Diagnosis Of Chronic Rhinosinusitis Research Articles

Effect of Hormone Replacement Therapy on Chronic Rhinosinusitis Management.

To investigate whether hormone replacement therapy (HRT) impacts health care resource utilization in the management of chronic rhinosinusitis (CRS) in older women. Using the TriNetX US health record database, women 55 years or older with a diagnosis of CRS were included and followed for 3 years. The cohort was stratified into two groups: women who received HRT at the beginning of the study were compared to women who did not receive HRT. The groups were matched by age, race, ethnicity, history of asthma, and history of nasal polyps. Outcomes included whether the patient underwent endoscopic sinus surgery (ESS) and frequency of antibiotic use. Measures of association, Kaplan-Meier analysis, and cohort descriptive statistics were calculated. Of the 65,400 women included, the mean age was 66.9 years. 27.0% and 3.6% of patients had a history of asthma or nasal polyps, respectively. Overall, 2.0% of CRS patients underwent ESS, with the HRT group less likely to undergo ESS [OR: 0.28; 95% CI: (0.25-0.32)] compared to patients who did not receive HRT. When stratified by polyp status, HRT patients with nasal polyps had a greater decrease in ESS rates compared to control than HRT patients without nasal polyps. The HRT group had a higher mean number of antibiotic prescriptions compared to the non-HRT group. HRT is associated with decreased utilization of ESS to treat CRS, with a greater effect size for ESS among CRSwNP patients. However, HRT was associated with higher antibiotic utilization. Level 3 Laryngoscope, 2024.

Obesity is Associated with Increased Risk of New-Onset Chronic Rhinosinusitis: A United States Population-Based Cohort Study.

The aim of this study was to determine the risk of a new-encounter diagnosis of unspecified chronic rhinosinusitis (CRS), CRS with nasal polyps (CRSwNP), and eosinophilic granulomatosis with polyangiitis (EGPA) 1 and 2 years following body mass index (BMI) classification of obesity utilizing a large-population-based analytics platform. Retrospective cohort analysis SETTING: The U.S. Collaborative Network within the TriNetX Analytics platform contains deidentified electronic health record (EHR) data of more than 100 million patients and was used to determine the association between obesity and a new encounter diagnosis of 3 CRS phenotypes in this study. After 1:1 propensity score matching, patients with an overweight BMI and obesity were at a higher risk for a new-encounter diagnosis of unspecified CRS and CRSwNP compared to healthy-weight individuals. The obesity cohort had the greatest increased risk of new-onset unspecified CRS with a relative risk of 1.23 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.24-1.28) 1 and 2 years following BMI classification, respectively. Our study indicates an association between obesity and new-onset unspecified CRS and CRSwNP. With the increasing prevalence of obesity in the United States population, it will be important to understand how obesity-associated CRS may affect treatment response. Future prospective studies are needed to assess causality and define a mechanistic link.

Intraoperative incidental finding of maxillary hypoplasia: a rare case report

Hypoplastic and aplastic paranasal sinuses are rare conditions which can lead to obstruction of mucociliary clearance. most of these patients are asymptomatic, however these conditions may lead to chronic headaches and nasal obstruction which can be misleading towards the diagnosis of chronic rhinosinusitis. it has been reported in literature that conventional radiography could not differentiate between inflammatory pathologies, neoplasm, and hypoplasia of the sinus. Computed tomography and cone beam computed tomography are the modalities of choice to differentiate these conditions, wherein cone beam CT is found to be more accurate for diagnosis of hypoplasia. In the present study, we report an incidental intraoperative finding of hypoplastic left sided maxillary sinus of a 17-year-old male patient who had clinical features of chronic rhinosinusitis.

Imaging of chronic rhinosinusitis with nasal polyps in the era of biological therapies.

Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder of the sinonasal cavities classified into two major phenotypes: CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). The diagnosis of CRS is based on clinical symptoms associated with imaging and/or nasal endoscopy findings of mucosal inflammation. Recently, novel biological therapies have emerged as therapeutic options for CRSwNP. Imaging is helpful in deciding whether surgery is likely to be beneficial and in guiding surgery. It can also help demonstrate a clinical response to medical therapy. However, specific guidelines concerning the role of imaging in CRwNP are lacking. This article provides a comprehensive and critical multidisciplinary review of the role of conventional radiology, computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis and characterization of CRSwNP. Since the complete characterization of nasal polyps on CT or MR images is very challenging, we provide a critical review of the best imaging methods and essential reporting elements used to assess nasal polyps.

Coincidence of chronic rhinosinusitis with nasal polyps and neurofibroma

Background: Nasal polyps are painless inflammatory lesions originated from around the middlemeatus or paranasal sinus cavity; while neurofibroma is benign peripheral nerve sheath tumor. Purpose:To report a rare case of neurofibroma concurrently with nasal polyps in chronic rhinosinusitis. Casereport: A 64-year-old female with chief complaint congestion on the right nose cavity. There was a mass on both nasal cavities. Patient diagnosed with benign mass at right nasal cavity and chronic rhinosinusitis with nasal polyps at left nasal cavity; with a differential diagnosis of chronic rhinosinusitis with bilateral nasal polyps. Computer tomography scan results showed homogeneous isodense lesion in the right nasal cavity, and mucosal thickening in left nasal cavity and maxillary sinus. Patient was managed with total extirpation of the bilateral nasal cavity mass and functional endoscopic sinus surgery. Pathological examination revealed neurofibroma in the right nasal cavity and polyps in the left nasal cavity. Clinical question: “How to differentiate inflammation with tumor of nasal and paranasal sinuses? Is there a causal relationship?” Review method: Literature searching was performed with the keywords “nasal cavity neurofibroma”, AND “nasal polyps”, AND ”chronic rhinosinusitis” through database Google Scholar, PubMed, and hand searching/e-book. Result: There were 11 literatures published in the last 5 years, and 7 articles relevant with the subject. Conclusion: Chronic rhinosinusitis with nasal polyps, along with neurofibroma on nasal cavity is a rare co-incidence, and there was no correlation between those lesions. Pathological examination is a gold standard in differentiating a definite diagnosis of neurofibromas and polyps.Keywords: nasal cavity neurofibroma, nasal polyps, chronic rhinosinusitis

Application of roc-analysis to assess the quality of predicting the risk of chronic rhinosinusitis recurrence

Aim: To propose a new, original approach to assessing the quality of a multivariate regression model for predicting the risk of recurrence in patients with chronic rhinosinusitis based on ROC analysis with the construction of appropriate curves, estimating the area under them, as well as calculating the sensitivity, accuracy, specificity, and predictive value of a positive and negative classification results, the likelihood ratio of positive and negative patient detection results. Materials and Methods: 204 patients aged with a diagnosis of chronic rhinosinusitis were examined. Results: To build a multivariate regression model 14 probable factors of chronic rhinosinusitis occurrence were selected to determine the diagnostic value of the proposed model we calculate the sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), the likelihood ratio of a positive test (LR+), the likelihood ratio of a negative test (LR-) and prediction accuracy % of the proposed mathematical model. In order to determine the prognostic value of the risk ratio of CRS recurrence model, ROC- analysis was performed, ROC curves were obtained Conclusions: The multivariate regression model makes it possible to predict potential complications and the possibility of disease recurrence. The construction of ROC-curves allows us to assert the excellent classification quality of chronic rhinosinusitis recurrence.

Real-Life Effects of Omalizumab on Chronic Rhinosinusitis with Nasal Polyposis.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B lymphocytes in response to a stimulus. Omalizumab is an anti-IgE monoclonal antibody with well-recognized roles in allergic asthma and chronic spontaneous urticaria. The aim of this study was to evaluate the clinical efficacy of omalizumab in a cohort of 13 patients suffering from chronic rhinosinusitis with CRSwNP. The inclusion criteria considered were as follows: 18 years of age, with a diagnosis of chronic rhinosinusitis with severe nasal polyposis expressed by an NPS greater than or equal to 5 and/or a SNOT-22 greater than or equal to 50. In addition, in the enrolled patients, the classic treatment with corticosteroids had to have been suspended due to recurrence after surgery or lack of response. Our results highlighted that omalizumab treatment for 16 weeks improved the parameters analyzed: SNOT-22, NPS, NRS, and NCS. The clinical efficacy of omalizumab was further strengthened by a significant improvement in respiratory function as well as reductions in the nasal polyps' size and in the associated symptoms.

