Symptoms Of Chronic Rhinosinusitis Research Articles

Association between outdoor air pollution and chronic rhinosinusitis patient reported outcomes

BackgroundThe aetiology of chronic rhinosinusitis (CRS) is multifactorial with a complex interplay between environmental, microbial endogenous and genetic factors. The impact of outdoor air pollution on prevalence or severity of CRS remains largely unknown.MethodsReal-life geolocation data (2017–2018, Belgium) from 278 CRS patients (2576 health records) using the mySinusitisCoach mobile application were analysed to calculate the patients’ individual exposure to outdoor air pollutants (ozone (O3), black carbon (BC), nitrogen dioxide (NO2) and particulate matter with diameter < 2.5 μm (PM2.5)) and to associate these pollutants with the patients’ sinus related symptoms measured at multiple occasions by visual analogue scale (VAS).ResultsThe adjusted seasonal model for the spring–summer (n = 1000 health entries, N = 83 patients) population revealed an increase of 6.07 (p < 0.0001) in overall CRS symptom scoring for an interquartile range (IQR) increase in exposure to O3 (26.9 μg/m3). An increase of 1.69 (p = 0.05) in total CRS symptom scoring was observed for an IQR increase of PM2.5 (7.1 µg/m3) exposure. Sex-stratified analysis in the spring–summer population showed significant interaction between air pollution and sex with male patients having higher total CRS symptom scores for an IQR increase in exposure to PM2.5 (3.52, p = 0.001), and O3 (8.33, p < 0.0001), while no significant association with symptom severity was seen in the female patients. In the analysis stratified by comorbid asthma, CRS patients with comorbid asthma had higher total CRS symptoms for an IQR increase in exposure to PM2.5 (2.58, p = 0.04) and O3 (7.72, p < 0.0001) while the patients without comorbid asthma had no significant symptom increases.ConclusionExposure to outdoor air pollution is associated with increased symptom severity in CRS patients. The extent to which CRS patients are sensitive to outdoor air pollution exposure varies per season and depends on their sex and comorbid asthma status. mHealth technology has the potential to reveal novel insights on the patients’ exposome and disease severity in the real-life situation.

LB1581. Exhalation Delivery System with Fluticasone (EDS-FLU) Significantly Reduces Acute Exacerbations and Associated Antibiotic Use in Chronic Rhinosinusitis

Abstract Background Data suggest chronic rhinosinusitis (CRS) may be the top reason for adult outpatient antibiotic use; of ≈10 million office visits per year for CRS, ≈70% result in antibiotic use. Acute exacerbations of CRS (AECRS) are common, possibly due to persistently impaired mucociliary clearance, and drive use of antibiotics. No drugs have been shown effective for reducing AECRS. ReOpen1 and 2 are randomized controlled trials that evaluated prevention of AECRS with the exhalation delivery system with fluticasone (EDS-FLU; XHANCE®), a novel device delivering topical steroid into chronically inflamed sinonasal regions not typically accessible with standard nasal sprays (eg, past the nasal valve and above the inferior turbinate). Methods CRS patients were randomized to EDS-FLU one or two sprays per nostril or placebo twice daily (BID) for 24 weeks. Frequency of AECRS, defined as worsening of at least 1 cardinal symptom of CRS (nasal congestion/obstruction, rhinorrhea, facial pain/pressure, hyposmia/anosmia) for ≥ 3 days requiring escalation of medical care (eg, doctor visit, antibiotic or steroid prescription), was analyzed using pooled data from both trials. Results Among 555 patients enrolled, 39.4% were using standard nasal steroids at study entry and 38.8% reported prior sinus surgery. There were 76 AECRS over 24 weeks, almost all (71) resulting in antibiotic use. Patients receiving EDS-FLU had a large reduction in AECRS versus placebo (incidence rate ratio [IRR]=0.39, P=0.001, vs placebo). Reduction was greater at the higher dose (2 sprays/nostril BID) than the lower dose (1 spray/nostril BID): IRR=0.34, P=0.002; IRR=0.44, P=0.012, respectively. 9.9% of low-dose patients and 7.8% of high-dose patients had ≥ 1 AECRS (20 and 15 events, respectively) vs 15.7% receiving placebo (41 events; P=0.012 and P=0.002 vs placebo, respectively). Treatment was well tolerated: adverse events in ≥ 3% of patients and more common in one active group than placebo were epistaxis, COVID-19, headache, and nasopharyngitis. Conclusion EDS-FLU is the first and only medication shown in randomized controlled trials to significantly reduce acute exacerbations of CRS, offering potential to improve antibiotic stewardship by substantially reducing one of the most common drivers of outpatient antibiotic use. Disclosures Ramy Mahmoud, MD, MPH, OptiNose Inc.: Employee of OptiNose Inc.

