Rhinology Clinic Research Articles

Olfactory Impairment in Chronic Rhinosinusitis Using Threshold, Discrimination, and Identification Scores.

Differences in testing modalities and cut-points used to define olfactory dysfunction contribute to the wide variability in estimating the prevalence of olfactory dysfunction in chronic rhinosinusitis (CRS). The aim of this study is to report the prevalence of olfactory impairment using each component of the Sniffin' Sticks test (threshold, discrimination, identification, and total score) with age-adjusted and ideal cut-points from normative populations. Patients meeting diagnostic criteria for CRS were enrolled from rhinology clinics at a tertiary academic center. Olfaction was assessed using the Sniffin' Sticks test. The study population consisted of 110 patients. The prevalence of normosmia, hyposmia, and anosmia using total Sniffin' Sticks score was 41.8%, 20.0%, and 38.2% using age-appropriate cut-points and 20.9%, 40.9%, and 38.2% using ideal cut-points. Olfactory impairment estimates for each dimension mirrored these findings, with threshold yielding the highest values. Threshold, discrimination, and identification were also found to be significantly correlated to each other ( P < 0.001). In addition, computed tomography scores, asthma, allergy, and diabetes were found to be associated with olfactory dysfunction. In conclusion, the prevalence of olfactory dysfunction is dependent upon olfactory dimension and if age-adjusted cut-points are used. The method of olfactory testing should be chosen based upon specific clinical and research goals.

Posterior Septal Widening as a Cause of Nasal Airway Obstruction

Nasal airway obstruction, a well-known cause of patient discomfort, is one of the most common presenting complaints to the otolaryngologist. The different causes of nasal airway obstruction are very wide-ranging, spanning from congenital life threatening causes to acquired benign causes. Herein, we present a case of nasal obstruction caused by widening of the posterior septum. A 52-year-old gentleman presented to the rhinology clinic with complaint of chronic nasal congestion for 4 years. Trials of topical steroid sprays and nasal saline rinses had been unsuccessful in symptoma- tic resolution. On anterior rhinoscopy, the septum was noted to be straight anteriorly, but appeared to be deviated bilaterally, flaring into the nasopharynx and obstructing the airway. A CT scan was performed, which showed soft tissue enlargement on the posterior aspect of the septum. The patient was subsequently taken to the operating room for a posterior septectomy and inferior turbinectomy. He reported alleviation of symptoms postoperatively. It is important for the otolaryngologist to be aware of the myriad of causes of nasal airway obstruction. An accurate history and physical examination including anterior and posterior rhinoscopy is important in the diagnosis of nasal airway obstruction. More importantly, the physician should be aware of the possibility of a widened posterior septum as a cause of nasal airway obstruction.

Multimedia in the informed consent process for endoscopic sinus surgery: A randomized control trial.

To determine patient recall of specific risks associated with endoscopic sinus surgery and whether an adjunct multimedia education module is an effective patient tool in enhancing the standard informed consent process. Prospective, randomized, controlled trial. Fifty consecutive adult patients scheduled for endoscopic sinus surgery at a rhinology clinic of a tertiary care hospital were recruited for this study. Informed consent was studied by comparing the number of risks recalled when patients had a verbal discussion in conjunction with a 6-minute interactive module or the verbal discussion alone. Early recall was measured immediately following the informed consent process, and delayed recall was measured 3 to 4 weeks after patient preference details were also collected. Early risk recall in the multimedia group was significantly higher than the control group (P = .0036); however, there was no difference between the groups in delayed risk recall. Seventy-six percent of participants expressed interest in viewing the multimedia module if available online between the preoperative and procedural day. Sixty-eight percent of patients preferred having the multimedia module as an adjunct to the informed consent process as opposed to the multimedia consent process alone. There is an early improvement in overall risk recall in patients who complete an interactive multimedia module, with a clear patient preference for this method. Here we emphasize the well-known challenges of patient education and demonstrate the effectiveness of integrating technology into clinical practice in order to enhance the informed consent process. 1b Laryngoscope, 126:1273-1278, 2016.

