Symptoms Of Rhinosinusitis Research Articles

The Effects of Nigella Sativa (Black Seed) in Rhinosinusitis Subjects: A Systematic Review

Introduction: Allergic rhinitis is a persistent inflammatory nasal condition triggered by an exaggerated immune response to allergens. Its primary complication is sinusitis which progresses to rhinosinusitis. Nigella Sativa known for its anti-inflammatory effects, has shown promising efficacy in treating rhinosinusitis. While various studies have reported Nigella Sativa's effects on rhinosinusitis, there is paucity in specifically addressing the optimal therapeutic dose and efficacy compared to conventional anti-histamine or anti-allergic drugs. Thus, this study aims to systematically review the effects of Nigella Sativa on rhinosinusitis in both human and animal subjects. Method: This systematic review followed the guidelines of PRISMA. A systematic literature search was performed through searches in PubMed, Scopus, Cochrane Library, and Google Scholar, along with the application of the snowball technique. Two authors independently evaluated the identified articles at various stages, including title, abstract, and full text, against predefined eligibility criteria. The assessment of potential bias in the studies incorporated the Joanna Briggs Institute (JBI) checklist for critical appraisal of human studies and the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool for assessing bias in animal studies. Results: Twelve studies were included in this study. Six studies were found to exhibit a low risk of bias, whereas three studies were categorized with a moderate risk of bias, and an additional three studies were identified as having a high risk of bias. Seven studies recorded significant symptom reduction while other studies showed better histological changes and chemical parameters compared with conventional medication. Conclusion: Nigella Sativa demonstrates anti-inflammatory, anti-histaminic, and antimicrobial properties, aiding in alleviating symptoms of allergic rhinitis and rhinosinusitis. 10 to 100 mg/kg/day Nigella Sativa is proposed to be considered as the optimum dose range as an alternative to conventional drugs such as montelukast, mometasone furoate, and dexamethasone due to its minimal side effects.

A Crowded Nasal Cavity.

A 41-year-old male patient had symptoms of chronic rhinosinusitis lasting several years. Endoscopy revealed edematous mucosa without discrete mass and was followed by a computed tomography scan to assess severity and inform surgical planning. What is your diagnosis?

Alleviating symptoms of paediatric acute rhinosinusitis and acute otitis media with otorrhea using nasal-spraying Bacillus probiotics: a randomized controlled trial

Acute rhinosinusitis (ARS) in children may be accompanied by acute otitis media (AOM) which is often associated with bacterial co-infections. These conditions are among the primary reasons that children visit hospitals and require antibiotic treatment. This study evaluated the efficacy of the nasal-spraying probiotics (LiveSpo Navax containing 5 billion Bacillus subtilis and B. clausii spores/5 mL) as a supportive treatment for dual ARS and AOM with otorrhea in a randomized, single-blind, controlled clinical trial. Eighty-two patients (41 per group), aged 1 month to 12 years, received standard care along with nasal spraying of either physiological saline (Control group) or LiveSpo Navax (Navax group), administered three times daily over a 7-day follow-up period. A total of sixty-one patients (30–31 per group) completed the trial. The Navax group experienced 68.00% and 96.77% reductions in nasal congestion (by day 3) and rhinorrhea (by day 7), respectively, which were 2.04 and 1.94-fold higher than the Control group, with odds ratios (OR) of 4.31 and 30.00 (p < 0.05). Endoscopic results indicated 8% and 11% higher reductions in nasal mucopurulent discharge and tympanic membrane hyperemia in the Navax group compared to the Control group. By day 3, compared to day 0, the Navax group exhibited > 1200-fold reduction in Streptococcus pneumoniae and ≥ 4-fold reduction in Haemophilus influenzae concentrations (p < 0.05) in both nasopharyngeal and middle ear fluid samples, whereas the Control group showed no significant reductions. Navax treatment reduced IL-6 by 1.35- to 1.74-fold and TNF-α by 1.17- to 1.45-fold, more effectively than the Control group (p < 0.05). These results suggest that nasal-spray Bacillus spore probiotics, with their ability to reduce bacterial load and modulate immune responses, provide a cost-effective and safe solution for alleviating symptoms of both ARS and AOM in children.Trial registration: ClinicalTrials.gov, Identifier NCT05804123 on April 7, 2023.

Real-world effectiveness of mepolizumab in Japanese asthma patients with diverse backgrounds: Improvements in rhinosinusitis imaging (J-Real-Mepo).

