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Background: The chronic rhinosinusitis patient-reported outcome (CRS-PRO) is a recently published disease-specific questionnaire designed for CRS patients, with fewer entries and ease of completion. This study aimed to translate the CRS-PRO questionnaire into Chinese and assess its reliability, validity, and responsiveness to provide Chinese patients with a more concise and efficient subjective assessment instrument. Methods: The Chinese version of the CRS-PRO was created through forwardbackward translations and cultural adaptation. Here, 168 CRS patients (118 patients CRS with nasal polyps [CRSwNP] and 50 patients with CRS without nasal polyps [CRSsNP]) and 43 healthy individuals were enrolled. All participants completed the CRS-PRO, 22-item Sinonasal Outcome Test (SNOT-22), and EuroQol five dimensions questionnaire (EQ-5D) questionnaires preoperatively as well as 3 and 6 months after surgery. Results: The Chinese version of the CRS-PRO demonstrated good internal consistency, with a Cronbach's a of 0.813. It also exhibited a higher criterion validity (r=0.65, p<0.05) than the SNOT-22.Amoderate associationwas found between the CRS-PRO and objective indicators such as the Lund-Mackay and endoscopic scores. Furthermore, the CRS-PRO, like the SNOT-22, could clearly distinguish CRS patients from healthy subjects (p < 0.01), as well as between the CRSwNP and CRSsNP subtypes (p < 0.01). Additionally, changes in the CRS-PRO exhibited a larger effect size compared to changes in the SNOT-22 (Cohen's d = 1.05 and 0.93 vs. 0.71 and 0.90 for 3 and 6 months, respectively, all p < 0.01). Conclusions: The Chinese version of the CRS-PRO is a concise, reliable, and responsive instrument that can be utilized as a novel subjective evaluation tool for future clinical practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the safety and efficacy of the piezoelectric knife as a new tool for frontal beak surgery in patients with chronic rhinosinusitis (CRS) both in terms of imaging and perception of symptoms' outcomes. Materials and methods: The study involved 28 patients with CRS who underwent endoscopic sinus surgery (ESS) using a piezoelectric knife in the frontal recess region. Assessment of sinus imaging and patients' quality of life (QoL) was performed before and after surgery with the Lund-Kennedy and Lund-Mackay systems and the 22-item Sino-Nasal Outcomes Test (SNOT-22). Results: Median scores on the Lund-Kennedy and Lund-Mackay systems decreased within 24 weeks after surgery with piezo knife assistance by 4 and 5 points, respectively. QoL improved with SNOT-22 scores decreasing by 35.5 points. Conclusions: ESS with the piezoelectric knife used for frontal beak reduction turned out to be a safe procedure. In the studied group of patients, the improvement was observed in terms of imaging, patients' perceptions of symptoms, and QoL outcomes. Therefore, the piezoelectric knife might be a valuable supporting tool in ESS in patients with CRS, although further observation is needed. [ABSTRACT FROM AUTHOR]

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition that significantly impacts the health-related quality of life (HRQOL) of patients. This study aims to investigate the disparities in preoperative examination findings, postoperative HRQOL, and disease control status based on CRSwNP subtypes. (2) Methods: A retrospective analysis was conducted on 202 patients who underwent endoscopic sinus surgery for CRSwNP. The study assessed clinical characteristics, blood eosinophil and immunoglobulin E (IgE) levels, modified Lund–Kennedy and Lund–Mackay scores, and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. HRQOL was evaluated using the Sino-nasal Outcome Test (SNOT-22) scores, and disease control status was assessed based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 guidelines. (3) Results: Of the 202 patients, Eosinophilic CRSwNP patients exhibited significantly higher preoperative peripheral blood eosinophil ratios and IgE levels, and JESREC scores (p < 0.05). Two years postoperatively, patients in the non-eosinophilic group showed significantly improved SNOT-22 scores compared to preoperative scores (p = 0.007). Notably, the proportion of patients with uncontrolled disease was significantly higher in the eosinophilic group (p = 0.035). Logistic regression analyses identified preoperative SNOT-22 scores and eosinophilic CRSwNP subtype as influential factors on disease control status (p < 0.05). (4) Conclusions: Patients with more severe preoperative symptoms and eosinophilic CRSwNP demonstrated poorer long-term treatment outcomes. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS) represents chronic inflammation of the sinus mucosa characterised by dysfunction of the sinuses' natural defence mechanisms and induction of different inflammatory pathways ranging from a Th1 to a Th2 predominant polarisation. Recalcitrant CRS is associated with Staphylococcus aureus dominant mucosal biofilms; however, S. aureus colonisation of the sinonasal mucosa has also been observed in healthy individuals challenging the significance of S. aureus in CRS pathogenesis. We aimed to investigate the relationship between CRS key inflammatory markers, S. aureus biofilm properties/virulence genes and the severity of the disease. Tissue samples were collected during endoscopic sinus surgery from the ethmoid sinuses of CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps and controls (n = 59). CD3+ T‐cell subset frequencies and key inflammatory markers of CD4+ helper T cells were determined using FACS analysis. Sinonasal S. aureus clinical isolates were isolated (n = 26), sequenced and grown into biofilm in vitro, followed by determining their properties, including metabolic activity, biomass, colony‐forming units and exoprotein production. Disease severity was assessed using Lund–Mackay radiologic scores, Lund–Kennedy endoscopic scores and SNOT22 quality of life scores. Our results showed that S. aureus biofilm properties and CRS severity scores correlated positively with total CD4+ T‐cell frequencies but looking into CD4+ T‐cell subsets showed an inverse correlation with Th1 and Th17 cell frequencies. CD4+ T‐cell frequencies were higher in patients harbouring lukF.PV‐positive S. aureus while its regulatory and Th17 cell subset frequencies were lower in patients carrying sea− and sarT/U‐positive S. aureus. Recalcitrant CRS is characterised by increased S. aureus biofilm properties in relation to increased total CD4+ helper T‐cell frequencies and reduced frequencies of its Th1, Th17 and regulatory T‐cell subsets. These findings offer insights into the pathophysiology of CRS and could lead to the development of more targeted therapies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the putative association between subjective symptoms and eosinophilic inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: 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. Results: 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. Conclusion: Sneezing was an independent predictor of eCRSwNP, and thick nasal discharge and blockage/congestion of nose were independent predictors of neCRSwNP. [ABSTRACT FROM AUTHOR]

