Chronic Rhinosinusitis Without Nasal Polyposis Research Articles

Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta-analysis.

Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re-examination of the current literature. Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo-controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio). Ten trials (N=751) were included for meta-analysis, with a mean age of 47.5 years (range: 18-80 years; 95% confidence interval [CI]: 43.9-51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI: 0.3-0.6; p<0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI: 0.1-0.7; p=0.01), but not with topical spray (Δ0.04; 95% CI: -0.9 to 1.0; p=0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR]: 3.4; 95% CI: 1.9-6.0; p<0.0001; OR: 12.4; 95% CI: 1.8-83.8; p<0.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9-4.0; p=0.12). Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.

Early Ear, Nose and Throat Manifestations in Eosinophilic Granulomatosis with Poliangioitis: Results from Our Cohort Group and Literature Review.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, systemic necrotizing vasculitis affecting small-to-medium-sized vessels. EGPA's clinical manifestations are heterogeneous, affecting different organs and systems, and the upper respiratory tract can be affected by ear, nose and throat (ENT) involvement. The aim of our study was to assess type manifestations at the time of diagnosis in a cohort of EGPA patients and correlate findings with baseline variables (sex, age, antineutrophil cytoplasmic antibodies-ANCA-status) and literature reports. The main ENT manifestations in our patients at the time of diagnosis were: chronic rhinosinusitis with nasal polyposis (CRSwNP) (52%), turbinate hypertrophy (48%), nasal swelling (40%), rhinorrhea (40%), chronic rhinosinusitis without nasal polyposis (CRSsNP) (32%), nasal bone deformities (32%), nasal crusts (20%), nasal mucosal ulcers (12%), corditis (12%), hoarseness/dysphonia (12%), hearing loss (12%), mucoceles (4%) and eosinophilic rhinitis (4%). No correlations were found between sex, age, ANCA status and ENT clinical manifestations. A polymorphic ENT involvement is often observed in the early stages of EGPA. The presence of nasal, sinus, ear and/or laryngeal manifestations in patients with asthma and hypereosinophilia, independently of sex, age or ANCA status, should raise an alert for further investigation and differential diagnosis for EGPA. ENT specialists should be aware of their leading position in this diagnostic race.

DUPILAMAB FOR POST-VIRAL SMELL LOSS IN ALLERGIC RHINITIS AND CHRONIC RHINOSINUSITIS WITHOUT NASAL POLYPOSIS

<h3>Introduction</h3> Evaluate effectiveness of dupilamab for post-viral smell loss with allergic rhinitis (AR), and chronic rhinosinusitis without nasal polyposis (CRSsNP). <h3>Case Description</h3> 76-year-old male presented with AR, rhinosinusitis, wheezing, treated with oral/inhaled steroids, nebulized albuterol, and antibiotics. Two weeks later he developed anosmia that did not respond to 2 weeks of prednisone or 6 months of intranasal theophylline. No history of nasal polyps, aspirin sensitivity, whiplash injury/head trauma, neurodegenerative disease. Exam remarkable for normal nares, no polyps, expiratory wheezing. Nasopharyngolaryngoscopy: septal deviation, edematous turbinates. LABS: University of Pennsylvania Smell Identification Test (UPSIT) score of 17 of 40, normal >34; negative CXR; sinus CT: chronic ethmoiditis; reactive allergy testing to pollens/dust mites/molds. PFT: reversible small airways obstruction, positive methacholine challenge. Thyroid functions/antibodies, IgE, CRP/ESR, CBC with differential, chemistries, serum/urine immunofixation/immunoelectrophoresis, ANA/ANCA, immunoglobulins, B6/B2, zinc were normal. Dual maintenance controller treatment failed to completely improve wheezing or PFT and he was started on dupilamab. After 8 months of dupilamab self-administered 300 mg bimonthly, improvement in smell and UPSIT score rose to 21. Wheezing and PFT improved. After 22 months of dupilamab, smell subjectively improved. UPSIT rose to 33 (Figure 1). <h3>Discussion</h3> First case report of post-viral smell loss with AR and CRSsNP with significant subjective and objective improvement in smell with dupilamab. Improvement noted objectively within 8 months of treatment and showed progressive improvement through 22 months of therapy. Based on this case report, further research using dupilamab in individuals with post-viral smell loss with AR and CRSsNP should be considered.