Although randomized controlled trials (RCT) have demonstrated the efficacy of mepolizumab for asthma, they have excluded certain patient subgroups. To bridge the gap between RCT and real-world practice, the effectiveness of mepolizumab in a diverse population, including those potentially excluded from RCT, was assessed. Its effects on imaging findings and symptoms of chronic rhinosinusitis (CRS) with asthma were also assessed. This retrospective observational study of patients in Japan (J-Real-Mepo: UMIN000045021) evaluated multiple endpoints and analyzed the relationship between clinical background and treatment outcomes. Mepolizumab significantly reduced exacerbations, improved Asthma Control Test (ACT) scores, and forced expiratory volume in 1s, and reduced oral corticosteroid (OCS) dose, regardless of patient characteristics, including age, body mass index, smoking history, and comorbidities. Regarding RCT exclusion criteria, 29.4% of patients had no history of exacerbations. Although 25.4% of these patients required continuous OCS, the OCS dose was reduced similar to those with a history of exacerbations. Disease control and mepolizumab effectiveness in patients with a smoking history ≥10 pack-years was similar to that of never-smokers. Patients with eosinophil counts <150/μL had lower ACT scores and higher OCS use compared with patients with eosinophilia and comparable effectiveness regarding exacerbation and OCS reduction. Significant improvements in Lund-Mackay scores and CRS symptoms were observed. Mepolizumab effectiveness was demonstrated in a broad range of patients including those with RCT exclusion criteria, who had significant disease or OCS burden. These findings may explain the consistent results between RCT and real-world studies of mepolizumab.

Immediate Full-Arch Restorations Supported by Conventional Implants Plus Uni- or Bilateral Zygomatic Implants: A Three to Five Years Retrospective Radiologic and Clinical Comparison.

The study aimed to compare the short-term outcomes (3.7±0.4yrs) of full-arch immediately loaded fixed maxillary prostheses supported by conventional and unilateral single zygomatic implants versus those supported by conventional and bilateral single zygomatic implants. A retrospective analysis was conducted on patients suffering severe bone loss in the posterior area of the maxilla. The success of zygomatic implants was defined following Offset-Rhinosinusitis-Infection-Stability (ORIS) criteria. The criteria used to define success of standard dental implants were absence of mobility, pain, discomfort/neurologic disorder, and of persistent or chronic infection. The level of significance was 0.01. Thirty-eight patients received 2-5 standard implants plus two zygomatic implants (bilateral), whereas 10 patients had 3-5 standard implants plus a single zygomatic implant (unilateral). The cumulative success rate for standard implants was 99% and 97.3%, respectively, in the bilateral and unilateral groups. Four patients showed symptoms of acute rhinosinusitis (R-criterion): 1 in the unilateral and 3 in the bilateral group. Following the O-criterion, just 2 dental implants in the bilateral group showed a success grade 1. One zygomatic implant, belonging to the group bilateral, developed peri-implant mucositis with a success grade 3 (I-criterion). All zygomatic implants were checked individually and did not show either any signs of mobility or rotation after applying forces to the implant (S-criterion). The ORIS criteria divided the implants into three groups according to the success grades I,II,III: 32,36,8 for the bilateral, and 6,1,3 for the unilateral group, with no significant difference between the two groups. No zygomatic implant failure occurred so that the same zygomatic implant success rate (100%) was recorded for both groups. A prosthetic failure was registered in the unilateral group. The overall prosthesis success rates were 89.5% and 70%, respectively, in the bilateral and unilateral groups. A high degree of success was achieved for both groups treated with zygomatic implants, although in group unilateral there was one failure of a standard dental implant placed in the posterior area. This suggested that the use of zygomatic implants could provide adequate support to the fixed full-arch prostheses even in the configuration with a single unilateral zygomatic implant.

