Rhinosinusitis Patients Research Articles

Differentiation of eosinophilic and non-eosinophilic chronic rhinosinusitis on preoperative computed tomography using deep learning.

This study aimed to develop deep learning (DL) models for differentiating between eosinophilic chronic rhinosinusitis (ECRS) and non-ECRS (NECRS) on preoperative CT. Axial spiral CT images were pre-processed and used to build the dataset. Two semantic segmentation models based on U-net and Deeplabv3 were trained to segment the sinus area on CT images. All patient images were segmented using the better-performing segmentation model and used for training and testing of the transferred efficientnet_b0, resnet50, inception_resnet_v2, and Xception neural networks. Additionally, we evaluated the performances of the models trained using each image and each patient as a unit. A total of 878 chronic rhinosinusitis (CRS) patients undergoing nasal endoscopic surgery at Renmin Hospital of Wuhan University (Hubei, China) between October 2016 to June 2021 were included. The precision of each model was assessed based on the receiver operating characteristic curve. Further, we analyzed the confusion matrix and accuracy of each model. The Dice coefficients of U-net and Deeplabv3 were 0.953 and 0.961, respectively. The average area under the curve and mean accuracy values of the four networks were 0.848 and 0.762 for models trained using a single image as a unit, while the corresponding values for models trained using each patient as a unit were 0.893 and 0.853, respectively. Combining semantic segmentation with classification networks could effectively distinguish between patients with ECRS and those with NECRS based on preoperative sinus CT images. Furthermore, labeling each patient to build a dataset for classification may be more reliable than labeling each medical image.

Prevalence of Fungal Rhinosinusitis in Patients Presenting with Nasal Polyps

Aim: To see the prevalence of fungal rhino sinusitis in patients presenting with nasal polyposis. Study design: Cross-sectional study. Place and duration of study: Department of Otorhinolaryngology and Head and Neck surgery, PIMS, Islamabad from 1st October 2021 to 31st March 2022. Methodology: Patients presenting with nasal polyps fulfilling our inclusion criterion in ENT Department in PIMS. Eighty patients presenting with nasal polyps for surgery after admitting them and the specimen was sent for fungal culture. Results: Sixty nine patients showed positive culture for fungal rhino sinusitis and only 11 patients were negative for fungal growth. Among 69 patients 51 patients were males and 18 were females. Eighty five percent male patients showed fungal growth while 90% females showed fungal growth. Conclusion: The nasal polyps is closely related to fungal infection, so all patients presenting with nasal polyps are suggested to undergo fungal culture and work-up should be done for fungal rhino sinusitis to rule fungal infection is suggested, so that early diagnosis is made and earliest treatment is started for the disease. Key words: Nasal polyps, Fungal culture, Fungal rhino sinusitis

Outcomes of Endoscopic Sinus Surgery of Adult Chronic Rhinosinusitis in First Central Hospital of Mongolia

Objective: Evaluate the outcome of endoscopic sinus surgery among chronic rhinosinusitis (CRS) patients and assess the quality of life. Methods: 200 CRS patients aged between 17 to 73 who were operated endoscopic sinus surgery at the Otorhinolaryngology department of First Central Hospital between November 2019 and November 2020, were involved in this study. Subjects were divided into 2 groups: 1) CRS with nasal polyp; 2) CRS without nasal polyp. CT changes were evaluated according to Lund-Mackay, Hoover score, and Hounsfield unit before and after surgery. Results: Of the total subjects analyzed, 56 % were male and 44 % were female. The average age of subjects was 38.4 ± 13.9. The tissue radiodensity of the maxillary sinus decreased in both groups significantly. The mean value of 21.3 ± 6.9 HU preoperatively dropped to 13.5 ± 3.9 HU postoperative in the CRSsNP group, while the CRSwNP group had similar results. The preoperative mean value of 20.3 ± 3.9 HU declined to 12.0 ± 2.2 HU after the procedure. For assessment of paranasal sinus mucosal thickness, the mean value of preoperative imaging study in the CRSsNP group measured as 5.5 ± 1.7mm, and then it reduced by 3.8mm to reach 1.7 ± 1.4 mm after the surgery (p < 0.000). Consequently, the CRSwNP group shows similar outcomes such as the preoperative mean value assessed with a thickness of 5.8 ± 1.4 mm, declined by 4.4 mm and reached an almost normal mucosal thickness of 1.5 ± 1.0 mm after the procedure (p < 0.000). Conclusion: ESS for CRS is effective according to the evaluation of the Lund-Mackay, Hoover, and Hounsfield unit, and it was statistically significant (p < 0.000).

