Sinonasal Symptoms Research Articles

Predicting Odontogenic Sinusitis in Unilateral Sinus Disease: A Prospective, Multivariate Analysis.

Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature. Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT. A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses. Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered. With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.

Clinical observation of Zhen’ai needling method in Nei Jing (Classic of Internal Medicine) for children with allergic rhinitis accompanied by adenoid hypertrophy

To observe the clinical efficacy of Zhen’ai needling method in Nei Jing (Classic of Internal Medicine) for children with allergic rhinitis (AR) accompanied by adenoid hypertrophy (AH). A total of 74 children who met the screening criteria were divided into a Zhen’ai group and a control group by the random number table method, with 37 cases in each group. The control group was treated with acupuncture at Zusanli (ST 36), Hegu (LI 4), Yingxiang (LI 20), Juliao (ST 3), Yintang (GV 29), Shangxing (GV 23) and Baihui (GV 20). The Zhen’ai group added points of Zhen’ai needling method {Shanglianquan [Extra, located at 1 cun above Lianquan (CV 23)], Tianrong (SI 17) and Lieque (LU 7)} in addition to the points in the control group. The needles were retained for 30 min. The treatment was performed twice a week. The total nasal symptom score (TNSS), sino-nasal outcome test-20 (SNOT-20) and symptom scale for AH (SSAH) were assessed before and after 10 treatments. The clinical efficacy of the two groups was compared after treatment. During the treatment, 5 cases dropped out in the control group and 2 cases in the Zhen’ai group. After treatment, the total effective rate of the Zhen’ai group was 94.3%, versus 93.8% in the control group. There was no significant difference between the two groups (P>0.05). The markedly effective rate of the Zhen’ai group was 42.9%, versus 12.5% in the control group, and the difference was statistically significant (P<0.05). After treatment, there were significant intra-group differences in the scores of TNSS, SNOT-20 and SSAH in both groups (all P<0.05); the scores of SNOT-20 and SSAH in the Zhen’ai group were lower than those in the control group, and the differences between the groups were statistically significant (both P<0.05). Both conventional acupuncture and conventional acupuncture plus Zhen’ai needling method can improve clinical symptoms of children with AR accompanied by AH; and conventional acupuncture plus Zhen’ai needling method has a better effect than conventional acupuncture in improving AH symptoms.

The effect of surgical menopause after bilateral oophorectomy on hormonal changes, mucociliary clearance, and quality of life.

The removal of the ovaries for any reason causes surgical menopause. Hormonal changes that occur progressively over 5-10years in natural menopause occur acutely in surgical menopause. Signs of estrogen deficiency appear suddenly and are permanent after this surgery. This study investigated the short- and long-term effects of estrogen deficiency occurring after surgical menopause on both nasal mucociliary activity and sinonasal symptoms. This prospective study included women aged 20-45years who were not in the menopause, who had a planned bilateral oophorectomy and who attended the Gynecology Clinic at the Faculty of Medicine at a university hospital between January 2018 and December 2019. The nasal mucociliary clearance time, and blood Estradiol (E2) and FSH levels were measured once in the preoperative period, and at the postoperative 3rd, 6th, 9th, and 12th months. At the same times, the Sinonasal Outcome Test 22 (SNOT-22) was also applied. The average age of the 47 patients was 41.2 ± 2.7. The mean serum estradiol levels of the women were 164.7 ± 63.4pg/ml in the preoperative period, 14.8 ± 3.7pg/ml at the postoperative 3rd month, 12.5 ± 3.5pg/ml at the postoperative 6th month, 11.6 ± 3.0pg/ml at the postoperative 9th month, and 11.1 ± 2.7pg/ml at the postoperative 12th month. The mean FSH levels of the women were 9.4 ± 2.4 mIU/ml in the preoperative period, 60.5 ± 9.6 mIU/ml at the postoperative 3rd month, 61.9 ± 9.4 mIU/ml at the postoperative 6th month, 63.0 ± 9.3 mIU/ml at the postoperative 9th month, and 64.6 ± 8.7 mIU/ml at the postoperative 12th month. The changes in postoperative mean estradiol and FSH levels over a year were significant and consistent with menopausal symptoms (p < 0.001). The mean mucociliary clearance times were 12.6 ± 1.2 before menopause, 13.2 ± 1.7 at the postoperative 3rd month, 14.5 ± 1.7 at the postoperative 6th month, 17.5 ± 1.6 at the postoperative 9th month, and 19.4 ± 1.9 at the postoperative 12th month. The extension of the mean mucociliary clearance time over 1 year was significant (p < 0.001). The mean scores for the SNOT-22 were 17.3 ± 6.9 before the operation, 17.8 ± 6.0 at the postoperative 3rd month, 19.6 ± 6.9 at the postoperative 6th month, 23.4 ± 10.4 at the postoperative 9th month, and 36.1 ± 10.0 at the postoperative 12th month. The mean scores for rhinologic symptoms were 5.2 ± 1.9 (3-11) in the preoperative period, 5.7 ± 2.0 (3-12) at the postoperative 3rd month, 7.1 ± 2.3 (4-14) at the postoperative 6th month, 9.3 ± 3.3 (4-16) at the postoperative 9th month, and 11.9 ± 3.3 (6-18) at the postoperative 12th month. The 1-year change in the SNOT-22 scores was found to be significant (p < 0.001). After bilateral oophorectomy, menopausal hormonal values were acutely high in women. At the 1-year postmenopausal follow-up, the mean scores for the SNOT-22 had increased significantly. In other words, quality of life decreased in parallel with prolonged nasal mucociliary clearance time.

