Infectious complications are a leading cause of morbidity and mortality post-lung transplantation. Chronic rhinosinusitis (CRS) frequently occurs in patients with conditions that are common indications for lung transplantation. Proactive management of sinonasal disease may help to reduce airway colonization and improve clinical outcomes after lung transplantation, but CRS prevalence, clinical features, and management strategies in lung transplant recipients are poorly studied. Thus, we sought to clarify the prevalence, clinical characteristics, and management strategies of chronic rhinosinusitis (CRS) among lung transplant recipients at a single lung-transplant center in Japan, with particular attention to regional differences in disease etiology and management. We included 272 patients who underwent or were scheduled to undergo lung transplantation at the University of Tokyo Hospital between 2015 and 2024. Patient demographics, underlying respiratory diseases, pre- or posttransplant sinonasal status, and otolaryngological management data were collected. CRS was diagnosed based on the EPOS 2020 criteria, which incorporate clinical symptoms, endoscopic findings, and radiological evidence. We evaluated CRS prevalence and its associations with specific pulmonary diagnoses, surgical intervention rates, and clinical outcomes. CRS was identified in 7.2 % (16/222) of pre-transplant and 13.8 % (8/58) of post-transplant patients. Significantly higher CRS prevalence was observed in patients with bronchiectasis (53.8 %, odds ratio [OR] 17.7, p < 0.001) and diffuse panbronchiolitis (60.0 %, OR 18.5; p = 0.005), suggesting that ciliary dysfunction is a major risk factor for CRS. Imaging predominantly revealed maxillary and ethmoid sinus involvement. Fungal balls were noted in approximately 10 % of patients. Endoscopic sinus surgery was performed in refractory CRS cases, which resulted in good postoperative outcomes, with preservation of lung graft function and absence of surgery-related complications and opportunistic infections. Although based on a limited number of surgical cases, histopathological examination of the surgical specimens revealed a predominance of neutrophilic and non-eosinophilic inflammation. CRS is a clinically significant and relatively common complication in Japanese lung transplant recipients, particularly in those with underlying ciliary dysfunction. These findings highlight distinct regional differences in disease phenotypes and management approaches for CRS in lung transplant recipients. Systematic otolaryngological evaluation and timely intervention for CRS, including endoscopic sinus surgery, may help to prevent severe infections and optimize post-lung transplant outcomes.

Sensory functions beyond taste: multifaceted role of solitary chemosensory cells and taste receptors in mucosal immune defense and disease pathogenesis.

Integrative bioinformatics analysis reveals that microplastics promote chronic rhinosinusitis with nasal polyps through NOXO1-mediated oxidative stress and myoepithelial cell reprogramming.

Pelargonium sidoides - from ethnopharmacology to evidence-based medicine: a systematic review.

Chronic rhinosinusitis (CRS) and olfactory dysfunction (OD) are highly prevalent among people with cystic fibrosis (PwCF) and negatively impact quality of life. The 40-item Smell Identification Test (SIT) is widely used to assess psychophysical olfaction, but a CF-specific minimal clinically important difference (MCID) has not been established. This study aimed to determine the SIT MCID in PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI) and/or endoscopic sinus surgery (ESS). Data from three prospective, multi-institutional observational studies were pooled. Participants were ≥12 years old with confirmed CF and CRS who completed SIT at baseline and ≥1 follow-up (3, 6, 9, 12, or 24 months). Distribution-based MCIDs were calculated using four methods: standard error of measurement (SEM), minimal detectable change (MDC=1.96×SEM), 0.5×baseline standard deviation (SD), and 0.5×SD of change scores (ΔSD). A total of 122 participants were enrolled (mean age 32.9 years, 54% female). Of these, 99 contributed follow-up SIT scores (79 ETI, 20 ESS). SIT scores remained stable with ETI, with a small but statistically significant decline at 6 months (-1.4, p=0.02). ESS was associated with mean gains of 3.1-4.5 points at early follow-up, though these did not reach significance. Pooled distribution-based MCID estimates ranged from 2 to 4 points, with an overall threshold of 3.1 (95% CI: 2.1-4.1). This CF-specific SIT threshold provides a clinically interpretable cut-off for assessing olfaction. These findings establish a foundation for future work and highlight the importance of developing disease-specific MCIDs to guide clinical care and research.

