Postnasal Drip Research Articles

Тактика ведения пациентов с первично выявленным новообразованием носоглотки. Клинические случаи

In 5% of cases in the nasopharynx of an adult can be found a neoplasm with benign or malignant nature. Clinical manifestations of such pathology are next: persistent dysfunction of the auditory tubes, nasalness and postnasal drip syndrome. Endoscopy of the nasopharynx, computed tomography of the sinuses and magnetic resonance imaging of the head are the main diagnostic criteria for detecting neoplasms in this area. The tactics of treatment depends on the dysplasia type of the pathological process and varies from endoscopic one-stage resection to chemoradiation treatment. Using the example of two clinical cases, we will consider an algorithm for diagnosis and treatment the patients.

Clinical Variants, Rates of Post-Operative Recurrence and Malignant Transformation of Sino-Nasal Inverted Papilloma

Background: Inverted Papilloma (IP) is the most common benign neoplasms arising from the mucosal lining of the of the Sino-Nasal tract with single or multifocal attachment sites. The high propensity to recur, local aggressive behavior and possibility of malignant transformation attract considerable interest. Objective: To assess the factors affecting Sino-nasal IP, malignant transformation rate, and post-operative recurrence rate. Methods: A retrospective study was carried out on all cases diagnosed as Sino-Nasal Papilloma between January 2010 and December 2020 at Salmaniya Medical Complex, Bahrain. Data gathered from medical records were analyzed using SPSS. A total of 49 Sino-Nasal Papilloma cases were recorded of which 37 were IP. Factors affecting Sino-Nasal IPs are presented. Results: Sino-Nasal IP was recorded in 37 cases, composed of 28 males and 9 females with first presentation average age of 45.86 years. These involved 20 cases in the left side, 14 in the right side and 3 were bilateral. Recurrence in males and females was found to be 35.7% and 33%, respectively, with an average of 12.6 months. The symptoms include nasal blockage (97.3%), epistaxis and postnasal drip (13.5% each), headache (8.1%) and hyposmia and rhinorrhea (5.4%, each). The main recurrence was at stage T2 (60.5%), while in smokers (26.7%) and non-smokers (50%). Malignant transformation occurred in one patient only (2.6%). Conclusion: IP is the most common type of SNP with male predominance. The recurrence rate is high with an average of a year and the malignant transformation occurred in 2.6 % of the cases.

CLINICAL AND LABORATORY JUSTIFICATION FOR USE OF POLYVALENT BACTERIOPHAGE IN TECHNIQUE OF DELAYED PRESCRIBING OF ANTIBIOTICS IN PATIENTS WITH ARS

The aim: Of research was to evaluate the effectiveness of bacteriophage in patients with acute rhinosinusitis in respect of technique of delayed prescribing of antibiotics. Materials and methods: There were examined 155 patients who were given irrigation therapy with isotonic solution of sea water 4 times a day and mometasone furoate of 100 mg twice a day for 10 days. The patients of intervention group (n - 80) were additionally prescribed the polyvalent bacteriophage endonasally, in drops of 2-10 ml 3 times a day. Results: The patients in the control group were observed the decrease in intensity of rhinorrhea, nasal congestion and post-nasal drip on the third day of supervision (p < 0.05), the reduction in bacterial load with Staphylococcus aureus, S. pneumoniae, Haemophilus influenza and M. Catarrhalis (р <0,005), the increase of IgА and sIgA levels (p<0,005) and the reduction in prescription of antibacterial medications by 20%. Conclusions: Adding of polyvalent bacteriophage contributes to reducing the use of antibiotics and is recommended in the framework of the strategy of delayed prescribing of antibiotics.

