Thick Nasal Discharge Research Articles

Ringer’s Lactate versus Isotonic Saline: The Nasal Irrigation Solution of Choice in Chronic Rhinosinusitis

IntroductionNasal douching is a simple and highly effective treatment option for chronic rhinosinusitis. This study aimed to compare the efficacy of Ringer’s lactate versus isotonic saline for nasal irrigation in treating chronic rhinosinusitis (CRS) with or without polyposis using the SNOT-22 score. MethodsThis quasi-experimental study was conducted at the Department of ENT and Head & Neck Surgery, Tribhuvan University Teaching Hospital, from September 2020 to November 2021. Seventy-eight patients aged ≥ 16 years with CRS were included in the study. Patients were grouped into either isotonic saline or Ringer’s lactate groups based on the clinician’s preference. Nasal irrigation was prescribed for four weeks. Pre and post-irrigation SNOT-22 scores were analyzed using paired t-test and Student’s t-test. ResultsA significant improvement in the SNOT-22 scores before and after nasal irrigation was observed in both the Ringer’s lactate (26.76±14.07 vs 14.41±7.92, p<0.001) and isotonic saline groups (24.64±11.12 vs 12.58±6.62, p<0.001). However, the difference in post-nasal irrigation SNOT-22 scores between these groups remained statistically insignificant (p=0.27). Common symptoms such as nasal blockage and thick nasal discharge showed substantial improvement. The most common side effect was fluid pooling in the paranasal sinuses. ConclusionBoth isotonic saline and Ringer’s lactate were effective for nasal irrigation in patients suffering from chronic rhinosinusitis, with no significant difference in their efficacy, making either solution a suitable choice for nasal irrigation in the management of the CRS.

Role of leukotriene receptor antagonist in improvement of symptoms after functional endoscopic sinus surgery for chronic rhinosinusitis with or without sinonasal polyposis

Background: Chronic rhinosinusitis is one of the common ENT diseases encountered daily. Due to its chronicity, it leads to patient morbidity and decreased quality-of-life of the patient. Although various medical and surgical management options are available, none can manage the condition effectively. So, the aim of the study is to evaluate the efficacy of the montelukast in the subjective and objective improvement after the FESS for patients with chronic rhino sinusitis. Methods: This randomized controlled trial was conducted among 50 patients diagnosed with chronic rhino sinusitis. All the patients underwent FESS, and after that, they were divided into two groups; one group received the Montelukast tablet in addition to the standard post-operative regimen, and the other group received the standard post-operative medications only. The subjective and objective measurements were made using SNOT-22 and Lund-Kennedy endoscopic scores during the pre- and post-operative periods. Results: The study showed a significant reduction in the various parameters of SNOT-22, viz runny nose (p=0.013), cough (p=0.003), post-nasal discharge (p=0.037), thick nasal discharge (p=0.013), ear fullness (p=0.021), difficulty in falling asleep (p=0.018), walking up at night (p<0.001), reduced concentration (p=0.001) in Group-A than in Group-B. The study also showed a significant reduction in the overall SNOT-22 score in the Group-A. The Lund-Kennedy endoscopic score (p=0.006) also showed a significant reduction during the postoperative period in Group-A. Conclusion: The Montelukast positively affects the reduction of the various domains in the SNOT-22 and the Lund-Kennedy endoscopic score. It can be used as adjuvant therapy during the post-operative period in patients operated with FESS for CRS.

Features of the clinical and functional state of the nose in patients with chronic polypous rhinosinusitis and impaired sense of smell