Chronic Rhinosinusitis in Patients with Primary Immunodeficiency

Introduction: Primary immunodeficiencies are a heterogeneous group of diseases associated with an increased incidence of infections, autoimmunity, autoinflammatory diseases, allergies, and cancer. Rhinosinusitis is one of the most common infections in these patients. In our study, we aimed to determine the presence of chronic rhinosinusitis in our patients with primary immunodeficiency and to investigate the etiology of chronic rhinosinusitis. Methods: Forty-four patients (age range: 4–26 years) diagnosed with primary immunodeficiency were enrolled in our study. Patients were interviewed about the symptoms of chronic rhinosinusitis, and nasal endoscopic examinations were performed prospectively. The results of laboratory tests, medications, skin allergy tests, and the patients’ lung computed tomography were retrospectively recorded from patient files. Results: The distribution of patients’ diagnoses included 38.6% (n = 17) primary antibody deficiencies, 6.6% (n = 3) combined immunodeficiencies, 27.3% (n = 12) combined immunodeficiencies with syndromic features, 6.8% (n = 3) phagocytic disorders, and 20.5% (n = 9) immune dysregulation disorders. There was no significant difference in the frequency of chronic rhinosinusitis among the different immunodeficiency groups. There were no significant differences between chronic rhinosinusitis and conditions such as atopy, hypogammaglobulinemia, and treatments with immunoglobulin and/or azithromycin. The incidence of chronic rhinosinusitis was 77.8% (n = 7) in patients with a history of acute sinusitis and 20% (n = 7) in patients without a history of sinusitis, with a statistically significant difference between them (p = 0.002). Conclusion: Chronic rhinosinusitis is more common in patients with primary immunodeficiencies than in the normal population. For effective treatment, it is necessary to identify the factors that cause chronic rhinosinusitis. Further studies involving larger patient populations are needed to explain the mechanisms of chronic rhinosinusitis.

Evaluation, complications and treatment of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a disease which commonly affects people of all ages and significantly impacts the quality of life. The clinical symptoms of CRS, which is defined by a chronic inflammation of the sinonasal mucosa, include persistent rhinorrhoea, nasal congestion, sinus pressure, and a diminished sense of smell that lasts longer than 12 weeks. CRS can be categorized into two groups: CRS with nasal polyps and CRS without nasal polyps. Inflammatory, environmental, and host factors are responsible for causing CRS although the mechanism is debatable. Diagnostic examination including anterior rhinoscopy, endoscopy or radiography, ideally from sinus computed tomography, can aid in confirmational diagnosis of CRS. The objective of the treatment is to improve mucociliary clearance, nasal drainage and outflow, reduce local infection and inflammation, and facilitate topical medicament access. Nasal saline irrigation and intranasal corticosteroid sprays are the first-line treatments. Antibiotics may be helpful for patients who have symptoms of a superimposed, acute active sinus infection. Endoscopic sinus surgery may be useful if medical therapy is ineffective. Referrals to otolaryngologists should be made for patients who are not responding to first-line medical therapy. CRS if not treated timely can further lead to complications including development of various diseases such as asthma breathing issues, smell disorders and certain bacterial and fungal infections. Effective treatment of the CRS is hence needed. The purpose of this research is to review the available information about evaluation, complications and treatment of CRS.