BMP-7, MMP-9, and TGF-β tissue remodeling proteins and their correlations with interleukins 6 and 10 in chronic rhinosinusitis.

Chronic rhinosinusitis without nasal polyposis (CRSsNP) and Chronic rhinosinusitis with nasal polyposis (CRSwNP) present distinct tissue remodeling processes. The proteins involved in the process of tissue remodeling have their production and activity related to the inflammatory environment they are. This study aimed to evaluate the protein expression of BMP-7, MMP-9, TGF-β in chronic sinusitis with and without nasal polyposis and their relations with IL-6 and IL-10. Cross-sectional observational study with 86 participants was divided into three groups: patients with CRSwNP (n = 34), patients with CRSsNP (n = 26), and a control group (CG) without inflammatory disease of the nasal mucosa (n = 26). The primary outcomes were the concentrations of BMP-7, MMP-9, TGF-β, IL-6, and IL-10. Secondary outcomes were the correlations of these markers. The TGF-β dosage was elevated in the CRSsNP group and reduced in the CSwNP group. The dosage of IL-6 was higher in the CSwNP group, and the IL-10 dosage lower in the groups with sinusitis, and IL-10 was positively correlated with BMP-7 in all groups. There was a negative correlation between IL-6 and IL-10 in all groups observed. The correlation between MMP-9 and interleukins was lost in the CRSsNP group. There was a positive correlation between TGF-β and IL-6 in the CG, and negative in the CRSsNP group. An inflammation shown in rhinosinusitis with an increase in IL-6 and decrease in IL-10 when compared with the control group; only TGF-β was altered in the tissue remodeling process when compared with BMP-7 and MMP-9 in rhinosinusitis. There is a loss of correlation between tissue remodeling proteins and interleukins studied in CRSsNP.

Olfactory cleft mucus inflammatory proteins in CRS: a case-control study.

Multiple hypotheses are evolving that suggest several, potentially overlapping etiologies for olfactory dysfunction (OD) in chronic rhinosinusitis (CRS). Understanding inflammatory cytokine profiles of the olfactory cleft (OC) and their association with olfactory function is foundational for future clinical care and research. This cross-sectional, case-control study evaluates associations among OC mucus inflammatory proteins, psychophysical olfactory testing, and computed tomography (CT) analysis of the OC and sinuses. Normative reference intervals were determined for each protein and odds ratios (ORs) were used to compare proportions of altered expression between CRS without nasal polyposis (CRSsNP) and CRS without nasal polyposis (CRSwNP). Case subjects with CRS (n = 151) and controls (n = 74) were evaluated. A majority of OC proteins tested were found within detectable ranges for cases and controls. The CRS cohort had significantly higher concentrations for 23 of 26 proteins. CRS cases with abnormal levels of C-C motif chemokine ligand 2 (CCL2), CCL3, interleukin 5 (IL5), IL10, and IL13 associated with greater olfactory deficits. The prevalence of elevated IL5 and IL13 in anosmic patients was 64.6% and 62.5%, respectively (p < 0.004). CRS cases with the highest odds of elevated expression in CRSwNP were IL5 (OR = 10.83) and IL13 (OR = 8.36). However, both IL5 and IL13 were still elevated in approximately 14% of CRSsNP patients. The highest magnitude of correlation between the total percent of OC opacification was found to be with IL5 (r = 0.543; p < 0.001), whereas other moderate correlations were noted with immunoglobulin E (IgE), IL10, and IL13. This study confirmed that OC inflammatory proteins vary both by disease phenotype and in their association with OD. Type 2 inflammatory mediators are increased in CRS, especially within the CRSwNP group. However, a substantial proportion of CRSsNP also express type 2 inflammatory mediators. Further research is necessary to understand the complex roles OC mucous inflammatory proteins might play in defining endotype and in impacting CRS-related OD. ©2021 ARSAAOA, LLC.

