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Chronic rhinosinusitis with (CRwNP) or without (CRsNP) nasal polyps can have a great impact on quality of life. Typical symptoms include nasal obstruction, olfactory dysfunction, nasal discharge, and facial pain or pressure. Diagnostic gold standard is nasal endoscopy followed by CT scan of the paranasal sinuses. Besides first-line treatment with topical or systemically applied glucocorticoids, nasal rinsing, and surgical therapy, monoclonal antibodies have been approved in Germany since 2019.Eine chronische Rhinosinusitis mit (CRSwNP) oder ohne (CRSsNP) nasale Polyposis bedeutet für viele Patienten eine starke Einschränkung der Lebensqualität. Typische Symptome umfassen eine Nasenatmungsbehinderung, Riechstörungen, einen nasalen Sekretfluss sowie Schmerzen oder Druckgefühl. Goldstandard in der Diagnostik ist eine nasale Endoskopie mit anschließender Bildgebung mittels Computertomographie der Nasennebenhöhlen. Neben der Erstlinientherapie mit topischen oder systemischen Glukokortikoiden, Nasenspülungen sowie der chirurgischen Therapie ist in Deutschland seit 2019 auch der Einsatz von monoklonalen Antikörpern zugelassen.

With increasing age, structures of the internal and external nose change. Many elderly patients complain about rhinitis with nasal obstruction, endonasal crusting, epistaxis, intermittent rhinorrhea, and olfactory disorders. These symptoms are mainly caused by atrophy of the mucosa and the olfactory epithelium, but may also be an expression of drug side effects. Additionally, there are changes in the shape of the nose (continuous growth, altered elasticity of supporting structures) and in the dermis, which may develop tumors due to its sun-exposed position. These multiple internal and external changes of the nose can be summarized by the collective term "aging nose," whose treatment options are complex. These range from conservative (nasal care, medication changes, hemostatic measures) to surgical lines of therapy (septorhinoplasty, tumor excision, vascular ligation) and will require further scientific study in the future.Mit zunehmendem Alter ändern sich Strukturen der inneren und auch der äußeren Nase. Viele ältere Patienten klagen über eine Rhinitis mit Nasenatmungsbehinderung, endonasaler Krustenbildung, Epistaxis, intermittierender Rhinorrhö und Riechstörungen, die u. a. durch eine Atrophie der Schleimhaut und des Riechepithels bedingt sind, aber auch Ausdruck von Medikamentennebenwirkungen sein können. Gleichzeitig ergeben sich Veränderungen der Nasenform (kontinuierliches Wachstum, veränderte Elastizität von Stützstrukturen) und der Dermis, die durch ihre sonnenexponierte Lage nicht selten Tumoren entwickelt. Diese multiplen inneren und äußeren Veränderungen der Nase firmieren unter dem Sammelbegriff einer „Altersnase“, deren Therapiemöglichkeiten komplex sind. Sie reichen von konservativen (Nasenpflege, Medikamentenumstellung, blutstillende Maßnahmen) bis zu operativen Therapien (Septorhinoplastik, Tumorexhärese, Gefäßunterbindung) und bedürfen zukünftig weiterer wissenschaftlicher Studien.

Chronic rhinosinusitis (CRS) is defined as an inflammation of the nose and paranasal sinuses with prevalence of 10.9 % and by the presents of 2 or more symptoms, which last more than 12 weeks. The symptoms are nasal obstruction, nasal discharge (anterior/post nasal drip), facial pain or pressure and/or olfactory disorder. CRS has a high negative impact on an individual's quality of life. The pathogenesis is multifactorial and complex. CRS has been subclassified into 2 groups: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Regarding further knowledge of the inflammatory pathway the primary CRS is considered by endotype dominance, either type 2 or non-type 2. 80 % of the CRSwNP reveals a type 2 inflammation. The proteins, interleukin (IL)-4, IL-5, IL-13, and IgE were previously identified as key mediators in nasal polyp tissues pattern. CRSwNP is often refractory to medical and surgical management, especially in patients with asthma and aspirin intolerance. In most cases the control of the disease is a challenge. Patients with asthma but especially with Samter's triad are significantly more likely to have a recurrence of nasal polyps and undergo a second surgery following recurrence. In patients with severe CRSwNP, in whom the current standard of care including topical and oral corticosteroids, antibiotics and surgical procedures fail to control the disease, biologics can open new perspectives in treatment. They allow avoiding the possible adverse events resulting from repeated use of systemic corticosteroids and surgery. These biologics have a high impact on type 2 immune reaction and lead to a reduction of IgE as well as of local mucosal eosinophil migration and activation, resulting in a significant effect on nasal polyps, smell, quality of life and asthma comorbidity.

For patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) which cannot be controlled by continuous therapy with intranasal corticosteroids (INCS) and systemic corticosteroids and/or surgical treatment, there were no approved curative options for a long time. For CRSwNP treatment with T2-addressing biologics is possible. On October 24, 2019, the European Commission granted extended approval for dupilumab as the first biological agent for treatment of insufficiently controlled severe CRSwNP. The Federal Joint Committee (G‑BA) evaluates the benefits of reimbursable drugs with new active ingredients. This includes assessment of the additional benefit and its therapeutic relevance.A meta-analysis was performed using individual patient data based on two phase III studies. Both studies examined the safety and efficacy of dupilumab as an add-on therapy to INCS for treatment of CRSwNP in adults inadequately controlled with systemic corticosteroids and/or surgery compared to INCS alone.Based on the present data, the G‑BA decided that there is an indication of a considerable additional benefit of dupilumab compared to mometasone furoate.For patients with severe CRSwNP inadequately controlled with INCS and systemic corticosteroids and/or surgery, there is an indication of a considerable additional benefit for the administration of dupilumab as an add-on therapy to INCS compared to mometasone furoate alone.HINTERGRUND: Für Patienten mit schwerer chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP), die durch eine Dauertherapie mit intranasalen Kortikosteroiden (INCS) und Gabe von systemischen Kortikosteroiden und/oder eine chirurgische Behandlung nicht ausreichend kontrolliert werden konnten, gab es für lange Zeit keine zugelassenen kurativen Therapieoptionen. Bei der CRSwNP ist eine Behandlung mit T2-adressierenden Biologika möglich. Am 24.10.2019 hat die Europäische Kommission für Dupilumab als erstes Biologikum eine Zulassungserweiterung zur Therapie von unzureichend kontrollierter, schwerer CRSwNP ausgesprochen. Der Gemeinsame Bundesausschuss (G‑BA) bewertet den Nutzen von erstattungsfähigen Arzneimitteln mit neuen Wirkstoffen. Hierzu gehört insbesondere die Bewertung des Zusatznutzens und seiner therapeutischen Bedeutung.Auf der Grundlage zweier Phase-III-Studien wurde eine Metaanalyse anhand von individuellen Patientendaten durchgeführt. In beiden Studien wurde die Wirksamkeit und Sicherheit von Dupilumab als Add-on-Therapie zu INCS zur Behandlung von Erwachsenen mit schwerer CRSwNP, die mit systemischen Kortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden kann, im Vergleich zu INCS untersucht.Basierend auf den Studiendaten hat der G‑BA entschieden, dass für Dupilumab als Add-On zu INCS ein Hinweis auf einen beträchtlichen Zusatznutzen gegenüber Mometasonfuroat vorliegt.Für Patienten mit schwerer CRSwNP, die durch eine Erhaltungstherapie mit INCS und Gabe von systemischen Kortikosteroiden und/oder eine chirurgische Behandlung nicht ausreichend kontrolliert werden, besteht für die Gabe von Dupilumab als Add-On zu INCS ein Hinweis auf einen beträchtlichen Zusatznutzen gegenüber Mometasonfuroat allein.

