Sinusitis Research Articles

Radiographic Variants Associated With Allergic Fungal Rhinosinusitis: Key Differences for Pre-Operative Planning.

Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants. A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups. Twenty-one patients were included in each cohort. The AFRS group was younger in age (P = .015) and had a significantly longer AEA-SB length (P = .014) compared to the CRSwNP group. No significant differences were observed between the 2 groups regarding Keros measurement, presence of concha bullosa, infraorbital ethmoid, sphenoethmoidal, or SOEC. No association was seen between AEA-SB length and Keros class in either group. AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS.

Effectiveness of Vidian Neurectomy in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Meta-Analysis.

To evaluate the clinical efficacy of vidian neurectomy (VN) or posterior nasal neurectomy (PNN) combined with endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). A systematic search of six databases (PubMed, SCOPUS, Embase, Web of Science, Google Scholar, and Cochrane) was conducted to identify relevant studies up to May 2024. The effects of combining VN or PNN with ESS were evaluated in comparison to ESS alone. Outcomes were assessed by evaluating changes in Lund-Kennedy score, patient-reported symptom scores (VAS), quality of life, as well as adverse effects and recurrence rate of CRSwNP. A total of 6 studies, comprising 407 patients, were included in the analysis. The neurectomy group showed significant improvements in Lund-Kennedy score (SMD = 0.7276 [0.5695; 0.8857]), with statistically significant improvements maintained at 6, 12, and 24 months postoperatively. The treatment group maintained better improvements in sinusitis-related quality of life (SMD = 0.4540 [0.1784; 0.7297]) and VAS (SMD = 0.7096 [0.4356; 0.9837]) until 12 months postoperatively, but not at 24 months. Regarding adverse effects, additional neurectomy did not significantly induce epistaxis (odds ratio [OR] = 0.9806 [0.2348; 4.0960]) or dry eye (OR = 2.4194 [0.1114; 52.5255]) compared to the control group. On the other hand, there was no difference in the recurrence rate of CRSwNP between the 2 groups during the follow-up periods. Additional neurectomy shows better efficacy in improving endoscopic findings and symptoms in patients with CRSwNP and appears to be a safe and effective treatment.

Endoscopic Sinus Surgery for Chronic Rhino Sinusitis with Nasal Polyps: Predictive Factors of Recurrence.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition which may have a significant impact on quality of life. Endoscopic sinus surgery (ESS) is usually indicated for patients' refractory to maximal medical treatment and presents high recurrence and revision surgery rates. Objective: The aims of this study are to evaluate ESS outcome in CRSwNP management and to assess independent predictive factors for recurrence. Methods: Retrospective medical chart review of patients who underwent ESS for recalcitrant CRSwNP, from January 2002 to December 2021, with a minimum follow-up time of 12 months. Results: This study enrolled 280 patients; 52.5% of whom were males, with a mean age of 41.44 ± 14.25 years. Asthma was the most common comorbidity (36.4%, n = 102) and aspirin exacerbated respiratory disease was present in 16.8% (n = 47) of the study population. We found a recurrence rate of 20.7% (n = 58) and 8.9% (n = 25) of patients required revision surgery. Multivariate analysis identified as independent variables of recurrence (95% CI): no compliance with medication after surgery using topical steroids (OR = 16.056; CI 7.887-32.684; P < .001). Conclusions: ESS proved to be an effective treatment in CRSwNP but with a considerable rate of recurrence. These results indicated an important correlation of postoperative topical steroids compliance with disease recurrence.

Pott’s Puffy Tumor in Young Age: A Systematic Review and Our Experience

Background: Pott’s Puffy Tumor (PPT) in young-age patients is a rare clinical entity characterized by osteomyelitis of the frontal bone with a subperiosteal abscess collection. Previous reviews primarily consist of small, retrospective case series and anecdotal reports. This study aims to present the largest, most up-to-date systematic review of essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches for managing PPT in pediatric and adolescent populations. Methods: PubMed, Scopus, and Web of Science databases were systematically screened until 3 January 2024. The protocol of this investigation was registered on PROSPERO in January 2024, and the systematic review was performed according to the PRISMA statement. The study included 184 patients from 109 articles and an additional case from the authors’ institution. Results: PPT commonly stems from untreated rhinosinusitis, respectively, acute pansinusitis, frontal acute rhinosinusitis and chronic rhinosinusitis, and direct head trauma. Infections typically involve a polymicrobial anaerobe-predominant microbiome. Computed tomography and magnetic resonance imaging are routinely used for presurgical assessment and posttreatment surveillance. Intracranial complications were significantly associated with the type of surgical treatment (p value &lt; 0.0001). Conclusions: PPT is a significant and relatively morbid disease often under-recognized and misdiagnosed due to its variable clinical presentation. Management includes both antimicrobial therapy and surgical intervention, emphasizing the importance of an interdisciplinary approach.