A Descriptive Study of Anatomical Variations of Uncinate Process on Sinonasal Computed Tomography

Aim: The purpose of our study was to assess various anatomical variations of the uncinate process of the lateral nasal wall and to study the clinical association of its anatomical variations on computed tomography. Methods: A descriptive study of anatomical variations of the uncinate process with clinical association was undertaken in the Department of Ear, Nose &amp; Throat of a Medical College and Tertiary Health care centre. The study was of 2 years duration and included 50 patients from August 2014-2016 and included 50 patients. Patients were selected according to a specified criteria and sinonasal computed tomography scans were undertaken with the help of Somatom Emotion 6 CT machine. Data was organised charted and analysed using statistical software SPSS 16. Results: The key findings in our study were that six types of anatomical variations of uncinate process and there frequency distribution was identified according to Landstiener and Friedman classification. Uncinate process types according to age and gender were charted and tests of association were applied. Conclusion: After statistical analysis we found no association between type of uncinate process and sinonasal symptoms. No association was seen between age and gender and variations of uncinate process. In our study, variation of superior attachment of uncinate process were found in 100% cases.

Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers.

Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients’ demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.

Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort.

BackgroundPrimary ciliary dyskinesia (PCD) is a genetically diverse disease which causes impaired mucociliary clearance, and results in pulmonary, otologic, and rhinologic disease in affected patients. Genetic mutations in multiple genes impair the ability of patients to clear mucous from the lungs, middle ear, and sinonasal cavity and lead to chronic pulmonary and sinonasal symptoms.MethodsWe identified 17 PCD patients who had available CT scans. Volumes for bilateral maxillary, sphenoid, and frontal sinuses were calculated. A control population of patients who had preoperative CT scans for endoscopic endonasal resection of skull base pathology without sinonasal cavity involvement was also identified.ResultsThe mean age of PCD was 33 and ranged from 13 to 54 years. Patients were age- and gender-matched to a control group that underwent resection of anterior skull-base tumors and had a mean age of 35 that ranged between 17–53 years old. The volumes for all thee sinus cavities were significantly smaller (p < 0.007) compared to the control population. The average Lund-Mackay score was 10.6 in the PCD cohort (range 6–16) in comparison to an average of 0.7 in the control cohort (range 0–2).ConclusionsOverall sinus volumes were smaller in patients with PCD compared to our control population. Future studies will be aimed at understanding defects in sinus development as a function of specific genetic mutations in PCD patients. Ultimately, a better understanding of the underlying pathophysiology of PCD will allow us to identify the optimal treatment practices for this unique patient group.

Characterising the potential for recall bias in anchor-based MCID calculation of patient-reported outcome measures for chronic rhinosinusitis.