Symptoms of chronic rhinitis in old and very old populations may result from isolated hyperplasia of nasal inferior turbinates. Turbinoplasty is a possible method of treatment in these individuals. However, preoperative concerns are associated with their poor general condition: tendency to epistaxis, treatment with anticoagulants, hypertension, and less effective healing.The aim of this study was to determine differences in results of turbinoplasty obtained in old and very old individuals with chronic rhinitis, compared to young and otherwise healthy patients.We analyzed records of 130 patients with hyperplasia of the inferior turbinates, who had undergone bipolar diathermy turbinoplasty: 82 individuals aged 18-59 (mean = 33.8; SD = 10.2), 30 patients aged 60-74 (mean = 66.0; SD = 3.7) and 18 participants aged 75 + years (mean = 85.3; SD = 6.5). The patients were questioned about the intensity of their symptoms before and one month after the surgery, using the SNOT-20 questionnaire. The duration of wound healing and satisfaction scores were also noted.Nasal patency, nasal discharge and post-nasal drip improved in old and very old patients, similarly as in the young ones. Olfactory and taste function improved significantly more in young individuals. Postoperative healing time was significantly longer in very old patients.Some results of turbinoplasty in old and very old patients were significantly worse than in young ones.Die Symptomatik der chronischen Rhinitis in der alten und sehr alten Bevölkerung kann aus der isolierten Schleimhauthyperplasie der unteren Nasenmuscheln resultieren. Als eine zielführende Therapie kommt eine Muschelplastik in Betracht. Bedenken bestehen hinsichtlich des oftmals reduzierten Allgemeinzustands, der häufig erhöhten Neigung zur Epistaxis, vor allem bei der Verwendung von Antikoagulanzien, und der Komorbiditäten wie der arteriellen Hypertonie. Hinzu kommt die Problematik der verzögerten Heilung. ZIEL: In der vorliegenden Studie sollten die Ergebnisse einer Muschelplastik, die in der Gruppe der alten bzw. sehr alten Patienten erzielt wurden, mit den Ergebnissen in der Gruppe der jungen Individuen verglichen werden.Die Krankenakten von insgesamt 130 Patienten, die in drei Altersgruppen eingeteilt wurden: 82 Patienten 18–59 Jahre (M = 33,8; SD = 10,2); 30 Patienten 60–74 Jahre (M = 66,0; SD = 3,7) und 18 Patienten 75 + Jahre (M = 85,3; SD = 6,5) wurden einer Analyse unterzogen. Die Befragung der Patienten in Bezug auf die Intensität ihrer Symptome erfolgte direkt prä- und einen Monat postoperativ. Zur Beurteilung wurde der Sinonasal Outcome Test (SNOT-20) eingesetzt. Die Dauer der Heilung und die Zufriedenheitswerte der Patienten wurden ebenfalls notiert.Es zeigte sich eine vergleichbare Verbesserung des Nasendurchflusses, der Rhinorrhoe und des Postnasal-Drip-Syndroms bei den alten und sehr alten Patienten sowie den jungen Probanden. Die Funktion des Geruchssinns verbesserte sich dagegen in einem höheren Maß in der Gruppe der jungen Patienten. Die postoperative Heilung dauerte länger bei den alten und sehr alten Patienten als bei den jungen Probanden.Einige klinische Ergebnisparameter waren bei den alten und sehr alten Patienten signifikant schlechter als bei den jungen Probanden.

Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal mucosa, lasting for more than 12 weeks. By now approximately 15 % of the European and American population are affected, which indicates that CRS is a serious health problem. Beside other subgroups the most important classification is CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). Standard-of-care therapies include nasal saline solution as well as topic or systemic corticosteroids. If this does not lead to a sufficient recovery, surgical therapy is a good option. A new therapy option is represented by biologics, particularly monoclonal antibodies (mAB). They are well-established for treatment of asthma bronchiale. Due to the fact that asthma is often associated with nasal polyps, and mAB may could also lead to improvements in CRS, studies were conducted. In the meantime there is a number of mAB which have emerged as an alternative treatment for patients with CRSwNP.

