Infection Of Paranasal Sinuses Research Articles

Microbiological and Molecular Study of Paranasal Sinus Infections of Children with Malignancy and Unknown Origin Fever in Markazi Province, Iran

BackgroundChildren with malignancies are vulnerable to various infections, including sinus infections. Sinusitis is primarily caused by bacterial infections, followed by fungal infections. Due to this issue, evaluating the occurrence, diversity, and antibiotic susceptibility patterns of bacterial species that cause paranasal sinus infections in children with malignancy and unexplained fever is important. ObjectiveInvestigate the bacterial species accountable for sinusitis in children with malignancy and unexplained fever, and determine their susceptibility to antibiotics. MethodsThe study involved collecting 90 sinus samples from children aged 5-15 years with malignancy in Arak city. The isolates were identified using a combination of phenotypic, biochemical, and molecular techniques, including specific PCR and 16S rRNA gene sequencing. drug susceptibility testing was performed following the CLSI 2021 guidelines. ResultsA total of 36 isolates (40%) were obtained, including 4 isolates of Nocardia (11.12%), 4 isolates of E. coli (11.12%), 3 isolates of K. pneumoniae (8.33%), 5 isolates of P. aeruginosa (13.88%), 3 isolates of A. baumannii (8.33%), 4 isolates of S. aureus (11.12%), 3 isolates of S. epidermidis (8.33%), 5 isolates of S. agalactiae (13.88%), 2 isolates of S. pneumoniae (5.55%), and 3 isolates of E. faecium (8.33%). The isolates showed the most sensitivity to imipenem and trimethoprim-sulfamethoxazole and the least sensitivity to erythromycin and tetracycline. ConclusionsThe findings of the study indicate that sinusitis can contribute to fever of unknown origin in cancer patients. Therefore, it is recommended to use a combination of molecular and phenotypic methods for accurate identification of isolates. This approach can provide more reliable and precise results, leading to better diagnosis and treatment of sinusitis infections in children with malignancy.

The Post-COVID Deadly Trio of Mucormycosis, Invasive Aspergillosis, and Acute Kidney Injury: Physician’s Nightmare and Management Dilemma in Resource Constraint Setting

Abstract Invasive fungal infections are common in clinical settings of diabetes mellitus, immunosuppression, malignancy, and organ and tissue transplantation. Fungal infections were reported increasingly during the COVID-19 waves, with many cases ending in fatality. The reason for such increased incidence is deemed to be a mix of factors, with high steroid use being a major contributor. We present a patient with mixed mucormycosis and invasive aspergillus infection of paranasal sinuses, postrecovery from moderate COVID-19 disease. The patient developed acute kidney injury after starting liposomal amphotericin B, and it had to be stopped. The dilemma was “What next?” since the drug of choice could not be continued. The patient was managed with surgical debridement, intense surveillance, and alternate antifungals. The outcome was encouraging. We discuss the dynamics of polyene-induced renal function impairment, the possibility of the use of alternate antifungals and their basis, and the importance of a combination approach as a recipe for success.

Pediatric Odontogenic and Paranasal Sinus Infections.

Odontogenic and sinogenic infections are frequently encountered in the pediatric population. Although the diagnosis is often suspected clinically, imaging can play a significant role in localizing the site of infection, assessing for involvement of deep neck spaces, detection of abscess and other potentially life-threatening complications, and providing valuable information to help with treatment planning. This article reviews the general imaging considerations and anatomy relevant to odontogenic and paranasal sinus infections and describes the salient clinical and imaging features of infectious diseases of the dentition and sinuss.

