American Journal of Rhinology & Allergy最新文献

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.

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.

BackgroundInferior turbinate hypertrophy is a common cause of chronic nasal obstruction, and radiofrequency treatment has become an effective minimally invasive option for management. However, the impact of this procedure on nasal bacterial flora and the need for postoperative antibiotics remains unclear.ObjectiveTo investigate the effect of inferior turbinate radiofrequency treatment on the nasal cavity bacterial flora and the need for postoperative antibiotics.MethodsForty-five voluntary patients aged 18 to 65, who were referred to the Otorhinolaryngology clinic between 11/2023 and 02/2024 due to chronic nasal obstruction, were included in the study. The patients had noninfective inferior turbinate hypertrophy, were recommended for inferior turbinate radiofrequency treatment, and agreed to undergo the procedure. Before and one month after the procedure, nasal swabs were taken from the patients and sent to the Clinical Microbiology Department for culture. The microorganisms isolated from both swabs were compared. The statistical analysis of the study data was conducted using SPSS 26.0 software.ResultsNo significant difference was observed in the total bacterial colonization count after the radiofrequency procedure compared to before the procedure (p = .44). There was no significant difference in the total count of normal flora elements and potentially pathogenic bacteria between the pre and post procedure (p = .10, p = .23). Among the isolated normal flora microorganisms, no significant difference was observed in the bacterial colonization count for all species except coagulase-negative staphylococci, in which a significant decrease was detected (p > .05, p = .004).ConclusionThe data from this study suggest that inferior turbinate radiofrequency treatment does not significantly affect nasal flora bacterial colonization and does not cause a significant increase in the number and variety of pathogenic bacteria, thereby indicating that postoperative antibiotic therapy is not necessary. However, further studies with a larger sample size are required.

BackgroundChronic rhinitis (CR) is characterized by refractory symptoms such as rhinorrhea, sneezing, nasal congestion, postnasal drip (PND), and cough. Most patients do not achieve lasting symptom relief with medical management.ObjectiveTo evaluate the long-term efficacy and safety of temperature-controlled radiofrequency treatment targeting posterior nasal nerves (PNNs) for CR.MethodsThis prospective, single-arm, open-label, multicenter study included patients aged 18-85 years across 19 centers in the United States and Germany. Outcome measures included reflective Total Nasal Symptom Score (rTNSS), PND and cough scores, and the Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Outcomes, including adverse events, were reported through 3 years post-procedure.SettingAll procedures were performed in an outpatient office-based setting.ResultsOne hundred twenty-nine patients received treatment; 101 completed 3-year follow-up. The adjusted mean rTNSS Score improved from 7.8 (95% confidence interval [CI]: 7.5-8.1) at baseline to 3.2 (95% CI: 2.8-3.7) at 3 years (mean change: -4.5 [95% CI: -5.1 to -4.0]; P < .001). Rhinorrhea symptom scores improved from 2.6 to 1.2 (55.8% reduction). Compared to baseline, at 3 years, adjusted mean cough and PND scores declined from 1.3 to 0.4 (mean change: -0.9; P < .001, 69% reduction) and from 2.4 to 1.2 (mean change: -1.2; P < .001, 50% reduction), respectively. MiniRQLQ scores were significantly reduced from an adjusted mean of 3.0 (95% CI: 2.8-3.2) at baseline to 1.2 (95% CI: 1.0-1. 4) at 3-year follow-up; P < .001. No serious device- or procedure-related adverse events were reported.ConclusionA single temperature-controlled radiofrequency treatment of the PNN safely and effectively reduced CR symptoms, including cough and PND, improved quality of life, and decreased medication burden through a period of 3 years with no serious adverse events.

