American Journal of Rhinology & Allergy最新文献

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.

BackgroundDacryocystorhinostomy (DCR) is a surgery performed for nasolacrimal duct obstruction (NLDO). A high septal deflection may limit surgical access, and if not corrected, contribute to an increase in DCR failure rates due to increased adhesion formation. We hypothesize that a narrower distance between the nasal septum (NS) and lacrimal fossa (LF) is associated with higher rates of DCR failure.ObjectiveTo evaluate whether a reduced nasal septum-lacrimal fossa (NS-LF) distance is associated with higher rates of endoscopic DCR (Endo DCR) failure and to determine a clinically relevant cutoff distance that may guide consideration for concomitant septoplasty.MethodsA single-institution retrospective chart review was performed for patients who received an endoscopic "Endo" DCR between July 2018 and July 2023. Data collected included demographics, septal deviation presence and laterality, NLDO laterality, and failure rates, where failure was defined as the need for a repeat ipsilateral DCR. The NS-LF distance was determined on preoperative computed tomography.ResultsA total of 521 patients were identified, with an average age of 60.3 years (SD = 16.47); 4.4% (n = 23) of patients experienced Endo DCR failure, requiring revision Endo DCR; 8.7% (n = 45) of patients underwent concomitant septoplasty with initial DCR. Patients who failed had a significantly shorter NS-LF distance (8.47 mm vs 9.25 mm, P = .028). Receiver operating characteristic curve analysis cutoff distance of 8.85 mm demonstrated a NS-LF distance ≥8.85 mm had a significantly lower failure rate compared to those with a distance <8.85 mm (2.6% vs 7.3%, P = .016). All revision DCRs were successful regardless of septoplasty status.ConclusionA NS-LF distance of <8.85 mm was significantly associated with Endo DCR failure, suggesting that concomitant septoplasty should be considered in these patients. Prospective studies and standardized preoperative imaging may improve surgical planning and outcomes in Endo DCR.

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) presents significant management challenges, largely due to reliance on systemic corticosteroids (SCS) for symptom control. Advances in biologic therapies targeting type 2 inflammation have shown promise in reducing polyp burden, improving symptoms, and decreasing the need for SCSs and surgery.ObjectiveThis systematic review and meta-analysis compare the steroid-sparing efficacy of biologics and safety with other biologics or standard care in CRSwNP. Key outcomes include reducing SCS Use and drug safety.MethodsWe searched PubMed, Embase, Cochrane Library, Scopus, and the Web of Science. We included randomized controlled trials (RCTs) comparing biologics versus placebo/standard care in adults with CRSwNP. The primary outcomes were SCS reduction and safety. Meta-analyses, which use a statistical method called random effects models, were employed.ResultsThis meta-analysis of seven RCTs (n = 3097) revealed that biologic therapies significantly reduce SCS use in CRSwNP patients (pooled proportion: 20.9%, 95% CI: 8.4%-37.0%), though with substantial heterogeneity (I² = 98.3%). Trial-level predictors included control-arm safety profiles (higher serious adverse events (SAEs) reduced treatment effects) [odds ratio (OR) 0.70]. In contrast, placebo-arm SAEs enhanced them [OR 1.81]) and sample size (larger trials showed diluted responses [OR 0.993 per patient]). These results highlight the role of trial design and baseline patient risk in determining the interest of the results. They further highlight the possibility for individualized strategies in terms of treatment and call for more in-depth studies with patient-level data to refine the steroid-sparing therapeutic strategy, providing an impetus for future work in this area.ConclusionsThe biologics, specifically dupilumab, represent a paradigm shift in treating CRSwNP, significantly decreasing the burden of SCS-their consistent safety and efficacy support integration into treatment algorithms for severe cases.