Isolated fungal sinusitis of the sphenoid sinus - A case report

Introduction: Isolated sphenoidal fungal sinusitis is a rare disease, representing 3% of all sinusitis cases. The disease usually occurs together with other paranasal sinus infections. Viral, bacterial, parasitic, and fungal infections can cause sinusitis. Fungal infection of the sphenoidal sinuses is rarely diagnosed, as it has no characteristic symptoms and is not much different from bacterial or other sinusitis infections. The diagnosis of fungal sphenoid sinusitis is based on history taking, physical examination, and supporting examination. The therapy aims to reduce sinus cavity inflammation, improve drainage, and overcome the pressure on the sinuses that cause painful symptoms. Endoscopic Sinus Surgery (ESS) is a surgical technique on the paranasal sinuses using an endoscope that aims to improve ventilation and mucociliary clearance of the sinuses.

Paranasal Sinus Infection Leading to Orbital Compartment Syndrome – A Case Report.

Sinusitis is the inflammation of the paranasal sinus. Symptoms vary; it includes nasal obstruction, purulent discharge from the nose, facial pain, headache mainly in the frontal region, fever, hyposmia, and generalized malaise. Infection can be caused by a virus, which is the most common, followed by bacteria and fungi. Treatment will be based on etiology and can vary between 2 to 4 weeks. Early detection of infection and initiation of treatment is crucial and can prevent complications. Orbital complication is the most common complication due to its proximity, and if it is not identified early and addressed accordingly, the outcome will be unfavorable.

COVID-19 infection and extensive subdural empyema: cause or consequence?

Adolescent, female, 12 years old, with a history of headache and vomiting, without fever, with progressive worsening and coma. Laboratory tests showed positive SARS-CoV-2 PCR RNA. She has not had the vaccine for COVID-19. A non-contrast-enhanced cranial tomography(Figure 1a) showed a right fronto-temporo-parietal cortical hypodense area with significant midline shift. A decompressive craniectomy was performed with drainage of extensive subdural empyema(Figure 1c). Subdural empyema is most often a consequence of paranasal sinus infections. With the COVID-19 virus also located in the paranasal sinuses, it is not possible to determine whether it is a consequence or cause of subdural empyema (1). Although the pathophysiology is unclear, it is possible that upper respiratory infection by COVID-19 creates a favorable environment for bacterial sinusitis coinfection(Figure 1b), intracranial extension, and formation of subdural empyema (2). Another possible explanation is that the SARS-CoV-2 virus infection affects the immune system and makes the individual more susceptible to infection (3). Therefore, more studies are needed to clarify the relationship between SARS-CoV-2 infection and other infections. Figure Caption Figure 1 (a) Computed tomography of the skull, with the axial section showing a right fronto-temporo-parietal hypodense area(black arrows) with significant midline shift(black arrowheads). (b) Computed tomography of the skull, with the coronal section showing signs of sinusitis with opacification of the right ethmoid sinus(black arrow). (c) Intraoperative view after opening the dura mater showing exposure of the right fronto-temporo-parietal cortex covered by viscous purulent secretion(black arrow). (d) Computed tomography of the skull, with the coronal section showing after treatment without ethmoid opacification(black arrow) and small postoperative CSF collection(black arrowhead).

Sensitivity of KOH Mount in the Early Diagnosis of Fungal Infections of Nose and Paranasal Sinuses in COVID-19 Infected Patients Suspected with Mucormycosis