Оценка эффективности одномоментной септопластики при выполнении эндоскопических риносинусохирургических вмешательств

The purpose of this study was to analyze results of simultaneous septoplasty and functional endoscopic sinus surgery in children. The study included 341 children who underwent endoscopic functional sinus surgery. The average age of patients was 11.2 ± 0.4 years. The follow – up period was 33.06 ± 6.9 months. Endoscopic septoplasty was performed simultaneously with FESS (functional endoscopic sinus surgery) in 72 children (21.1%). A comparative analysis of the results of FESS and endoscopic septoplasty showed a statistically significant association for 15 indicators on the SNOT 20 scale (p &lt; 0.05). Significant differences were found both in general symptoms: sleep disturbance, cough, irritability, dizziness, decreased concentration, fatigue, emotional depression, sadness, grief, and local: nasal obstruction, post-nasal drip, hyposmia, mucosal edema, secretory otitis media, rhinorrhea, dry throat. Correlation analysis of the results of FESS and endoscopic septoplasty in relation to the child’s age did not reveal statistically significant differences: chi2 = 3.42 p = 0.33. The results of the study showed the efficacy of single-stage septoplasty when performing endoscopic rhinosinus surgery in childhood in improving local and general symptoms and a low degree of complications in the postoperative period.

Frequency of Pulmonary Manifestations of in Patients with Gastroesophageal Reflux Disease

Introduction: Pulmonary manifestations of GERD are attracting increasing attention. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. The gastric contents can cause throat irritation, postnasal drip and hoarseness also recurrent cough. Objectives: This study is to determine frequency of pulmonary manifestations in patients with Gastroesophageal Reflux Disease. Settings: This cross-sectional study was conducted in Aeer ud din Medical college during June 2019 to December 2019. All patients with heartburn, both males and females of 20-70 years of age. Results: Out of 150 patients’ laryngeal symptoms were 10% have dry cough 8% have hoarseness and dry cough hoarseness both in 10% in patients with heartburn. 34% patients with GERD were found to be asthmatic. Nasal symptoms were infrequent 2%. Out of 150 patients 36% do not have any pulmonary manifestations. Conclusion: There is high prevalence of pulmonary manifestations in patients with GERD.

Retrospective Study of the Effects of Post-nasal Drip Symptoms on Cough Duration.

The aim of this study was to elucidate the significance of allergic rhinitis and post-nasal drip symptoms in patients with cough-variant and cough-predominant asthma. We conducted a retrospective analysis of 91 patients who had cough-variant or cough-predominant asthma and first visited the Nakajima Medical Clinic in Japan between June 2012 and July 2015. Post-nasal drip symptoms were reported in 58 (63.7%) patients. The patients with post-nasal drip symptoms (19.5±8.3 days) had a significantly longer time until cough disappearance than those without post-nasal drip symptoms (11.0±4.8 days) (p=0.000034). Multivariate analysis showed that post-nasal drip symptoms are independent prolonged factors of cough duration. Post-nasal drip symptoms may affect cough control in patients with cough-variant and cough-predominant asthma.

Fractional Exhaled Nitric Oxide (FeNO) Integrating Airway Hyperresponsiveness (AHR) Examination Promotes Etiologic Diagnosis and Treatment for Children with Chronic Cough.

BackgroundChronic cough is the main reason why parents seek medical treatment for their children. This study aimed to evaluate changes in airway function and inflammation levels and associated values in diagnosing and treating chronic cough.Material/MethodsThis study involved 118 children with chronic cough, including 45 cough-variant asthma (CVA) patients, 53 upper-airway cough syndrome (UACS) patients, and 20 post-infection cough (PIC) patients. Chronic cough was diagnosed as described by guidelines of the American College of Chest Physicians for evaluating chronic cough. Pulmonary ventilation function and airway hyperresponsiveness (AHR) were evaluated. Fractional exhaled nitric oxide (FeNO) levels and eosinophilic airway inflammation were measured. Eosinophil (EOS) count in sputum was also examined. CVA patients were treated with inhaled glucocorticoids, which have anti-inflammatory effects.ResultsFeNO and sputum EOS levels were higher in CVA patients compared with UACS and PIC patients (P<0.05). CVA patients demonstrated significantly higher small airway indexes, including 25% forced expiratory flow (FEF), 50% FEF, and 75% FEF, compared with UACS and PIC patients (P<0.05). FeNO level was positively correlated with EOS in sputum (r=0.468, P=0.0001) and cough symptom scores (r=0.402, P<0.05). FeNO, EOS, and cough symptoms were significantly improved in CVA patients after glucocorticoid treatment. AHR was improved in all chronic cough patients after treatment. Cough-relief CVA patients demonstrated significantly higher FeNO levels compared with those without cough relief (P<0.05).ConclusionsFeNO integrating pulmonary function and AHR examination can improve etiologic diagnosis and treatment for chronic cough in children.