Incidence Rates and Risk Ratios of Normal Tension Glaucoma in Patients with Chronic Rhinosinusitis: A Population-Based Longitudinal Follow-Up Study.

Several studies have investigated the association between chronic rhinosinusitis (CRS) and ophthalmological complications. However, it remains uncertain whether CRS is independently associated with the development of normal tension glaucoma (NTG). Therefore, this retrospective cohort study aimed to investigate the prospective association between CRS and the increased incidence and risk of NTG using a representative population-based dataset. The selection of both the CRS and comparison groups was meticulously conducted through the propensity scoring method. The incidence and risk ratios of NTG were measured using person-years at risk and a weighted Cox proportional hazards model. We enrolled 30,284 individuals without CRS (comparison group) and 15,142 individuals with CRS. The NTG incidence rates were 1.19 and 0.81 in the CRS and comparison groups, respectively. The CRS group showed a significantly increased risk of subsequent development for NTG (adjusted hazard ratio = 1.41, 95% confidence interval = 1.16-1.72), regardless of the CRS subtype. Additionally, the risk of developing NTG was relatively higher in the first 2 years after CRS diagnosis. Moreover, a subgroup analysis revealed a higher risk of NTG in elderly female individuals with CRS. The present findings underscore the importance of monitoring and managing NTG risk in individuals with CRS, especially in elderly female patients.

Recent guidelines addressing chronic rhinosinusitis with nasal polyps: practical aspects.

Chronic rhinosinusitis (CRS) is common in adults. It is diagnosed based on a high index of suspicion alongside objective means of assessing sinus inflammation. Determining the impact of CRS on patient quality of life is an important starting point for discussions regarding treatment, and is critical for longitudinal assessment of response to specific treatments. CRS can be further categorized by the presence or absence of nasal polyps. Recent Joint Task Force on Practice Parameters Grading of Recommendations Assessment, Development, and Evaluation guidelines for the management of CRS with nasal polyps (CRSwNP) focused on 3 treatment options: intranasal corticosteroids with multiple delivery methods, biologics (monoclonal antibodies targeting type 2 inflammation), and aspirin therapy after desensitization, which only applies to the subset of patients with CRSwNP who experience acute respiratory reactions following nonsteroidal anti‑inflammatory drug ingestion. The authors of the guidelines made conditional recommendations in favor of each of these 3 treatment options, highlighting the importance of shared decision‑making when choosing appropriate therapy for individuals with CRSwNP.

Periodontitis of maxillary teeth screened by community periodontal index is associated with chronic rhinosinusitis defined by EPOS 2020 guideline

We aimed to evaluate the association between periodontitis in the upper jaw and chronic rhinosinusitis (CRS) using the nationwide Korean National Health and Nutrition Examination Survey (KNHANES) data. In this cross-sectional study, data of KNHANES participants enrolled between 2008 and 2012 were reviewed. Periodontitis of the upper teeth was diagnosed by dentists according to the community periodontal index with standardized methods. CRS was diagnosed by otorhinolaryngologists according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 with nasal endoscopy findings. We also evaluated the association between periodontitis and CRS according to smoking and drinking status. Univariate and multivariate logistic regression analyses were performed. Overall, 28,761 participants were eligible for analysis, and 210 were diagnosed with CRS. Periodontitis was associated with CRS diagnosis (odds ratio [OR] = 1.391, 95% confidence interval [CI] = 1.013–1.912). Non-drinkers showed no significant association between periodontitis and CRS (OR = 1.142, 95% CI 0.746–1.749). However, among drinkers, periodontitis was significantly associated with CRS (OR = 1.733, 95% CI 1.091–2.753). The number of smokers with CRS was not statistically sufficient and a logistic regression model based on smoking status could not be generated. Individuals with periodontitis in the upper jaw may need to consult an otorhinolaryngologist for comorbid CRS especially according to drinking status.