Postoperative Debridement versus No Debridement in Chronic Rhinosinusitis.

Introduction:This study aimed to assess the long-term effects of postoperative debridement on the 4th and 8th postoperative weeks versus no debridement in terms of subjective and objective outcomes.Materials and Methods:The statistical population of this study (n=80) consisted of 40 patients having chronic rhinosinusitis with nasal polyposis (CRSwNP) and 40 patients having chronic rhinosinusitis without nasal polyposis (CRSsNP). These samples were randomly divided into two groups of debridement and control. Results:According to the results, 8 weeks after endoscopic sinus surgery (ESS), the 22-item Sino-Nasal Outcome Test questionnaire score (P =0.03), Lund-Kennedy score (P<0.001), nasal blockage (P=0.02), and loss/decrease in sense of smell (P=0.02) in CRSwNP were significantly lower in the debridement group than in the control group. Moreover, 6 months after ESS, in both CRSwNP and CRSsNP, no significant difference was observed between the two groups considering the outcomes (P>0.05).Conclusion:This study showed that debridement could lead to short-term improvements in CRSwNP patients; however, no long-term benefit was observed.

Microarray analysis of primary epithelial and fibroblast cells in chronic rhinosinusitis without nasal polyps.

Chronic rhinosinusitis is an inflammatory condition with an as yet unknown pathophysiology. We aimed to detect clusters of differentially regulated genes in the epithelial and fibroblast cells of patients with Chronic Rhinosinusitis without nasal polyposis (CRSsNP) and healthy controls. Carefully phenotyped CRSsNP and healthy control participants were recruited. Primary cultures of isolated epithelial and fibroblast cells were established. Whole transcriptome analysis of the cells was performed using microarrays and replicated with quantitative RT-PCR and immunohistochemistry. Fibroblast cells from CRSsNP patients showed a significant upregulation (more than 2x) of the transcription factor NFE2L3 when compared to healthy controls by microarray with multiple hypothesis testing correction, qRT-PCR and immunohistochemistry. Here we have utilized microarray analysis to search for differentially expressed genes in isolated patient derived epithelial and fibroblast cells. The transcription factor NFE2L3 has been shown to be upregulated in fibroblast cells consistent with increasing evidence that fibroblasts play a key role in tissue specific inflammation within the paranasal sinuses.

Differentiation of Clinical Patterns Associated With Rhinologic Disease

Common rhinologic diagnoses have similar presentations with a varying degree of overlap. Patterns may exist within clinical data that can be useful for early diagnosis and predicting outcomes. To explore the feasibility of artificial intelligence to differentiate patterns in patient data in order to develop clinically-meaningful diagnostic groups. A cross-sectional study of prospectively-acquired patient data at a tertiary rhinology clinic was performed. Data extracted included objective findings on nasal endoscopy, patient reported quality of life (PRQOL) instrument ratings, peripheral eosinophil fraction, and past medical history. Unsupervised non-hierarchical cluster analysis was performed to discover patterns in the data using 22 input variables. A total of 545 patients were analyzed after application of inclusion and exclusion criteria yielding 7 unique patient clusters, highly dependent on PRQOL scores and demographics. The clusters were clinically-relevant with distinct characteristics. Chronic rhinosinusitis without nasal polyposis (CRSsNP) was associated with two clusters having low frequencies of asthma and low eosinophil fractions. Chronic rhinosinusitis with nasal polyposis (CRSwNP) was associated with high frequency of asthma, mean (standard deviation [SD]) NOSE scores of 66 (19) and SNOT-22 scores of 41 (15), and high eosinophil fractions. AR was present in multiple clusters. RARS was associated with the youngest population with mean (SD) NOSE score of 54 (23) and SNOT-22 score of 41 (19). Broader consideration of initially available clinical data may improve diagnostic efficiency for rhinologic conditions without ancillary studies, using computer-driven algorithms. PRQOL scores and demographic information appeared to be useful adjuncts, with associations to diagnoses in this pilot study.

