Assessment of health-related quality of life and olfactory loss in relation to nasal polyp recurrence after endoscopic sinus surgery in patients with chronic rhinosinusitis: a real life-study

Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps.

Dupilumab improves patient-reported outcomes in patients with chronic rhinosinusitis with nasal polyps and comorbid asthma

ObjectiveTo identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsWe performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP. Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation: sex, serum eosinophil levels, history of prior surgery, endoscopic scores, and comorbid conditions (asthma and allergic rhinitis). The primary outcome was the rate of post-operative intervention on day 30, and the secondary outcome was the rate of polypoid tissue formation (grades 2–3) on days 14, 30, and 90.ResultsA total of 151 patients with CRSwNP were included in the post-hoc analysis. Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30, with an odds ratio of 23.71 (95% CI, 2.81, 200.16; P=0.004) for the need for post-operative intervention and 19 (95% CI, 2.20, 164.16; P=0.003) for moderate-to-severe polypoid tissue formation. In addition, the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30. Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.ConclusionComorbid asthma, but not blood eosinophil level, impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Olfactory changes after endoscopic sinus surgery in patients with chronic rhinosinusitis

Impact of residual ethmoidal laminae on dupilumab efficacy following endoscopic sinus surgery in patients with chronic rhinosinusitis: A STROBE analysis.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinuses characterized by intense inflammation, decreased health-related quality of life (HRQoL), and in severe cases high frequency of co-morbidities and recurrence despite treatment. Conservative treatment consists of nasal lavage, intranasal corticosteroids, and courses of oral corticosteroids, and antibiotics in exacerbations. Endoscopic sinus surgery (ESS) and/or biological therapy is considered if appropriate conservative treatment is not sufficient. The optimal extent of ESS in recalcitrant CRSwNP is not known. The aim of this randomized controlled trial is to evaluate and compare the efficacy and safety of limited ESS with partial ethmoidectomy with extended ESS with total ethmoidectomy in patients with severe CRSwNP. Methods: AirGOs Operative is a randomized controlled trial. It is an investigator-driven multicenter trial led by Helsinki University Hospital. The two surgery arms are compared. The primary outcome is the change in the SNOT-22 score at the 12-month follow-up. Secondary outcomes include the change in the SNOT-22 score at 24-months follow-up, the changes in polyp score, Lund-Mackay (LM) CT score, health-related quality of life (HRQoL), loss of productivity, nasal patency (peak nasal inspiratory flow (PNIF) ± acoustic rhinometry (ARM), olfaction test (Sniffin’ Sticks, identification), lung function (spirometry and PEF) and findings in pathological analysis at 12/24-months follow-up. Discussion: AirGOs Operative trial will lead to a better understanding of the optimal extent of ethmoidectomy in the treatment of recalcitrant severe CRSwNP.

The purpose of this study was to assess voice outcomes after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Individual cohort study. A study was performed of patients with CRSwNP who underwent ESS from July 2015 to May 2016 at a tertiary referral medical center. The main outcome measures were subjective improvement in patient-reported outcomes, using the 22-item Sino-Nasal Outcome Test (SNOT-22) and 10-item Voice Handicap Index (VHI-10). A total of 50 patients (age 47.9 years; 48% female), 66% revision and 34% primary, were available at a follow-up of 3 months. At the 3-month follow-up, both SNOT-22 and VHI-10 scores were improved from preoperative values (-41.8 and -14.7, respectively). Successful treatment of sinonasal disease can help to improve voice outcomes in patients with CRSwNP. There are inherent differences in the long-term outcomes of the results beyond 3 months based on practice patterns of ongoing medical management, but our results are interesting in that they show early improvement in voice outcomes. 2b Laryngoscope, 129:299-302, 2019.