Endoscopic finding versus CT nose and paranasal sinuses appearance in chronic rhinosinusitis: A comparative study

Background: Chronic rhinosinusitis (CRS) is a common disease encountered in otorhinolaryngology field, however, there is no consensus about its definitive diagnostic method. Nasal endoscopy and sinus CT scan are successfully used as diagnostic modalities. Aim: To evaluate the correlation between nasal endoscopy as compared to sinus CT in CRS diagnosis. Material and methods: A prospective randomized study, in which, 80 patients attended outpatient ENT clinic, from March 2018 to April 2019, whom met the diagnostic criteria of CRS guidelines, were recruited, and the diagnostic modalities were; nasal endoscopy using Lund-Kennedy scoring system, followed with sinus CT scan using Lund-Mackay scoring system within 1 week. Both modalities were compared, with focus on pathological findings, as well as, the specificity, sensitivity, positive predictive value and negative predictive values, in addition, to the anatomic variations data. All the above-mentioned respective parameters were statistically analyzed. Results: Nasal obstruction (92.5%), maxillary sinus (82.5%) with mucosal thicken opacity (83.75%) by CT scan, and muco- -purulent middle meatus discharge (73.75%) by nasal endoscopy. The association between diagnostic endoscopy and CT scan had P value = 0.001 by Student-t-test, and r = 0.734 by Pearson`s correlation coefficient. Diagnostic accuracy of nasal endoscopy was 95%, sensitivity was 91.6 % (95% CI 87.38–93.67%), specificity was 88.3% (95% CI 85.91–89.59%), while positive predictive value 81.7% and negative predictive value was 79.87%. Conclusion: Strong and statistical correlation between the nasal endoscopic and sinus CT findings, also between nasal obstruction symptom and nasal endoscopy, while, no significant difference on anatomical variants data.

Diagnostic therapeutic assistance pathway (PDTA) of type 2 chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a complex and heterogeneous disorder whose etiopathogenetic picture is not yet completely known and is classically divided into CRS with (CRSwNP) and without nasal polyps (CRSsNP). But today the distinction is made with type 2 and nontype 2 variants. A rational and defined pathway for the diagnosis of chronic rhinosinusitis is an indispensable means to be able to arrive at a correct identification of the patient. This typing is essential to be able to arrive at the correct course of treatment, which turns out to be different for different types of patients. For this reason, the realization of a diagnostic therapeutic pathway represents a fundamental way for the otolaryngologist specialist but not only, since today diagnostics has a multidisciplinary framework. In the present work, precise indications have been developed to arrive at a correct diagnosis. The various diagnostic pathways and processes to arrive at a correct therapeutic framing have been highlighted. Therapy ranging from medical therapy to surgical therapy without neglecting the new biological therapies. It does not represent a guideline but a diagnostic method that can be adapted to all the various territorial realities.

Targeting IL-4 and IL-13 Receptors on Eosinophils in CRSwNP Patients: The Clinical Efficacy of Dupilumab.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease linked to type 2 inflammation. Several biologics have demonstrated therapeutic potential for the treatment of this pathology in which IL-4, IL-5 and IL-13 represent the major cytokines involved in the control of eosinophilic respiratory inflammation. 25% of CRSwNP patients relapse after the use of oral glucocorticoids or after surgery and often require several surgeries during their lifetime. In our study we enrolled 14 patients, 11 male and 3 female. The inclusion criteria were: age ≥ 18 years; confirmed diagnosis of chronic rhinosinusitis with severe nasal polyposis; disease severity with NPS Nasal Polyposis Endoscopic Score total score ≥ 5 and/or SNOT-22 ≥ 50; previous treatment failure due to lack of efficacy or discontinuation of systemic corticosteroid therapy and/or non-response or recurrence following surgery. The results presented in this study showed the ability of Dupilumab to improve all the parameters analysed. In particular, statistically significant data were obtained for NPS, SNOT-22, NRS, and IgE in patients exposed to Dupilumab treatment for 24 weeks, highlighting the ability of Dupilumab to produce clinical benefit in CRWwNP patients. In light of these data, the administration of dupilumab every two weeks represents a valid clinical strategy that ENT specialists can adopt for the treatment of adults with inadequately controlled CRSwNP.