Recurrence Pattern and Complication Rate of Allergic Fungal Sinusitis: A 10-Year Tertiary Center Experience.

Background Allergic fungal rhinosinusitis is a noninvasive form of highly recurrent chronic rhinosinusitis. Despite the advancement in medical and surgical strategies, recurrence in AFRS in general poses another challenging problem with reported incidence that eventually can reach more than 60%. Recognition and understanding the pattern of disease recurrence will lead to greater understanding of the disease response in our population. Method A retrospective cohort study was performed in King Abdulaziz Medical City in Riyadh, Saudi Arabia. All patients diagnosed with chronic rhinosinusitis and underwent functional endoscopic sinus surgery from the period of January 2006 to December 2016 were reviewed. Results 28 patients were found to have AFRS based on clinical, radiological, and microscopic examination suggestive of allergic fungal rhinosinusitis. Among these patients, 53% of them were female and 46% were male. The age ranged from 13 to 55 years, with a mean age of 31.57 years. 28.57% of the patients presented with recurrent allergic fungal sinusitis. The duration between the surgery and symptoms recurrence was around one year. Male and female patients had similar recurrence rate (50%). At first visit, 95% of the patients with nonrecurrent disease presented with nasal obstruction compared to 87.5% of the patients with recurrent disease. On the other hand, patients with recurrent disease had more nasal discharge (87.5%), postnasal drip (37.5%), facial pressure/pain (50%), headache (50%), nasal polyposis (87.5%), hypertrophy of inferior turbinate (37.5%), and proptosis (12.5%). Nasal obstruction (87.5%) and nasal polyps (87.5%) were the most common presenting symptoms for the disease recurrence. The pattern of disease recurrence in the previously unilateral disease was 18% ipsilateral and 27% bilateral. For the patients who had bilateral disease formerly, 17% (n = 3) of them had recurrent bilateral disease. Conclusion Allergic fungal rhinosinusitis is a distinct clinical entity. A high recurrence rate is a pathognomonic feature of the disease, despite all the development in medical and surgical trials. This study demonstrated that recurrence rate is lower in our population. However, more studies with a greater number of patients are needed in the future to clearly recognize the pattern of recurrence in patients with AFRS.

Demographic profile of subjects undergoing sphenoidotomy for sphenoid sinusitis, in a tertiary care centre of Punjab- analysis of 75 subjects

Background: The demographic profile of patients with Sphenoiditis undergoing surgical intervention, in the state of Punjab was studied. The emphasis was on the age, gender and clinical presentation in this prospective study.Methods: There were 75 patients of sphenoethmoidal recess pathology with sphenoditis, who were selected from the Rhinology clinics of Otorhinolaryngology and head Neck services of Dayanand Medical College and Hospital Ludhiana , in a period one and a half years (November 2002 to October 2004). All patients were taken up for Functional endoscopic sinus surgery of the sphenoid sinus surgery with sphenoidotomy.Results: The age range of subjects with sphenoiditis was between 12 years to 70 years. The mean age was 38.13 years. The maximum number of patients were in 19-30 years age group and the minimum in 31-40 years age group. Males outnumbered the females by a ratio of 1.7:1. The most common was posterior nasal drip (69.33% cases) behind the Eustachian tube and the least common complaint was diplopia (5.33% cases. Ocular involvement was observed in 32%. The right eye was more frequently involved (17.33%) as compared to the left (12%).Conclusions: Patients with Sphenoid sinusitis were seen in the broad age range from 19 to 30 years with a male predominance. Posterior nasal discharge behind the Eustachian tube, rather than the typical occipital ache was the primary complaint .Right sided eye involvement with ptosis and lateral rectus palsy were commonly noted.

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients.

BackgroundNasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis.MethodsWe conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks.ResultsFour hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high‐volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post‐nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps.ConclusionsNasal irrigation with high‐volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post‐nasal drip than that with other types of devices.Level of Evidence2C

Use of Nonmedicated Control Substances in Randomized Clinical Trials of Patients With Chronic Rhinosinusitis

The effect of nonmedicated control substances in chronic rhinosinusitis remains unclear. To assess the association of nonmedicated control substances in randomized clinical trials with disease outcomes in patients diagnosed with chronic rhinosinusitis. In this single-arm systematic review and meta-analysis, the Cochrane Library of Systematic Reviews, Ovid MEDLINE, Embase, PubMed, and ClinicalTrials.gov databases were searched for randomized clinical trials with a preintervention and postintervention design for chronic rhinosinusitis that were published between 1946 and January 23, 2019. Paired reviewers independently extracted data. The analyses used random-effects models and the Cochrane risk of bias assessment to rate the quality of the evidence. The primary outcomes were the association of nonmedicated control substances with 22-item Sinonasal Outcome Test (SNOT-22) scores or nasal symptom scores when SNOT-22 was not available. A total of 2305 abstracts were identified and screened, 725 articles were reviewed in full text, and 38 articles met the study criteria and were included in the meta-analysis. Among the 38 included studies, a total of 2258 adults (mean age range, 27-53 years; 20.0%-72.5% women) were randomized to receive nonmedicated control substances or sham interventions. Topical nonmedicated control substances were associated with significant reduction in SNOT-22 scores (mean difference [MD], -8.81; 95% CI, -12.60 to -5.03). A subgroup analysis of topical therapies, limited to saline irrigation and nasal spray diluents, found that topical diluents were associated with a greater reduction in SNOT-22 scores (MD, -11.45; 95% CI, -13.50 to -9.41) compared with saline irrigation (MD, -13.60; 95% CI, -19.95 to -7.25). Nonmedicated control substances were associated with a significant reduction in nasal obstruction scores (standardized MD [SMD], -0.42; 95% CI, -0.81 to -0.03). No significant change was found in rhinorrhea scores (SMD, -0.34; 95% CI, -1.37 to 0.69), postnasal drip scores (SMD, -0.96; 95% CI, -2.18 to 0.25), facial pain scores (SMD, -0.57; 95% CI, -1.68 to 0.55), or loss of smell scores (SMD, -0.18; 95% CI, -0.68 to 0.32). This systematic review and meta-analysis of the use of nonmedicated control substances in randomized clinical trials of chronic rhinosinusitis outcomes suggests that the use of nonmedicated control substances is associated with limited improvements in SNOT-22 and nasal obstruction scores. These findings highlight potential areas of future research directions and the importance of randomized clinical trials to accurately estimate treatment effect.

Comparison of Postoperative Results According to Fungus Ball Extension in Maxillary Sinus

Background and Objectives Fungus ball is the most common type of fungal sinusitis commonly associated with good prognosis. However, postoperative results depending on the extent of the lesion has not been investigated. This study aimed to identify differences in postoperative results depending on the location and extent of the fungus ball.Subjects and Method Medical records of 165 patients who underwent endoscopic sinus surgery and who were diagnosed with fungus balls by biopsy from 2010 to 2019 were retrospectively reviewed. Patients were classified into four grades according to the location and extent of the fungus ball based on their endoscopic and CT findings. Poor outcome is defined as any pathologic signs such as nasal secretion, granulation, and polyps or narrowing of the natural ostium observed postoperatively according to Kennedy’s criteria, whereas good outcome is defined as absence of pathologic signs.Results A total of 23 patients were Grade 1, 38 Grade 2, 67 Grade 3, and 37 Grade 4. Grades 1 and 2 were mostly asymptomatic. However, as the location of the fungus ball became closer to the natural ostium, patients complained postnasal drip and purulent discharge. Grades 3 and 4, who have much severe and more extensive lesions than those of Grades 1 and 2, had poor outcome (&lt;i&gt;p&lt;/i&gt;=0.007) and took longer time to completely recover (&lt;i&gt;p&lt;/i&gt;&lt;0.001).Conclusion Wound healing was delayed and poor when the fungus ball was located closer to the natural ostium of the maxillary sinus. Therefore, preoperative consultation using endoscopic and CT findings could be useful for predicting their postoperative results.