Type 1/type 2 inflammatory cytokines correlate with olfactory function in patients with chronic rhinosinusitis.

Olfactory dysfunction secondary to chronic rhinosinusitis (CRS) has been highly associated with impaired quality of life. Asian CRS patients showed a distinct inflammatory profile, with less type 2 endotype compared with European and North American. This study aimed to explore the pattern of the inflammatory cytokines in CRS patients from China and their association with olfactory function. Institutional review board-approved prospective study in which the olfactory function of 71 CRS patients was assessed with Sniffin' Sticks before the nasal endoscopic surgery. A set of cytokines and inflammatory mediators including type 1 and type 2 inflammatory cytokines were measured in nasal mucus by using a multiplex flow cytometric bead assay (CBA). Baseline characteristics in CRS patients were collected and the Spearman r statistic was performed to assess the association of olfactory function with cytokines and inflammatory mediators. A total of 71 nasal mucus samples of CRS patients, including 25 chronic rhinosinusitis without nasal polyposis (CRSsNP) patients and 46 chronic rhinosinusitis with nasal polyposis (CRSwNP) patients, were evaluated in this study. The nasal mucus levels of type 1 inflammatory cytokine IFN-γ (interferon-γ), type 2 inflammatory cytokines including IL-4, IL-5 and GM-CSF (granulocyte-macrophage colony-stimulating factor) and anti-inflammatory cytokine IL-10 were significantly and inversely correlated with olfactory function in total patients with CRS (r=-0.308, p=0.009; r=-0.250, p=0.036; r=-0.399, p=0.001; r=-0.269, p=0.023; r=-0.273, p=0.021, respectively). In CRSsNP, the olfactory function was inversely correlated with levels of type 1 inflammatory cytokine TNF-α (tumor necrosis factor-α) (r=-0.637, p=0.001) and IL-10 (r=-0.468, p=0.018). Nevertheless, the olfactory function in CRSwNP was inversely correlated with type 2 inflammatory cytokines including IL-4 (r=-0.303, p=0.041) and IL-5 (r=-0.383, p=0.009). Both type 1 and type 2 inflammatory cytokines may contribute to the pathogenesis of CRS-associated olfactory dysfunction in the Chinese population.

A study to evaluate the relationship between serum vitamin d level and chronic rhinosinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic rhinosinusitis (CRS) places a relatively large socioeconomic burden on developed nations, yet remains a difficult disease to treat. Vitamin D3 (VD3) deficiency is reported to be associated with increased incidence of allergic airway diseases. The ability of VD3 to augment innate and adaptive immune responses has sparked interest in its immunologic role in allergy. The objective of the present study is to evaluate the relationship between serum vitamin D level and chronic rhinosinusitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 90 patients were included in the study and divided into three groups i.e., 30 patients of chronicrhinosinusitis with nasal polyposis (CRSwNP), 30 patients of chronic rhinosinusitis without nasal polyposis (CRSsNP) and 30 healthy subjects were used as control. The severity of CRSwNP was assessed with the Lund-Mackay (LM) score and polyp grading system. VD3 status was assessed by measuring circulating 25-hydroxyvitamin D (25OHD) by using ELISA. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Serum 25OHD levels (ng/ml±SD) were significantly lower in patients with CRSwNP (16.16±8.86) than in those with CRSsNP (23.28±5.35; p=0.001) and control 44.37±19.87. The incidence of vitamin D deficiency (&amp;lt;20 ng/ml) in CRSwNP and CRSsNP patients were 60% and 20%; however, the incidence of vitamin D insufficiency (20-30 ng/ml) in these patients were 37% and 70%, respectively. A significantly inverse relationship was found between serum 25OHD level and polyp grade (p=0.048), indicating lower serum 25OHD was associated with higher polyp grade. Serum 25OHD was inversely related to both LM endoscopic and LM CT scan score, which is found to be significant (p=0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The available evidence indicates that there is a significant relationship between low VD3 levels and CRSwNP phenotype. Lower 25VD3 levels were associated with more severe mucosal inflammation on nasal endocscoy and CT scan.&lt;/p&gt;

Current indications for balloon sinuplasty.