Determination of the effect of topical application of N-acetylcysteine on the recovery rate of patients with chronic rhinosinusitis after surgical treatment, based on SNOT-22 test scores

endonasal endoscopic sinus surgery ( FESS ) is the gold standard for the treatment of patients with chronic rhinosinusitis worldwide. The task of the otorhinolaryngologist is aimed at restoring the function of the osteomyetal complex . However, the tactics of the postoperative period, especially the topical form of treatment, remain an extremely important issue. The purpose of the study: Determination of the influence of the topical form of N-acetylcysteine on the speed of recovery of patients after FESS, compared to standardized topical treatment, based on the sino-nasal outcome test. The study was carried out at the Department of Otorhinolaryngology of Bogomolets National Medical University  on the basis of the Oleksandriv Clinical Hospital of Kyiv together with the CNME "Kremenchuk City Hospital of Planned Treatment",  Kremenchuk. A population of 96 patients aged 18 to 60 with a diagnosis of chronic rhinosinusitis after surgical treatment. The randomization method was two groups of patients were formed. 1st group (study) - 47 patients who received irrigation of the topical form of N-acetylcysteine. 2nd group (control) - 49 patients who received topical therapy using irrigation of 0.9% NaCl solution. The volume of surgical intervention of both groups of the study: Endonasal endoscopic maxillotomy, septoplasty , bilateral vasotomy of the lower nasal turbinates. To participate in the study, all participants had to sign an informed consent. All patients were surveyed using the SNOT22 test on the 1st day before surgery treatment and on the 3rd, 10th and 28th days after surgical treatment.According to the obtained results, the effectiveness of both methods of topical treatment was revealed (p=0.001). However, the use of topical N -acetylcysteine in patients of the study group has more effective dynamics of symptoms, according to the SNOT -22 questionnaire on the 3rd (p=0.034), 10th (p=0.002) and 28th day (p=0.001) after surgical treatment. Therefore, the topical form of N-acetylcysteine has an effective effect on the speed of recovery of the mucous membrane of the nasal cavity and paranasal sinuses and improves the quality of life in patients with chronic rhinosinusitis after FESS.

Residential Proximity to a Commercial Pesticide Application Site and Risk of Chronic Rhinosinusitis

Environmental and occupational toxicants have been shown to be associated with an increased prevalence of chronic rhinosinusitis (CRS). However, few to no studies have evaluated patients for CRS using objective testing and workup protocols that fulfill guidelines for CRS diagnostic criteria. Furthermore, no study, to our knowledge, has investigated the risks of CRS in the context of residential exposure through proximity to a commercial pesticide application site. To evaluate associations of residential proximity to a commercial pesticide application site and the prevalence of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSwoNP). This was a retrospective cohort study of patients who presented to a tertiary care institution for rhinology evaluation between March 1, 2018, and December 31, 2022. The outcome variable was the clinical diagnosis of CRS (CRSwNP, CRSwoNP, or non-CRS control). Patients' residential addresses were utilized to determine pesticide exposure status based on a validated computational geographic information algorithm based on data from the California Pesticide Use Report System. The dichotomous independent variable of exposure status (exposed or non-exposed) was determined by assessing reports of any pesticide applications within 2000 m of each participant's residence in 2017. Multivariable logistic regressions assessing CRS status and CRS subtypes were conducted with pesticide exposure as the primary covariate of interest. The primary study outcome and measurements as well as study hypothesis were all formulated before data collection. Among a total of 310 patients (90 CRSwNP, 90 CRSwoNP, and 130 control), the mean (SD) age was 50 (17) years; 164 (53%) were female. Race and ethnicity information was not considered. Controlling for patient demographic information, smoking history, county of residence, and medical comorbidities, pesticide exposure was associated with an approximately 2.5-fold increase in odds of CRS (adjusted odds ratio, 2.41; 95% CI, 1.49-3.90). Pesticide exposure was associated with similar risks for CRSwNP (adjusted relative risk ratio [aRRR], 2.34; 95% CI, 1.31-4.18) and CRSwoNP (aRRR, 2.42; 95% CI, 1.37-4.30). The findings of this retrospective cohort study and analysis revealed that residential exposure to commercial pesticide application within a 2000-m buffer was independently associated with an approximately 2.5-fold increase in odds of being diagnosed with CRS. If validated by additional research, this association would have substantial implications for public health.