Effect of Continued Medical Therapy on Productivity Costs for Refractory Chronic Rhinosinusitis.

It is estimated that lost productivity related to chronic rhinosinusitis (CRS) costs society in excess of $13 billion per year in the United States. Given this tremendous cost to society, it is important to evaluate the effect of current interventions on improving this productivity loss. To define the change in productivity costs in patients with refractory CRS who select continued medical therapy. Observational cohort study. Thirty-eight patients with a guideline-based diagnosis of CRS whose initial appropriate medical therapy failed were enrolled from 4 tertiary-level rhinology clinics. The study was conducted from December 6, 2010, to April 23, 2013, and data analysis was performed from December 6, 2010, to June 1, 2015. Continued medical therapy for CRS. The human capital approach was applied to quantify productivity costs. Absenteeism, presenteeism, and lost leisure time were quantified to define annual lost productive time, which was measured at enrollment (baseline) and at a minimum of 6 months after treatment. Lost productive time was monetized using the annual daily wage rates obtained from the 2012 US National Census and the 2013 US Department of Labor statistics. Thirty-eight patients with refractory CRS who selected continued medical therapy had a mean (SD) baseline annual productivity cost of $3464 ($4900) per patient. After continued medical therapy for a mean of 12.8 (4.8) months, productivity costs were $2730 ($3720) (before vs after continued medical therapy productivity cost, P = .74). Mean annual absenteeism was reduced from 5 (12) days to 2 (8) days (P = .02). Mean annual presenteeism (17 [27] days reduced to 15 [23] days; P = .93) and mean annual household days lost (7 [7] days reduced to 6 [6] days; P = .51) were maintained at baseline levels. There were no significant differences in productivity outcomes based on endoscopy, the 22-item Sinonasal Outcome Test score, age, or polyp status (all P ≥ .11). Patients with refractory CRS often make treatment decisions based on the degree of quality-of-life and productivity impairment. Outcomes from this study suggest that productivity in patients with refractory CRS who have minor reductions in baseline productivity can remain stable with continued medical therapy. Physicians can use this information to inform appropriate patients with CRS of their expected outcomes from continued medical therapy.

Managing chronic rhinosinusitis and respiratory disease: a qualitative study of triggers and interactions

Objective: The aim of this analysis is to explore views of patients with chronic rhinosinusitis (CRS) about of the aetiology of their respiratory symptoms and the relationship between upper and lower respiratory symptoms. Methods: This study is part of a larger mixed methods study investigating the epidemiology of CRS, which comprises a questionnaire study of patients with CRS and controls and a qualitative study of 21 patients with CRS. Semi structured qualitative interviews were undertaken with these patients; 11 males and 10 females. Twelve patients had asthma. Patients were recruited with a tertiary outpatient rhinology clinic. Interviews were transcribed verbatim and analysed using thematic analysis, using Nvivo software (QSR International, Melbourne, Australia). Several important and recurring themes were highlighted. Results: Patients described many perceived triggering factors and an interaction between upper and lower respiratory tract symptoms. They felt that their symptoms could be managed more holistically. Conclusions: Concerns about triggers of respiratory symptoms and interactions between upper and lower respiratory symptoms are of significant concern to patients. These should be appropriately managed and acknowledged in formal treatment pathways, for example, through the use of combined ENT/respiratory clinics.

Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery.

There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.

Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery

There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.