To analyze the factors influencing recurrence after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). A nomogram model for risk prediction was constructed and validated. Retrospective analysis of clinical data of 460 patients with chronic sinusitis and nasal polyps at the 82nd Group Military Hospital of the People's Liberation Army of China from January 2020 to May 2022. Randomly divide into training set (n = 322) and validation set (n = 138) in a 7:3 ratio. Divide the training set into a Recurrence group or a Non-recurrence group based on whether the patient relapses within one year after surgery. Analysis the risk factors of postoperative recurrence in patients and draw a risk prediction nomogram model. Gastroesophageal reflux disease (GERD), bronchial asthma, sinusitis type, allergic rhinitis, eosinophil count, neutrophil count, lymphocyte count, and total sinus score were independent risk factors for postoperative recurrence in CRSwNP patients (P < 0.05). The Nomogram model constructed based on the above factors was validated, and the results showed that the C-indices of the training set and validation set are 0.935 and 0.923, respectively. The internal validation receiver operating characteristic (ROC) curve of area under the curve (AUC) was 0.948; The external validation set AUC is 0.932. The decision curve shows a higher net benefit value when the threshold probability is between 5% and 100%. The predictive nomogram model constructed in this article has high recognition efficiency.

Objective:We sought to compare clinical characteristics between eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma, and explored the association of chronic rhinosinusitis inflammation subtypewith bronchial inflammation phenotype in CRSwNP with asthma. Method:Fifty-one consecutive patients suffering from CRSwNP with asthma undergoing endoscopic sinus surgery (ESS) were recruited. Preoperative computed tomography (CT), skin-prick test, bronchial provocation test, lung function, and oral fractional exhaled nitric oxide (FeNO) measurements were conducted. Venous blood was taken within 1 week before ESS. Nasal polyps (NPs) specimens were obtained from each patient during ESS, and stained with hematoxylin and eosin. According to the pathologic characteristics of NP samples, fifty-one patients suffering from CRSwNP with asthma were grouped as eosinophilic CRSwNP (ECRSwNP) and non-ECRSwNP and three levels of eosinophil infiltration were recognized. Result:Fifty-one patients suffering from CRSwNP with asthma were grouped as ECRSwNP (n=33) and non-ECRSwNP (n=18). History of surgery, history of allergy, Lund-Mackay scores, duration of asthma, frequency of severity asthma, numbers of asthma exacerbation in the last year, FeNO, blood eosinophil percentage and absolute count were all significantly higher in the ECRSwNP with asthma group compared with the non-ECRSwNP with asthma group (P<0.05). Blood eosinophil percentage had a significant correlation with degree of eosinophil infiltration in NPs (r=0.459, P<0.01) and FeNO (r=0.591, P<0.01). There was a correlation between degree of eosinophil infiltration in NPs and FeNO (r=0.556, P<0.01). Furthermore, Lund-Mackay scores had a positive correlation with blood eosinophil percentage (r=0.327, P<0.05) and degree of eosinophil infiltration in NPs (r=0.412, P<0.01) and FeNO (r=0.691, P<0.01). Conclusion:There is different clinical characteristics between ECRSwNP with asthma and non-ECRSwNP with asthma. These data suggest that CRSwNP inflammation subtype is significantly correlated with bronchial inflammation phenotype in patients suffering from CRSwNP with asthma.

BackgroundChronic rhinosinusitis (CRS) is a chronic inflammation of the sinonasal mucosa that is clinically associated with sinus pressure, nasal congestion, rhinorrhea, and a decreased sense of smell that lasts more than 12 weeks. Endoscopic sinus surgery (ESS) for medically refractory CRS is mainly undergone to improve sinus function and access to topical medicinal treatments. However, olfactory changes after ESS can be unpredictable.AimThe current study aimed to assess olfactory change patterns after endoscopic sinus surgery in patients with chronic rhinosinusitis.MethodsA record-based retrospective study was conducted in Aseer Central Hospital (ACH) ear, nose, and throat outpatient (ENT OPD) department and Khamis Mushayt General Hospital from August 15, 2021, to December 15, 2021. Data were collected using pre-structured data extraction sheet to avoid errors. Data extracted and collected included patients’ biodemographic data, CRS-associated symptoms, and endoscopic surgery-related data, including duration since surgery, presurgical medications, and duration of surgery. Also, postsurgical complications were extracted, especially olfactory complications.ResultsA total of 168 patients with chronic rhinosinusitis (CRS) and who had undergone endoscopic sinus surgery in the Aseer region were included. Patient ages ranged from 10 to 61 years, with a mean age of 39.8 ± 12.4 years old. Regarding the associated symptoms and complaints of the study patients, 110 (65.5%) complained of sinusitis, and 86 (51.2%) had allergic RS. The postsurgical complications of patients with CRS who had undergone endoscopic sinus surgery were olfactory dysfunction (OD) in 32 (19%), no complications in 115 (68.55%), and other nonspecific complications, such as headache, drowsiness, nose dryness, and bleeding, in 21 (12.55%). Also, 71 (42.3%) reported that they hardly perceive the fragrance in perfumeries.ConclusionIn conclusion, olfactory impairment is a frequent clinical presentation in patients with CRS. In this study, olfactory dysfunction was improved, except among nearly one out of each five patients after ESS. Olfactory dysfunction was more among patients who had undergone recent surgery and those with chronic rhinosinusitis with nasal polyps (CRSwNP). Also, among patients who reported no complications, olfactory function did not return to normal in most patients as they hardly perceive fragrance.