Allergic rhinitis masks: Nasal polyposis in two preschool children

Nasal symptoms such as nasal congestion, rhinorrhea, and cough are especially common in children. Despite symptomatic treatment (various nasal sprays, physiotherapy, antibiotics and topical glucocorticosteroids), nasal congestion can persist for a long time. In such cases, several diseases are most likely: adenoids, allergic rhinitis, various anomalies in the structure of intranasal structures and sinuses (for example, curvature of the nasal septum), rhinosinusitis (acute, subacute). If a child has two main symptoms ― congestion and discharge from the nose ― and such additional symptoms as a headache with predominant localization in the paranasal sinuses and a deterioration in smell (possibly also the taste of food) for more than 3 months, it is necessary to exclude the diagnosis of chronic rhinosinusitis, which can be combined with a nasal polyp.
 The purpose of this article is to analyze clinical cases of chronic rhinosinusitis with nasal polyp in two preschool children, including one of them with intolerance to non-steroidal anti-inflammatory drugs, and to raise physicians' awareness of this nosology.
 In children with symptoms such as prolonged nasal congestion, rhinorrhea, possibly impaired sense of smell, headache, intolerance to non-steroidal anti-inflammatory drugs, in the absence of sensitization and immunodeficiency, a computed tomography scan of the paranasal sinuses is recommended to exclude nasal polyp.

Retrospective Analysis of Artifacts in Cone Beam Computed Tomography Images Used to Diagnose Chronic Rhinosinusitis.

Cone beam computed tomography (CBCT) is frequently used to corroborate the signs and symptoms of chronic rhinosinusitis (CRS). However, artifacts induced by dental restorations might complicate the diagnosis of CRS. Here, we assessed the frequency and location of artifacts in CBCT images taken to confirm the CRS. All CBCT images of the patients referred to the Emergency Radiology unit, Turku University Hospital, with an indication of CRS in 2017 were re-examined. The prevalence of the artifacts was analyzed in three cross-sectional views and three horizontal levels delimited by anatomical landmarks. In total, 214 CBCT images of patients with CRS were evaluated. The diagnosis of apical periodontitis (AP) was impaired by artifacts present in 150/214 images (70%). The diagnosis of CRS was impaired in 5 of the 214 images (2.3%). The main origins of the artifacts were large dental fillings or crowns, and endodontic fillings were present in 95% (203/214) and 52% (111/214) of the images, respectively. AP as an etiology of CRS is possible to miss because of artifacts originating from dental and endodontic fillings in the CBCT images of the paranasal sinuses.

Association between ambient temperature and chronic rhinosinusitis.