Introduction. According to EPOS 2020, сhronic rhinosinusitis with nasal polypsis detected in 2–4.3% of the population, in Russia about 1.5 million people suffer from polyposis. In clinical practice, attention is most often paid to indicators of respiratory function. At the same time, the assessment of olfactory impairment characteristic of CRSwNP is carried out only by answering one of the 22 questions of the SNOT-22 questionnaire, and indicators of olfactory function are rarely taken into account when evaluating the results of objective research methods.Aim. To study the features of the clinical and functional state of the nose in patients with chronic rhinosinusitis and impaired sense of smell.Materials and methods. 50 patients with сhronic rhinosinusitis with nasal polypsis were examined. The study included an assessment of the sense of smell using Sniffin Stiks test-12, a study of respiratory function, performing a video endoscopy of the nose, computed tomography of the nose and paranasal sinuses. A comprehensive assessment of the condition was carried out using the SNOT-22 questionnaire.Results. The subjective assessment of the sense of smell by patients with CRSwNP does not always coincide with the results of identification tests. The results of the SNOT-22 questionnaire often depend on the degree of olfactory impairment. Patients with CRSwNP and anosmia are more likely to complain of postnasal congestion, thick nasal discharge and cough than patients with hyposmia, which is consistent with objective research methods.Conclusions. In patients with Ghronic rhinosinusitis with nasal polypsis and varying degrees of olfactory impairment, heterogeneity of the clinical and functional state of the nasal cavity and paranasal sinuses was noted. When interpreting the results of the SNOT-22 questionnaire, it is advisable to use factor analysis, taking into account the patient’s complaints. To plan individual management of patients with CRSwNP, a comprehensive assessment of the sense of smell is necessary, including identification tests, as well as an additional assessment of the results of computed tomography of the nose and paranasal sinuses and a video endoscopic picture of the nose according to generally recognized scales.

Correlation between Lund-Mackay computed tomography score and subjective symptoms in Chinese patients with nasal polyps

Background The association between objective imaging findings and subjective symptoms remains undefined. Aims To investigate the correlation between objective imaging findings and symptom severity in the overall chronic rhinosinusitis with nasal polyps (CRSwNP) population as well as its subendotypes according to the eosinophilic inflammation. Methods Patients with CRSwNP undergoing endoscopic sinus surgery were included. All participants completed the Sino-Nasal Outcome Test (SNOT-22) questionnaire. The Lund-Mackay (LM) CT scores was also obtained. Spearman correlation analysis was performed to evaluate the correlation between CT scores and SNOT-22 scores. Results Forty-four non-eosinophilic CRSwNP(neCRSwNP) and 93 eosinophilic CRSwNP (eCRSwNP) patients were recruited. There was significant association between LM total score and nasal subdomain of SNOT-22 in the overall CRSwNP patients. The nasal symptom of SNOT-22 was significantly associated with maxillary, frontal, sphenoid, anterior drainage, and posterior drainage in all CRSwNP patients. In eCRSwNP and neCRSwNP patients, the sense of smell/taste was associated with sphenoid and posterior drainage. Thick nasal discharge was positively correlated with maxillary, frontal, and anterior drainage only in eCRSwNP patients. Conclusions The high score of sphenoid and posterior drainage may suggest the occurrence of loss of sense of smell/taste, while high score of maxillary sinus may indicate suffering from thick nasal discharge in eCRSwNP patients.

Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

BackgroundThe endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. MethodsUtilizing a retrospective cohort from a preeminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and nasal obstruction symptom evaluation (NOSE) ResultsThe transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (p < 0.001), along with fewer subjective complaints of smell/taste loss (p = 0.022) and thick nasal discharge (p = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the two approaches (p = 0.243 and p = 0.454 for CCCRC and CCSIT, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (p = 0.067). ConclusionFor the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.

Efficacy of Topical Anticholinergic in Control of Symptoms in Patients with Vasomotor Rhinitis and non-Vasomotor Rhinitis Patients and Normal Individuals. A Controlled Comparative Study

Abstract Background The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis. Objective To assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not. Patients and Methods This prospective interventional study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: Study group (1): includes 20 patients diagnosed clinically non allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2): includes 20 patients diagnosed as allergic rhinitis. Study group (3): includes 20 patients performing surgery for non-vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty). Results Comparison between the pre and post SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; Nasal obstruction, runny nose, post nasal drip, thick nasal discharge and lack of good night sleep. Among allergic cases group, there was a significant difference between the pre and post treatment immunohistochemistry findings considering epithelium, glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre and post SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre and post treatment SNOT questionnaire symptoms; runny nose, post nasal drip, and thick nasal discharge. Among non- vasomotor rhinitis non allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre and post treatment IHC findings considering epithelium, glands, and arteries, however no significant difference between the pre and post IHC veins grade. Also, there was no significant difference between the pre and post treatment SNOT questionnaire symptoms. Conclusion Topical anticholinergic such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center.