Introduction: Mucormycosis represents a group of life threatening infections caused by fungi of the order Mucorales especially in Coronavirus Disease 2019 (COVID-19). It is a highly invasive and rapidly progressive disease resulting in high grades of morbidity and increased mortality. Aim: To study the sensitivity of potassium hydroxide (KOH) mount in the early diagnosis of mucormycosis in COVID-19 infected patients. Materials and Methods: A prospective, longitudinal (single group) study was done in McGANN Teaching District Hospital, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, among the patients with high index of clinical suspicion of mucormycosis from May 2021 to August 2021. Specimen from the nasal cavity or the suspected lesion on hard palate, gums, skin was sent for KOH mount and fungal culture and also biopsy of the nasal mucosa sent for histopathological examination. The sample was sent both preoperatively and intraoperatively. The positive KOH report and its role in early diagnosis and management of mucormycosis suspected cases were assessed. Results: Out of 26 patients, 6 (23.1%) were females and 20 (76.9%) were males. COVID-19 positive suspected mucormycosis were 5 (19.2%) and post COVID-19 suspected mucormycosis were 21 (80.8%). Species isolated after processing the sample were rhizopus in 10 (38.5%), candida in 1 (3.8%), aspergillus in 1 (3.8%); while in 14 (53.8%) no organisms were isolated. Out of 26 patients KOH positive sample on the day of admission confirming with positive intraoperative histopathological examination were 10 (41.7%). Admission day fungal culture positivity was seen in (n=12, 46.2% ) and negativity in 14 (53.8%) cases. Intraoperative fungal culture was positive in 24 (92.3%) cases. There was 100% specificity for both fungal culture and KOH mount and sensitivity for KOH was 41.7% and 50% for fungal culture. False negativity rate for KOH was 58.3% and for fungal culture was 50%. Conclusion: The results of KOH mount can be obtained within an hour of sending nasal scrapping samples. Hence, it helps in making the early diagnosis and early initiation of treatment for suspected cases. But in the current study, even in patients presenting with high clinical suspicion of mucormycosis, the sensitivity of KOH mount on the day of admission to the hospital was 41.7%.In view of severe morbidity and mortality of mucormycosis, this sensitivity though less is of paramount importance in these patients because treatment can be started early.

Is Brain MRI Essential for the Evaluation of Headache in Patients with Normal Neurological Examination?

Aim: Headache is amongst the most common reasons of consulting a doctor. In addition to impairing the quality of life of the individual, there are societal as well as fiscal outcomes like workforce loss along with health expenditures. MRI findings of patients with headache were examined retrospectively through the relevant literature with a view to scrutinizing the necessity of the very procedure carried out, and the results were shared accordingly. Through our study we delved into the recent situation in our country and investigated whether MRI devices with advancing and novel technologies give dissimilar results with diffusion and sensitivity-weighted images in the MRI findings of patients who seek medical advice visiting a health institution with complaint of headache. Materials and Methods: The study included 224 patients over the age of 18, who underwent brain MRI between January 2020 and December 2021 in our center, with normal findings on neurological examination and who had not undergone surgery. All abnormal appearances such as mass, metastasis, aneurysm, hydrocephalus, encephalitis, sinusitis, mastoiditis, otitis, which may cause secondary headache, were recorded in MR images. Results: Of the 224 patients, 120 (53.57%) were male and 104 (46.43%) were female. The mean age was 39.45±12.55 years. None of the 224 examinations revealed mass suspicious for malignancy, aneurysm, encephalitis, or meningitis. Extraaxial mass lesion compatible with meningioma was detected in 3 patients (1.33%), arachnoid cyst in 3 patients (1.33%), and developmental venous anomaly in 2 patients (0.89%). There was paranasal sinus infection in 145 patients (64.73%), mastoiditis in 37 patients (16.52%), and otitis in 8 patients (3.57%). The remaining 66 patients had no MRI findings except ischemic-gliotic changes, enlarged perivascular distances, and physiological calcifications. Conclusion: In studies designed according to CT and MRI examinations taken regardless of neurological examination and history, the rate of completely normal findings is quite high, as in our study. MRI scans conducted for these patients, who can indeed solely be diagnosed with examination or simpler imaging methods, lead to loss of time and money. In order to fix the said situation, we are of the opinion that the red flag practice should become widespread and nonessential examination requests should be supervised.

The effectiveness of platelet rich plasma therapy in chronic sinusitis patients with odor disorder undergoing endoscopic sinus surgery