Bacterial Flora and Antibiotics Sensitivity Pattern in Chronic Rhinosinusitis Outpatient Cases in Tertiary Care Hospital

Background Chronic rhinosinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. The initial treatment is clinical evaluation followed by starting empirical antibiotics. With the use of empirical antibiotics there is a possibility of aggravating the disease and leading to the persistence of chronic sinusitis. In order to start a protocol for rational use of antibiotics, we need to have the bacteriological profile in cases of chronic rhinosinusitis along with the sensitive group of antibiotics.
 Objective To determine the bacterial flora in nasal swab of patients with chronic rhinosinusitis and identify the sensitive antibiotics for the bacterial isolate.
 Method A prospective, cross-sectional study was conducted in ENT Head and Neck Department of tertiary care hospital. The study population was the patients with clinical diagnosis of chronic rhinosinusitis whose nasal swabs were taken during nasal endoscopy and sent for culture and sensitivity. The data were entered in Microsoft Excel and analyzed using statistical computer program Statistical Package for the Social Sciences (SPSS). The ethical approval for the study was taken from Ethical Committee of Kathmandu Medical College.
 Result There were 60 (87%) bacterial isolate growths out of 69 samples of which 49 (82%) were gram positive and 11 (18%) were gram negative. The most common bacteria isolated was S aureus (42%) followed by Cogaulase neagative Staphylococcus (25%).
 Conclusion Among gram positive isolates, amoxycillin was the most sensitive antibiotic and among gram negative isolates, ceftriaxone, levofloxacin, imipenem, meropenem and piperacillin were most sensitive antibiotics. In this study, we have determined the bacterial flora from endoscopic nasal swab of the sinuses in chronic rhinosinusitis patients and identified the sensitive antibiotics. This study would help us prescribe rational antibiotics in cases of chronic rhinosinusitis.

Transcriptomic Analysis of Genes Associated with Oxidative Stress in Chronic Rhinosinusitis Patients with Nasal Polyps: Identifying Novel Genes Involved in Nasal Polyposis.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complicated inflammatory disease, and the underlying mechanism remains unclear. While some reactive oxygen/nitrogen species-related gene products are reported to participate in CRSwNP, a systemic and full analysis of oxidative-stress-associated genes in CRSwNP has not been extensively studied. Therefore, this study sought to catalog the gene-expression patterns related to oxidative stress and antioxidant defense in control and CRSwNP patients. In total, 25 control and 25 CRSwNP patients were recruited. The distribution and expression of 4-hydroxynonenal and 3-nitrotyrosine as markers of oxidative stress—which is represented by lipid peroxidation and the protein nitration of tyrosine residues in CRSwNP nasal polyps (NPs)—were more apparently increased than those found in the control nasal mucosae, as determined by immunohistochemistry (IHC). The expression of 84 oxidative-stress-related genes in nasal mucosae and NP tissues was analyzed via real-time PCR, which showed that 19 genes and 4 genes were significantly up- and downregulated, respectively; among them, inducible nitric oxide synthase (iNOS) and heme oxygenase 1 (HO-1) were notably upregulated, whereas lactoperoxidase (LPO), myeloperoxidase (MPO), and superoxide dismutase 3 (SOD3) were highly downregulated. Changes in the mRNA and protein levels of these redox proteins were confirmed with a customized, real-time PCR array and RT-PCR analysis, as well as Western blotting and IHC assays. A receiver operating characteristic curve analysis further suggested that LPO, MPO, SOD3, HO-1, and iNOS are possible endotype predictors of CRSwNP development. Collectively, we present an oxidative-stress-related gene profile of CRSwNP NP tissues, providing evidence that the systemic changes in oxidative stress and the antioxidative defense system, including novel iNOS, heme peroxidases, and other genes, are closely linked to CRSwNP pathology, development, and progression.