This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84years (26-80years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker's approach. The average follow-up was 86.60 (13-192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1year.

When It's Not Allergic Rhinitis: Clinical Signs to Raise a Patient's Suspicion for Chronic Rhinosinusitis.

To identify predictors of chronic rhinosinusitis (CRS) in patients presenting with the chief complaint of nasal allergies. Cross-sectional study. Tertiary care, academic center. Clinical and demographic characteristics were collected from participants who were patients presenting with the chief complaint of nasal allergies. From all participants, a 22-item Sinonasal Outcome Test (SNOT-22) was collected, and a modified Lund-Kennedy endoscopy score was calculated from nasal endoscopy. Association was sought between having CRS and variables of clinical and demographic characteristics, SNOT-22, and endoscopy score. A total of 219 patients were recruited and 91.3% were diagnosed with allergic rhinitis; 45.2% were also diagnosed with CRS. Approximately half of the patients with CRS reported no intranasal corticosteroid usage. Having CRS was associated with male sex (odds ratio [OR] = 2.29, 95% confidence interval [CI]: 1.30-4.04, P = .004), endoscopy score (OR = 1.96, 95% CI: 1.59-2.42, P < .001), and the SNOT-22 nasal subdomain score (OR = 1.07, 95% CI: 1.03-1.11, P = .001) related to SNOT-22 items: "need to blow nose,""thick nasal discharge,""sense of taste/smell,"and "blockage/congestion of nose."At least moderate (item score ≥3) "blockage/congestion of nose" or "thick nasal discharge,"mild "need to blow nose" (item score ≥2) or very mild decreased "sense of taste/smell" (item score ≥1), and any nasal endoscopy findings (endoscopy score ≥1) were statistically significant predictors of CRS. Moderate or more severe nasal obstruction or discharge symptoms, any decreased sense of smell/taste, or positive nasal endoscopy findings in patients believing they have allergic rhinitis should prompt further evaluation of CRS to avoid delays in treatment.

Assessment of the protective role of submucosal saline injection of the inferior turbinates prior to submucosal diathermy or coblation techniques

BackgroundInferior turbinate hypertrophy is a common cause of chronic nasal obstruction with many procedures for management including submucosal diathermy and coblation with a variation in their techniques. The aim of this study was to assess the protective role of submucosal saline injection in the inferior turbinates prior to submucosal diathermy or coblation techniques. A prospective cohort study was conducted on 80 patients diagnosed with bilateral hypertrophied inferior turbinates causing persistent nasal obstruction and not responding to medical treatment. The patients were distributed randomly and equally between 2 groups. Group I included 40 patients operated on with coblation of the inferior turbinates. Group II included 40 patients operated on with submucosal diathermy of the inferior turbinates. The right side of the nose of both groups had a saline injection of the inferior turbinates before the procedure and the left side of the nose did not have such injection. Each side of the nose in every patient was assessed for the degree of nasal crusting at 1 week postoperative, the presence of turbinate gangrene at 3 weeks postoperative, and the visual analog scale (VAS) of four symptoms (nasal discomfort, nasal pain, nasal obstruction, and thick nasal discharge) at 1 week postoperative.ResultsIn the coblation group, there was a significant difference between the right and left sides regarding the degree of crusting at 1 week postoperative, and a non-significant difference between the two sides regarding the presence of gangrene at 3 weeks postoperative. In the diathermy group, there was a significant difference between the right and left sides regarding the same parameters. Comparison between the injection and non-injection sides in each group regarding the nasal symptoms showed a highly significant difference between the two sides in each group favoring the injection side.ConclusionSaline injection prior to inferior turbinate coblation or submucosal diathermy had a protective effect against crusting with both techniques and gangrene formation with submucosal diathermy. This was reflected on better postoperative nasal symptoms.