Anchor-based methods to calculate the minimal clinically important difference (MCID) of a patient-reported outcome measure (PROM) may suffer from recall bias. This has never been investigated for otolaryngic PROMs. We sought to identify evidence of recall bias in calculation of MCIDs of PROMs for patients with chronic rhinosinusitis (CRS). Retrospective analysis of data from two previous studies calculating the MCID of the 22-item Sinonasal Outcome Test (SNOT-22) and 5-dimensonal EuroQol questionnaire (EQ-5D) in CRS patients. Tertiary rhinology clinic. Adults with CRS. SNOT-22 score, and EQ-5D visual analog scale scores (EQ-5D VAS) and health utility values (EQ-5D HUV) before and after medical treatment for CRS. After treatment, participants were asked to rate the change in sinonasal symptoms and general health (the anchor question) as "Much worse," "A little worse," "About the same," "A little better" or "Much better." Participants' responses to the anchor question were checked for association with post-treatment and pre-treatment scores using ordinal regression. On univariate association, post-treatment SNOT-22 and EQ-5D scores were associated with respective participants' anchor question responses (P<.001 in all cases). Only pre-treatment SNOT-22 score was associated with anchor question responses (P=.017) on univariate association, in contrast to pre-treatment EQ-5D scores. Pre-treatment EQ-5D scores only associated with anchor question responses when controlling for post-treatment scores. The anchor-based MCIDs of the SNOT-22, which reflects disease-specific QOL, and the EQ-5D, which reflects general health-related QOL, appear to be largely free of recall bias.

Comparative validity evaluation of para-nasal sinus diseases using conventional radiography and computed tomography in a tertiary care hospital of Madhya Pradesh

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Sinonasal diseases include a wide spectrum ranging from inflammatory conditions to neoplasms, both benign and malignant and with the advancement in medical sciences and technology, and the ability to detect and control most illnesses, time has witnessed a momentous evolutionary change in medical practice. Objectives of the present study was to assess the demographical profile of sinonasal diseases patients and to compare the role of X-ray and computed tomography (CT) in the diagnosis of sinonasal diseases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted on 100 cases presenting in the ENT OPD, patients admitted in ENT ward and cases referred from medical and surgical departments of G. R. Medical College and J. A. Group of Hospitals, Gwalior, who had chronic sinonasal symptoms. All the collected data was analyzed using SPSS15.0 and frequencies, validity of both the modalities were compared. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age was 33.75 years with youngest patient of 5 years and oldest being 85 years of age. CT had a good sensitivity and specificity for bacterial sinusitis (95.1%, 93.2%), fungal sinusitis (80%, 97.9%), single nucleotide polymorphism (90%, 88.6%), benign lesions (75%, 97.7%), malignant lesions (78.6%, 98.8%) respectively with a p value of &amp;lt;0.001, reflecting a highly significant level.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Present study proves the significance of CT in diagnosing sinonasal pathologies and guiding their management. However, the importance of X-ray as a preliminary investigation, especially in acute or chronic cases which cannot be ignored.&lt;/p&gt;

Olfactory Dysfunction and Sinonasal Symptomatology in COVID-19: Prevalence, Severity, Timing, and Associated Characteristics.

ObjectiveOlfactory dysfunction (OD)—hyposmia or anosmia—is a symptom of coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We sought to better determine prevalence, severity, and timing of OD in COVID-19 relative to other sinonasal and pulmonary symptoms.Study DesignProspective, cross-sectional.SettingRegional/cantonal hospital.SubjectsIn total, 103 patients diagnosed with COVID-19 with reverse transcription polymerase chain reaction (RT-PCR)–based testing.MethodsAll patients testing positive for COVID-19 at Kantonsspital Aarau over a 6-week period were approached. Timing and severity (at its worst, on scale of 0 [none], 1 [mild], 2 [moderate], and 3 [severe]) of OD, loss of taste, nasal obstruction, rhinorrhea/mucus production, fever, cough and shortness of breath (SOB) were assessed for each patient.ResultsPrevalence of OD was 61.2%, and severity of OD was strongly correlated with severity of loss of taste experienced (ρ = 0.87, P < .001). OD was experienced on the first day of COVID-19 by 8.7% and overall occurred at median infection day 3 (mean, 3.4; range, 0-12). Most experiencing OD reported anosmia, and mean severity of all with OD was moderate to severe (mean [SD], 2.7 [0.6]). Nasal obstruction (49.5%) and rhinorrhea (35.0%) were frequently reported but not correlated with OD. SOB was more severe in patients with OD. OD was associated negatively with older age (OR, 0.96; 95% CI, 0.93-0.99; P = .007) and positively with female sex (OR, 2.46; 95% CI, 0.98-6.19; P = .056).ConclusionsOD is highly prevalent during COVID-19, occurring early and severely, often in conjunction with loss of taste. OD is associated negatively with older age and positively with female sex. Patients with OD may also experience more severe SOB.