BackgroundWith a 10% risk for malignant transformation to squamous cell carcinoma (SCC), the treatment of inverted papilloma (IP) is surgical resection. Biopsy of IP can be helpful for diagnosis, but there are accuracy limitations.ObjectiveTo determine the diagnostic accuracy of office biopsy in patients who underwent surgical resection for sinonasal papilloma, and to examine clinical and pathological factors that impacted this accuracy.MethodsThis was a retrospective review of patients who underwent resection of sinonasal papilloma at a tertiary care center from January 2015 to April 2025 and had office biopsies performed at the same institution before surgery. Patient demographic and tumor characteristics were reviewed. We compared the accuracy of office biopsy against the final pathology from surgical resection.ResultsA total of 94 patients were included. Mean age was 59.6 (±12.5) years, with 69.1% male. Final pathology revealed 72 (76.6%) sinonasal papilloma without dysplasia, 19 (20.2%) sinonasal papilloma with dysplasia, and 3 (3.2%) SCC in situ. 13.9% (10/72) of the papilloma without dysplasia cases had false negative biopsies showing inflammatory lesions, while none of the pre-malignant papillomas had a false negative (non-neoplastic) biopsy (P < .001). The false negative biopsy cases were significantly associated with contralateral pathology on CT (50.0% vs 12.9%, P = .005) and concurrent inflammatory polyp (40.0% vs 4.8%, P < .001). Tumor characteristics were not significantly associated with higher rates of false negative biopsy.ConclusionsInaccurate biopsy results were mainly attributed to concurrent inflammatory processes. With a false negative rate of 14% on office biopsy, proceeding to surgical resection is warranted when there is a strong clinical suspicion for IP.

BackgroundEndoscopic sphenopalatine artery ligation (ESPAL) is a safe and effective procedure to manage intractable epistaxis. However, in the literature, the peri-operative and patient factors which contribute to surgical success or failure have been poorly defined.ObjectiveThe purpose of this study was to identify the patient, disease and surgical factors which influence the effectiveness of ESPAL in the management of intractable epistaxis.MethodsAll ESPALs performed over a 14-year period at a single tertiary otolaryngology department to manage epistaxis refractory to conservative management were retrospectively analyzed. Recurrence of epistaxis was defined as any patient who presented to an emergency department with epistaxis on the same side as their previous ESPAL at any time post-operatively. Subjects were grouped as either a non-recurrence or recurrence group.Results40 patients underwent ESPAL to treat intractable epistaxis. Anticoagulation, smoking, and active malignancy were associated with higher rates of recurrence after ESPAL (P < .05). The recurrence rate was 20% with an average follow-up period of 5 years. The average time between ESPAL and epistaxis recurrence was 10 days. 50% (n = 4) of patients with recurrence required escalation to endovascular embolization. No patients had recurrence of epistaxis following additional radiological intervention.ConclusionOne in five patients experienced a recurrence in epistaxis following ESPAL within 3 weeks of their surgery. Smokers, patients on anticoagulation and patients with malignancy are more likely to experience recurrence. If re-presenting with epistaxis following ESPAL, patients are likely to require radiological intervention.

BackgroundAcute invasive fungal rhinosinusitis (AIFRS) is an aggressive and often fatal disease process that principally impacts immunocompromised patients. Maxillary dental trauma and infections have been associated with the development of maxillary sinus fungal balls, but the role of dental procedures/trauma in the pathogenesis of AIFRS remains poorly defined.ObjectiveThis study seeks to review a single-institutional experience with AIFRS and examine the association between dental events and AIFRS severity and outcomes.MethodsRetrospective review of 95 consecutive patients with biopsy-proven AIFRS treated at a tertiary institution between 2010 and 2024. Demographic information, comorbidities, disease course and outcomes were evaluated. The primary objective was to evaluate the impact of antecedent dental events on AIFRS morbidity and mortality. Secondary objectives included evaluating variability in demographic factors, comorbidities, and extent of disease.ResultsEleven patients with an antecedent dental event within 2 weeks of AIFRS diagnosis were identified for a rate of 11.6%. Dental AIFRS patients were more likely to be African American (P = .003) and more likely to have diabetes mellitus as their underlying immunodeficiency (P = .03) than non-dental AIFRS patients. Patients with dental-related AIFRS were more likely to present with invasion of the orbit (OR 6.0, 95% CI 1.2-29.5) and nasal floor (OR 4.2, 95% CI 1.1-17.1) than non-dental AIFRS patients. There was no difference in mortality between dental and non-dental AIFRS (36.4% vs 52.4%, P = .31).ConclusionMore investigation is necessary to further evaluate the association between dental events and the development of AIFRS. In our cohort, 11.6% of patients experienced AIFRS within 2 weeks of a dental event and these patients tended to present with higher rates of orbital involvement without a resultant increase in mortality.