Localization of nitric oxide syntases and small apoptotic molecules in the nasal mucosa in polypoid rhinosinusitis

Aim. To study the localization of NO synthases and apoptosis markers in the nasal mucosa in rhinosinusitis patients with nasal polyps (RNP).Methods. We studied the biopsy material of nasal cavity polyps and mucous membrane sections of the inferior turbinates of female and male patients aged 35–70 years (n = 70, mean age 57.4 ± 1.52) undergoing surgical treatment in the otorhinolaryngological department of the Vladivostok Clinical Hospital No. 1. The experimental group included polyp materials obtained via polypectomy from patients (n = 50) with a clinically verified diagnosis of nasal polyps without a concomitant pathology of the nasal mucosa. The control group included two variants of nasal mucosa samples. Group I (control I) comprised the nasal mucosa material of patients diagnosed with deviated septum who underwent rhinoseptoplasty (n = 20) without polyposis and concomitant inflammatory and allergic pathologies. Group II (control II) comprised the mucous membrane material of inferior turbinates (n = 50), which was obtained during surgical treatment of patients with a clinical diagnosis of nasal polyps.Results. It was found that nasal mucosa cells in RNP are characterized by an increased expression of nNOS/iNOS markers, which correlates with the distribution of proapoptotic factors and depends on the clinical and morphological type of polyps.Conclusions. The development of RNP is accompanied with an increased expression of NOS and apoptosis factors in the nasal mucosa. The specific signal microenvironment provides favorable conditions for the formation of polyps of various morphological types.

Patient Perspectives on Acute Exacerbations of Chronic Rhinosinusitis: A Qualitative Study.

Acute exacerbations of chronic rhinosinusitis (AECRS) are currently defined as a transient worsening of symptoms that return to baseline. This definition is narrow and can only be made retrospectively. The literature has studied this phenomenon from the physician perspective, yet a key stakeholder's-the patient's perspective is not well elucidated in the literature. To understand AECRS from the patient's perspective, we performed this study to further clarify this phenomenon. Basic qualitative study via patient interviews using constant comparative methodology was conducted. Tertiary care academic center. Two of the authors served as coders, and via group discussion, a common codebook was created and used to identify recurrent themes. The themes were analyzed for meaning and conclusions were summarized. Ten interviews were conducted with chronic rhinosinusitis (CRS) patients. Recurring themes included the following: (1) patients identify with the term flare or sinus infection more than exacerbation; (2) consistent with the current definition, patients identify AECRS by worsening sinonasal symptoms but also relate secondary symptoms, including poor sleep, fatigue, exacerbation of lower respiratory tract symptoms, and malaise to AECRS; and (3) patients are greatly affected by AECRS via decreased quality of life (QOL), worsening of general health, and decreasing productivity. Beyond worsening of sinonasal symptoms, the concept of AECRS reflects a more complex construct to patients with associated extranasal symptoms and systemic manifestations. In addition, AECRS have a large impact on patients, and therefore, understanding this component of CRS is pivotal in improving disease control and QOL in this patient population.

Characterization of human nasal organoids from chronic rhinosinusitis patients.

ABSTRACTPatient-derived organoids grown in three-dimensional cultures provide an excellent platform for phenotypic high-throughput screening and drug-response research. Organoid technology has been applied to study stem cell biology and various human pathologies. This study investigates the characteristics and cellular morphology of organoids derived from primary human nasal epithelial cells (HNECs) of chronic rhinosinusitis (CRS) patients. Nasal organoids were cultured up to 20 days and morphological, cell composition and functional parameters were measured by immunofluorescence, RT-qPCR, western blot and FACS analysis. The results showed that nasal organoids expressed the stem cell marker leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5), and markers for apical junction genes, goblet cells and ciliated cells. Moreover, we were able to regrow and expand the nasal organoids well after freezing and thawing. This study provides an effective and feasible method for development of human nasal organoids, suitable for the phenotypic high-throughput screening and drug response research.

Chronic rhinosinusitis patient with nasal polyps at Dr. Soetomo General Academic Hospital Center