Postseptoplasty Quality of Life among Patients in Aseer Region, Saudi Arabia

Background: Deviated nasal septum is among the most common causes of nasal obstruction (NO) in adults. The efficacy of septoplasty for the treatment of septal deviation and the predictors of satisfactory surgical outcomes remains controversial. A significant improvement in the preoperative NO symptom evaluation score was noted after 3 months. Septoplasty resulted in a significant improvement in the disease-specific quality of life (QOL). Aim: The aim was to examine the postseptoplasty QoL and symptoms in patients in Aseer region, Saudi Arabia. Methodology: A descriptive follow-up study was conducted to assess postseptoplasty QoL in patients who underwent surgery from 2020 to 2022. Patients with psychological, behavioral, and severe chronic health problems were excluded. Information on demographic data and postsurgical symptoms was collected. QoL was assessed using the Sino-Nasal Outcome Test 20 questionnaire. Results: A total of 246 patients who underwent septoplasty were included. Patients' age ranged from 19 to 55 years, with a mean age of 33.6 years. Furthermore, 148 (60.2%) patients were men and 104 (42.3%) were aged &gt; 40 years. In terms of rhinological symptoms, 87.8% of the patients reported their need to blow nose, 82.9% had sneezing, 72.8% had a runny nose, 69.6% complained of thick nasal discharge, and 69.1% had postsurgical discharge. Furthermore, 43.5%, 43.9%, 41.1%, 40.7%, 32.9%, and 30.9% of the patients experienced NO, headache, oral breathing, sinusitis, smell disturbance, and snoring, respectively. Conclusions and Recommendations: A clinically significant improvement was noted in olfactory and rhinological symptoms after septoplasty and thus QoL. Psychological and otorhinological functions showed more improvement than rhinological functions.

Effect of topical anticholinergic medication on clinical manifestations control among patients with vasomotor rhinitis versus allergic rhinitis: as comparative clinical trials

BackgroundThe use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis.ObjectiveTo assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not.Patients and methodsThis prospective intervention study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: study group (1) includes 20 patients diagnosed clinically non-allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2) includes 20 patients diagnosed as allergic rhinitis. Study group (3) includes 20 patients performing surgery for non-vasomotor rhinitis non-allergic causes (as septoplasty or rhinoplasty).ResultsComparison between the pre- and post-SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre- and post-treatment SNOT questionnaire symptoms; nasal obstruction, runny nose, post-nasal drip, thick nasal discharge and Lack of good night sleep. Among allergic cases group, there was a significant difference between the pre- and post-treatment IHC (immunohistochemistry) findings considering Epithelium, Glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre- and post-SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre- and post-treatment SNOT questionnaire symptoms; runny nose, post-nasal drip, and thick nasal discharge. Among non-vasomotor rhinitis non-allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre- and post-treatment IHC findings considering epithelium, glands, and arteries; however, no significant difference between the pre- and post-IHC veins grade. Also, there was no significant difference between the pre- and post-treatment SNOT questionnaire symptoms.ConclusionTopical anticholinergics such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

Subjective symptoms as predictors for eosinophilic chronic rhinosinusitis with nasal polyps in the Chinese population.