Far-infrared irradiation inhibits proliferation of human upper airway epithelial cells via protein phosphatase 2A-promoted dephosphorylation of p70 S6 kinase.

Far-infrared (FIR) ray, an invisible electromagnetic radiation with a wavelength of 3‒1000μm, elicits various biological effects. Excessive proliferation of human upper airway epithelial cells (HUAEpCs) contributes to the development and exacerbation of nasal narrowing diseases, including nasal polyposis and chronic rhinosinusitis with nasal polyps (CRSwNP). Here, we investigated the molecular mechanisms through which FIR irradiation inhibits the proliferation of HUAEpCs. FIR irradiation significantly inhibited the proliferation of NCI-H292 cells without alteration in cell viability. The anti-proliferative effect of FIR radiation was accompanied by decreased phosphorylation of p70S6K at Thr389 (p-p70S6K-Thr389), without changes in the phosphorylation of mammalian target of rapamycin and adenosine monophosphate-activated protein kinase (AMPK). Overexpression of p70S6K-T389E mutant gene, not dominant negative-AMPKα1 gene, significantly reversed FIR irradiation-inhibited p-p70S6K-Thr389 and cell proliferation. Cotreatment with okadaic acid or knockdown of protein phosphatase 2A catalytic subunit (PP2Ac) gene expression significantly reversed FIR irradiation-decreased p-p70S6K-Thr389 and cell proliferation. FIR irradiation remarkably promoted the physical association of p70S6K and PP2Ac without change in total PP2Ac expression. Hyperthermal stimulus (39°C) did not alter p-p70S6K-Thr389 and cell proliferation. In line with NCI-H292 cell results, FIR irradiation, not hyperthermal stimulus, significantly decreased p-p70S6K-Thr389 and cell proliferation in primary human nasal turbinate and polyp epithelial cells. These results demonstrated that FIR irradiation decreased the proliferation of HUAEpCs through PP2A-mediated inhibition of p70S6K phosphorylation, independent of its hyperthermal effect. Our data suggest that FIR therapy can be used to treat upper airway narrowing epithelial hyperplastic diseases, including nasal polyposis and CRSwNP.

ETIOPATHOGENIC ASPECTS OF ODONTOGENIC MAXILLARY SINUSITIS OF PERIAPICAL ORIGIN

Anatomically, the roots of the upper premolar and molar teeth are near the maxillary sinuses. Thus, periapical inflammation of the elements close to the sinuses enables the formation of odontogenic sinusitis. This study aimed to analyze the available literature on the etiopathogenic aspects of odontogenic maxillary sinusitis of periapical origin. A literature review was conducted in the following databases: SciELO, MEDLINE/Pubmed, and LILACS, using the keywords "Maxillary Sinusitis", "Dentistry", "Tooth" and "Infection". Articles written in English, Spanish, and Portuguese were included; those that fit the focus of the paper and those that were most relevant in terms of outlining the desired information. Papers reporting odontogenic sinusitis arising from an operative process were excluded. Odontogenic maxillary sinusitis (OMS) occurs due to sinus infection caused by inflammation of one or more dental elements near this cavity. Despite presenting specific features, sinusitis of odontogenic and non-odontogenic origin are quite similar, making the differential diagnosis difficult. Cone-Beam Computed Tomography (CBCT) is considered the reference standard for diagnosis, and the best treatment is to eliminate the causal factor. It was also found that apical periodontitis is the main non-iatrogenic cause and premolars and molars are the most affected teeth due to their anatomical location near the maxillary sinuses. The anatomical location of the maxillary sinus and the roots of the molars and premolars will allow, through the proximity between them, the OMS. In cases where periodontitis has proven to be the most frequent non-iatrogenic cause of this condition, also due to a great symptomatological similarity with non-odontogenic sinusitis, complementary examinations such as CBCT are necessary. Moreover, the treatment can be performed in a case-specific manner, through accurate diagnosis and etiopathogenesis.