Patient characteristics of suspected mast‐cell activation syndrome with sinonasal obstruction: a single institution experience

Mast-cell activation syndrome (MCAS) is increasingly recognized. Sinonasal obstruction is common among these patients. There is a paucity of literature describing the characteristics of MCAS and treatment outcomes. Retrospective review of 192 patients with nasal congestion July 2017 to May 2019 among 3 providers (1 allergist, 2 rhinologists) was conducted. Suspected MCAS criteria were as follows: (1) at least 2 recurrent severe symptoms in addition to nasal congestion: flushing, pruritus, urticaria, angioedema, wheezing, throat swelling, headache, hypotension, diarrhea; (2) clinical response to medications that target mast cell mediators. Quality of life (QOL) outcomes were quantified using the 22-item Sino-Nasal Outcome Test (SNOT-22). Thirty-two patients with nasal congestion were suspected of MCAS. The median age was 47 years; 24 of 32 were female; 13 of 32 had prior history of sinonasal surgery and 11 of 32 allergen immunotherapy. Out of 32, 19 had history of asthma, 10 drug allergy, 11 food allergy, and 10 anaphylaxis. The median number of medications targeting mast cell activation was 4 (range, 2-7). Eleven patients were offered surgery by a rhinologist after adequate medical management. Three of 32 patients showed elevation of serum tryptase. Fourteen completed pretreatment and posttreatment SNOT-22 (4/14 surgery, 10/14 medical management). Pretreatment score was 59.8 ± 6.2 (mean ± standard error [SEM]) and posttreatment score was 42.8 ± 6.7; the difference was statistically and clinically significant (p = 0.0015). Both groups showed a mean 17-point reduction. A multidisciplinary approach to the treatment of sinonasal symptoms using both escalation of medical therapy and surgical approaches may improve QOL of patients with suspected MCAS. Consensus criteria for MCAS, which includes elevation in tryptase over baseline during an episode, may exclude the full spectrum of individuals with MCAS from potentially beneficial treatment.

Food Elimination in the Management of Refractory Chronic Rhinosinusitis: A Pilot Study.

Chronic rhinosinusitis (CRS) is one of the most commonly reported chronic diseases. Refractory CRS represents a subgroup of patients who continue to be symptomatic even after adequate medical and surgical therapy. These patients started to form a significant portion of patients with CRS. Food elimination as a therapeutic method to control symptoms of different chronic diseases, such as eosinophilic esophagitis, asthma, and atopic dermatitis, has been described in the literature with variable success rates. To evaluate the effectiveness of food elimination therapy as adjuvant treatment in refractory patients having CRS with positive food sensitization. Prospective open-label study. Tertiary academic center. Consecutive adult patients with refractory nonobstructive CRS (patients who had persistent sinonasal symptoms despite endoscopic sinus surgery and patent sinuses ostia with adequate medical treatment) with positive food sensitization were included. Subjects were asked to eliminate the sensitized food from their diet. Clinical outcome was assessed using the Lund-Kennedy symptom and Lund-Kennedy endoscopic appearance scores. Twenty-two patients were initially enrolled in the study. Six patients were excluded; 4 were lost to follow-up, and 2 did not eliminate the causal food for the required period. The average age of the patients was 36 years old. There were 10 female and 6 male patients. Nasal discharge and facial pressure were the most common presenting symptoms. Shellfish, egg, and meat mix were the most common eliminated foods. There was a significant difference in the patients' Lund-Kennedy symptom and Lund-Kennedy endoscopic appearance scores at 6 and 12 weeks after food elimination therapy. Food elimination in refractory CRS is an effective adjuvant treatment and should be considered in the treatment algorithm of patients with persistent symptoms after successfully performed sinus surgery.

Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective, randomized, double-blind, controlled study.

Sodium hyaluronate has been proposed as a treatment for improving the symptoms of chronic rhinosinusitis. The present study evaluated the effect of the intranasal administration of hyaluronic acid in a group of patients affected by chronic rhinosinusitis without nasal polyps (CRSsNP). Thirty subjects aged 18-65years affected by CRSsNP were enrolled. The subjects were randomly administered hyaluronic acid or isotonic saline solution by nasal nebulizer twice per day for 30days. They were evaluated before (T0) and after the treatment (T1) with Sino-Nasal Outcome Test-22, visual analogue scale for rhinorrhea, nasal obstruction, facial pain and hyposmia/hypogeusia, nasal endoscopy, active anterior rhinomanometry, peak nasal inspiratory flow and nasal cytology. Comparing the study and the control group, at T1 no significant differences were observed in both objective and subjective parameters. Being included in the study group rather than in the control group did not have a significant effect on the variation of the considered parameters between T0 and T1. Considering the effects of the micronized douches independently from the type of solution used (either hyaluronic acid or isotonic saline solution), although no difference emerged between study and control group for any of the objective parameters, there was an improvement of Sino-Nasal Outcome Test-22 scores (p=.0005), visual analogue scale for nasal obstruction (p=.0006) and for hyposmia/hypogeusia (p=.04). The treatment with micronized nasal douches can improve the sino-nasal symptoms of CRSsNP, in particular nasal obstruction and olfactory ability. No advantage of the use of hyaluronic acid over isotonic saline solution emerged.

Subjective and Objective Measurements of Sinonasal Manifestations in Patients With Autoimmune Disorders.

A number of autoimmune disorders (ADs) are associated with a spectrum of sinonasal manifestations comparable to chronic rhinosinusitis (CRS). Our objective was to study the subjective and objective measurements of sinonasal manifestations of ADs. Retrospective cohort study. All patients with ADs referred to our tertiary care rhinology clinic from 2008 to 2019 with sinonasal symptoms were compared to randomly selected cohorts of noneosinophilic CRS without nasal polyps (neCRSsNP) and eosinophilic CRSsNP (eCRSsNP). Demographic data, along with the 22-item Sino-Nasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy score, Lund-Mackay (LM) computed tomography (CT) score, nasal crusting, and epistaxis were reviewed at presentation. Fifty-three patients with an AD (26 with sarcoidosis, 14 with systemic lupus erythematosus, 10 with granulomatosis with polyangiitis [GPA], and three with pemphigoid vulgaris) were identified, and compared to 75 randomly selected neCRSsNP patients and 75 eCRSsNP patients. Patients with an AD had an average SNOT-22 score of 44.4 (confidence interval [CI]: 34.6-51.2) compared to 25 (CI: 24.4-25.1) and 29.7 (CI: 20.3-29.7) for neCRSsNP and eCRSsNP patients, respectively (P < .0001), and an average LK endoscopy score of 5.3 (CI: 4.3-6.3), compared to 3.4 (P = .005, CI: 2.7-4) in neCRSsNP and 4.4 in eCRSsNP (P = .2, CI: 3.7-5). There was no significant difference in the CT score compared to both groups. Patients with an AD also scored significantly worse on all four SNOT-33 subdomains, nasal obstruction, nasal crusting, and epistaxis. Additionally, patients with GPA had the worst symptomatic and endoscopy scores. Patients with ADs presenting with sinonasal symptoms have a more severe subjective and objective presentation than patients with CRS without nasal polyps. 4 Laryngoscope, 131:255-259, 2021.