Einführung: Rhinitis und Asthma sind chronisch-entzündliche Atemwegserkrankungen mit weltweit häufigem Auftreten bereits im Kindes- und Jugendalter. Bei der Asthma- Prävalenz scheint eine männliche Dominanz in der Kindheit zu bestehen, die von einer weiblichen Dominanz in der Jugend und im Erwachsenenalter abgelöst wird. Die Datenlage zur Prävalenz von Rhinitis und von respiratorischer Multimorbidität (d.h. dem gleichzeitigen Auftreten von Rhinitis und Asthma) ist dagegen unzureichend. Die vorliegende Dissertation untersuchte geschlechtsspezifische Prävalenzen und Inzidenzen von Rhinitis, Asthma und respiratorischer Multimorbidität vor und nach Pubertätsbeginn. Methoden: In einer systematischen Übersichtsarbeit mit Metaanalyse (Publikation I) wurden 6.540 Publikationen zu Rhinitis-Prävalenzen vom Kindes- bis Erwachsenenalter gescreent; 67 Publikationen erfüllten die Kriterien zum Einschluß in die Metaanalyse. Des Weiteren wurden zwei Metaanalysen zur Bestimmung der geschlechtsspezifischen Prävalenzen (Publikation II) und Inzidenzen (Publikation III) von Rhinitis, Asthma und respiratorischer Multimorbidität in Abhängigkeit vom Pubertätsstatus durchgeführt. Primärdaten internationaler bevölkerungsbasierter Geburtskohortenstudien mit über 18.000 rekrutierten Kindern konnten harmonisiert und analysiert werden. Spezifisches Immunoglobulin-E (IgE) gegen Aeroallergene wurde im Serum bestimmt, um für IgE- versus nicht-IgE-assoziierte Rhinitis, Asthma und respiratorische Multimorbidität zu stratifizieren. Ergebnisse: Publikation I zeigte für die Rhinitis-Prävalenz im Kindesalter eine Dominanz der Jungen und bei Jugendlichen und Erwachsenen eine Dominanz der weiblichen Teilnehmer. Die Publikationen II (Prävalenz) und III (Inzidenz) zeigten eine männliche Dominanz für Rhinitis, Asthma und respiratorischer Multimorbidität vor Pubertätsbeginn. Für IgE-assoziierte Rhinitis- Inzidenz blieb die männliche Dominanz auch nach Pubertätsbeginn bestehen (female/male Harzard Ratio (HR) 0,66; 95% Konfidenzintervall 0,54-0,80), während sich für die nicht-IgE-assoziierte Rhinitis-Inzidenz eine Tendenz zu einer weiblichen Dominanz zeigte (1,20; 0,98-1,47). Nach Pubertätsbeginn deutete sich für die Inzidenz von IgE-assoziiertem Asthma (0,77; 0,53-1,11) und IgE-assoziierter respiratorischer Multimorbidität (0,74; 0,50-1,08) eine Tendenz zu einem ausgeglicheneren Geschlechterverhältnis an. Dies war deutlicher für die Inzidenzen von nicht-IgE- assoziiertem Asthma (1,23; 0,75-2,00) und nicht-IgE-assoziierter respiratorischer Multimorbidität (0,96; 0,54-1,71). Die Ergebnisse für die Prävalenzen waren ähnlich. Diskussion: Die vorliegenden Analysen großer bevölkerungsbezogener Datensätze zeigten, dass der Pubertätsbeginn das geschlechtsspezifische Auftreten respiratorischer Erkrankungen, insbesondere der nicht-IgE-assoziierten, beeinflusste. Weibliche Teilnehmer hatten nach Pubertätsbeginn im Vergleich zu vor Pubertätsbeginn ein erhöhtes Risiko für Asthma, Rhinitis und respiratorische Multimorbidität. Diese Erkenntnisse sollten nicht nur in der Grundlagenforschung bei der Aufklärung der den Allergien zugrundeliegenden Mechanismen berücksichtigt werden, sondern auch Implikationen für die klinische Forschung und Praxis haben. Um eine mögliche Unterversorgung zu vermeiden, bedarf es einer erhöhten Aufmerksamkeit bezüglich neuauftretender Rhinitis, Asthma und respiratorischer Multimorbidität bei weiblichen Patienten ab Pubertätsbeginn, insbesondere bei negativen IgE-Status und Skin-Prick-Test., Introduction: Rhinitis and asthma are common chronic inflammatory airway diseases, which can start as early as in childhood or adolescence. For asthma the prevalence shows a male predominance during childhood whereas it switches to a female predominance starting after puberty-onset; data for rhinitis and respiratory multimorbidity (i.e. the co-occurrence of rhinitis and asthma) are scarce. The current dissertation investigated the possible sex-switch of incidences and prevalences of rhinitis, asthma and respiratory multimorbidity before and after puberty-onset in large international population-based datasets. Methods: In a systematic review and meta- analysis (publication I) 6,540 publications were screened for data of sex-specific rhinitis prevalences throughout the lifespan; 67 publications fulfilled the inclusion criteria for the meta-analyses. Additionally, two meta-analyses included population-based birth cohort studies with over 18,000 recruited children to determine sex-specific prevalences (publication II) and incidences (publication III) of rhinitis, asthma and respiratory multimorbidity before and after puberty-onset. The participants’ status of serum Immunoglobulin-E (IgE) was assessed to stratify for IgE-associated versus non-IgE- associated rhinitis, asthma and respiratory multimorbidity. Results: Publication I showed a male predominance in childhood compared to a female predominance in adolescence and adulthood for the rhinitis prevalence. Similarly, publications II (prevalence) and III (incidence) based on European birth cohorts found a male predominance in rhinitis, asthma and respiratory multimorbidity before puberty-onset. For IgE-associated incident rhinitis a male predominance remained after puberty-onset (female/male Hazard Ratio (HR) 0.66; 95%Confidence-interval 0.54-0.80); whereas, for non-IgE-associated incident rhinitis there was a tendency towards a female predominance (1.20; 0.98-1.47). IgE-associated incident asthma (0.77; 0.53-1.11) and IgE-associated incident respiratory multimorbidity (0.74; 0.50-1.08) showed a slight tendency towards a more sex-balanced distribution after puberty-onset. For non-IgE- associated incident asthma (1.23; 0.75-2.00) and respiratory multimorbidity (0.96; 0.54- 1.71) the tendency towards a sex balanced distribution seemed more pronounced. The results for the prevalences were similar. Discussion: Independent of age, puberty- onset was related to a sex-switch of prevalence and incidence distribution patterns of rhinitis, asthma and respiratory multimorbidity, especially for non-IgE-associated conditions. Females had an increased risk for asthma, rhinitis and respiratory multimorbidity after puberty-onset compared to before puberty-onset. These results should be considered in basic scientific research to investigate underlying mechanism of allergies and also lead to implications in clinical research and practice. Clinicians should be attentive to detect incident respiratory diseases in adolescent girls for a timely diagnosis and treatment, especially with a negative IgE-status and skin prick test to avoid possible insufficient medical care in this patient group.