ObjectiveTo evaluate disparities in the management of chronic rhinosinusitis (CRS) across racial, ethnic, and gender groups, focusing on treatment patterns and associated comorbidities.MethodsThis cross-sectional study analyzed data from 28,278 adults with CRS in the NIH All of Us Research Program between 2018 and 2022. Multivariable logistic regression was used to assess associations between demographic variables, associated comorbidities, and receipt of treatments including systemic steroids, leukotriene modifiers, antibiotics, biologics, and sinus surgery.ResultsBlack individuals had higher odds of receiving systemic steroids (OR: 1.59, P < .0001) and antibiotics (OR: 1.67, P < .0001), but were less likely to receive biologics (OR: 0.30, P = .051). Non-Hispanic individuals were more likely to receive systemic steroids (OR: 1.54, P < .001) and antibiotics (OR: 1.54, P = .0007), but were less likely to undergo sinus surgery (OR: 0.67, P = .016). Male sex was associated with reduced odds of receiving systemic steroids (OR: 0.86, P < .0001), leukotriene modifiers (OR: 0.81, P < .001), and antibiotics (OR: 0.91, P < .001) but increased odds of undergoing surgery (OR: 1.37, P < .0001). Presence of nasal polyps and comorbid asthma strongly predicted use of biologics (ORs: 4.39 and 13.83, respectively, P < .0001) and surgical intervention (ORs: 13.13 and 1.34, respectively, P < .0001).ConclusionSignificant racial, ethnic, and gender disparities exist in the treatment of CRS, independent of comorbidities. These findings highlight the need for equity-focused strategies to ensure timely access to advanced therapies and to address structural barriers that may influence treatment allocation.

IntroductionChildren with choanal atresia (CA) typically present with nasal obstruction and require surgical intervention to establish a patent airway. Transnasal endoscopic surgery is the preferred treatment approach. However, long-term outcome data are lacking. This study aims to assess the long-term outcomes and quality of life (QoL) after endoscopic repair of CA.MethodsChildren under age 18 years underwent endoscopic repair of CA using mucoperichondrial flaps developed from the nasal septum between 2007 and 2022. Their parents completed two standardized telephonic QoL questionnaires (Hebrew version, Sino-Nasal 5 (SN-5H) and Nasal Obstruction Symptom Evaluation (He-NOSE)).ResultsThe cohort consisted of 40 children, 60% female. Eight had syndromic disease; seven were born prematurely. Mean age at surgery was 25 days for bilateral atresia (65% of patients) and 3.8 years for unilateral atresia. Ten children, most with unilateral CA, needed revision surgery. The mean duration of follow-up was 3.1 years. At the last follow-up, 84.6% of the children had normal choanae, and the remainder had narrowed choanae. Mean time from last follow-up to the parental interview was 5.2 years. SN-5H and He-NOSE scores were similar to those of historical healthy subjects: 1.95 versus 1.76 (P = 0 .4) and 22.3 versus 14.9 (P = 0.08), respectively. Children born prematurely had a higher rate of sinus infections (P = 0 .01) and nasal congestion (P = 0 .05) than children born at term.ConclusionsLong-term follow-up of children who underwent endoscopic repair of CA using mucoperichondrial flaps showed a stable patent nasal passage with normal QoL for both unilateral and bilateral disease.