Dupilumab improves sense of smell and clinical outcomes in patients with severe chronic rhinosinusitis with nasal polyps with anosmia

Objective Loss of sense of smell is a cardinal symptom of chronic rhinosinusitis with nasal polyps (CRSwNP) and significantly impacts health-related quality-of-life. Dupilumab significantly improved smell outcomes (loss of smell [LoS] score; University of Pennsylvania Smell Identification Test [UPSIT]) versus placebo in the phase 3 SINUS-24/-52 studies (clinicaltrials.gov, NCT02898454/NCT02912468) in patients with severe CRSwNP. This post hoc analysis investigated the effect of dupilumab on olfaction using UPSIT smell impairment categories. Methods Patients with baseline smell impairment (UPSIT ≤34/≤33 [women/men; score range 0–40] AND LoS score ≥1 [0–3] AND smell/taste item of the 22-item Sinonasal Outcome Test >0 [SNOT-22; 0–5]) treated with dupilumab 300 mg or placebo once every 2 weeks on background intranasal corticosteroids were analyzed. Results Of 724 patients, 665 (91.9%) had smell impairment at baseline; most had anosmia (UPSIT 0–18) (dupilumab/placebo: 80.9%/79.8%). At week 24, the proportion of dupilumab-treated patients with anosmia decreased to 28.5%, while 14.9% achieved normosmia; most placebo-group patients (79.2%) remained anosmic and only 1.2% achieved normosmia (odds ratio = 17.3; 95% confidence interval = 5.1–59.0; p <.0001); results were similar at week 52. Improvements in Nasal Polyp Score, nasal congestion, and SNOT-22 total score were moderately correlated with improvements in UPSIT at weeks 24 and 52 (r = −.38 to −.50). Conclusion Most patients with severe CRSwNP had anosmia at baseline. Dupilumab treatment significantly improved smell versus placebo, with 14.9% achieving normosmia by week 24. There was a trend for better clinical outcomes in patients with greater smell improvement.

Nasal septal perforation in fungal rhinosinusitis: A case report

Background: Fungi are ubiquitous in our environment, they can be found in healthy or diseased mucus. Symptoms of fungal rhinosinusitis are different depending on their immunological status. Diagnostic based on history, physical examination, CT scan and histopathological findings. Objective: To report a case of fungal rhinosinusitis with complications. Case Report: A man, 56-year-old with a chief complaint of bad odor in the nose in the last 3 months. CT scan showed bone erosion in the maxillary sinus. Intraoperative found fungus ball in nose cavities and perforated nasal septal. Clinical question: What is the management of nasal septal perforation in fungal rhinosinusitis? Methods: Evidence-based literature study of nasal septal perforation in fungal rhinosinusitis. Result: Treatment for fungal rhinosinusitis is surgery. Antifungal and steroid therapy can be added to reduce recurrence. Conclusion: Debridement surgery is needed for fungal rhinosinusitis. A radiologic test is important to find extra sinuses expansion and bone erosion. Nasal septal perforation is treated by eliminating the cause, applying ointment, saline solution spray, and surgical.

A possible alternative to antibacterial therapy in the treatment of acute rhinosinusitis

High incidence of acute rhinosinusitis in a population remains one of the topical issues in practical otolaryngology. Statistical data show an increasing trend towards transition of acute rhinosinusitis in patients into chronic rhinosinusitis. According to literary sources, the emergence of bacterial resistance to antibiotics is as a rule the major reason of protracted course of the disease. Unreasonable antibiotics prescription, irrational use and uncontrolled intake result in the rapid development of antibiotic resistance. In this context, the use of herbal medicines having not only antibacterial, but also mucolytic, fungicidal, antioxidant effects in the complex therapy is a modern solution for disease management. Respero Myrtol, a standardized myrtol-based medicine, has taken its rightful place in the therapy. This article is aimed to investigate the possibilities of the effective use of medicine containing standardized myrtol as its main ingredient in the treatment of acute rhinosinusitis (based on the review of literature). Research materials included scientific articles on aspects of acute rhinosinusitis in otorhinolaryngology practice that were published in domestic specialized periodicals of eLIBRARY and scientific databases Scopus, Web of Science, Medline from 2014 to 2024. The published literature was analysed using the cause-and-effect technique. A clinical example was dis-cussed. With regard to the analysis of scientific literature, a brief overview of the epidemiology, etiology, predisposing factors for the development, diagnosis and treatment of acute rhinosinusitis was provided. The article addresses relevant socio-economic issues related to acute rhinosinusitis, the problem of antibiotic resistance. The issues of improving acute rhinosinusitis treatments using a standardized myrtol medicine in complex therapy as an alternative to antibiotic therapy were brought to attention. As a result, the authors concluded that the use of Respero Myrtol contributes to the rapid relief of clinical symptoms of acute rhinosinusitis, improves the patient’s quality of life, and can be advised as an alternative to antibiotic therapy in uncomplicated course of the disease.