Acute rhinosinusitis and chronic rhinosinusitis are inflammatory diseases of the mucosal membranes due to mislead immunological reactions to aeroallergens. T‑cells are divided into different groups based on their cytokine secretion: T‑helper type 1 (Th1) and type 2 (Th2) cells. The allergic immune response is caused by activation of specific Th2 cells. With specific immunotherapy, the mislead hyperactivated "allergic" immune response is reduced to a reaction within the normal range. The inflammatory forms of chronic rhinosinusitis are called endotypes, and, in the future, could enable a targeted, pathomechanistic therapy. These endotype-based treatment approaches target specific signaling pathways that have already shown good effects for chronic rhinosinusitis with nasal polyps using monoclonal antibodies. However, so far, only selected patients with non-rhinologic indications, off-label treatments, or in clinical trials have benefited from these treatments.

Human rhinoviruses (RV) belong to the Picornaviridae and are divided into three species: rhinovirus A, B and C. As causative viruses of upper airway infections (common cold), they possess enormous epidemiological and clinical importance. Furthermore, rhinoviruses are significant pathogens of acute exacerbations of chronic airway diseases such as asthma and chronic obstructive pulmonary disease. Their role as a cofactor in the development of pneumonia and their relevance in critically ill patients is still unclear and the focus of current research. Due to the unspecific clinical symptoms, diagnosis is difficult. Laboratory detection is sophisticated and a distinction between clinically relevant infection and contamination not always possible. Specific therapeutic antiviral strategies against rhinovirus infection do not exist as yet and, due to the large variety of subtypes, the development of vaccines remains a considerable challenge.

Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases. Among these patients the prevalence of immune defects is higher than in the healthy general population.A selective review of the literature was carried out in PubMed and Medline covering the period between 2008 and 2019. Additionally, recent German publications in journals not listed in the abovementioned databases were analyzed.The diagnostic workflow with respect to the immunodeficiency consists of a detailed anamnesis and physical examination, laboratory tests and the antibody reaction to polysaccharide vaccines and antigens. Beside antibiotic treatment, vaccinations and immunoglobulin replacement are available. Notwithstanding the above, functional endoscopic surgery of the paranasal sinuses should be performed according to guideline recommendations.Patients with CRS who do not sufficiently respond to conservative and surgical treatment should be checked for underlying immunodeficiencies.

Analgesic intolerance (AI) is an important diagnostic feature of disease progression in patients with chronic rhinosinusitis (CRS) accompanied by nasal polyps (CRSwNP) and asthma.The aim of the present study was to determine whether increasing the concentration of acetylsalicylic acid (ASA) used in the diagnostic nasal challenge would improve detection of ASA intolerance (NSAIDs-exacerbated respiratory disease, N‑ERD).Patients with CRSwNP, asthma, and with (CRSwNP-AAI, n = 20) or without (CRSwNP-A, n = 15) anamnestically reported AI, as well as control subjects with CRS but no nasal polyps, asthma, or AI (n = 15), were challenged nasally with 16 mg ASA and, in case of a negative result, with 25 mg of ASA.In CRSwNP-AAI subjects, the challenge with 16 mg ASA resulted in detection of AI in 80% of cases; increasing the challenge of ASA to 25 mg improved the AI detection to 95%. In CRSwNP-A subjects, the detection of AI increased from 40% (16 mg ASA) to 53% (25 mg ASA). In the control group, no reaction to nasal ASA challenge was detected. No difference in the diagnosis of positive reactions after provocation was found when using the German vs. the European recommended evaluation criteria. Mild pulmonary symptoms occurred in 2 (10%) CRSwNP-AAI patients following the 16 mg ASA challenge.In patients with CRSwNP, asthma, and anamnestic AI, nasal provocation can effectively confirm the diagnosis of N‑ERD and can also be recommended for patients with recurrent CRSwNP and asthma but without reported AI. Increasing the ASA challenge to 25 mg increases the overall detection rate.