Comparing the severity of chronic rhinosinusitis symptoms before versus during the COVID-19 pandemic.

COVID-19 measures such as masking, social distancing, and staying indoors may mitigate chronic rhinosinusitis (CRS) symptoms. We evaluate whether these measures correlated with improved symptoms in patients with CRS. This retrospective study compared SNOT-22 survey data from the Northwestern CRS Registry at the time of enrollment and at years 1-5 of follow-up. The final sample consisted of 1826 SNOT-22 surveys for 598 patients. April 10, 2020 to December 31, 2021 was considered "during the pandemic" and prior to March 11, 2020 was considered "pre-pandemic." Wilcoxon test was used to compare SNOT22 at enrollment pre-pandemic versus during pandemic. Separate linear mixed models were performed to estimate SNOT22 at 1 to 5 years after enrollment pre-pandemic versus during pandemic. Subjects enrolled during the pandemic had worse SNOT22 scores than those enrolled pre-pandemic (53 vs. 42, p=.0024). Total SNOT-22 scores were improved during the pandemic than before the pandemic at 1 year follow-up (18.17 vs. 12.22, p=.001). This effect persists when evaluating the nasal (7.33 vs. 5.13, p=.003), sleep (2.63 vs. 1.39, p=.008), function (1.40 vs. 0.72, p=.015), and emotion (0.77 vs. 0.17, p < .001) domains individually. There was no statistically significant difference in total SNOT-22 score at Years 2-5 of follow-up. Patients with CRS experience a greater reduction in symptom severity in their first year of treatment during the pandemic than before the pandemic, plausibly from measures such as masking and staying indoors. 4.

Deviated Nasal Septum a Risk Factor for the Occurrence of Chronic Rhinosinusitis.

The aim of this review article is to determine whether a deviated nasal septum (DNS)is a potential risk factor for the occurrence of chronic rhinosinusitis (CRS). Nasal septal deformities include spur, deviated nasal septum, thickening, and dislocation. Deformities of the nose tip and columella are examples of external deformities, together with the deviated part of either cartilage or both the bony and cartilage part of the dorsum of the nose. Various symptoms of chronic rhinosinusitis include nasal obstruction, nasal or post-nasal drainage, facial pain and pressure, and smell disturbances. For a long time, the deviation of the nasal septum is related to the pathogenesis, progression, and severity of chronic rhinosinusitis. Mechanisms involving mechanical and aerodynamics theory may be used to explain this relationship. Etiology in the occurrence of CRS are allergy, asthma, tooth Infection, immunodeficiency, mucociliary disorders, anatomical irregularities likeDNS, concha bullosa, septum spurring, or an expanded cystic middle turbinate or prominent agger nasi cells that compromise the osteomeatal complex. The computed tomography (CT) scan imaging of the nasal cavity and paranasal sinuses has dramatically improved especially since the use of coronary CT scans. These scans make it simple to find even minute changes and abnormalities in bony structures and mucosal pathologies. An increase in the angle of DNS is significantly linked to specific disease patterns in the osteomeatal complex. This reviewshows that not all subtypes of DNS always result in the development of CRS. Only extremely severe DNS appearsto contribute to the etiology of CRS.

Noninvasive fungal rhinosinusitis: a case series

Introduction:Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. Patients and methods:This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 - April 2021). Results:Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6-24] months of the symptom's onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Conclusion:Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.