Clinical and microbiological parallels of delayed prescribing of antibiotics in patients with acute rhinosinusitis

Topicality: The rate of acute bacterial rhinosinusitisis 0,5-2% of all cases of acute rhinosinusitis, however, up to 60 % of patients receive the course of antibiotics since the first day of disease. It is well known that earlier use of antibiotics has almost no effect on the development of bacterial ARS and its complications. The purpose of study was to examine the bacterial spectrum of post-viral RS and evaluate clinical and bac-teriological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy. Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the microbiological composition of nasal microflora was examined and its comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of microbiological changes. Outcomes and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitis as a part of technique of delayed prescribing of antibioticsensures clinically significant decrease in the intensity of rhinorrhea symptoms, nasal congestion and post-nasal drip on the third day of supervision (p&lt;0.05). It reduces the prescription of antibacterial medicines by 20%without negative impact on overall treatment results. Decrease in the number of prescription of antibacterial therapy correlates with the fair reduction in bacterial loadwith Staphylococcus aureus and typical representative of ABRS – S. pneumoniae, Haemophilus influenza and M. catarrhalis. Therefore, the intervention group in comparison with the control group has had “therapeutic advantage” during the first days of treatment which allowed to assess the course of disease as a “positive” and avoid in appropriate use of antibiotics. There have been documented no patients with adverse effects during the course of treatment. Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to reduce the use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

Chronic adenoiditis.

In addition to acute adenoiditis and adenoid hypertrophy/vegetation, chronic adenoiditis is another disease of the adenoids. However, most physicians overlook chronic adenoiditis or confuse it with adenoid hypertrophy/vegetation. The incidence of chronic adenoiditis has increased in recent years as a result of higher rates of chronic nasopharyngeal or upper airway infections. The clinical characteristics of chronic adenoiditis can include but are not restricted to the following: long-term infection (especially bacterial infection); obstruction of the upper airway; infections of adjacent regions, such as the nose, nasal sinus, pharyngeal space, middle ear, and atlantoaxial joint; induced upper airway cough syndrome; and the presence of several “infectious-immune” diseases, including rheumatic fever, autoimmune nephropathy, and anaphylactoid purpura. To date, no consensus on the treatment of chronic adenoiditis is available. However, adenoidectomy can address the local obstruction, and some patients benefit from systemic or local anti-bacterial therapy. Physicians in the Departments of Otolaryngology, Respiration, and Pediatrics should be familiar with the clinical manifestations of chronic adenoiditis and try to develop effective treatment methods for this disease.

Causes of chronic cough in adolescent and adult patients.

Background: Adolescents differ from adults in certain aspects, but the differences in the etiology of chronic cough between adolescents and adults have not been specifically investigated. The purpose of this study is to evaluate the causes of chronic cough in adolescent patients in comparison with those in adult patients. Methods: The electronic medical records were retrospectively screened for patients with the initial diagnosis of chronic cough from 2016 to 2018. Clinical variables and the causes of chronic cough were collected in patients who met inclusion criteria. Patients were assigned to adolescent (13 to 18 years) and adult (> 18 years) group based on age. The distribution of causes of chronic cough was compared by t-test and χ2 tests between adolescent and adult groups using SPSS. Significant level was set at 0.05. Results: The enrolled patients consisted of 16 adolescents and 73 adults with chronic cough. The most common causes of chronic cough were cough-variant asthma and upper airway cough syndrome in both adolescents and adults. The frequency of post infectious cough in adolescents was significantly higher than that in adults (12.5% vs. 1.36%; p= 0.024). Although no significant difference between the two groups was found, there was a trend that suggested that habitual cough was more common in the adolescent group (6.25%:1.36%); while gastroesophageal reflux disease (GERD) did not show similar results (6.25%:20.54%). Conclusion: There are moderate differences in the causes of chronic cough between adolescent and adult patients. Realizing those differences would be helpful for clinicians to establish an appropriate differential diagnosis and make referral decisions.