Retrospective evaluation of the diagnostic value of bacterial culture of nasal mucosal swabs and histopathologic assessment of nasal mucosal biopsies in dogs with nasal discharge.Medical records of dogs with the predominant clinical sign of nasal discharge that were referred to the ENT Unit of the Small Animal Department between January 2015 and December 2016 were reviewed.Data of 85 dogs were evaluated. On the basis of the results of computed tomography (CT), rhinoscopy, bacterial culture of a nasal mucosal swab and histopathologic examination of nasal mucosal biopsies, dogs were assigned to one of six groups of primary nasal diseases: nasal neoplasia (24/85, 28 %), oronasal defect (22/85, 26 %), idiopathic chronic rhinitis (17/85, 20 %), foreign body (8/85, 10 %), sinonasal aspergillosis (7/85, 8 %) and diseases of the planum nasale (7/85, 8 %). In brachycephalic dogs (14/85, 17 %), oronasal defects (8/14, 57 %) were the most frequent cause of nasal discharge. No cases of a primary bacterial infection of the nasal cavity were observed and, therefore, antibiotic treatment had not been successful. Nevertheless, 72 % of the dogs in this study had received prior antibiotic treatment. Secondary bacterial infec tions diagnosed via nasal mucosal swabs were not diagnostic for the underlying primary nasal diseases. Targeted biopsies of tumors obtained under endoscopic visualization may lead to a definitive diagnosis, whereas biopsies of the nasal mucosa and the type of the inflammatory infiltrate were not diagnostic.Nasal discharge in dogs is frequently an indicator of an underlying severe primary nasal disease possibly leading to mortality of the affected dogs. Further diagnostics under anesthesia should be performed early in the diagnostic evaluation. Rhinoscopy as the central diagnostic is supported by CT and biopsy. Bacterial culture of the nasal discharge does not provide a diagnosis for the primary nasal disease process.Without further diagnostics, antibiotic treatment of dogs presenting with nasal discharge is considered as not appropriate and can be harmful in dogs with nasal tumors or sinonasal aspergillosis. When an intranasal malignant neoplasia is suspected, endoscopic-guided biopsies of the nasal mass should be obtained, because blind nasal biopsies are associated with a high rate of false-negative results.Es sollte untersucht werden, inwieweit die bakteriologische Untersuchung von Nasenschleimhautabstrichen (BU) und die histopathologische Untersuchung (HP) von Nasenschleimhautbioptaten bei Hunden mit Nasenausfluss (NAF) für das Stellen einer Diagnose von Bedeutung sind.Retrospektiv wurden Patientenakten von Hunden ausgewertet, die mit dem Hauptsymptom NAF von Januar 2015 bis Dezember 2016 in der HNO-Abteilung der Klinik für Kleintiere vorgestellt wurden.Die Auswertung umfasste die Daten von 85 Hunden. Auf der Basis der Ergebnisse einer Computertomografie (CT) des Kopfes, einer Rhinoskopie, der BU und der HP wurden 6 Gruppen nach den Primärursachen klassifiziert: nasale Neoplasie (24/85, 28 %), oronasale Defekte (22/85, 26 %), idiopathische chronische Rhinitis (17/85, 20 %), Fremdkörper (8/85, 10 %), sinonasale Aspergillose (7/85, 8 %) und pathologische Veränderungen des Nasenspiegels (NSP; 7/85, 8 %). Bei brachyzephalen Hunden (14/85, 17 %) stellten oronasale Defekte (8/14, 57 %) mit Abstand die häufigste Ursache für NAF dar. Eine bakterielle Infektion der Nasenschleimhaut war bei keinem Tier die Primärursache für NAF und daher nicht allein mit einem Antibiotikum zu therapieren. Dennoch waren 72 % der Tiere antibiotisch vorbehandelt. Die BU zeigte Sekundärerreger, die für keine Primärursache charakteristisch waren. Die HP erwies sich nur für die endoskopisch kontrollierte Probenentnahme von Tumorgewebe als diagnostisch. Nicht diagnostisch waren dagegen die Biopsie von Nasenschleimhaut und die Bestimmung des Entzündungstyps.NAF ist beim Hund häufig Folge einer gravierenden Grunderkrankung, die zu bleibenden Schäden bis hin zum Tod führen kann. Daher bedarf es einer frühzeitigen weiterführenden Diagnostik in Narkose. Die Rhinoskopie als zentrales Diagnostikum wird durch CT und Biopsie ergänzt. Eine bakteriologische Untersuchung des Nasenausflusses ermöglicht keine Diagnose der zugrunde liegenden Primärerkrankung.Ohne Diagnose ist die Anwendung von Antibiotika bei Hunden mit NAF nicht indiziert, bei Tumorerkrankungen oder einer Pilzinfektion sogar schädlich. Bei Tumorverdacht sollten Bioptate unter endoskopischer Sicht gewonnen werden, da Blindbiopsien häufig benachbartes Gewebe erfassen und zu einer falschen Diagnose führen.