Individual SNOT-22 Items Aid in Differentiating Between Spontaneous Cerebrospinal Fluid Rhinorrhea and Chronic Rhinosinusitis Without Nasal Polyps.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)-22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP). A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared. One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P < .001) and was more likely to designate this symptom as most important (P < .001). The CRSsNP group scored significantly higher in nasal blockage (P < .001), thick nasal discharge (P < .001), facial pain/pressure (P < .001), and in the ear/facial (P < .001) and rhinologic (P = .003) domains. Multivariable logistic regression revealed that runny nose (P < .001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P < .001), thick nasal discharge (P < .001), and facial pain/pressure (P = .001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P = .676). Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.

Clinical symptoms of chronic rhinosinusitis with nasal polyps (eosinophilic and non-eosinophilic) are related to sinus computed tomography but not to endoscopic findings

BackgroundIn the clinical assessment of chronic rhinosinusitis with nasal polyps (CRSwNP), evaluation of symptoms, nasoendoscopy findings and sinus computed tomography (CT) scan staging is employed in the management plan. Although prior studies have been done to assess the correlation of the three modalities in CRSwNP, such evaluation in patients with eosinophilic and non-eosinophilic types of CRSwNP requires further investigation. The aim of this study was to correlate the sinus CT scan staging to symptom and endoscopic scores in both types of CRSwNP. Material and methodPatients with CRSwNP were classified into 2 types, eosinophilic and non-eosinophilic. Both types were assessed by Sino-Nasal Outcome Test 22 (SNOT-22) symptom score, nasal endoscopy Lund Kennedy grading (LK) score and sinus CT Lund Mackay (LM) staging score. All three modalities were correlated. ResultsForty-four patients were recruited for this study. There was significant correlation between sinus CT and symptom scores in the eosinophilic (r=.51, p=.031) and the non-eosinophilic (r=.76, p<.001) types. There was no significant correlation between symptom and nasoendoscopic scores in the eosinophilic (r=.12, p=.641) and the non-eosinophilic (r=.22, p=.276) types. There was also no significant correlation between sinus CT and nasoendoscopic scores in the eosinophilic (r=.20, p=.418) and the non-eosinophilic (r=.14, p=.508) types. ConclusionsSinus CT staging correlates well with the symptom score for both the eosinophilic and the non-eosinophilic types of CRSwNP. The good correlation suggests both modalities are a reliable guide for their evaluation and management planning.

Clinical Study of Septal Deviation and Its Association with Sinusitis

Introduction: Aim: To establish association between Septal deviation and sinusitis along with the clinical profile of Chronic Rhinosinusitis in Deviated nasal septum. Methodology: A cross sectional study of 50 patients attending ENT department of VIMS, Bellary with symptoms of chronic rhinosinusitis were included. Nasal trauma, Nasal polyposis, Septal perforation, Allergic rhinitis, Aggressive fungal infections, Odontogenic sinusitis, Neoplasia, Patients &lt;15 yrs of age, Immunodeficiency and mucociliary disorders, Prior history of nasal or sinus surgery, Other anatomic abnormalities were excluded. Included patients underwent detailed clinical examination, Diagnostic nasal endoscopy, X-ray or computed tomography of Paranasal sinuses. Results: Among 50 patients with chronic rhinosinusitis, 36 patients were found to have Deviated nasal septum. Male preponderance was observed in both sinusitis and septal deviation population. Bilateral maxillary sinus (28%) was the most common presentation in CTPNS. We found that significant association was found between anterior and posterior ethmoid sinusitis with Left sided S shaped obstructed or impacted type of deviated nasal septum. Conclusion: Chronic rhinosinusitis is most common rhinological problem encountered worldwide which has greater propensity to cause morbidity. Deviated nasal septum can be associated with significant sinonasal disease, especially a S-shaped obstructed and impacted type of DNS which showed statistically significant correlation with sinus disease in our study. Also, DNS to left, in general, was associated with higher incidence of sinuses disease than central and DNS to right. This study brings to light various presentations of DNS implicated in causation of chronic sinusitis which will influence the treatment decisions and also reduce the morbidity caused by it. Keywords: Chronic Rhinosinusitis (CRS), Deviated nasal septum (DNS)

Improvement of Eosinophilic Rhinosinusitis Headache after Endoscopic Modified Lothrop Procedure: Case Report and Literature Review

The main symptoms of eosinophilic chronic rhinosinusitis are olfactory disturbances, nasal obstruction and posterior rhinorrhea. chronic rhinosinusitis cases, only few reports have described an association between eosinophilic chronic rhinosinusitis and headache.