Objectives: In this study, the objective was to compare the effectiveness of fluticasone dipropionate and platelet-rich plasma treatments added to the treatment in patients undergoing functional endoscopic sinus surgery in patients with chronic sinusitis involving odor dysfunction, different stages and types of sinusitis. Methods: The study included a total of 60 patients between 18 and 60 years who underwent endoscopic sinus surgery due to chronic paranasal sinus infection followed by olfactory dysfunction. Group 1: paranasal sinus surgery + steroid therapy (first 30 patients) and Group 2: paranasal sinus surgery + steroid therapy + PRP therapy (second 30 patients) were grouped together without the patients' knowledge of the operating physician and of the treatment protocol. For the paranasal sinus CT evaluation, Lund-Mackey staging was used and the degree of the disease was determined using the Kennedy staging system. Modified Sniffin Stick test was applied to all patients in the preoperative 1st week and in the 3rd month postoperatively. The Modified Sniffin Stick test was conducted on all patients during the preoperative 1st week and the postoperative 3rd month. The modified Sniffin Stick test and endoscopic evaluation score were evaluated and whether or not the patients benefited from PRP treatment were compared. Results: According to the postoperative endoscopy score, there was a difference between the experimental group and the control group in terms of postoperative endoscopy score, and it was found to be statistically significant. Besides, the postoperative endoscopy score of the experimental group was found to be lower than the control group. The average of Modified Sniffin’ Stick Test scores in the postoperative period of the patients in the study was 28.27 ± 7.88 for the experimental group, while it was determined as 20.08 ± 5.75 for the control group, and this difference was statistically significant. The average anosmia times of the experimental and control group patients in the study were compared, and the mean duration of anosmia was 48.53 ± 20.40 (6-96) for the experimental group and 44.27 ± 19.45 (6.96) for the control group. The difference in the mean duration of anosmia between the experimental and control groups was not found statistically significant. Conclusions: In this research, PRP, which is applied to functional endoscopic sinus surgery and fluticasone dipropionate treatment, has been shown to be a readily applicable, safe and highly efficient method of treatment in patients with chronic sinusitis accompanied by smell dysfunction.

WHEN FLU LEADS THE WAY: A CASE OF PARVIMONAS MICRA POLYMICROBIAL EMPYEMA IN A PATIENT WITH INFLUENZA A INFECTION

WHEN FLU LEADS THE WAY: A CASE OF PARVIMONAS MICRA POLYMICROBIAL EMPYEMA IN A PATIENT WITH INFLUENZA A INFECTION

Sino-orbital gas gangrene – A guest unknown

Orbital cellulitis is a dreaded entity that can lead to an array of complications from visual loss to cavernous sinus involvement. Paranasal sinus (PNS) infection and trauma are the most common etiology. We report a case series of three patients who were victims of landslide and developed orbital cellulitis. Facial edema, proptosis, central retinal artery occlusion and hyperdense foci in the orbit, and PNS with proven growth of Clostridium perfringes were the common features in all these patients. Natural calamity leading to this fulminant infection led to mortality of all three patients. This is the first case series of sino-orbital gas gangrene in victims of heavy rainfall causing landslide.

Management of Oral Cavity Mucormycosis in a Ketoacidotic Patient with Targeted Debridement and a Palate Obturator

Mucormycosis is an opportunistic mycosis common in poorly-controlled insulin dependent diabetic patients particularly with ketoacidosis. It often begins as a nasal and paranasal sinus infection with inhalation of spores into the paranasal sinuses of a susceptible host. In this case report we review the clinical symptoms, relevant imaging.

Fungal Infections of Paranasal Sinuses: Sequelae to 2020 Pandemic

Background: In recent decades, the prevalence of fungal sinus infection has increased. It’s plausible that this is related toincreased awareness, antibiotic usage, and the use of immunosuppressive drugs. Furthermore, much has been written onthe involvement of fungus as a causative organism.Objectives: To identify fungal pathogens and correlate laboratory findings with clinical findings.Materials and Methods: Patients with AIFR following recent COVID-19 infection were included. After performingpotassium hydroxide (KOH) wet mounts, post-operative material was collected and cultured on two tubes of Sabourauddextrose agar (SDA) and stored at 250 C and 370C for isolation and identification.Results: Out of 329 diabetic individuals with AIFS following COVID-19 infection, 51% exhibited mucopurulent dischargeand 75.6 % had unilateral involvement. Only 57.4% of KOH mount samples were positive for fungal components, however76.3% of SDA samples exhibited positive growth, with 62 % Mucorales, 8% Aspergillus, and 6 % Candida species.Conclusion: Mucor mycosis can develop in COVID-19 patients, particularly those with diabetes, a high and imprudentuse of corticosteroids, and invasive ventilation. KOH test resulted in a preliminary diagnosis, whereas Culture remainsthe gold standard for identification.

