Symptoms Of Chronic Rhinosinusitis Research Articles

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

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

Sinonasal immunoglobulin G4-related disease: a case report of an atypical and rare entity

BackgroundImmunoglobulin G4-related disease is marked by extensive inflammation and fibrosis of an unknown autoimmune component, with an overall incidence ranging from 0.78 to 1.39 per 105 person-years. Sinonasal immunoglobulin G4-related disease is atypical and exceedingly uncommon in the existing literature, frequently manifesting clinically as chronic rhinosinusitis, epistaxis, and facial pain.Case presentationThis report describes a 25-year-old Iraqi female who has been suffering from symptoms of chronic rhinosinusitis for 8 years. Despite undergoing several surgeries, there has been no improvement in her symptoms. A tissue biopsy that revealed dense lymphoplasmocytosis with noticeable plasma cell infiltration, storiform fibrosis, and obliterative angitis, along with positive immunohistochemical staining for Immunoglobulin G4 plasma cells, finally confirmed the diagnosis of sinonasal immunoglobulin G4-related disease. The patient responded well to oral prednisolone and methotrexate treatments.ConclusionsThe main objective of the current report is to raise awareness among physicians about the significance of promptly identifying and diagnosing this rarity, thus preventing the adverse consequences linked to delayed diagnosis and treatment initiation.

The criteria for chronic rhinosinusitis in children with cystic fibrosis are rarely fulfilled after initiation of CFTR modulator treatment.

The vast majority of people with cystic fibrosis (pwCF) have untreated secondary chronic rhinosinusitis (CRS). Whereas the introduction of the cystic fibrosis transmembrane conductance regulator modulator (CFTRm) treatment regime has improved the lung function of pwCF, few studies have been published examining the effect on sinonasal symptoms in children. Our aim was to explore the effect of double CFTRm treatment on CRS and olfaction in children with CF. pwCF were included in this non-randomized cross-sectional study, where an otolaryngologist performed a complete ENT examination before initiating treatment with elaxacaftor/tezacaftor/ivacaftor (ETI). Twenty-three pwCF aged 6-12 years were included. Eighteen of 23 patients were on a double CFTRm treatment, and 5 patients were CFTRm naive, respectively. Altogether, 19 had normal olfaction, 20 had none or mild CRS symptoms according to SNOT-22, and 14 had a normal endoscopy. None of the patients had symptoms of chronic rhinosinusitis lasting for more than 12 weeks, thus none of the patients fulfilled the criteria for CRS. Children with CF treated with double CFTRm have few to no symptoms of CRS and normal olfaction, which is an improvement compared with children following treatment modalities prior to CFTRm.

Surgical management of headache and facial pain/pressure in chronic rhinosinusitis: A systematic review and meta-analysis.

Headache and facial pain are common symptoms of chronic rhinosinusitis (CRS). However, given the numerous etiologies that can cause these symptoms, the impact of sinus surgery is not well characterized. A systematic review was performed by searching the literature from inception through June 6, 2023. English-language articles reporting outcomes for facial pain/pressure or headache following endoscopic sinus surgery were selected for inclusion. Meta-analyses were performed using random and fixed effect models on continuous measures (mean), mean difference (Δ), and proportions (%). A total of 26 articles reporting on 2839 patients were selected for inclusion. The mean patient age was 44.0±3.9 (range 16.0-84.0), with an average symptom duration of 5.3±2.8 years. Among these patients, 56.5% (95% confidence interval [CI]: 52.3-60.6) were male and 77.0% (95% CI: 56.6-92.3) had nasal polyposis (NP). Patients with and without NP reported substantial reductions in both 22-item sino-nasal outcome test facial pain/pressure (with NP: -1.4 [95% CI: -1.6 to -1.2; relative reduction 59.1%]; without NP: -1.5 [95% CI: -1.9 to -1.1; relative reduction 60.9%]) and visual analogue scale (VAS) headache (with NP: -2.5 [95% CI: -2.8 to -2.1; relative reduction 67.2%]; without NP: -2.8 [95% CI: -4.7 to -1.0; relative reduction 42.7%]). Symptom reductions were greater in the without NP versus with NP group; VAS facial pain/pressure: Δ0.4 (95% CI: 0.2-0.6; p=0.0006) and VAS headache: Δ0.4 (95% CI: 0.1-0.7; p=0.02). Our findings suggest that CRS patients, regardless of polyp status, benefit from significant reductions in facial pain/pressure and headache following surgical therapy.