Chronic Rhinosinusitis and COVID-19

The COVID-19 pandemic has raised awareness about olfactory dysfunction, although a loss of smell was present in the general population before COVID-19. Chronic rhinosinusitis (CRS) is a common upper airway chronic inflammatory disease that is also one of the most common causes of olfactory dysfunction. It can be classified into different phenotypes (ie, with and without nasal polyps) and endotypes (ie, type 2 and non–type 2 inflammation). However, scientific information regarding CRS within the context of COVID-19 is still scarce. This review focuses on (1) the potential effects of severe acute respiratory syndrome coronavirus 2 infection on CRS symptoms, including a loss of smell, and comorbidities; (2) the pathophysiologic mechanisms involved in the olfactory dysfunction; (3) CRS diagnosis in the context of COVID-19, including telemedicine; (4) the protective hypothesis of CRS in COVID-19; and (5) the efficacy and safety of therapeutic options for CRS within the context of COVID-19.

Crenotherapy as a Complementary and Integrative Treatment for Chronic Rhinosinusitis: A Systematic Review and Discussion of Current Evidence Limitations.

Chronic rhinosinusitis (CRS) is a common condition that affects patients' quality of life. Standard treatments for CRS have known side effects and variable efficacy rates. Thus, complementary and integrative (CIM) treatments for CRS such as crenotherapy, which utilizes high mineral content water or vapor as an inhalation therapy, are of continued interest. To summarize and evaluate the current research investigating crenotherapy's therapeutic potential and clinical outcomes for the treatment of CRS. Systematic review and qualitative analysis. A systematic review was performed, with a comprehensive search strategy applied to 6 databases from inception to March 2021: CINAHL, Cochrane, Embase, PubMed, Scopus, and Web of Science. Studies with at least 10 patients, which investigated crenotherapy as the sole or adjunctive treatment for CRS in humans were included. In total, 10 articles out of 756 were included. Of these, 6 were randomized controlled trials. The remaining four articles were non-randomized prospective cohort studies. Six studies assessed clinical symptoms in response to crenotherapy, and there were unanimous improvements in Visual Analog Scale (VAS), Sino-Nasal Outcome Test-20 (SNOT-20), and other quality of life metrics. The studies that assessed inflammatory markers, cytology, or other measures showed significant improvement in neutrophil count, spores, ciliary motility, IgE, and manometry. Minimal to no adverse events were reported across all 10 studies. There is limited data to support crenotherapy's effectiveness in treating patients with CRS. However, published studies suggest that for certain patients crenotherapy can both improve CRS symptoms and objective measures of nasociliary function with minimal side effects. Findings must be interpreted with caution due to study heterogeneity, inconsistent use of standard CRS definitions and outcomes measures, as well as other study design flaws. Given these results, as well as a growing interest in CIM, crenotherapy treatments for CRS deserve further investigation.

Occupational and environmental exposures, the association with chronic sinusitis.

