Sino-Nasal Outcome Test Research Articles

The effect of allergen immunotherapy in patients with central compartment atopic disease post-surgery.

To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery. A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell×109/L), tissue eosinophilia (%>100/HPF), and serum IgE (kU/L) were also recorded. Eighty-six CCAD patients were assessed (41±14yrs, 64% female). AIT was applied in 37% (n=32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p=0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (%≥diffuse 15.6 vs. 52.9, p<0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (%≥4/week, 37.5 vs. 79.6%, p<0.01). The rhinologic symptoms were similar (21.1±17.1 vs. 20.1±21.6, p=0.83). Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.

Correlation between Serum Vitamin D Levels and Allergic Rhinitis Severity at Vajira Hospital: A Cross-Sectional Study

OBJECTIVE: Vitamin D affects the immune system and inflammatory process, and its deficiency is significantly associated with an increased prevalence of allergic rhinitis (AR). Therefore, the correlation between the serum 25-hydroxyvitamin D levels and the severity of AR symptoms must be investigated.METHODS: This research utilized a cross-sectional approach, focusing on patients aged 18 years and above diagnosed with AR at the Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from August 15, 2023, to January 15, 2024. The relationship between AR severity and serum vitamin D levels was analyzed using Pearson correlation coefficient. AR severity on symptoms and quality of life was assessed using the Thai version of Sinonasal Outcome Test-22 (SNOT-22) and Rhinoconjunctivitis Quality of Life questionnaire-36 (RCQ-36) questionnaires. Serum-specific immunoglobulin E (IgE) and total IgE levels were also measured to examine their relationship with the serum vitamin D level.RESULTS: Among the 58 participants, 34 (58.60%) had vitamin D deficiency. These individuals with vitamin D deficiency exhibited significantly higher AR severity compared with those without vitamin D deficiency. The mean difference between these groups was 21.90 points for SNOT-22 scores (95%CI: 17.71–26.69, p-value &lt; 0.001) and 19.17 points for RCQ-36 scores (95%CI: 12.08–27.34, p-value &lt; 0.001). Further analysis revealed a significant inverse correlation between serum vitamin D level and AR severity, with Pearson correlation coefficients of −0.72 for RCQ-36 (95%CI: −0.82 to −0.56, p-value &lt; 0.001) and 0.80 for SNOT-22 (95%CI: −0.88 to −0.68, p-value &lt; 0.001). No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.CONCLUSION: A significant inverse relationship existed between serum vitamin D levels and AR severity. No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.

Sinonasal Outcomes Obtained after 2 Years of Treatment with Benralizumab in Patients with Severe Eosinophilic Asthma and CRSwNP: A "Real-Life" Observational Study.

Benralizumab is a monoclonal antibody that targets the interleukin-5 receptor (IL-5Rα), leading to the rapid depletion of blood eosinophils. RCTs have demonstrated efficacy in patients with severe eosinophilic asthma (SEA). The aim of this study was to assess the efficacy of benralizumab on sinonasal outcomes in a real-life setting in patients with SEA and concomitant chronic rhinosinusitis with nasal polyps (CRSwNP). We included 25 patients (mean age: 57.47 years, range: 35-77, F/M = 12:13) who were prescribed 30 mg benralizumab every month for the first three administrations and then every 2 months. The primary endpoint was to evaluate changes in the SinoNasal Outcome Test-22 (SNOT-22) and nasal polyp score (NPS) over a 24-month treatment period. Secondary endpoints included measuring the effects on nasal obstruction and impaired sense of smell. The mean NPS score decreased significantly from 5.11 ± 1.84 at baseline to 2.37 ± 1.96 at 24 months. The mean SNOT-22 decreased from 57 ± 15.30 at baseline to 26 ± 16.73 at 24 months. The SSIT-16 mean score improved with an increase in olfactory performance from 5.23 ± 2.58 at baseline to 7 ± 3.65 at 24 months. Moreover, 8/25 patients (32%) required rescue treatment with systemic steroids and 2 patients required endoscopic sinus surgery. While the improvement may not seem optimal at 12 months, a progressive enhancement was noted during the second year of treatment. Despite our data showing an improvement in quality of life and a reduction in the size of nasal polyps, no significant improvement in olfactory sensitivity was observed. In addition, in several patients, rescue treatments were required to maintain control of nasal and sinus symptoms. A careful risk-benefit assessment is therefore needed when deciding to continue treatment, weighing the potential for further improvement against the risks of complications. Such decisions should always be made in the context of a multidisciplinary team.