Prevalence of Chronic Rhinosinusitis in the Jazan Region of Saudi Arabia

Background: Chronic rhinosinusitis (CRS) is one of the most common medical problems worldwide. It has a significant impact on the quality of life and productivity of many people. The prevalence of CRS varies throughout the world. In this study, we evaluated the prevalence of CRS in the Jazan region of Saudi Arabia. Methods: We conducted a cross-sectional study, using an online questionnaire to collect data on demographic, Sinonasal outcome test-22 (SNOT-22), chronic diseases, and smoking status. The prevalence was estimated based on the established diagnosis and a high SNOT-22 score with the presence of three of the cardinal symptoms of CRS. Variables associated with the presence of CRS were evaluated. Results: The 1081 contributors that met our inclusion criteria included 594 males and 487 females with a median (interquartile range) age of 31 (17) years. More than half of all participants (n = 653, 60.4%) had high SNOT-22 (>18/110), but many did not fulfill the criteria for CRS in this study. Of the 1081, 215 had an established diagnosis and had three or more of the cardinal symptoms of CRS. In addition, 134 cases had not been clinically evaluated before but were suffering from three or more of the cardinal symptoms of CRS. Based on this, the estimated prevalence of CRS among our sample was 349 CRS patients (32.3%). CRS was less in people from mountainous areas (24.8%, P = 0.020). Conclusions: CRS was more prevalent in the hotter plains and coasts than in the mountains. Further studies are warranted to estimate the annual incidence and the impact on the health-care services as well as on the occupational and personal lives of the individuals.

Association of mucus eosinophil-derived neurotoxin levels with disease control status in patients with chronic rhinosinusitis.

Identifying the biomarkers for uncontrolled chronic rhinosinusitis (CRS) is important for directing treatment decisions. Eosinophilia has been reported to be involved in the poor disease control of CRS and mucus eosinophil-derived neurotoxin (EDN) is potentially a biomarker of intense eosinophil activation. This study aimed to assess the relationship between mucus EDN levels, disease severity, and degree of CRS control. A total of 150 adult patients with CRS and 25 healthy controls were prospectively enrolled. The nasal mucus and tissue specimens were collected to analyze EDN levels. Disease severity was assessed by Lund-Mackay score and 22-item Sino-Nasal Outcome Test (SNOT-22) score. Five CRS symptom severities during the prior month (nasal blockage, rhinorrhoea/postnasal drip, facial pain/pressure, smell, sleep disturbance or fatigue), use of rescue medications in the last six months, and the presence of diseased mucosa on nasal endoscopy were obtained. Consistent with the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 CRS control criteria, uncontrolled CRS was defined as meeting at least three items. 40% of patients with CRS presented with uncontrolled status. Patients with uncontrolled CRS had significantly higher nasal mucus EDN levels (P = 0.010), percentage of blood eosinophil (P = 0.015), SNOT-22 score (P < 0.001), Lund-Mackay score (P = 0.008), and a more eosinophilic dominant phenotype of CRS (P < 0.001) than patients with controlled CRS. Furthermore, mucus EDN levels were positively correlated with blood eosinophils (r = 0.541, P = 0.005), SNOT-22 score (r = 0.460, P = 0.021), and Lund-Mackay score (r = 0.387, P = 0.039). Mucus EDN levels were the significant parameter related to uncontrolled CRS in multivariable analysis after adjusting for patient demographics and comorbidities (odds ratio = 1.323; P = 0.004). Mucus EDN levels may be a potential biomarker for identifying the CRS control status.

Antiseptics in otorhinolaryngology-asubstance overview

For preoperative skin antisepsis, alcohol-containing iodine solutions and octenidine are suitable. For wound antisepsis, polyhexanide and hypochlorous acid (HOCL) are also available, but only PVP-iodine and HOCL can be applied to cartilage. Chlorhexidine should only be used as mouth- and bodywash for Staphylococcus aureus (MRSA) decolonization. For the many other throat antiseptics, evidence of clinical efficacy is lacking. For decolonization of the nares, polyhexanide and octenidine are available as nasal gels, but these are inferior to mupirocin for MRSA decolonization. PVP-iodine and HOCL are safe to use for nasal irrigation, but only HOCL has proven effective to improve symptoms of chronic rhinosinusitis. All antiseptics exhibit acertain ototoxicity. With an intact eardrum, acetic acid-containing eardrops can be used to prevent and treat external otitis and myringitis. When the eardrum is perforated, only alcohol-free PVP-iodine and HOCL may be used.