Objectives:To find the association between environmental and occupational exposures and chronic rhinosinusitis (CRS) development.Methods:The Preferred Reporting Items Of Systematic Reviews Guidelines were used when a systematic literature review was conducted to find all published cases of CRS by searching PubMed database and Google Scholar. Published articles between 1989 and 2021 that reported chronic and occupational rhinosinusitis were included. However, articles that reported allergic rhinitis or upper airway diseases and non-English articles were excluded from this study.Results:A total of 97 articles were extracted initially, and 15 articles were reviewed after excluding 82 articles that did not match our inclusion criteria. Most studies linked CRS development to smoke exposure (n=9734), followed by living in rural areas as farms (n=5504). Exposure to pesticides (n=4248) contributed to a higher prevalence of CRS. Blue-collar occupations, such as fire fighters, farmers, and fishermen were significantly related to CRS development in a total of 5260 patients. Chronic rhinosinusitis mainly affected more men (n=8912) than women (n=8076).Conclusion:We found that smoking was the most aggravating environmental factor. Chronic rhinosinusitis symptoms’ severity increased with direct contact with allergens. Thus, the greatest proportion of patients with CRS was those with blue-collar occupations, such as firefighters, farmers, and fishermen.

Chronic rhinosinusitis symptoms differentially impact the likelihood of major depressive disorders.

ObjectivesThe extent to which sinonasal symptoms impact the likelihood of major depressive disorders in chronic rhinosinusitis patients with nasal polyposis (CRSwNP) remains incompletely characterized. In this study, we sought to determine whether individual symptom clusters differentially impact the likelihood of depression in a cohort of CRSwNP patients.MethodsWe retrospectively included 77 patients with CRSwNP. The severity of sinonasal symptoms was assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and grouped according to a previously validated four‐subdomain structure: nasal, otologic/facial pain, sleep, and emotional subdomains. The likelihood of major depressive disorders was assessed using the Patient Health Questionnaire‐2 (PHQ‐2). The clinical characteristic of symptom severity (nasal polyp size) and disease‐specific information, such as the number of previous sinonasal surgeries, were also collected.ResultsThe sleep subdomain was most strongly associated with the likelihood of major depressive disorders, followed by the otologic/facial pain subdomain, after controlling for demographics and clinical indicators of symptom severity (nasal polyp size). We found a SNOT‐22 score ≥ 30.5 to be an accurate indicator of scoring higher than or equal to 2 on the PHQ‐2 in CRSwNP patients. This had a sensitivity of 83.33% and a specificity of 75.47%.ConclusionDistinct sinonasal symptom clusters differentially impact the likelihood of depression in CRSwNP patients. Raising awareness for those with severe sinonasal symptomatology might help identify more patients with a higher probability of comorbid depression. Level of Evidence: 4.

The use of cone beam computed tomography of paranasal sinuses in the investigation and management of rhinosinusitis: a national survey and our ‘one-stop’ rhinology clinic experience

Cone beam computed tomography is an imaging technique that can be used for the paranasal sinuses. This study assessed how widely it is used and the impact it has on chronic rhinosinusitis management in the ENT department of one hospital. A nationwide survey was conducted to assess the use of cone beam computed tomography throughout ENT UK members. A retrospective analysis of four-year rhinology clinic data for patients presenting with chronic rhinosinusitis symptoms was subsequently performed to assess how many scans were achieved the same day and the subsequent patient management. The survey results indicated that a majority of staff do not use cone beam computed tomography to image sinuses (86.5 per cent), and this was largely because of lack of access (92 per cent). This study assessed 355 cone beam computed tomography requests. Overall, 306 cases had a cone beam computed tomography scan on the same day as their clinic appointment with the majority seen back in clinic during the same hospital attendance for the results. Overall, 97 patients were discharged on the same day. This study suggested a lack of awareness and understanding of cone beam computed tomography in managing rhinosinusitis. The 'one-stop' rhinology clinic model offers benefits including reduced patient hospital attendance.

UNILATERAL VS. DIFFUSE CHRONIC RHINOSINUSITIS.