Correlation of sino-nasal outcome test and nasal polyp score in dupilumab-treated chronic rhinosinusitis with nasal polyps

Correlation of sino-nasal outcome test and nasal polyp score in dupilumab-treated chronic rhinosinusitis with nasal polyps

Safety and effectiveness of a drug-loaded haemostatic sponge in chronic rhinosinusitis: a randomized, controlled, double-blind study

Some cases of chronic rhinosinusitis (CRS) require surgical treatment and postoperative nasal packing, but bleeding and adhesion are common complications after nasal surgery. Biodegradable drug-loaded implants hold great therapeutic options for the treatment of CRS, but little data are available regarding the safety and efficacy of a novel drug-loaded haemostatic sponge (DLHS) in the sinus. The aim of this study was to investigate the safety and efficacy of DLHS in the sinus. We conducted a prospective, randomized, controlled, double-blind clinical trial. In this clinical trial, 49 patients were enrolled and randomly divided into 2 groups: group A (n = 25) had the DLHS containing 1 mg budesonide and 0.67 mg sodium hyaluronate placed into the sinus, and group B (n = 24) had the Nasopore placed after ESS. Endoscopic follow-up was performed for 12 weeks, and the findings were classified using the discharge, inflammation, polyps/oedema (DIP) endoscopic appearance scores. All patients completed questionnaires to evaluate their sinonasal symptoms by using the sinonasal outcome test-22 (SNOT-22) Chinese version and visual analogue scale (VAS). Serum cortisol concentration in group A was measured prior to surgery and at days 1, 3, 7, and 14 after nasal surgery. Comparing group A and group B, at 2 weeks, no significant differences were observed in either objective or subjective parameters. The mean value of VAS for rhinorrhoea and DIP for oedema and the mean value of nasal adhesion were significantly lower in Group A than in Group B at 6 and 12 weeks, but a significant difference did not occur in SNOT-22 and VAS for dysosmia between the two groups at 6 and 12 weeks. The mean serum cortisol concentrations in group A at the follow-up were within normal limits without remarkable fluctuations. This study demonstrates the safety and efficacy of a novel biodegradable DLHS with the possibility of being used in CRS patients, and this sponge may reduce inflammation and minimize adhesions via controlled local drug delivery without measurable systemic exposure.

Non-Mucosa Sparing (Reboot) Surgery as a Possible Rescue Therapy in Patients Locally Unresponsive to Biologics

Objective: Evaluation of effectiveness of non-mucosa-sparing (eg, reboot) surgery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), poorly responders to mAb therapy, who failed repeated comprehensive endoscopic surgeries. Methods: Retrospective observational study. Patients who were under mAb for a comorbid condition but still had no control over their CRSwNP were included. Data collected were preoperative tissue eosinophilia, nasal polyp score (NPS), 22-item sinonasal outcome test (SNOT-22), visual analog scale (VAS) for nasal symptoms, Lund–Kennedy score for nasal crusts (LK-c) and synechiae (LK-s), and Lund–Mackay score (LMS). The same data were also collected postoperatively (at 12 months), besides LMS, and compared. Results: Overall, 20 patients were included. Pre-reboot scores were: NPS = 4.95 ± 1.70; SNOT-22 = 63.90 ± 19.15; VAS-global = 7.06 ± 1.50; LM = 19.0 ± 4.01; LK-c = 1.10 ± 0.64; and LK-s = 1.30 ± 0.73. Tissue biopsies revealed a high density of eosinophils in all cases, ≥10/HPF (range 10-60). Mean postoperative outcomes were: NPS = 0; SNOT-22 = 17.90 ± 6.80; VAS-global = 1.91 ± 1.17; LK-c = 1.45 ± 0.51; and LK-s = 1.50 ± 0.61. The difference of mean pre- and postoperative scores was significant for both NPS, SNOT-22 and VAS-global ( P &lt; .001). No differences were observed for LK-c and LK-s ( P &gt; .05). Nasal specimens showed markedly reduced tissue eosinophils (100% of cases). Conclusion: Reboot sinus surgery might be an effective solution for recalcitrant CRSwNP patients unresponsive to mAbs and multiple sinus surgeries.