Objective: Due to the high postoperative recurrence rate in eosinophilic chronic rhinosinusitis (eCRS) patients, there is a need for an index to predict the postoperative outcomes. Group 2 innate lymphoid cells (ILC2s) are important effector cells for type 2 immune responses in eosinophilic airway inflammation. The aim of this study was to investigate whether the prevalence of ILC2s in sinonasal tissues or in peripheral blood is associated with the postoperative outcome in CRS patients.Methods: Twelve patients with eCRS and ten patients with non-eCRS were recruited. We examined the ILC2 prevalence in sinonasal tissues and in peripheral blood before and after endoscopic sinus surgery (ESS). Pre- and postoperative blood eosinophil counts were also examined. Lund-Mackay computed tomography (LMK-CT) scores were used to evaluate the disease severities and the postoperative outcomes; cases with more than 50% improvement were categorized into the good outcome group, and cases with less than 50% improvement were categorized into the poor outcome group.Results: The ILC2 prevalence in sinonasal tissues was correlated with that in preoperative blood in eCRS and non-eCRS patients. The ILC2 prevalence in sinonasal tissues and in preoperative blood was not correlated with the pre- or postoperative LMK-CT scores. Postoperatively, the ILC2 prevalence in blood was decreased in eCRS and non-eCRS patients, and blood eosinophil count was also decreased in eCRS patients but not in non-eCRS patients. The ILC2 prevalence in postoperative blood was decreased in the good outcome group but not in the poor outcome group. Blood eosinophil counts were not decreased postoperatively in both good and poor outcome groups.Conclusion: The decreased ILC2 prevalence in postoperative blood may be a predictive biomarker for evaluating postoperative outcomes in eCRS and non-eCRS patients. [ABSTRACT FROM AUTHOR]

Purpose: Despite endoscopic sinus surgery (ESS) being the standard best treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), there still remains a high recurrence rate of nasal polyps after ESS. The aim of this study was to analyze the impact of ESS in the treatment of CRSwNP and identify possible predictors for revision surgery. Methods: We conducted a cross-sectional retrospective study of patients with CRSwNP submitted to ESS between the years 2013 and 2021. Results: We analyzed 517 cases, of which 15.1% were submitted to revision ESS. The presence of hyposmia/anosmia, asthma, intolerance/allergy to non-steroid inflammatory drugs, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and bilateral polyposis were more frequent in patients who needed revision surgery. Initial values of peripheral eosinophilia and Lund–Mackay scores were significantly higher in this sub-group of patients. Lund–Mackay score was the only independent risk factor for revision surgery. Conclusions: Factors like peripheral eosinophilia and Lund–Mackay score were associated with a higher probability of revision ESS. Applying these concepts to the clinical practice could help predict the evolution of patient's pathology in the post-operative period and identify in advance those cases that may need a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Comparative effectiveness research between endoscopic sinus surgery (ESS) and biologic therapy for severe chronic rhinosinusitis with nasal polyposis (CRSwNP) is a nascent field as new therapeutic modalities become clinically available. Methods: A prospective, multicenter cohort of CRSwNP patients, undergoing ESS between 2011 and 2019, were compared to phase‐3 biologic trial data. Patients undergoing ESS received baseline nasal endoscopy quantified via Lund‐Kennedy (LK) grading. Patients meeting inclusion criteria, modified from Dupilumab‐LIBERTY‐NP‐24&52, omalizumab‐POLYP‐1&2, and Mepolizumab‐SYNAPSE clinical trials, were included in this study. Baseline characteristics and outcome measures were compared between these cohorts at 24 weeks and 52 weeks, when possible. Results: A total of 111 CRSwNP patients met modified inclusion criteria. There were no statistically significant differences in baseline age, sex, asthma status, aspirin‐exacerbated respiratory disease status, smell identification, LK‐polyp score, and Lund‐Mackay computed tomography (CT) scores between ESS and biologic groups. At 24 weeks, ESS demonstrated significantly greater improvements in 22‐item Sino‐Nasal Outcome Test (SNOT‐22) compared to one (of two) dupilumab trials (p < 0.05) and both omalizumab trials (p < 0.001). ESS associated with significantly lower nasal polyp scores (NPS) compared to dupilumab (p < 0.001) and omalizumab (p < 0.001), despite comparable improvements in smell identification (p > 0.05). At 52 weeks, ESS resulted in statistically similar improvement in SNOT‐22 scores compared to dupilumab (p = 0.21), but NPS remained significantly lower in the ESS group compared to dupilumab (p < 0.001) and mepolizumab (p < 0.001). Conclusion: At 24 weeks and 52 weeks, ESS offers comparable SNOT‐22 improvements compared to dupilumab. ESS and dupilumab offer comparable improvement in smell identification at 24 weeks. Compared to omalizumab, ESS offers superior SNOT‐22 improvements. ESS offers significantly greater reductions in polyp size compared to omalizumab, dupilumab, and mepolizumab therapies. [ABSTRACT FROM AUTHOR]