Chronic rhinosinusitis (CRS) is a widespread disease with various symptoms. It is defined as an inflammation of the nasal mucosa and paranasal sinuses lasting for 12 weeks, with symptoms of nasal obstruction and/or congestion and facial pain and/or pressure as well as decreased sense of smell. Despite the widespread prevalence of the disease, the diagnosis and treatment of CRS are still not adequately developed, so many patients remain misdiagnosed. This study involved 150 patients who, according to EPOS guidelines, met the diagnosis of CRS without nasal polyposis. Each patient underwent a computerized tomography (CT) scan of the paranasal sinuses, which was evaluated according to the Lund-Mackay scoring system. Furthermore, patients completed a visual analog scale (VAS) score questionnaire which examined the severity of their symptoms. The aim of this study was to find an association between the degree of mucositis and the clinical symptoms reported by the patient. Our results showed a low positive correlation between nasal secretion and Lund-Mackay score for the bilateral ostiomeatal complex (OMC). Furthermore, a low positive correlation was found between the severity of reduced sense of smell and severity of anterior ethmoid and sphenoid sinusitis. The results demonstrated a low negative correlation between the severity of facial pain or pressure and the severity of inflammation of the anterior ethmoid and sphenoid sinus. The results of statistical testing did not show statistical differences in severity of subjective symptoms for almost all of the observed symptoms in persons with unilateral inflammation and persons without unilateral inflammation, except for cough. People who did not have unilateral inflammation had a more pronounced cough compared with people who had unilateral inflammation. However, these correlations were very mild and not clinically significant, so we cannot say that the distribution of sinusitis significantly affects the occurrence of characteristic symptoms in chronic rhinosinusitis.

ЭФФЕКТИВНОСТЬ РЕСЛИЗУМАБА В ЛЕЧЕНИИ АСТМЫ И КОМОРБИДНОГО ХРОНИЧЕСКОГО РИНОСИНУСИТА С ПОЛИПАМИ

Introduction. Chronic rhinosinusitis with polyps and asthma are comorbid, mutually aggravating, and difficult to treat diseases. The correlation between the severity of chronic rhinosinusitis with polyps and eosinophilic asthma, the similarity of the endotypes of these diseases and the success of humanized monoclonal antibodies for the treatment of severe asthma explain the interest in studying the possibility of using this group of drugs in patients with chronic rhinosinusitis with polyps. Aim. The aim of the study was to assess changes in the severity of symptoms of chronic rhinosinusitis in patients with comorbid asthma against the background of reslizumab treatment. We evaluated clinical effect of treatment, dynamics of subjective and objective characteristics of symptoms of chronic rhinosinusitis and asthma, indices of total and local eosinophilia. Material and methods. The study involved 18 patients with severe eosinophilic asthma selected for treatment with reslizumab. Study protocol: The first examination, performed before starting reslizumab treatment, included assessment of clinical symptoms using the standardized Sino-nasal Outcome Test-22 (SNOT-22) and Asthma Control Test (ACT) questionnaires, endoscopic nasal cavity examination, spiral computed tomography of the paranasal sinuses, rhino cytogram, determination of eosinophils and eosinophilic cationic protein (ECP) in blood, allergological examination using ImmunoCAP method, and external respiratory function study. The results of treatment were evaluated after 6 injections of reslizumab at the dose of 3 mg/kg weight once every 4 weeks. The obtained data were processed using Statistica 12.0 program (StatSoft, USA). The differences were considered statistically significant at p&lt;0,05. Results and discussion. When assessing the outcomes of treatment after 6 injections of reslizumab, both a marked improvement in asthma control (Asthma Control Test – increase from 7,0 [6–8] to 22,0 [16–22]) and a decrease in nasal symptoms (SNOT-22 was 78,0 [62–81] and 39,0 [29–49], respectively) were noted. There was a significant improvement in the Lund-Mackay spiral computed tomography data of the paranasal sinuses (16,0 [11–19] and 7,0 [5–12], respectively), spirometry values, and a decrease in eosinophils and eosinophilic cationic protein content in the blood. In the presence of polyposis rhinosinusitis in patients with severe eosinophilic asthma, a more pronounced effect of reslizumab on the attenuation of asthma symptoms was obtained comparing to patients without polyps. Conclusions. Treatment with reslizumab in patients with eosinophilic asthma and concomitant chronic rhinosinusitis with polyps and eosinophilic chronic rhinosinusitis leads not only to better control of asthma symptoms but also to a significant regression of nasal symptoms.