In recent years, the international literature has contained numerous reports indicating a high prevalence of depression and anxiety symptoms in patients with chronic rhinosinusitis (CRS). Measurement of subjective health-related quality of life in CRS patients, also as an assessment of treatment outcome, has received increasing attention in the past two decades.The aim of this study was to investigate the correlation between results of screening tests for the two most frequent mental disorders in Germany and the results of the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) in patients with CRS.121 in- and outpatients with a confirmed diagnosis of CRS were examined with the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI), and the SNOT-20 GAV. Possible correlations were verified by statistical tests.Of 108 evaluated tests, 23.1% contained indications of moderate or severe depressive syndromes, clinically relevant anxiety disorders, and combined disorders. For the results of BDI-II, BAI, and the overall quality of life (ALQ) subscore of SNOT-20 GAV, significantly more mental comorbidities and a worse quality of life were observed in women and older patients. There was a high/moderate correlation between the total score of BDI-II/BAI and the ALQ subscore for the entire patient group. The correlation between total scores of BDI-II/BAI and the subscore of primary nasal symptoms (PNS) was very weak.The presented trial points out the considerable number of mental comorbidities in patients with affirmed CRS. Furthermore, the results of this examination demonstrate the significant influence of mental comorbidity on the quality of life of these patients.

Chronic rhinosinusitis (CRS) is a heterogeneous and multifactorial inflammation of the nasal and paranasal mucosa. Until now, no internationally standardized classification could be developed. In most cases, CRS is phenotypically classified according to chronic rhinosinusitis with (CRScNP) and without nasal polyps (CRSsNP). However, recent studies could show that there are numerous endotypes within these phenotypes based on different inflammatory mechanisms. This review describes the important immunological mechanisms of CRScNP and highlights modern treatment options with biologicals directly addressing particular immunological processes.Current knowledge on immunological and molecular processes of CRS, particularly CRScNP, was extracted from Medline, PubMed, national and international study- and guideline-registers, and the Cochrane library by a systematic review of the literature.Based on current literature, various immunological mechanisms for CRS and CRScNP could be identified. Relevant studies for the treatment of eosinophilic conditions such as asthma or CRScNP are presented and, if available, results of these studies are discussed.The growing insight into the underlying immunological mechanisms of CRScNP could pave the way for new personalized treatment options such as biologicals in the future.