Anatomical Variations on NCCT Nose and Paranasal Sinuses and Their Relation with Symptoms of the Patients: A Retrospective Analysis

Background: There are various bones around the nasal cavity that pneumatize to form the paranasal sinuses; namely, maxilla, ethmoid bone, frontal bone, and sphenoid bone. The CT scan of nose and paranasal sinus is the gold standard investigation for the patients of chronic rhino-sinusitis (CRS). Objective: This study was conducted with aim to determine the prevalence anatomical variation of Nose and Paranasal Sinuses on CT-scan and their relation with symptoms. Methods: A retrospective study was conducted among 200 patients over a period of one year (2022-2023). Patients with various symptoms of chronic rhinosinusitis were subjected to non-contrast enhanced Computed Tomography of nose and paranasal sinuses. Results: In our study 56% patients had septal deviation with most common C shaped deviation followed by S shaped deviation. 99.5% patients have agger nasi cells. The attachment of uncinate process was to the lamina papyracea in 83.0%, followed by the base of skull in 13.0%. The least common types were free uncinate process in 1.5%. The prevalence of concha bullosa was found 16.5%. However, paradoxical turbinate was present in 2.0% subjects. The incidence of Haller cells was found to be 5.0% and Onodi cells were found in 4.5%. The type of frontal cell was Agger Nasi followed by a Supra-bullar. In Sphenoid sinus, commonest type was pre-sellar type of pneumatisation. Conclusion: Our study concluded these various anatomical variations and its prevalence. The relation of variations with disease symptomatology is inconclusive.

Effect of Tezepelumab on Sino-Nasal Outcome Test (SNOT)-22 Domain and Symptom-Specific Scores in Patients with Severe, Uncontrolled Asthma and a History of Chronic Rhinosinusitis with Nasal Polyps.

Tezepelumab blocks the activity of thymic stromal lymphopoietin, an epithelial cytokine implicated in the pathogenesis of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). In a previous analysis, tezepelumab improved asthma and rhinosinusitis symptoms compared with placebo in patients with severe, uncontrolled asthma and a history of CRSwNP in the 2years before randomization in the NAVIGATOR study. This post hoc analysis of patients with a CRSwNP diagnosis at any time before randomization in NAVIGATOR enabled domain and symptom-specific analyses of Sino-Nasal Outcome Test (SNOT)-22 outcomes. Patients (aged 12-80years) with severe, uncontrolled asthma were randomized to tezepelumab 210mg or placebo subcutaneously every 4weeks for 52weeks. SNOT-22 total, domain, and item scores were assessed in patients with a history of CRSwNP. Annualized asthma exacerbation rate (primary efficacy outcome), pre-bronchodilator forced expiratory volume in 1s, and Asthma Control Questionnaire-6, Asthma Quality of Life Questionnaire (standardized) for patients 12years and older, and Asthma Symptom Diary scores were also assessed in patients with and without a history of CRSwNP. Of 1059 patients with severe asthma, 165 (15.6%) had a history of CRSwNP. Tezepelumab treatment resulted in sustained improvements versus placebo in SNOT-22 total score throughout the 52-week study period [least-squares mean difference (95% confidence interval) - 11.08 (- 17.80, - 4.35)]. Tezepelumab improved all five SNOT-22 domain scores (sleep, nasal, function, ear/facial, and emotion) and the five SNOT-22 item scores of most clinical interest (decreased sense of smell/taste, nasal blockage, reduced productivity, waking up tired, and cough). Tezepelumab improved asthma-related clinical outcomes in patients with and without a history of CRSwNP. In patients with severe, uncontrolled asthma and a history of CRSwNP, tezepelumab improved rhinosinusitis symptoms across multiple domains, as well as asthma exacerbations, lung function, asthma control, and health-related quality of life. NCT03347279 ( https://classic. gov/ct2/show/NCT03347279 ).

Orthonasal and retronasal olfactory function in patients with chronic rhinosinusitis without nasal polyps undergoing endoscopic sinonasal surgery.