The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area. The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms. Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia.

Radiographic Nuances in Allergic Fungal Rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) is characterized by higher revision endoscopic sinus surgery (ESS) rates and unique radiographic features when compared to chronic rhinosinusitis with nasal polyposis (CRSwNP) or chronic rhinosinusitis without nasal polyposis (CRSsNP). We hypothesized that an increased frequency of concha bullosa in AFRS or other radiographic nuances might allow for accumulation of allergic mucin and contribute to increased ESS revision rates. A retrospective cohort study was performed. Patient diagnosis (AFRS, CRSwNP, and CRSsNP), basic demographics, and prior ESS rates were collected. A total of 210 consecutive patients were included (AFRS = 70, CRSwNP = 70, and CRSsNP = 70). Pediatric AFRS patients had more unilateral disease (38.1% vs 4.4%; P = .007) and anterior ethmoid skull base erosion (23.8% vs 6.7%; P = .047) than adult AFRS patients. AFRS patients were more likely to be younger (24.9 ± 10.1 years vs 45.6 ± 14.4 years vs 48.7 ± 18.2 years; P < .001), African American (70% vs 14.3% vs 11.4%; P < .001), and have undergone prior ESS (54.3% vs 45.7% vs 31.4%; P = .02) than CRSwNP or CRSsNP patients. Concha bullosa were more prevalent in AFRS patients than CRSwNP or CRSsNP patients across the population (42.9%, 18.6%, and 14.3%; P < .001) and in the setting of no previous surgery (53.1%, 31.6%, and 16.7%; P < .001). In this cohort, pediatric AFRS patients had more unilateral disease and anterior ethmoid skull base erosion. Concha bullosa prevalence was significantly higher in AFRS as compared to those with CRSwNP or CRSsNP, despite prior ESS. Surgeons should consider concha bullosa as a potential anatomical subsite to harbor recurrent or residual disease.

SNOT-22-based clusters in chronic rhinosinusitis without nasal polyposis exhibit distinct endotypic and prognostic differences.

Endotypic and prognosticating features of chronic rhinosinusitis without nasal polyposis (CRSsNP) are poorly understood. Our objectives were to use an unbiased symptom-based approach to: (1) study symptoms, clinical and endotypic features; and (2) identify features predicating outcomes from endoscopic sinus surgery (ESS). Clinical, computed tomography (CT), histopathology, and 22-item Sino-Nasal Outcome Test (SNOT-22) data was collected on 146 adult CRSsNP patients who underwent ESS. Unsupervised network modeling of presurgical SNOT-22 scores was performed to classify symptom-based clusters. Subject characteristics and post-ESS SNOT-22 scores were compared between clusters. Baseline characteristics of the subject population were as follows: females, 56.2%; revision ESS status in 35%; asthma prevalence, 32.6%; median Lund-Mackay CT score, 8; and median SNOT-22 total score, 43. Network mapping and unsupervised clustering of preoperative SNOT-22 scores revealed 4 clusters: (A) severely burdened with high scores in all 4 subdomains; (B) moderately burdened with high scores in the rhinologic subdomain; (C) moderately burdened with high scores in psychological-sleep subdomains; and (D) mildly burdened. The number of previous ESS and asthma prevalence differed significantly between clusters; CT scores were similar. Asthma burden and tissue eosinophilia were greatest in cluster A (p = 0.03). All groups showed significant improvement at 3 months post-ESS (p < 0.0001). At 6 months, patients in cluster C tended to worsen. SNOT-22-based network modeling of CRSsNP patients yielded 4 clusters with distinct features. Asthma prevalence and tissue eosinophilia were highest in the cluster with highest SNOT-22 scores. All patients showed significant improvement from ESS at 3 months; those with high sleep-psychosocial symptoms tended to show worsening at 6 months.