Assessing the effect of absorbable steroid sinus implant: a state-of-the-art systematic review.

Endoscopic sinus surgery is not a definitive treatment for chronic rhinosinusitis (CRS). The use of sinus stents after surgery to maintain sinus patency and deliver local steroids has gained popularity. The first steroid-eluting bioabsorbable implant (SEBI) approved for this indication, later Propel, was developed in 2011. This state-of-the-art review aims to summarize the available evidence, as well as to point out potential pitfalls and lack of specific analyses to guide future research on this new therapeutic option. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. Nine research questions were defined: Are steroid-eluting Sinus implants useful for the control of CRS symptoms after surgery? Do they improve surgical field healing after CRS surgery? Do they decrease polyp regrowth after ESS? Do they decrease the need for ESS? Are they useful in symptom control as in-office procedure? Are they better than other steroid-impregnated resorbable materials? Do they have a positive impact on olfaction? Are they safe? Are they cost-effective? Retrieved articles were reviewed by two authors. Twenty nine studies were included: 3 metanalysis, 1 systematic review, 10 randomized clinical trials, 4 quasi-experimental studies, 1 retrospective cohort study, 4 cost studies, 3 case seriesand 2 expert consensus. The review encompassed a population of 3,012 patients treatedwith SEBI and 2826 controls. This is the first state-of-the-art review assessing steroid eluting bioabsorbable stent evidence. Despite the effort in recent years, still several questions remain unanswered. This review will hopefully guide future research efforts to better define the role of SEBI in the otolaryngology practice.

Сhronic rhinosinusitis in adult patients with cystic fibrosis receiving CFTR modulators

Cystic fibrosis-associated chronic rhinosinusitis (CRS) is a separate form of CRS that progresses gradually over the course of patient’s life and worsens with age. The reasons for this are the mechanical congestion of mucus in the paranasal sinuses and the persistence of colonies of pathogenic antibiotic-resistant microorganisms. Therapy with CFTR modulators has resulted in a significant reduction in the severity of CRS. The nature of these changes and the dynamics in the microbial landscape of the upper respiratory tract are not sufficiently explored.Aim of the article is to highlight various aspects of the impact of CFTR modulators on the course of CRS in adult patients with cystic fibrosis (CF) based on literature data and a number of our own clinical observations. The article presents a series of clinical cases of CRS in adult CF patients treated with CFTR modulators for different periods of time.Conclusion. During targeted therapy with CFTR modulators, the symptoms of CRS are reversed due to the restoration of normal rheological properties of nasal secretions, the clinical picture improves, and the severity of CRS decreases. However, this type of treatment has no direct effect on the microbial landscape of the respiratory tract and requires additional interventions in the form of local and systemic antibacterial therapy. Therapy with CFTR modulators alters the course of CF in the nasal cavity, as well as in the pharynx and larynx.

Apoptosis and turnover disruption of olfactory sensory neurons in eosinophilic chronic rhinosinusitis.

Olfactory dysfunction (OD) is one of the important and difficult-to-treat symptoms of eosinophilic chronic rhinosinusitis (CRS), which is typically associated with type 2 inflammation where eosinophils (EOSs) function as both effectors and initiators. Eosinophilic infiltration in the olfactory mucosa (OM) is associated with severe OD, mucosal erosion, and more loss of olfactory sensory neurons (OSNs). Active EOS-derived cytokines, chemokines, and eosinophil granule proteins may lead to aggravation of inflammation, tissue damage, and impairment of the survival and regeneration of OSNs. Recent studies show that EOSs can lead to apoptosis of OSNs through axonal and neural body damage, turnover disorder of OSNs through the loss of immature OSNs and globose basal cells (GBCs), changed proliferative activity of horizontal basal cells (HBCs), and dysfunction of OSNs through the breakdown of neuroepithelial integrity and alteration of ion concentration in OSNs and mucin. In this review, we outline the current progress on the role of EOSs on OD in patients with eosinophilic CRS and the mechanism of EOS-associated injury of the OM and OSNs in experimental animal models with sinonasal inflammation. Further investigations on the molecular mechanisms of tissue eosinophilia-induced injury of OSNs are warranted to obtain new therapeutic targets and achieve better restoration of olfactory function.