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to impaired olfactory function and reduced quality of life. When conservative treatments such as nasal irrigation and topical steroids fail, functional endoscopic sinus surgery (FESS) is often necessary, because it improves symptoms and enhances quality of life. Materials and methods: A total of 88 patients was included in this prospective study. All subjects underwent an extensive examination both presurgically and 4 months after operations including nasal endoscopy and psychophysical olfactory testing (Sniffin' Sticks). Moreover, disease-specific quality of life was assessed and presurgical CT scans were rated regarding the opacification of the paranasal sinuses. Results: Presurgically psychophysical tests showed an overall olfactory dysfunction. Olfactory test results (TDI score) correlated with endoscopic (Lund–Kennedy and Lildtholdt score) and CT scores (Lund–Mackay and TOCS scores). Four months after surgery olfactory function was enhanced and quality of life significantly showed an overall improvement. However, the outcome was dependent on the extent of presurgical olfactory function: olfaction and quality of life improved most pronounced in anosmics compared to hyposmic and especially normosmic patients. Conclusions: This study confirmed that FESS in CRSwNP leads to a significant improvement of both olfaction and disease-specific quality of life. Moreover, preoperative psychophysical assessment of the extent of olfactory dysfunction can help to objectively assess possible risks and expected benefits of the surgery in terms of olfaction and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The current studies in the literature report that periostin contributes to the formation of nasal polyps and may be a molecular biomarker for chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to investigate the effect of periostin in determining polyp burden in CRSwNP patients and evaluate its impact on postoperative surgical results and its functionality as a biomarker. Methods: The study included 26 patients who underwent endoscopic sinus surgery due to CRSwNP and 30 patients who were scheduled to undergo septoplasty due to isolated nasal septum deviation. We performed preoperative Lund–Mackay scoring and preoperative and postoperative SNOT-22 and Modified Lund–Kennedy scoring for the patients. Tissue and serum samples were collected from all patients in surgery and another serum sample was taken from CRSwNP patients at postoperative month 6. Results: Tissue eosinophil (p < 0.001), preoperative serum (p < 0.001), and tissue (p = 0.002) periostin were significantly higher in the CRSwNP group. We observed a statistically significant positive correlation between tissue eosinophil values and tissue periostin values in CRSwNP patients (p = 0.004). We found a statistically significant positive correlation between the tissue periostin values and postoperative SNOT-22 scores of the CRSwNP group patients (p = 0.005). Conclusion: According to the results of our study, we think that periostin can be used as a biomarker in the prediction, determination of disease severity, and prognosis of CRSwNP. Comprehensive cohort studies with larger patient series are needed to provide more information on the role and effects of periostin in cases of CRSwNP undergoing surgical treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study introduced and evaluated the efficacy of an ultrasonic bony aspirator (UBA) in revision endoscopic sinus surgery and compared the outcomes to those of the traditional cold instrument approach. Methods: This retrospective study enrolled 57 patients who underwent revision endoscopic sinus surgery between June 2010 and December 2017, 17 patients with a UBA approach and 40 patients with traditional instruments. Results: Median Lund--Kennedy scores showed a statistically significant difference between the two groups at 3 months (p=0.004). Synechiae occurred in 17.6% and 35% of cases in the UBA and traditional groups, respectively. The mean operative time was significantly shorter in the traditional group (p=0.001). Conclusion: The use of a UBA in revision endoscopic sinus surgery was safe and effective. [ABSTRACT FROM AUTHOR]

Bone remodelling is a normal physiological process which occurs in all bones. Hence bone changes should also be detected in undiseased or minimally diseased ethmoids as well as in chronic rhinosinusitis (CRS) patients. To test this hypothesis, we compared ethmoid bone histology between two groups of patients; a study group of CRS patients and a group of patients whose radiological, endoscopic and symptom scores were significantly less when compared to the CRS group. The study group had 75 patients who underwent functional endoscopic sinus surgery for CRS. The control group included 16 patients who had significantly different endoscopic and radiological scores from the study group. On histopathology, the bone harvested from the ethmoid sinuses were grouped as no remodelling activity (Score 1), mild activity (Score 2) and marked activity (Score 3). Thirty-six percent of patients in the study group and 37.5% of patients in the control group had Score 2 and 3 bone changes and the difference was not statistically significant (χ2 = 1.824, p = 0.402). Correlation of bone changes in CRS done with parameters like Lund–Mackay radiological, surgical and symptom scores and Lund–Kennedy endoscopic scores showed no statistical significance. Similar bone changes were detected in CRS patients and the control group. The bone changes seen in histopathology in CRS patients could partly be due to the normal physiological remodelling occurring in all bones. [ABSTRACT FROM AUTHOR]

OBJECTIVE. To compare the outcomes of Intranasal Antrostomy (INA) with Nasoantral Window-Plasty and endoscopic Middle Meatal Antrostomy (MMA) in patients with isolated chronic maxillary sinusitis using an elaborate and detailed set of parameters. MATERIAL AND METHODS. All patients with clinically diagnosed chronic maxillary rhinosinusitis (unilateral/bilateral) were assessed based on radiological (Lund-Mackay Scoring System) and endoscopic evidence (Lund-Kennedy Scoring System). The Visual Analogue Scale was used to understand the severity of symptoms. Strict inclusion and exclusion criteria were used. One hundred patients were included in the study and divided into two equal groups of fifty each. Group 1 of patients underwent Intranasal Antrostomy with Nasoantral Window-Plasty and Group 2 underwent endoscopic Middle Meatal Antrostomy. All the surgeries were done in the same environment, under local anaesthesia and by the same surgeon. The parameters were noted before surgery and 8 weeks after surgery. RESULTS. MMA did about 6.82% better than INA in relieving symptoms, had 1.08% better CT image and 4.58% better in regards of nasal endoscopy findings. CONCLUSION. Although endoscopic Middle Meatal Antrostomy is a newer and more non-invasive procedure, the age-old Intranasal Antrostomy with Nasoantral Window-Plasty is still relevant in the management of chronic maxillary sinusitis in this modern age in our rural area. [ABSTRACT FROM AUTHOR]

