American Journal of Rhinology & Allergy最新文献

ObjectivesWhile autoimmune diseases (ADs) are known for systemic inflammation, their specific association with upper airway inflammation (UAI) has not been extensively characterized. We aim to investigate the associations between various ADs and subsequent UAI development in a large, national cohort.MethodsThis retrospective cohort study utilized de-identified electronic health records from TriNetX, a national collaborative database. Adolescent and adult patients with a diagnosis of 1 or more ADs were identified. A 12 month washout period was implemented to exclude preexisting UAI. The primary outcome was the incidence of UAI (chronic rhinosinusitis, allergic rhinitis, nonallergic rhinitis, chronic laryngitis, obstructive sleep apnea) following AD diagnosis. Hazard ratios and relative risks (RRs) with 95% confidence intervals (CIs) were calculated.ResultsAfter propensity matching, 1 327 186 patients with ADs and 1 327 186 controls were included. Patients with ADs exhibited a significantly lower overall incidence of UAI compared to controls (9.11% vs 13.81%; RR 0.71, 95% CI 0.70-0.71). This reduced risk was notable for allergic rhinitis (RR 0.64, 95% CI 0.64-0.65) and chronic sinusitis (RR 0.88, 95% CI 0.87-0.89). Juvenile idiopathic arthritis and type 1 diabetes demonstrated the most pronounced reductions in UAI risk. However, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis were associated with a significantly increased risk of UAI.ConclusionMost ADs were associated with a reduced overall risk of subsequent UAI. However, certain vasculitides significantly increased UAI risk, highlighting disease-specific pathophysiological mechanisms. These findings suggest a complex interplay between systemic autoimmunity and localized airway inflammation, warranting further investigation into underlying mechanisms and the impact of AD treatments.

BackgroundPrevious research has reported inconsistent results when evaluating long-term revision rates of patients undergoing balloon sinus dilation (BSD) compared to primary endoscopic sinus surgery (ESS).ObjectiveWe aimed to compare outcomes and long-term rates of revision surgery in patients with chronic rhinosinusitis without nasal polyps (CRSsP) who underwent primary standalone BSD versus primary ESS. We also wanted to better understand the post-procedure utilization of major healthcare resources between these groups.MethodsRetrospective cohort study using the TriNetX platform to identify patients with CRSsP undergoing standalone BSD versus primary ESS. 1:1 propensity score matching was performed to balance age and gender in each cohort. The primary outcome was revision ESS rates at 1 and 10 years. Secondary outcomes were rates of healthcare utilization and complications, including orbital, cerebrospinal fluid (CSF) leak, and epistaxis within 90 days.ResultsAfter matching, each cohort had 2112 patients. At 1 year, the revision ESS rate was 3.5% in the balloon cohort and 3.5% in the ESS cohort (OR = 0.97, 95% CI: 0.70-1.35). Extending follow-up to 10 years, revision rates were also not statistically different: 5.8% in the balloon cohort and 6.3% in the ESS cohort (OR = 0.92, 95% CI: 0.72-1.19). Patients in the balloon cohort had a lower 90-day risk of inpatient encounters (OR = 0.29, 95% CI: 0.23-0.38), CRS-related patient visits (OR = 0.63, 95% CI: 0.55-0.71), diagnostic nasal endoscopies (OR = 0.57, 95% CI: 0.50-0.65), antibiotic prescriptions (OR = 0.53, 95% CI: 0.43-0.66), and corticosteroid prescriptions (OR = 0.62, 95% CI: 0.53-0.71).ConclusionNo significant difference was observed in revision ESS rates in CRSsP patients who underwent primary BSD versus ESS after 10 years in this large database study. Findings suggest that in appropriately selected patients, BSD offers a durable response and a favorable value proposition in the management of patients with CRSsP.

AimsWe compared the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in patients with chronic dacryocystitis (CD), with or without previous temporary nasolacrimal stent implantation (TNLSI), then explored whether previous TNLSI influenced postoperative outcomes.MethodsThis retrospective study included consecutive patients with CD and previous TNLSI who underwent En-DCR (group A) between September 2019 and May 2022, and an age- and sex-matched control group of patients with CD who had not undergone previous implantation (group B). Lacrimal sac parameters were measured by computed tomography-dacryocystography, and surgical findings were recorded during surgeries. The surgical success rates were compared between the two groups at 12 months after surgery.ResultsThere were 53 patients in group A and 106 patients in group B. In group A, the mean horizontal, sagittal, and vertical lengths were 4.94 ± 1.30 mm, 4.88 ± 1.17 mm, and 7.85 ± 2.03 mm; in group B, these three lengths were 6.16 ± 1.25 mm, 5.97 ± 1.20 mm, and 10.00 ± 2.18 mm, respectively. All three parameters were significantly smaller in group A than in group B. Scar formation in the sac was observed in all patients in group A; it was not present in group B. At 12 months after surgery, the anatomical and functional success rates were 75.47% (40/53) and 71.70% (39/53), respectively, in group A; they were 93.40% (99/106) and 91.51% (97/106) in group B. The success rates were significantly higher in group B than in group A.ConclusionPrevious TNLSI may reduce lacrimal sac parameters and cause scar formation, thereby reducing the likelihood of success after En-DCR.

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.