Pulmonary functions, nasal symptoms, and quality of life in patients with primary ciliary dyskinesia (PCD).

Several factors may influence quality of life (QOL) for patients with primary ciliary dyskinesia (PCD). We aimed to evaluate the association between pulmonary functions, nasal symptoms and QOL in PCD patients. A prospective single center study. Patients performed spirometry, whole body plethysmography, forced oscillation technique (FOT), lung clearance index (LCI), 6-min walk test (6MWT), and filled two questionnaires: a specific PCD QOL questionnaire (PCD-QOL) and Sino-nasal outcome test (SNOT-22) questionnaire, assessing symptoms of chronic rhinosinusitis and health related QOL. Twenty-seven patients (56% females), age 19.4 ± 10.5 years were included; their, FEV1 was 74.6 ± 22.7%, and RV/TLC was (157.3 ± 39.3% predicted). Health perception and lower respiratory symptoms domains of PCD-QOL had the lowest score (median [IQR]: 50 [33.3-64.6] and 57.1 [38.9-72.2], respectively). FOT parameters correlated with several PCD-QOL domains. R5 z-score (indicating total airway resistance) and AX z-score (indicating airway reactance) correlated negatively with physical domain (r = -0.598, p = .001, and r = -0.42, p = .03, respectively); R5 z-score also correlated negatively with hearing domain (r = -0.57, p = .002). R5-20 z-score (indicating small airway resistance) correlated negatively with role domain (r = -0.49, p = .03). SNOT-22 score correlated negatively with several PCD-QOL domains (lower respiratory symptoms r = -0.77, p < .001; physical r = -0.72, p < .001; upper respiratory symptoms r = -0.66, p < .001). No correlations were found between spirometry values, LCI, 6MWT, and PCD-QOL. FOT suggested small airway dysfunction, and correlated negatively with several PCD-QOL domains. Nasal symptoms had strong negative correlations with PCD-QOL. Larger longitudinal studies will further elucidate factors affecting QOL in PCD.

PREVALENCE AND SYMPTOMS OF ASTHMA AND ALLERGIC RHINITIS IN ADULTS WITH CHRONIC RHINOSINUSITIS IN THE EASTERN REGION OF SAUDI ARABIA

Background: This cross-sectional study explores the prevalence and symptoms of asthma and allergic rhinitis among adults diagnosed with Chronic Rhinosinusitis (CRS) in the Eastern Region of Saudi Arabia. Methods: Involving 386 participants, the research employs demographic profiling and symptom analysis and explores the interplay of upper and lower airway conditions. This study investigates the prevalence of asthma and allergic rhinitis among 386 adults with chronic rhinosinusitis (CRS) in Eastern Saudi Arabia. Employing a cross-sectional design, participants from King Fahad Specialist Hospital and Jubail General Hospital were selected through random and stratified sampling. Results: The study reveals a higher prevalence of asthma (40.6%) compared to allergic rhinitis (25.1%), emphasising the need for a comprehensive understanding of these respiratory conditions. Intriguing associations between asthma attacks and specific CRS symptoms, such as chest tightness and waking due to shortness of breath, provide insights into shared pathways. Demographically, higher prevalence is observed among females, individuals with lower educational attainment, and nonsmokers, highlighting socio-demographic influences on respiratory health. Conclusion: The study discloses a noteworthy prevalence of asthma (40.6%) in comparison to allergic rhinitis (25.1%) among adults with Chronic Rhinosinusitis in Eastern Saudi Arabia. Asthma attacks showcase distinctive associations with specific CRS symptoms, emphasising the intricate interplay of these respiratory conditions. The demographic influences of education and smoking underscore the importance of lifestyle factors. Recommendations for future research include longitudinal studies and clinical validations to enhance the validity and depth of our findings.

