American Journal of Rhinology & Allergy最新文献

Background: Allergic rhinitis (AR) affects millions of people worldwide, impacting quality of life and causing economic burden. Intranasal corticosteroids (INCs) are the mainstay treatment for AR, delivered via aerosol or aqueous sprays. Objective: This systematic review and meta-analysis investigate the comparative efficacy and safety of aerosol and aqueous delivery methods in AR treatment. Methods: Two independent reviewers searched 4 databases (Embrace, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science) for English-language, prospective randomized controlled trial (RCT), comparing aqueous and aerosol INCs for AR treatment. Studies were excluded for specific reasons (wrong comparisons, full text unavailable, insufficient data for extraction, wrong patient population, incorrect route of administration (non-intranasal), unverifiable inclusion criteria). Primary outcomes were Total Nasal Symptom Score (TNSS) and subset scores; secondary outcome was adverse event (AEs). Results: No significant difference in overall TNSS was found between the delivery methods. However, aqueous sprays showed a slight edge in reducing specific symptoms like congestion, itching, sneezing, and rhinorrhea. AEs did not differ significantly. Conclusion: Our findings suggest no significant difference in efficacy or safety between aerosol and aqueous INCs for AR treatment. Patient preference should be a primary consideration when choosing a delivery method to optimize adherence and symptom control.

BackgroundMinimally invasive techniques for the resection of sinonasal masses have become increasingly important over the past few decades. Sinonasal disease involving the lamina papyracea remains difficult to manage given the risk of injury to critical orbital structures and hemorrhage from nearby vessels.ObjectiveDetail the transcaruncular approach with orbital protection for the resection of benign and malignant sinonasal pathologies.MethodsDescription of surgical technique and presentation of 2 representative cases that were successfully managed with this surgical technique.ResultsThe transcaruncular approach involves incising the lateral 1/3 of the caruncle in a vertical plane between the upper and lower puncta. Dissection is then carried through the retrocaruncular fascia posterior to Horner's muscle to the posterior lacrimal crest along the medial orbital wall. Dissection can then be performed in a subperiosteal or supraperiosteal plane with subsequent ligation of the anterior ethmoidal artery. Once dissected, a nylon sheet used for orbital reconstruction and colored orbital shield can then be placed to aid in protection and visualization or orbital contents during endonasal tumor resection.ConclusionThe transcaruncular approach with orbital protection provides intraoperative protection of the orbital contents, allowing for safer removal of the mass irrespective of integrity of the lamina papyracea.

BackgroundOlfactory dysfunction (OD) is both under-recognized and underdiagnosed in aging adults. Prior studies in chronic rhinosinusitis have demonstrated a correlation between the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) and psychophysical olfactory testing, indicating potential utility for screening in this group. This study examined the correlation between QOD-NS scores, psychophysical function, and olfactory-associated patient-reported outcome measures (PROMs) in a novel, aging population. Additionally, we examined the potential utility of the QOD-NS as a screening instrument in this population.MethodsProspective cohort study in which healthy, adult volunteers completed the QOD-NS, olfaction-related visual analog scale (VAS) questions, Sniffin' Sticks (TDI), De Jong Giervald Loneliness Scale, UCLA loneliness survey (UCLA), and the Patient Health Questionnaire-9 (PHQ9).ResultsTwo-hundred and twenty-eight adults with mean age 50.3 ± 17.7 years were included. Subjects ≥50 years old had higher prevalences of hyposmia (58.3% vs 19.8%, P < 0.001) and anosmia (9.1% vs 3.1%, P < 0.001), and had worse QOD-NS and VAS (P < 0.001 for both). Aging subjects had significant correlations between QOD-NS and TDI (r = -0.386, p < 0.001), all VAS scores (P < 0.001), PHQ9 (r = 0.283, P = 0.001). Receiver operating characteristic curve demonstrated a QOD-NS of 8.0 as the optimal cutoff for a Youden's index of 0.23 for detection of dysosmia in aging patients.ConclusionsThe QOD-NS has significant, although weak correlation with psychophysical testing and psychosocial PROMs in aging subjects. However, a low Youden Index suggests limited potential of the QOD-NS as an OD screening tool in this population.

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.

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.

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.

BackgroundSinonasal pathology, such as chronic inflammatory disease or neoplasm, can cause secondary nasolacrimal duct obstruction (sNLDO). There is a paucity of data on dacryocystorhinostomy (DCR) techniques and outcomes for NLDO secondary to known sinonasal pathologies.ObjectiveTo describe case characteristics, management, and surgical outcomes of sNLDO at a tertiary academic center.MethodsCharts of DCR cases with at least 3 months follow-up done at a single institution over a 5-year period (2018-2022) were reviewed. Patient and surgical characteristics were recorded and compared between secondary and primary NLDO groups. The primary outcome was early functional success of DCR, assessed by improvement or resolution of epiphora at 3 months.ResultsA total of 236 cases were included. Of those, 79 (33.5%) were classified as secondary NLDO associated with sinonasal pathology. Reasons for sNLDO were sinonasal cancer (46.8%), chronic inflammatory disease (24.1%), trauma (16.5%), or prior head and neck radiation (31.6%). When comparing primary acquired NLDO to sNLDO cases, DCR for sNLDO was more likely to be performed endoscopically (68.4% vs 31.8%, P < .01), by a multidisciplinary team of rhinologist and oculoplastic surgeon (70.9% vs 8.3%, P < .01), and required bilateral surgery (36.7% vs 5.7%, P < .01). The overall functional success rate was 79.7% for sNLDO compared to 87.9% for primary acquired NLDO (P < .01). Revision surgery for sNLDO, history of sinonasal malignancy, and radiation were associated with lower functional success rates (66.7%, 70.3%, and 68.0%, respectively). Canalicular pathology was more common in sNLDO cases (29.0% vs 8.3%, P < .01).ConclusionsSecondary NLDO was more commonly managed with an endoscopic approach by a multidisciplinary team. Revisions for sNLDO, as well as cases with a history of sinonasal malignancy and radiation, had a markedly lower success rate, and sNLDO was frequently associated with canalicular obstruction. These findings may facilitate surgical planning and patient counseling.