Comparison between clinical and cytological findings in chronic rhinosinusitis with nasal polyps treated with Dupilumab.

Biologics represent a new therapeutic strategy for severe and recurrent chronic rhinosinusitis with nasal polyps (CRSwNP). Usually, their actual therapeutic effectiveness is assessed by reduction in nasal polyps and/or improvement in nasal symptoms and quality of life. However, these measures do not consider nasal immunophlogosis, which can be evaluated through nasal cytology. The purpose of this study was to assess not only the clinical impact but also the cellular changes in the nasal inflammatory infiltrate observed through nasal cytology of CRSwNP patients treated with Dupilumab for 24 months. Fifty-five CRSwNP patients treated with Dupilumab were collected. Patients were evaluated before starting treatment and at one, three, six, nine months, one year, one and a half years, and two years after the first drug administration. During follow-up visits patients underwent endoscopic evaluation, nasal symptoms and quality of life assessment, complete blood count and nasal cytology. During follow-up, significant improvement was found in Nasal Polyps Score (NPS), nasal patency, olfaction, Sino-Nasal Outcome Test (SNOT-22) score, and Visual Analogue Scale (VAS). Regarding nasal cytology, a reduction in eosinophils and mast cells in the cellular infiltrate was observed over the two-year follow-up period compared to baseline. Dupilumab has demonstrated broad efficacy in the management of CRSwNP from both clinical and cytological findings. Further studies are needed to confirm our findings and evaluate the biologics' impact on nasal mucosal inflammatory cells by nasal cytology with the aim of better identifying each patient's endotype and predicting the response to biologics.

Patient-reported disease control versus overall symptom severity as global metrics of chronic rhinosinusitis disease status.

Overall symptom severity (OSS) and patient-reported chronic rhinosinusitis (CRS) control are global measures of CRS identified as consensus, essential criteria for CRS disease control assessment. We sought to determine the functional relationship between these two metrics. Using an international multicenter mixed-methods design, 260 CRS patients were recruited. OSS score was measured using a visual analog scale. Patient-reported CRS control was measured as "controlled," "partly controlled," and "uncontrolled." Twelve participants underwent semi-structured interviews to discuss OSS and patient-reported CRS control. The majority of interviewed participants felt OSS and patient-reported CRS control measured different constructs-while OSS only measured symptoms, patient-reported CRS control was more global, including not only symptom severity but also concepts such as medication usage, activity impairment, and exacerbations. Nevertheless, OSS score was strongly correlated with (ρ=0.67, p<0.001) and highly predictive of patient-reported CRS control. OSS score of >4 (95% confidence interval [CI]: 1.8-4.2) had 74.7% sensitivity and 93.2% specificity in identifying patients reporting their CRS as not controlled. OSS score of >6.6 (95% CI: 4.1-7.1) had 77.0% sensitivity and 75.9% specificity in identifying patients reporting their CRS as uncontrolled. The 22-item Sinonasal Outcome Test score was also predictive of patient-reported CRS disease control but OSS was significantly more predictive. Patients conceptually view patient-reported CRS control as a more global measure that subsumes OSS. Quantitatively, however, OSS is highly correlated with patient-reported CRS control, possibly reflecting their redundancy. For ease of use, we recommend patient-reported CRS control be reflected by OSS <4 for controlled, 4≤ OSS<7 for partly controlled, and OSS ≥7 for uncontrolled CRS.

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).

Age-related differences in olfactory training outcomes: A prospective cohort study.