Clinical Evaluation of &lt;i&gt;Pippalyadi Avapeeda Nasya, Elakanadi Kashaya&lt;/i&gt; and &lt;i&gt;Vyoshadi Ghrita&lt;/i&gt; in Chronic Rhinosinusitis: Case Series

Introduction: Chronic Rhino Sinusitis (CRS) is an inflammatory disease of the nose and sinuses with clinical features such as nasal blockage, nasal discharge and hyposmia. Current treatment modalities are antibiotics, corticosteroids and surgical interventions but the recurrent rate is high. In classics, dushtaprathisyaya features are similar to chronic rhinosinusitis. Materials and Methods: To analyze the effect of pippalyadi avapeeda nasya, elakanadi kashaya and vyoshadi ghrita in reducing the symptoms of chronic rhino sinusitis using nasal signs and symptom score, anterior rhinoscopy, X-ray Para Nasal Sinus (PNS) Waters view and nasal endoscopy. The study discusses the Ayurvedic intervention of 30 cases diagnosed as CRS. Pachana - deepana with astachoorna, snehapana with vyoshadi ghrita and virechana with nimbamritadi eranda taila for kayashodhana followed by shira shodhana with pippalyadi avapeeda nasya. Orally Elakanadi kashaya and vyoshadi ghrita was administered. Results and Discussion: Combined use of sodhana and samana aushadhi showed significant reduction in nasal obstruction, nasal discharge and hyposmia with an improvement of 100, 100 and 56.66 % respectively. Statistical analyses were performed with SPSS software and are clinically significant with p &lt; 0.0001. Conclusion: A combination of kayasodhana and sirasodhana is effective in improving subjective symptoms like nasal blockage, nasal discharge and hyposmia which was evident with anterior rhinoscopy, endoscopy and X-ray PNS Waters view.

Benefits of Immunoglobulin (Ig) Replacement Therapy for Primary and Secondary Immunodeficiency in Chronic Rhinosinusitis.

This is the first study to examine chronic rhinosinusitis (CRS) outcomes after starting immunoglobulin (Ig) replacement therapy for patients with primary (PID) and secondary immunodeficiency (SID). This is a retrospective review of patients diagnosed with CRS from 2018 to 2022 prior to initiating Ig therapy for the treatment of PID or SID. Outcomes included medication use and Sinonasal Outcome Test (SNOT-22) scores. Ten patients met the inclusion criteria. PID and SID patients had a decrease in antibiotics (PID: 9.40 to 3.20, P = .05, SID: 8.20 to 2.00, P = .04) and steroids (PID: (5.40 to 0.60; P = .06; SID: 2.20 to 0.20, P = .047) prescribed in the year after Ig compared to the year prior. Patients with SID had a decrease in mean SNOT-22 scores by 12 months after Ig (47.50 to 20.50, P = 0.03). Patients receiving Ig for PID and SID showed decreased medication use and SID patients experienced subjective improvement in CRS symptoms in year-over-year comparison.

Evaluating symptoms of chronic rhino sinusitis and most common sinuses affected

Background: Chronic rhinosinusitis is a common condition that significantly affect the quality of life, high health-care consumption and significant comorbidity.&#x0D; Objective: To investigate and identify the symptoms that are most often experienced by people with chronic rhinosinusitis.&#x0D; Patients and Methods: In this cross-sectional study, we conducted one hundred patients complaining of chronic rhinosinusitis presented to the outpatient clinic for otolaryngology at Baquba teaching hospital; the patients were chosen randomly. A careful clinical examination following comprehensive history taking done for all of the patients. All patient's main complaint were nasal airway obstruction, nasal discharge, and anosmia. In addition to a clinical evaluation, a computed tomography (CT) scan of the nose and paranasal sinuses was performed,. And Diagnostic nasal endoscopy&#x0D; Results: The population under investigation had a mean age of 35 years and was mostly comprised of males. The majority of patients in this study reported a common symptoms, including nasal congestion (72%), headache (68%), and rhinorrhea (mucus discharge) (58%)&#x0D; Conclusion: Chronic rhinosinusitis is characterised by a set of symptoms that, if caught early, may be diagnosed and treated effectively.