Olfactory dysfunction (OD) is a key symptom of chronic rhinosinusitis (CRS). Although extensively studied in CRS with nasal polyps (CRSwNP), OD in CRS without nasal polyps (CRSsNP) remains under-researched. This study aims to assess the prevalence of OD and its evolution in surgically naïve patients with CRSsNP undergoing endoscopic sinus surgery (ESS). This prospective study included 97 participants with CRSsNP (mean age, 46.5 years; 70.1% men) and 97 healthy controls (mean age, 46.5 years; 70.1% men). Participants underwent psychophysical evaluations of orthonasal (using the Sniffin' Sticks test) and retronasal olfaction (using powdered aromas) at enrolment and 6 months post-ESS. Out of 97 patients, 81 (83.5%) completed all assessments. At enrolment, 23 (28.4%) CRSsNP patients had OD based on composite threshold, discrimination, identification scores, compared with 7 (8.6%) controls (absolute % difference, 19.8% [95% CI, 8.2-31.4]). Retronasal olfactory function was also significantly worse in CRSsNP patients. Six months post-ESS, 30 patients (37.0%) experienced a clinically significant improvement in olfactory, whereas nonsignificant changes were observed in retronasal olfactory score, and 3.7% of patients experienced a deterioration of the olfactory function. In conclusion, although 37% of patients experienced a clinically significant improvement in their sense of smell following ESS, the overall prevalence of OD in this surgically naive population appears relatively low, especially when compared to that observed in patients with CRSwNP. Therefore, ESS may offer some benefits for enhancing orthonasal olfactory function, but the extent of these improvements appears to be limited.

Computed Tomography Analysis of the Nasal Septal Deviation and Related Paranasal Sinus Pathologies

Purpose: Nasal Septum Deviation (NSD), which is defined as a dislocated septum, is a prevalent condition that is mostly asymptomatic; however, it can cause difficulties such as nasal obstruction and rhinosinusitis symptoms. Other Paranasal Sinuses (PNS) disorders, e.g., Osteo Meatal Complex (OMC) obstruction, have been assumed to be correlated with NSD. This study investigates the possible correlation of specific radiological findings of PNS pathologies in patients with or without the existence and direction of NSD. We also discussed the different types of NSD and their incidence among different groups stored by age, gender, etc. Materials and Methods: This is a cross-sectional study conducted at multiple imaging centers in Iran between July 2019 and February 2020 to estimate the prevalence of deviated nasal septum and correlate between NSD and other findings using paranasal sinus scans. All the individuals who met the inclusion and exclusion criteria were included in the study. NSD types have been classified based on Mladina's method. Results: We prospectively reviewed PNS Computed Tomography (CT) scans obtained from 254 cases (82 men and 172 women), aged 18 to 81 years (mean: 35.53), evaluated over seven months. Out of 254 cases, 135 (53 %) patients had NSD, without any direction predominance (right-sided vs. left-sided), and equally distributed between genders. The most common NSD types were type V with a frequency of 42.22% and type III with a frequency of 24.44%. Other PNS CT findings were also investigated in our patients, like OMC obstruction, pansinusitis, mucocele, air-fluid level, mucosal thickening, and concha bullosa. There was no statistically significant correlation between any of these pathologies and NSD (P-value &gt; 0.05). Conclusion: Although NSD was observed in more than half of our cases' PNS CTs, there was no significant correlation between NSD and other findings in most subjects. This reveals that the effectiveness of septal repair surgeries in relieving patients' symptoms might not be as high as expected.

Patient-reported outcome measures for acute rhinosinusitis in adults and children: a systematic review of the quality of existing instruments

BackgroundAcute rhinosinusitis (ARS) is a self-limiting inflammation of the nose and sinuses caused by viral or bacterial infections that requires primarily symptomatic treatment. Patient-reported outcome measures (PROMs) are suitable tools for the assessment of the effectiveness of remedies for ARS from the patient’s perspective in clinical trials and real-world studies. Data regarding the quality of existing PROMs for ARS are limited.PurposeTo conduct a systematic review of the quality of existing disease-specific PROMs for use in adults and children with ARS according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the identified instruments in future clinical studies.MethodsWe systematically searched PubMed, Web of Science and Embase for studies reporting on the development and/or validation of PROMs for ARS. We assessed the methodological quality of each included study, evaluated the quality of measurement properties per PROM and study, and graded the evidence. Based on the overall evidence, we derived recommendations for use of the instruments.ResultsWe identified four studies on three PROMs measuring symptoms of ARS and quality of life in adults (Sinonasal Outcome Test-16, SNOT-16; Measurement of Acute Rhinosinusitis, MARS; Rhinosinusitis Quality-of-Life Assessment, RhinoQoL). For ARS in children, we identified two studies on two PROMs measuring symptoms of ARS (Pediatric Rhinosinusitis Symptom Scale, PRSS; Sinus Symptom Questionnaire, S5). Our assessment of measurement properties indicates that all instruments require further validation before they can be unrestrictedly recommended for use in future research (COSMIN category B). In particular, there were no content validity studies for any of the identified instruments, but also data on other important measurement properties, e.g., structural validity, are lacking.ConclusionCurrently, no PROM for ARS in adults and children can be unrestrictedly recommended based on the evaluation of their quality. Further validation is required for all identified PROMs. Content validation involving patients and experts should be given priority.Systematic review registrationOSF (https://doi.org/10.17605/OSF.IO/VAP8U).