Chronic Rhinosinusitis and Mood Disturbance

Objectives: This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors that influence the onset and severity of chronic rhinosinusitis (CRS).The aim of this analysis is to determine the number of patients consulting with their family physician about anxiety or depression among those with CRS and controls. Methods: CRES is a mixed methods study of patients with CRS including qualitative interviews and study-specific questionnaires. This analysis considers only the questionnaires. These included comprehensive questions about demographic and socioeconomic factors and past medical history as well as SNOT-22 (nasal symptom score) and SF-36 (quality of life tool). Questionnaires were distributed to patients with CRS attending general ENT and rhinology clinics within the National Health Service and private sector and to a control population across many centers in the United Kingdom from 2004 to 2013. Results: A total of 1519 participants, including 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Self-reported consultation with family physician for depression was 9 out of 57 (15.8%), 132 out of 659 (20.0%), 142 out of 577 (24.6%), and 36 out of 226 (15.9%), respectively. P &lt; .02 for differences between participant subgroups. For anxiety: AFRS 10 out of 57 (17.5%), CRSwNP 105 out of 659 (15.9%), CRSsNP 130 out of 577 (22.5%), controls 39 out of 236 (16.5%), P = .04 between groups. Conclusions: There are differences in rates of consulting with family physicians for depression and anxiety disease between those with different types of CRS and controls; those with CRS without polyps were most likely to have consulted. This may influence management strategies for patients with different nasal pathologies.

Endoscopic Balloon Dacryocystorhinostomy

Objectives: (1) Describe new endoscopic balloon technique for dacryocystorhinostomy. (2) Review preliminary outcomes of endoscopic balloon DCR. Methods: This study has 2 parts. The first entails a cadaver study looking at feasibility of applying balloon dilation technology to nasolacrimal duct obstruction. Five cadavers (10 sides) were used to confirm the technique. All 10 nasolacrimal ducts were successfully cannulated and dilated with a 5 × 16 mm balloon via a 70° guide. The second part of the study details our preliminary experience using this technique in patients referred to a tertiary rhinology clinic for nasolacrimal duct obstruction. Results: A total of 5 patients have enrolled in our prospective study. All patients were successfully cannulated. Follow-up ranges from 1 to 6 months. Resolution or decrease of preoperative epiphora has been noted in all 5 patients. Conclusions: Transnasal endoscopic balloon dilation of the nasolacrimal duct system may be a possible therapeutic option for the treatment of nasolacrimal duct obstruction. Furthermore, this may be a particularly attractive option for patients who are not candidates for a general anesthetic or cannot be taken off of anticoagulant medication. Further study is warranted.

The fate of chronic rhinosinusitis sufferers after maximal medical therapy

Many chronic rhinosinusitis (CRS) treatment regimes revolve around "one-off" maximal medical therapy (MMT) protocols, and although many patients initially respond, long-term control is unpredictable. The value of imaging, endoscopy, and patient progress after MMT for CRS is assessed. Symptomatic CRS patients with computed tomography (CT)-confirmed disease were recruited at a tertiary rhinology clinic. All patients received at least a 3-week oral prednisone course as part of their MMT. Pretreatment and posttreatment nasal symptoms scores (NSS), quality of life (22-item SinoNasal Outcomes Test [SNOT-22]), and CT (Lund-Mackay [LM]) scores were recorded along with post-MMT endoscopy status. A total of 86 patients (38% female, age 46 ± 13 years) met inclusion criteria. Pre-MMT and post-MMT LM scores were 10.9 ± 5.3 and 8.3 ± 5.5 (change 2.6 ± 3.8, p < 0.001). Median follow-up after their initial post-MMT assessment was 6.3 (interquartile range [IQR] 17) months. At initial post-MMT review, 43 (50%) were symptomatic with persistent radiologic disease ("symptomatic CRS"), 12 (14%) were asymptomatic with no radiologic disease ("resolved CRS"), 21 (24%) were asymptomatic with persistent radiologic disease ("asymptomatic CRS"), and 10 (12%) were symptomatic with no radiologic disease ("alternate diagnosis"). Pre-MMT NSS and SNOT-22 were similar among groups. The "asymptomatic CRS" group had the highest age (52 ± 11 years, p = 0.07). The "alternate diagnosis" group had the lowest initial LM scores (5.2 ± 2.9, p = 0.001). Of the "asymptomatic CRS" patients, 43% relapsed between 3 and 23 months (median 6; IQR 4.4 months) post-MMT and 29% eventually underwent surgery. Although MMT for CRS achieved symptomatic relief in 38% patients, objective evidence of disease was associated with clinical relapse. The concepts of "response" to medical therapy and the need to "control" long-term inflammatory burden need to be balanced.