Evaluating symptoms of chronic rhino sinusitis and most common sinuses affected

Background: Chronic rhinosinusitis is a common condition that significantly affect the quality of life, high health-care consumption and significant comorbidity. Objective: To investigate and identify the symptoms that are most often experienced by people with chronic rhinosinusitis. Patients and Methods: In this cross-sectional study, we conducted one hundred patients complaining of chronic rhinosinusitis presented to the outpatient clinic for otolaryngology at Baquba teaching hospital; the patients were chosen randomly. A careful clinical examination following comprehensive history taking done for all of the patients. All patient's main complaint were nasal airway obstruction, nasal discharge, and anosmia. In addition to a clinical evaluation, a computed tomography (CT) scan of the nose and paranasal sinuses was performed,. And Diagnostic nasal endoscopy Results: The population under investigation had a mean age of 35 years and was mostly comprised of males. The majority of patients in this study reported a common symptoms, including nasal congestion (72%), headache (68%), and rhinorrhea (mucus discharge) (58%) Conclusion: Chronic rhinosinusitis is characterised by a set of symptoms that, if caught early, may be diagnosed and treated effectively. Keywords: chronic rhinosinusitis, Rhinorrhea, nasal congestion.

Patient perspectives on recall period and response options in patient-reported outcome measures for chronic rhinosinusitis symptomatology: An international multi-centered study.

Existing patient-reported outcome measures (PROMs) for chronic rhinosinusitis (CRS) use a variety of recall periods and response scales to assess CRS symptom burden. Global perspectives of CRS patients regarding optimal recall periods and response scales for CRS PROMs are unknown. This was a multi-center, cross-sectional study recruiting 461 CRS patients from sites across the United States, Saudi Arabia, New Zealand, and Austria. Participants chose which CRS symptom recall period (1 day, 2weeks, 1 month,>1 month) was most reflective of their current disease state and upon which to best base treatment recommendations (including surgery). Participants also chose which of six response scales (one visual analogue scale and five Likert scales ranging from four to eight items) was easiest to use, understand, and preferred. A plurality of participants (40.0%) felt their CRS symptoms' current state was best reflected by a 1-month recall period. However, most patients (56.9%) preferred treatment recommendations to be determined by symptoms experienced over a>1 month period. The four- and five-item Likert scales were the easiest to understand (26.0% and 25.4%, respectively) and use (23.4% and 26.7%, respectively). The five-item (26.4% rating it most preferred and 70.9% rating it preferred) and four-item Likert (22.3% rating it most preferred and 56.4% rating it preferred) response scales were most preferred. Future PROMs for CRS should consider assessment of symptoms over a 1-month period and use a four- or five-item Likert response scale to reflect global patient preferences. These findings also inform interpretation of current CRS PROMs.

Prevalence of Risk Factors of Chronic Rhinosinusitis With Nasal Polyps Among the Saudi Population.

Background The burden of chronic rhinosinusitis symptoms experienced by Saudi citizens is considered an important factor in getting an overall insight of the problem in the region, therefore our study aimed to determine the prevalence of risk factors of chronic rhinosinusitis with nasal polyps and correlate the risk factors with various sociodemographic parameters among Saudi population. Methods This study analyzed five-year cross-sectional data from 2017-2021. A total of 386 participantswere enrolled and subsequently divided into four groups: aged 18-25 years, 26-35 years, 36-45 years, and > 45 years. A study was conducted utilizing non-probability sampling targeting a population of Saudi nationality living in selected regions of Saudi Arabia. Data was collected through an online questionnaire which had been distributed through social media and had been analyzed accordingly using a statistical package for social sciences. Results In this study, 272 (70.5%) participants were female and 114 (29.5%) were male. A total of 374 (96.9%) participants were Saudis while 12 (3.1%) were non-Saudis. Risk factors were compared by age and gender of study participants. Having polyps in the nose (p-value 0.016) and a family history of polyps (p-value 0.049) showed a significant association with the gender of study participants. The frequency of having nasal polyps was significantly higher among male participants, however, having a family history of nasal polyps was significantly higher among female participants. The educational status of study participants showed a significant association with the use of cortisone (p-value 0.032) and having a broken nose (p-value 0.032). Having a family history of nasal polyps showed a significant (p-value 0.017) association with the socioeconomic status of study participants. Conclusion Nasal polyps are more common in males than females, however, having a family history of nasal polyps was significantly higher among female participants.