Background: Woakes' syndrome, first described by Woakes in 1885 which is also better known as ethmoiditis, is a very uncommon entity of severe nasal polyposis causing disfigured facial appearance. In this study, we aimed to present the diagnosis and management of seven patients' series with Woakes' syndrome in the light of current literature. Methods: The medical records of seven patients who had functional endoscopic sinus surgery because of nasal polyposis that caused nasal roof deformity between January 2013 and June 2020 in a tertiary hospital otorhinolaryngology department were evaluated retrospectively. Demographic aspects, examination data, rhinological surgery history, Lund-Mackay scores at admission, surgical procedures performed, and followup periods were analyzed. Results: All patients had bilateral severe nasal polyposis and significant nasal bone expansion. Bilateral functional endoscopic sinus surgery was applied to all patients and additionally septoplasty was applied to one patient and septorhinoplasty to two patients in the same session. Five patients stated they did not want septorhinoplasty in the same session. We tried reduction of nasal bones with a finger pressure in these patients. While we achieved a satisfactory reduction in three of these patients, it was unsuccessful in two cases. Conclusion: Treatment of nasal polyps should be achieved by functional endoscopic sinus surgery for Woakes' syndrome. Topical and systemic treatment of the nose should slow down or evade the recurrence of the nasal polyps. Approach to nasal deformity should be addressed during the initial surgery if feasible. [ABSTRACT FROM AUTHOR]

Post-operative care in FESS is an important aspect. Nasal saline irrigation and Nasal steroid spray are highly recommended worldwide in post-operative protocol after endoscopic sinus surgery. Hence patients compliance for both these procedures becomes a deciding factor for outcomes following FESS and there is not much evidence in literature regarding the same. The present study was conducted to evaluate the role of giving patients pictorial handouts regarding nasal saline irrigations and various positions of using nasal steroid spray in improving outcomes of FESS. It was a randomised control study.46post operative patients of FESS were randomised into two groups. Group A patients were verbally explained and practically demonstrated the technique of nasal saline irrigation and nasal steroid spray in the language best understood and by showing them the relevant images. Group B patients were also verbally explained as well as practically demonstrated the above mentioned procedure but were also given pictorial handouts (depicting in detail the positions of nasal saline irrigation and steroid spray} which were explained and handed over to them at the time of discharge. The patients were evaluated a 1st, 2nd 3rd and 4th post-operative week for compliance of both the procedures and its effect on post-operative cavity. In the present study there were 21 females versus 25 males. The average male: female ratio in group A was 1.3 versus 1 in group B. The mean age was 35.5652 ± 4.595 in group B versus 33.1739 ± 4.438 in group A. The average compliance over three weeks was 2.5765 ± 0.207 in Group B as compared to 1.4935 ± 0.27 in Group A. The t score for the difference in compliance between two groups was 15.2691. The two-tailed P value was less than 0.0001. The average Lund and Kennedy endoscopic appearance score for crusting was 1.75 ± 0.532, 1.217 ± 0.6, 0.696 ± 0.703 for Group A in post-operative follow up during week 1, 2 and 3 respectively as compared to 1.45 ± 0.59, 0.304 ± 0.47, 0.826 ± 0.49 for Group B. The P value was < 0.05 for the difference in both groups for all three weeks. The average Lund and Kennedy score for edema and other parameters has been enumerated in Table 1. 11/23 followed correct method for nasal saline irrigation in Group A as compared to 20/23 in Group B. 18/23 used nasal steroidal spray in all positions compared to only 9/23 in Group A. 3/23 in group B had polypoidal mucosa at frontal recess area at 1 month post-operative as compared to 16/23. Overall their was a negative correlation between the compliance of nasal saline irrigation with edema, crusting and discharge. The respective R score was −0.5311, −0.25296 and −0.19889 respectively. The pictorial handouts definitely improved compliance and hence outcomes in our study. We recommend this practice in routine to all our fellow rhinologists. [ABSTRACT FROM AUTHOR]