Our previous study revealed that serum amyloid A (SAA) levels in polyp tissues could serve as a biomarker for the prediction of corticosteroid insensitivity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, their association with disease control status in the patients after endoscopic sinus surgery remains to be assessed. Polyp tissues and control uncinate process mucosa were collected from 48 patients with CRSwNP and 10 healthy control subjects. SAA expression was examined using immunohistochemistry and enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curves were performed to determine the predictive value of SAA in nasal polyps. The clinical characteristics of 2 CRSwNP subtypes (SAAhigh and SAAlow) were evaluated. The SAA expression levels in polyp tissues were significantly elevated both in non-eosinophilic and eosinophilic CRSwNP as compared to the healthy controls. In patients with CRSwNP, the tissue SAA level was significantly higher in the disease-controlled patients than those of the partly controlled and uncontrolled. ROC curve analysis revealed that a cut-off value of 114.9ng/mL for the tissue SAA level predicted the patients with disease-controlled status with 93.33% sensitivity and 63.64% specificity (AUC = .8727, P < .001). Furthermore, The SAAhigh subgroup showed higher tissue eosinophil numbers and percentage of the disease-controlled patients compared to the SAAlow subgroup. Our findings suggest that measurements of SAA in polyp tissues may provide useful information for evaluating CRSwNP conditions, especially identifying the CRSwNP patients with disease-controlled status after endoscopic sinus surgery.

Although patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may benefit from endoscopic sinus surgery (ESS), some patients will experience polyp recurrence, adding to the overall disease burden of CRSwNP. We aimed to investigate predictors of revision ESS in patients with CRSwNP. A nationwide population-based study including all adults diagnosed with CRSwNP who had surgical procedure codes for ESS (N=3506), followed up between January 2012 and December 2019. Logistic regression models provided adjusted odds ratios (OR) with 95% confidence intervals (CIs) for the odds of revision surgery within one and 3years post-index surgery. 559 (15.9%) of the patients had at least one revision surgery during the follow-up. Median time to revision of ESS was 425days (interquartile range: 213-898). Baseline asthma (OR=1.58, 95% CI 1.17-2.12) and antibiotic use (OR=1.61, 95% CI 1.27-2.04) were associated with higher odds of revision ESS, particularly within 3years post-index surgery, whereas Increasing age was inversely associated with the odds of ESS revision (OR=0.82, 95% CI 0.76-0.88). The highest odds of revision ESS were observed within 3years post-index surgery in patients who had undergone extensive surgery at index (OR=14.13, 95% CI 3.41-95.64) compared with those who had undergone limited surgery. OCS use was frequent among CRSwNP patients, with a higher cumulative dose in patients undergoing multiple ESS revisions (63%, n=97, median daily dose 3.29mg, IQR: 1.64-3.70) compared with patients without revisions (49%, n=1361 and 1.64mg, IQR: 1.64-3.29, respectively. p-value <0.001). A small proportion of CRSwNP patients require revision ESS with associated high cumulative OCS doses, highlighting the need for additional therapies to achieve disease control and reduce the corticosteroid burden. A few simple baseline characteristics can predict the need for recurrent surgery among the patients with CRSwNP.