BackgroundAtrophic rhinitis (AR) is a chronic condition characterized by mucosal atrophy, crusting, and impaired mucociliary clearance. Current treatments are palliative and do not focus on tissue regeneration. Although platelet-rich plasma (PRP) has gained attention for its regenerative properties, evidence supporting its effectiveness in AR remains limited.ObjectiveTo systematically evaluate the effectiveness and safety of PRP in the treatment of AR, focusing on nasal symptom relief, mucociliary clearance, and tissue repair biomarkers.MethodsA systematic literature search was conducted in PubMed and the Cochrane Library from database inception to September 2024 for randomized clinical trials, prospective trials, and case series evaluating PRP for AR. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale.ResultsPRP treatment resulted in significant improvements in nasal symptoms, with sino-nasal outcome test scores decreasing from 22.4 to 12.7. Four studies demonstrate enhanced mucociliary clearance, including a reduction in saccharin transit time from 420 s to 220 s in 1 study. Biochemical analyses revealed elevated levels of nitric oxide synthase and arginase, suggesting tissue regeneration. Improvements in anosmia and nasal obstruction symptom scores were also reported. No severe adverse effects were observed.ConclusionWhile PRP shows promise for AR, current evidence is compromised by diagnostic uncertainty, methodological inconsistencies, and potential commercial bias. Significant demographic variations suggest different patient populations were evaluated. Rigorous, independently funded trials with standardized protocols are essential before clinical recommendations.

BackgroundChronic rhinosinusitis (CRS) is a common inflammatory condition of the paranasal sinuses and nasal mucosa. Despite significant advances in understanding its pathogenesis, CRS remains a complex condition to manage due to its heterogeneous nature. Identifying biomarkers could be beneficial in enhancing the diagnostic accuracy and guiding personalized treatment strategies for CRS patients.ObjectiveThis study aimed to evaluate Omentin-1 usage as a biomarker in CRS patients and to investigate its functionality. Serum Omentin-1 levels were evaluated in the phenotypes of CRS, which are CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP).MethodsA total of 90 participants, including CRSwNP (n = 30), CRSsNP (n = 30), and control group (n = 30) individuals, were included in the study. Symptom severity was scored using the Sino-Nasal Outcome Test-22 questionnaire, and disease severity was assessed radiologically with the Lund-Mackay scoring system. Venous blood samples were collected from all participants to evaluate serum Omentin-1 levels.ResultsMedian serum Omentin-1 levels were 124.511 ng/ml (CRSwNP), 131.889 ng/ml (CRSsNP), and 249.138 ng/ml (Control). A significant difference in serum Omentin-1 levels was found between CRSwNP, CRSsNP, and control groups (P = .005). Additionally, significant differences were observed between the CRSwNP group and the control group (P = .015), and between the CRSsNP group and the control group (P = .014). In the CRSwNP group, serum Omentin-1 levels were significantly higher in patients with a positive skin prick test (P = .006).ConclusionIn our study, Serum Omentin-1 levels were found to be significantly lower in CRS patients compared to the control group. Additionally, in the CRSwNP group, serum Omentin-1 levels were significantly higher in patients with a positive skin prick test compared to those with a negative skin prick test. These findings suggest that Omentin-1 could serve as a potential biomarker for differentiating CRS phenotypes, particularly in CRSwNP patients, and the insights gained from these findings may highlight the potential for future comprehensive studies.

BackgroundOlfactory dysfunction affects approximately 29% of the population and has a profound impact on quality of life. It frequently follows upper respiratory tract infections and lacks effective pharmacological treatments. Vericiguat, a soluble guanylate cyclase stimulator that increases intracellular cyclic guanosine monophosphate, is approved for heart failure and has potential neuro-modulatory effects relevant to olfactory processing.ObjectiveThis pilot study investigates the efficacy of oral vericiguat in improving olfactory function in patients with persistent anosmia following upper respiratory tract infections.MethodsIn a double-blind, randomized controlled trial, 88 participants with post-infectious anosmia were assigned to receive either placebo (n = 44) or vericiguat (4 mg, twice daily; n = 44) for 12 months. Olfactory function was assessed monthly using the Sniffin' Sticks test, measuring Threshold (T), Discrimination (D), and Identification (I) scores. Data were analyzed using repeated-measures ANOVA and post-hoc Bonferroni corrections.ResultsAt baseline, all olfactory scores were similar between groups. In the vericiguat group, T scores increased from 3.84 ± 0.19 to 4.65 ± 0.20 (P = 0.003), D scores from 8.25 ± 0.65 to 9.20 ± 0.86 (P = 0.008), and I scores from 7.34 ± 0.72 to 8.62 ± 0.79 (P = 0.008). No significant changes were observed in the placebo group. Between-group differences became statistically significant for D at month 4 (P < 0.05), T at month 6 (P < 0.05), and I at month 7 (P < 0.05). However, the mean total TDI improvement in the vericiguat group (+ 3.19) did not reach the clinical threshold of 5.5 points.ConclusionVericiguat significantly improved olfactory threshold, discrimination, and identification scores compared to placebo. These findings highlight its potential as a pharmacological option for olfactory dysfunction, although the clinical magnitude of benefit remains below the established threshold. Further studies should explore mechanisms and broader clinical applications.Trial registrationDFM-IRB00012367-23-07-008.

