0 ± 2.8 (P < .001) and the change from Baseline to PostRinse LK scores was -3.2 ± 2.8 (P < .001). On pairwise comparison for SNOT scores, significant improvement was observed between Baseline and PostRinse scores (-19.4 ± 20.7, P = .001) but not between PostOp and PostRinse scores. There was one musculoskeletal adverse event noted.ConclusionTopical levofloxacin rinses afforded a possible benefit in endoscopic appearance of operated sinuses but less definitive benefit in symptom scores. Further, they were safely tolerated with one mild musculoskeletal adverse event.

BackgroundUltra-processed foods (UPF) are industrial formulations derived mostly from substances refined or extracted from foods. UPF intake has been linked to obesity, cardiovascular disease, and adult mortality, with recent studies demonstrating possible associations with asthma and allergy.ObjectiveWe investigate the association of UPF intake with self-reported sinusitis and other sinonasal symptoms.MethodsWe retrospectively reviewed 3 cycles of the National Health and Nutrition Examination Survey (NHANES), ranging from 2005 to 2014, which includes dietary and sinonasal symptom data on a large, representative sample of the US population. Individuals were divided into quartiles based on the percent of daily caloric intake consisting of Nova category 4 UPF. Multivariable logistic regression was performed to assess the association of UPF intake with sinonasal symptoms, adjusting for demographic data and medical comorbidities.ResultsAnd 10,068 individuals (mean age 54.2 years, 52.1% female) were studied. Compared to the lowest quartile of UPF intake, the highest quartile had a higher rate of asthma (16% vs 11%, P = .03), obesity (40% vs 30%, P < .001), smoking (51.6% vs 44.4%, P < .001), emphysema (2.9% vs 1.8%, P = .02), and food insecurity (26% vs 21%, P = .002). On multivariable regression, the highest quartile of UPF intake was associated with self-reported sinusitis (odds ratio [OR] = 1.54, 95% confidence interval [CI] 1.15-2.05, P = .007). UPF intake was also associated with xerostomia-related dysgeusia (OR 1.79, CI 1.15-2.80, P = .02) but not with other sinonasal symptoms, including hyposmia, allergies, hay fever, or nasal congestion from allergies.ConclusionUPF intake is significantly associated with self-reported sinusitis and xerostomia-related dysgeusia, although not with other sinonasal symptoms. Further studies are needed to elucidate the mechanism of this association.

BackgroundAt present, there are many therapeutic regimens for allergic rhinitis (AR), but their therapeutic effects are not better. Therefore, it is a focus to find new therapeutic targets by exploring AR immune regulation.ObjectiveTo explore the possible mechanism that adipose mesenchymal stem cell-derived exosomes (AMSC-exos) regulate the balance of Th2/Treg cells by mTOR pathway in AR patients.MethodsThirty patients with AR and 30 patients with deviated nasal septum alone were selected as AR group and control group. From each patient, 10 ml of peripheral blood were collected for determining the levels of blood plasma IL-4 and TGF- β as well as protein levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389) in peripheral blood mononuclear cells (MCs) and the proportions of Th2 and Treg cells. And then MCs from AR patients were divided into two groups. One group was as AR cell group. Another group was co-cultured with AMSC-exos and served as AR cell + exos group. The levels of IL-4 and TGF- β in supernatant, the protein levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389) in MCs and the proportions of Th2 and Treg cells were also determined.ResultsThe levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389), the IL-4 level and the proportion of Th2 cells were significantly higher in the AR group than in the control group (all P < 0.05). However, the levels of p-PI3K (P85), p-AKT (Ser473), p-mTOR (Ser2448) and p-p70S6K (Thr389), the IL-4 level and the proportion of Th2 cells were significantly lower in the AR cell + exos group than in the AR cell group (all P < 0.05).ConclusionsAMSC-exos may regulate the balance between Th2 and Treg cells by PI3K/AKT/mTOR/p70S6K pathways in vitro.

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.