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.

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.

BackgroundOlfactory dysfunction is a frequent symptom experienced by individuals recovering from coronavirus disease 2019 (COVID-19) and significantly impacts daily life activities. Recent studies suggest that reducing nasal calcium levels may help restore olfactory function. Glutamate diacetate (GLD) is a natural sequestering agent that binds calcium ions and may offer therapeutic benefits in managing post-COVID olfactory dysfunction.ObjectiveThis study aimed to evaluate the effectiveness of topical GLD treatment in reducing nasal calcium levels and improving olfactory function in individuals with chronic olfactory dysfunction following COVID-19.MethodsA double-blind, placebo-controlled trial was conducted with 66 participants who were randomized into two groups: GLD (1% solution) and saline placebo (0.9% solution). Participants received nasal treatment three times daily for six months. Olfactory function was assessed using the Sniffin' Sticks test, measuring threshold (T), discrimination (D), and identification (I) scores. Nasal calcium levels were also measured. Statistical analysis included independent t-tests and change-from-baseline comparisons.ResultsSignificant improvements were observed in the GLD group across olfactory assessments. By month 6, threshold scores increased by 0.78 ± 0.15, discrimination scores by 0.72 ± 0.15, and identification scores by 1.80 ± 0.15, all exceeding gains in the saline group. Nasal calcium levels decreased significantly in the GLD group (7.36 ± 1.21 mM vs 2.49 ± 0.51 mM in saline), suggesting a contribution mechanism in olfactory improvement.ConclusionGLD treatment resulted in statistically significant improvements in olfactory function and a reduction in nasal calcium levels in individuals with post-COVID olfactory dysfunction. However, the observed changes did not reach the threshold for clinical significance. These findings suggest a potential role for GLD in olfactory recovery, but further studies are needed to evaluate its long-term efficacy and clinical relevance.

BackgroundTertiary care centers often manage patients with iatrogenic CSF leaks from sinus surgeries performed elsewhere. There is little published regarding clinical presentation, patterns of injury, and guidance for management.ObjectiveTo analyze management of patients with iatrogenic skull base injury during sinus surgery managed in a secondary setting and review the literature regarding common management considerations.MethodsThis is a review of patients who underwent endoscopic sinus surgery at an outside facility with iatrogenic CSF leak and secondary repair at our institution between January 2009 and March 2023. The record was reviewed for clinical characteristics, medical interventions, and outcome measures.ResultsNineteen patients were included with an average age of 54.6 years. There was a roughly even split between patients with chronic sinusitis with and without nasal polyps (n = 10, n = 9). Under half (42.1%) of skull base injuries were identified intraoperatively, all injuries occurred to the ethmoid skull base, and there was a predisposition toward right-sided injury. All patients underwent endoscopic repair with a 100% success rate. Two patients (10.5%) were started on acetazolamide postoperatively, both with a body mass index greater than 40.ConclusionsOur findings underscore the importance of maintaining a high degree of suspicion for skull base injury as well as understanding endonasal anatomy and patient-to-patient variations. Our work adds to the literature suggesting a higher-than-suspected rate of missed skull base injury during sinus surgery. We anticipate an impending increase in iatrogenic injuries managed in the secondary setting, reflecting the trend toward sinus procedures being performed in the office setting. We recommend a thoughtful patient-specific approach toward secondary management, including evaluating for intracranial injury for suspected penetrating trauma and tailoring reconstruction to the particular defect.

BackgroundChronic rhinosinusitis (CRS) can be difficult to treat medically secondary to crusting and biofilms resistant to oral antibiotics. Treatment with topical antibiotics has grown in popularity due to their ability to administer a high local drug concentration while mitigating systemic effects. Published literature on topical antibiotic efficacy for CRS is mixed and sparse.ObjectiveTo describe the efficacy of postoperative topical mupirocin rinses in reducing objective and subjective markers of CRS disease severity.MethodsPatients with suspected biofilm formation following functional endoscopic sinus surgery who were treated with mupirocin 15 mg or 30 mg rinses twice daily between 2018-2023 were included. These patients' symptoms and endoscopic findings were refractory to high-volume steroid irrigations and oral antibiotics. Data collected involved comorbidities, rinse duration, concurrent therapies, Lund-Kennedy (LK) scores, sino-nasal outcome test-22 (SNOT) scores, and adverse effects. LK and SNOT scores were compared across 3 time points (preoperative, 3-month-postoperative-prerinse, postrinse) using one-way analysis of variance and Wilcoxon rank sum for pairwise comparisons.ResultsThirty patients were included. Average age was 63.3 years, 66.7% of patients were female, and 60% had nasal polyposis. There was a statistically significant decrease in LK scores between the 3-month-postoperative-prerinse period and the postrinse period (-0.92 ± 1.25; P-value = .01) whereas the SNOT-22 score reduction was not significantly different (P-value = .62). One patient reported a "burning sensation" and stopped after 4-weeks of treatment; no other adverse events were reported.ConclusionTopical mupirocin rinses may result in improvement of CRS burden on endoscopy without a significant reduction in symptoms. Additional studies are necessary to delineate the safety and appropriate duration and dosing of mupirocin rinses as well as to compare mupirocin to standard saline irrigations for treatment of recalcitrant CRS.

BackgroundThis study aimed to investigate the clinical value of lactic acid metabolism-related genes (LRGs) in nasopharyngeal carcinoma (NPC).MethodsClinical and genetic information was extracted from the TGCA and Gene Expression Omnibus databases. Consistency clustering was employed to identify NPC subpopulations. Immune infiltration was appraised using TIMER, ESTIMATE, and MCPCounter. Functional analysis was conducted to elucidate potential mechanisms. A prognostic risk model was successfully constructed using the LASSO algorithm and multivariate Cox regression analysis. Phenotypic experiments were conducted to validate the glycolysis and lactic acid metabolism.ResultsAccording to prognostically LRG genes, two clusters were identified and exhibited significant difference in immune landscape, which indicated variations in immune status. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis revealed that the differentially expressed genes were predominantly implicated in immune-related pathways. These findings suggested that the LRG-based risk model could successfully predict the prognosis of NPC patients. Moreover, the risk model retained its predictive potency by stratifying patients with sex and age, with lower risk score patients displaying improved prognosis. In the training cohort, the low-risk group showed significantly lower stromal score, immune score, and ESTIMATE score compared with the high-risk group. To further enhance the precision of prognostic predictions, we developed a nomogram that integrated the risk model with clinical features. In the training cohort, the established nomogram could accurately predict the prognosis of NPC patients. Mechanically, the knockdown of FARS2 in NPC cells resulted in altered glycolysis and lactification. Deregulated FARS2 led to the accumulation of metabolic intensity, which resulted in the disruption of lactic acid metabolism.ConclusionThese results highlighted the potential association between LRGs expression and immune dysfunction, which might contribute to adverse prognosis in NPC patients. This study represented a pioneering effort in exploring the prognostic value of LRGs in NPC.