Objective: Chronic rhinosinusitis with nasal polyps (CRSwNP) presents with nasal obstruction, facial pressure, smell alterations, and post-nasal drainage. Endoscopic sinus surgery (ESS) is indicated when medical treatments fail, however some patients' nasal polyps can recur. Biologic therapies targeting type-2 inflammation have been shown to improve sinonasal symptoms in CRSwNP. Few studies compare ESS to biologic outcomes longitudinally. To review and compare the efficacy of ESS to biologics in managing CRSwNP using standardized outcome measures longitudinally. Data Sources: We searched electronic databases, including MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception through August 2024. Review Methods: Primary outcome included changes in symptom scores (SNOT-22). Secondary analyses included change in nasal polyp score (NPS) and olfactory function scores. The mean differences and 95% CI were synthesized using a random-effects meta-analysis with heterogeneity assessed using I² statistics. Results: Although there was significant heterogeneity between and within groups, we performed a meta-analysis of SNOT-22 outcomes from both biologic and ESS studies (n = 27). SNOT-22 significantly improved at 6/12 months in biologic and ESS studies with no differences between groups. Secondary analysis of NPS and olfactory function were limited by the small number of studies. Both treatments improved outcomes from baseline, with biologics showing improved olfaction at 6 months compared to ESS. Conclusion: Significant heterogeneity in patient selection, testing methods, and longitudinal data collection was identified. Future comparative studies should incorporate individual complete data with consistent follow-up to reduce heterogeneity and synthesize the best evidence comparing biologic to ESS outcomes in CRSwNP.

Objective: This systematic review aims to evaluate and summarize the available literature on the relationship between olfactory cleft (OC) airflow and olfactory function in both healthy individuals and those with olfactory dysfunction. Methods: A systematic search was conducted in PubMed, Google Scholar, OVID, and Cochrane databases to identify studies on OC airflow and olfactory function. Studies were selected based on predefined inclusion criteria. Results: 12 studies were included. The average OC airflow rate and velocity of healthy people were strongly correlated with olfactory threshold (OT) and olfactory discrimination (OD), but weakly with olfactory identification (OI). The anatomical localization of nasal polyps (NP) significantly influenced nasal airflow patterns, with lesions situated in the pre-olfactory region or occupying the entire OC demonstrating complete obstruction of OC airflow and consequent impairment of olfactory recognition thresholds. In contrast, NP localized to the superior or middle meatus exerted minimal clinical impact on airflow parameters. Quantitative analysis revealed an inverse correlation between polyp volume and both OI scores and peak nasal inspiratory flow measurements. In patients with nasal septum deviation, the OT and OI scores were significantly lower on the affected side, though these parameters demonstrated improvement following septoplasty. Combined septoplasty with partial inferior turbinectomy improved the nasal airflow and olfaction, particularly the OD and OI scores. Patients with hypertrophic inferior turbinate due to chronic rhinitis had higher nasal resistance and lower OT, OD, and OI scores compared to healthy controls. There was a significant recovery in resistance, OT, OD, and OI scores postoperatively. Middle turbinate resection demonstrated efficacy in augmenting the olfactory flux and nasal airflow. Notably, superior turbinate lateralization in chronic rhinosinusitis with NP increased the cross-sectional area of OC and improved odor identification function. Conclusion: Impaired OC airflow was highly associated with olfactory dysfunction. Precise mapping through computational fluid dynamics of the airflow-olfaction axis not only enhances diagnostic accuracy but also informs targeted surgical interventions.