Fanconi Anaemia, What Anaesthesiologists Should Consider about.

Fanconi anaemia (FA) is a rare autosomal recessive inherited disease, which consists of bone marrow failure, skeletal deformities and multi organ nvolvement. Here, we report an emergency surgery on a FA patient with mucormycosis infection of paranasal sinuses. Since there are a few reports about FA, there is no general consensus on anaesthetic considerations so we deal with recommendations that are based on the pathology of FA. Possible difficult air way is the main concern, and low oxygen concentration and avoidance of nitrous oxide are among recommendations.

COVID-19–associated central nervous system mucormycosis

Mucormycosis is a life-threatening infection caused by fungi of the order Mucorales. Central nervous system (CNS) mucormycosis is usually an extension of the infection from the sinuses to the eyes and brain. CNS mucormycosis arises from an adjacent paranasal sinus infection (rhinocerebral) by direct extension or hematogenous dissemination from the lungs, but isolated CNS mucormycosis is a rare presentation. During an episode of fungemia, seeding may occur in brain tissue, leading to this infection. The most common clinical presentation of mucormycosis is rhino-orbital-cerebral infection, which is presumed to start with inhalation of spores into the paranasal sinuses of a susceptible host. In this article, we emphasize on the COVID-19–associated mucormycosis, particularly the involvement of CNS.

Mucormycosis and its implication in COVID-19

Mucormycosis is a life-threatening fungal infection caused by a group of moulds known as mucormycetes. It is a viral disease, increasingly progressive, rapidly triggers in diabetic, immunocompromised and trauma patients. Diabetic patients seem to have the classic rhinocerebral variant. Rhinocerebral mucormycosis begins as a nasal cavity, paranasal sinus, and orbital soft tissue infection. In immunocompetent patients, direct injection also induces cutaneous form. Cutaneous mucormycosis occurs in soft tissue and may infect underlying tissues. Mucormycosis is more frequent in people with major underlying disorders such as diabetic acidosis or acute leukaemia and those taking corticosteroids or cytotoxic drugs. This disease occurs in patients by inhaling fungus spores. Mucormycosis occurs in clinical manifestations. Disseminated mucormycosis is a rare form of mucormycosis, affecting individuals with compromised immune systems. The disease travels to other areas of the body, thereby being prevalent. Brain, core, spleen, eyes, and other organs are among the organs that may be affected. Mucormycosis is a dangerous infection that requires antifungal drugs such as amphotericin B, posaconazole, or isavuconazole. This compilation addresses conceptual background on medicines used to treat mucormycosis, especially in India.

Image findings in patients with chronic invasive fungal infection of paranasal sinuses

ObjectivesMore clear classification of chronic invasive fungal infection of paranasal sinuses in the clinical presentation, radiologic findings, and pathology is needed. To describe the imaging findings of patients with chronic invasive fungal sinusitis (CIFS) and chronic granulomatous invasive fungal sinusitis (CGIFS). MethodsEleven patients with CIFS or CGIFS between January 2014 and July 2019 were included in this retrospective study. The demographic, pathologic, and imaging characteristics of the included patients were reviewed by rhinologist, pathologist, and radiologist, respectively. In terms of imaging analysis, overall lesions were categorized as diffuse infiltrative and mass-forming patterns. ResultsAmong eleven patients, ten patients were aged ≥ 60 years (mean age 74.2 years) and nine had hypertension and/or diabetes mellitus. Aspergillus species were the most common pathogens (82%). Of the seven patients with CIFS, five (71%) had diffuse infiltrative patterns and two (29%) had mass-forming patterns, whereas all four patients (100%) with CGIFS had a mass forming pattern. All 11 patients showed both bony erosion and sclerosis. Almost all proven pathologic sites showed predominantly intermediate to high signal intensity on T1WI. ConclusionsCIFS or CFIFS showed chronic course of rhinosinusitis in the patients with old age, imaging findings of bone erosion and sclerosis, and imaging patterns of diffuse infiltration or mass formation.