How often is sinus surgery performed for chronic rhinosinusitis with versus without nasal polyps?

There currently are no data on the relative frequency of endoscopic sinus surgeries (ESS) performed for chronic rhinosinusitis with nasal polyposis (CRSwNP) versus chronic rhinosinusitis without nasal polyposis (CRSsNP) in the United States. To compare the rate of surgical interventions for CRSwNP and CRSsNP. Cases identified by CPT codes were extracted from the 2009-2011 State Ambulatory Surgery Databases for California, Florida, Maryland, and New York. Patient demographics, extent of surgery, mean charges, and operating room (OR) time were compared. A total of 97,228 ESS cases were performed in the four states; 29.3% of surgeries were for patients with CRSwNP, 66.0% of patients with CRSsNP, and 4.8% for other indications. The proportion of ESS for CRSwNP varied across states, with California having the highest percentage (34.6%) and Maryland having the lowest (26.4%) (p < 0.0001). Patients with Medicaid (33.8%) and Medicare (32.2%) had higher rates of surgery for CRSwNP compared with patients with private insurance (29.9%) (p < 0.001). Surgeons who performed a higher volume of sinus surgery compared to lower volume surgeons performed a lower percentage of surgery for CRSwNP (24.4 versus 33.5%; p < 0.001). ESS cases for CRSwNP were more extensive (relative risk of four sinus surgeries of 1.88; p < 0.0001), used image guidance more frequently (relative risk, 1.39; p < 0.0001), and were less likely to include a balloon procedure (relative risk, 0.69; p < 0.0001). Patients with CRSwNP had longer OR times (ESS that involved all four sinuses took 14 minutes longer) (p < 0.0001), but no difference in charges compared with patients with CRSsNP who underwent a similar extent of surgery. Almost 30% of ESS were performed for CRSwNP, and these cases were, on average, more extensive, used more OR time, and more often used image guidance than surgeries for CRSsNP. The rate of surgery performed for CRSwNP varied based on geography, payer, and surgical volume, which indicted that patient selection impacted surgical management.

Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis.

Although the majority of patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) suffer from bilateral disease, a subset suffer from unilateral disease. Currently, outcomes following endoscopic sinus surgery (ESS) for medically recalcitrant CRS are inferred from outcomes for patients with bilateral disease. This study compares outcomes of ESS between patients with unilateral and bilateral disease. Patients with CRSsNP who failed appropriate medical therapy and elected ESS were enrolled between 2011 and 2015. Patients were dichotomized according to radiographic evidence of unilateral disease (Lund-Mackay [LM] score = 0 for 1 side) or bilateral disease (LM ≥ 1 for both sides). The primary outcome of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22), with secondary outcomes including the Brief Smell Identification Test (BSIT) and the Lund-Kennedy (LK) endoscopy staging system. A total of 190 patients met inclusion criteria consisting of 19 with unilateral (10%) and 171 with bilateral CRSsNP (90%). Both groups were similar across all preoperative demographic factors, SNOT-22, and BSIT scores. Postoperatively, patients with bilateral disease reported greater improvement in mean SNOT-22 scores compared to unilateral disease, but this difference was not statistically or clinically significant (-24.3 ± 21.1 vs -21.5 ± 24.0, p = 0.582). Mean LK scores improved for patients with bilateral disease but not unilateral disease, without a difference between groups (-2.0 ± 3.5 vs -0.4 ± 2.4, p = 0.090). Patients with unilateral CRSsNP experience improvement after ESS comparable to patients with bilateral disease on patient reported outcome measures.

Health utility values for patients with recurrent acute rhinosinusitis undergoing endoscopic sinus surgery: a nested case control study.