Background: Nasal and sinus illnesses are diagnosed with computed tomography (CT) because CT scans effectively bone anatomy is depicted with air spaces, opacified sinuses, and detailed structural details. Objective: The significance of using multislice CT for the detection and characterization of sinus polyps and the relationship between the CT findings and those of functional endoscopic sinus surgery (FESS) have been studied. Patients and methods: At Zagazig University's Radiodiagnosis Department, we conducted this study on 18 patients, 10 of which were females and eight were males, from a total of 33 individuals. To emphasize the role of multislice (CT) in diagnosis and characterization of sinonasal polypi during functional endoscopic sinus surgery, numerous CT parameters were used and correlated with operational findings. Results: There was a strong correlation calculated by Spearman correlation coefficient (r) for rightsided and left-sided surgeries of 0.76 and 0.87, respectively, for operative endoscopic and Lund-Mackay staging scores. Conclusion: Based on functional endoscopic sinus results, CT and diagnostic endoscopy may be the new standard of care in the diagnosis of sinonasal diseases. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the efficacy of endoscopic selective vidian neurectomy in the treatment of severe persistent allergic rhinitis (AR) combined with chronic rhinosinusitis (CRS) with nasal polyps (ARwCRSwNP). Methods: One hundred thirty patients with moderate to severe persistent ARwCRSwNP were enrolled at Xuanwu Hospital, Capital Medical University, from September 2015 to September 2017. Patients were divided into 2 groups. Sixty-one patients (the control group) underwent conventional surgical treatment for CRS with nasal polyps and received conservative treatment for AR. Sixty-nine patients (the experimental group) received conventional surgical treatment for CRS with nasal polyps plus endoscopic selective vidian neurectomy with amputation of the posterior nasal nerve and pharyngeal branch of the vidian nerve. Clinical parameters, including visual analog scale (VAS) score, Lund-Kennedy endoscopic mucosal morphology score, and Lund-Mackay sinus computed tomography (CT) scan lesion range score, were used to analyze and evaluate the preoperative and postoperative data. Comparisons were based on patient scores, and preoperative and postoperative scores obtained at 6, 12, and 24 months were analyzed. Results: The experimental group had higher therapeutic efficacy in nasal obstruction, nasal itching, rhinorrhea, sneezing, and general symptoms than the control group (p < 0.05). No complications such as tear-secretion disorder or atrophic rhinitis occurred in the experimental group, and no significant difference in complications incidence was observed between the 2 groups (p > 0.05). Conclusion: Endoscopic selective vidian neurectomy is an effective and safe technique for the management of moderate to severe persistent ARwCRSwNP. [ABSTRACT FROM AUTHOR]

Objectives: Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS. Design: Retrospective review of medical records. Setting: Academic Hospital. Participants: 40 adult CF patients. Main outcome measures: Rate of lung function decline (% predicted Forced Expiratory Volume in 1 second [ppFEV1]), number of pulmonary exacerbations (IV/oral antibiotic therapy ± hospital admission) and total number days hospitalised 2‐year postoperatively was collected. CRS patients undergoing ESS were matched to those without ESS by gender, age, and F508del genotype. Results: Forty patients (mean age 37.4, 60% male) were reviewed. No significant difference was found between the surgical group and controls in baseline ppFEV1(72.5% vs. 72.7%, P =.98), 2‐year preoperative number of pulmonary exacerbations (3.05 vs. 1.65, P =.10), or Lund‐Mackay scores (12.25 vs. 11.55, P =.71). No significant difference was found in 1‐year (70.5% vs. 72.8%, P =.84) or 2‐year (70.4% vs. 72.6% P =.80) postoperative ppFEV1 and 2‐year postoperative pulmonary exacerbations (1.7 vs. 1.45, P =.87). A significant increase was identified in total number days hospitalised postoperatively (4.85, P =.02). In the surgical group, no significant difference was identified between preoperative and postoperative ppFEV1, 1 year (−2.51%, P =.32) and 2 years after ESS (−3.10%, P =.51), postoperative rate of pulmonary exacerbations (−1.28, P =.11), or in total number days hospitalised (3.74, P =.14). Conclusions: In this study, ESS does not appear to significantly improve ppFEV1 or decrease the number of pulmonary exacerbations postoperatively. [ABSTRACT FROM AUTHOR]

Background: The clinical characteristics of central‐compartment‐type chronic rhinosinusitis (CRS) in East Asian individuals are not clear. We sought to investigate the clinical features and the cytokine profiles of central‐compartment‐type CRS in our patient group. Methods: Adult patients diagnosed with bilateral CRS were recruited, and patients who had previously undergone sinus surgery and pansinusitis (Lund‐Mackay scores >23) were excluded. Central‐compartment‐type CRS was defined by both endoscopic and radiological features. The symptoms, inhalant allergen sensitization status, endoscopic findings, and radiological assessments were recorded and compared between patients with central‐compartment‐type CRS and other types of CRS. We also examined the extent of tissue eosinophilia and specific cytokine protein levels (eosinophil cationic protein [ECP], myeloperoxidase [MPO], immunoglobulin E [IgE], interleukin [IL]‐4, IL‐5, and IL‐13) in the sinonasal tissues. Results: Central‐compartment‐type CRS was found in 16 (23.9%) patients, and non–central‐compartment‐type CRS was found in 51 (76.1%) patients. Hyposmia or anosmia as the major symptom was more common in the central‐compartment‐type CRS group. The numbers of eosinophils in tissue and serum were significantly higher in the central‐compartment‐type CRS patients. The presence of allergen sensitization was not significantly different between groups. The levels of IL‐5 and IL‐13 were increased in middle turbinate tissues of patients with central‐compartment‐type CRS. Conclusion: Central‐compartment‐type CRS was associated with hyposmia or anosmia, eosinophilic subtypes, and elevated levels of IL‐5 and IL‐13 in middle turbinate tissues but not necessarily correlated with allergic disease in our patients. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease treated with sinus surgery when refractory to medical intervention. However, recurrence postsurgery is common. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor for interleukin 4 (IL‐4) and IL‐13, key and central drivers of type 2 inflammation. We report the efficacy of dupilumab in patients with CRSwNP from the SINUS‐24/SINUS‐52 trials (NCT02912468/NCT02898454), by number of prior surgeries and time since last surgery. Methods: Patients were randomized to placebo or dupilumab 300 mg every 2 weeks. Post hoc subgroup analyses were performed for patients with 0, ≥1, 1/2, or ≥3 prior surgeries, and for patients who had surgery within <3, 3 to <5, 5 to <10, or ≥10 years. Efficacy outcomes at 24 weeks included co‐primary endpoints nasal polyp score (NPS) and nasal congestion (NC), and Lund‐Mackay (LMK), 22‐item Sino‐Nasal Outcome Test (SNOT‐22), and smell scores. Results: Of 724 patients randomized, 459 (63.4%) had ≥1 prior surgery. Baseline sinus disease (NPS, NC, LMK) and olfactory dysfunction (University of Pennsylvania Smell Identification Test [UPSIT] and loss of smell) scores were worse for patients with ≥3 prior surgeries vs no surgery. Baseline NPS and LMK were worse in patients with <3 years since last surgery than in patients with ≥5 years since last surgery. Dupilumab significantly improved all outcome measures vs placebo in all subgroups by number of surgeries and by time since last surgery. Improvements in NPS and LMK were greater in patients with <3 years since last surgery than patients with ≥5 years. Safety results were consistent with the known dupilumab safety profile. Conclusion: Dupilumab improved CRSwNP outcomes irrespective of surgery history, with greater improvements in endoscopic outcomes in patients with shorter duration since last surgery. [ABSTRACT FROM AUTHOR]