Exploratory pharmacodynamics and efficacy of PF-06817024 in a Phase 1 study of patients with chronic rhinosinusitis and atopic dermatitis

PF-06817024 is a humanized antibody against interleukin-33 that has the potential to inhibit type 2 inflammation. An exploratory analysis of the pharmacodynamics and clinical effects of single and repeat doses of PF-06817024 was assessed in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and patients with moderate-to-severe atopic dermatitis (AD), respectively, as part of a Phase 1, first-in-human study. Rhinosinusitis symptoms were improved, and nasal polyps were decreased in size following treatment with PF-06817024 in patients with CRSwNP. In patients with AD, PF-06817024, in aggregate, reduced disease severity and improved symptoms, as demonstrated by greater percentage decrease from baseline in Eczema Area and Severity Index (EASI) scores and reduced pruritus numerical rating scores, compared with placebo. The efficacy in AD appeared to be bimodal with a sub-group of participants exhibiting high levels of improvement (EASI75 and EASI90) for a sustained period of time after dosing. In patients with CRSwNP, a consistent trend of decrease in eosinophil levels was observed in the PF-06817024 group, compared with placebo. Further research would be needed to confirm the clinical benefit and safety of PF-06817024 as a treatment for allergic diseases.Trial registration ClinicalTrials.gov, NCT02743871. Registered 15 April 2016, https://clinicaltrials.gov/study/NCT02743871?term=NCT02743871&rank=1.

Nasal Symptoms of Chronic Rhinosinusitis Were Related to Its Nasoendoscopic Findings: A Retrospective Cohort Study at Dr. Soetomo General Academic Hospital, Surabaya

Highlights: Nasal congestion was the most common symptom presented in CRS patients. Nasal symptoms of CRS were positively associated with nasoendoscopic findings. Abstract Introduction: Chronic rhinosinusitis (CRS) is often encountered in Indonesia. Nasal endoscopy, or nasendoscopy, is considered the gold standard for assessing the severity of CRS. However, as nasendoscopy is unavailable in Indonesia, only symptom assessments can be conducted at primary healthcare facilities. This study aimed to elucidate the relationship between nasoendoscopic findings based on the Lund-Kennedy score (LKS) and symptoms in CRS patients based on the visual analogue scale (VAS) score. Methods: This retrospective analytic study evaluated CRS cases identified in the Ear, Nose, and Throat (ENT) Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, from July 2021 to July 2022. Statistical analysis was conducted using Spearman’s rank correlation test to identify the correlation (R-value) between LKS and the VAS score. Statistical significance was achieved if p-value &lt;0.05. All statistical tests were conducted using the International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 26.0 for Windows. Results: A total of 57 CRS patients were included in this study, mostly females (64.9%) and those aged 50–59 years old (26.9%). Nasal congestion was the dominant nasal symptom (80.7%), with mostly moderate symptom severity (VAS 4-7) reported. Across both nasal cavities, the most frequent nasoendoscopic finding among CRS patients was nasal edema (82.4% and 93%). A positive and weak correlation existed between the total VAS score of all symptoms and the total LKS of both nasal cavities (r = 0.387, p &lt; 0.05). Conclusion: The nasal symptoms of CRS patients were significantly associated with its nasoendoscopic findings.