Dual clinical remission in patients treated with biologics for severe asthma and eosinophilic chronic rhinosinusitis.

Excision of Suspected Chronic Infected Suture Sinus

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits distinct bacterial colonization patterns between eosinophilic (ECRSwNP) and non-eosinophilic (non-ECRSwNP) subgroups. It remains unclear to what extent these differences are clinically relevant to the response to glucocorticoid (GC) treatment. Objective: This study aimed to investigate differences in nasal bacterial colonization between ECRSwNP and non-ECRSwNP patients in relation to their GC treatment response. Methods: We enrolled 347 CRSwNP patients, including 222 ECRSwNP and 125 non-ECRSwNP patients. Nasal swabs were collected from all participants, and bacterial composition was assessed via standard culture techniques. Of these, 189 patients received a 2-week course of oral GC treatment (24 mg of methylprednisolone daily), and nasal bacterial colonization was analyzed in relation to GC treatment response. Results: Of the 347 CRSwNP patients recruited, Staphylococcus was the most prevalent bacterial genus, followed by Corynebacterium and Streptococcus . Compared to ECRSwNP patients, non-ECRSwNP patients exhibited higher colonization rates of Streptococcus viridans and Haemophilus influenzae , and lower colonization rates of Klebsiella . Among the 189 patients who received GC treatment, further subgroup analysis was performed based on GC sensitivity. In GC-sensitive patients, S. viridans and H. influenzae were significantly more prevalent in non-ECRSwNP than in ECRSwNP. Conversely, among GC-resistant patients, Corynebacterium pseudodiphtheriticum was increased considerably in ECRSwNP than in non-ECRSwNP. Conclusion: Our findings indicate that there are distinct bacterial compositions in non-ECRSwNP and ECRSwNP patients. Streptococcus viridans and H. influenzae are linked to GC-sensitive non-ECRSwNP, while C. pseudodiphtheriticum is associated with GC resistance in ECRSwNP, highlighting their potential role in modulating GC treatment outcomes.

Background and ObjectivesTo investigate the impact of pathogenic bacterial distribution in the nasal cavity on postoperative nasal function recovery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), and to analyze the risk factors for postoperative recurrence.MethodsA total of 178 CRSwNP patients who underwent ESS in our hospital from May 2021 to May 2023 were selected. Based on preoperative nasal secretion pathogen culture results, patients were categorized into the pathogen-negative group (42 cases), bacterial-positive group (90 cases), and fungal-positive group (46 cases). The nasal symptom visual analogue scale (VAS) score, Lund-Kennedy endoscopic score, and Lund-Mackay computed tomography (CT) score were assessed preoperatively and at 12 weeks postoperatively. Patients were followed up for 24 months and categorized into the recurrence group (36 cases) and the recurrence-free group (142 cases) based on postoperative recurrence. Relevant risk factors for recurrence were analyzed.ResultsAmong the 178 patients, the bacterial positivity rate was 50.56% (mainly Corynebacterium, Staphylococcus, and Haemophilus influenzae), while the fungal positivity rate was 25.84% (mainly Candida albicans and Aspergillus). Postoperatively, the nasal symptom VAS scores for individual items, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores showed significant improvement compared to preoperative values (P < 0.05). Comparisons among the 3 groups revealed a trend of pathogen-negative group < bacterial-positive group < fungal-positive group in nasal symptom VAS scores, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores, with significant differences observed between each pair of groups (P < 0.05). Univariate analysis showed that the proportions of asthma, history of revision surgery, eosinophilic (EOS)-type nasal polyps, and preoperative Lund-Mackay CT scores were all higher in the recurrence group than in the recurrence-free group (P < 0.05). Multivariate analysis identified history of revision surgery (OR = 6.963, 95% CI: 2.275-21.313), EOS-type nasal polyps (OR = 4.566, 95% CI: 1.449-14.392), and high preoperative Lund-Mackay CT scores (OR = 1.928, 95% CI: 1.475-2.522) as independent risk factors for postoperative recurrence (P < 0.05). Corynebacterium infection might reduce the risk of recurrence (P = 0.065).ConclusionNasal bacterial and fungal colonization in patients with CRSwNP are associated with poor postoperative nasal function recovery, with fungal colonization leading to the worst prognosis. Postoperative recurrence is closely related to EOS-type nasal polyps, a history of previous surgery, and a high preoperative Lund-Mackay CT score. Corynebacterium may serve as a protective microbial population.

Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impairs quality of life (QOL), especially in individuals with comorbid asthma and nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD). The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated questionnaire for assessing QOL in these patients. Objectives: To evaluate the subjective burden of CRSwNP, CRSwNP with asthma, and N-ERD using SNOT-22 and investigate associations with serum chemokines and cytokines as biomarkers in a representative sample of individuals from the 3 phenotypes. This cross-sectional study analyzed data from 117 participants in the rhinology unit between 2015 and 2021. Symptoms and disease severity were evaluated (mean [SD]) using the visual analog scales (VAS), SNOT-22, Lund-Mackay score (LMS), nasal polyp score (NPS), and aeroallergen sensitization test (atopy). Serum levels of 17 cytokines and chemokines were measured using Luminex/ELISA. The SNOT-22 (56.3 [22.5]), LMS (19.2 [4.9]), and NPS (5.3 [1.4]) scores were worse for the N-ERD phenotype than for CRSwNP with and without asthma. This group was the most affected in sinonasal severity VAS scores (P<.0500). Nasal obstruction and loss of smell were the most affected SNOT-22 domains and VAS symptoms, respectively (P<.0500). In N-ERD, NPS correlated positively with the total SNOT-22 score (coefficient values 6.51 and 10.9, P<.0500). Sex did not correlate with SNOT-22 scores (P=.1500). Higher serum levels of VEGF-A (P=.0460), TARC (P=.0378), and TSLP (P=.0491) were detected in the N-ERD group. SNOT-22 can be used to effectively assess QOL and differentiate between CRSwNP phenotypes, highlighting a greater burden in N-ERD patients. Biomarker analysis supports the distinct inflammatory profile of N-ERD.

Primary ciliary dyskinesia (PCD) is a rare but underdiagnosed genetic cause of adult bronchiectasis, with current predictive tools (e.g., PICADAR, NA-CDCF) primarily validated in children and lacking adult-specific predictors (e.g., subfertility). This study aimed to develop and validate a practical tool (PCDSOS) for PCD screening in adult bronchiectasis. Derivation group (n = 287) from Peking Union Medical College Hospital (2013-2025) and validation group (n = 107) from The Second Xiangya Hospital (2016-2024) were included. All patients completed ≥ 1 PCD diagnostic test (nasal nitric oxide, whole-exome sequencing, transmission electron microscopy, or high-speed video microscopy analysis). Logistic regression was used to develop PCDSOS, with performance assessed by AUC, calibration curve, and decision curve analysis. Existing tools showed reduced accuracy in adults (AUC: 0.76-0.85 vs. 0.84-0.98 in original studies). PCDSOS included 6 predictors: pulmonary atelectasis/lobectomy in middle lobe/lingula (P, 2 points), neonatal chest symptoms (C, 2 points), organ laterality defects (D, 5 points), chronic sinusitis (S, 2 points), chronic otitis media/hearing loss from childhood (O, 1 point), and subfertility (S, 1 point). At cutoff = 3, PCDSOS had sensitivity 0.86, specificity 0.76 (derivation cohort, AUC = 0.90) and sensitivity 0.90, specificity 0.67 (validation cohort, AUC = 0.92). A free web-based version of PCDSOS for automated scoring is available to facilitate clinical application. PCDSOS outperforms existing tools in adult bronchiectasis, providing a cost-effective screening strategy to identify patients requiring further PCD diagnostic testing-critical for preventing irreversible lung damage and guiding genetic counseling.