Cerebral venous sinus thrombosis: Clinical profile and surgical outcome

Thrombosis of the cerebral venous sinuses (CVST) is common cause of acute neurological deficit and altered sensorium. Most of the patients are young and can suffer severe morbidity and mortality if not treated aggressively. Early diagnosis and management is necessary for good outcome in case of CVST. Material and Methods: Retrospective observational study over a period of 4 year 3 months from oct' 2013 to feb'2018 in our institute. CVST was affirmed by MRI brain venogram of 84 patients were included in this study. Decompressive craniectomy done in case of mass effect or herniation. All patients were treated according to standard guideline and protocol. Result:This study include 51 (60.7%) females and 33 (39.2%) males with the age of 39 ± 10 years and 29 ± 7 years, respectively. Out of which 25 patients (29.7%) had hemiparesis/hemiplegia, vomiting and headache was manifested in 79 (94%) patients, seizures in 13(15%), and fever in 30(35.7%). 38(45.2%) out of 84 patients were presented with sagittal sinus thrombosis, 10(11.9%) of 84 with multiple sinus thrombosis and 35(41.6) of 84 patients with transverse/sigmoid sinus thrombosis. On funduscopic examination papilledema in 25(29.7%) patients. Patients had diagnosis of CVST during peripartum period altogether 8(15.6%) out of 51 female. 1 patient had bilateral cavernous sinus thrombosis. Signs of infection seen in patients in the study as Chronic supportive otitis media (CSOM), fever, 11(13.09%) patients had paranasal sinus (PNS) infections, 10 (11.9%) patients had evidence and history of lack of hydration. 8 (9.5%) patients of the total deceased during the course of treatment and 79 (94%) out of 84 patients were discharged with partial or/and total recovery. Three 25(29.7%) required decompressive craniectomy. Multiple sinus thrombosis had poor prognosis. Conclusion:Most commonly involved sinus is superior sagittal sinus while transverse or sigmoid sinus and bilateral cavernous sinus thrombosis follows it being

Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review.

Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.

A Prospective Cross-Sectional Study on Exhaled Nitric Oxide and Sensitivity to Indoor Inhaled Aeroallergens in Patients with Rhinosinusitis with Nasal Polyps

Background: Rhinosinusitis is a nasal and paranasal sinus infection. Chronic infection and allergies are two major causes of nasal polyp formation. Objectives: In this study, we examined the relationship between NO and aeroallergens to determine the relationship between exhaled nitric oxide level and sensitivity to aeroallergens in chronic rhinosinusitis with nasal polyps (CRSwNP) patients referring to Hazrat Rasool Hospital in Tehran from December 2016 to May 2017. Methods: A cross-sectional study was conducted on 72 patients. The prick test and exhaled NO measurements were done to determine allergens in CRSwNP patients. Statistical analysis was done to determine the relationship between the allergy and sensitivity to indoor aeroallergens in patients with CRSwNP. Results: The correlation coefficient of. 0.014 and 0.001 were evaluated for Mosquito and Cockroach respectfully, which were significantly correlated with nitric oxide. The less correlation with nitric oxide was 0.003, which was evaluated for MUCOR. Conclusions: This study showed that most people with CRSwNP had a sensitivity to at least one indoor aeroallergen, and cockroaches were the most common allergen in patients with CRSwNP with a 17.9% prevalence. This study showed that the correlation of FeNO with the sensitivity of these patients to home aeroallergens can be used, and this correlation for mosquito and cockroach aeroallergens is very valuable. The NO level and prick testing of aeroallergens can be used to estimate the relapse or lack of appropriate response to medical treatment in patients with CRSwNP.