Background: Nasal polyps are benign chronic inflammatory masses with epithelial tissues of the nasal mucosa and paranasal sinuses. The clinical diagnosis is made based on sinonasal symptoms for more than three months and the presence of polyps in the nasal cavity. The classification of nasal polyps based on the histopathological structure is divided into three types, i.e., oedematous, eosinophilic polyps, inflammatory polyps, and chronic seromucous inflammatory polyps. This study aims to describe the profile of patients with nasal polyps at Dr. Soetomo Public Hospital Surabaya. Methods: This study applied a descriptive method with a retrospective approach by obtaining data from the medical records of the outpatient unit in the Ear, Nose, Throat, and Head-Neck (ENT-HN) Department of Dr. Soetomo Public Hospital Surabaya for the period January 2017-December 2018 based on age, gender, clinical symptoms, symptoms duration, polyp types, location of nasal polyp, and comorbidities. Results: The number of patients with nasal polyps was slightly more in women, as many as 13 patients or 52%, mostly aged 51-60 years old, amounting to 11 patients or 44%. The most common clinical symptom experienced by patients was nasal obstruction, as many as 24 patients or 96%. Patients who experienced symptom duration for one to three years before treatment amounted to 13 patients or 52%. Patients with histopathology of inflammatory nasal polyps were 19 patients or 76%, while patients of nasal eosinophil polyps were six patients or 24%. Additionally, patients with comorbidity in nasal polyps of allergic rhinitis medical history were 11 patients or 44%. Also, bilateral nasal polyps were mostly experienced by patients, reaching 14 patients or 56%. Conclusion: This study reveals nasal polyps in women aged 51-60 years with clinical symptoms of nasal obstruction with the results of a histopathological examination of the inflammation type at bilateral polyps.

The difference in pathogenic bacteria between chronic rhinosinusitis in patients with and without Sjogren’s syndrome: a retrospective case–control study

BackgroundChronic rhinosinusitis (CRS) affects the quality of life of many people worldwide and can cause comorbidities. Our previous research proved that Sjogren’s syndrome (SS) is a predisposing factor for CRS, with a 2.5-fold associated risk. Antibiotics are important in CRS treatment; however, there is a paucity of research on the pathogenic bacteria of SS-CRS in the past. We conducted this study to investigate the pathogenic difference of SS-CRS and non-SS-CRS and aimed to give clinicians references when selecting antibiotics to treat SS-CRS.Materials and methodsA total of 14,678 patients hospitalized for CRS operation from 2004 to 2018 were identified from the Chang Gung Research Database. These CRS cases were classified as either SS-CRS or non-SS-CRS. We analyzed their bacterial distribution by studying the results of the pus cultures performed alongside surgery.ResultsThe top three facultative anaerobic or aerobic isolated bacteria in the SS-CRS group were coagulase-negative Staphylococcus (CoNS: 34.3%), Pseudomonas aeruginosa (28.6%), methicillin-sensitive Staphylococcus aureus (MSSA: 20%), and Staphylococcus epidermidis (20%). In the non-SS-CRS group, S. epidermidis (29.3%), CoNS (25.7%), and MSSA (14.2%) were identified. The top three anaerobic bacterial genera were Cutibacterium (54.3%), Peptostreptococcus (11.4%), and Fusobacterium (11.4%) in the SS-CRS group and Cutibacterium (53.8%), Peptostreptococcus (25%), and Prevotella (12.9%) in the non-SS-CRS group.ConclusionsP.aeruginosa is a major pathogen in SS-CRS patients. In addition, physicians should be aware of potential Fusobacterium and antibiotic-resistant bacterial infection in patients with SS-CRS.

The relative proportion of comorbidities among rhinitis and rhinosinusitis patients and their impact on visit burden.

BackgroundThe aim was to evaluate the relative proportion of Non‐steroidal anti‐inflammatory drug exacerbated respiratory disease (NERD) and other comorbidities, and their impact on the burden of outpatient visits due to allergic rhinitis (AR), non‐allergic rhinitis (NAR), acute rhinosinusitis (ARS), and chronic rhinosinusitis with nasal polyps (CRSwNP) and without (CRSsNP).MethodsWe used hospital registry data of a random sample of 5080 rhinitis/rhinosinusitis patients diagnosed during 2005–2019. International Statistical Classification of Diseases and Related Health Problems (ICD10) diagnoses, visits, and other factors were collected from electronic health records by using information extraction and data processing methods. Cox's proportional hazards model was used for modeling the time to the next outpatient visit.ResultsThe mean (±standard deviation) age of the population was 33.6 (±20.7) years and 56.1% were female. The relative proportion of AR, NAR, ARS, CRSsNP and CRSwNP, were 33.5%, 27.5%, 27.2%, 20.7%, and 10.9%, respectively. The most common other comorbidities were asthma (44.4%), other chronic respiratory diseases (38.5%), musculoskeletal diseases (38.4%), and cardiovascular diseases (35.7%). Non‐steroidal anti‐inflammatory drug exacerbated respiratory disease existed in 3.9% of all patients, and 17.7% of the CRSwNP group. The relative proportion of subjects having 1, 2, 3 and ≥ 4 other diseases were 18.0%, 17.6%, 17.0%, 37.0%, respectively. All diseases except AR, ARS, and mouth breathing, were associated with a high frequency of outpatient visits.ConclusionsOur results revealed a high relative proportion of NERD and other comorbidities, which affect the burden of outpatient visits and hence confirm the socioeconomic impact of upper airway diseases.