Causal relationships between allergic and autoimmune diseases with chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a prevalent inflammatory airway disease affecting over 10% of the global population, leading to considerable socio-economic impacts, especially in developing countries. The pathogenesis of CRS is multifactorial, involving potential contributions from both genetic and environmental factors. While the influence of allergic and autoimmune diseases on CRS has been observed, the causal relationships between these diseases and CRS remain unclear. We extracted data from large-scale genome-wide association studies (GWAS) and utilized a bidirectional two-sample Mendelian randomization (MR) analysis to explore the causal relationships between CRS and ten autoimmune and allergic diseases, including asthma, allergic rhinitis (AR), atopic dermatitis (AD), psoriasis, type 1 diabetes (T1D), hypothyroidism, celiac disease (CeD), multiple sclerosis (MS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Additionally, we conducted colocalization analysis to determine whether the allergic/autoimmune diseases showing statistical causal relationships with CRS are driven by the same genetic variants. The MR analysis identified that AR (OR = 1.30; 95% CI = 1.21–1.40; P = 3.26E−13), asthma (OR = 1.35; 95% CI = 1.25–1.45; P = 1.35E−14), and AD (OR = 1.17; 95% CI = 1.06–1.30; P = 0.003) were significantly associated with an increased risk of developing CRS. Interestingly, psoriasis (OR = 0.05; 95% CI = 0.01–0.37; P = 0.004) appeared to have a protective effect against CRS. Associations for T1D and hypothyroidism were also suggestive as potential risk factors for CRS. No significant associations in the reverse MR analysis, suggesting a one-directional relationship. Colocalization analysis indicated that asthma (PP.H4 = 0.99) shared the same genetic variant (IL-33 rs3939286) with CRS. In conclusion, our study confirmed the causal relationships between allergic and autoimmune diseases (AR, asthma, AD, and psoriasis) and CRS. Notably, we identified a shared genetic variant, rs3939286 in the IL-33 gene, between asthma and CRS, suggesting that targeting the IL-33 pathway may provide a therapeutic strategy for both diseases.

Compare nasal endoscopy with Computed Tomography scans for chronic rhinosinusitis detection in adult Iraqi patients

Background: Chronic rhinosinusitis (CRS) is often diagnosed based on clinical features. Assurance in this context is based on the finding of inflammatory features during nasal endoscopy and computed tomography (CT) scans of the paranasal sinuses. While a CT scan is considered the most reliable method, research has shown that nasal endoscopy is also valuable and can sometimes provide additional information to supplement the CT scan in diagnosing CRS. Objective: The study goal was to demonstrate the comparative reliability of nasal endoscopy and computed tomography scans in diagnosing chronic rhinosinusitis in adult patients treated at Baqubah Teaching Hospital. Patients and Methods: The study sample consisted of consecutive adult participants clinically diagnosed with chronic rhinosinusitis. Patients who had a computed tomography scan of the paranasal sinuses and a nasal endoscopy during three months were the subjects of this investigation; the outcomes were linked. Results: Study results exhibit that the most prevalent symptoms seen in the study participants were nasal discharge and nasal obstruction, reported by 95% and 90%, respectively; the most prevailing observation during nasal endoscopy was middle meatus purulent discharge, noticed in 58% of the patients. Maxillary sinus was most often affected, seen in 65% of the patients on a CT scan, and 40% had obstruction of the osteomeatal complex on CT imaging. The nasal endoscopy had a sensitivity of 73.3%, specificity of 85.3%, positive predictive value of 92.7%, and negative predictive value of 55.8%. The research also found no significant differences in positive predictive value (PPV) between nasal endoscopy and CT scan. In contrast, the sensitivity of nasal endoscopy was significantly greater than that of CT scan. Conclusion: The study found that nasal endoscopic findings for patients with positive clinical features were purulent (cream-colored) discharge and middle meatus polyps, which is sufficient for diagnosing chronic rhinosinusitis; the study showed that Nasal endoscopy is almost as accurate as CT scans and CT scan findings are well correlates with sinus endoscopy, due to its precision, cheap cost, and radiation dosage.