Objective: To analyze the factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: This was a retrospective analysis. Eighty-eight patients with CRSwNP who underwent endoscopic sinus surgery in Beijing Anzhen Hospital from 2014 to 2018 were enrolled, including 22 males and 66 females, with the age of (48.1±11.3) years old(Mean±SD). Sniffin' Sticks olfactory test, Lund-Mackay score and modified sinus CT olfactory cleft score, nasal resistance and acoustic reflex examination, blood routine and blood biochemistry test, serum specific IgE test were performed before surgery and nasal polyps of all patients were collected for eosinophil count during surgery. According to bilateral total TDI score, the patients were divided into normal olfactory function group and olfactory disfunction group. The clinical baseline data were compared between the two groups. According to the results of single factor analysis, factors which were significant different between the two groups and clinically useful indicators were further included in the multivariate Logistic regression model analysis, then a model predicting olfactory disfunction in patients with CRSwNP was initially established. P<0.05 was considered statistically significant. Results: Among 88 patients with CRSwNP, 32 (36.4%) patients were with normal olfaction and 56 (63.6%) patients were with olfactory disfunction, including 40 (45.5%) of hyposmia and 16 (18.2%) of anosmia. Tissue eosinophil count, blood eosinophil percentage and blood urea concentration had significant difference between the two groups (12.7[2.0, 52.3]/HP (M[P(25), P(75)]) vs 38.6[16.2, 87.0]/HP, 2.75[1.60, 4.80]% vs 4.35[2.50, 6.60]%, (5.56±1.15) mmol/L vs (4.98±1.33) mmol/L, all P<0.05). Modified sinus CT olfactory cleft score and Lund-Mackay score except for ostiomeatal complex score were statistically significant between the two groups (all P<0.05). Multivariate Logistic regression analysis showed that the bilateral and total olfactory cleft score and blood urea concentration were statistically significant, in addition, the bilateral and total olfactory cleft score was a risk factor (OR=2.108, 95%CI: 1.407-3.159, P<0.001) and blood urea within a certain concentration was a protective factor (OR=0.461, 95%CI: 0.240-0.884, P=0.020). Further studies found that the area under the ROC curve of the model with tissue eosinophil count, blood eosinophil percentage, bilateral and total olfactory cleft score, total inspiratory volume and blood urea concentration was 0.888 (P<0.01), which had good predictive value for olfactory disorders in CRSwNP. Conclusions: The modified sinus CT olfactory cleft score is closely related to the olfactory disorders in patients with CRSwNP. A certain degree of elevated blood urea concentration may have a protective effect on the olfactory function of patients with CRSwNP.

Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) nasal polyps is a global health concern. Several clinical biomarkers, such as inhaled carbon monoxide and exhaled nitric oxide (NO), have been studied to assess the presence and degree of inflammation in the airway mucosa. To evaluate the clinical application of exhaled nasal NO (nNO) in distinguishing between CRSwNP and CRSsNP in consideration of the atopic status of patients. Eighty-eight patients with CRS and 20 healthy volunteers were recruited for this study. The exhaled nNO level was measured by using a hand-held device. Nasal endoscopy (with Lund-Mackay scoring of CRS) and sinus computed tomographies (CT) were used to evaluate the nasal cavity and sinuses of the subjects. Atopic status was confirmed by using skin prick tests (SPTs). The mean ± standard deviation (SD) levels of nNO in patients with CRSsNP were significantly higher than those in patients with CRSwNP (591 ± 153 ppb versus 360 ± 181 ppb, p < 0.001), whereas patients with CRS exhibited lower levels of nNO compared with the control subjects (449 ± 204 ppb versus 881 ± 161 ppb, p < 0.001). Patients with atopy and with and without nasal polyps exhibited significantly higher levels of nNO compared with patients without atopy (atopic CRSsNP versus nonatopic CRSsNP, 734 ± 120 ppb versus 503 ± 92 ppb [p < 0.001]; atopic CRSwNP versus nonatopic CRSwNP, 518 ± 161 ppb versus 299 ± 150 ppb [p < 0.001]). The levels of nNO were negatively correlated with the Lund-Mackay scores in both atopic (r = -0.45; p = 0.016) and nonatopic (r = -0.600; p < 0.001) patients with CRS. Receiver operating characteristic curves differentiated patients as CRSwNP, CRSsNP, and healthy controls, and in atopic and nonatopic subgroups, with acceptable sensitivity and specificity (>70 to 90%). Exhaled nNO levels can be used to distinguish between patients with CRSwNP and patients with CRSsNP. However, the atopic status of the patient influenced the use of nNO as a diagnostic or monitoring biomarker in CRS.

Fevipiprant in CRSwNP and comorbid asthma: Wrong target population or wrong PGD2 receptor?