A novel risk score for disease control prediction of chronic rhinosinusitis.

ObjectivesTo assess the impact of risk factors on the disease control among chronic rhinosinusitis (CRS) patients, following 1 year of functional endoscopic sinus surgery (FESS), and combining the risk factors to formulate a convenient, visualised prediction model.DesignA retrospective and nonconcurrent cohort study.Setting and ParticipantsA total of 325 patients with CRS from June 2018 to July 2020 at the First Affiliated Hospital of Sun Yat‐sen University, the Third Affliated Hospital of Sun Yat‐sen University, the Seventh Affiliated Hospital of Sun Yat‐sen University.Main Outcomes MeasuresOutcomes were time to event measures: the disease control of CRS after surgery 1 year. The presence of nasal polyps, smoking habits, allergic rhinitis (AR), the ratio of tissue eosinophil (TER) and peripheral blood eosinophil count (PBEC) and asthma was assessed. The logistic regression models were used to conduct multivariate and univariate analyses. Asthma, TER, AR, PBEC were also included in the nomogram. The calibration curve and area under curve (AUC) were used to evaluate the forecast performance of the model.ResultsIn univariate analyses, most of the covariates had significant associations with the endpoints, except for age, gender and smoking. The nomogram showed the highest accuracy with an AUC of 0.760 (95% CI, 0.688–0.830) in the training cohort.ConclusionsIn this cohort study that included the asthma, AR, TER, PBEC, which had significantly affected the disease control of CRS after surgery. The model provided relatively accurate prediction in the disease control of CRS after FESS and served as a visualised reference for daily diagnosis and treatment.

Clinical outcomes of Eustachian tube dysfunction in chronic rhinosinusitis following endoscopic sinus surgery.

The effects of endoscopic sinus surgery (ESS) on the symptom burden of Eustachian tube dysfunction (ETD) in chronic rhinosinusitis (CRS) patients were investigated. Ninety-two patients with CRS following ESS were prospectively enrolled and followed up every 3 months for 1 year. The 7-item ETD Questionnaire (ETDQ-7) and 22-item Sino-Nasal Outcome Test (SNOT-22) were administered before ESS and at each visit following ESS. Before surgery, 25% of patients reported ETDQ-7 scores ≥ 14.5, indicating the presence of ETD. The mean preoperative ETDQ-7 and SNOT-22 scores were 13.3 and 40.0, respectively. The mean ETDQ-7 and SNOT-22 scores were significantly decreased to 8.2 and 17.0 at 1 year following ESS, respectively. Most patients reported alleviation of their symptoms within the first 3 months, and the prevalence of ETD had decreased to 3.3% at 1 year. Patients who received revision surgery had higher ETDQ-7 scores during the follow-up period. Additionally, 5.4% of patients reported worsening of their symptoms. ETD symptoms can be effectively alleviated in most patients within 3 months following ESS. However, 5.4% of patients reported worsening of their symptoms at the 1-year follow-up. Additional objective studies should be conducted to evaluate Eustachian tube function thoroughly in CRS patients.

Prevalence of Allergic Rhinitis in Patients Diagnosed with Chronic Rhinosinusitis in a Tertiary Care Hospital

Background: Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and paranasal sinuses lasting for 12 weeks or longer. Aim: To explore the prevalence of allergic rhinitis and common allergens in chronic rhinosinusitis patients. Methods: The study was conducted in Department of ENT at Dr. Akbar Niazi Teaching Hospital Islamabad from April 2021 to March 2022. On the basis of inclusion criterion, one hundred patients of CRS included in this study. All patients met the diagnostic criteria for CRS through, history, nasoendoscopic examination, and radiological findings. Allergic rhinitis was diagnosed on the basis of skin prick test (SPT). All patients who were operated for CRS were excluded from the study. Results: Male and female ratio was almost equal with slight male predominance. The incidence of polypoidal CRS and non-polypoidal CRS was 52 (52%) and 48 (48%) respectively. Almost two third of polypoidal CRS patients suffered from severe disease based on Nasoendoscopic examination and radiological findings (CT-Scan). The commonest presenting symptoms were nasal discharge and nasal blockage effecting around 92% and 91% patients respectively. Skin prick test (SPT) showed 73% patients were suffering from allergic rhinitis with pet dander being the most common allergen. Conclusion: Chronic Rhinosinusitis is a common disease and majority of patients develop CRS secondary to allergic reaction. Early diagnosis of allergic rhinitis with identification of specific allergens and its management can help in prevention of CRS. Keywords: Allergic rhinitis (AR), Chronic rhinosinusitis (CRS), Sinunasal Polyposis, non-allergic rhinitis, Skin prick test (SPT)