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases in Germany and is often accompanied by years of chronic rhinosinusitis. According to the current German guideline "Rhinosinusitis", the nasal application of salt solutions, topical corticosteroids and in individual cases also systemic corticosteroids appear useful for a symptomatic therapy of CRS. The evidence for other therapeutic procedures such as acupuncture, homeopathy and phytotherapeutics is seen as insufficient. The aim of the present study was to investigate whether anti-inflammatory effects of electrostimulation therapy can also be demonstrated in CRS.randomized, prospective single center study, primary setting; 16 patients with moderate chronic rhinosinusitis with polyps (cRScNP), corresponding to a Lund / Mackay score of 6-12; home based electrostimulation therapy (EST) with amplitude modulated current (base frequency of 4000 Hz, frequency band of 100-250 Hz) over 2 weeks adjuvant to a concurrent sinusitis therapy with topical corticosteroids; measurement of nasal nitric oxide concentration and self-assessment of complaints with the questionnaire instrument SNOT-20 GAV; survey points t0 before EST, t1 after EST, t2 6 weeks after t1.Home based EST was performed by 16 patients. The results indicate that the positive effects of electrostimulation therapy in inflammatory processes also exist in CRS.Adjuvant transsinuidal electrostimulation could thus enrich the conservative therapy of CRS. Further studies with larger collectives are desirable.Die chronische Rhinosinusitis (CRS) zählt in Deutschland zu den häufigsten chronischen Erkrankungen und geht nicht selten mit einem jahrelangen Verlauf einher. Nach der aktuellen deutschen Leitlinie Rhinosinusitis sind für eine symptomatische Therapie der CRS die nasale Anwendung von Salzlösungen, topische Kortikosteroide, in Einzelfällen auch systemische Kortikosteroide sinnvoll. Die Evidenzlage für andere therapeutische Verfahren wie Akupunktur, Homöopathie und Phytotherapeutika wird als nicht ausreichend gesehen. In der vorliegenden Studie sollte untersucht werden, ob antiinflammatorische Effekte einer Elektrostimulationstherapie auch bei einer CRS nachgewiesen werden können. METHODIK: randomisierte, prospektive Single center Studie, primäres Setting; 16 Patientinnen und Patienten mit mittelgradig ausgeprägter chronischer Rhinosinusitis mit Polypen (cRScNP), entsprechend einem Lund / Mackay score von 6–12; heimbasierte Elektrostimulationstherapie (EST) mit amplitudenmoduliertem Strom (Basisfrequenz von 4000 Hz, Frequenzband von 100–250 Hz) über 2 Wochen adjuvant zu einer leitliniengerechten Sinusitistherapie mit topischen Kortikosteroiden; Messung der nasalen Stickstoffmonoxid Konzentration und Selbstbewertung der Beschwerden mit dem Fragebogeninstrument SNOT-20 GAV; Erhebungszeitpunkte t0 vor EST, t1 nach EST, t2 6 Wochen nach t1.Die heimbasierte EST wurde von 16 Patientinnen und Patienten durchgeführt. Die vorliegenden Ergebnisse deuten darauf hin, dass die bereits seit langem bekannten positiven Effekte einer Elektrostimulationstherapie bei inflammatorischen Prozessen auch bei einer CRS bestehen.Die adjuvante transsinuidale Elektrostimulation könnte somit die konservative Therapie der CRS bereichern. Weitere Studien mit größeren Kollektiven sind wünschenswert.

The aim of this study was to verify whether the following peripheral blood cell count and inflammation-based markers differ between various types of chronic rhinosinusitis (CRS): neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR), as well as erythrocyte sedimentation rate (ESR) and C‑reactive protein (CRP) levels.In all, 386 patients had complete peripheral blood count, ESR, CRP and nasal cytology. The severity of CRS symptoms was assessed using three-stage Lund-Mackay computed tomography (CT) scores. The participants were stratified based on the results of nasal cytology and by the presence of nasal polyps (NP). The inflammation-based markers were calculated by dividing the cell numbers of the different cell types by numbers of the other cell types.Blood leukocyte and neutrophil counts were higher in neutrophilic CRS. Differences between patients with CRS with nasal polyps (NP) and CRS without NP were significant for blood leukocytes, neutrophils, monocytes, eosinophils, CRP, NLR and MLR values. In CRS with NP, peripheral blood leukocyte, neutrophil, monocyte and eosinophil counts, as well as CRP, NLR and MLR values were higher than in CRS without NP. Our results show that all individuals with CRS could benefit from the analysis of blood counts and inflammation-based markers at the beginning of their evaluation. High levels of inflammation-based markers might guide the clinician towards planning more radical CRS therapy and use of systemic anti-inflammatory medication.

Chronic rhinosinusitis is a heterogeneous group of inflammatory diseases with significant annual costs for the health care system. To date, there is no distinct signaling pathway known that explains the entire process from the beginning to tissue transformation. Due to the diversity of chronic rhinosinusitis, no uniform treatment has yet been developed. With a focus on chronic rhinosinusitis with nasal polyps (CRSwNP), molecular biologic gene expression studies have been performed to identify specific characteristics of nasal polyps that might allow the development of new therapeutic procedures. Microarray analysis revealed alterations in cell adhesion and differentiation as well as blood vessels. Further examinations identified two mechanisms that could play an important role in the pathogenesis of nasal polyps. In the context of the underlying disease, i.e., Th2-mediated chronic inflammation with predominantly eosinophilic cell infiltration, these findings might explain the pathogenesis of nasal polyps and allow development of new therapeutic strategies.