While olfactory function decreases with age, it is unknown how age affects olfactory training (OT) efficacy. This study compared OT in two cohorts of subjects: aged ≤50 (younger cohort) and aged 51+ (older cohort) with olfactory dysfunction (OD) primarily from COVID-19 infection. Subjects with OD primarily secondary to COVID-19 infection were prospectively recruited and enrolled into an OT registry. Baseline data were collected and they were provided with a training kit and asked to complete OT at home twice daily for 6 months. Participants were asked to follow-up at 3 and 6 months during training for olfactory testing and quality-of-life surveys (Sino-Nasal Outcomes Test-22 [SNOT-22] and Questionnaire of Olfactory Disorders Negative Statements [QoD-NS]). Fifty-six participants completed OT (younger cohort: n=26, older cohort: n=30). There were no significant differences between cohorts' Affordable Rapid Olfactory Measurement Array (AROMA), QoD-NS, or SNOT-22 scores at any time point. Both cohorts showed significant AROMA score improvement of more than 16 points from baseline to 3 months (younger cohort: p=0.001; older cohort: p=0.008). The younger cohort had significant improvements in QoD-NS (p=0.008) and SNOT-22 (p=0.042) between baseline and 3 months while the older cohort improved from 3 to 6 months (QoD-NS: p=0.027, SNOT-22: p=0.049). Both cohorts demonstrated similar significant improvement in olfactory function after 3 months of OT. The timeline of subjective improvement was different between cohorts, with younger patients experiencing earlier improvement.

Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Impact of Overweight on Response to Dupilumab Treatment in Chronic Rhinosinusitis with Nasal Polyps.

Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts quality of life and often presents therapeutic challenges, with biologics like dupilumab showing promise in managing severe, uncontrolled cases. The aim of this study was to assess the influence of overweight on the effectiveness of dupilumab in patients with uncontrolled CRSwNP. This retrospective study analyzed treatment outcomes of 75 CRSwNP patients receiving dupilumab, categorizing them into underweight/normal-weight (BMI ≤ 24.9 kg/m2) and overweight/obese (BMI ≥ 25 kg/m2) groups. Outcome measures included changes in nasal polyp score (NPS) and sinonasal outcome test (SNOT-22) scores. Results demonstrated that the underweight/normal-weight group experienced significantly greater improvements in NPS and a higher rate of total NPS improvement compared to the overweight/obese group. While SNOT-22 scores improved in both groups, no significant differences were observed. Among patients with comorbid asthma, the underweight/normal-weight subgroup also showed significantly better outcomes, including greater reductions in both NPS and SNOT-22 scores. Multiple regression analysis identified BMI as an independent prognostic factor for NPS outcomes. The findings suggest that overweight/obesity adversely affects the response to dupilumab in CRSwNP, emphasizing the need for personalized treatment strategies considering BMI.

Dupilumab Versus Mepolizumab for Chronic Rhinosinusitis With Nasal Polyposis: An Indirect Treatment Comparison

BackgroundDupilumab and mepolizumab have shown efficacy and safety in treating chronic rhinosinusitis with nasal polyps (CRSwNP). ObjectiveWithout available results from head-to-head randomized control trials (RCTs) comparing dupilumab with other biologics, we conducted an indirect treatment comparison (ITC) with mepolizumab. MethodsA systematic literature review identified RCTs of biologics in CRSwNP. A Bucher ITC was performed, including nasal polyp score (NPS; range 0–8), nasal congestion (NC; 0–3), loss of smell (LOS; 0–3), University of Pennsylvania Smell Identification Test (UPSIT; 0–40), visual analog score (VAS; 0–10), Sino-Nasal Outcome Test (SNOT-22; 0–110), systemic corticosteroids (SCS) use or surgery for nasal polyps (NPs), and binary responder analyses for NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively. Matching-adjusted indirect comparisons (MAIC) were conducted as supporting analyses. ResultsSINUS-24/-52 (SYNAPSE-like subpopulation only) and SYNAPSE were identified for ITC. At 24 weeks, change from baseline in NPS and proportion of patients with a binary responder outcome of NPS improvement ≥1 were significantly (P<0.05) greater in patients receiving dupilumab versus mepolizumab. At 52 weeks, improvements in NPS, NC, LOS, UPSIT, and VAS were significantly (P<0.05) greater for dupilumab versus mepolizumab. Proportion of patients achieving binary responder outcomes of NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively, was significantly (P<0.05) higher, while SCS use was significantly (P<0.05) reduced, for dupilumab versus mepolizumab. Surgery rate was numerically reduced with dupilumab versus mepolizumab. The MAIC analyses confirmed these results. ConclusionsDupilumab was associated with greater improvements in CRSwNP-related outcomes versus mepolizumab.