Investigation of Blood Count-Based Inflammatory Biomarkers as Predictors of Response to Dupilumab Treatment in Patients with Chronic Rhinosinusitis with Nasal Polyps

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease often resistant to standard treatments. Dupilumab, a monoclonal antibody targeting the IL-4α receptor, has shown efficacy in CRSwNP, but a significant subset of patients do not respond to this therapy. This study aims to investigate pretreatment complete blood count (CBC)-based inflammatory biomarkers as predictors of response to dupilumab in patients with CRSwNP. Methods: This mono-centric, retrospective, single-arm longitudinal cohort study included 80 patients with uncontrolled CRSwNP who received dupilumab treatment at the Medical University of Graz. Patients were classified into responder and non-responder groups based on a reduction of &gt;1 in nasal polyp score (NPS) and a sinonasal outcome test-22 (SNOT-22) score &lt;40 points at six months. Pretreatment CBC-derived biomarkers, including eosinophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation indices including the aggregate inflammation systemic index (AISI), systemic inflammation index (SII), and systemic inflammation response index (SIRI), were analyzed for their predictive value. Results: Of the 80 patients, 72.5% were classified as responders, while 27.5% were non-responders. A significant positive correlation was found between baseline eosinophil count and NPS reduction (p = 0.027), suggesting that higher eosinophil levels may predict higher NPS reduction in dupilumab treatment. However, no significant associations were observed between NLR, PLR, and systemic inflammation indices with treatment outcomes. Conclusions: Pretreatment eosinophil count may serve as a potential biomarker for predicting nasal polyp reduction in dupilumab treatment of CRSwNP. Other CBC-based inflammatory markers did not show significant predictive value. Further prospective studies are needed to validate these findings and explore additional, reliable biomarkers to optimize treatment outcomes for CRSwNP patients.

Chronic rhinosinusitis with osteomyelitis in a geriatric snow leopard (Panthera uncia)

AbstractA geriatric, 16‐year‐9‐month‐old, male snow leopard (Panthera uncia) under human care was necropsied after euthanasia over concerns for worsening chronic kidney disease and bilateral blindness. Gross and histological examinations revealed necrotising frontal sinusitis and osteomyelitis with mixed‐cellular rhinotracheitis, affecting the right frontal sinus, right nasal cavity and trachea, respectively, with intralesional and cilia‐associated Gram‐negative bacilli detected. Microbiological cultures were inconclusive, although Bordetella bronchiseptica and feline herpesvirus 1 were positive on PCR analysis. Immunohistochemistry, however, refuted active feline herpesvirus 1 involvement. Marked, chronic, bilateral, renal degeneration and fibrosis (chronic kidney disease), mild hepatic cirrhosis, bilateral chronic degenerative stifle joint disease and testicular intratubular seminoma were also detected on postmortem examination. No gross ocular or optic nerve lesions were identified; however, histology indicated bilateral diffuse outer retinal atrophy and retinal detachment, supportive of clinical blindness at time of death. This case represents the first report of chronic rhinosinusitis and osteomyelitis in a snow leopard.

Anatomical Variations in Nasal Cavities and Paranasal Sinuses on Computed Tomography in Chronic Rhinosinusitis: Implications for Diagnosis and Treatment

Anatomical Variations in Nasal Cavities and Paranasal Sinuses on Computed Tomography in Chronic Rhinosinusitis: Implications for Diagnosis and Treatment

Eosinophil-Airway Epithelial Cells crosstalk reveals the eosinophils-mediated DUOX1 up-regulation in a murine allergic inflammation setting.

Blood and airway eosinophilia represent markers for the endotype-driven treatment of allergic asthma. Little is known on mechanisms that link eosinophils and airway epithelial cells before and after these cells are infiltrated by eosinophils during allergic response. Given that innate immune mechanisms, mainly mediated by epithelial-derived cytokines (IL-33, IL-25, TSLP), induce eosinophil-maturing/attractive substances, we thought to evaluate the crosstalk between eosinophils and airway epithelial cells in the context of IL-33-mediated allergic inflammation. DUOX1 was previously described in clinically relevant aspects of allergic inflammation in a HDM -induced allergic asthma mice model, and in patients with chronic sinusitis or allergic asthma. Thus, we evaluated the involvement of HDM and eosinophils in the regulation of DUOX1 in airway epithelial cells. To recapitulate the lung environment present at the allergen challenge time in acute asthma, we set up an in vitro model based on murine bone marrow-derived eosinophils differentiated with IL-5 and then activated with IL-33 (EOs33) and TC1 or C57 airway epithelial cells. We found that treatment of epithelial cells with HDM induced an eosinophil-attractive environment and increased DUOX1 expression. Importantly, we found that the co-culture of airway epithelial cells with EOs33 or with conditioned medium from EOs33 enhanced the expression of DUOX1, which was further increased by combined stimulation (HDM plus EOs33). Our results suggest that lung recruited EOs once activated by IL-33 could be involved in a crosstalk loop with airway epithelial cells by DUOX1-mediated IL-33 secretion.