Real-world data show sustained therapeutic effects of dupilumab in chronic rhinosinusitis with nasal polyps (CRSwNP) over 3 years.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent chronic inflammatory condition affecting the nose and paranasal sinuses, posing a significant socio-economic impact with substantial challenges in management. Biologics targeting type 2 inflammation such as dupilumab, have emerged as promising options. This study addresses a critical knowledge gap by comprehensively evaluating the 3-year impact of sustained dupilumab therapy in CRSwNP. A multicentric, retrospective collection of real-world data from five tertiary referral centers in Germany was conducted, enrolling 150 adult patients. The study investigated patient-reported outcomes, disease-specific indices and clinical measures, focusing on therapeutic response persistence, adverse events, and factors influencing treatment continuity. Results indicate significant improvements in clinical parameters from baseline (n = 150) with sustained effectiveness after 36 months (n = 138) as indicated in mean score ± standard deviation. Dupilumab treatment significantly improved overall disease-related impairment (VAS score: 7.5 ± 2.5 to 1.6 ± 1.3) and rhinosinusitis symptoms (SNOT-22: 59.4 ± 19.4 to 18.0 ± 15.0). Nasal Polyp Scores (NPS) decreased (5.3 ± 1.8 to 0.7 ± 1.1), and olfactory function improved (3.2 ± 2.5 to 8.4 ± 2.8), with three out of four patients achieving normosmia or hyposmia after 36 months. An "Excellent" treatment response according to EUFOREA23 criteria was observed in 76.5% of patients after 36 months. Sixteen patients discontinued Dupilumab, 12 permanently. Adverse events totaled 69 in 48 patients, commonly self-limiting. The study highlights the enduring effectiveness and lack of habituation to dupilumab after a sustained therapy of 3 years, providing valuable insights into its long-term therapeutic implications for CRSwNP patients.

The validity of clinical guidelines and nasal endoscopy in the diagnosis of chronic rhinosinusitis—a prospective observational study

BackgroundChronic rhinosinusitis is a common disease entity seen by ENT surgeons as well as general practitioners all over the world. This study is aimed to evaluate and validate whether the clinical guideline symptoms (set by AAO-HNS 2015) alone and/or nasal endoscopic findings can predict the diagnosis of CRS, taking CT as the gold standard.MethodsA total of 118 patients with symptoms of chronic rhinosinusitis were taken. They were divided into two groups on the basis of whether they fulfilled the Guideline symptom criteria laid down by AAO-HNS in 2015 for diagnosing chronic rhinosinusitis. Each group underwent diagnostic nasal endoscopy (DNE), and patients with either purulence, edema in the middle meatus or ethmoid, and polyps in the nasal cavity or middle meatus were considered positive for DNE. A Lund-Mackay CT score of > 4 was considered diagnostic of CRS. Each group was analyzed separately. Sensitivity, specificity, and positive predictive value of guideline symptom with and without the addition of nasal endoscopy was recorded taking CT as the gold standard.ResultsNasal obstruction was the most common seen in all cases (100%) followed by headache in 45 (38.1%), facial pain in 32 (27.1%), anterior nasal discharge in 28 (23.7%), decreased sense of smell in 22 (18.6%), and posterior nasal discharge in 19 (16.1%). Two-thirds of patients (78, 66.1%) fulfilled the clinical guideline symptoms criteria, and one-third of patients (40, 33.9%) did not fulfill the clinical guideline symptoms criteria. A positive finding on DNE was found in 59.3% (n = 70) of patients. More than half of patients (62, 52.5%) had mild grade on endoscopic examination, while only 8 (6.8%) had moderate grade, and none had severe grade. Guideline symptoms have a high sensitivity (80%) but a low specificity (50.94%) in the diagnosis of CRS, with a fair level of agreement with CT diagnosis (Kappa = 0.32). DNE has a moderate sensitivity (72.31%) but a low specificity (56.60%) in the diagnosis of CRS, with a fair level of agreement with CT diagnosis (Kappa = 0.29). Sensitivity and specificity were 80.77% and 57.69% respectively when guideline symptoms and DNE findings are taken in series.ConclusionWe conclude that neither Guideline Symptom Criteria nor DNE is independently sufficient enough to have a high diagnostic accuracy for CRS. Comparing the diagnostic efficiency among various modalities, we report that in patients who meet guideline symptom criteria for CRS, the addition of nasal endoscopy turned out to be a cost-effective diagnostic approach and improves the diagnostic accuracy of DNE for CRS reasonably, hence should be emphasized as a diagnostic tool in the evaluation of patients for CRS.