Chemerin and IL-17 are potential predictors and Chemerin silencing alleviates inflammatory response and bone remodeling in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is an inflammatory disease of paranasal sinuses. This study is formulated to explore the roles of pro-inflammatory factors Chemerin and interleukin-17 (IL-17) in CRS. Patients suffering from CRS without/with nasal polyps (CRSsNP/CRSwNP), along with volunteers, were recruited. CRS rabbit models were constructed by Staphylococcus aureus infection and rabbits were injected with lentiviral vectors of short hairpin RNA-targeting Chemerin (shChemerin), followed by micro-computed tomography (CT) scan. Levels of Chemerin and IL-17 were determined, and histopathological lesions were observed in subjects and CRS rabbits. Correlations between Chemerin/IL-17 level and Lund-Mackay/Lund-Kennedy scores of subjects and the predictive value of Chemerin or IL-17 for CRS were analyzed. In CRS patients and rabbits, inflammatory degrees and the level of Chemerin/IL-17 were increased in pathological tissues or plasma, while Chemerin silencing alleviated CRS symptoms of CRS rabbits. Chemerin and IL-17 were mainly located in the immune cells of pathological tissues and presented the positive correlation with Lund-Mackay/Lund-Kennedy score of CRS patients. Also, they showed high predictive value for CRS. Micro-CT scan uncovered that CRS rabbits had increased bone remodeling, which was alleviated by Chemerin silencing. Collectively, Chemerin and IL-17 are potential predictors and Chemerin silencing alleviates inflammatory response and bone remodeling in chronic rhinosinusitis.

A clinical observational study on the preliminary effect of dupilumab in the treatment of severe asthma

Objective: To investigate the effect and safety of dupilumab in the treatment of patients with severe asthma in a preliminary clinical observational study. Methods: This study retrospectively analyzed the clinical data of 20 patients with severe asthma who received dupilumab for 4-12 months between 2019 and 2022 at the First Hospital of Guangzhou Medical University, comparing pre-and post-treatment laboratory data, oral glucocorticoid dose (OCS), asthma control test (ACT) and adverse effects. The median age of the 20 patients was 48.5 (41.0-52.8) years, including 14 males and 6 females. The clinical data of 10 patients treated with other biologic agents were further analyzed to determine the reasons for switching to biologic drug treatment and the efficacy of dupilumab in these patients. Paired t-tests or Wilcoxon signed-rank tests were used for comparisons. Mann-Whitney analysis was used for inter-group comparison, and chi-square test or Fisher test was used for inter-group comparisons of count data. Results: A total of 20 patients were included in this study. All 20 severe asthma phenotypes were type 2 (T2)-high and completed at least the first 4 months of treatment, including 17 patients who completed 12 months of treatment. Among patients who completed 4 months of treatment, the asthma exacerbation score decreased from 1.0(0.3-1.0) episodes/4 months to 0.0(0.0-1.0) episodes/4 months, P<0.001, and FEV1/FVC increased from 58.4% (50.5%-69.0%) to 66.9% (59.6%-77.7%), P<0.01. The number of patients requiring OCS maintenance therapy decreased from 15 (75%) to 9 (45%), P<0.05. Among patients who completed 12 months of treatment, the asthma exacerbation score decreased from 1.0(0.5-1.0) episodes/4 months to 0.0 (0.0-0.0) episodes/4 months, P<0.01, and FEV1/FVC increased from 57.9% (49.6%-67.8%) to 72.7% (64.6%-78.7%), P<0.01. The number of patients requiring OCS maintenance therapy decreased from 13 (76%) to 6 (35%), P<0.01. In 10 patients with a history of previous biologic therapy, the most common reasons for switching to a biologic were a poor response to previous monoclonal antibodies (40%) and loss of control of asthma symptom control after discontinuation of monoclonal antibodies (30%). The remaining reasons were patients' uncontrolled symptoms of chronic rhinosinusitis (20%) and irregular or underdosed use of previous biologics (10%). After 4 months of switching to dupilumab, 10 patients experienced varying degrees of improvement in asthma control. Conclusions: The application of dupilumab for the treatment of T2-high severe asthma showed good efficacy and few adverse effects. Biologically targeted therapy is an important treatment approach to achieving better control of severe asthma.