The safety and efficacy of short‐term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal polyposis

Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis (CRS). The standard for prescribing budesonide is via impregnated nasal saline irrigation (INSI), although recently the mucosal atomization device (MAD) has emerged as a theoretically superior method of distributing medication into the sinuses. The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability. However, no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression. The objective of this study is to determine whether budesonide via MAD affects the hypothalamic-pituitary-adrenal (HPA) axis. Twenty CRS patients were recruited from a tertiary rhinology clinic and randomized to take budesonide (1 mg) via MAD or via INSI twice a day for 60 days. The adrenocorticotropic hormone (ACTH) stimulation test and 22-item Sinonasal Outcomes Test (SNOT-22) questionnaire were administered on days 1, 30, and 60 of the study. Plasma budesonide and cortisol levels were simultaneously quantified using a high-performance liquid chromatography-tandem mass spectrometry technique. There was no indication of adrenal suppression in either group (n = 20) based on ACTH stimulation test results nor was there significant plasma budesonide levels detected in either group. Quality of life, as indicated by SNOT-22, did not differ between groups at 60 days (p = 0.404; 95% confidence interval [CI], -37.2 to 15.9), but SNOT-22 scores for patients using MAD did show statistically significant improvement at 60 days compared to baseline (p = 0.02). The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term.

Clinical study on the acupuncture of "zhibi 3" in the treatment of non-allergic rhinitis

Objective To observe the Clinical study on the acupuncture ot zhibi 3 in the treatment of non-allergic rhinitis.Methods 20 individuals over 15 years old with non-allgergic rhinitis were prospectively recruited from rhinology clinic and ward of Beijing TongRen Hospital from December 2008 to August 2009.Acupuncture points of treat nasal 3 and the compatibility of Fengchi,Hegu were performed by once a week for 7 weeks.The changes of the total nasal symptom score (TNSS) and the Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire (Mini-RQLQ) were observed at baseline and recertification every week.Results After 7 weeks treatment,we found the fourth week of score in fatigue (0.5±0.2; 2.6±1.2,respectively),embarrassed (1.0±0.3; 3.7-0.3,respectively),sleep (0.8±0.1; 4.1±0.9,respectively)、the quality of life (1.0±0.4; 3.8±0.7,respectively),congestion (0.6±0.4; 2.6± 1.0,respectively),rhinorrhea (1.2±0.5; 4.4±0.7,respectively),sneezing (1.6±0.5; 5.0±0.6,respectively),nasal itching (1.7±0.6; 4.4±0.9,respectively) were significantly improved over 75％ (15/20) compared with the baseline (P＜0.05).However,at the sixth week,congestion,rhinorrhea,sneezing were recurring,especially rhinorrhea,but the benefit effects of acupuncture were more than 55％ comparing with baseline.Contusion Acupuncture of zhibi 3,and Fengchi,Hegu may have the effective effects on non-allergic rhinitis. Key words: Non-allergic rhinitis; Acupuncture ofzhibi 3; TNSS; Mini-RQLQ

Comparison of endoscopically‐guided swab vs aspirate culture techniques in post–endoscopic sinus surgery patients: blinded, prospective analysis