Multidisciplinary Approach to Allergic Fungal Sinusitis: A Scoping Review

Multidisciplinary Approach to Allergic Fungal Sinusitis: A Scoping Review

Differential Nasal Recolonization and Microbial Profiles in Chronic Rhinosinusitis With Nasal Polyps Patients After Endoscopic Sinus Surgery or Dupilumab Treatment: A Prospective Observational Study.

The role of microbial profiles in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) pathogenesis is increasingly recognised, with microbial imbalances perpetuating inflammation. We performed this study to associate the different nasal microbiological profile changes with the response to surgical or monoclonal treatment. This prospective observational study evaluated changes in the nasal microbial profiles of 44 patients (22 dupilumab, 22 surgery) over 6 months. Clinical assessments were performed at baseline and follow-ups, including Sino-Nasal Outcome Test-22 (SNOT-22) scores and Sniffin Sticks-Identification (SS-I) olfactory testing. Microbial profiling of nasal swabs was carried out by microbial culture and subsequent molecular identification by Polymerase chain reaction (PCR) and sequencing. Baseline characteristics of 44 patients (22 dupilumab, 22 surgery) enrolled in this study were similar between groups. In the dupilumab group, Staphylococcus epidermidis prevalence rose from 37.03% to 59.25%, while Pseudomonas aeruginosa was eradicated. Moreover, dupilumab stabilised Staphylococcus aureus at 63.64%, while its prevalence increased in the surgery group (from 22.72% to 50%). When bacterial groups were associated with clinical scores, P. aeruginosa carriers had worse SNOT-22 (21.00 ± 1.41) and SS-I (5.50 ± 0.71) scores. Instead, S. epidermidis-colonised patients exhibited significantly lower mean SNOT-22 (15.39 ± 8.54) and greater SS-I scores (8.39 ± 3.77). The best outcomes were found in the subgroup of S. epidermidis carriers undergoing the dupilumab treatment. The two treatments modulated the microbial profiles differently, and, most importantly, clinical responses might depend on the association between treatment and the dominant bacterial species colonising the nasal cavity. Further investigation into microbial-restorative strategies could enhance outcomes for better treatment of CRS.

Perioperative adjuvant therapy with short course of dupilumab with ESS for recurrent CRSwNP.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a high rate of disease recurrence following endoscopic sinus surgery (ESS). Type 2 disease is associated with a higher incidence of recurrence and is believed to impact disease resolution via interference with epithelial healing and pathogen immunity. We wished to verify if perioperative control of Type 2 inflammation with an anti-IL4/IL13 targeting monoclonal antibody and during the resolution period following surgery leads to better control of the disease long term. In this prospective, placebo-controlled, double-blinded trial. Thirty adult subjects with recurrent CRSwNP underwent ESS plus or minus 14 weeks of perioperative dupilumab, initiated 4 weeks (two injections) pre-ESS. Subjective and objective parameters of nasal patency, olfaction, quality of life (QoL), and adverse events were monitored up to 52 weeks post-ESS. Microbiological culture was performed to characterize pathogens colonization under both conditions. ESS safely improved subjective and objective measures of nasal patency, olfaction, and QoL in both groups. Olfaction was conserved longer in the dupilumab-treated group, with 33.3% of subjects presenting anosmia at 12 months after ESS in the dupilumab group compared to 50.0% with placebo. This was associated with persistent decreases in serum IgE, which were not seen with placebo treatment. No unusual safety signals were observed. Short-course adjuvant perioperative treatment with dupilumab is associated with improved long-term olfactory outcomes and persistent lowering of serum IgE.

Age-Related Increase in Type C Tympanogram

Background: This study evaluated the relationship between aging and tympanometric changes, specifically the incidence of type C tympanograms, using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: We analyzed data from the 2019–2022 KNHANES, including 26,738 ears from individuals aged 40 and older. Tympanometry at 226 Hz identified type C tympanograms based on peak pressure below −100 daPa. Multiple logistic regression evaluated the association between age and type C tympanograms, adjusting for confounders such as sex, smoking status, allergic rhinitis, chronic sinusitis, and lifestyle disease markers. Results: The incidence of type C tympanograms increased significantly with age (R2 = 0.953, p &lt; 0.001). Age was the most significant factor associated with type C tympanograms (p &lt; 0.001, odds ratio 1.052), while other factors were not statistically significant. Ears with type C tympanograms had significantly poorer hearing thresholds compared to those with type A tympanograms (p &lt; 0.001). Conclusions: Aging is significantly associated with an increased incidence of type C tympanograms, indicating possible middle ear dysfunction in older adults. The correlation between type C tympanograms and poorer hearing thresholds suggests that age-related changes in middle ear function may contribute to hearing impairment. Tympanometric screening in older adults may facilitate early detection and management of middle ear dysfunction, potentially improving hearing outcomes and quality of life.