Functional Outcomes of Endoscopic Sinus Surgery: A Prospective Cohort Study Using the Sino-Nasal Outcome Test-16 Questionnaire.

Chronic rhinosinusitis affects a large portion of the adult population, and its symptoms can be burdensome to patients' quality of life. Functional endoscopic sinus surgery (FESS) is usually required after medical therapies fail. To analyze the outcomes of FESS in a tertiary hospital using the modified Arabic Sinonasal Outcome Test. This prospective cohort study involved administering an electronic questionnaire, the modified Arabic Sinonasal Outcome Test-16, pre-operatively to patients diagnosed with chronic rhinosinusitis who underwent FESS. This test was subsequently resent six weeks post-operatively. Scores were calculated by adding the total score of the 16 questions. The lowest possible score was 0, and the highest score was 48. Pre- and post-operative scores were compared. Twenty-eight patients were included, with a mean age of 37.3±14.6. Our findings showed that FESS significantly improved all symptoms except cough and exophthalmos (p < 0.001). Nose congestion had the highest improvement score, with 78.6% of patients experiencing better symptoms. Lack of good night sleep was the second most ameliorated symptom, with 75% of patients showing improvement. Modified Arabic Sinonasal Outcome Test scores were significantly improved after FESS. Therefore, primary treatment with FESS should be considered for patients with chronic rhinosinusitis with nasal polyposis. However, further studies are recommended to investigate the long-term benefits of FESS and the impact of comorbidities, such as asthma and allergic rhinitis, on outcomes.

Correlations of pre- and post-operative symptoms with cytokines in different phenotypes and endotypes of chronic rhinosinusitis.

Recognising inflammatory endotypes in chronic rhinosinusitis (CRS) has become more important, especially with the advent of biological treatments. In this study, we investigated the correlations of pre- and post-operative symptoms with cytokine positivity in different endotypes and phenotypes of CRS. In total, 102 patients undergoing routine functional endoscopic sinus surgery were enrolled. The endotype classification (type 1, 2, or 3 CRS) was defined based on positivity for interferon-γ, interleukin (IL)-5, or IL-17 respectively, in sinonasal tissue samples. Clinical symptom scores were evaluated pre- and post-operatively using the 22-item Sinonasal Outcome Test and its four symptom subdomains: sleep, nasal, otologic/facial symptoms, and emotional function. Symptoms were compared between endotypes and phenotypes, and exploratory factor analysis (EFA) based on principal component analysis (PCA) was performed. The correlations of cytokine levels with baseline symptoms and changes in symptoms after 1 year were analysed. Symptoms in the otologic/facial pain category were associated with non-type 2 endotypes in PCA and confirmatory analysis. Non-type 2 CRS patients exhibited significantly more improvement in facial symptoms 1 year after surgery. Neutrophil-associated cytokines, such as IL-17, matrix metalloproteinase 9, and myeloperoxidase, were significantly correlated with baseline otologic/facial pain symptoms and changes in those symptoms after surgery. Otologic/facial pain symptoms may be indicative of non-type 2 endotypes. Neutrophil-associated cytokines, such as IL-17, MMP-9, and MPO, were significantly correlated with these symptoms. The establishment of links between specific symptoms and certain cytokines may help use and develop biological therapies for CRS.

Sino-Nasal Outcome Test-22: translation, cross-cultural adaptation, and validation in Polish-speaking patients.