Chronic exposure to particulate matter air pollution (PM2.5 ) is associated with chronic rhinosinusitis (CRS). Elevated ambient temperature may increase PM2.5 levels and thereby exacerbate sinonasal symptoms. This study investigates the association between high ambient temperature and the risk of CRS diagnosis. Patients with CRS were diagnosed at Johns Hopkins hospitals from May to October 2013-2022, and controls were matched patients without CRS meanwhile. A total of 4752 patients (2376 cases and 2376 controls) were identified with a mean (SD) age of 51.8 (16.8) years. The effect of maximum ambient temperature on symptoms was estimated with a distributed lag nonlinear model (DLNM). Extreme heat was defined as 35.0°C (95th percentile of the maximum temperature distribution). Conditional logistic regression models estimated the association between extreme heat and the risk of CRS diagnosis. Exposure to extreme heat was associated with increased odds of exacerbation of CRS symptoms (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.03-1.19). The cumulative effect of extreme heat during 0-21 lag days was significant (OR 2.37, 95% CI 1.60-3.50) compared with the minimum morbidity temperature (MMT) at 25.3°C. Associations were more pronounced among young and middle-aged patients and patients with abnormal weight. We found that short-term exposure to high ambient temperature is associated with increased CRS diagnosis, suggesting a cascading effect of meteorological phenomena. These results highlight climate change's potentially deleterious health effects on upper airway diseases, which could have a significant public health impact.

Diagnostic value of myeloperoxidase and eosinophil cationic protein in nasal secretions for endotypes of chronic rhinosinusitis.

To explore associations between inflammatory endotypes and clinical presentations in CRS. To investigate the value of secretions myeloperoxidase (MPO) and eosinophilic cationic protein (ECP) detections in the diagnosis of endotypes of chronic rhinosinusitis (CRS), so as to provide guidance for the clinical application of MPO and ECP detection in secretions. We collected clinical symptom scores from patients with CRS and examined the differences between endotypes in clinical features. Patients' nasal secretions and polyps (or middle turbinate for control) were collected and their NEU number, EOS%, MPO and ECP levels were measured. Correlation analysis was performed for these biomarkers in secretions and tissues, respectively. Receiver operating characteristic curves were used to assess the predictive potential of the biomarkers mentioned above in nasal secretions. Patients with Eos+Neu+ and Eos+Neu-CRS scored highest in most clinical symptom scores, while Eos-Neu+ and Eos-Neu-CRS scored lowest. Correlation analysis showed that tissues NEU number was correlated with NEU number and MPO level in nasal secretions (R = 0.4088; 0.6613); tissues EOS % was correlated with EOS% and ECP level in nasal secretions (R = 0.2344; 0.5774). To diagnose Neu+CRS, the highest area under the curve (AUC) (0.8961) was determined for MPO in secretions; the highest AUC (0.7400) was determined for NEU number in secretions. To diagnose Eos+Neu-CRS from Eos-Neu-CRS in Neu-CRS, the highest AUC (0.8801) was determined for ECP in secretions. Clinical presentations are directly associated with CRS endotypes. Measurement of MPO and ECP in nasal secretions is useful for the endotypes diagnosis of CRS.

Association between laryngopharyngeal reflux, gastroesophageal reflux and recalcitrant chronic rhinosinusitis: A systematic review.

To investigate the association between laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant chronic rhinosinusitis (CRS). PubMed, Cochrane Library and Scopus. Three investigators searched the specified databases for studies investigating the relationship between LPR, GERD and recalcitrant CRS with or without polyposis. The following outcomes were investigated with PRISMA criteria: age; gender; reflux and CRS diagnosis; association outcomes and potential treatment outcomes. The authors performed a bias analysis of papers and provided recommendations for future studies. A total of 17 studies investigated the association between reflux and recalcitrant CRS. According to pharyngeal pH monitoring, 54% of patients with recalcitrant CRS reported hypo or nasopharyngeal acid reflux events. The number of hypo- and nasopharyngeal acid reflux events was significantly higher in patients compared to healthy individuals in 4 and 2 studies, respectively. Only one study did not report intergroup differences. The proportion of GERD was significantly higher in CRS patients compared to controls, with a prevalence ranging from 32% to 91% of cases. No author considered nonacid reflux events. There was significant heterogeneity in the inclusion criteria; definition of reflux and association outcomes, limiting the ability to draw clear conclusions. Pepsin was found in sinonasal secretions more frequently in CRS patients than controls. Laryngopharyngeal reflux and GERD may be contributing factors of CRS therapeutic resistance, but future studies are needed to confirm the association considering nonacid reflux events.