Introduction. Chronic rhinosinusitis, a very common inflammatory condition, is a main public health issue affecting the quality of life. Furthermore, some patients do not respond to either medical or surgical intervention, which could be explained by the presence of the bacterial biofilm in the rhinosinusal zone. Objectives. The aim of this study is to evaluate the influence of endoscopic sinus surgery on olfactory impairment caused by chronic sinusitis with and without nasal polyps (CRSNP and CRS), by testing the olfactory function and potential dysfunction before and after endoscopic sinus surgery. Another objective is to find a connection between the percentage of coverage with bacterial biofilm of the nasal mucosa from patients with CRSNP and CRS and to evidence the fountain of infection role of the bacterial biofilm, while demonstrating that antibiotic therapy is not efficient once the bacterial biofilm is formed in the nasal sinuses. Materials and methods. We investigated 123 patients with CRSNP and CRS, which underwent functional endoscopic sinus surgery (FESS). The olfactory function was tested pre and post FESS. We also analyzed and compared the scores of endoscopic images of Lund-Kennedy and CT staging scale of Lund- Mackey for the two study groups. The degree of olfactory rehabilitation in patients with CRSNP and CRS was evaluated performing smell diskettes test. The presence of bacterial biofilm on the surface of the nasal mucosa extracted during FESS from patients with CRSNP and CRS was examined with the electronic microscope and the percentage of coverage with bacterial biofilm was measured with Carnoy software. Results. Bacterial biofilm was present in a higher percentage in patients with CRS vs. CRSNP. By comparing the level of olfactory function, significant improvement was found after FESS intervention in both study groups. Postoperatively, Lund-Kennedy scores decrease significantly for the whole group (Z = -9.66 at p < 0.001, d Cohen = 4.40), indicating the major role of surgery in the treatment of CRS. The decrease in Lund-Kennedy score values is also significant for each group. In the case of subjects diagnosed with CRS, the mean values decrease from 6.57 (preoperative) to 0.90 (postoperative), respectively Z = -6.779 to p < 0.001. In the case of subjects diagnosed with CRSNP, the mean values decrease from 9.03 (preoperative) to 1.44 (postoperative), Z = -6.927 at p < 0.001. Out of the total number of patients included in the study, 59 patients tested positive with the Prick test for dust and mites and more than half of the patients with positive allergy test were from the lot diagnosed with CRSNP. Conclusions. FESS plays an important role in the improvement of olfactory function in patients with CRS. Bacterial biofilm was present in both study groups but in higher percentage in the CRS group and was found in lower percentage in the group with positive allergy tests. The CRSNP group presented a higher positive result regarding the allergy Prick test and a lower percentage of coverage with bacterial biofilm of the nasal mucosa. In conclusion, chronic rhinosinusitis with or without nasal polyps that is refractary to antibiotic therapy should be directed to the ENT department in order to receive surgical therapy in order to improve olfactory function. [ABSTRACT FROM AUTHOR]

Nasal polyposis is one of the most common chronic upper airway diseases. Management of allergic rhinosinusitis with polyps is to control the disease process and the local immune response of the nasal mucosa. This is achieved by surgical removal of polypoid mucosa of all sinuses by functional endoscopic sinus surgery (FESS) followed by suppression of local immune response by using steroids. Budesonide nasal douching was introduced recently for postoperative management of patients with allergic rhinosinusitis. The therapeutic effectiveness and safety of this procedure are becoming accepted by many physicians. Evaluation of the efficacy of budesonide nasal irrigation in the postoperative management of chronic allergic rhinosinusitis with polyps. A total of 60 postoperative chronic allergic rhinosinusitis with polyps patients were randomly divided into two groups. Both groups received routine post-FESS medication as per the institute protocol. One group of patients received budesonide nasal douching in addition to regular care. Both groups were evaluated endoscopically at 1, 2, 6 and 10 weeks after surgery. Pre and postoperative quality of life change, the patient complaints, need for revision surgery were evaluated. Endoscopic Lund–Kennedy scoring (objective measurement) and Sino-Nasal Outcome Test-22 (subjective analysis) were used to compare the two postoperative groups. The average preoperative Sino-Nasal Outcome Test 22 score was 52.2. It was reduced to an average of 29.4 in patients who used the standard postoperative regimen and to 15.8 postoperatively in patients who had budesonide added to their douching solutions. The average endoscopy score was 2.2 for patients who did receive budesonide as compared to 2.9 for patients who did not receive budesonide nasal douching. Budesonide nasal douching can offer a safe and effective tool in managing local inflammatory response in allergic rhinosinusitis. It leads to a significantly better quality of life and has an adequate response on nasal mucosa—leading to less mucosal oedema and lower incidence of polypoidal changes postoperatively. [ABSTRACT FROM AUTHOR]