Culture-directed antibiotic therapy remains imperative in the management paradigm of chronic rhinosinusitis (CRS). The objective of this study was to conduct a prospective, blinded comparison of endoscopically-guided swab and aspirate cultures from the same sinonasal site in patients presenting with acute infectious exacerbations post-sinus surgery. Forty-nine CRS patients were prospectively enrolled in a tertiary care rhinology clinic. At the conclusion of the study, all cultures were unblinded to determine mean culture yield, most common pathogens, potential contaminants, and therapeutic correlation. The mean patient age was 49 years and 40.8% were males. All patients had evidence of symptomatic exacerbation with purulence on endoscopy at the time of presentation. There was a mean of 1.367 pathogens assayed per aspirate culture vs a mean of 1.102 per swab culture (p = 0.0032). The prevalence of Pseudomonas aeruginosa was 42% for aspirate vs 30% for swab cultures, respectively. The prevalence of Staphylococcus aureus was 49% for suction cultures vs 45% for swab cultures. There were 9 and 11 likely contaminants using aspirate and swab cultures, respectively. Therapeutic correlation was strong in 67%, moderate in 18%, and weak in 14% of patients. This prospective analysis demonstrated higher culture yield, particularly with Pseudomonas, with aspirate vs swab cultures in postoperative patients. There is a strong clinical correlation between the 2 methods, and both aspirate and swab techniques serve as acceptable alternatives for endoscopic-guided cultures in patients with post-functional endoscopic sinus surgery infectious exacerbations.

Intranasal trigeminal chemosensitivity in patients with postviral and post-traumatic olfactory dysfunction

Conclusions: The olfactory and intranasal trigeminal systems are closely connected. With regard to intranasal trigeminal event-related potential (ERP), patients with olfactory dysfunction (OD) showed longer latency and lower amplitude, which indicated decreased trigeminal sensitivity. Different age, etiology, and olfactory status also affect trigeminal sensitivity differently. Objective: OD is a common symptom in the rhinology clinic. ERP is considered an important method to evaluate chemosensitivity. The aim of this study was to investigate changes of intranasal trigeminal sense in patients with postviral OD (PVOD) and post-traumatic OD (PTOD). Methods: A total of 96 participants (30 healthy adults and 66 patients with OD) aged 20–65 years were investigated. The T&T olfactometer, the Sniffin' Sticks olfactory test, and trigeminal ERPs (tERPs) were used. We evaluated trigeminal sensitivity influenced by different factors (age, etiology, and olfactory status) in healthy subjects with normal olfactory function and in patients with PVOD and PTOD. Results: Patients with OD showed higher trigeminal thresholds than normal controls. Compared with controls, N1/P2 latencies of tERPs increased and amplitudes decreased in patients with OD. Older subjects showed longer latencies and lower amplitudes than young subjects in both controls and the OD group. Patients with PTOD exhibited worse psychophysical olfactory function and decreased trigeminal sensitivity.

Nasal sarcoidosis: a cause for a medical rhinoplasty?

We report the use of triamcinolone injections to correct severe nasal deformity due to sarcoidosis, as an alternative to formal surgical rhinoplasty. A 30-year-old woman with a long-standing history of sarcoidosis presented to a tertiary referral rhinology clinic complaining of breathing difficulty and nasal deformity. Flexible nasoendoscopy revealed red nasal plaques typical of nasal sarcoidosis, together with significant widening of the nasal bridge. Triamcinolone, a long-acting corticosteroid, was injected both intralesionally and subcutaneously over the nasal dorsum, at zero, three and eight months, resulting in long-lasting improvement of the nasal shape. Sarcoidosis is a non-caseating, granulomatous, epithelioid inflammation. Otorhinolaryngological manifestations occur in approximately 10 per cent of patients; however, there is little published experience of nasal reconstruction in such patients. We describe a quick, simple and relatively cost-effective technique, with little or no co-morbidity, with which to improve the aesthetic and symptomatic outcomes of nasal sarcoidosis.

