American Journal of Rhinology & Allergy最新文献

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.

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease frequently requiring surgical intervention and the long-term use of topical corticosteroids to control patient symptoms. However, corticosteroids may delay postoperative recovery following sinus surgery by disrupting tissue inflammation, a key mediator of early wound healing. This study therefore seeks to assess the impact of topical corticosteroids on sinonasal epithelial healing following local injury.MethodsPrimary human nasal epithelial cells (HNECs) were collected from two patients with CRSwNP and differentiated at air-liquid interface (ALI). A linear scratch was introduced to each monolayer of differentiated HNECs, followed by apical treatment with or without budesonide (2 μg/mL) to simulate topical use. Live-cell imaging assessed time to wound closure. Epithelial barrier function was assessed with trans-epithelial electrical resistance (TEER) before the injury as a baseline, immediately post-injury, and at 12 and 24 hours.ResultsAll wounds closed within 19 hours. The average time to wound closure was 15.1 hours for CRSwNP HNECs exposed to budesonide and 12.3 hours for those exposed to control media. This difference was statistically significant (P = .0033) despite a relatively small cohort. TEER values universally increased following an initial drop from baseline induced by scratch injury. No statistically significant difference in TEER recovery was observed between groups.ConclusionWound closure was delayed in CRSwNP HNECs exposed to budesonide versus control; however, no wounds failed to close, and no difference was identified in the return of epithelial barrier function. Topical corticosteroids may be safely initiated 24 hours following ESS.

BackgroundPatients with chronic rhinosinusitis (CRS) refractory to medical management often require endoscopic sinus surgery (ESS). Oral corticosteroids (OCSs) are frequently prescribed postoperatively, but the evidence of their efficacy is limited.ObjectiveThe purpose of this study is to evaluate the efficacy of OCS use in patients with CRS following ESS.MethodsA systematic search was performed to identify studies examining the use of OCSs in patients undergoing ESS for CRS. The primary outcomes were sinonasal outcome test (SNOT) and Lund-Kennedy (LK) endoscopic scores. Secondary outcomes were visual analog scale (VAS) scores. Meta-analysis was conducted using a fixed effects model with a heterogeneity test via the I2 statistic.ResultsThe search yielded 1899 articles, and 22 were included in the qualitative analysis, 14 of which were randomized controlled trials with 793 total patients. OCS use differed based on type, dosage, and duration. Studies included in meta-analysis did not show a significant difference in SNOT (Standardized Mean Difference [SMD] -0.03, Confidence Interval [CI] -0.47-0.40, I2 0%), LK (SMD -0.20 CI -0.57-0.17 I2 58%), or VAS (SMD 0.19 CI -0.25-0.63 I2 54%) scores between steroid and non-steroid groups. Two studies that assessed OCSs in the allergic fungal rhinosinusitis (AFRS) subtype of CRS showed significant improvement in outcomes. Two additional studies examined OCS versus itraconazole in AFRS, with both groups showing improvement but neither one with greater significance.ConclusionThis study showed no significant difference in SNOT, LK, or VAS scores in patients with CRS who received OCSs following ESS. Given the limited number of studies in the analysis, further investigations are warranted before making recommendations.