Outcome of an outpatient specialty clinic for chronic epipharyngitis

ObjectiveIn Japan, chronic epipharyngitis became a subject of interest in the 1960s and is currently garnering renewed attention. Previous studies have focused only on the similarities between the immunological characteristics of the tonsil and epipharynx and reported the efficacy of epipharyngeal abrasive therapy (EAT) in patients with IgA nephropathy. However, endoscopic findings of chronic epipharyngitis have not yet been fully evaluated, and. this study aimed to elucidate those findings. MethodsThe study period was from November 2016 to October 2017. Two hundred and twelve new patients visited the specialty outpatient clinic for EAT. Age distribution and mean age of patients, sex, chief complaint, diagnosis at other departments and outcomes were retrospectively reviewed based on medical records. Band-limited light endoscopy was performed, and the findings were videotaped in 102 of the 212 new patients, who underwent endoscopic EAT for the first time. ResultsThe study included 32 men and 70 women with a mean age of 46.0 years (range, 22–83 years). The most common complaint was postnasal drip (42 patients), followed by pharyngeal pain (12 patients), and throat discomfort (11 patients). The outcomes of 74 patients who continued treatment until the last session were; complete cure in 48.6% of cases, marked improvement in 21.6%, improvement in 16.2%, and no change in 13.5%. Band-limited light endoscopic findings included black spots (73%), granular changes (76%), vessel truncations (92%), crust/mucus adhesion (54%), adenoidal hypertrophy (31%) and tonsil cysts (7%). With regard to the appearance of the mucous membranes, 48% patients had an ivory-like-colored mucous membrane, 72% had a green vascular network, and 89% had a dark red to reddish-brown appearance. Six to nine months’ EAT remarkably improved their symptoms with resolution of the endoscopic findings in 86% of the patients. ConclusionNasal endoscopy using band-limited light is useful for diagnosis and management of chronic epipharyngitis. We believe that this study not only provides information to help the diagnosis of chronic epipharyngitis but also contributes to treat sick patients suffering from chronic epipharyngitis.

Understanding the foundations of chronic cough.

Despite chronic cough being one of the most frequent reasons for both primary care and specialty physician visits, its diagnosis and treatment remain challenging. The most common causes are upper airway cough syndrome, asthma, and gastroesophageal reflux disease; however, new research has implicated a cough hypersensitivity syndrome that may link many underlying etiologies. To accurately diagnose and treat patients with chronic cough, a thorough understanding of the various definitions, epidemiology, and pathophysiology is crucial. This article reviews these factors as well as the healthcare and socioeconomic burden of chronic cough.

S3431 An Odd Place for Acne: Ectopic Esophageal Sebaceous Glands

INTRODUCTION: Sebaceous glands are typically found on the skin, providing lubrication to the skin and hair follicles. These glands are generally clustered on the face and scalp with fewer being found on the remaining skin surface. Esophageal sebaceous glands are extremely rare. As of 2017, less than 25 case reports had been published on this entity. Although rare and therefore not fully understood, esophageal sebaceous glands have not been linked to any attributable symptoms or risk or cancer. The following is a case of a patient evaluated for chronic cough who was ultimately found to have sebaceous glands in his esophagus. CASE DESCRIPTION/METHODS: A 63-year-old man was seen in gastroenterology clinic for evaluation of chronic cough and globus sensation. An esophagogastroduodenoscopy (EGD) displayed yellow, plaque-like material extending from proximal to distal esophagus (images A and B). These lesions could not be removed with lavage and were subsequently biopsied. The biopsy demonstrated a collection of round cohesive cells with cleared out cytoplasm and small centrally located nuclei arranged in an acinar configuration, consistent with ectopic sebaceous glands (image C). These glands are located within the lamina propria underlying a normal appearing stratified squamous cell epithelium. The patient also had esophageal pH testing showing a normal DeMeester score. Patient was treated with nasal fluticasone with improvement in his presenting symptoms. Therefore, symptoms were attributed to post-nasal drip, rather than the ectopic sebaceous glands. DISCUSSION: Ectopic esophageal sebaceous glands are a rare, benign finding. There is no known malignant potential to these lesions and no known attributable symptoms. Although rare and benign, endoscopists should have a familiarity with the appearance of ectopic esophageal sebaceous glands in order to distinguish them from other, non-benign lesions (such as squamous cell carcinoma) and potentially avoid unnecessary biopsies or other invasive testing.Figure 1.: Esophagus with sebaceous glands.Figure 2.: Esophagus with sebaceous glands.Figure 3.: Pathology slide of sebaceous glands in the esophagus.