There are many specific instruments for assessing the quality of life (QoL) in patients with chronic rhinosinusitis. Of all these tests, the Sino-Nasal Outcome Test-22 (SNOT-22) is the most widely used internationally. The purpose of the study was linguistic adaptation and validation of the SNOT-22 scale in the Polish language. The SNOT-22 was adapted into Polish and was administered to 148 subjects (108 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and 40 asymptomatic controls. Seventy-one patients completed the SNOT-22 a second time to evaluate test-retest reliability. The Polish SNOT-22 was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity. The Polish SNOT-22 exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient (α = 0.89) was obtained. Significantly higher scores (p < 0.01) were revealed in the Study Group with a median score of 32 (range 15-53) points in comparison with controls: 5 (range 0-20). A moderate correlation was found between SNOT-22 and the Lund-Kennedy test score (r = 0.334; p < 0.001) and a strong correlation between SNOT-22 and the Lund-Macay test score (r = 0.469; p < 0.001). The best cut-off point was set at a 16 score with a sensitivity of 0.981 and a specificity of 0.995. The determined Area Under Curve (AUC = 0.997; p < 0.001) confirms the diagnostic accuracy of the Polish SNOT-22. The Polish version of the SNOT-22 is a valid and reliable tool for measuring health-related quality of life in patients with CRSwNP in the Polish-speaking population.

EDS-FLU efficacy in patients with chronic rhinosinusitis with or without prior sinus surgery in ReOpen1 and ReOpen2 randomized controlled trials.

The inability of topical medications to reach sinus cavities is a potential reason for lack of efficacy in chronic rhinosinusitis (CRS). One purpose of endoscopic sinus surgery (ESS) is to enable delivery of medications into the sinus cavities. The exhalation delivery system with fluticasone (EDS-FLU; XHANCE) creates unique biomechanics that enable deposition of intranasal corticosteroid into sinuses and sinus drainage pathways but may have differing efficacy in operated versus unoperated sinuses. Two 24-week randomized trials (ReOpen1/2) evaluated EDS-FLU versus EDS-placebo in patients with CRS, stratified by surgical status. Surgery-naive (n=332) and prior-surgery (n=215) patient groups were analyzed as pooled data from ReOpen1/2. Outcome measures (least-squares mean change from baseline) included combined symptom score (CSS) and congestion score at weeks 4, 8, and 12 and average of percentages of opacified volume (APOV) of ethmoid/maxillary sinuses on CT and Sinonasal Outcome Test 22 (SNOT-22) total score at week 24. Baseline scores suggested moderate-severe disease: mean CSS=5.8; APOV=67.2%. EDS-FLU produced significant improvement versus placebo (p<0.05): CSS (surgery-naive, -0.68vs. -1.42; prior ESS, -0.70vs. -1.87); congestion (surgery-naive, -0.24vs. -0.59; prior ESS, -0.24vs. -0.69); and SNOT-22 (surgery-naive, -7.56vs. -18.30; prior ESS, -10.72vs. -18.74). Similar results were observed for APOV (p<0.05). No statistically significant difference was observed between surgery subgroups with either EDS-FLU dose. EDS-FLU improved symptoms, sinus opacification, and quality of life in patients with CRS with or without prior ESS, suggesting a role for EDS-FLU in both populations.

Efficacy of different biologics for treating chronic rhinosinusitis with nasal polyps: a network meta-analysis.

Currently, there is a debate around the use of biological agents in the treatment of chronic sinusitis with nasal polyps. Therefore, this study's purpose was to assess the effectiveness of various biologics in the treatment of chronic rhinosinusitis with nasal polyps. A systematic and manual search was conducted for all relevant studies from inception to December 20, 2023. Two independent authors carried out the search, screening, assessment, and data extraction. Network meta-analysis was conducted using STATA 14 software. Our analysis includes a comprehensive set of 19 studies. These studies compared the efficacy of four distinct biologic treatments. The results of reticulated Meta-analysis showed that Dupilumab (MD = -1.85, 95% CI: -2.47, -1.24), Omalizumab (MD = -1.30, 95% CI: -1.90, -0.70), Benralizumab (MD = -0.84, 95% CI: -1.66, -0.03) and Mepolizumab (MD = -1.48, 95% CI: -2.22, -0.74) were superior to placebo from the nasal polyp score(NPS), Dupilumab (MD = -12.56, 95% CI: -22.49,-2.63) was superior to placebo from the Sino-Nasal Outcome Test-22(SNOT-22)score, and Dupilumab (MD = -0.84, 95% CI: -1.08, -0.59) and Omalizumab (RR = -0.51, 95% CI: -0.83, -0.19) were superior to placebo from the nasal congestion severity(NCS). In terms of cumulative sorting under the surface of the curve (SUCRA) values, Dupilumab was the best performer in the NPS (0.92), SNOT-22 score (0.70), and NCS (0.93); Four different biologics outperformed placebo in the NPS, SNOT-22 score, and NCS. In patients with CRSwNP, based on the efficacy (NPS, (SNOT-22) score, NCS) and, dupilumab is the most efficacious for CRSwNP.