Health utility scores quantify an individual's valuation of particular health states and are vital components of health economic studies and cost-effectiveness research. We sought to characterize health utility values for patients with recurrent acute rhinosinusitis (RARS) both before and after endoscopic sinus surgery (ESS), as well as compare health utility to chronic rhinosinusitis without nasal polyposis (CRSsNP). Patients with RARS (n = 20) and CRSsNP (n = 20) undergoing ESS were enrolled as part of a longitudinal, observational, prospective cohort. Case patients diagnosed with RARS were age- and gender-matched to controls with CRSsNP using a nested case-control design at a 1:1 ratio. Health utility was measured using the Medical Outcomes Study Short Form-6D (SF-6D) survey. Patients with RARS were followed for an average of 14.0 ± 6.1 (mean ± standard deviation) months compared to an average of 14.4 ± 5.3 months for CRSsNP controls (p = 0.779). Mean preoperative SF-6D health utility scores were statistically comparable between RARS (0.71 ± 0.14) and CRSsNP (0.66 ± 0.12; p = 0.341). Both patients with RARS and CRSsNP reported significant postoperative improvement in SF-6D scores from 0.71 ± 0.14 to 0.79 ± 0.13 (p = 0.031) and from 0.66 ± 0.12 to 0.77 ± 0.13 (p = 0.004), respectively. No difference in last postoperative SF-6D scores were found between RARS and CRSsNP (p = 0.583) or in the average magnitude of postoperative improvement (0.08 ± 0.16 vs 0.11 ± 0.13; p = 0.620). Patients with RARS and CRSsNP report significant impairment in health utility as measured by the SF-6D. ESS significantly improves health utility in patients with RARS and CRSsNP to near normative values. These data will help inform future economic analysis and cost-effectiveness research.

The radiologic evaluation of osteitis type and formation in chronic rhinosinusitis with and without nasal polyposis.

To evaluate the amount and type of osteitis observed in chronic rhinosinusitis with nasal polyposis (CRSwNP) and compare it with that of chronic rhinosinusitis without nasal polyposis (CRSnNP). Sisli Etfal Research and Education Hospital, Istanbul, Turkey. Prospective, single-blind, cohort study. Three different patient groups, designated as the CRSwNP, CRSnNP, and control groups, were included in the study. Forty patients who had CRSnNP and/or CRSwNP confirmed with a paranasal sinus computerized tomography (CT) study were included for the study group, and 20 individuals were included in the control group. Paranasal sinus CTs were evaluated and compared for osteitis. Hounsfield units obtained from the right and left agger nasi walls and the medial maxillary sinus wall in the control group were significantly different from the entire group. Similarly, values for the anterior ethmoid wall were statistically significant for the CRSwNP group compared with all the subjects. When the groups were compared to one another, there were significant differences in both the right and left agger nasi walls and the frontal sinus wall. Differentiating and acknowledging osteitis induced by CRSwNP rather than CRSnNP may aid in preoperative planning and indicate where to be more aggressive when excising bony structures. This may help in reducing recurrence and in increasing quality of life.

Prevalence of chronic rhinosinusitis in the setting of Behçet disease.

Behçet disease (BD) is a systemic autoimmune/autoinflammatory, T helper 1-mediated condition. It is well known that the prevalence of a T helper 1-mediated disease increases in the presence of another T helper 1-mediated comorbidity. The purpose of this study was to investigate the prevalence of T helper 1-mediated chronic rhinosinusitis without nasal polyposis (CRSsNP) and T helper 2-mediated chronic rhinosinusitis with polyposis in the presence of comorbid BD. Sixty-nine patients and 74 healthy controls were included in the study. Participants were asked to complete a questionnaire for symptoms of rhinosinusitis. Nasal cavities were scored using the Lund-Kennedy endoscopy scores. Paranasal sinus computed tomography imagings were scored according to Lund-Mackay radiology scores. Skin prick tests were carried out for all participants to determine the predisposing role of allergy (T helper 2 disease) in the etiopathogenesis of rhinosinusitis among patients and controls. Patients' endoscopy, radiology, and skin prick testing scores were evaluated with regard to BD activity.The prevalence of CRSsNP was 23.2 % in BD and 2.7% in normal population. The CRSsNP was more frequently seen in patients than in the healthy controls (P = 0.002). The BD patients displayed worse scores on their left sinonasal endoscopy. No statistically significant difference was seen between BD and control groups with regard to Lund-Mackay radiology scores of both sides. The presence of an allergic response to a specific allergen in skin-prick testing were confirmed in 25 patients (36.2%) and 17 controls (23.0%). However, the difference was not statistically significant. There were positive responses to more allergens when BD activity was reduced.The CRSsNP thought to be of T helper 1-mediated origin was more frequently seen in the presence of comorbid BD.