Laryngopharyngeal reflux: Comparing improvements in reflux symptom index with reflux finding score.

The objective of this study was to determine the correlation of reported symptom improvement in laryngopharyngeal reflux (LPR) with physical findings on laryngoscopic examination following medical therapy. This IRB-approved, retrospective, single-institution study included all patients who were diagnosed and medically treated for LPR from Jan. 1, 2015-October 21st, 2019. Only patients who received at least six weeks of treatment with a proton pump inhibitor and those with pre- and post-treatment Reflux Symptom Index; RSI (n=91) and Reflux Finding Score; RFS (n=33) were included in the study. A total of 91 patients were included in the analysis (61.54% female). There was a 19.99% improvement in total RSI (p=0.0034) and a 25.20% improvement in total RFS (p=0.0011) following at least six weeks of treatment (average=253±213 SD days). RSI symptoms were significantly decreased between pre- and post-treatment for hoarseness (p=0.0005), clearing of the throat (p=0.0066), excess throat mucus or postnasal drip (p=0.0004), troublesome cough (p=0.0231), and heartburn/chest pain (p=0.0053). RFS demonstrated a statistically significant decrease in only subglottic edema (p<0.0001) and ventricular obliteration (p=0.0295). Pearson's correlation test did not demonstrate a relationship between RSI and RFS in the pre- and post-treatment analyses alone, but did demonstrate a statistically significant relationship when analyzed across all captured pre and post data (r=0.265, p=0.006). RSI and RFS are complimentary to one another when assessing for treatment response, but improvement in RSI does not correlate with that in RFS.

The correlation between nasal bacterial microbiome diversity and surgical prognosis for chronic sinusitis with nasal polyp

Objective:To compare the nasal microbiota diversity between chronic rhinosinusitis with nasal polyp（CRSwNP） patients and controls, postoperative recurrent with non-recurrent CRSwNP, in order to provide new sight in CRSwNP treatment and prognosis. Method:Forty-eight patients with CRSwNP were recruited as the experimental group, and 33 patients who underwent FESS and had no sinus inflammatory disease, including nasal septum deviation,inverted papilloma, pituitary adenomas, chronic dacryocystitis,or optical canal fractures, were recruited as control group. High-throughput sequencing of 16S rRNA was used to detect the bacterial communities in the nasal secretion which was collected from middle meatus during the operation. The difference of the microbiota diversity between CRSwNP and controls was compared. Patients with CRSwNP were followed up for 1 year after surgery to observe whether they had relapsed or not, and nasal secretions were collected again for bacterial microbiota detection. The difference between postoperative and preoperative microbiota of the non-recurrent CRSwNP were compared, and the difference between postoperative and preoperative microbiota of the recurrent CRSwNP were compared. Result:One year after surgery, 12 cases of CRSwNP recurred（recurrent rate 25%）. The clinical history of the recurrent group was longer than that of the non-recurrent group（P=0.018）, and the preoperative CT score（P=0.001）, nasal polyp size score（P=0.004） and the severity of postnasal drip symptom（P=0.032） in the recurrent group were significantly higher than non-recurrent group. Comparing the preoperative nasal microbiota of CRSwNP with control, there was no significant difference about the richness, α diversity and β diversity, but the relative abundance of Actinobacteria（FDR P=0.004） and Corynebacterium（FDR P=0.005） of CRSwNP were significantly lower than that of control. After operation, the relative abundance of Actinobacteria（FDR P＝0.012） and Corynebacterium（FDR P＝0.003） increased, while the Bacteroidetes（FDR P＝0.040） decreased in the non-recurrent CRSwNP; However, there was no change in the nasal bacterial microbiota in the recurrent group. Conclusion:CRSwNP was associated with nasal bacterial dysbiosis, and the postoperative improvement of dysbiosis was correlated with the prognosis of CRSwNP.