The clinical impact of self-reported symptoms of chronic rhinosinusitis in people with bronchiectasis.

BackgroundChronic rhinosinusitis affects 62% of adults with bronchiectasis and is linked to greater bronchiectasis severity. However, the impact of symptoms of chronic rhinosinusitis on disease‐specific and cough‐related quality of life is unknown.MethodsIn this cross‐sectional study, adults with stable bronchiectasis and chronic rhinosinusitis symptoms completed the sinonasal outcome test‐22 (SNOT‐22), quality of life–bronchiectasis questionnaire, and Leicester cough questionnaire. Bronchiectasis severity was assessed using the bronchiectasis severity index (BSI) and chest high‐resolution computed tomography (HRCT).ResultsSixty participants with bronchiectasis (mean [SD] forced expiratory volume in 1 s of 73.2 [25.5] %predicted) were included. Greater severity of chronic rhinosinusitis symptoms (based on SNOT‐22) was moderately associated with impaired cough‐related quality of life (according to the Leicester cough questionnaire; all r > −.60) and impaired bronchiectasis‐specific quality of life (based on the quality of life–bronchiectasis questionnaire), with impaired physical function (r = −.518), less vitality (r = −.631), reduced social function (r = −.546), greater treatment burden (r = −.411), and increased severity of respiratory symptoms (r = −.534). Chronic rhinosinusitis symptoms were unrelated to disease severity according to the BSI (r = .135) and HRCT scoring (all r < .200). The severity of chronic rhinosinusitis symptoms was not affected by sputum color (p = .417) or the presence of Pseudomonas aeruginosa colonization (p = .73).ConclusionsIn adults with bronchiectasis, chronic rhinosinusitis has a consistent and negative impact on both cough‐related and bronchiectasis‐specific quality of life.

Olfactory Outcomes With Dupilumab in Chronic Rhinosinusitis With Nasal Polyps

Loss of smell (LoS) is one of the most troublesome and difficult-to-treat symptoms of severe chronic rhinosinusitis with nasal polyps (CRSwNP). To assess the impact of dupilumab on sense of smell in severe CRSwNP. In the randomized SINUS-24 and SINUS-52 studies, adults with severe CRSwNP received dupilumab 300 mg subcutaneously or matching placebo every 2 weeks for 24 or 52 weeks, respectively. Smell was assessed using daily patient-reported LoS score (0-3) and University of Pennsylvania Smell Identification Test (UPSIT; 0-40). Data from the 2 studies were pooled through week 24. Relationships between patient phenotypes and smell outcomes were also assessed. We randomized 724 patients (286 placebo, 438 dupilumab); mean CRSwNP duration was 11 years; 63% had prior sinonasal surgery. Mean baseline LoS was 2.74. Dupilumab produced rapid improvement in LoS, evident by day 3, which improved progressively throughout the study periods (least squares mean difference vs placebo-0.07 [95% CI-0.12 to-0.02]; nominal P < .05 at day 3, and-1.04 [-1.17 to-0.91]; P < .0001 at week 24). Dupilumab improved mean UPSIT by 10.54 (least squares mean difference vs placebo 10.57 [9.40-11.74]; P < .0001) at week 24 from baseline (score 13.90). Improvements were unaffected by CRSwNP duration, prior sinonasal surgery, or comorbid asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. Baseline olfaction scores correlated with all measured local and systemic type 2 inflammatory markers except serum total immunoglobulin E. Dupilumab produced rapid and sustained improvement in sense of smell, alleviating a cardinal symptom of severe CRSwNP.