American Journal of Rhinology & Allergy最新文献

BackgroundThere is increasing evidence of the contribution of periostin in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP).ObjectiveThis study aims to investigate the expression of periostin in nasal polyp tissue along with serum periostin and its potential function as a biomarker.MethodsThe study included 36 CRSwNP patients and 12 controls. Nasal polyp tissue from CRSwNP patients and inferior turbinate mucosa samples from controls were intraoperatively collected. POSTN gene mRNA expression from nasal polyp tissue was assessed with polymerase chain reaction and periostin levels on tissue samples were measured with ELISA and Western Blot. ELISA was performed to evaluate serum periostin on blood samples collected from patients undergoing functional endoscopic sinus surgery for CRSwNP (n = 36) and results were compared with assays performed on control subjects (n = 12).ResultsTissue periostin gene expression in terms of mRNA levels was significantly elevated in patients with CRSwNP than in healthy control subjects (P-value <.05). Τissue periostin values in CRSwNP patients were also significantly higher in CRSwNP compared to controls. A positive correlation between periostin levels and the presence of asthma and smoking was observed in the patient group. Serum periostin did not present a statistically significant difference between the 2 groups.ConclusionsOur data suggest that periostin expression is upregulated in nasal polyps and might determine a crucial role in the occurrence and evolution of the disease. Periostin appears to be a promising therapeutic target candidate in CRSwNP.

Background and objectivePreviously, it was reported that droplet SLIT in Japanese cedar pollinosis reduced metachromatic cell and eosinophil counts in nasal swabs along with symptom improvement. In this study, it was confirmed that SLIT using tablets also reduces the number of these cells along with symptom improvement, and examined the time course of these effects.MethodsOne hundred twenty-one visits of 57 subjects treated with SLIT occurred in our clinic between January 16 and April 8, 2023 (Jc pollen season). The 57 patients had been receiving SLIT for 0.16 to 7.8 yr, and symptoms were assessed using a self-reported questionnaire. Nasal swab cytology was used to compare the reduction in Mc, eosinophil and neutrophil numbers with that of non-SLIT 110 subjects. We then investigated the timelines of the decrease in Mc and eosinophils and their relationship to symptoms.ResultsC Subjects who received SLIT had significantly reduced moderate to most severe symptoms compared to non-SLIT subjects over the Jc pollen season. There was symptom improvement for subjects with ≤2 yr SLIT treatment, but more improvement after >2 yr of SLIT treatment. Mc and eosinophil numbers in nasal swabs of SLIT subjects were significantly lower than in non-SLIT subjects. Moreover, levels of eosinophilia decreased within 2 yr of SLIT treatment, but further decreased with >2 yr of SLIT. Mc numbers in subjects with >2 years of SLIT were significantly lower than in non-SLIT subjects. There was no significant difference in neutrophil numbers in nasal swabs between non-SLIT and SLIT subjects.ConclusionSLIT administered by tablet was effective in improving symptoms within 2 yr, and further improved after 2 yr. The eosinophil counts also decreased within 2 yr, and further decreased over 2 yr. The Mc count significantly decreased only after 2 yr of SLIT treatment.

BackgroundThe representation of women in otolaryngology has increased significantly over recent decades, yet discrepancies remain in certain subspecialties, including rhinology. Despite overall improvements in gender equity within otolaryngology, the specific demographic trends and scholarly productivity of fellowship-trained rhinologists have not been thoroughly examined.ObjectiveWe aimed to address this gap by examining demographic trends and academic productivity among rhinology fellowship graduates.MethodsThis cross-sectional study examined publicly available data to analyze fellowship-trained rhinologists in the United States, focusing on gender, career stage, practice setting, h-index, and academic rank. Statistical analyses included Fischer's exact test, Wilcoxon rank sum test, ANOVA, and η².ResultsWe included 477 fellowship-trained rhinologists who trained at 31 fellowships. No gender differences in career stage or practice type were found. Despite an absolute increase in women per year (0 to 9, η² = 0.65), the percentage of women in rhinology fellowships has plateaued since 2002 (η² = 0.001), averaging 21.1% (SD = 10.8%). Most fellowship-trained rhinologists were mid-career, with a median of 7 practice years; 55% worked in academics, mainly as assistant professors. Overall, women rhinologists had a slightly lower h-index than men (7 vs 9; P = .01), but when stratified by academic rank, there was no difference in h-index between men and women.ConclusionThe percentage of women fellowship-trained rhinologists has not increased since 2002 (η² = 0.001), remaining at a mean of 21.1%. Contrasting with other subspecialties, women and men rhinologists have similar h-indices by academic rank. However, there are still fewer women in rhinology overall than men.