Background/aims: This study aimed to determine the dynamic change of postoperative T-helper cell cytokines in nasal secretions and serum in chronic rhinosinusitis with nasal polyps (CRSwNP).Methods: Nasal secretions and serum samples of 30 CRSwNP patients and 10 healthy subjects were collected. Among CRSwNP patients, samples of 30 patients were collected 1 day before endoscopic sinus surgery (ESS) and that of 18 patients (12 asthmatic and 6 non-asthmatic) were collected 4, 8, and 12 weeks after ESS. Concentrations of interleukin (IL)-2, IL-4, IL-5, IL-17, and interferon gamma (IFN-γ) were determined by Cytometric Beads Array. The Sino-Nasal Outcomes Test 22 and Lund-Kennedy endoscopic scoring (LKES) system were collected for all patients.Results: The levels of IL-2 and IL-5 in secretions of CRSwNP were significantly higher than that of healthy control at the baseline. At the 4th and 8th week after ESS, the IL-4 levels in nasal secretions of the asthmatic group were significantly higher than their baseline controls (preoperatively). From the 4th to 12th week after ESS, the IL-2, IFN-γ, IL-4, and IL-17 levels in nasal secretions of the non-asthmatic group were significantly increased as compared to their baseline controls. Postoperative IL-5 levels in serum of the asthmatic group decreased significantly as compared to their baseline controls. There was no significant association between LKES and levels of cytokines in postoperative secretions and serum.Conclusions: Our results indicate that postoperative endoscopic findings may not directly reflect the underlying mucosal inflammation, and surgery could not change the systemic immunity status. Despite endoscopic resolution of mucosal abnormalities, it may not avert the need for subsequent postoperative medical intervention to treat the underlying mucosal inflammation. [ABSTRACT FROM AUTHOR]

Background: A randomized controlled trial was held to compare nonabsorbable packs to steroid‐eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). Methods: CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non‐latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund‐Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. Results: Forty CRS patients were prospectively enrolled in this institutional review board (IRB)‐approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT‐22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund‐Kennedy scores. Conclusion: In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT‐22 scores at the 20‐day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug‐eluting stents when compared to nonabsorbable packing. [ABSTRACT FROM AUTHOR]

BACKGROUND. Sinonasal polyposis represents a chronic inflammatory condition characterized by nasal obstruction, reduction in the sense of smell and impaired quality of life. Intranasal steroids play an important role in preventing the postoperative recurrences in these cases. We carried out a study to evaluate and compare intra nasal budesonide and intranasal fluticasone propionate in the postoperative management of ethmoidal nasal polyposis. MATERIAL AND METHODS. 106 patients with ethmoidal polyposis were treated with endoscopic polypectomy and were postoperatively started and maintained on intranasal steroids. 54 patients were managed with budesonide and 52 patients maintained on fluticasone propionate nasal spray. The patients were followed-up for 6 months and recurrences and control of symptoms evaluated. RESULTS. There was a statistical difference in the SNOT-22 (p<0.0001) and Lund-Kennedy scores (p=0.015) between patients using fluticasone propionate as compared to those using budesonide intra nasal spray by the end of the 6th month. CONCLUSION. Both intranasal budesonide and fluticasone propionate are effective in controlling symptoms after endoscopic sinus surgery in patients with sinonasal polyposis; however, intranasal fluticasone propionate was more efficacious than budesonide in the control of postoperative symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Budesonide improves the prognosis of chronic rhinosinusitis (CRS). However, few reports have examined whether its use for nasal irrigation, compared to normal saline, improves the prognosis of patients after endoscopic sinus surgery (ESS). We compared the effects of nasal irrigation with budesonide and normal saline in CRS patients after ESS. Methods: Sixty CRS patients who had undergone ESS were randomly divided into an experimental group (30 patients), which used budesonide nasal irrigation, and a control group (30 patients), which used normal saline nasal irrigation. All patients received regular follow-up evaluations and were assessed via questionnaires, including the Lund–Kennedy endoscopic score (LKES), the symptom visual analog scale (VAS), the 22-item Sino-Nasal Outcome Test (SNOT-22), the Short-Form 36-Item Questionnaire (SF-36), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS) and a side effects scale. Results: Scores of polyposis, mucosal edema, secretions and total score of LKES; VAS scores of nasal blockage, hyposmia and rhinorrhea; and SNOT-22 results in both groups were significantly improved 3 months after ESS. Scores of polyposis, mucosal edema, secretions and scarring and total score of LKES in experimental group were significantly better than in control group 3 months after ESS. No significant differences were observed in SF-36, SAS or SDS before or 3 months after ESS within or between the two groups. The side effects of the two groups were not significantly different. Conclusions: Nasal irrigation improved the prognosis of CRS patients after ESS. Budesonide nasal irrigation had a better effect than normal saline nasal irrigation. [ABSTRACT FROM AUTHOR]