Computed Tomography Grading of Nasal Obstruction Severity in Recurrent Acute Rhinosinusitis Patients

Computed Tomography Grading of Nasal Obstruction Severity in Recurrent Acute Rhinosinusitis Patients

Bacterial community of chronic rhinosinusitis patients and therapeutic ultrasound efficacy: clinical trial study.

Bacterial involvement in chronic rhinosinusitis (CRS) condition made it difficult to treat using available antibiotic therapy. Therapeutic ultrasound was investigated here to evaluate bacterial diversity and quantity before and after continuous/pulsed ultrasound strategy compared to control patients. Totally, 34 CRS patients were studied in three groups, including continuous ultrasound, pulsed ultrasound and control. Bacterial culture and identification were done before and after treatment. Computed tomography scan (CT scan) and questionnaire scores were recorded two times before and after intervention. The most prevalent bacterial isolates were non-hemolytic Streptococci (34 patients), coagulase-negative Staphylococcus (33 patients), Gram-negative cocci (26 patients), Staphylococcus aureus (19 patients), Streptococcus pneumoniae (five patients) and Streptococcus pyogenes (five patients). Both continuous and pulsed ultrasound could significantly reduce the quantity of bacterial isolates after treatment. CT scan and questionnaire results support the effectiveness of therapeutic ultrasound. The quantity of clinically important bacteria was significantly reduced using ultrasound treatment and recovery of patients was supported by CT scan and questionnaire scores. Alternative therapeutic ultrasound could be an effective procedure in CRS patients.

Risk Stratification of Acute Invasive Fungal Rhinosinusitis in Patients With Hematologic Pathology.

The purpose of this study is to identify objective perioperative diagnostic factors for acute invasive fungal rhinosinusitis (AIFS) to create a diagnostic scoring system using objective criteria. Retrospective case-control study performed at an academic, tertiary care center. Biopsy-proven cases of AIFS identified from pathology records (2015-2019) were compared to patients the otolaryngology service was consulted to "Rule out AIFS" in the year 2019, only including those with underlying hematologic malignancy. Eighteen patients with AIFS and 20 patients without were included. One and two tailed T-tests were used for p-values. Receiver operating characteristic curves were generated for the significant data, and Youden's J-statistic was used to create the ideal cutoff values for each. Likelihood ratios were used to give a power for the scoring system. Compared to patients with non-hematologic malignancy-related AIFS, patients with hematologic malignancy-related AIFS have significantly elevated C-reactive protein (CRP) and blood glucose; while albumin, hematocrit, platelet count, and absolute neutrophil count (ANC) were found to be significantly lower. In addition, Lund-Mackay score asymmetry, extra-sinus spread, aspergillus antigen, and pre-existing diabetes mellitus correlated with disease. A scoring system with three categories: AIFS Unlikely, Indeterminate/AIFS Suspicious, and AIFS Highly Likely was developed. Patients with hematologic malignancy-related AIFS have measurable differences in lab values and standard imaging that could be used in determining the diagnostic probability of AIFS including: CRP, albumin, hematocrit, platelets, ANC, blood glucose, aspergillus antigen, Lund-Mackay score asymmetry, extra-sinus spread, and pre-existing diabetes mellitus. A novel scoring system was proposed that will require prospective validation. 3 Laryngoscope, 133:1059-1064, 2023.

Comparison of sinus distribution between nasal irrigation and nasal spray using fluorescein-labelled in patients with chronic rhinosinusitis: A randomised clinical trial.