BackgroundOrbital decompression is an essential tool for reducing proptosis in thyroid eye disease (TED), yet the impact of surgical approach and preoperative factors on outcomes remains uncertain.ObjectiveTo compare proptosis reduction following different orbital decompression techniques, identify additional risk factors that may play a role in surgical orbital decompression outcomes, and develop clinical decision-making recommendations based on these results.MethodsA retrospective analysis was performed on TED patients who underwent endoscopic medial wall, orbital floor, and/or open lateral wall decompression. We evaluated the influence of preoperative comorbidities, anatomic and laboratory values, and surgical approach on postdecompression Hertel exophthalmometry outcomes.ResultsAnalysis encompassed 130 orbits from 80 patients, 83% female, 48 with preoperative diplopia, and mean age of 54.4 years. Preoperative Hertel measurement was predictive of extent of proptosis reduction (P < .0001), indicating that higher initial Hertel measurement predicts greater absolute reduction following surgical intervention. Surgical technique correlated with outcome on univariate analysis (P = .04), but not multivariate (P = .13) analyses. When categorized into preoperative Hertel ranges, combined endoscopic medial and open lateral wall decompression resulted in mean proptosis reduction of 3.13 mm for range 20.01 to 24 mm and 3.85 mm for range 24.01 to 28 mm. Three-wall decompression resulted in mean proptosis reduction of 2.49 mm for and 3.84 mm for these ranges, respectively. Variables such as smoking, body mass index, orbital wall height, and TRAb level, did not affect outcomes. Nine patients had new onset diplopia.ConclusionsPreoperative Hertel exophthalmometry is the strongest predictor of proptosis reduction following orbital decompression in TED. Surgical technique appears to be less impactful on outcome than expected. Surgical decision making should be individualized based on patient goals; these findings can be used to achieve proptosis reduction and limit the risk of new onset diplopia.

BackgroundThe diagnosis of chronic rhinosinusitis (CRS) relies upon patient-reported symptoms and objective nasal endoscopy and/or computed tomography (CT) findings. Many patients, at the time of evaluation by an otolaryngologist or rhinologist, lack objective findings confirming CRS and do not have this disease.ObjectiveWe hypothesized that a machine learning model (MLM) could predict probable CRS using patient-reported data acquired prior to rhinologist-directed treatment. We leveraged patient-generated health data using a machine learning approach to predict: (1) the primary endpoint of sinonasal inflammation on CT evidenced by a Lund-Mackay score (LMS) ≥ 5 and (2) the secondary endpoint of LMS ≥ 5 and ≥2 cardinal symptoms of CRS.Methods543 patients were evaluated at a tertiary care rhinology clinic and subsequently underwent CT imaging with LMS. Patient-reported outcome measures and additional patient data were collected via an electronic platform prior to in-person evaluation. Three MLMs, a random forest classifier, a deep neural network, and an extreme gradient Boost (XGBoost) algorithm, were trained on predictors drawn from patient-generated health data and tested on a naïve test set (90:10 training:test set split). Cross-validation was executed, and model performance compared between algorithms and with linear regression techniques.Results57 predictors were extracted from the patient-generated health data. The best model (XGBoost) achieved an area-under-the-curve (AUC) of 71.3% (accuracy 74.5%, sensitivity 38.9%, specificity 91.9%) in predicting the primary endpoint, and an AUC of 79.8% (accuracy 85.5%, sensitivity 36.4%, specificity 97.7%) in predicting the secondary endpoint. This exceeded the performance of a linear regression model.ConclusionA MLM using patient-generated health data accurately predicted patients with probable CRS (≥2 cardinal symptoms and LMS ≥ 5). With further validation on a larger cohort, such a tool could potentially be used by otolaryngologists to inform clinical utility of diagnostic imaging and for screening prior to subspecialty Rhinology referral.