Olfactory Dysfunction in Allergic Fungal Rhinosinusitis

To correlate patient reports of olfactory dysfunction after surgical intervention for allergic fungal rhinosinusitis (AFRS) with endoscopic findings, psychophysical testing, and quality-of-life scores. A prospective cohort study. A tertiary care rhinology clinic at St Paul's Hospital, Vancouver, British Columbia, Canada. Eighty-one patients with AFRS seen at routine postoperative follow-up. The Sniffin' Sticks test and a visual analog scale for the perceived olfactory ability of patients with AFRS were administered, along with a 36-Item Short-Form Health Survey. An endoscopic staging score was assigned for each patient. Forty men and 41 women with AFRS underwent olfactory testing; 52 of these individuals completed all parts of the assessment. The mean threshold, discrimination, and identification score was 19 (hyposmic), with a significant correlation between patients' performance on the Sniffin' Sticks test and endoscopic staging, as well as their reported olfactory ability (P < .001 for all 3 tests). The mean score for the 36-Item Short-Form Health Survey was 71, but there was a poor correlation between it and the threshold, discrimination, and identification score; visual analog scale; and endoscopic scores (P > .05 for all 3 tests). All patients with AFRS should be evaluated with olfactory testing and treated according to the results.

Treatment of Chronic Rhinosinusitis With Nasal Polyposis With Oral Steroids Followed by Topical Steroids

Chronic rhinosinusitis (CRS) with nasal polyposis is common. The long-term efficacy and safety of approaches to medical management are not well-known. To evaluate the efficacy and safety of a 2-week regimen of oral steroid therapy followed by 26 weeks of sequential topical steroid maintenance therapy. Parallel randomized trial with computer-generated block randomization and central allocation. Patients and investigators were blinded to group assignment. (ClinicalTrials.gov registration number: NCT00788749) A specialty rhinology clinic in Tayside, Scotland. 60 adults with CRS and moderate-sized or larger nasal polyps who were referred by their primary physicians for specialty care. Patients were randomly assigned in a 1:1 ratio to receive oral prednisolone, 25 mg/d, or placebo for 2 weeks, followed in both groups by fluticasone propionate nasal drops, 400 µg twice daily, for 8 weeks and then fluticasone propionate nasal spray, 200 µg twice daily, for 18 weeks. Polyp grading (primary outcome), hyposmia score, quality of life, symptoms, nasal patency, adrenal function, and bone turnover. The mean decrease in polyp grade from baseline to 2 weeks was 2.1 units (SD, 1.1) in the prednisolone group and 0.1 unit (SD, 1.0) in the placebo group (mean difference between groups, -1.8 units [95% CI, -2.4 to -1.2 units]; P < 0.001). The difference between groups was -1.08 units (CI, -1.74 to -0.42 unit; P = 0.001) at 10 weeks and -0.8 unit (CI, -1.8 to 0.2 unit; P = 0.11) at 28 weeks. The mean decrease in hyposmia score from baseline to 2 weeks was 31.12 mm (SD, 30.1) in the prednisolone group and 1.41 mm (SD, 30.6) in the placebo group (mean difference between groups, -28.33 mm [CI, -42.71 to -13.96 mm]; P = 0.002). The difference between groups was -16.06 mm (CI, -30.99 to -1.13 mm; P = 0.03) at 10 weeks and -12.13 mm (CI, -30.55 to 6.29 mm; P = 0.19) at 28 weeks. Prednisolone therapy resulted in transient suppression of adrenal function and increase in bone turnover after 2 weeks, with a return to baseline at 10 and 28 weeks. Patients were referred from primary care to a single-center rhinology clinic, which limits the generalizability of results. Serial measurements of surrogates of nasal inflammation (such as nitric oxide or cytokine levels) were not performed. Initial oral steroid therapy followed by topical steroid therapy seems to be more effective over 6 months than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients referred for specialty care of CRS with at least moderate nasal polyposis. Chief Scientist Office, Scotland; National Health Service Tayside Small Grants Scheme; and an Anonymous Trust grant from University of Dundee.