Eosinophilic granulomatosis with polyangiitis: a review article

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of ANCA-associated vasculitis (AAV) within the group of small vessel vasculitides. It is defined by vasculitis of small and medium-sized vessels with granulomatous inflammation and blood and tissue eosinophilia. Almost all patients have allergic symptoms with bronchial asthma and rhinosinusitis symptoms. Further clinical manifestations vary depending on the localisation, severity, and type of disease manifestation. Eosinophilic infiltration and inflammation may result in rhinosinusitis, pneumonitis, gastrointestinal involvement, and cardiomyopathy. The latter, in particular, is associated with a poorer prognosis. As a necrotising pauci-immune small-vessel vasculitis, EGPA, similar to the other AAVs, can cause pulmonary infiltrates with alveolar haemorrhage, glomerulonephritis, cutaneous vasculitis with purpura as well as central and peripheral neurologic injuries. The presence of perinuclear ANCA (pANCA) with specificity against myeloperoxidase (MPO) is observed in approximately one-third of patients but is not specific to EGPA. MPO-ANCA-positive patients are more likely to have peripheral neurologic involvement and glomerulonephritis, whereas ANCA-negative patients are more likely to have cardiac and pulmonary involvement. What is frequently challenging in the clinical routine is to differentiate EGPA from the hypereosinophilic syndrome (HES). The therapeutic approach to EGPA depends on whether the severity of the disease is potentially organ or life-threatening. For severe forms of EGPA, acute therapy mainly includes glucocorticoids in combination with cyclophosphamide. Rituximab has come to be mentioned as an alternative treatment option in the guidelines. Various immunosuppressive therapies are available for remission maintenance. In EGPA without severe organ involvement, IL-5 blockade with mepolizumab is an approved treatment.

Overall symptom severity as a patient-reported outcome measure for chronic rhinosinusitis: what it reflects and how to measure it.

The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and whether it can be measured using alternatives to the standard visual analog scale (VAS). CRS patients from four sites across three continents rated their OSS scores, severities of nasal obstruction, nasal drainage, decreased sense of smell, facial pain/pressure and sleep disturbance using a standard VAS, VAS with labeled tick marks at every 1 centimeter, and by writing down their OSS on a scale of 0 - 100 (which was divided by 10), all of which lead to severity scores ranging from 0 - 10 in 0.1 intervals. Quality of life was measured using the SNOT-22 and EQ-5D VAS. In 311 CRS patients, OSS score was significantly correlated with SNOT-22 and EQ-5D VAS. OSS score was most greatly associated with the mean of all individual symptom severity scores. From individual CRS symptoms, OSS was most greatly associated with nasal obstruction followed by nasal drainage and facial pain/pressure severities. These results held true for participants with and without nasal polyps. Measurement of OSS and individual symptom severity scores using a standard VAS, tick-marked VAS, and write-in option had near-perfect consistency. We demonstrate for the first time that OSS largely reflects the mean of individual CRS symptom severities, although OSS is=== most weighted by nasal obstruction severity. OSS and individual symptom severity scores can be measured using a standard VAS, tick-marked VAS or write-in prompt with near-perfect consistency.

Nasal resistance and inflammation: mechanisms for obstructive sleep apnea from chronic rhinosinusitis.

We have previously estimated that the prevalence of obstructive sleep apnea (OSA) among World Trade Center rescue and recovery workers is 75% and identified that having symptoms of chronic rhinosinusitis (CRS) is an independent risk factor for OSA in this population. Nasal inflammation and/or elevated awake nasal resistance that carried over into sleep could explain this association. To understand the mechanism(s) for the elevated risk of OSA observed in World Trade Center responders with CRS symptoms we examined if elevated awake supine nasal resistance was associated with OSA, CRS and/or nasal inflammatory biomarkers. A total of 601 individuals (83% male, average age 53 years, body mass index = 29.9 ± 5.5 kg/m2) enrolled in the World Trade Center Health Program and without significant snoring prior to September 11, 2001 underwent 2 nights of home sleep apnea testing, measurements of anterior rhinomanometry in the supine position, and nasal lavage. Awake supine nasal resistance was not associated with OSA; 74.8% and 74.4% of the participants with low and high nasal resistance respectively, had OSA. Patients with CRS had elevated nasal inflammatory markers (interleukin 6, interleukin 8, eosinophilic cationic protein, and neutrophil) but did not have high nasal resistance. Nasal inflammatory markers were not correlated with nasal resistance. As awake nasal resistance did not explain the relationship of CRS to OSA in this large and well characterized dataset, our findings suggest that either "sleep" nasal resistance or other factors such as increased supraglottic inflammation, perhaps through impairing upper airway reflex mechanisms, or systemic inflammation are involved in the pathophysiology of OSA in the World Trade Center population. Ayappa I, Laumbach R, Black K, etal. Nasal resistance and inflammation: mechanisms for obstructive sleep apnea from chronic rhinosinusitis. J Clin Sleep Med. 2024;20(10):1627-1636.