P119 Characteristics and treatment of fibrosclerosing orbital inflammatory disease

Abstract Background Orbital inflammatory disease (OID) encompasses a group of disorders which affect the orbit and neighbouring areas. Several multi-system inflammatory diseases including small vessel vascuilitides, Sarcoidosis and IgG4 disease can manifest as an OID. Treatment generally includes steroid therapy in combination with conventional immunosuppressant’s, cyclophosphamide or rituximab. Herewith we describe a series of non-vasculitic, fibroinflammatory OID. Methods We retrospectively reviewed records of 5 patients referred to rheumatology with inflammatory OID after malignancy, infection and Graves’ ophthalmopathy were excluded. General demographics, histology, MRI and treatment responses were reviewed. Results Patients were generally female (4:1) and of a young age (range 33-54). Proptosis and diplopia were the key symptoms with occasional sino-nasal symptoms. Inflammatory markers on presentation were marginally raised (CRP mean 11, ESR mean 37). All patients were negative for autoantibodies and had normal serum IgG4 levels. MRI showed fibrotic mass lesions in all cases with bone erosion/ destruction in 2 cases. Biopsy showed fibrosclerosis mixed with chronic inflammatory cells. 3 cases stained positive for IgG4 cells but only one of them achieved diagnostic levels (case 3). All patients were initially treated with high dose steroids (prednisolone 1mg/kg or IV methylprednisolone (MP)) with either methotrexate or cyclophosphamide (1g EUVAS protocol). Highly resistant cases were treated with rituximab (total 2g). There was a good clinical response to treatment in all cases but in 4 patients residual fibrosis persisted on follow-up MRI (Table 1). Conclusion We describe a series of fibrosclerosing OID with histology like IgG4 disease, but with normal serum IgG4 levels and negative tissue immunofluorescence (IF) in some cases. Most cases will respond well to steroids and second-line therapy, but residual fibrosis may persist with mild clinical sequelae. Early recognition and intensive therapy may minimise fibrotic complications. Disclosures V. Thanopoulou None. A. Weller None. E. Nigar None. J. Marais None. V. Lee None. B. Marjanovic None. A. Ahmed None. I. Balasundaram None. S. Hamdulay None.

Rhinosinusitis without nasal polyps in COPD.

The validity of the united airway disease concept for rhinosinusitis (RS) and chronic obstructive pulmonary disease (COPD) has been questioned because of methodological limitations in previous studies. In this study we investigated the prevalence of RS without nasal polyps (RSsNP) and the severity of sinonasal symptoms in COPD and a corresponding control group. We also evaluated the diagnostic accuracy of these symptoms for RSsNP in COPD. 90 COPD patients and 93 controls were included in an observational cross-sectional study where globally accepted diagnostic criteria of RS and COPD (EPOS 2012 and GOLD) were incorporated; symptomatic and endoscopic criteria for the diagnosis of RS, and spirometry with reversibility for diagnosis of COPD. RS symptoms were identified by responses to the sinonasal outcome test (SNOT-22), nasal endoscopy identified signs of sinonasal disease and discriminated between RS with and without nasal polyps, and visual analogue scales (VAS) rated the severity of sinonasal symptoms. We found RSsNP in 51% of our COPD patients which is threefold greater than in the control group (p<0.001). Nasal discharge (72%) and nasal obstruction (62%) were the two most frequently reported symptoms in COPD. The diagnostic accuracy for RSsNP is better for the composite VAS for rhinological symptoms than for facial symptoms. We conclude that RSsNP is present in 51% of our COPD patients, which is significantly more prevalent compared to a corresponding control group. These results suggest that COPD is associated with RS.

Characterization of Chronic Sinonasal Disease Symptoms in an Urban Homeless Population.

The urban homeless population has increased exposure to risk factors associated with chronic rhinosinusitis (CRS). However, a gap in knowledge of the prevalence of sinonasal symptoms in these demographic limits complete understanding of CRS epidemiology. There is a need to elucidate sinonasal disease burden in this vulnerable patient population to bring awareness to any existing disparities. To assess the prevalence, severity, and associated factors of CRS clinical symptoms and health-care barriers in an urban homeless population. Homeless adults completed a sociodemographic questionnaire and the 22-item Sinonasal Outcome Test (SNOT-22) and EuroQol-5 Dimension-3 Level-Visual Analog Scale surveys. Responses were categorized by potential CRS symptoms defined as reporting at least 2 CRS cardinal symptoms. Risk factors associated with potential CRS symptoms were analyzed with multivariate regression models. Fifty-six (16%) out of 341 total subjects reported potential CRS symptoms. Those with potential CRS symptoms had a higher median SNOT-22 score (53 vs 22, P < .001) than those without. Logistic regression models identified history of smoking (odds ratio [OR], 6.54; 95% confidence interval [CI], 2.04-21.04) and duration of homelessness over 3 months (OR, 3.46; CI, 1.51-7.94) as factors associated with potential CRS symptoms. Duration of homelessness over 3 months was associated with higher SNOT-22 scores (standardized beta coefficient [β], 0.48; CI, 0.39-0.57). Among those reporting 2 or more CRS cardinal symptoms, 18% had ever been seen by any physician for their symptoms. Our study estimates a high prevalence of potential CRS symptoms in the urban homeless population. Longer duration of homelessness was associated with potential CRS symptoms and poor CRS-specific quality of life scores. Disparities in access to care emphasize the need for increased preventive efforts designed for this unique patient group.

Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery.

Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. We screened 2829 ESS procedures from 2010-2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund-Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months' follow-up. Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction (P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction (P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores (P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively (P < .001). Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.

Endoscopic Transsphenoidal approach for extrasellar extended Pituitary Macroadenomas, Surgical outcome.

Abstract Words: 246 Background: Transsphenoidal approaches usually are the preferred method for treatment of pituitary tumors because of a lower risk of complications. Recently, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery. This study was conducted at Al-Azhar University Hospitals and Nasr City Health Insurance Hospital to evaluate the role of endoscope in dealing with pituitary tumors with suprasellar and parasellar extensions. Patients and methods: A total of 32 cases with pituitary adenoma with extrasellar extension were included. All cases were clinically and radiologically assessed. Pituitary hormones were also assessed. The endoscopic transsphenoidal endonasal procedure was performed for all included cases by the same surgical team. Results: The mean age of the included cases was 41.35 years. The mean size of pituitary lesions was 39.15 mm. Total resection was achieved in 22 cases (68.8%) while subtotal resection was achieved in 10 cases (31.2%). Complications included vascular injury (6.25%), visual deterioration (9.4%), deterioration of consciousness (9.4%), transient diabetes insipidus (6.25%), hydrocephalus (6.25%) and sinonasal symptoms (15.6%). There was a significant improvement of visual symptoms after surgery. Follow up showed a decrease in the number of cases having endocrinopathy although it was not significant (p = 0.052). Conclusion: Endoscopic transsphenoidal surgery is the preferred method for removal of the pituitary tumors because it provides better visualization and makes the orientation in the operative field easier and safer than the microscopic transsphenoidal approach. Also, we recommend to work in combination with E.N.T. to achieve the best results.

AB086. Tooth be told, odontogenic sinusitis is an underdiagnosed cause of sinusitis

Background: Odontogenic sinusitis is an underdiagnosed cause of rhinosinusitis. The reported incidence of odontogenic sinusitis varies between 10–40% but the literature is limited. Sinonasal symptoms dominate over dental symptoms compounding differentiation from other causes of sinus disease. Furthermore there is a lack of association between dental and sinus disease in the radiology literature, resulting in poor recognition and thus under-reporting of associated dental disease on computerized tomography (CT) imaging by radiologists. Symptoms including unilateral foul discharge and facial pain are associated but not specific to sinusitis of dental origin.

What is the evidence for fluticasone exhalation delivery system in chronic rhinosinusitis?

The aim of this article is to review the current literature regarding a novel method of topically delivering nasal steroids, namely exhalation delivery system-fluticasone (EDS-FLU), for the treatment of chronic rhinosinusitis (CRS). Recent Food and Drug Administration approval of EDS-FLU and increasing evidence surrounding its efficacy and safety has led to an additional tool for the treatment of chronic rhinosinusitis. Compared with placebo, EDS-FLU has demonstrated significant improvements in patients' sinonasal symptoms and overall inflammatory control as well as quality of life measures. Additionally, using EDS-FLU can lead to polyp grade improvement and polyp elimination in patients with chronic rhinosinusitis with polyps. Furthermore, compared with controls, patients who received EDS-FLU were less likely to meet predefined surgical criteria at the conclusion of the study. EDS-FLU has demonstrated significant improvement in managing symptoms and polyps in CRS. Receiving EDS-FLU was associated with a significant reduction in the proportion of patients meeting surgical criteria. Further studies are warranted to evaluate the long-term outcomes of EDS-FLU, especially as compared with steroid sprays and topical steroid irrigations, in management of CRS.