BackgroundChronic rhinosinusitis (CRS) is a common condition that significantly impacts quality of life. While endoscopic sinus surgery (ESS) has proven effective in the general adult population, its specific effectiveness in older patients remains understudied.ObjectiveThis meta-analysis assessed the therapeutic effect and safety of ESS in patients aged 55 years and older with CRS.MethodsFive electronic databases were queried: PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Therapeutic effectiveness of ESS was quantitatively assessed using random-effects meta-analysis, in which mean changes of pre- versus postoperative scores of the Sino-Nasal Outcome Test-22 (SNOT-22) were pooled. Meta-regression was conducted to predict the variability in SNOT-22 changes. Comparative meta-analyses evaluating surgical complications between older and younger adult patients were conducted.ResultsA total of 12 studies were synthesized. Both short- and long-term follow-up data demonstrated significant improvement by reference to baseline. Our analysis demonstrated statistically significant mean reduction in the SNOT-22 score by 21.4 points (95% confidence interval [CI], -26.9 to -15.9) at an average follow-up of approximately 9 months. This improvement exceeds the minimal clinically important difference for SNOT-22. The presence of nasal polyposis was a favorable prognostic indicator of SNOT-22 improvement (β = -0.21; P = .002). The rates of surgical adverse events among older patients were 4.2% for significant bleeding, 0.6% for orbital injury, and 0.2% for skull base injury. A significant difference between the two age groups was observed only in skull base injury (odds ratio = 2.98; 95% CI, 1.53-5.80; P < .001).ConclusionESS offers clinically significant benefits for older individuals, particularly those with nasal polyposis. It is a safe treatment option for CRS in the older patients, with outcomes largely comparable to those in younger adults, though certain risks, such as skull base injury, may be slightly higher in older populations.

BackgroundDraf III procedures are considered to be time- and supply-intensive compared to standard functional endoscopic sinus surgery (FESS).ObjectiveTo quantify the cost of a Draf III compared to standard FESS and examine time- and supply-related cost factors.MethodsWe performed a retrospective analysis of inflammatory sinus surgeries at a tertiary care medical center from July 2021 to July 2023. The medical record was reviewed for patient factors and cost variables, and multivariable analysis was performed.ResultsThree hundred and fifty patients were included with a mean age of 50.6 years. One hundred and twenty-nine patients underwent a Draf III, 99 of whom (76.7%) underwent a Draf III as part of a full FESS whereas 30 (23.3%) underwent a targeted revision Draf III. Among all Draf III procedures, operating room and supply costs represented 63.1% ($6231.67) and 16.6% ($1638.46) of total costs, respectively, compared to 54.8% ($4912.46) and 14.5% ($1296.06) for standard FESS (both p < .001). The average total cost for a full FESS with Draf III was $10118.60, compared to $9414.29 for a targeted Draf III, and $8960.31 for standard FESS (n = 221). Using these values, we calculated that the approach of performing an upfront Draf III would be less costly relative to the approach of performing standard FESS with Draf II and then revision Draf III as needed when the expected revision rate exceeds 12.3%.ConclusionsSurgical costs associated with a FESS with Draf III are driven primarily by operating room time costs, to a greater degree even than for standard FESS. The cost of performing a full FESS with Draf III is not considerably higher than a standard FESS or a targeted Draf III revision, suggesting that an upfront Draf III may represent a relatively less costly treatment approach for patients at high risk of recurrent frontal disease.

BackgroundSquamous metaplasia is commonly observed in eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP). However, its underlying mechanisms remain unclear. This study aimed to evaluate the role of glucose transporter 1 (GLUT1) in the development of squamous metaplasia in eCRSwNP.MethodsTissue proteomics was employed to identify disease-specific proteins in eCRSwNP. Immunofluorescence, western blotting, and RT-qPCR were used for validation. Human nasal epithelial cells were utilized to assess GLUT1 expression and its regulatory mechanisms. A chronic rhinosinusitis with nasal polyps (CRSwNP) mouse model was used to examine the effect of GLUT1 inhibition on squamous metaplasia and nasal inflammation.ResultsProteomic analysis revealed a disease-specific protein expression profile in eCRSwNP polyps. Cohort validation demonstrated that GLUT1 and keratin 13 (KRT13) expression levels were significantly higher in the eCRSwNP group, with expression primarily localized in the epithelial regions. GLUT1 expression was positively correlated with the incidence of squamous metaplasia as well as KRT13 and involucrin (IVL) expression. In vitro experiments confirmed that combined Interleukin (IL)-4/IL-13 treatment upregulated GLUT1, KRT13, and IVL expression in human nasal epithelial cells in a dose-dependent manner, whereas GLUT1 inhibition reduced KRT13 and IVL expression, possibly through suppression of the PI3K-AKT signaling pathway. Animal experiments demonstrated that GLUT1 inhibition alleviated squamous metaplasia and inflammation in the nasal mucosa of mice.ConclusionElevated GLUT1 expression plays a key role in driving squamous metaplasia in eCRSwNP. GLUT1 inhibition attenuates nasal epithelial squamous metaplasia and inflammation in CRSwNP.