PurposeFractional nasal exhaled NO (FnNO), fractional exhaled NO (FeNO) and lung function tests were performed in children with moderate-to-severe persistent allergic rhinitis (AR) to investigate the significance of the above indices in the assessment and diagnosis of children with AR.MethodsA total of 135 children with persistent AR were selected and divided into moderate-to-severe and mild groups; serum total immunoglobulin E (IgE), peripheral blood eosinophil counts (EOS), FnNO, FeNO, and lung function tests were performed.ResultsChildren in the moderate-to-severe group had increased levels of FnNO and FeNO and decreased levels of forced expiratory flow at 75% of forced vital capacity as a percentage of the predicted value (FEF75%) and maximum mid-term expiratory flow as a percentage of the predicted value (MMEF%) . IgE in children with AR was positively correlated with FeNO and FnNO and negatively correlated with FEF75% . EOS was positively correlated with FnNO. FeNO was negatively correlated with FEF75% and forced expiratory flow at 50% of forced vital capacity as a percentage of the predicted value (FEF50%). FnNO was negatively correlated with FEF75%, FEF50%, and MMEF%.ConclusionFnNO, FeNO, and pulmonary function tests may help assess disease severity and level of disease control in children with persistent AR.

ObjectivesThis study aims to compare Chitogel^® with topical corticosteroid versus PureRegen^® gel on wound healing and postoperative outcomes in the treatment of chronic rhinosinusitis.MethodsA double-blinded randomized controlled trial was performed with patients undergoing functional endoscopic sinus surgery who were prospectively recruited and randomized to receive Chitogel with triamcinolone to one side of the sinuses and PureRegen to the contralateral sinuses. The patients underwent endoscopic follow-up at 2, 6, and 12 weeks postoperatively. Patient factors including age, gender, smoking status, comorbidities (reflux, allergy, and asthma), and disease specific factor (chronic rhinosinusitis phenotype) were collected. Sinus ostial measurements, adhesions, mucopurulent discharge, edema, crusting, and granulation were assessed. A visual analogue scale questionnaire on quality of life was assessed in each follow-up appointment.ResultsA total of 40 patients were randomized. At 12 weeks, Chitogel had a 10.7 mm² reduction in frontal sinus ostium area compared to 15 mm² in the PureRegen group; Chitogel had a 2.2 mm² increase in maxillary ostium area compared to 0.1 mm² in the PureRegen group; Chitogel had a 27.6 mm² reduction in area of the sinus ostium compared to 28.7 mm² in the PureRegen group. However, these differences were not statistically significant. The difference between the two groups when analysing adhesion, mucopurulent discharge, mucosal oedema, crusting, granulation, and phenotype was not statistically significant. Patient self-directed grading on quality of life was not statistically significant.ConclusionBoth Chitogel with triamcinolone and PureRegen have demonstrated to be great options to prevent adhesion, stenosis, and optimize healing. There were no clinical and statistical differences between both products in wound healing and postoperative outcomes in the treatment of chronic rhinosinusitis.

BackgroundEndoscopic sinus surgery (ESS) is a minimally invasive procedure indicated for medically refractory chronic sinusitis (CRS). As with any surgical procedure, there are potential risks and complications.ObjectiveThe purpose of this study is to report skull base, orbital, and hemorrhagic-associated complication rates following ESS.MethodsA retrospective query on the TriNetX platform identified patients diagnosed with CRS who subsequently underwent ESS in the last 20 years. Outcomes analyses were performed to determine the incidence of skull base (cerebrospinal fluid rhinorrhea, bacterial meningitis, dural tear), orbital (diplopia, optic nerve injury, blindness, epiphora, orbital hemorrhage, canthotomy/canthoplasty), and hemorrhagic (epistaxis, carotid artery injury, blood transfusion) complications within 30 days postoperatively. Kaplan-Meier Analysis estimated survival probability from each complication type. Outcome rates were also compared between female and male patients.ResultsA total of 116 669 patients from 55 healthcare organizations fit the study criteria. The average age at surgery was 47.9 ± 17.9 years. The gender distribution of the cohort was 50% female and 48% male. The risk of skull base, orbital, and hemorrhagic complications within 30 days of the surgery was found to be 0.212%, 0.741%, and 3.00%, respectively. Kaplan-Meier Analysis revealed that survival probability from each complication type was 99.783%, 99.260%, and 96.903%, respectively. Comparison of outcome risks stratified by gender revealed no major differences for skull base and orbital complications; however, males exhibited a significantly higher risk of hemorrhagic complications (3.2% vs 2.8%, P < .0001).ConclusionsThe study supports ESS as a safe procedure for the management of CRS. Though rare, hemorrhagic complications are more common than orbital and skull base complications. Hemorrhagic complications are also more common in men than women. These findings provide insights for counseling patients about ESS risks and benefits.