BackgroundOlfactory dysfunction (OD) is a significant symptom in non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP), but its non-type 2 inflammation-driven mechanisms remain unclear.ObjectiveTo investigate the roles of local nasal non-type 2 inflammatory cytokines and systemic immune indicators in neCRSwNP-associated OD.MethodsSeventy-nine neCRSwNP patients were enrolled and divided into neCRSwNP with OD (neCRSwNP-wOD, n = 49) and neCRSwNP without OD (neCRSwNP-woOD, n = 30) groups. Olfactory function was assessed using the T&T Olfactometer. Nasal mucus cytokines (IFN-γ, TNF-α, IL-1β, IL-17) were measured by ELISA. Peripheral blood inflammatory indicators including absolute neutrophil count (Neut), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), were analyzed. Statistical methods included the Mann-Whitney U test, Spearman correlation analysis, multivariate logistic regression, and ROC curve analysis.ResultsNasal IFN-γ and IL-17 levels were significantly elevated in the OD group (both P < 0.05), while TNF-α and IL-1β showed no difference. Patients with OD also exhibited higher Neut, NLR, and SII (all P < 0.05). Olfactory scores strongly correlated with Neut (r = 0.639, P < 0.01) and moderately with IFN-γ (r = 0.533, P < 0.01). Multivariate regression identified IFN-γ, IL-17, and Neut as independent risk factors for OD. ROC analysis indicated that Neut had the highest predictive accuracy (AUC = 0.839), and a combined model of three indicators (Lund-Kennedy score, IL-17 and Neut) achieved excellent diagnostic performance (AUC = 0.964).ConclusionOlfactory dysfunction in neCRSwNP is associated with the combined involvement of local Th1/Th17 pathway activation (IFN-γ/IL-17) and neutrophil-mediated systemic inflammation. IFN-γ, IL-17, and peripheral blood neutrophils may be involved in the development of olfactory dysfunction in neCRSwNP.

Effects of Environmental Factors on Incidence of Allergic Rhinitis and Chronic Rhinosinusitis: A Comparative Study.

Vitamin D Status and Supplementation in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

Impact of Immunosuppressive Medications on Chronic Rhinosinusitis and Endoscopic Sinus Surgery in Transplant Recipients.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent, often Type 2-mediated inflammatory disease that markedly impairs quality of life. While dupilumab provides rapid improvement, there is limited evidence on long-term outcomes beyond 2 years, and the clinical impact of dosing-interval extension remains unclear. We therefore set out to evaluate long-term real-world outcomes of dupilumab therapy in CRSwNP and assess the effectiveness and safety of dosing-interval extension after achieving disease control. This retrospective single-center cohort included 224 adults with CRSwNP (37% with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease) treated with dupilumab for up to 4.5 years with outcomes modeled to 5 years. Longitudinal changes in polyp size, symptom burden, olfaction, asthma control, and Type 2 biomarkers were analyzed using mixed-effects models. Outcomes were then compared between patients who maintained standard 2-week dosing and those who voluntarily extended dosing intervals after achieving stable control. Dupilumab led to significant improvements in polyp burden, olfactory function, and quality of life peaking within 6 months, with sustained benefit through 5 years according to longitudinal modeling. Forty percent of patients extended dosing intervals without loss of efficacy and reported fewer treatment-related adverse events. Overall, 16% experienced side effects, most commonly musculoskeletal complaints, followed by skin reactions and injection site reactions. Long-term dupilumab therapy provided durable disease control and excellent safety. Personalized dosing-interval extension maintained efficacy and reduced treatment burden, supporting its potential role in optimizing long-term management of CRSwNP, especially in patients with troublesome side effects.