To evaluate the putative association between subjective symptoms and eosinophilic inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). A total of 102 patients with CRSwNP who underwent endoscopic sinus surgery were prospectively enrolled. The Sinonasal Outcomes Test-22 scores (SNOT-22), EuroQol 5-dimensional Questionnaire scores (ED-5D), and Lund-Mackay scores by computed tomography (CT) were obtained. Patients were grouped as eosinophilic CRSwNP (eCRSwNP) and non-eosinophilic CRSwNP (neCRSwNP). ECRSwNP was defined if tissue eosinophils of nasal polyps were greater than or equal to 8/HPF according to positive major basic protein (MBP) staining, and neCRSwNP otherwise. Thirty neCRSwNP and 72 eCRSwNP patients were included. ECRSwNP patients had higher incidences of asthma (p = 0.001), allergic rhinitis (p = 0.001), and ethmoid-to-maxillary opacification ratio on CT scans (p < 0.001), whereas the proportion of purulent discharge (p < 0.001) and maxillary sinus score (p = 0.002) was higher in the neCRSwNP patients. There were no significant differences between patients on the mains of the EQ-5D health utility values and total SNOT-22 score. However, eCRSwNP patients had higher SNOT-22 scores of sneezing (p = 0.006), runny nose (p < 0.001), and ear/facial domain (p = 0.012), and lower scores of thick nasal discharge (p = 0.015) and blockage (p = 0.042). Sneezing, thick nasal discharge, and blockage/congestion of nose were recognized as independent factors of CRSwNP. Sneezing was an independent predictor of eCRSwNP, and thick nasal discharge and blockage/congestion of nose were independent predictors of neCRSwNP.

Management of hypertrophic rhinitis by application of Kadali kshara

Nasal obstruction is a predominant symptom in hypertrophied inferior turbinate. It can be understood as Nasanaha (~nasal obstruction) in Ayurveda. Even though there are many conditions of the nose causing nasal blockage; inferior turbinate hypertrophy which is a cardinal feature in hypertrophic rhinitis is one of the most common causes of anatomical nasal obstruction, the others being internal nasal valve stenosis and septal deviation. The turbinate hypertrophy in this condition can be managed medically using nasal decongestants and corticosteroids and it can be also managed surgically. Continuous use of nasal decongestants can cause rebound congestion. Surgical management also has limitations such as synechiae formation and postoperative bleeding. Kshara pratisarana (~external application of alkali), which is one among the types of parasurgical procedures explained in Ayurveda, can be used effectively in this condition. Moreover, nasal obstruction is one of the most common symptoms presented to an otorhinolaryngologist and it badly affects the quality of life of the patient. The present case report is a case of a 24-year-old female who was unable to sleep properly due to severe nasal obstruction and chronic rhinitis along with hypertrophy of both inferior turbinates. This also affected her studies badly. She also complains of thick nasal discharge along with obstruction. The patient had the complaints for two years but the symptoms became more severe during the past six months. On anterior rhinoscopic examination using Thudicum's nasal speculum, the presence of bilateral inferior turbinate hypertrophy was observed. The patient was treated with Pratisarana of Kadali kshara (~alkali of Musa paradisiaca Linn.) along with Sigrusimhyadi taila nasya. The treatment was effective in the present case with no recurrence during a follow-up period of 30 days. This case report revealed that nasal obstruction, which is a common problem seen nowadays can be managed effectively using Ayurvedic intervention.

SNOT-22 Quality of Life Scores Improve After Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea.

Patients with spontaneous cerebrospinal fluid (CSF) rhinorrhea can experience significant sinonasal symptom burden, leading to poor quality of life (QOL). The objective of this study was to investigate sinonasal outcome test-22 (SNOT-22) scores in patients undergoing endoscopic endonasal surgery for spontaneous CSF rhinorrhea and compare them to patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis without nasal polyps (CRSsNP). A multi-institutional retrospective review of patients with spontaneous CSF rhinorrhea and CRSsNP was performed. Pre-surgery and post-surgery SNOT-22 scores and domains were compared within each group. Improvements in SNOT-22 scores after surgery were compared between the groups. Ninety-one patients were in the CSF rhinorrhea group and 105 patients were in the CRSsNP group. Within each group, surgery significantly improved total SNOT-22 scores, domain scores, and most of the individual symptoms. Comparing the 2 groups revealed similar improvements in total SNOT-22 scores (P = .244). The CSF rhinorrhea group improved more in runny nose (P < .001), postnasal discharge (P < .001), wake up at night (P = .024), and embarrassed (P = .002). The CRSsNP group improved more in sneezing (P = .027), nasal blockage (P < .001), decreased sense of smell/taste (P = .011), thick nasal discharge (P < .001), facial pain/pressure (P = .008), and the ear/facial domain (P = .010). Patients with spontaneous CSF rhinorrhea experience significant symptom burden. Those who undergo CSF leak repair should experience significant improvement in QOL similar to patients who undergo ESS for CRSsNP as measured by SNOT-22.