BackgroundOlfactory dysfunction significantly impacts daily life, affecting safety, appetite, and sensory enjoyment. Olfactory receptor neurons (ORNs) are essential for odor detection, but environmental exposure can lead to dysfunction. Regeneration of these neurons is crucial for maintaining olfactory function, and elevated calcium levels in nasal mucus are linked to this dysfunction.ObjectiveThe study evaluated chitosan nasal gel for persistent olfactory dysfunction lasting over 6 months, focusing on ORNs regeneration and reduced calcium levels in nasal mucus.MethodsA randomized, double-blind trial included 215 participants with persistent olfactory dysfunction lasting over 6 months. Participants were divided into two groups: 116 received nasal chitosan gel, and 99 received a control sodium chloride gel. Over 3 months, 11 participants in the chitosan group and 9 in the control group were lost to follow-up. Olfactory function was assessed with the Sniffin' Sticks test, and calcium levels were measured before and after treatment.ResultsPatients treated with chitosan nasal gel showed an increased composite threshold, discrimination, identification (TDI) score, indicating improved olfactory function. Discrimination and identification scores improved, while threshold scores showed no significant change. Notably, while the total TDI score improved by 4.55 points, it did not reach the threshold for clinical significance (5.5 points). Furthermore, chitosan nasal gel significantly reduced calcium levels in nasal secretions compared to the control group. No improvement was observed in the placebo group, likely due to the strict inclusion criteria targeting individuals with treatment-resistant olfactory dysfunction persisting over 6 months.ConclusionThis small-scale pilot study highlights the potential of chitosan nasal gel to improve specific domains of olfactory dysfunction and reduce nasal calcium levels. However, further studies with larger sample sizes, diverse populations, and longer follow-up periods are required to confirm these preliminary findings.

ObjectivesTo meet the high demand for polymerase chain reaction (PCR) tests to diagnose COVID-19 and rapidly control the outbreak, an efficient and safe molecular diagnostic protocol is necessary. In this study, we evaluated the efficacy and safety of the medical robot developed for non-face-to-face nasopharyngeal swab specimen collection.MethodsIn a nonclinical study, an otorhinolaryngologist collected swab specimens manually and using a medical robot. In a single-institution, randomized, open-label, prospective, exploratory clinical trial, nasopharyngeal swab specimens were collected from the enrolled participants both manually and by using the medical robot.ResultsEvaluation of the efficacy and safety of nasopharyngeal swab collection using a medical robot was assessed. After the operation of the robot, subjective discomfort experienced by the participants and any side effects or abnormalities in the nose were also monitored. Preliminary nonclinical data revealed comparable results between robotic and manual methods in terms of RNA metrics and cytokeratin-8 expression. Minor initial damage to A549 cells by the robot improved with subsequent use. In the clinical setting, the robot-assisted technique yielded a 92.31% detection rate for human RNase P, while the manual method achieved 100%. Post-swabbing discomfort reported by participants was similar for both methods and resolved within 48 h.ConclusionsThe medical robot system could efficiently, safely, and accurately collect nasopharyngeal swab samples in a non-face-to-face manner. Its installation in respiratory clinics, airports, or ports could minimize the infection risk between individuals and healthcare workers, thereby contributing to an efficient distribution of medical resources.