Effect of the KTP Laser in Inferior Turbinate Surgery on Eosinophil Influx in Allergic Rhinitis

Intranasal corticosteroids (INCS) are first-line medications for moderate to severe allergic rhinitis (AR). Patients who have had nasal congestion for many years often develop inferior turbinate (IT) hypertrophy. Some patients are refractory to INCS yet decline to receive allergen-specific immunotherapy. IT reduction is then indicated. There have been very few studies evaluating the allergic biomarker changes after IT reduction in AR. This study aimed to determine the effect of potassium titanyl-phosphate (KTP) laser IT surgery on eosinophil influx after challenge with dust mites. A randomized prospective controlled study. Tertiary academic rhinology clinic. Thirty-five house dust mite AR patients were randomly assigned to receive either INCS or KTP laser IT surgery. On the first visit, 2 nasal lavages prior to and 6 hours after challenge with Dermatophagiodes pteronyssinus were performed before receiving treatment. On the second visit, 3 months after treatment, the same procedures were repeated. No antiallergic medications were allowed for 2 weeks before each visit. Net changes in eosinophil numbers in the lavages were compared at baseline and 3 months after treatment and between the 2 treatments. Treatment with KTP laser IT surgery resulted in a significant reduction in eosinophil influx after nasal challenge (P = .013), whereas such a reduction was not shown in the control. However, the net changes in the percentage of eosinophils were not different between the 2 groups at either visit. KTP laser IT surgery reduces eosinophil influx after nasal challenge in perennial AR.

Nasopharyngeal bursitis: from embryology to clinical presentation

Nasopharyngeal bursitis is a relatively rare syndrome characterized by a collection of symptoms that multidisciplinary specialists should be aware of. Here we present an audit of cases presenting to a rhinology clinic over a two-year period, as well as an overview of the relevant embryology and different clinical presentations of nasopharyngeal bursitis. For 2008–2009, six patients were diagnosed to have nasopharyngeal bursitis, including four males and two females, of mean age 54 years. Two distinct pathologic types were observed, comprising three patients with classical Tornwaldt’s cyst and three with crust-type bursitis. This audit highlights the importance of recognition of the crust-type of nasopharyngeal bursitis and its anatomic and clinical features. A combined endonasal and transoral endoscopic approach is a minimally invasive procedure and an effective method of treating both types of the disease. Our findings are discussed in relation to the embryology of the disorder, with a clinical emphasis on crust- type nasopharyngeal bursitis.

Olfactory Event–Related Potential in Patients with Rhinosinusitis-Induced Olfactory Dysfunction

Olfactory disorders are a common syndrome in the rhinology clinic. Olfactory event-related potential (OERP) has been considered as an important alternative method to evaluate olfactory function. The aim of this study was to find the consistency of OERP and the psychophysics olfactory test (T&T olfactometry assessment) in rhinosinusitis patients with or without nasal polyposis. Both the psychophysics olfactory test and the OERP were performed in all patients before functional endoscopic sinus surgery (FESS). Detailed information including demographic, comorbidity, subjective symptoms, CT, and endoscopic examination were recorded. Six months later, the T&T test and OERP were reexamined in patients with preoperative identified OERP. Preoperative OERP was identified in 26 patients of the nonpolyp group and 12 patients of the polyp group. Good correlation existed between T&T scores and amplitude and latency of N1 and P2 in 26 nonpolyp patients (p < 0.05). No meaningful correlation was apparent in 12 polyp patients (p > 0.05). Significant correlation existed in 7 polyp patients with a free olfactory cleft (OC) according to CT (p < 0.05). The other 5 patients with partial OC obstruction were anosmic according to the psychophysics olfactory test; however, OERP was present. Six months later, T&T scores decreased significantly only in these five patients (p < 0.05). Significant correlation was obtained between postoperative T&T scores and OERP in both polyp and nonpolyp groups (p < 0.05). OERP can be used to investigate olfactory function of rhinosinusitis patients. Nasal polyp obstruction in specific parts of the OC might influence the consistency between the psychophysics olfactory test and OERP.