This study aims to compare the potential sinus distribution between high-volume nasal irrigation and nasal spray in chronic rhinosinusitis (CRS) patients who have not undergone sinus surgery. A randomised clinical study was conducted at the Otolaryngology-Head & Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. Forty patients undergoing endoscopic sinus surgery (ESS) for CRS. Thirty-eight patients met the inclusion criteria and were randomly assigned to receive nasal irrigation or nasal spray mixed with fluorescein sodium preoperatively. The primary outcome was the mean difference in the staining score of fluorescein in all sinuses between the two groups. The total fluorescein staining score for all sinuses in the nasal irrigation group was significantly higher than the score from the nasal spray group, with a mean difference score of 2.90, 95% confidence interval: 1.22-4.58, p=.001. The most significantly affected sinuses were the maxillary and the anterior ethmoid sinuses, while the frontal and sphenoid sinuses had only minimal staining from both techniques. Nasal irrigation is a potential route to deliver drugs into the sinus in unoperated CRS patients. However, it is not considered a superior method to nasal spray in the most challenging anatomical areas, that is, the frontal and sphenoid sinuses.

Nazal Polipli Hastalarda COVID-19 İnsidansının ve Prognozunun Değerlendirilmesi

Objective: Coronavirus disease 2019 (COVID-19) is a global pandemic infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Type 2 immune response accompanied by type 2 cytokines such as IL-4, IL-5, IL-13, and eosinophilic inflammation, may have a potential protective effect against COVID-19 in chronic rhinosinusitis patients with nasal polyps (CRS + P). In the study, it was aimed to investigation the prevalence and prognosis of COVID-19 in chronic rhinosinusitis patients with nasal polyps (CRS + P). Materials and Methods: Patients between the ages of 15-65 operated for CRS + P and were compared with the control group in terms of incidence and disease severity. Results: Covid RT-PCR test was positive in 5.04% of CRS + P patients. This rate was 8.96% in the control group, and the difference between both groups was statistically significant. When the two groups were compared in terms of disease severity, no significant difference was found. Conclusions: The incidence of COVID-19 was lower in patients with CRS + P. However, further prospective studies are needed to research the relationship between nasal polyp and COVID-19.

0796 The sleep instability in chronic rhinosinusitis patients with nasal polyps using CAP analyses during NREM sleep

Abstract Introduction The sleep instability can increase the impact of several sleep disorders. The chronic rhinosinusitis leads to sleep fragmentation, and changes in systemic inflammatory biomarkers followed by upper airway flow limitation or nasal mucosa inflammation near the skull base. To evaluate the effect of sleep dysruption in chronic rhinosinusitis patients with nasal polyps using CAP analyses, this study aimed to analyse these patients before and after the anti-inflammatory effect of intranasal corticosteroids on nasal obstruction. Methods After two months of washout, thirty individuals with nasal polyps and sleep-disordered breathing used intranasal budesonide 400 mcg every day for one month. Before and after the treatment, they underwent the same exams: nasal endoscopy, subjective nasal resistance scores, fatigue severity scale, and Epworth sleepiness scale. Besides, T helper-two inflammation was measured by serum levels of eosinophils, interleukin-four and five. Intermittent hypoxia impact was documented using serum levels of IL-6 and tumor necrosis factor-alpha. Type 1 polysomnography was performed. It was scored according to the last manual of AASM and Terzano’s rules. The nonparametric Wilcoxon test was used to assess within-group differences before and after exposure to corticosteroids. Correlation between quantitative variables was analyzed by using the Spearman correlation coeficient, and p< 0.05 was statistically significant. Results All the participants had sleep' fragmentation in non-REM sleep. The treatment decreased the subjective nasal obstruction (p<0.005) and IL-5 levels (p<0.05), without significant impact on other biomarkers, nasal endoscopy results, fatigue or somnolence scales, and sleep architecture. Interestingly, the subtypes of phase A of CAP weren′t statistically significant (p>0.05) decreased compared two groups (before and after treatment). Conclusion The anti-inflammatory effects of intranasal corticosteroid decreased the nasal resistance and Th2 systemic inflammation without any changes in sleep fragmentation, highlighting. Terzano’s manual quantifies the sleep fragmentation using the cyclic alternating pattern, and it can be a sensitive electroencephalogram analysis of the non-NREM sleep described as a marker of sleep instability, however the analyse of phase A subtypes CAP did not show changes sleep disruption in patients with nasal polyps after their treatment of nasal mucosa inflammation. More studies are need to clarify the sleep complaints in these patients. Support (If Any)