Individual SNOT-22 Items Aid in Differentiating Between Spontaneous Cerebrospinal Fluid Rhinorrhea and Chronic Rhinosinusitis Without Nasal Polyps.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)-22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP). A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared. One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P < .001) and was more likely to designate this symptom as most important (P < .001). The CRSsNP group scored significantly higher in nasal blockage (P < .001), thick nasal discharge (P < .001), facial pain/pressure (P < .001), and in the ear/facial (P < .001) and rhinologic (P = .003) domains. Multivariable logistic regression revealed that runny nose (P < .001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P < .001), thick nasal discharge (P < .001), and facial pain/pressure (P = .001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P = .676). Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.

The application of polyethylene glycol-coated collagen patches in nasal surgery.

Nasal packing is a significant factor of postoperative morbidity that affects quality of recovery following nasal surgery. The polyethylene glycol-coated (PEG) collagen patch (Hemopatch® ) is a synthetic hemostatic agent with a dual mechanism of action, but whether it can be applied in nasal surgery remains unexplored. The postoperative symptoms of thick nasal discharge, loss of smell, headache, postnasal discharge, ear fullness and lack of good night's sleep in patients with Hemopatch are minimal after surgery. The total nasal resistance at postoperative day 1 (0.224 Pa/cm3) is lower than the preoperative total nasal resistance (0.412 Pa/cm3), indicating that the nasal air flow increases after surgery in patients using Hemopatch at postoperative day 1. This is the first report to demonstrate that Hemopatch is an alternative nasal packing to reduce the postoperative morbidity after nasal surgery.

Sinonasal Symptom Outcomes following Endoscopic Anterior Cranial Base Surgery in the Pediatric Population.

Objective This study aimed to evaluate the impact of endoscopic anterior cranial base (ACB) surgery on sinonasal symptoms in the pediatric population utilizing the Sino-Nasal Outcome Test (SNOT)-22 questionnaire. Design This is a retrospective review. Setting The study was conducted at a tertiary academic medical center. Participants Thirty-four consecutive patients, age 6 to 17 years, M:F 14:20, who underwent endoscopic ACB surgery from July 2008 to August 2019. Ten patients had baseline and a minimum of two subsequent postoperative SNOT-22 questionnaires available for analysis. Main Outcome Measures Baseline and postoperative SNOT-22 scores were compared. The mean change from baseline sinonasal symptom scores in the pediatric and historical adult cohorts was compared. Results The mean baseline SNOT-22 score for our 10 patient cohort was 0.46 out of 5 for each of the first 10 sinonasal-specific questions. This worsened to 1.69 at 1 month and returned to near baseline, 0.7, at 3 months postoperatively. The mean quality-of-life score improved to 0.91 at 1 month and 0.6 at 3 months postoperatively. The mean change from baseline for the following items: need to blow nose, runny nose, postnasal discharge, thick nasal discharge, wake up at night, reduced concentration, and frustrated/restless/irritable were similar to those in our historical adult cohort at 3 months postoperatively. Conclusion Endoscopic ACB surgery in the pediatric population results in increased sinonasal symptom morbidity in the early postoperative period; however, symptoms return to near baseline by ∼3 months, and quality-of-life scores progressively improve in the postoperative period. These trends were similar to those seen in our historic adult cohort.

Olfactory Dysfunction is not a Determinant Of Patient-Reported Chronic Rhinosinusitis Disease Control.

