American Journal of Rhinology & Allergy最新文献

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.

BackgroundThe mechanisms driving chronic rhinosinusitis with nasal polyps (CRSwNP)-related olfactory loss remain largely unknown. Here we sought to identify novel modulators of olfactory function via the examination of nasal mucus biomarkers using an expansive 71-cytokine plex analyzed via machine learning models.MethodsOlfactory testing was performed via 40-question smell identify test (UPSIT). During endoscopic sinus surgery, sponges were placed in the middle meatus of individuals with CRSwNP (n = 15). Nasal mucus samples were screened by multiplex analysis for 71-cytokine/chemokines. Results underwent analysis with statistical and machine learning model approaches to assess whether protein concentrations were predictive of olfactory dysfunction.ResultsIn CRSwNP, multiple machine learning models revealed novel cytokines IL-21 and MIP-1δ as positive predictors of greater olfactory dysfunction. Other cytokines detected by more than one model as predictive of olfactory dysfunction were IL-18, MCP-1, IL-22, and BCA-1. Other cytokines identified to be predictive by at least one model were FLT-3L, LIF, IL-20, SCF, IL-23, and TPO.ConclusionUsing a 71-cytokine/chemokine plex analyzed via machine learning, we identified potentially novel roles for MIP-1δ and IL-21 as modulators of olfactory function in CRSwNP. Use of machine learning for the analysis of nasal mucus cytokines, may serve as powerful tool to analyze complex multiplex immune mediator data.

BackgroundSaline nasal irrigation (SNI) is an effective first-line treatment for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), yet adherence remains challenging. Better understanding of adherence patterns and related barriers is important for the development of patient-centered interventions to improve adherence.ObjectiveTo investigate adherence to SNI in patients with AR and CRS, including clinical and sociodemographic predictors of adherence, reported barriers to adherence, and patient-recommended methods to increase adherence.MethodsAdult patients treated with SNI for AR or CRS at our medical center in January 2024 were surveyed via phone in December 2024, and their medical records were reviewed. The primary outcome was adherence rate. Secondary outcomes included patient-reported barriers and proposed methods for improving adherence.ResultsOf 174 patients surveyed, 38.9% were adherent. Adherence was significantly associated with English as a primary language (P = .026) and history of allergies (P = .043), with a borderline significant association with prior endoscopic sinus surgery (ESS) (P = .053). The most cited barriers were logistical issues (n = 26, 21.3%), discomfort or pain (n = 21, 17.2%), forgetting (n = 17, 13.9%), and the time required (n = 16, 13.1%). The most commonly suggested interventions were better instructions for use (n = 28, 28.0%), increased education about SNI (n = 27, 27.0%), offering a list of affordable options (n = 24, 24.0%), and help setting up reminders (n = 21, 21.0%).ConclusionIn our urban population, adherence to SNI among patients with AR and CRS is relatively low. English speakers, those with allergies, and those with prior ESS are more likely to adhere. Barriers include logistics, discomfort, forgetfulness, and time commitment. Patient-centered interventions such as education, clearer instructions, cost transparency, and reminders may increase adherence.

BackgroundDendritic cells (DCs) are antigen-presenting cells that play a critical role in airway diseases by initiating and regulating immune responses. DCs are classified into plasmacytoid DCs (pDCs) and conventional DCs (cDCs), with the cDC lineage further divided into cDC1 and cDC2 subsets. Each subset exhibits distinct functions in immune regulation and disease pathogenesis. Thus, analyzing DC subsets is crucial for understanding the pathogenesis of airway diseases with diverse endotypes.ObjectiveAllergic rhinitis (AR) and chronic rhinosinusitis (CRS), further divided into eosinophilic CRS (ECRS) and non-eosinophilic CRS (NECRS), are typical upper airway diseases with diverse endotypes. AR and CRS often occur simultaneously, and their severity tends to increase when they are comorbid. To understand the endotypes of AR and CRS, we classified the presence or absence of AR and CRS, analyzed the changes in DC subsets in the nasal mucosa, and compared these results with clinical features.MethodsNasal polyp tissues and ethmoid mucosa were collected from 42 patients who underwent endoscopic sinus surgery. DC were analyzed by flow cytometry to detect the expression of blood DC antigen (BDCA)-1, BDCA-2, and BDCA-3.ResultsBDCA-3⁺ cDC levels were significantly reduced in patients with both AR and CRS, compared to those with AR alone or CRS alone. This reduction was especially prominent in patients with ECRS, polysensitization, and total serum IgE ≥ 200 IU/mL. BDCA-3⁺ cDC levels were also inversely correlated with preoperative computed tomography scores and serum eosinophil and immunoglobulin E levels.ConclusionBDCA-3⁺ cDC levels may be involved in mucosal immune regulation and are associated with increased disease burden in patients with comorbid AR and ECRS.

BackgroundA substantial proportion of patients with chronic rhinosinusitis (CRS) remain partly controlled or uncontrolled despite endoscopic sinus surgery (ESS) and maximal medical therapy. For these difficult-to-treat cases, topical antibiotic irrigations have been proposed as an adjunctive therapy, particularly when delivered via large-volume, low-pressure systems that enhance sinus penetration post-ESS. Evidence on their efficacy and prescribing patterns in this population remains limited.ObjectiveThis study aims to evaluate the use and outcomes of topical antibiotic irrigations in patients with difficult-to-treat CRS.MethodsA retrospective, multi-site cohort study was conducted across tertiary academic medical centers. Adult patients with persistent CRS symptoms despite bilateral full-house ESS and conventional postoperative medical management were included. Patients with cystic fibrosis or granulomatosis with polyangiitis were excluded. Demographic, clinical, and treatment data were collected. Primary outcomes were infection resolution at 8 weeks and changes in Sino-Nasal Outcome Test-22 (SNOT-22) scores.ResultsSixty-seven patients met inclusion criteria. Mupirocin (41.8%), tobramycin (23.9%), and gentamicin (17.9%) were the most commonly prescribed agents. After 8 weeks, 62.7% of patients achieved infection clearance. Among 44 patients with SNOT-22 data, scores improved significantly from 34.8 ± 20.2 to 21.8 ± 14.7 (P < .001). Improvement in SNOT-22 scores was more pronounced in patients who cleared the infection compared to those who did not.ConclusionLarge-volume topical antibiotic irrigations were associated with high infection resolution rates and clinically meaningful SNOT-22 improvements in patients with difficult-to-treat CRS. These findings support their potential utility as an adjunctive therapy in select postsurgical patients and warrant further prospective investigation.