Serum 25-hydroxyvitamin D Levels are Lower in Chronic Rhinosinusitis with Nasal Polyposis and are Correlated with Disease Severity in Taiwanese Patients

Vitamin D deficiency is reported to be associated with increased incidence of allergic airway diseases and is correlated with the severity of asthma. This study was designed to determine if serum Vitamin D level is lower in chronic rhinosinusitis with nasal polyposis (CRSwNP) patients and if low serum Vitamin D level is correlated with the severity of CRSwNP. New CRSwNP patients undergoing elective endoscopic sinus surgery were recruited. Patients with malignancies or asthma were excluded. Twenty chronic rhinosinusitis without nasal polyposis (CRSsNP) patients were used as control. Demographic characteristic information was collected. The severity of CRSwNP was assessed with the Lund-Mackay (LM) score and polyp grading system. Vitamin D status was assessed by measuring circulating 25-hydroxyvitamin D (25OHD) by using commercial chemiluminescence immunoassay. Data were stratified by factors known to affect serum 25OHD, including sex, race, and body mass index. Serum 25OHD levels (ng/mL ± SD) were significantly lower in patients with CRSwNP (21.4 ± 5.7) than in those with CRSsNP (28.8 ± 6.2; p < 0.001). The incidences of vitamin D deficiency (<20 ng/mL) in CRSwNP and CRSsNP patients were 45.5 and 6.3%; however, the incidences of vitamin D insufficiency (20-30 ng/mL) in these patients were 50.0 and 62.5%, respectively. A significantly negative relationship was found between serum 25OHD level and polyp grade (r = -0.63; p = 0.001), indicating lower serum 25OHD was associated with higher polyp grade. Serum 25OHD was inversely related to both LM score and total IgE level as well; however, statistical significance was not found. A significantly lower vitamin D level was found in a group of Taiwanese CRSwNP patients, which revealed an association with greater nasal polyp size. Serum vitamin D levels could be added to the routine workup of patients suffering from CRS and these data could be used to potentially help determine the disease severity.

Serum 25Hydroxyvitamin D Levels in Taiwanese Patients with Chronic Rhinosinusitis with Nasal Polyposis

Objectives: Vitamin D deficiency is associated with increased incidence of allergic airway diseases and is correlated with the severity of asthma. The study was designed to determine if serum Vitamin D level is lower in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and correlated with the severity of CRSwNP. Methods: Patients with latest diagnosis of CRSwNP undergoing elective endoscopic sinus surgery were recruited. Twenty patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) were used as control. Demographic characteristic information was collected. The severity of CRSwNP was assessed with the Lund-Mackay score and polyp grading system. Vitamin D status was assessed by measuring circulating 25-hydroxyvitamin D (25OHD). Data were stratified by factors known to affect serum 25OHD, including sex, race, and body mass index. Results: Serum 25OHD levels (ng/ml ± SD) were significantly lower in patients with CRSwNP (21.4 ± 5.7) than in those with CRSsNP (28.8 ± 6.2) ( P &lt; 0.001). A significantly negative relationship was found between serum 25OHD level and polyp grade (r=-0.63, P = 0.001), indicating lower serum 25OHD was associated with higher polyp grade. Serum 25OHD was inversely related to both LM score and total IgE level as well; however, statistical significance was not found. Conclusions: A significantly lower vitamin D level was found in a group of Taiwanese CRSwNP patients, which revealed an association with greater nasal polyp size. Serum vitamin D levels could be added to the routine workup of patients suffering from CRSwNP.