Air pollution has long been recognized as a threat to human health. There is growing evidence that exposure to air pollution increases the risk of upper airway inflammatory disease including allergic and non-allergic rhinitis, and chronic rhinosinusitis. Recent improvement in air pollution measurement, including wearable pollution monitors, may improve our understanding of patient exposures. In this piece, we summarize salient literature and interventions.

Identifying the causal relationship between gut microbiota and chronic sinusitis and the mediating effects of inflammatory cytokines: Insights from a Mendelian randomization study and mediation analysis.

To explore patient and clinician experiences of participation in the MACRO randomised controlled trial (RCT)-which found endoscopic sinus surgery (ESS) to be clinically effective whereas clarithromycin was no better than placebo for chronic rhinosinusitis (CRS)-and to identify barriers and facilitators to the implementation of the trial results. Qualitative study embedded within the multicentre MACRO RCT. Semistructured interviews with patients and clinicians were analysed using thematic analysis. 21 secondary and tertiary ear, nose and throat centres in England and Scotland participating in the MACRO RCT. 20 CRS patients (16 with nasal polyps, 4 without) were interviewed approximately 6 months after trial completion, and 17 clinical staff including principal investigators (PIs), associate PIs and research nurses. This study explored patients' and clinicians' experiences of the trial to identify barriers and facilitators to implementing the findings. Adopting the outcomes of the trial would involve recommending surgery to more patients with CRS. Yet patient and clinician interviews highlighted polarised views on ESS among patients, between those with positive experiences and expectations of ESS and those expressing fear of complications and hesitancy to receive surgery. During the trial, many participants randomised to surgery reported rapid improvement in symptoms, but with postoperative challenges for some patients including pain, unexpected symptoms and variations in recovery period. Priorities for implementation include providing patients with information about risks and support to make informed choices. Clinicians also reflected on the resource implications for offering ESS to more patients. ESS is effective for CRS, but patient hesitancy and recovery concerns persist. Implementation requires clear communication, recognition and respect for individual preferences, tailored support for decision-making and post-surgical care to optimise acceptance and outcomes. ISRCTN36962030.

Abstract Objective Observational studies have linked gastroesophageal reflux disease (GERD) to various otolaryngologic diseases (ear, nose, and throat [ENT] disorders), but causal inference is limited by confounding and reverse causation. We used Mendelian randomization (MR) to evaluate causality while minimizing these biases. Methods MR analyses were conducted using genome-wide association study (GWAS) data from individuals of European ancestry. GERD data were derived from a meta-analysis of UK Biobank and QSKIN ( N = 602,604; cases = 129,080), and outcome data were obtained from FinnGen (outcome sample sizes ranged from 157,453 to 404,309). Six complementary MR methods (including IVW and MR-Egger) were applied to assess the causal effect of GERD on seven otolaryngologic diseases: allergic rhinitis (AR), chronic sinusitis (CRS), nasal polyps (NP), vocal cord dysfunction (VCD), sudden idiopathic hearing loss (SIHL), head and neck cancer (HNC), and thyroid carcinoma (THCA). After harmonization, the number of SNPs included in the analyses varied across outcomes, ranging from 65 to 75. Sensitivity analyses, including tests for heterogeneity, multiplicity, and leave-one-out analysis, were conducted to ensure robustness of the results. Results GERD was causally associated with an increased risk of AR–OR 1.17(95% CI 1.05–1.30), CRS–OR 1.25(95% CI 1.15–1.37), VCD–OR 1.52(95% CI 1.31–1.77), and SIHL–OR 1.38(95% CI 1.14–1.67). No causal effect was found for NP–OR 1.09(95% CI 0.95–1.25), HNC–OR 1.13(95% CI 0.90–1.42), or THCA–OR 1.07 (95% CI 0.83–1.39). Conclusion These results provide genetic evidence supporting a causal association between GERD and increased risks of AR, CRS, VCD, and SIHL. If validated in further studies, improved GERD prevention and management strategies could potentially reduce these risks.