A rare case of disseminated amebiasis in a patient on biologic therapy for chronic rhinosinusitis.

Dupilumab targets Th2-associated inflammatory mediators to reduce disease burden in CRSwNP. While rare, potential sequelae include viral, helminth, and potentially amebic infections.

Unraveling the Narrative of Orbital Cellulitis as a Sequelae to Trauma

Abstract Orbital cellulitis is often seen as a serious complication of acute rhinosinusitis. Facial trauma is one of the possible causes of orbital cellulitis. A middle-aged man, a mason by occupation, presented to ENT OPD following a facial trauma. He presented with a laceration over the right zygomatic region with right-sided periorbital swelling and redness. Wide-spectrum antibiotics were initiated for the patient. Pus was drained daily, and surgical debridement of the wound followed by sterile dressing of the wound cavity was done regularly until the pus discharge totally stopped. The patient was taken for secondary suturing and was discharged after that. However, the patient lost to follow-up. Facial trauma is a cause of orbital cellulitis. Orbital cellulitis is an emergency condition and requires urgent medical attention. Adequate antibiotic therapy is of utmost importance to treat the condition. Surgical care is advisable if the medical line of management fails.

IL-1β-induced epithelial cell and fibroblast transdifferentiation promotes neutrophil recruitment in chronic rhinosinusitis with nasal polyps

Neutrophilic inflammation contributes to multiple chronic inflammatory airway diseases, including asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), and is associated with an unfavorable prognosis. Here, using single-cell RNA sequencing (scRNA-seq) to profile human nasal mucosa obtained from the inferior turbinates, middle turbinates, and nasal polyps of CRSwNP patients, we identify two IL-1 signaling-induced cell subsets—LY6D+ club cells and IDO1+ fibroblasts—that promote neutrophil recruitment by respectively releasing S100A8/A9 and CXCL1/2/3/5/6/8 into inflammatory regions. IL-1β, a pro-inflammatory cytokine involved in IL-1 signaling, induces the transdifferentiation of LY6D+ club cells and IDO1+ fibroblasts from primary epithelial cells and fibroblasts, respectively. In an LPS-induced neutrophilic CRSwNP mouse model, blocking IL-1β activity with a receptor antagonist significantly reduces the numbers of LY6D+ club cells and IDO1+ fibroblasts and mitigates nasal inflammation. This study implicates the function of two cell subsets in neutrophil recruitment and demonstrates an IL-1-based intervention for mitigating neutrophilic inflammation in CRSwNP.

Ambient air pollution and risk of allergic respiratory diseases in European and East Asian populations: A Mendelian randomization study

BackgroundAmbient air pollution has become a challenging global health issue since industrialization, especially affecting respiratory diseases. However, the causal link between air pollution and allergic respiratory diseases (ARDs) remains unclear due to confounding factors in conventional epidemiological studies across different populations. Thus, we aimed to clarify the causal associations between air pollution and ARDs in European and East Asian populations using Mendelian randomization (MR). MethodsMR utilizes genetic variants and provides a satisfactory level of causal evidence. Genetic data for exposures (PM2.5, PM2.5 absorbance, PM10, PMcoarse, NO2 and NOx) and outcomes (allergic rhinitis, chronic rhinosinusitis, asthma, and obesity related asthma) were obtained from genome-wide association studies. Instrumental variables were strictly filtered based on core assumptions. Two-sample MR and sensitivity analyses were conducted separately for European and East Asian populations. ResultsPMcoarse was causally associated with an increased risk of chronic rhinosinusitis (OR = 1.588 [1.002–2.518]; p = 0.049) and obesity related asthma (OR = 1.956 [1.012–3.780]; p = 0.046) in European population, and PM10 was associated with a decreased risk of allergic rhinitis in East Asian population (OR = 0.882 [0.798–0.974]; p = 0.013). No heterogeneity or pleiotropy was detected in any significant causal association. ConclusionOur findings indicate that ambient air pollution has opposite impacts on the etiology of ARDs in European and East Asian populations, which provides evidence for decisions on public policies and suggests that different responses to environmental factors such as air pollution may contribute to racial heterogeneity of ARDs.