As a cardinal symptom of chronic rhinosinusitis (CRS), hyposmia has been recommended to be assessed as a component of CRS disease control. Herein we determine the significance of hyposmia in CRS in the context of nasal obstruction and drainage symptoms. Prospective, cross-sectional METHODS: Cross-sectional study of 308 CRS patients (102 CRSwNP, 206 CRSsNP) without prior endoscopic sinus surgery. The burden of nasal obstruction and hyposmia were assessed using the corresponding item scores on the 22-item Sinonasal Outcome Test (SNOT-22). Burden of nasal discharge was assessed using the mean of "thick nasal discharge" and "thick post-nasal discharge" SNOT-22 item scores. Patients were all asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," or "completely." In CRSwNP, only 4.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. In CRSsNP, only 1.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. On univariate association, CRS symptom control was significantly associated with nasal obstruction, hyposmia, and drainage in both CRSwNP and CRSsNP (P < .05 in all cases). Using multivariable regression to account for all nasal symptoms, only nasal obstruction and nasal discharge scores (but not hyposmia) were significantly associated with CRS symptom control. Hyposmia rarely occurs without nasal obstruction or nasal drainage, and may therefore be redundant to assess for CRS disease control. Moreover, hyposmia was not associated with patient-reported CRS symptom control when accounting for the burden of nasal obstruction and drainage. 3 Laryngoscope, 131:E2116-E2120, 2021.

Optimising trial outcomes and patient retention for the MACRO trial for chronic rhinosinusitis.

This study aimed to evaluate current subjective and objective outcome assessments for the MACRO (defining best Management for Adults with Chronic RhinOsinusitis) Trial which compares antibiotics, placebo and sinus surgery. This was to identify any redundant assessments and to include patient perspectives to determine acceptability for confirmation in the trial. Adults CRS patients meeting the provisional eligibility criteria for the MACRO trial were recruited to this mixed-method study at 2 sites. Correlations between the objective outcome measures and SNOT-22 scores were evaluated. Selected participants took part in a semi-structured telephone interview to explore their experiences and views of undergoing outcome measures. Seventy patients (37% male) were recruited, 36 had CRS without nasal polyps, 34 had CRS with nasal polyps. There was a weak inverse correlation between the SNOT-22 â€Blockage†ratings and Peak Nasal Inspiratory Flow readings, a moderate inverse correlation between the SNOT-22 â€Smell†ratings and Sniffin’ Sticks scores, but no significant correlation between the SNOT-22 and Saccharin test results. The participants’ experience of the trial visit was positive with an acceptable duration of trial visit. Most proposed outcome measures were valued by participants with the exception of the Saccharin test. The Sniffin’ Sticks test and PNIF correlate with their respective component SNOT-22 scores but are considered important by patients; PNIF is simple, cheap test to perform. The Saccharin test will be removed as participants did not value it and was not highly rated in parallel work on a core outcome set for CRS.

Symptom Profile of Chronic Rhinosinusitis Versus Obstructive Sleep Apnea in a Tertiary Rhinology Clinic.

Patients with undiagnosed obstructive sleep apnea (OSA) often present to an otolaryngologist with symptoms of chronic rhinosinusitis (CRS). This study analyzes symptom profiles of such patients to help identify those who may benefit from polysomnography. This is a 2-year retrospective analysis of adult patients at an academic practice with a rhinologic chief complaint. Results of the 22-Item Sinonasal Outcomes Test (SNOT-22) were compared between patients with untreated OSA without CRS (OSA group) and a control group of CRS patients (CRS group). Univariate analysis with Bonferroni correction and multiple logistic regression were used. Forty-one patients were included in the OSA group (mean apnea-hypopnea index = 28.8, SD = 21.0) and 124 patients in the CRS group. CRS group demonstrated higher scores in nasal, extra-nasal, and ear/facial symptom domains (P < .001), while OSA group displayed higher psychological (P = .020) and sleep domain scores (P = .048). Nasal discharge (P < .001) and loss of smell/taste (P = .004) scores were higher in CRS group, whereas facial pain (P = .285) and nasal obstruction (P = .822) were not significantly different. On logistic regression, thick nasal discharge, loss of smell/taste, and ear pain were predictive of CRS, while waking up tired was predictive of OSA. Finally, OSA group was more likely to choose a sleep-related issue as a most important symptom (MIS) (P < .001). OSA and CRS have significant overlap in symptom profiles. The SNOT-22 can help identify those with undiagnosed OSA. OSA should be suspected in patients who report a sleep-related item as a MIS and display higher psychological and sleep domain scores.