Peak nasal inspiratory flow assessment of polyp size and response from SYNAPSE

BackgroundIn the Phase III SYNAPSE study, mepolizumab plus standard of care (SoC) reduced nasal polyp score (NPS) versus placebo in patients with chronic rhinosinusitis with nasal polyps. ObjectiveInvestigate relationships between NPS and (1) peak nasal inspiratory flow (PNIF) and (2) patient-reported outcomes (PROs). MethodsIn this post hoc analysis, patients randomized 1:1 received mepolizumab 100 mg or placebo subcutaneously every 4 weeks (plus SoC). Changes from baseline in PNIF (Week 52), visual analog scale (VAS) scores (overall symptoms, nasal obstruction, loss of smell; Weeks 49–52), and 22-item Sino-Nasal Outcome Test (SNOT-22) total score (Week 52) were assessed in patients with NPS improvements (≥1-point) or without (<1-point, or worsening). ResultsPatients with NPS improvements had greater improvements in median (interquartile range [IQR]) PNIF (mepolizumab 50 L/min [10.5, 87.5], placebo 40 L/min [0, 85.0]) than those without (0.0 L/min [─10.0, 45.0], 0.0 L/min [─30.0, 30.0]); similar results were seen for median (IQR) change from baseline in overall symptoms (with: ─5.8 [─8.1, ─3.8], ─4.1 [─7.0, ─1.2]; without: ─1.3 [─6.3, 0.0], ─0.1 [─3.4, 0.0]), nasal obstruction (with: ─5.7 [─8.2, ─3.5], ─4.5 [─7.3, ─1.2]; without: ─1.3 [─6.6, 0.0], 0.0 [─3.6, 0.0]), loss of smell (with: ─2.8 [─7.9, 0.0], ─0.7 [─4.0, 0.0]; without: 0.0 [─2.4, 0.0], 0.0 [─0.3, 0.0]) VAS, and SNOT-22 total score (with: ─37.0 [─52.0, ─24.0], ─29.0 [─43.0, ─9.0]; without: ─16.0 [─42.0, 0.0], 0.0 [─27.0, 0.0]). ConclusionNPS improvement was associated with PNIF and PRO improvements irrespective of treatment. PNIF could be a useful non-invasive tool for monitoring nasal polyp size.

Comparative Effectiveness of Dupilumab Versus Sinus Surgery for Chronic Rhinosinusitis With Polyps: Systematic Review and a Meta-Analysis.

Current treatment paradigms recommend surgical intervention when conventional medical management proves ineffective in resolving chronic rhinosinusitis with nasal polyposis. To assess and compare the efficacy of dupilumab and functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis with nasal polyp (CRSwNP) over time. Studies comparing CRSwNP patients who received dupilumab with those who underwent FESS were included. Outcome measures included the nasal congestion score (NCS), Sino-nasal Outcome Test-22 (SNOT-22), University of Pennsylvania Smell Identification Test-40 (UPSIT-40), and nasal polyp score (NPS). The risk of bias was evaluated using the Newcastle-Ottawa Scale. A total of 4 studies with 724 participants were included. The dupilumab group had a superior NCS, but an inferior NPS, compared to the FESS group during the follow-up period. The SNOT-22 score of the dupilumab group was inferior to that of the FESS group until 6 months posttreatment, but the scores were similar at around 1 year. A similar trend was observed for the UPSIT-40 score, but the score of the dupilumab group was higher at around 1 year. Functional endoscopic sinus surgery was more effective than dupilumab for several months after treatment. However, at 1 year after treatment, the effects of the 2 treatments became similar, with greater olfactory improvement seen in the dupilumab group.