Background: Nasal polyposis is a common problem facing the otolaryngologist. Its incidence is estimated to be in the range of 0.2 to 4.3%. It may be associated with other conditions such as bronchial asthma (about 25%-30% of polyposis patients) and Aspirin sensitivity (12%). Objectives: The aim of this work was to study the importance of searching and identifying the effect of medical versus surgical modalities in treatment of chronic allergic nasal polyps. Patients and Methods: Thirty patients with bilateral nasal polyps were enrolled in this study. They were randomly arranged into 2 groups. Group I was treated by functional endoscopic sinus surgery while Group II was treated by local and systemic corticosteroids. The age in Group I ranged from 17 to 66 years with a mean of 42 ± 16.51 years while the age in Group II ranged from 19 to 60 years with a mean of 39.4 ± 11.24 years. In Group I, 12 patients (80%) were male while 3 patients (20%) were female. In Group II, 9 patients (60%) were male while 6 patients (40%) were female. No past history was found in 18 patients (60%) while bronchial asthma was found in 8 patients (26.67%) and aspirin sensitivity was found in 3 patients (10%). Both bronchial asthma and aspirin sensitivity were found in one patient in Group II. Results: The mean Total nasal symptoms score (TNSS) were 22.33 ± 1.21 in Group I and 20.07 ± 3.31 in Group II. The mean Total Nasal Polyp Score (TNPS) were 4.67 ± 0.82 in Group I and 4.8 ± 0.862 in Group II. The mean Lund- Mackay Score (LMS) were 10.87 ± 0.74 in Group I and 11 ± 0.66 in Group II. Conclusion: Patients treated by FESS have less residual symptoms, size and severity of residual polyps and rate of recurrence than patients treated medically. [ABSTRACT FROM AUTHOR]

Background Nasal endoscopic surgery is widely used for nasal diseases, including sinusitis and tumors. However, scar hyperplasia, nasal irritation, scab, and nasal obstruction delay nasal mucosal recovery, with prolonged cleaning exacerbating the patient's financial burden. Here, we presented a novel approach for the treatment of nasal mucosal defects, termed acellular dermal matrix. Methods A total of 31 patients with bilateral chronic sinusitis (maxillary sinusitis and ethmoid sinusitis) underwent nasal surgery and nasal mucosal repair in September–October 2016. We divided the nasal cavities of each patient into control and acellular dermal matrix groups, randomly selected one side for nasal mucosal repair by surgery. A suitable acellular dermal matrix size was selected according to the defect in each patient. After pruning, the acellular dermal matrix was placed on the wound surface and filled with gelatin sponge. All patients were followed up for 14 weeks to compare nasal mucosal epithelialization between the control and acellular dermal matrix groups. Results：No obvious complications and adverse reactions were observed after nasal surgery. Lund-Kennedy scores in the acellular dermal matrix group were significantly decreased compared with the control group at 8 (0 (0, 1) vs. 2 (2, 4); P<0.05) weeks. Epithelialization time of eight weeks in the acellular dermal matrix groups was significantly decreased than the control group of 14 weeks. Conclusion Acellular dermal matrix provides a growth framework for the healthy mucosa on the wounded surface and reduces postoperative epithelialization time. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to look into how functional endoscopic sinus surgery (FESS) for CRSwNP without asthma affects lung function. The investigators aimed to determine any correlation between Lund-Kennedy scores, Lund-Mackay scores and pulmonary function. Methods: All participants underwent nasal endoscopic examination and CT scanning paranasally. Lund-Kennedy endoscopy and Lund-Mackay CT scores were calculated and compared with postoperative findings. Statistical analysis was performed to compare preoperative and postoperative spirometry findings to assess efficacy of surgery on pulmonary function. Results: There were no statistically significant differences between the Lund-Mackay scores for primary FESS and revision. Nevertheless, Lund-Kennedy scores did show evidence of greater statistical significance when comparing revision FESS and primary FESS (p=0.04) With respect to both primary and revision FESS patients there was no statistical significance between the preoperative values of FEV1, FEV1/FVC, FVC, and FEF25-75 and the same parameters measured one month postoperatively (p>0.05). Conclusion: Our results reveal that FVC improves following FESS in cases of CRSwNP that are not also asthmatic. No relationship was demonstrable between how severe the disease is and how the lung functions. Further research that looks at FESS in asymptomatic cases of airway obstruction over more prolonged follow-up needs to be undertaken. [ABSTRACT FROM AUTHOR]

The existing data demonstrate the potential role of trace elements in nasal mucociliary clearance, although the association between trace element and mineral status and ciliary function in children with chronic rhinosinusitis is insufficiently studied. Therefore, the objective of the present study is evaluation of trace element and mineral status and mucociliary function in pediatric CRS patients before and after functional endoscopic sinus surgery. The present study involved 30 children with chronic rhinosinusitis without nasal polyps. During this follow-up the patients were examined preoperatively (point 0), underwent functional endoscopic sinus surgery, and were repeatedly examined at three months postoperatively (point 1). At both points the patients were subjected to quality-of-life assessment using SNOT-20 questionnaire; endoscopic and computer tomography examination of the nasal sinuses; evaluation of ciliary function and mucosal cytology using high-speed videomicroscopy; assessment of blood count and inflammatory markers; as well as analysis of trace element and mineral levels in whole blood, serum, and hair using inductively-coupled plasma mass-spectrometry. The obtained data demonstrate that endoscopic sinus surgery significantly improved sinonasal pathology in children with chronic rhinosinusitis, as evidenced by significantly reduced Lund-Mackay, Lund-Kennedy, and SNOT-20 scores. At the same time, no significant improvement of ciliary functions or mucosal cytology was observed postoperatively. Trace element status assessment demonstrated that postoperative serum Zn, whole blood Mg and Cu were significantly lower as compared to preoperative values. In contrast, serum Mn and Cr, as well as whole blood Cr and hair Se were characterized by a significant increase at three months postoperatively. Multiple linear regression analysis demonstrated that serum Zn is significantly associated with the number of ciliated cells and cell viability, whereas serum Mn and whole blood Cu concentrations are inversely associated with cell viability and ciliary length, respectively. Hair Se was found to be associated with the number of neutrophils in the mucosa biopsy. Redistribution of trace elements and minerals may at least partially mediate prolonged recovery of mucosal ciliary function in children with chronic rhinosinusitis in three months after functional sinus surgery, although the particular mechanisms of these alterations in trace element levels are to be discovered. [ABSTRACT FROM AUTHOR]